Head Injury Management

Making swift assessments, stabilizing and providing treatment to patients with head and spinal injuries, are all actions that are crucial and contribute significantly to the patient’s recovery. A team of trained experts, comprising of neurosurgeons, neurologists, and neuro-critical care specialists are always geared and ready to provide emergency care, to expeditiously stabilize, diagnose and treat patients with head and spinal injuries.

The Kauvery Institute of Orthopaedics and Neurosciences’ neurologists and neurosurgeons are available 24 hours a day, 7 days a week and are poised to quickly provide emergency care. Our Neurological Intensive Care Units are equipped with specially trained medical staff, who provide round the clock surveillance, using advanced monitoring techniques, together with specialized medical and surgical treatments. Comprehensive management is provided by a panel of neurosurgeons, neuro-radiologists, intensivists, neuro-oncologists, neurophysiologists, neuro-rehabilitation specialists, euro-pathologists and emergency care physicians, with an aim to optimize the outcome of the patients.

Head injuries are of varying degrees, ranging from severe trauma to the brain to mild concussions. Severe brain injury might cause a patient to become comatose or could even lead to the death of a patient. The sudden and intense impact to the brain could cause both primary and secondary brain injuries. The secondary injuries could precipitate changes in the cellular, chemical tissue and blood vessels, changes that could occur within hours or days after an accident has occurred. The neurological team at The Kauvery Institute of Orthopaedics and Neurosciences, employs avant-garde techniques to monitor their patients who have been seriously injured so as to treat and avert any secondary brain injury.

Patients with severe head trauma are monitored closely as there may be a possibility of the brain swelling, which in turn could cause pressure inside the skull and if left untreated, it could lead to brain damage. Our trained physicians use advanced technology to monitor and measure the level of pressure within a patient’s cranium. Our neuro-critical care specialists are trained to also use advanced cooling techniques to monitor and limit damage from trauma. If our expert neurosurgeons deem it necessary, then they are fully equipped to perform surgery to remove part of the skull to ease the pressure on the brain, so as to stop any further swelling.

Injuries and trauma to the spinal cord, can be caused by slipping and falling, or through work related accidents such as industrial accidents and through sports activities.

Patients with such spinal injuries need immediate care and treatment in order to avoid any further impairment to the spinal cord. The Kauvery Institute of Orthopaedics and Neurosciences team, comprising of neurology, neuro-critical care and neurosurgeons, act speedily to stabilize patients with spinal injuries thereby ensuring maximum recovery. Post assessment of the injury, surgery may be performed to fix fractured vertebrae, so as to release pressure from the injured area. Surgeries are performed to realign fractured spinal bones, remove fluid or tissue that is applying pressure on the spinal cord, remove bone or discfragments / foreign objects, fuse broken spinal bones or place spinal braces. Patients in general will be able to begin rehabilitation, soon after their treatment.

Microscopic and Minimally Invasive Surgeries of Brain and Spine

On the wave of technological advancement in medical and surgical techniques, the way brain and spine surgeries are performed at The Kauvery Institute of Orthopaedics and Neurosciences, are by the lesser invasive procedures than the traditional surgeries of yesteryears. Neurosurgeons use the minimally invasive technique to locate, repair, isolate or remove a lesion without damaging any of the adjacent tissues. Consequently the time spent in recovery is short and the risk of complications reduced.

The advantage to patients in any microscopic brain or spine procedure is reduced post-operative pain, shorter healing period, small surgical incisions and high degree of safety.

During minimally invasive surgery, image-guided neurosurgery and neuro-endoscopy, are the two types of primary techniques used.

Image-guided neurosurgery is the advanced computerized technology and software that is used to navigate within the brain, to locate with precision, the presence of traumatic, vascular, congenital abnormalities or cancerous growth. The neurosurgeons at The Kauvery Institute of Orthopaedics and Neurosciences centre, use image-guided neurosurgery to spot different areas of the brain. The sophisticated navigational pointer registers pictures of the brain which helps the surgeons to reconstruct a 3-D image onto a monitor close by. This reconstruction gives the surgeons a clarity of the depth at which the lesion is present, the size and the precise location in relationship to the brain, arteries, veins and nerves. Consequently, repairing or removing the lesion safely, precisely and quickly is possible, when compared to the traditional form of surgery.

