Sustainable Construction
Lorem ipsum dolor...
Spinal cord tumor is a broad term for any space occupying disease inside the spinal canal. Your tumor has been confirmed by CT / MRI which tells us where exactly it is situated inside the skull but does not tell us what type of tumor it is. The radiologist has tried to guess the type of tumor but the radiologist requests for clinical and histopathological correlation. Only after analyzing the tumor the pathologist will tell us what type of tumor it is and whether it is benign or malignant. We do not know the exact reasons for any individual getting such a tumor; there are many theories. It is not related to your food habits or work or environment or character.
The treatment options are surgery, observation and medicines. The preferred treatment for these tumors is removal of the bone (laminectomy) and an attempt at complete resection. Biopsy of these tumors is not justified unless the differential diagnosis is not conclusive.
Most often the presentation for such spinal cord tumors is with symptoms such as weakness and numbness of limbs associated with pain. If symptoms are rapidly progressing, urgent treatment is required to prevent permanent neurological damage. If there is gross disability before surgery, recovery may be delayed and/or incomplete.
Though some of these tumors respond to a very small extent to medications, surgery is the best option to bring down the size of tumor so that the compression on the spinal cord is relieved. Surgery is the best option for you. We encourage you to do Google Search on this and you are welcome to discuss further for any clarification.
Surgery for spinal tumors is a major procedure that takes 2 to 4 hours. Once inside the operating room you will be anaesthetized and you will fall asleep. Most often the skin incision will be through the back and the procedure will involve some amount of bone removal (Laminectomy) as dictated by the size and location of the tumor. Sometimes we use an X-ray machine during the surgery to correctly locate the level of the spinal tumor. We use an operating microscope to ensure complete removal of tumor and preservation of normal structures. Once tumor removal is completed we stitch the tissues together. Sometimes we have to take fat from the thigh or abdomen to fill the gaps in bone and support the inner stitches. After the operation, you will be moved to postoperative ward / Neuro ICU for close observation and care. The anesthesiologist will usually decide on the need for giving oxygen and artificial breathing (ventilator support) depending on your BP, pulse, breathing, conscious level and brain recovery. The close family members will be allowed to see you after the operation in the Neuro ICU.
Any treatment whether it is oral medication, injection or operation, there is a small risk. We have to understand the risk of the disease and its natural course and weigh against the risks of treatment. Before surgery, we will do thorough check up by blood test, urine tests, nasal swab, ECG, X-ray Chest, Echo; get anesthesiologist to see and then only plan surgery. If left alone, the tumor will continue to grow and affect the functions of the spinal cord which can cause paralysis of limbs, difficulty in carrying out activities of daily life etc. Spinal cord tumor removal surgery like heart surgery is a high risk surgery and cannot be taken lightly. While removing the tumor, we are required to gently separate the normal nerves and blood vessels and protect them. The nerves of the spinal cord are very delicate structures and may stop functioning for a variable time. In fact you will be required to give consent for this surgery before operation. The risks include paralysis of hands and legs, risks of blood transfusion, infection, prolonged ICU care, prolonged hospitalization, inability to return to work. Though there is very little direct risk of death, the complications mentioned above can endanger life during the postoperative period. As mentioned earlier, we have to understand the risk of the disease and its natural course and weigh against the risks of treatment.
There are no limitations or precautions following removal of the vertebrae. However, in very young patients and particularly children there is a concern for progression of a spinal deformity which needs to be monitored.
The role of radiotherapy should only be reserved for tumors which are malignant or those tumors which are not surgically operable. This accounts for very few tumors.
You will be admitted the evening before surgery. After the operation, you will be observed in Neuro ICU for 24 hours and when all parameters are normal, you will be shifted to Room. Your diet, medications will be the responsibility of Nurses. Usually you can have liquid diet after a few hours and normal diet from next day. You will be progressively mobilized out of bed in a few days. Usually you will be discharged from hospital on the 4th or 5th day, provided you feel comfortable to get discharged.
The speed of recovery also depends on pathology of tumor and how your functional status was before surgery. The better your functional status was before surgery, the shorter your recovery time will be after surgery.
We recommend 2 weeks rest at home after any major surgery like this one. We advise certain precautions such as avoiding lifting weights, forward bending, prolonged sitting or standing for a few weeks. You can walk to toilet, sit and eat, talk to family and friends, see TV, use your mobile but do not strain too much as you may develop a few side effects even after discharge: Low sodium, Excess urination, CSF leak, fever, deep vein thrombosis, wound complications, systemic infections, poor control of diabetes. These are very rare but may need readmission for treatment – It is the responsibility of you and your family to come to hospital Emergency in such circumstances.
