neurosurgical and spinal services

The Neurological and Spinal Services offered by The Kauvery Institute of Orthopaedic and Neurosciences, to patients are related to the nervous system and spine, from the lower back to the neck, nerve compression syndromes, spinal cord compression syndrome, recurring pain and herniated intervertebral discs.

At our neurological and spine service centre, either our Physiatrists or our experienced Neurosurgeons meet with our patients, when discussing their comprehensive diagnosis and treatment assessments. If and when surgery is deemed necessary, then our neurosurgeons will meet with the patient(s). All of our experts, specialists and subspecialists at our neurological and spine centre, work with their patients to provide the best comprehensive diagnosis and the right treatment, individualized for every patient under their care.

Our multidisciplinary team of neurologists, neurosurgeons, pain specialists, rehabilitation physicians, physical medicine and physiotherapists, have all been specially trained to treat neurological and spinal disorders. Some of the disorders treated at our centre are:

  • Tumors
  • Chiari malformations – structural defects in the cerebellum
  • Arachnoid cysts
  • Compression Fractures
  • Diplomyelia or diastematomyelia - a congenital disorder
  • Nerve root compressions
  • Lipomyelomeningocele
  • Disk herniation and herniation syndromes
  • Traumatic spine injuries
  • Spinal infections
  • Spinal cord arteriovenous malformation (AVM)
  • Spina bifida or myelomeningocele
  • Tethered spinal cords
  • Syringomyelia
  • Spinal stenosis

We generally favour a conservative and non-surgical approach in many of our cases, but if surgery is considered necessary, our neurosurgeons will then review the patient. Our centre also provides outpatient consultations and evaluations for low back problems where patients have already had multiple surgical procedures and need more treatment or therapy. Additionally, we also provide regular treatment to patients with undiagnosed neurological conditions related to the spine as well as for complicated spine syndromes.

Our Neurological services and care, ranges from setting up of appointments to diagnostic investigations, such as a x-ray, MRI, CT scan, Myelogram and other neuro analytical studies.

  • Head and Spine Injury 24/7 Care

    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 Orthopaedic and Neurosciences’ neurologists and neurosurgeons are available through 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, neuro-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 be 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 to 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 Orthopaedic 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 Orthopaedic 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 disk fragments / 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 Orthopaedic 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 Orthopaedic 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 to 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 ventriulostomy
    • 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, safety for the patient, and in providing the best possible results.

  • Brain and Spine Tumors Management

    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 and 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, from radiation or exposure to cancer causing chemicals. The cause of many cancers are 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 Orthopaedic 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 the patient as a whole person.

    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), neurosurgery can be performed by either the Neurosurgeons or by the Orthopaedic surgeon, but to treat tumor on the nervous tissue that forms the spinal cord, only neurosurgeons perform the surgery.

  • Scoliosis Spine Reconstruction

    The abnormal curvature of the spine, either to the right or left is a spine disorder known as Scoliosis. The curvature can range from moderate to severe and the most common parts of the spine that are normally affected by scoliosis are the chest or thoracic and the lower back or lumbar region. No known cause has been discovered so far and it is said to be idiopathic.

    Children with scoliosis do not normally require any major correctional treatment, as the condition will sort itself out as they grow. In cases where the condition requires a corrective solution, back braces are used and yet in others where it is necessary, surgery will be performed. Scoliosis should not be left untreated as it can lead to serious spine, pelvis, chest and lung, and heart damage.

    Some of the known causes for the occurrence of scoliosis are:

    • Genes – gene GPR126 is identified as the gene that is involved in the growth and development of the spine
    • Idiopathic Scoliosis or unknown reasons for deformity in the spine
    • Congenital Scoliosis – This form of scoliosis is present in the newborn at birth, and because of the development of the spine while the baby was in the womb
    • Neuromuscular disorders such as cerebral palsy or muscular dystrophy prevents the child from walking or staying upright, hence preventing the spine from developing normally
    • Length of Leg – when one leg is shorter than the other, then there is a possibility that scoliosis may develop
    • Bad Posture – usage of satchels, backpacks and through exercise may cause scoliosis

    Some forms of scoliosis are painful, while others are not so painful. The heart and lungs may not function to their full capacity, in patients who have been severely affected.

    Following a physical exam and after examining the history of the patient and if the study warrants it, then an x-ray of the spine will be taken to measure the exact curvature of the spine. Using the Risser sign, the skeletal age is measured to determine the risk of deterioration. Neurological tests may also be executed on children diagnosed with scoliosis and certain associated disorders.

    Surgery will be the last step that will be considered, when a patient has failed to respond to all conservative treatments. Patients with disabling conditions such as back and leg pain or spinal imbalance, and where their functional activities are acutely impacted together with substantial reduction in their quality of life, will undergo surgery.

    At our Neurological and Spinal Services Centre, the aim of performing surgery on a patient debilitated with scoliosis, is to restore spinal balance and to reduce pain and discomfort. The surgery is performed to remove pressure on the nerves (minimally invasive decompression), to stabilize the spinal segments through corrective alignment and fusion, which involves anchoring of the spinal cord with wires, hooks, screws and metal rods as tethers. Fusion of the spinal segments is performed by using either the patient’s own bone or synthetic or cadaver substitutes. We also perform osteotomy or vertebral column re-sectioning, in more severe cases. There are many different types of surgical procedures designed to treat scoliosis, and our team of multi-specialists provide comprehensive care, prior to surgery, during the surgical procedure and after.

    We use the best in class surgical techniques that are minimally invasive; we make only small incisions, as well as, use only biologic substances to accelerate the fusion process. During a surgical procedure we use computer-assisted navigation systems and other forms of spinal cord and nerve monitoring systems to enable precision and accuracy.

  • 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 Orthopaedic 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 hemorrhage, intracranial hemorrhage, 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, hemorrhagic 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, which helps improve the outcome in patients. Additionally, in the regular course of the day, patients and families are counseled on the genetic risks that could possibly occur from some of these inherited diseases.

    We treat neurovascular conditions such as cerebral aneurysms, acarotid and intracranial atherosclerosis, arteriovenous malformations, stoke, Moyamoya disease and cavernous malformations.

    Neurovascular surgical procedures performed at The Kauvery Institute of Orthopaedic and Neurosciences, Neurovascular Surgery Centre, include 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 neurosurgical 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 mage 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)
  • 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 packed and complicated area through which, the opening of the spinal cord, nerves and blood vessels, all pass.

    To remover 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 a 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 to be needed, depending on the type of abnormality or growth that was removed.

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