Neuro-endoscopy is a minimally invasive procedure used in conjunction with microscopic neurosurgery. In this procedure the neurosurgeon uses a rod-lens and fiber-optic endoscope (looks like a small telescope), to view the innards of the peripheral nervous system, brain and spinal cord. The image is relayed to a computer monitor, which allows the surgeon to identify the exact location of the lesion. This type of minimally invasive procedure requires a very small incision in the skull with even lesser navigation within the brain, thereby providing greater precision and a high degree of safety to the patient.

Keyhole Skull Base Surgery – Our team of neurosurgeons use comprehensive neurosurgical procedures, integrating the image-guided navigation system with neuro-endoscopy technology, to further increase precision and safety of the patient, while accessing infinitesimal details, simultaneously. This technology is especially very efficient in locating difficult to reach lesions bordering the base of the skull or brain. An incision the size of a keyhole is made, and with the aid of the microscopic and endoscopic instruments, the surgeon performs the procedure to set right the disorder. This type of procedure is commonly used in:

  • Opening multi-lobulated ventricular cysts
  • Placement and revision of ventriculoperitoneal shunts
  • In a third ventriculostomy
  • Removal of retained ventricular catheter
  • Opening the septum pellucidum
  • Choroid plexus coagulation or plexectomy
  • Trans-sphenoidal procedures associated with lesions, arachnoid cyst, pituitary tumors, and choroid cyst removals and openings
  • Microvascular decompression, craniotomy resection of brain tumors and craniotomy clipping of aneurysms

All of these procedures may not be appropriate for every case, however these procedures have demonstrated their effectiveness, their safety for the patient and they provide the best possibleresults.


Neuro-oncology - Brain Tumour

Abnormal growths of tissue found inside the skull or the spinal cord (the brain and spinal column comprise the primary component of the central nervous system), are brain and spinal cord tumors. There are two types of tumors – benign or non-cancerous and malignant or cancerous. The presence of tumors on the bony structures of the skull and the spinal cord, can apply pressure on the sensitive tissue and impair normal functions.

Cancers that are of unknown primary origin are called secondary cancers .Primary cancers are tumors that arise in the brain or spinal cord. In most cases, primary tumors are the result of uncontrolled growth of cells that surround and support neurons. However, cancer can be caused due to genetic disorders such as tuberous sclerosis, neurofibromatosis or from radiation or exposure to cancer causing chemicals. The cause of many cancers is still unknown, the good news is that they are not contagious but the bad news is that as on date no known means of prevention exists.

Manifestation of brain tumors are:

  • Seizures
  • Headaches
  • Nausea and vomiting
  • Impairment of vision / hearing
  • Motor / ambulatory coordination
  • Imbalance
  • Cognitive disorders
  • Symptoms of spinal tumors include changes to the sensory perceptions, pain, and motor functional problems.

The Brain and Spine Tumor Management Centre at The Kauvery Institute of Orthopaedics and Neurosciences is dedicated to the diagnosis and treatment of skull base tumors, brain, and spine tumors. Our multidisciplinary, comprehensive approach gives our patients the best advanced treatments available, in the process also reducing the impact on the patient’s body. At our Brain and Spine Tumor Management Centre, our patients are surrounded by the strengths of one of India’s largest, most comprehensive and well-experienced medical care, with the capability to provide wellness and support services not just to treat the disease but to treat the patient holistically.

We use the most sophisticated and specialized imaging equipment to determine the presence of either brain or spinal cord tumors. Our range of systems include, EEG, magnetic resonance imaging, computed tomography, spinal tap and position emission tomography.

Our dedicated and care services include:

  • Individualized, targeted and innovative treatments and therapies
  • Multispecialty diagnosis, prognosis and care
  • Skilled neurosurgeons, neurologists who use the latest techniques to treat brain and spinal tumors
  • Specialized neuropathologists and diagnostic technology

Early and skilled detection of brain and spinal tumors is very important and our multidisciplinary team of neurologists, neurosurgeons, neurophysiologist, neuro-radiologist, specialist intensivist and other related specialties including rehab services, radiation oncologists and interventional neuro-specialists and psychiatrists, are vastly experienced in pinpointing the type and degree of malignancy.