You can go back to your work after 3 or 4 weeks from the date of surgery but this is highly variable and will depend on your recovery and also the need for any further treatment like radiotherapy.
The speed of recovery also depends on pathology of tumor and how your functional status was before surgery. The better your functional status was before surgery, the shorter your recovery time will be after surgery.
We recommend 2 weeks rest at home after any major surgery like this one. We advise certain precautions such as avoiding lifting weights, forward bending, prolonged sitting or standing for a few weeks. You can walk to toilet, sit and eat, talk to family and friends, see TV, use your mobile but do not strain too much as you may develop a few side effects even after discharge: Low sodium, Excess urination, CSF leak, fever, deep vein thrombosis, wound complications, systemic infections, poor control of diabetes. These are very rare but may need readmission for treatment – It is the responsibility of you and your family to come to hospital Emergency in such circumstances.
You can go back to your work after 3 or 4 weeks from the date of surgery but this is highly variable and will depend on your recovery and also the need for any further treatment like radiotherapy.
The long term outcome is good to excellent.
The nerve roots supplying the legs and private parts are within the Lumbo-sacral vertebrae in the low back region. Normally there is adequate space for the nerves inside the spinal canal and Foramina through which they come out. When there is “wear and tear” in the disc and joints of the back, this space gets narrowed by bulging disc, thickened ligaments, bony projections (osteophytes), synovial cysts and thickened nerves themselves. The nerves get pinched especially during movements and specific positions. When we stand or walk the space is further narrowed. In sitting position, the space is more. When you lie down there is no weight transmission through the spine and there is less narrowing. In some individuals, by birth the space is narrow; in them even mild degenerative changes can cause significant symptoms.
Apart from symptomatic treatment of pain with analgesics, there are no drugs to increase the space in canal stenosis. If the narrowing is due to inflammation, it will respond to anti-edema medications. The space can be increased by a program of exercise and weight reduction; patient’s efforts and perseverance are essential. Physical therapy methods will give temporary benefit for a few hours or days only.
Any operation in the spine or brain is to be considered as a major surgery and should not be taken lightly. On the day of surgery you will be required to have special shampoo bath. Once inside the operating room, you will be given general anesthesia and you will fall asleep and will not feel any pain. You will be turned to lie on the chest-hip-knee position over special bolsters. Usually it is a keyhole surgery for single level. For 2 or more levels, Mini open microsurgery technique will be used. We prefer Microscope to endoscope. We confirm the level of disease with X-ray (C-arm). Through a 3 cm long skin incision over midline, we expose the space between 2 vertebrae (interlaminar space) and widen it using special bone-removing instruments (ronguers, nibblers and high speed drill). We essentially trim the structures – bone, ligaments, disc, joint capsule so as to get adequate space for the nerves. At the same time, we preserve the structures essential for transmission of body weight and spinal movements.
Any treatment whether it is oral medication, injection or operation, there is a small risk. We have to understand the risk of the disease and its natural course and weigh against the risks of treatment. Before surgery, we will do thorough check up by blood test, urine tests, nasal swab, ECG, X-ray Chest, Echo; get anesthesiologist to see and then only plan surgery.
1) Most important concern is the persistent back pain that needs to be controlled by core muscle exercise program and weight reduction. If the preoperative stress x-rays show instability, you’d have been advised stabilization surgery. If the back pain > leg pain, you’d have been advised stabilization. Rarely when we trim structures to increase the space, more bone may need to be removed which can cause instability.
2) Injury to nerve roots: in 5 to 10% of cases, there may be transient weakness or numbness of part of the foot. Very rarely, nerves to the bladder and anal canal may be pressed by the instrument. In < 1% of cases, there can be accidental injury to dura with CSF leak. It will be recognized during surgery and will be repaired. If there is postoperative CSF leak, it is a serious matter because of the risk of infection – meningitis.
3) Wound complications like bleeding, infection occur very rarely
4) Systemic complications likes low sodium, high blood sugar, heart ailments, pneumonia, DVT-PE etc.
All these complications are rare occurring in < 5% of patients and in 95%, there are no complications.
