The Department of Neurosurgery of FV Hospital has surgeons who specialise in all phases of neurological surgery for comprehensive management of brain, spinal cord, spine and peripheral nerve diseases and disorders. We treat elective cases and emergency cases in adults and children.
We offer a multidisciplinary approach with neurologists, intensive care specialists, pain specialists, imaging physicians, physiotherapists.
Endovascular Neurosurgery is a subspecialty within neurosurgery, it is also called Interventional Neuroradiology because it has been developed by both neurosurgeons and radiologists in the 80s and 90s. It uses catheters and radiology to diagnose and treat various conditions and diseases of the central nervous system. The central nervous system is made up of the brain and the spinal cord.
Endovascular Neurosurgery treatments are accomplished through microcatheters inserted in the groin area and, under X-ray guidance, threaded through the blood vessels leading into the brain. Endovascular neurosurgeons employ minimally invasive procedures to accomplish a wide variety of treatments.
- Back and neck injuries are the most common musculoskeletal problems. In fact, 80% of people will experience back pain at some point in their lives. Pain occurs when the spine, a complex structure of vertebra, disks, the spinal cord, and nerves, is abnormal. When this happens,turning, bending, standing, and lifting become difficult and painful. The most common problems are herniated disks and stenosis.
- The most common problems are herniated disks and stenosis.
- Often, people recover from herniated disks by taking medication and limiting the positions that cause pain. Sometimes, physical therapy also helps. When these treatments don’t work, surgery is an option. During surgery, a neurosurgeon removes the portion of the disk that is protruding. This relieves the pressure on nerves and the resulting pain and discomfort go away
- Often, people with stenosis take medication to relieve pain and reduce inflammation. Steroid injections and physical therapy can also help. For those who do not find relief from these treatments, surgery is an option. The goal of surgery is to relieve pressure in the spinal column by opening up more space inside the spinal canal.
- Spondylolisthesis: Common nonsurgical treatment methods include wearing a back brace, doing physical therapy exercises and taking medication to relieve pain. For severe cases of spondylolisthesis may need to have a surgery called a spinal fusion. The surgeon will stabilise the spine by using a bone graft and metal rods. He may insert an internal brace to help support the vertebra while it heals.
- A meningocele is a birth defect where there is a sac protruding from the spinal column. The sac includes spinal fluid, but does not contain neural tissue. It may be covered with skin or with meninges (the membranes that cover the central nervous system). The sac often is visible from the outside of the back. To close meningoceles at the skull base or top of the spine, our surgeons may use the minimally invasive Endoscopic Endonasal Approach (EEA). This innovative, minimally invasive technique uses the nose and nasal cavities as natural corridors to access hard-to-reach or previously inoperable tumors or lesions. For closing meningoceles lower in the spine, our specialists use minimally invasive spine surgery techniques.
- Patients who suffer from advanced degenerative disease of the spine, as well as scoliosis and other kinds of spine deformities, may require complex spinal fusion operations. Such operations use titanium screws to immobilize joints of the spine that are thought to cause pain through mechanisms such as arthritis or spinal instability. In both cases, bones and joints of the spine are moving abnormally.
- The goal of a fusion operation is to reduce such patients’ motion-related pain, by locking those bones in place so that the body can convert the abnormally moving joints to solid bone. Only then is the fusion procedure considered successful. Screws and rods must be implanted to prevent motion of the spine while the bony fusion occurs.
- Compared to open surgical procedures, minimally invasive alternatives offer smaller incisions and reduce post-operative pain, infection risk, and recovery time, and better chance of minimizing damage to normal structures in the surgical area which can help maximize the effectiveness and durability of the surgical treatment
- Minimally invasive approaches to treating stenosis and disc disease involve the use of tubes inserted through the skin, through which the entire operation is performed. Minimally invasive spinal surgery techniques for stabilization of the spine can often be used in patients who require spinal fusion due to trauma or advanced degenerative disc and joint disease
- Treatment for spine injuries depends on the severity of the injury or injuries. For example, immediate surgery may be necessary to determine the extent of a spinal injury, relieve pressure, or stabilise a fracture to prevent future deterioration and avoid long-term pain or disability
- Vertebroplasty and kyphoplasty are minimally invasive procedures used to treat vertebral compression fractures of the spine. These painful, wedge-shaped fractures can be caused by osteoporosis and injury. Left untreated, they can lead to a humped spine (kyphosis). By restoring the vertebra height with a balloon and injecting cement into the fractured bone, patients can recover faster and reduce the risk of future fractures.
