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Brain Aneurysm Treatment | Endovascular Coiling for Brain Aneurysms | Aneurysm Clipping - Sakra World Hospital
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  1. Home
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  3. Aneurysms and Arteriovenous Malformations (AVMs)

Aneurysms and Arteriovenous Malformations (AVMs)

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What are aneurysms?

An aneurysm is an abnormal out-pouching on the side or wall of a blood vessel in the brain. It results from an interplay of weakness of the wall as well as high blood flow in the brain blood vessels. These vessels (known as arteries) are commonly seen in the base of the brain.

The problem with aneurysms are many. Due to their weakness, they are liable to rupture or break open. This initially leads to what is known as a warning bleed. This presents with severe headache (the worst ever experienced by the patient) coupled with vomiting, loss of consciousness or confusion and occasionally loss of function of a particular limb or limbs. In such situations, the patient should be immediately shifted to a neurosurgical center for intensive care and a probable surgery.

How can Aneurysms be diagnosed and treated?

Aneurysms are detected by angiograms (either direct or CT) where the defect in the vessel wall is visualized as well as its relation to the surrounding structures at the base of the brain, an incredibly complex and vital area of the central nervous system. Once detected, the neurosurgeon will probably discuss modalities of treatment for aneurysms, which include:

Microsurgical Clipping of the aneurysm: This involves surgery where highly skilled Neuro-Vascular Surgeons operate under an operative microscope and place a titanium clip at the neck of the aneurysm occluding it completely and thoroughly.

Endovascular Coiling: This involves a small incision at the thigh from which a catheter is placed into the artery in question upto the aneurysm under X-ray guidance. Once inside the aneurysmal sac, metallic coils are packed into the aneurysm until it is completely full blocking blood flow into it and rendering it completely safe.

Both modalities have their own pros and cons. Both modalities are available at Sakra World Hospital and are offered on the advice of the treating Neurosurgeon.

What are Arterio-Venous Malformations?

AVM is an abnormal tangle of dilated blood vessels in spine or brain. If an AVM ruptures, it can cause brain damage, stroke, or death. Some AVMs have no exact symptoms and little or no risk to one’s health or life, while others lay ground for severe and demoralizing effects when they bleed.

 
AVMs are dangerous for 2 reasons:

1)  They can bleed as their friable thin blood vessels are subjected to the high pressure of the cerebral blood circulation. The bleed can result in a stroke with loss of function, loss of consciousness, or even death if not tended to surgically.

2)  They short circuit the blood flow to the normal brain tissue as they offer less resistance to the flow of blood. Hence normal brain is starved of blood supply and can die giving rise to infarcts (also strokes).

What are the common symptoms of an AVM?

Common symptoms of AVMs include:

  • Vision problems
  • Severe headache similar to migraine
  • Weakness in arms or legs
  • Confusion
  • Paralysis
  • Unexpected, severe back pain
  • Seizure
  • Weakness of muscle in facial area or body
  • Numbness in entire body
  • Dizziness

How can AVMs be treated?

AVMs are managed in 3 ways:

1. Surgery: here the entire structure is removed under an operating microscope. This is the most effective and commonly used technique for treatment with excellent results.

2. Embolization: here a glue like thick fluid is used to ‘clog up’ and finally solidify the blood vessels in the AVM thereby eliminating the chances of them bleeding or short-circuiting the brains blood supply. Embolization is nowadays used along with surgery or radiation therapy and rarely done alone as it does not completely destroy the AVM resulting in recurrence.

3. Radiation Therapy: RT is used for specific types of AVMs where surgery cannot be offered. The effects are equally good but it takes time to show good results.

The modality required will be decided by the treating neurosurgeon. All modalities are available in Sakra World Hospital.  

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Dr. Satish Rudrappa.

Director - Neurosciences
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Director - Neuro Sciences
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Testimonials

Testimonial On Left Optical Despicia Treatment

Mrs.Veena Leela M/o Sanjay speaks about how he suffered due to Left Optical Despicia and he also underwent Brain surgery twice on advice of Dr.Satish Rudrappa. She expresses her gratitude

Treatment: Left Optical Despicia

Name: Sanjay

Read More

Patient Testimonial On Conquering Epilepsy

Can epilepsy be cured permanently? Parvati shares her struggles and head problems due to conquering epilepsy. She speaks about the treatment and support provided by Dr Satish Rudrappa and how

Treatment: Epilepsy

Name: Parvati

Read More

Congenital Scoliosis Correction Surgery At Sakra World Hospital

Is congenital scoliosis hereditary? or How bad does your scoliosis have to be to get surgery? Know

Treatment: Congenital Scoliosis Correction Surgery

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Mrs Anita Vimal

The patient's Husband speaks about his wife who was treated for Skull Based Schwannoma by Dr Swaroop Gopal and Dr Honey Ashok, about their journey of the treatment and appreciates

Treatment: Skull Based Schwannoma

Name: Mrs Anita Vimal

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Sakra Patient Testimonial - Spine surgery & Parkinson's Disease

Testimonial of a patient who underwent treatment at Sakra World Hospital for spine surgery and Parkinson's disease

Read More

Sakra Patient Testimonial - Epilepsy

Testimonial from a patient who underwent successful treatment for Epilepsy at Sakra World Hospital.

Read More

A Young Boy Recovers From Epilepsy

In honour of National Epilepsy Day, we would like to shed some light on the treatment of epilepsy and bring hope to those who live with this condition. Here is

Read More

Testimonials by Mrs. Bharathi Bidap

The food and services from the F&B department were satisfactory and on time. The staff was courteous and polite. Thank you for everything.