Our treatment techniques include minimally invasive surgical techniques, awake craniotomy, gamma knife stereotactic radiosurgery, proton therapy, computerized image-guidance surgery, intraoperative brain mapping, intraoperative MRI imaging, skull base surgery, the latest in implantable chemotherapy techniques, and targeted therapies. To treat tumors of the spine (bony structure), surgerycan be performed by either the neurosurgeons or by the orthopaedic surgeons, but treatment of tumor on the nervous tissue that forms the spinal cord can be performed only by neurosurgeons.


Minimally Invasive Brain Surgery

On the wave of technological advancement in medical and surgical techniques, the way brain and spine surgeries are performed at The Kauvery Institute of Orthopaedics and Neurosciences, are by the lesser invasive procedures than the traditional surgeries of yesteryears. Neurosurgeons use the minimally invasive technique to locate, repair, isolate or remove a lesion without damaging any of the adjacent tissues. Consequently the time spent in recovery is short and the risk of complications reduced.

The advantage to patients in any microscopic brain or spine procedure is reduced post-operative pain, shorter healing period, small surgical incisions and high degree of safety.

During minimally invasive surgery, image-guided neurosurgery and neuro-endoscopy, are the two types of primary techniques used.

Three developments in minimally invasive brain surgery have changed the way the procedures are done:

Image Guided Neurosurgery: Navigating inside the brain is an extremely delicate procedure. The detection and location of traumatic injuries, cancerous growths and abnormalities must be done with absolute accuracy and precision. That is why the neurosurgery specialists at the Kauvery Institute of Orthopaedics and Neurosciences use image guided neurosurgery to steer them through the brain. This state-of-the-art technology creates pictures of the brain that can be turned into 3-D images in real time and displayed on a monitor in the operation theater. This provides the surgeons with a clear guide as to where the abnormality is present, its exact size and shape and its proximity to other delicate brain tissue, nerves and arteries. This enables surgery on the affected regions of the brain to be completed with greater safety, accuracy and speed than is possible with traditional forms of surgery.

Neuroendoscopy: This is a procedure that uses a fiberoptic endoscope to obtain a clear view of the interior of the peripheral nervous system, spinal cord and brain. The endoscope is a highly sophisticated device that looks similar to a very small and highly precise telescope. The image that is obtained is available in real time on a monitor in the operation theater which enables surgeons to identify the exact location of the abnormality or injury and access this area with complete accuracy and precision. The use of the neuro endoscope means that only a very small incision, the size of a keyhole, is made and this, combined with the use of highly specialized microscopic instruments, allows the surgery to be done with the greatest precision and accuracy to provide greatly increased patient safety and optimal results.

Keyhole Skull Base Surgery: This combines image guided navigation with endoscopy to give neurosurgeons a clear picture and detailed understanding of the area of the brain they will work on. Surgeons are provided with the minutest details of the brain to enable them to operate with the utmost precision, thereby increasing patient safety. This procedure is especially effective in locating and accessing lesions and injuries in areas bordering the base of the skull or brain which are otherwise difficult to access. An incision that is the size of a keyhole is made and through this opening, highly specialized microscopic instruments are inserted to enable surgeons to perform the required procedures. Keyhole skull base surgery is now used in a number of procedures, including:

  • Microvascular decompression, craniotomy resection of brain tumors and craniotomy clipping of aneurysms
  • Trans-sphenoidal procedures associated with lesions, arachnoid cyst, pituitary tumors, and choroid cyst removals and openings
  • Opening multi-lobulated ventricular cysts
  • Placement and revision of ventriculoperitoneal shunts
  • Choroid plexus coagulation or plexectomy
  • Opening the septum pellucidum
  • Removal of retained ventricular catheter
  • In a third ventriculostomy

The use of the procedures outlined here will be decided upon by the surgeons as the suitability will depend on the exact nature of the problem and the optimal surgical solution. That being said, all of the procedures have been proven to be safe, effective and they provide the best results possible.


Pituitary Gland Surgery

The pituitary gland is a small pea-sized gland that sits in a bony hollow below the brain and behind the nasal cavity. It is the ‘master gland’ and controls, monitors or regulates the functioning of other glands and organs of the body. It controls various vital physical functions and processes of the body such as normal growth, metabolism, sexual maturation, reproduction, blood pressure, etc.