- Patients with head trauma may have skull fractures or ruptured brain blood vessels leaking blood onto the surface of the brain, and often have injury to the brain itself caused by these problems. One of the common operations for treatment of these conditions is a craniotomy, which involves surgical removal of a piece of skull to access the brain itself and relieve pressure.
- Brain tumours, the growth of abnormal cells in the brain, can be quite complex. Our surgeons have extensive experience with their diagnosis and management and treatment is highly tailored to your individual history and situation. The most appropriate treatment plan will be decided upon through the participation and collaboration of patients, families, oncologists and other doctors involved in your care.
- Meningiomas are one of the most common types of brain tumours, and while usually benign, they may be cancerous (malignant). These abnormalities develop in the meninges, the system of membranes that surround your brain and spinal cord.
- We also treat tumours that originate in the tissue of the brain itself, called the parenchyma. These include astrocytoma and glioblastoma (both tumours of the support cells of the brain), ependymomas (tumours of the lining of the brain’s fluid-containing ventricles), medulloblastomas (tumours of the cerebellum), and pituitary tumours.
- Some pituitary tumours are best managed with medication and some are more responsive to surgery. Minimally invasive techniques using endoscopes to access the pituitary gland allow to avoid making a large incision in the skull (craniotomy), and they reduce pain, infection and complication rates and hospital stay. Working closely with the Department of Otolaryngology (ear, nose and throat surgery), many pituitary tumour surgeries can be performed in this way via the endonasal transphenoidal approach, which allows to avoid the brain and reduce risk of brain injury. In this technique, the neurosurgeon works to access the pituitary gland through the nasal cavity. This technique reduces the risks associated with other, more extensive surgical approaches.
- Often, neurosurgical treatment can cure or improve hormonal function enough to enable you to decrease the amount of medication you are taking, or even eliminate the need for medication altogether
- Hydrocephalus is a condition commonly referred to as “water on the brain.” The term describes a situation where the ventricles (normal fluid-filled spaces deep in the brain) contain too much fluid or in which the fluid is under excessively high pressure. Hydrocephalus often affects children, and can be caused by inborn conditions, in which a baby’s brain develops abnormally and the proper pathways through which the fluid drains out of the brain are malformed, causing fluid build-up. It can also be caused by brain tumours, intracranial haemorrhage (bleeding in the brain) and other acquired problems.
- Hydrocephalus is often treated using a neurosurgical procedure called a ventriculo-peritoneal (VP) shunt, which works like a pipe with an adjustable faucet. A neurosurgeon inserts a catheter directly into brain, through a specially drilled hole, so that the tip ends up inside the enlarged ventricle.
- The tube is connected to a valve which controls the flow of fluid out of the brain. The tubing and valve are all located underneath the skin. A magnetic device can be placed over the top of the valve, outside the skin, to permit the surgical staff to adjust the pressure in the valve up or down, like opening or closing a faucet, to drain more or less fluid depending on the patient’s needs.
- We have extensive experience in the diagnosis and management of a broad range of cerebrovascular disorders:
- Arterio-venous malformation
- Subarachnoid haemorrhage
- Ischemic stroke and intracranial haemorrhage
- Carotid stenosis
- Aneurysms are bulging areas of weakened arteries. Arterio-venous malformations are tangles of thin-walled blood vessels. The danger with both of these conditions is that they can rupture and cause haemorrhage, which may lead to stroke, brain damage or death
- We use the latest diagnostic imaging, such as CT angiogram and catheter-based conventional angiography as well as CT angiography which avoids the risks of catheter techniques, to quickly and accurately diagnose your condition. Our treatments for aneurysms can include open operation (clipping), which involves placing a clamp on the neck of the aneurysm. In addition, we offer non-surgical endovascular treatments
- FV Hospital Stroke Unit: patients with acute ischemic stroke can be treated within 45 minutes by thrombolytics
- One possible cause of both of these conditions is a blood vessel coming in contact with a nerve (the sensory and motor nerve), causing pressure. The trigeminal nerve is affected in trigeminal neuralgia, resulting in pain in the face. The facial nerve is affected in hemifacial spasm, resulting in uncontrollable movement of the facial muscles
- We offer a variety of treatment options, some of which are minimally invasive and some of which involve craniotomy, or open incision. Minimally invasive therapies are often preferred, as they reduce pain, complication and infection rates, and hospital stay. One such alternative is rhizotomy, a needle-based ablative technique that destroys the parts of the trigeminal nerve that causes trigeminal neuralgia.