Read More

My mother was admitted in Sakra World Hospital

My mother was admitted in Sakra World Hospital on 16th February 2018 in a critical condition, but thanks to the services here, she is healthy now and I have to

Read More

Special heartful thanks to Dr. Satish Rudrapa and Dr. Swaroop Gopal

Thought it is important to share this post as it might be helpful to anyone out there. My dad was suffering from severe back pain since August 2016, after an

Treatment: Spine Surgery

Location: Bangalore

Read More

I am grateful to Dr Satish Rudrappa and Dr Siva Kumar who cured my daughter

My daughter has been suffering from Epilepsy from the last 7 years. In Iraq, no doctor has been able to diagnose and treat her for her condition. When we came

Treatment: Epilepsy Surgery

Name: Mother of Ms. Ramya Naeem

Location: Iraq

Read More

Dr Satish is the best neurosurgeon in India i strongly recommend him to my friends in Iraq

Bismillah ir Rahman ir Rahim, I am Haj Fawzi Ajami Abboud from Iraq. 3 years back I met with an accident and had a severe injury. I had undergone a

Read More

Mrs. Judy Paul from Dubai, Shares her experience after a complex surgery for brain tumor

Hear from Mrs. Judy Paul, who shares her experience after undergoing a complex neurosurgery procedure for the removal of a tumor in her brain. As she resides in Dubai, she

Read More

It’s one of the best hospitals in Bangalore

My Son Skand Karur got operated (Fronto orbital advancement) on 17.9.2014 by Dr. Derick A Mendonca & Dr. Swaroop Gopal with their team. We were very much pleased with the

Read More

The Recovery from the operation was excellent.

Dr. Satish Rudrappa, I am writing on behalf of my mother Mrs. Bandana Chatterjee. The Recovery from the operation was excellent. The care provided was very good. The consultant was

Read More

We are extremely humbled by your gesture and help

Good morning Dr. Satish Rudrappa, I am Mahadeshwara. Vivekananda’s son in law. Thank you very much for all your efforts. We are extremely humbled by your gesture and help. Hope

Read More

I am already feeling better after the surgery

Tarun Deep Singh share his experience after undergoing a navigation assisted micro surgery to treat a tumor in his brain. he is happy that is feels better soon after the

Read More

Dr Satish and Dr Swaroop took very good care of me

Rashida Qalandar sharing her experience of neuro surgery she has undergone  at Sakra World Hosptial by Dr,Satish and Dr. Swaroop Gopal top neuro surgeons in Bangalore, she is now totolly

Read More

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Mrs.Veena Leela M/o Sanjay speaks about how he suffered due to Left Optical Despicia and he also underwent Brain surgery twice on advice of Dr.Satish Rudrappa. She expresses her gratitude and thanks to Dr Satish Rudrappa, Dr.Shiv Kumar and entire Neuro unit for helping and supporting in getting her son back to normal.

Can epilepsy be cured permanently? Parvati shares her struggles and head problems due to conquering epilepsy. She speaks about the treatment and support provided by Dr Satish Rudrappa and how it has helped her get back to her normal life.

Is congenital scoliosis hereditary? or How bad does your scoliosis have to be to get surgery? Know more from our expert Doctors Dr Satish Rudrappa and Dr Ramachandran Govindaswamy.

The patient's Husband speaks about his wife who was treated for Skull Based Schwannoma by Dr Swaroop Gopal and Dr Honey Ashok, about their journey of the treatment and appreciates the support extended by Dr Swaroop Gopal and Dr Honey Ashok.

 

Testimonial of a patient who underwent treatment at Sakra World Hospital for spine surgery and Parkinson's disease

Testimonial from a patient who underwent successful treatment for Epilepsy at Sakra World Hospital.

In honour of National Epilepsy Day, we would like to shed some light on the treatment of epilepsy and bring hope to those who live with this condition. Here is a testimonial from one of our patients who underwent treatment for epilepsy under the care of Dr Satish Rudrappa, (Director - Neurosciences, Senior Consultant Neurosurgery, Head - Dept. of Spine Surgery)​

The food and services from the F&B department were satisfactory and on time. The staff was courteous and polite. Thank you for everything.

My mother was admitted in Sakra World Hospital on 16th February 2018 in a critical condition, but thanks to the services here, she is healthy now and I have to Gods to thank for this - Dr. Sathish Rudrappa and Dr. Swaroop Gopal. Apart from this, the nursing staff provided us with excellent service. My mom and I were advised on the do’s and don'ts everyday and we really appreciate this.

My special thanks to the following nurses and staff:

Nirmala, Soorya, Chaithra, Konsia, Jismi, Julee, Hepsi, Asha, Rosmi, Usha - ICU, Simi - ICU ,Prasad - ICU, Adityavani

 

Thought it is important to share this post as it might be helpful to anyone out there. My dad was suffering from severe back pain since August 2016, after an evening hike. He thought the pain would come down after taking rest. But, it didn't happen so. The pain became worse and in addition, his legs went numb. We took a scan and figured that he has got "nervous compression" in his lumbar (spine). We consulted almost all the top and local doctors in Bangalore they suggested that he needs to get a surgery done. Surgery! Spine! Screws! nope! That is risky and post surgery what?. Zillions of questions raised.

We thought and opted for all other options like Ayurveda, Neurotherapy, acupuncture, nadi vaydyam, Mysore homeopathy, Kerala oil, these gave only temporary relief. Trying all these different treatments almost six months just passed away.

In January 2017, Dad had a sudden fall as his legs went completely numb! We took another scan and found that the spine has been further damaged! We decided to go ahead with the surgery, as we did not have any other options left and did not want to take the risk to experiment because any further delay the nerves will get completely compressed and if it gets damaged the person will get paralyzed.

After a thorough check on different hospitals, we decided to go ahead with "Sakra World Hospital", Bellandur. It is a Japanese and Indian collaboration. The name means "Sakura" a pink flower that blooms in spring season in Japan. We consulted Dr. Satish Rudrapa and Dr. Swaroop Gopal, both spine experts. They explained us clearly about the medical condition and also gave us the confidence to go ahead with the surgery. The surgery was planned on February 27th, 2017. Right from day one till the discharge the service was amazing. The admission process was simple and not tedious. Superb infrastructure right from basement parking. The wards were very hygiene and tidy. Feedbacks were taken very seriously. Canteen was really good with good menu at affordable prices. They provide care takers who help the patients to go to washroom, take shower and change clothes. They provide service for grooming the patients like shaving, hair cut etc. Amazing attention in the ICU. Perfect diet food supplied on time for patients. Caring nurses.