1) Most important concern is the persistent back pain that needs to be controlled by core muscle exercise program and weight reduction. If the preoperative stress x-rays show instability, you’d have been advised stabilization surgery. If the back pain > leg pain, you’d have been advised stabilization. Rarely when we trim structures to increase the space, more bone may need to be removed which can cause instability.
2) Injury to nerve roots: in 5 to 10% of cases, there may be transient weakness or numbness of part of the foot. Very rarely, nerves to the bladder and anal canal may be pressed by the instrument. In < 1% of cases, there can be accidental injury to dura with CSF leak. It will be recognized during surgery and will be repaired. If there is postoperative CSF leak, it is a serious matter because of the risk of infection – meningitis.
3) Wound complications like bleeding, infection occur very rarely
4) Systemic complications likes low sodium, high blood sugar, heart ailments, pneumonia, DVT-PE etc.
All these complications are rare occurring in < 5% of patients and in 95%, there are no complications.
You will be admitted the evening before surgery. After the operation, you will be observed in Neuro ICU for 2 hours and when all parameters are normal, you will be shifted to Room. Your diet, medications will be the responsibility of Nurses. Usually you can have liquid diet after a few hours and normal diet from next day provided your bowel movements are normal. You will be able to sit and walk 6 hrs after surgery. When discectomy has been done, you should avoid bending your back forward. You will be discharged from hospital on 2nd day provided your back pain is tolerable and controlled with simple analgesics. Lumbosacral belt is often helpful in bringing down the pain. We recommend 2 week’s rest at home after the surgery like this one. You can walk to toilet, sit and eat, talk to family and friends, see TV, use your mobile but do not strain too much as you may develop a few side effects even after discharge: Low sodium, fever, deep vein thrombosis, wound complications, systemic infections, poor control of diabetes. These are very rare but may need readmission for treatment – It is the responsibility of you and your family to come to hospital Emergency in such circumstances. You can go back to your work after 3 or 4 weeks from the date of surgery.
Do-s:
a) Fall Prevention: After any surgery, your body systems are suboptimal and one can easily feel giddy when you get up and walk. Be careful; when you get up, move your feet up and down, make fists a few times, do deep breathing exercises for a few seconds, make sure you are not giddy and then walk. Request your family member to be with you when you go to toilet even at night time. Fall in the bathroom is very common complication we have seen and can be easily avoided.
b) DVT-PE prevention: Try to walk for a minimum of 5 minutes every hour except at night time 10 to 6. If your are not able to walk, please move your feet and legs for at least 5 minutes every hour. If you are not able to do this, you will need Ted stock and SCD devices for a few weeks. If you are in the high risk group for DVT-PE (past h/o DVT.PE, on certain medications like Oral contraceptives, you will be advised Injections / tablets to prevent this complication.
c) 7 to 8 hours Sleep is essential after any major surgery.
d) Eat healthy diet
e) Take medications as prescribed and follow the advice in discharge summary
f) Our team member (Non-medical) will call you on 2nd and 7th day of discharge, Please feel free to tell your problems to them and whenever needed, please ask for junior doctor or consultant doctor to clarify your doubts.
Don’t-s:
a) Avoid bending forward;
b) Avoid Driving for 3 weeks unless it is very essential.
c) No Smoking / Drinking for 4 weeks; if you are nicotine dependant, you will be advised accordingly. Take this operation as an opportunity to stop smoking and drinking for good.
d) Don’t forget to come for review after 2 weeks and at 3 months and one year for follow up MRI. Please remember surgery and discharge is not the end of your treatment. You need to do back exercises and avoid obesity
a) Fall Prevention: After any surgery, your body systems are suboptimal and one can easily feel giddy when you get up and walk. Be careful; when you get up, move your feet up and down, make fists a few times, do deep breathing exercises for a few seconds, make sure you are not giddy and then walk. Request your family member to be with you when you go to toilet even at night time. Fall in the bathroom is very common complication we have seen and can be easily avoided.
b) DVT-PE prevention: Try to walk for a minimum of 5 minutes every hour except at night time 10 to 6. If your are not able to walk, please move your feet and legs for at least 5 minutes every hour. If you are not able to do this, you will need Ted stock and SCD devices for a few weeks. If you are in the high risk group for DVT-PE (past h/o DVT.PE, on certain medications like Oral contraceptives, you will be advised Injections / tablets to prevent this complication.
c) 7 to 8 hours Sleep is essential after any major surgery.
d) Eat healthy diet
e) Take medications as prescribed and follow the advice in discharge summary
f) Our team member (Non-medical) will call you on 2nd and 7th day of discharge, Please feel free to tell your problems to them and whenever needed, please ask for junior doctor or consultant doctor to clarify your doubts.