In some individuals, a tumor develops in the pituitary gland which is detected only when an MRI scan of the brain is done to investigate dizziness, headache, and loss of hearing or deteriorating vision. Once detected, the physicians monitor its progress through a series of MRIs, and when the tumor reaches a certain size, surgery is inevitable.

Removing the pituitary tumor is important, else, it can trigger the gland to over-secrete hormones in some cases, the condition being called secretory tumor. This can impair eyesight and affect the balance and day-to-day activities of the patient.

There are 2 surgical options available.

The traditional and invasive method which involves making incisions into the skull is called craniotomy. This is rare, and used only when the tumor is growing fast and in directions that are inaccessible by option number 2.

The second option called transphenoidalfiberoptic endoscopy is a minimally invasive technique that involves an endoscope fitted with a fine microscope and cutting tools at its end pushes through the sphenoidal cavity in the head, to remove the tumor. This method involves less hospitalization and quick rehabilitation.


Neurovascular Surgery

Vascular neurosurgery with its cutting edge advances, requires a combination of quick decision making skills, microsurgical skills, and critical care skills with the use of advanced surgical technology. In 1923, Harvey Cushing first identified the need to arrest unstable intracranial aneurysms but the first procedure was performed in 1937-1938 by Walter Dandy. Ever since then, the dynamic evolution of devices and technology used in vascular neurosurgery procedures, particularly the operating microscope, has diversely, culminated in intracranial surgery, to arrest aneurysms displaying subarachnoid hemorrhage, becoming a routine procedure.

At The Kauvery Institute of Orthopaedics and Neurosciences Centre, our neurosurgeons are leaders in cerebrovascular and endovascular neurosurgery. Our team of experienced neurovascular surgeons, specialists and other subspecialists provide the most sophisticated, timely and compassionate care to patients with neurovascular disorders. Our multidisciplinary team of experts are equipped to perform both endovascular and open cerebrovascular surgeries to treat neurovascular conditions such as, brain aneurysms, stroke, subarachnoid haemorrhage, intracranial haemorrhage, cavernous malformations and arteriovenous malformations. The team provides diagnosis and treatment for the most complex cerebrovascular diseases of the brain and spinal cord. They are also skilled at managing various complex conditions such as skull base tumors, haemorrhagic strokes, aneurysms and vascular malformations of the brain. Our team of dedicated neuro-oncologists, neurologists, radiologists and other neuro-care experts, and neurosurgeons, provide the most innovative treatments to their patients, offering the best scope for all possible successes. The department is also fully equipped to provide patients with life-threatening brain and spinal cord illnesses with advanced treatment choices, such as microsurgery and focused irradiation. Additionally, in the regular course of the day, patients and families are counselled on the genetic risks that could possibly occur from some of these inherited diseases.

We treat neurovascular conditions such as cerebral aneurysms, carotid and intracranial atherosclerosis, arteriovenous malformations, stroke, moyamoya disease and cavernous malformations.

Neurovascular surgical procedures performed at The Kauvery Institute of Orthopaedics and Neurosciences, includes both endovascular neurosurgery and cerebrovascular surgery.

Endovascular surgical neuroradiology also known as endovascular neurosurgery, is a minimally invasive technique, which is a blend of neurosurgery and radiology with the involvement of advanced image-guidance technology. The procedure is performed by inserting thin catheters into the vascular system through a blood vessel either in the groin, neck or arm. Endovascular neurosurgeries are performed for the following purposes:

  • Balloon angioplasty
  • Diagnostic angiography
  • Embolization
  • Coiling
  • Stent placement

Cerebrovascular Surgery procedures include craniotomy for

  • Clipping aneurysms
  • Excision of arteriovenous malformations
  • EC-IC bypass and carotid endarterectomy

In order to obtain optimum results and to ensure neurosurgical precision with the help of computerized image guidance and to ensure surgical precision, our endovascular specialists use the most sophisticated and advanced intraoperative equipment like:

  • Continuous EEG
  • Motor evoked potential monitoring of the brain function
  • Somatosensory evoked potential
  • Intraoperative angiography
  • Video indocyanine green fluorescent videoangiography
  • X-ray fluoroscopy
  • Ultrasound
  • Computed tomography (CT)
  • Magnetic Resonance Imaging (MRI)

Epilepsy Surgery

Epilepsy seizures occur due to improper development of the brain or malformed development or due to injuries to the brain or due to infections from conditions such as meningitis. In this condition, there is abnormal activity of certain neurons which triggers the seizure. The region of the brain where this activity originates is called ‘seizure focus’.