Post surgery physiotherapy was provided and the physiotherapists were very encouraging. Most important "final bill". I was expecting a bomb! But, the amount was pretty less when compared to other hospitals and worth it!. Result! My dad was able to walk at a slow pace the third day after surgery! His back pain has come down drastically and numbness has gone completely. Now on recovering phase with physiotherapy and strict diet. To continue with regular check ups.

Special heartful thanks to Dr. Satish Rudrapa, Dr. Swaroop Gopal, Mrs. Bindu, Miss Vinuta, Sister Mini, Sister Banri, Sister Ramya Xavior, Brother Hemanth, Brother Biswajit, Physiotherapist Suresh and the entire Security guards, staff and nurses of Sakra!😊😊😊😊 Thanks again #DrSatishRudrapa #yourock

My daughter has been suffering from Epilepsy from the last 7 years. In Iraq, no doctor has been able to diagnose and treat her for her condition. When we came to Sakra World Hospital, the doctors not only diagnosed her properly but have also treated her very well. It is a very good hospital, the doctors and the staff are very nice. I want to thank Dr. Satish Rudrappa and Dr. Shivkumar who did her surgery and treated my daughter.

Ms. Ramya underwent - Right Temporal Lobectomy along with Amygdalo Hipo Campectomy Under ECog Guidance

 

Bismillah ir Rahman ir Rahim, I am Haj Fawzi Ajami Abboud from Iraq. 3 years back I met with an accident and had a severe injury. I had undergone a surgery in Iraq at that time. But after some time I started having severe pain and it became necessary for me to get advanced treatment for my pain. That is when I decided to come to India for further treatment and seek second opinion. Here in India, I got treated under Dr. Satish Rudrappa at Sakra world hospital. I had to undergo a spine surgery which was very successful and I was able to walk after 4 days. Dr. Satish’s team and the entire hospital staff have been very good and caring and present a high level of efficiency in their work. It is all because of the medical care that I received here that I would always recommend this hospital to my friends and relatives in my country. I had severe pain before coming here and have been so much better after the surgery done by Dr. Satish Rudrappa.

I am very pleased and delighted by the service provided by the hospital. I wish more success for this hospital for their dedication and service to humanity.

Thank you!
Haj Fawzi Ajami Abboud
Iraq

Hear from Mrs. Judy Paul, who shares her experience after undergoing a complex neurosurgery procedure for the removal of a tumor in her brain. As she resides in Dubai, she looked out for the Best Neuro Hospital in Bangalore and opted Sakra World Hospital to get the treatment done. She contacted Dr. Satish Rudrappa, the best neurosurgeon in Bangalore, where he took time from his busy schedule to attend her call and explain it in detail. She initially feared to undergo the treatment, but then the doctor explained the complete procedures and took an individual care for the patient. He remained very calm and composed throughout the entire procedure. Dr. Satish Rudrappa, with his vast experience and skill carefully removed the tumor, but ensured to preserve her facial nerves on.

Judy is now completely recovered and happy that she took this life changing decision. “Remain confident and remain beautiful” Judy Paul said smilingly

My Son Skand Karur got operated (Fronto orbital advancement) on 17.9.2014 by Dr. Derick A Mendonca & Dr. Swaroop Gopal with their team. We were very much pleased with the treatment. We are very much thankful for the entire team. It’s one of the best hospitals in Bangalore.
Skand Karur

 

Dr. Satish Rudrappa, I am writing on behalf of my mother Mrs. Bandana Chatterjee. The Recovery from the operation was excellent. The care provided was very good. The consultant was excellent and his confidence in the surgery performed was borne out by the patient’s recovery. Overall I am very satisfied with the care, service and facilities provided. 

Jaideep Chatterjee s/o Bandana Chatterjee
 

Good morning Dr. Satish Rudrappa, I am Mahadeshwara. Vivekananda’s son in law. Thank you very much for all your efforts. We are extremely humbled by your gesture and help. Hope to meet you in person during review. Once again thanks to your fantastic team from nurses to all the doctors, technicians, lab and particularly Mrs. Bindu and Physio Fayeza Akthar. Special thanks to you and Bindu.

Mahadeshwara

Tarun Deep Singh share his experience after undergoing a navigation assisted micro surgery to treat a tumor in his brain. he is happy that is feels better soon after the surgery and i happy to recomment Dr. Satish and Sakra World Hospital for anyone suffering from similar conditions. 

Tarun Deep Singh

Rashida Qalandar sharing her experience of neuro surgery she has undergone  at Sakra World Hosptial by Dr,Satish and Dr. Swaroop Gopal top neuro surgeons in Bangalore, she is now totolly recovered from severe neuro pain

Rashida Qalandar

A Journey Of Strength: Stand Tall This World Spine Day

What if you had a spine deformity so severe that you couldn’t walk? Does it seem like a hopeless situation? It doesn’t have to be. Sakra World Hospital is a pioneer in spinal care and surgery and we pride ourselves on our high success rates and the positive change we bring to the lives of our patients.

Here is an inspiring story from one of our patients who came to us with a severely deformed spine that left him immobile, in pain, and depressed. Thanks to our expert doctors, he walked away taller and stronger than ever.

Case History:

The patient presented with a history of hereditary motor neuropathy with resulting rigid kyphoscoliosis. He complained of breathlessness, difficulty walking, and feelings of depression due to his condition. His back was visibly crooked with a hunchback. The spine displayed gross deformity with a kyphotic degree of 75 and scoliotic degree of 70.