Don’t-s:
a) Avoid bending forward;
b) Avoid Driving for 3 weeks unless it is very essential.
c) No Smoking / Drinking for 4 weeks; if you are nicotine dependant, you will be advised accordingly. Take this operation as an opportunity to stop smoking and drinking for good.
d) Don’t forget to come for review after 2 weeks and at 3 months and one year for follow up MRI. Please remember surgery and discharge is not the end of your treatment. You need to do back exercises and avoid obesity
Please discuss with Line Manager or Sr Executive or with consultant / Billing Executive / Insurance i/c for details. If you tell your budget we can help you how to bring down the cost.
You may have a mild headache or feel discomfort from your incision lines for the first few days after your surgery. Your nurse will give you pain medication. Please tell your nurse if the medication is not helping your pain. You may have a sore throat after your surgery. This is caused by the breathing tube that was used during your surgery. You will be given cool liquids to drink and lozenges to suck on to help with the discomfort.
Most people stay in the hospital 1 to 3 days, but this will depend on your recovery.
Your parents, other family members and friends are welcome to visit you during your hospital stay as long as they are in good health. Visitors inside ICU will be limited as a protocol.
You will be given some water to drink within 2hrs of surgery. You will start with a semi-solid diet and then progress to solid food.
Mostly, your sutures would be inside the skin and not visible from outside and they are absorbable ones hence will not require removal. If routine stitches or staples are used then they will be removed after 7 days of your surgery. They may need to stay in longer if this is a repeat surgery. Your doctor or Physician assistant will remove them during your follow-up visit at the clinic.
- Check your incisions daily for any signs of redness, swelling, or drainage.
- Keep your incisions clean and dry for 5 days after your surgery.
You can shower from third day onwards after we have checked your wound. Try to avoid application of oil in hair as it lets the dirt to stick around the wound. When you wash your hair, use a gentle shampoo. Keeping your wound clean is your responsibility.
It is usually 2 to 4 weeks but we will tell you when you can go back to work. This depends on your age, type of work, medical condition and other factors.
You can go back to school as soon as you feel ready. Tell your school nurse that you have a VP shunt.
You can participate in all noncontact sports (i.e., swimming, running), exercise and go to the gym 2 weeks after your surgery. You cannot participate in any contact (collision) sports (i.e., football, boxing, wrestling). Remember to wear a helmet to decrease the risk of head injury, if needed.
Do not travel on an airplane until we give you fitness.
You will have regular visits with your neurosurgeon. They will monitor the function of your VP shunt over time.
Pituitary gland is situated in the centre of the head below the brain, behind the eyes and above the back of the nose. In normal persons it controls other endocrine glands of the body – Thyroid, adrenal glands, ovaries and breast in women and testes in men. It also secrets a few other hormones – like growth hormone and anti diuretic hormone.
The tumor arising from pituitary gland can sometimes have excess secretion of any one of the hormones and can cause symptoms even when tumor is very small (<10mm) – Called Microadenoma. It can cause Acromegaly or Cushing disease or Infertility/Impotence-Amennorhea-Galactorrhea syndrome. When the tumor is not secreting any hormone, as it expands it presses upon normal gland which gradually stop its function of secreting normal hormones leading to decreased levels of thyroid hormone, corticosteroids hormone and sex hormones. When the tumor expands above, it presses upon the optic nerves & chiasm and causes visual problem; the visual symptoms are the commonest reason for seeking medical attention. It can even lead to total blindness in advanced cases or when there is acute bleeding in the tumor. Sometimes these tumors are detected by chance by CT / MRI scan taken for head injury or some other illness.
The tumor arising from pituitary gland can sometimes have excess secretion of any one of the hormones and can cause symptoms even when tumor is very small (<10mm) – Called Microadenoma. It can cause Acromegaly or Cushing disease or Infertility/Impotence-Amennorhea-Galactorrhea syndrome. When the tumor is not secreting any hormone, as it expands it presses upon normal gland which gradually stop its function of secreting normal hormones leading to decreased levels of thyroid hormone, corticosteroids hormone and sex hormones. When the tumor expands above, it presses upon the optic nerves & chiasm and causes visual problem; the visual symptoms are the commonest reason for seeking medical attention. It can even lead to total blindness in advanced cases or when there is acute bleeding in the tumor. Sometimes these tumors are detected by chance by CT / MRI scan taken for head injury or some other illness.