- If traditional open surgery is deemed most appropriate for your condition, we perform a small operation through the skull. This directly reduces the pressure on the trigeminal and facial nerves and can result in long-term pain relief. If a blood vessel is compressing a nerve, the vessel is removed.
- Treatment options for chronic pain include using injection treatments, implantable devices and open surgery. We work with the Pain Clinic to coordinate injections of anti-inflammatory medicines and nerve root blocks in the spine as a technique for both diagnosing and treating pain that originates in the neck and back.
- In addition, we perform spinal cord and deep brain stimulation for long-term pain that has been resistant to other treatment methods. We also offer microvascular decompression and rhizotomy for trigeminal neuralgia.
- A common treatment that is helpful to many patients with certain kinds of pain in the neck and back is pain pump or stimulator implantation. This kind of treatment is appropriate for some patients who continue to suffer from pain after having undergone previous spine operations. We are able to implant specialised devices in your body that deliver medication (pumps) or electrical impulses (spinal stimulators) to the spinal cord via tiny incisions. The medication or electrical stimulation may be able to control your condition or reduce pain.
Peripheral Nerves Surgery
We offer a full range of services to evaluate, diagnose and treat a variety of peripheral nerve conditions, including Carpal Tunnel Syndrome, Ulnar or peroneal nerve compression, brachial plexus injuries, nerve tumours and nerve injuries
- Diseases that affect your peripheral nervous system can manifest with pain, sensory disturbance (tingling, burning, inability to know where your body parts are without looking at them, pressure, etc.), motor problems (weakness in moving a muscle or body part) or trouble with the involuntary functions of your body (abnormal sweating, breathing, etc.)
- Determination of an appropriate treatment is based on a comprehensive neurological examination that may require additional testing, including electromyogram and nerve conduction studies, imaging studies or nerve biopsy
- This is a radiology procedure that looks at how blood is flowing in the brain.
- This procedure uses a small balloon and/or a tiny metal scaffold called a stent to open a narrowed carotid artery. The carotid arteries supply blood to the brain.
- This procedure uses “clot-busting” medicine to dissolve a clot in a blood vessel in the brain or elsewhere in the body.
- A surgeon inserts a very thin metal wire that forms a coil inside a brain aneurysm to block blood flow. A brain aneurysm is a bulging, weakened area in the wall of an artery in the brain. This results in an abnormal widening or ballooning. Because the artery wall has a weakened spot, the aneurysm is at risk for bursting if blood flow isn’t blocked. Aneurysm can be treated by coiling or clipping it closed.
- This procedure is used to treat spinal disorders. These include fractures, tumors, compressed nerves, and other conditions that put pressure on the spinal cord.
- FV is equipped with the new high-performance Somatom Definition Drive from Siemens with the unique Dual Source technology which boosts accuracy and precision
- A CT scan of the brain may be performed to assess the brain for tumors and other lesions, injuries, intracranial bleeding, structural anomalies such as hydrocephalus, infections, brain function or other conditions, particularly when another type of examination such as X-rays or physical examination are not conclusive.
- A CT scan of the brain may also be used to evaluate the effects of treatment on brain tumors and to detect clots in the brain that may be responsible for strokes. Another use of brain CT is to provide guidance for brain surgery or biopsies of brain tissue.
- A CT scan of the spine may be performed to assess the spine for a herniated disk, tumors and other lesions, the extent of injuries, structural anomalies such as spina bifida (a type of congenital defect of the spine), blood vessel malformations, or other conditions, particularly when another type of examination, such as X-rays or physical examination, is not conclusive. CT of the spine may also be used to evaluate the effects of treatment of the spine, such as surgery or other therapy.
- FV Hospital is equipped with the Optim MR360 1.5Tesla from GE
- MRI is a diagnostic test that produces three-dimensional images of body structures using magnetic fields and computer technology. The images result from different water concentrations of the various tissues. MRI is an important tool in planning surgery, radiation therapy, treatment for stroke or other interventions for brain and spine disorders.
- MRI may be used for the following diagnostic purposes:
- Detecting brain and spinal cord tumors
- Diagnosing nervous system disorders such as multiple sclerosis
- Identifying diseases of the blood vessels including stroke
- Diagnosing pituitary diseases
- Detecting spinal stenosis and herniated discs
- FV is equipped with the Allura Xper FD20 from Philips
- The cath-lab allows for neuroradiology investigations such as cerebral angiography and for specialised treatment such as carotid artery angioplasty/stenting
- Operating microscope Carl Zeiss
- Mayfield skull clamps
- Microsurgery instruments
- Sonopet Ultrasonic Aspirator from Stryker microsurgical removal of brain tumours