The patient was advised to undergo kyphoscoliotic correction surgery to reverse the deformity and improve overall functionality and quality of life. The surgery was undertaken by a team of spine surgeons which included Dr Satish Rudrappa, Dr Ramachandran, and Dr Ramakrishna. 

Dr Satish Rudrappa was the head surgeon. The surgery was conducted in 8 hours and was a complete success.

Post-surgery, the patient had a rapid recovery. He began walking the day after surgery and his height had increased by 7 cms. He underwent rehabilitative treatment and was discharged in 5 days with full mobility.

Hereditary Motor Neuropathy and Kyphosis

Hereditary motor neuropathies, also called distal motor neuropathies, are a group of motor neuron diseases. As the name suggests, these neuropathies are genetic in nature. Distal motor neuropathy is primarily characterized by the loss of motor neurons in the anterior horn of the spinal cord resulting in motor impairment and muscular atrophy or degeneration.

The onset of hereditary motor neuropathy is usually during childhood or adolescence with rapidly progressive weakness and wasting of the large muscles of the legs. As the disorder progresses, the muscles of the arms and hands can also be affected. In some subtypes of hereditary motor neuropathies, the symptoms start in the feet instead of the legs.

Spinal deformities are reported in some patients with hereditary motor neuropathy such as scoliosis, kyphosis, or kyphoscoliosis. The normal spine has a natural curvature and three segments. The cervical section (neck) and the lower back curvature are ‘c-shaped’ and called lordosis. The portion of the spinal cord in the chest (thoracic spine) is ‘reverse c-shaped’ and is called kyphosis.

The natural curve of the spine is important for balance, stability, and mobility of the body. Any abnormal or excessive angles of curvature can affect these normal functions.

What You Need To Know About Kyphoscoliosis

Scoliosis is an abnormal curvature of the spine in a sideways direction while kyphosis is an abnormal curvature of the thoracic spine beyond the normal 20-40 degrees, which causes the upper back to appear more rounded and prominent than usual. When both these conditions co-exist, it is known as kyphoscoliosis.

Kyphoscoliosis can result due to a number of factors such as genetics, poor posture, certain infections, etc. This condition is not merely a spine deformity but also has a number of associated complications such as difficulty breathing, pulmonary hypertension, difficulty performing everyday tasks, and psychological problems such as anxiety and depression.

Treatment Options 

Treatment for kyphoscoliosis can include physical therapy, medication, surgery, or any combination of these.

Minor cases of this spine deformity can be corrected with exercise and physical therapy, along with medications if required. Placement of back braces can also be used to return the spine to a normal curvature.

Severe or progressive cases of kyphoscoliosis may not be completely corrected by non-invasive treatments and so corrective surgery may be needed.

Why Is Kyphoscoliosis Correction Surgery Difficult?

Surgery for kyphoscoliosis aims to correct the deformity, correct any nerve damage, and prevent further progression of the deformity.

The surgical procedure is a spinal fusion surgery with instrumentation. During the surgery, the area of the spine that needs to be corrected is exposed via a long incision. 2-inch titanium screws are placed into hard struts of bone called pedicles which are on either side of the vertebra. Once all the screws are in place, the surgical team corrects the angle of curvature. 

While the success rates of this corrective surgery are overwhelmingly positive, there are certain risks that need to be considered. Risk factors can include nerve damage leading to permanent paralysis, failure to correct the deformity, excessive bleeding, and infections.

The risk of paraplegia or complete paralysis can be the most troubling for many patients. However, this should not be a reason to delay or refuse surgery if it is required.

As with any other surgical procedure, it is important to analyse the risks and benefits. Hospital infrastructure, the presence of an experienced and expert multidisciplinary team, and the technique of the surgery are important factors that can improve the chances of success for patients undergoing corrective surgery.

What We Do Differently At Sakra

At Sakra World Hospital, we are committed to using the best medical technology available to better the lives of our patients. Our combination of expert doctors, evidence-based medical practices, and the latest technology allows us to achieve high success rates in our surgical procedures.

We understand the complex nature of surgical procedures such as spinal fusion and instrumentation. All our surgical patients undergo a comprehensive pre-surgical medical check to ensure that they go into surgery in the best possible condition. This, in turn, improves chances of success and recovery.

Spinal surgeries at Sakra are conducted by experienced multidisciplinary teams that include spine surgeons, neurosurgeons, orthopaedic surgeons, specialised nurses, and paramedical staff. We treat the body as a whole and not part by part. Spinal disorders are multifaceted and complex and a multidisciplinary approach is the best way to ensure complete correction of deformities and better quality of life after surgery.

One of our outstanding features is our extensive and up-to-date technology. We always use the latest in medical technology in our surgeries. For spinal surgeries such as spinal fusion, we supplement the expertise of the surgical team with state-of-the-art neuronavigation systems, neuromonitoring, and intraoperative CT guidance during pedicle screw placement and correction of curvature.

Ultimately, we are dedicated to bringing relief and a better life for our patients. Everyone deserves to live their best life, unencumbered by ill health. At Sakra World Hospital, we give you the strength and confidence to live your life to the fullest.

References:

1. https://www.hopkinsmedicine.org/
2. https://www.ncbi.nlm.nih.gov/
3. https://www.nhs.uk/
4. https://orthoinfo.aaos.org/
5. https://journals.lww.com/
6. https://www.healthline.com/
7. https://en.wikipedia.org/
8. https://en.wikipedia.org/
9. https://www.sciencedirect.com/

 

Knowledge is power. Learn about stroke to fight it now

What is a Stroke?

Stroke is also known as “Brain Attack”. It is similar to a heart attack in nature. It has the potential to affect people of all age groups. The stroke happens when the blood supply directed toward the brain is cut off abruptly. Without blood, the brain cells are deprived of oxygen and other nutrients and hence the brain cell begins to die. The damaged caused by it is relational to the area of the brain it affects. Stroke affects people’s most basic functional aspects such as speech, mobility and their ability to think, feel or respond. Consequences of a stroke on a person depend on where it occurs in the brain and the amount of damage caused by it.