Epilepsy is treated using anti-epileptic drugs or AEDs. Some patients over a period of time may develop a resistance to AEDs, which makes them ineffective, while some patients cannot handle the side effects. In such cases, surgery may be the only option to treat epilepsy. However, before advising surgery, the physician will check if the seizure focus can be clearly identified, and if the focus does not control critical brain functions such as movement, linguistic skills or memory. The aim of the surgery is to either remove the area of the brain causing seizures, or to disconnect the pathways or neurons which connect this region to the rest of the brain, or more recently, to implant a device to treat epilepsy.

Accordingly, there are different surgical options available.

For removing the affected area, also called resection surgery

  • Temporal lobectomy
  • Extratemporal resection
  • Lesionectomy

For disconnecting the affected area

  • Hemispherectomy
  • Corpus callosotomy
  • Multiple subpial transection

The surgery involves making one or more incisions on the skull to access the region. The procedure is done under general anesthesia and the patient will be able to resume a normal life in 3 months’ time.


Deep Brain Stimulation or DBS

With the onset of age, some individuals develop movement disorders such as dystonia (involuntary movements resulting in twisting and writing motions), Parkinson’s disease (tremor, rigidity and slow movements) and essential tremor (involuntary tremor of the arms and legs).

In recent years, Deep Brain Stimulation or DBS has been used to control or reduce the symptoms of these conditions when used along with medication. As the name implies, the brain cells in the affected region are continuously stimulated using electrical pulse signals, so as to control their erratic behavior.

In addition to movement disorders, DBS is being used to treat various psychosomatic conditions such as epilepsy, Obsessive Compulsive Disorder, substance addiction, cluster headache, dementia, chronic pain, severe depression, multiple sclerosis, Huntington's disease and Tourette syndrome. It is also used for people who have suffered a traumatic brain injury or recovering from a stroke.

The DBS system consists of a neurostimulator which is a programmable, battery-powered device that creates electrical impulses and is implanted in the chest region. A ‘lead’ wire with a number of tiny electrodes at the tip is implanted into the brain, in order to deliver the electrical pulses to the affected region. Finally, an extension wire inserted below the skin connects the neurotransmitter to the lead wire.

Undergoing DBS involves surgery to implant these 3 components of the system. The surgery is done under general anesthesia. Over a period of 6 months, the physician adjusts the settings in the neurotransmitter, using Wifi, to achieve optimum results from this treatment.


Skull Base Surgery

The bony structure of the cranium which encompasses the brain and the facial bones together with cartilage, make up the skull. The base of the skull is composed of 5 bones that also form the roof of the nasal cavity, the eye socket, the inner cochlear of the ear and some of the sinuses. The base of the skull is a packed and complicated area through which, the opening of the spinal cord, nerves and blood vessels, all pass.

To remove both benign and malignant growths, abnormalities present on the underside of the brain, at the base of the skull or at the top of a few vertebrae of the spinal column, the skull base surgery is performed. It is very difficult to see or access lesions located in any of these areas, consequently, a minimally invasive endoscopic procedure is done, in which instruments are inserted through the natal openings in the skull – the nose or mouth or by making a small incision just above the eyebrows. In this type of surgery we do employ the services of specialists such as an ENT (ear, nose and throat) surgeons, neurosurgeons, and radiologists.

A patient diagnosed with abnormalities or growths, based on symptoms after examinations, may require to undergo a skull base surgery. Some of the examinations and investigations involved are:

  • Scans or brain imaging, such as MRA, MRI, CT and PET imaging of the brain, will be carried out by the medical team, to study the abnormality or growth that is causing a problem
  • In the event there is a growth at the base of the skull, then a small piece by means of a biopsy, will be taken out and studied under the microscope. The biopsy will be done by inserting an endoscope through the nose and sinuses
  • Yet other tests to check out the patient’s balance, hearing and vision may be done

Prior to an advanced technique like endoscopic skull base surgery being developed, growths were surgically operated upon in the traditional manner, where a neurosurgeon would make an opening in the skull. The traditional method is still utilized in some cases depending upon the type of growth and location of the growth that requires to be removed.