Pituitary tumors are of different types; of these one type called Prolactinoma can most often be treated by a medicine called Cabergoline. Whether it is prolactinoma or not can be diagnosed by doing simple blood test of estimating Serum Prolactin. If the level is > 200ng/ml, then it can be treated by medicines. For all other types of pituitary tumors, surgery is the best option. Rarely Pituitary tumors are primarily treated by radiotherapy when the patient is not physically fit for surgery or when the tumor because of its location cannot be completely removed by surgery.
Pituitary tumors are operated through the nose using endoscope. This is similar to Sinus surgery done by ENT surgeons. There is no incision or scar over the skin of head or face. At SIMS Hospital, >95% of times, surgery is done through right side of nose only – Called UniNostril technique. With endoscope the surgeon can see the Sphenoid sinus opening which is enlarged with special instruments. Inside the sphenoid sinus the surgeon can see the bulging sella which houses the pituitary gland and tumor.
The sellar bone is often already thinned out by the tumor and is easily removed with bone punches and in rare cases when bone is thick by using high speed drill. The exposed sellar dura is opened and the tumor is removed using ring curettes, suction and punches. The endoscope takes the surgeon’s eyes into the sphenoid sinus and into the sella itself and magnifies the structures so that we can differentiate the tumor from normal pituitary gland and other normal structures. The surgeon and the assistant surgeon see the structures in a TV Monitor and operate. Most often the whole tumor can be removed. The average duration of operation is 2 to 2½ hours. After the tumor removal in 50% of cases, the cerebrospinal fluid will leak from above. This has to be carefully repaired and fluid leak is to be stopped by placing fat and fascia taken from thigh. If the fluid leak is heavy, we may have to insert a fine tube in the back to remove the CSF for 3 to 5 days so that there is good healing of the tissue barrier between the nose and brain.
The sellar bone is often already thinned out by the tumor and is easily removed with bone punches and in rare cases when bone is thick by using high speed drill. The exposed sellar dura is opened and the tumor is removed using ring curettes, suction and punches. The endoscope takes the surgeon’s eyes into the sphenoid sinus and into the sella itself and magnifies the structures so that we can differentiate the tumor from normal pituitary gland and other normal structures. The surgeon and the assistant surgeon see the structures in a TV Monitor and operate. Most often the whole tumor can be removed. The average duration of operation is 2 to 2½ hours. After the tumor removal in 50% of cases, the cerebrospinal fluid will leak from above. This has to be carefully repaired and fluid leak is to be stopped by placing fat and fascia taken from thigh. If the fluid leak is heavy, we may have to insert a fine tube in the back to remove the CSF for 3 to 5 days so that there is good healing of the tissue barrier between the nose and brain.
Any treatment whether it is oral medication, injection or operation, there is a small risk. We have to understand the risk of the disease and its natural course and weigh against the risks of treatment. Before surgery, we will do thorough check up by blood test, urine tests, nasal swab, ECG, X-ray Chest, Echo; get anesthesiologist to see and then only plan surgery. When the pituitary tumor is left untreated it can lead to progressive visual decline and even total blindness over a period of time. In functioning tumors it can lead to metabolic illnesses: refractory diabetes, hypertension and heart disease.
The risk of surgery itself is very low and the side effects are temporary. The Commonest side effects are 1) blocked nose, nasal discharge on the operated side of nose. The cerebro spinal fluid can leak through the nose in spite of repair in 5% and may need repacking of the sella (will need return to OT, anesthesia and procedure lasting for 20 to 30 minutes). 2) Excess urination with excess thirst occurs in nearly 10 - 20% temporarily for 2 to 4 days and in 5% it can be permanent but can be easily treated by taking Minirin tablet or nasal spray. 3) The most important serious complication is Meningitis which though occurs in < 1%, it can be life-threatening. We take all precautions to prevent this infection: a) we administer Pneumococcal vaccine 3-4 weeks prior to surgery whenever possible. b) We give prophylactic antibiotic (Ceftriaxone) 1 hour before surgery and 2 doses postoperatively. c) Before surgery we clean the front of nose thoroughly with antiseptics. d) During surgery, we use lots of saline to wash the germs e) We instill Betadine solution and hold for 3 minutes in the sphenoid sinus before opening the sellar dura.