Is a Stroke treatable?

Though Stroke is a complex medical issue, there are effective ways to minimize its effects. Identifying early signs of stroke and seeking emergency medical care in the dedicated “stroke unit” minimizes the effects of it. 
Stroke can be treated effectively if one seeks emergency stroke treatment in the initial 3-4.5 hrs. Also, an early access to the best professional care can significantly improve results.

What are the warning signs of a Stroke?

Symptoms of a stroke are sudden and unexpected. Here are the warning signs of a stroke: 

1. Sudden, severe headache 
2. Sudden trouble seeing in one or both eyes
3. Sudden weakness of the face, arm or leg, particularly on one side of the body
4. Sudden trouble speaking or understanding
5. Sudden trouble in walking, coordination and a significant loss of balance or dizziness

 If you notice one or more of these signs, don’t worry or panic.
Call your emergency medical services and get to a hospital immediately. 

6 Key facts about Stroke Treatment

1.  You can make a positive difference by recognizing the signs of Stroke
Recognizing the signs of Stroke and getting the treatment on time saves lives and accounts for a speedy recovery. 
If you think someone may have had a stroke, check for these signs quickly:
1. Face – Is one side drooping? 
2. Arms – Raise both arms. Is one side weak?
3. Speech – Is the person able to speak? Are words jumbled or slurred?
4. Time – Act quickly. Seek emergency medical attention immediately.

2. When cared for in a specialized stroke unit, around 1 in 10 diagnosed people make fast recovery 
All the patients with stroke (ischaemic or haemorrhagic) should be admitted to a specialized stroke unit, which involves a designated ward with a specialized team. This team includes a Neurologist, Neurosurgeon, Neurointerventionist, Neuroradiologist and a Stroke rehabilitation specialist. 

3. Provide the patient with clot-busting drugs (tPA or thrombolysis) and enhance his or her chances of recovery by 30%
Clot-busting drugs break up blood clots. This treatment can be administered up to 4.5 hours of symptom onset in many patients with ischaemic stroke. The earlier it is given, the greater the effect.

4. Provide the patient with clot retrieval treatment and enhance his or her chances of recovery by 50%
Clot retrieval treatment (mechanical thrombectomy) involves removing a blood clot from the large arteries by Neurointerventionists in the cath lab. Clot retrieval can improve survival rates and reduce disability for many people with ischaemic stroke caused by large artery blockage.

5. The most critical step in the treatment process is rehabilitation 
Rehabilitation starts in the hospital by neurosurgeons as soon as possible post a stroke. It can improve the patient’s functionality and assist him or her in regaining maximum independence with time.

6. One in four survivors will have another stroke.
Stroke risk can be reduced by treating risk factors for stroke. Treatments that prevent another stroke include drugs to lower blood pressure and cholesterol, antiplatelet therapies, anticoagulation for atrial fibrillation, surgery or stenting for selected patients with severe carotid artery narrowing.

“Right  Stroke Care Makes a Difference”

Join the fight against stroke.

Stroke affects all of us. So let’s take an action, a drive awareness and push for a better access to stroke treatments.
Learn how to contribute in spreading awareness and access with regard to a stroke. 

Individuals

1. Be aware. Learn the signs of stroke and know to take immediate action.
2. Share this information with family and friends.

Learn How To Prevent A Stroke 

Here are six steps anyone can take to reduce the risk and danger of a stroke:

1. Know your personal risk factors: High blood pressure, diabetes, and high blood cholesterol.
2. Be physically active and exercise regularly.
3. Maintain a healthy diet-  High in fruits and vegetables and low in salt to keep the blood pressure low.
4. Limit alcohol consumption.
5. Avoid cigarette smoke. If you smoke, seek help to stop now.
6. Learn to recognize the warning signs of a stroke.

To know more visit our best neurologists in Bangalore at our hospital

Seven year old undergoes awake brain surgery

Bengaluru doctors claim it to be first-of-its-kind on a child

Seven-year-old Nitin (name changed), who complained of a persistent headache and frequent bouts of fits, was diagnosed with the brain tumor around vital blood vessels in the speech area. He required a surgery immediately, without which he would lose the ability to talk.

Doctors at the Institute of Neurosciences, Sakra World Hospital, where he was admitted, realized that the patient’s speech and limb movements had to be monitored during resection of a tumor.

“This is a preferred technique for operations to remove lesions close to or involving functionally important regions of the brain,” institute director Satish Rudrappa told The Hindu.

A team of neurosurgeons, led by Dr. Rudrappa and neuro-anesthetists led by Sunil Kumar, who performed the awake craniotomy surgery, claimed it to be the first in the world on a patient so young.

“Awake craniotomy has been a great success in adults, but among children, a different set of challenges are involved like the ability of a seven-year-old to be able to cooperate during the five-hour procedure,” Dr. Rudrappa said.

Nitin was given regional skull block anesthesia and the craniotomy was performed using conscious sedation (sleeping and easily arousable). Once the brain and the tumor were reached, the boy was kept awake to speak, answer simple questions and identify simple objects using pictures, while the surgeons removed the tumor and preserved important blood vessels without coagulation, Dr. Rudrappa explained. At the end of the procedure, after a closure of the skull, the boy could talk normally without pain or discomfort. He was discharged within 48 hours and is on regular follow-up, he added.

The patient plays guitar during surgery

Meanwhile, 37-year-old musician Abhishek Prasad, who had musician’s dystonia (difficulty in moving left-hand fingers), a rare nervous disorder, underwent a brain circuit surgery at Bhagwan Mahaveer Jain Hospital recently.

During the surgery, the patient was fully awake and played the guitar, to give the doctors feedback to locate the exact location of the target to be lesioned. 