Minimally invasive or endoscopic skull base surgery is performed by using very small incisions, unlike the large incisions that are made in traditional surgery. The neurosurgeon will make a small incision inside the nose to insert a thin endoscope that has a light. Using the endoscope, the neurosurgeon will remove the growth or abnormality. During the surgical procedure, using an MRT the radiology specialist will capture a picture of the skull base using magnets and a computer. The MET imaging is done to ensure that every vestige of the growth has been removed.

Open or traditional skull base surgery, involves incisions being made in the facial area as well as in the skull. This procedure may also involve the removal of parts of the facial or skull bone to reach and remove the growth, where it is located. A microscope in the operating theatre is often used in this type of surgery.

Subsequent to a traditional or endoscopic surgery, other treatments, such as chemotherapy, gamma knife or radiation therapy, may be considered, depending on the type of abnormality or growth that was removed.


Neuro Endoscopy

Neuro Endoscopy is a minimally-invasive procedure that uses an endoscope to treat or investigate certain conditions in the brain, when traditional surgery cannot access the affected area, or can cause further damage. The endoscope is central to all minimally-invasive procedures, and consists of a long thin tube fitted with a camera, an eye-piece at one end, and surgical attachments such as scissors and forceps at the other end. The physician uses a large monitor to see an image and guide his/her movements accordingly.

Neuro Endoscopy is used under any of these conditions

  • Hydrocephalus: Here, the Cerebrospinal Fluid (CSF) present in different verticals of the skull increase suddenly, resulting in pressure on and hence damage to the brain.
  • Tumors: Endoscopy is used to either do a biopsy (removing a small amount of tissue for examination) of cancerous tissue in the brain, and at a later date, to even remove the tissue through a small hole made in the skull or the nose or the mouth
  • Neurological disorders such as intraventricular lesions, hypothalamic hamartomas,craniosynostosis, spinal lesions, intracranial cysts, acoustic neuromas, meningiomas, Rathke's cleft cysts,etc

In recent years, Neuroendoscopy is the preferred method to remove a wide range of tumors in the brain region such as skull base tumors, ventricular tumors, pituitary tumors and pineal region tumors.

Before conducting the procedure, a physician will evaluate your suitability for the procedure. Neuroendoscopy ensures minimal blood loss, scarring, pain, lower risk of complication and quick rehabilitation post-surgery.


Aneurysm and AVM Interventions

The abnormal ballooning of an artery carrying blood to the brain is an intracranial or brain aneurysm. An intracranial aneurysm is also known as a brain aneurysm or cerebral aneurysm. The surge of blood through the arteries carrying blood to the brain is at high pressure and an aneurysm develops when the arterial walls weaken, creating a bulge (an abnormality) or a balloon like structure.

Behavioural patterns of an aneurysm include:

  • Aneurysms can either inflate or apply pressure on the structures in the brain
  • If an aneurysm ruptures, the blood will seep out of the blood vessel, under high pressure, either directly into the brain or into the fluid surrounding the brain
  • Causes sudden and severe headache commonly
  • Sometimes stiffness of the neck may also be there, together with vomiting
  • Causes sensitivity to normal daylight
  • Rarely an aneurysm, can disrupt vision, causing double vision

Our Interventional Neurovascular Radiology department at The Kauvery Institute of Orthopaedics and Neurosciences provides both Magnetic Resonance Imaging (MRI) and Computed Tomography (CT scan) services to scan, diagnose and treat brain aneurysms.

Discovery of aneurysms that are yet to rupture are generally found when a patient undergoes a CT scan or MRI procedure for another reason. Such aneurysms which are yet to rupture, can be treated by the coil embolization process, provided the diagnosis is favorable that the aneurysm will not rupture or pose a risk for rupturing.