4) The other concern of the operation one should know is: in 20% of patients, total excision may not be possible especially if the tumor is extending on the side to cavernous sinus or extending into brain in multiple compartments. We make every attempt to remove the whole tumor but if the tumor is adherent to important blood vessels or nerves and removal of tumor in such instances will carry high risk to life or visual loss and hence we will leave behind such small portions of the tumor. In all patients, we do Repeat MRI after 3 months and again after 1 year to confirm if the whole tumor has been removed or not. If there is residual tumor and if it is likely to grow, radiotherapy will be indicated. Very rarely in 2% of patients revision surgery will be needed. 5) There is very very low risk of death or disabling brain damage during or after this surgery – Severe bleeding, Injury to optic chiasm, undersurface of brain, infection and complications due to blood transfusion, allergies to drugs, etc. Such overall risk is <1% (please remember in 99% there is no serious risk). We have to weigh this very small risk against the high risks to vision and life if the tumor is not treated.
The risk of surgery itself is very low and the side effects are temporary. The Commonest side effects are 1) blocked nose, nasal discharge on the operated side of nose. The cerebro spinal fluid can leak through the nose in spite of repair in 5% and may need repacking of the sella (will need return to OT, anesthesia and procedure lasting for 20 to 30 minutes). 2) Excess urination with excess thirst occurs in nearly 10 - 20% temporarily for 2 to 4 days and in 5% it can be permanent but can be easily treated by taking Minirin tablet or nasal spray. 3) The most important serious complication is Meningitis which though occurs in < 1%, it can be life-threatening. We take all precautions to prevent this infection: a) we administer Pneumococcal vaccine 3-4 weeks prior to surgery whenever possible. b) We give prophylactic antibiotic (Ceftriaxone) 1 hour before surgery and 2 doses postoperatively. c) Before surgery we clean the front of nose thoroughly with antiseptics. d) During surgery, we use lots of saline to wash the germs e) We instill Betadine solution and hold for 3 minutes in the sphenoid sinus before opening the sellar dura.
4) The other concern of the operation one should know is: in 20% of patients, total excision may not be possible especially if the tumor is extending on the side to cavernous sinus or extending into brain in multiple compartments. We make every attempt to remove the whole tumor but if the tumor is adherent to important blood vessels or nerves and removal of tumor in such instances will carry high risk to life or visual loss and hence we will leave behind such small portions of the tumor. In all patients, we do Repeat MRI after 3 months and again after 1 year to confirm if the whole tumor has been removed or not. If there is residual tumor and if it is likely to grow, radiotherapy will be indicated. Very rarely in 2% of patients revision surgery will be needed. 5) There is very very low risk of death or disabling brain damage during or after this surgery – Severe bleeding, Injury to optic chiasm, undersurface of brain, infection and complications due to blood transfusion, allergies to drugs, etc. Such overall risk is <1% (please remember in 99% there is no serious risk). We have to weigh this very small risk against the high risks to vision and life if the tumor is not treated.
You will be admitted the evening before surgery. After the operation, you will be observed in Postoperative (Recovery) ward or Neuro ICU for 2 to 3 hours and when all parameters are normal, you will be shifted to Room. Your diet, medications will be the responsibility of Nurses. Usually you can have liquid diet after 3 hours and soft solid diet for dinner. Your right nose will have packing and hence you have to breath through left nose. If it is blocked, nasal decongestants will be applied. Rarely you have to breath through the mouth. You can sit up with back rest for a while and even walk to toilet if there is no giddiness. Your nasal pack will be removed after 48 hours if there was no CSF leak and after 7 days if there was CSF leak during surgery. If you have excess urination and feel very thirsty, take water adequately – at a time, take about 50 ml only and after 15 to 20 minutes, if you still feel thirsty take another 50 ml only. Do not take more water at a time. If you are feeling very very thirsty and water intake is disturbing you too much or if you are becoming drowsy/ disoriented, you will be given Inj / Tab Minirin by duty Neuro doctor.
You will be discharged from hospital on 4th day. You should be safe for discharge and should feel comfortable to get discharged.
We recommend 2 week’s rest at home after any major surgery like this one. You can walk to toilet, sit and eat, talk to family and friends, see TV, use your mobile but do not strain too much as you may develop a few side effects even after discharge: Low sodium, Excess urination, CSF leak, fever, deep vein thrombosis, thigh wound complications, systemic infections, poor control of diabetes. These are very rare but may need readmission for treatment – It is the responsibility of you and your family to come to hospital Emergency in such circumstances.