 

Media Coverage: 

1. http://www.thehindu.com/news/national/karnataka/seven-year-old-undergoes-awake-brain-surgery/article19319203.ece

2. http://www.newindianexpress.com/cities/bengaluru/2017/jul/25/7-yr-old-stays-awake-calm-while-doctors-operate-brain-1633032.html

3. http://bangaloremirror.indiatimes.com/bangalore/others/rare-surgery-that-gave-7-yr-old-his-speech-life/articleshow/59672730.cms

 

Pituitary Adenoma

A pituitary adenoma is a slow growing and typically benign tumor arising from cells in the pituitary gland. Because they originate from cells in the pituitary gland, they often cause problems related to hormonal dysfunction. A large proportion of these tumors grow to a size where they cause symptoms because they compress surrounding structures. For these reasons, larger pituitary tumors (called macroadenomas) often present with headache, visual loss and pituitary gland dysfunction. Changes in energy level, sexual function and libido, and many other symptoms may be a result of a dysfunctional pituitary gland (called hypopituitarism).

Other types of tumors and cysts are also often seen in the pituitary area, and some require surgical management. These include craniopharyngiomas, Rathke’s cleft cysts, meningiomas, and other less common neoplasms and inflammatory processes.

Causes of pituitary adenomas
The specific cause of pituitary adenoma development is unknown, although they are likely to be caused in part by random mutations in cells of the pituitary gland. Congenital syndromes known to be associated with some pituitary adenomas make up only a minority of patients with these tumors.

Treatment for pituitary tumors involves various options, including removing the tumor, controlling its growth and managing your hormone levels with medications.

Signs and symptoms of pressure from a pituitary tumor may include:

  • Headache
  • Vision loss, particularly loss of peripheral vision
  • Nausea and vomiting
  • Symptoms of pituitary hormone deficiency
  • Weakness
  • Less frequent or no menstrual periods
  • Body hair loss
  • Sexual dysfunction
  • Increased frequency and amount of urination
  • Unintended weight loss or gain

Risk factors:

Although pituitary tumors can occur at any age, they're most likely to occur in older adults. People with a family history of certain hereditary conditions, such as multiple endocrine neoplasia, type I (MEN I), have an increased risk of pituitary tumors. In MEN I, multiple tumors occur in various glands of the endocrine system. Genetic testing is available for this disorder.

COMPLICATIONS

Vision loss, permanent hormone deficiency and diabetes insipidus.

A rare but potentially serious complication of a pituitary tumor is pituitary apoplexy, when sudden bleeding into the tumor occurs. Pituitary apoplexy requires emergency treatment, usually with corticosteroids and possibly surgery.

Tests and diagnosis: Blood and urine tests to determine whether there is any over production or deficiency of hormones.

Brain imaging: CT and MRI to judge the location and size of pituitary tumor.

  • Vision testing. Such tests can determine if growth of a pituitary tumor has impaired your sight or peripheral vision.

Treatment involves a team of medical experts, possibly including a brain surgeon (neurosurgeon), endocrine system specialist (endocrinologist) and a nervous system specialist (neurologist). Doctors generally use surgery, radiation therapy and medications, either alone or in combination, to treat a pituitary tumor and return hormone production to normal levels.

Surgery includes: Endoscopic transnasaltranssphenoidal and Transcranial approach (craniotomy).

Radiation therapy includes: External beam radiation and Gamma Knife stereotactic radiosurgery.

Craniosynostosis

Craniosynostosis is derived from the terms cranio, syn and ostosis that relates to the bone. It is a birth defect in which one or more of the joints between the bones on an infant's skull close prematurely, before the infant's brain is fully formed. Craniosynostosis transpire in one in 2000 births. An infant’s skull has seven bones. In general, these bones don’t fuse until the age of 2, giving enough time for the infant’s brain to develop. These bones are held together with a joint called cranial sutures, made of strong fibrous tissue.

Symptoms of Craniosynostosis

  • Increase of pressure inside the skull such as intracranial pressure
  • A distorted skull having the shape that depend upon which of the cranial sutures are affected
  • Development of a hard or raised ridge near the affected sutures
  • No or slow growth of the head as the baby grows
  • Abnormal disappearing or feeling of a soft spot on the skull of the baby

Craniosynostosis can be categorized into many types. Some of the most commonly found types are:

Sagittal synostosis (scaphocephaly)
Premature fusion of the sew up at the top of the head forces the head to grow long and thin, rather than wide. Scaphocephaly is the most common type of craniosynostosis.

Coronal synostosis (anterior plagiocephaly)
The premature fusion of a coronal suture may force the infant’s forehead to flatten on the affected side. It can as well cause a deviated nose and slanted skull.

Bicoronal synostosis (brachycephaly)
In this stage, the baby may have a flat, elevated forehead and brow. This happens when both of the coronal sutures fuse prematurely.

Treatment of Craniosynostosis
The overall health and medical history of the child has to be taken into priority. The only treatment for craniosynostosis is an intervention of surgery. An open surgery is performed for reshaping the skull of the child. This is made at the top of the head by an incision. Followed by the affected suture is removed by a neurosurgeon, giving a more normal shape to the skull bones by a craniofacial plastic surgeon. Screws and plates are used for holding the new shape till the time bone heals. The screws and plates are made up of special material that absolutely dissolves in 1-2 years. Only one surgery is required if a baby has single suture craniosynostosis. More than one surgery is required if a child has craniosynostosis caused by craniofacial syndromes.

Back and Neck Pain a paradise of myths

For a vast majority of us, Back and Neck Pain is a fact of life. The timescale of it may vary, but it does visit each of us at some point of time in our lives. Fortunately, majority (90%) of them will resolve on their own in 2-3 weeks, during which symptomatic treatment and physiotherapy is the mainstay of treatment aimed at maintaining range of movement during the episode. Back and Neck pain is an epidemic of modern day society and not surprisingly, conflicting messages are bound to contribute in spoiling the broth. The scale of the problem in a diverse society, with multiple professional contributing in the care, is bound to feed confusing and conflicting messages. The aim of this article is to present commonly encountered myths among my patients of back and neck pain.