In an endovascular coiling procedure or endovascular embolization, as it is otherwise known as, blood flow to the aneurysm is blocked by the insertion of a long thin tube called a catheter, into the artery located in the groin, and is then advanced forward, with the help of a fluoroscopy apparatus (live x-ray), to the artery that is afflicted. After the catheter is in place, a smaller tube is then passed through the catheter, into the aneurysm and a length of platinum coils are wound into the aneurysm. With the help of the live x-ray imaging system, the radiologist will continue to pack the aneurysm until it is filled up and the blood flow to the aneurysm is brought down to a trickle. Slowly the blood starts to clot around the platinum coils and stops in due time. Blocking the blood flow from entering the aneurysm, will prevent it from leaking or rupturing. This procedure normally takes around 2 or 3 hours.

An endovascular embolization is a minimally invasive procedure and does not need to be a surgical procedure.

The advantage of undergoing an endovascular embolization procedure as against an endovascular aneurysm clipping, is that the skull need not be operated upon, consequently saving on hospitalization and recovery time, which is shorter than that involved in traditional surgery. Whether a patient is qualified to undergo this procedure, however, will depend on the patient’s medical history and other factors.

During an evaluation and diagnostic endovascular coiling procedure, our skilled interventional neurovascular radiologists may also use some of our other state-of-the-art equipment (apart from the fluoroscopy), such as, an Electroencephalogram (EEG), cerebral arteriogram, Magnetic Resonance Imaging (MRI), Doppler Ultrasound, Computed Tomography (CT scan), Positron Emission Tomography (PET scan) and X-rays of the skull and craniotomy.

Defects in the brain’s circulatory system that form during the embryo or fetal stage of development are known as Arteriovenous Malformations or Brain AVMs. Arteries are the blood vessels that supply fresh oxygen carrying blood to all parts of the body, including the brain. Once the system has consumed the oxygen, the de-oxygenated blood is carried back to the heart by the veins to once again be oxygenated. The arteries carry blood at high pressure while the veins carry it at a lower pressure. To enable the arteries to stand up to the high pressure, their walls are much thicker than those of the veins, which have to deal with only a lower pressure. The arteries branch out into smaller tubes called capillaries which carry the oxygenated blood to the cells. As the blood passes through the smaller tubes, the pressure drops and by the time it reaches the veins for the return journey to the heart, the pressure is such that the veins can bear it safely. This is what normally happens.

However, in the case of Arteriovenous Malformations, the small capillaries with reduced pressure while carrying blood to the cells and then onwards to the veins are not present. This means that the arteries and veins are connected by larger tubes so there is no way for the pressure of the blood to be reduced to a level where the veins can transport it safely back to the heart. The large vessels that have replaced the capillaries are known as shunts. The network of shunts is called a nidus. Since the nidus cannot reduce the pressure of the blood, the high pressure at which it enters the thin walled veins causes rupture leading to leaks that result in bleeding in the brain. When this happens, it is known as a haemorrhagic stroke.

The reason for occurrence of such Arteriovenous Malformations has not yet been established. What is known is that, they occur during the fetal and/or embryonic stage of development. This does not normally cause any problems in infants, except in a few rare cases but the probability of issues developing increases with age. AVMs occur equally in both men and women and hereditary factors influence the development of the condition. If not treated a haemorrhagic stroke can cause a range of disabilities such as speech and vision problems, numbness and/or weakness in various parts of the body, seizures and even death if the bleeding is excessive.

The first sign of an AVM is often the sudden onset of a severe headache, often accompanied by nausea and vomiting. The presence of an AVM can be diagnosed through a Computed Tomography (CT) scan. If an AVM is found, the next step is to perform angiography and MRI (Magnetic Resonance Imaging) to determine the exact location of the AVM.

There are three ways of treating an AVM – surgery, radiation or neuro-vascular embolization. Neuro-vascular embolization is performed by Kauvery Hospital’s Interventional Neurovascular Radiologists. An angiogram, which is a minimally invasive procedure, as opposed to surgery, is performed by inserting a small plastic catheter (a fine tube) through the groin or into the femoral artery. The catheter is then navigated into the AVM shunts. An injection is then administered through the catheter to block the shunts permanently. Because the shunts are only connections between the arteries and do not serve any real purpose or have any function, blocking them in this way has no adverse effect on the patient.

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