Wednesday, February 21, 2018
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About the Department / Centre

The nervous system forms one of the important organ systems of the body. Surgical diseases affecting the nervous system are varied. The diseases can be congenital-from birth, may have genetic predisposition or may occur due to environmental factors. Head injuries, spinal diseases such as spondylosis occur commonly in the population and form the major part of the patients presenting for opinion at NIMHANS. A clear demarcation does not exist between neurological and neurosurgical diseases. Essentially, any disease which causes neurological damage by mass effect is treated by a neurosurgeon. Neurosurgical treatment is not restricted to brain and spinal cord diseases. Several diseases require manipulation of neural structures or an approach through a neurosurgical corridor. A neurosurgeon also treats these set of diseases. Examples include diseases related to the spine including disc prolapse, spondylolisthesis, deformity correction, surgical diseases involving the coverings of the eye, ear etc.

Neurosurgery is different from other surgical specialties. The brain, spinal cord and nerves constitute the information network of the human body. A small damage results in a large observable clinical deficit. This complexity is responsible for the high risks associated with neurological surgery. Even the smallest surgical procedure is thus fraught with risks and no neurosurgical procedure can be lightly taken.

Evaluation of a neurosurgical patient is a multi-staged procedure. It begins with a detailed neurological evaluation consisting of history and clinical examination. These are time consuming and are routinely performed. Hence a neurosurgical consultancy is more time consuming than many other specialties. Most clinical evaluations require further imaging as support investigation. Imaging is in the form of CT, MRI, angiography, MEG and PET. The selection and order of investigations is based on the disease process and the surgeon’s preference. Investigations such as MRI, angiography requires preparation and the procedures are scheduled based on the waiting list. Hence the neurosurgical evaluation and preparation for surgery is a time consuming procedure and requires multiple visits.

Modern neurosurgery is subdivided in several sub-specialties. These specialties reflect the evolution of surgical procedures dedicated to the treatment of a class of disorders. Each subspecialty has a multitude of procedures tailor-made to treat the individual disease process. Specialties include cerebrovascular onco-surgery, trauma, spine, endoscopy, skull base, pediatric, epilepsy surgery, movement disorders etc.

Surgery for neurological disorders can be an elective or emergency procedure. Surgeries for head trauma, specific other life threatening conditions are operated on an emergency basis. Most neurosurgical procedures are performed as elective procedures. Surgery for neurological diseases is based on a team approach, the team headed by the chief or operating surgeon. Most contemporary neurosurgical procedures are performed using an operating microscope using micro-instruments. Hence contemporary neurosurgery is also known as microneurosurgery. The microneurosurgeon uses several types of equipment to perform the operative procedure. These instruments include high speed pneumatic and electric drills, cavitron ultrasound, intraoperative diagnostic tools such as nerve stimulators, ultrasound, indocyanine green angiography etc.

The manipulation of structures critical to neurological function is a delicate art and forms the core study of neurosurgical residents who train to become future neurosurgeons.

In order to cater to diverse socio-economic strata, various wards such as general ward, special wards are available for admission. ICU facilities are separate for the care of elective neurosurgical patients and for patients suffering from head injuries. ICU facilities are equipped to manage complex issues of a critical care patient. Facilities include ventilators, multimodality monitors, facilities for intracranial pressure monitoring etc. A separate head injury ward caters to patients who have suffered severe head injuries and require prolonged specialist management.