Myth 1

“I can’t get back/ neck pain, I am way too healthy for it”

As I said in the introduction, nearly 70- 80 % of us will suffer with it at some point in our lives, even if it is for short period lasting days / weeks. Having a balanced range of activities to strength all muscle groups is the key.  Even athletes / sportspersons are affected if the sport involves excessive strain on a certain muscle group or body part. Habitual body posture / activity predisposes for injury or pain.

Health tip: Prevention is better than cure. Practicing good technique for our daily activities like sitting, standing, walking, lifting contributes in keeping pain at bay.

Myth 2

“My back / Neck hurts, I need bed rest”

The current consensus for optimal course of action is to stay as active as is feasible. Any extended periods of rest beyond 2-3 days, sows the seeds for persistent chronic pain (greater than 3 months). It is reasonable to modify your activities, but avoid taking complete bed rest. Attempt to return to your daily routine activity.  The health and strength of posture supporting muscles around your spine are just as important as your spine bones. Scientific studies have demonstrated weakening of your back muscles after just 2 days of rest (disuse atrophy). So, it time to jump (I mean climb) out of bed and attempt to return to your daily routine as much as possible.

Tip: Minimise any rest period and attempt return to daily routine.

Myth 3

“I have to give up my favorite activity like sport, jogging, etc”

Your back pain may act as a dampener to your intentions to continue your desired activity. Your doctor / physiotherapist will guide you in an individually tailored exercise regime to assist returning to your favorite activity. A combination of flexibility exercise, core muscle exercises, and appropriate posture will assist you in returning to most or all of your favorite activities.

Tip: Adapt rather than sacrifice your favorite activity and sport.

Myth 4

“I need an xray or scan to find out the cause of my back and neck pain before starting treatment”

Majority of back and neck pain episodes get better on their own with symptomatic treatment and scan should not delay the onset of treatment. In most situations, further investigations are required when pain does not get better after 2-3 weeks. Your doctor is the best placed to assess the need for scan.

Tip: The professional’s assessment and advice should guide your treatment plan.

Myth 5

“My scan and x-ray will find the cause of my pain”

The sophisticated scan provide nice images of your back / neck that might show an abnormality. However, such changes are a common (30-40%) in over 40 year olds people routinely carrying non-painful spine changes. However, your doctor is best placed to guide you in correlating your pain pattern with your scans. It is fairly common to not identify a specific cause on your scans for your pain. After all, the body does not live all day lying flat like in the tunnel of the MRI scanner. The constant weight bearing, strain of posture and movement are something that can’t be replicated in any scanner.

Tip: Your tests will guide and supplement the professional’s meticulous assessment, but can’t replace it.

Myth 6

“I have back / neck pain, and I need surgery”

The indications for surgery for back and neck pain are very few, and only a small proportion of people need it. You would need to be assessed in detail before considering surgery, usually to relieve pressure on nerves (not irritation of nerves). There are many simple treatment options including minimally invasive procedures that may be suitable before considering surgery as a treatment option.

Myth 7

“I have always been overweight, how can this be the cause of my back pain”

The skeleton supported by its ligaments and muscles carries all your weight. Any weight you carry squeezes the disc in your spine and hence does correlate with pain. Moreover, a large belly tilts your pelvis forwards making an abnormal curve in your spine. This can contribute in causing your pain. Any exercise you undertake in reducing your weight has an added benefit of promoting production of endorphins (body’s own painkillers).

Tip: Reducing weight and maintain it have multiple ancillary benefits like sense of wellbeing, self-confidence, improved muscle endurance and activity tolerance.

Myth 8

“Back and Neck pain is a very disabling condition”

Excessive fear and unwarranted misinformation will harm your chances in helping yourself. Staying motivated, leading a healthy lifestyle, maintaining active lifestyle and social engagements. People who return to normal routine activities without excessive rest or overdoing exercises will fair better in the long run.

Tip: How you adapt and accommodate to your medical condition determines the severity of disability.

Myth 9

“All the heavy lifting, I have been doing and continue to do is bad for my back and neck”

Lifting with knees rather than your back is the key message in lifting hygiene. It is more about how you lift, than how much you lift. Of course, excessive weight, does mean more chances of back and neck pain. Having the right help, aids and lifting technique will keep you in good health.

Tip: Often poor lifting hygiene rather than lifting weight is the culprit.

Myth 10

“No doctor can find the cause for my pain, it is all in my head”

Pain is real and pain is what you say it is, irrespective of what the tests and doctors say. You need assessment by a qualified professional (like pain physician, rheumatologist, neurosurgeon, orthopedician). Pain experience has many dimensions inclusive of an emotional component that drains a lot of energy and motivation. You need help with a meticulous assessment and guidance from an experienced professionals to guide you in your fight against pain.

Summary: Back and neck pain are inevitable short term visitors in our lives (self or relatives). For the unfortunate few left with chronic pain, a plethora of misinformation contributes to the suffering and experience of pain. A plethora of myths accumulated along the way do more harm than good for this long term condition. High quality evidence based treatments are now available, many without the need for surgery. Getting the right qualified help and advice in your fight against persistent back and neck pain is the best thing you can do for yourself.

Blog by

Dr. Hirachand S Mutagi.
Senior Consultant in Pain Management.
Dept. of Interventional pain Management.
Sakra World Hospital.

Health Warning at your desk to work can be injurious to health.

Can we imagine a life without computers? Electronic s and computers have percolated into our life at an alarming pace and magnitude. This has occurred at a scale to make me wonder if typing skills in my children are at par, if not more significant than handwriting skills. Needless to say many of us spend hours in form of a computer at work and top it up with a few more hours in front of Mr. Computer at home. As a pain physician involved in helping desperate patients with persistent pain, I see an epidemic of occupational hazards.

“@your Desk to work can be injurious to health” is not a tagline I would associate with undertaking a routine relaxing job on a posh comfy expensive chair. The sound of it resonates with health hazards of smoking. The sheer volume of time spend in front of Mr. Computer in its many forms , small and big, is making a generation regress back to the dark ages …really?

Musculoskeletal disorders due to sustained unhygienic postures is creating epidemic of health problems centered mostly around the neck, shoulders, arms and upper back. You could argue, I don’t think our ancestors with similar postures suffered with health problems. Well…… probably not since they were not ashamed and frequently to ambulate on all fours (limbs).

We have to take charge and modify our workplace, accommodate our schedules to reduce the impact of our activities on our health. I draw inspiration from the “Microsoft Healthy computing Guide” to suggest modifications in our work / leisure related Mr. Computer activities to ensure we continue to benefit with the marvels of the rapidly developing / evolving world we live in. We should aspire to be comfortable and productive with Mr. Computer.

This guide is designed for anybody spending more than 2 hours with Mr. Computer. This is relevant and probably equally important even if you are fortunate enough to have had no aches and pain in top half of your body. The commonly issues are occasional discomfort in hands, arms, shoulders, neck, upper back and even headaches. Any persistent aches, tingling numbness, burning / shooting pains in your arms / fingers warrant an assessment by a qualified doctor. The suggestions / advice below are generic and applicable across a wide spectrum of people. However, I recommend an individual detailed assessment, if you continue to experience ongoing discomfort. If you have access to an occupational therapist / physician professional guidance to arrange tour workstation will be beneficial.

Tip 1: Position Yourself

Avoid sustained postures for extended periods of time with any activity to avoid discomfort, fatigue and pain. Workstation redesign is essential to avoid unhygienic and awkward sustained postures. The workstation should promote and maintain a comfortable relaxed posture.

To support your back, try the following:

  • Use a chair that supports your lower back preventing arching with convexity pointing behind you. (See detail 1).

  • Adjust your work surface and chair height to assume a comfortable and natural body posture (see detail 2).

To promote comfortable leg postures, try the following:

  • Clear away items from beneath your desk to allow comfortable leg positioning and movement.

  • The height of seating should ensure a rested foot on the floor and horizontal thighs on the seat.

Tip 2 - For a comfortable shoulder and arm postures:

  • Place your keyboard and mouse or trackball at about elbow level. Your upper arms should fall relaxed at your sides (see detail 3).

  • Centre your keyboard in front of you located close to it (see detail 4).

  • Place frequently used items comfortably within arm's reach (see detail 5).

Tip 3 - For comfortable wrist and finger postures:

  • Keep your wrists straight while typing or mouse navigation. Avoid bending your wrists up, down or to the sides.

Tip 4 - For Comfortable neck posture:

  • The top of the screen should be positioned at your eye level. If using bifocal glasses, it may be useful to lower the screen.

  • Centre your monitor or document holder in front of you depending on what you refer to most often.

  • Consider using a document holder to position your documents near eye level.

    Tip 5 - To reduce eye strain:

  • Position your monitor an arm's length away from you when seated comfortably in front of it.

  • Place monitor away from sources of glare.

  • Maintain a clean screen and glasses if you wear some.

  • Optimize the monitor's brightness and contrast, along with a good font size.

    Tip 6 – Avoid repetitive strain injuries – Be gentle to yourself

    Repeated monotonous work maneuvers, or sustained pressure / impact on body parts can result in body injuries. Common examples include pressing the keys while typing, clicking the mouse buttons, holding your mouse or cradling the phone and resting your wrists on the edge of your desk. You can dampen the effect of these.

  • Be gentle to yourself - Type with relaxed hands and fingers ensuring a light touch that is sufficient to activate the keyboard keys, clicking a mouse button, when using a joystick or other gaming controller.

  • Try maintaining a floating wrist and hands (see detail 7). The palm rest, if provided, should only be used during breaks from typing.

  • Relax your arms and hands when you are not typing or using your mouse. Avoid resting hands on furniture edges.

  • Adjust your chair so the seat does not press into the back of your knees (see detail 8).

Tip 7 - Take Breaks

In a supercharged workplace taking breaks may not be feasible. You can certainly take a break from repetitive task and resort to change in activity. Take a walk out supervising juniors. Stretch yourself during a telephonic conversation. These breaks can be tailored to you and your work place.

Tip 8 – Balance between work and play to limit strain on same body part:

  • Organize your diary to have a good admixture of activities that do not strain the same body part for extended periods of time.

  • Utilize the different Mr. Computer input devices to accomplish the same task. E.g. scrolling with move wheel versus arrow keys.

  • Understand feature in Mr. Computer to work efficiently. E.g. Ctrl C instead of mouse right click copy.

  • Eat a balanced diet and get adequate rest.

  • Regular exercise for overall fitness and to improve the strength and flexibility of your body.

  • Manage stress of and home by good scheduling and time management.

Tip 9 – A healthy body and mind

A healthy peaceful mind ensures productivity and higher tolerance for repetitive tasks. A tensed, stressed mind tightens / strains the muscles in your upper back and neck limiting the tolerance of MR. Computer related activities.

Maintain good health by:

  • Eat a balanced diet and get adequate rest.

  • Regular exercise for overall fitness and to improve the strength and flexibility of your body.

  • Manage stress of and home by good scheduling and time management.

To conclude:

I wish you a healthy, productive, efficient, happy relationship with Mr, Computer who is likely to encroach into all domains of our lives. We wish you a happy computing experience, and don’t forget to look after yourself.

If you are concerned about any aspect of your health at work or home, please speak to a qualified professional. He may be able to guide to with possible contributing factors along with customized solutions for your problems. You can access further resources to help yourself from the “Healthy Computing Guide” on the Microsoft website.

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