You can go back to your work after 3 or 4 weeks from the date of surgery.
You will be discharged from hospital on 4th day. You should be safe for discharge and should feel comfortable to get discharged.
We recommend 2 week’s rest at home after any major surgery like this one. You can walk to toilet, sit and eat, talk to family and friends, see TV, use your mobile but do not strain too much as you may develop a few side effects even after discharge: Low sodium, Excess urination, CSF leak, fever, deep vein thrombosis, thigh wound complications, systemic infections, poor control of diabetes. These are very rare but may need readmission for treatment – It is the responsibility of you and your family to come to hospital Emergency in such circumstances.
You can go back to your work after 3 or 4 weeks from the date of surgery.
Do-s:
a) Fall Prevention: After any surgery, your body systems are suboptimal and one can easily feel giddy when you get up and walk. Be careful; when you get up, move your feet up and down, make fists a few times, do deep breathing exercises for a few seconds, make sure you are not giddy and then walk. Request your family member to be with you when you go to toilet even at night time. Fall in the bath room is very common complication we have seen and can be easily avoided.
b) DVT-PE prevention: Try to walk for a minimum of 5 minutes every hour except at night time 10 to 6. If your are not able to walk, please move your feet and legs at least 5 minutes every hour. If you are not able to do this, you will need Ted stock and SCD devices for a few weeks. If you are in the high risk group for DVT-PE (past h/o DVT.PE, on certain medications like Oral contraceptives, you will be advised Injections / tablets to prevent this complication.
c) 7 to 8 hours Sleep is essential after any major surgery.
d) Eat healthy diet
e) Take medications as prescribed and follow the advice in discharge summary including Solespray for a week and then steam inhalation through the nose for 2 weeks.
f) Our team member (Non-medical) will call you on 2nd and 7th day of discharge, Please feel free to tell your problems to them and whenever needed, please ask for junior doctor or consultant doctor to clarify your doubts.
Don’t-s:
a) Avoid prolonged coughing, sneezing and straining at stools as these can cause CSF leak: Sneezing can be avoided by firm pressure over anterior nasal spine (Bone immediately above the upper lip over midline). Avoid constipation; can take mild laxatives.
b) Avoid Driving for 3 weeks unless it is very essential.
c) No Swimming for 12 weeks
d) Avoid Nose-picking
e) No Smoking / Drinking for 4 weeks; if you are nicotine dependant, you will be advised accordingly. Take this operation as an opportunity to stop smoking and drinking for good.
f) Don’t forget to come for review after 2 weeks and at 3 months and one year for follow up MRI. Please remember surgery and discharge is not end of your treatment which continues for a minimum of one year. Residual tumors will need additional treatment. You should be sure that you are cured of this disease for ever.
a) Fall Prevention: After any surgery, your body systems are suboptimal and one can easily feel giddy when you get up and walk. Be careful; when you get up, move your feet up and down, make fists a few times, do deep breathing exercises for a few seconds, make sure you are not giddy and then walk. Request your family member to be with you when you go to toilet even at night time. Fall in the bath room is very common complication we have seen and can be easily avoided.
b) DVT-PE prevention: Try to walk for a minimum of 5 minutes every hour except at night time 10 to 6. If your are not able to walk, please move your feet and legs at least 5 minutes every hour. If you are not able to do this, you will need Ted stock and SCD devices for a few weeks. If you are in the high risk group for DVT-PE (past h/o DVT.PE, on certain medications like Oral contraceptives, you will be advised Injections / tablets to prevent this complication.
c) 7 to 8 hours Sleep is essential after any major surgery.
d) Eat healthy diet
e) Take medications as prescribed and follow the advice in discharge summary including Solespray for a week and then steam inhalation through the nose for 2 weeks.
f) Our team member (Non-medical) will call you on 2nd and 7th day of discharge, Please feel free to tell your problems to them and whenever needed, please ask for junior doctor or consultant doctor to clarify your doubts.
Don’t-s:
a) Avoid prolonged coughing, sneezing and straining at stools as these can cause CSF leak: Sneezing can be avoided by firm pressure over anterior nasal spine (Bone immediately above the upper lip over midline). Avoid constipation; can take mild laxatives.
b) Avoid Driving for 3 weeks unless it is very essential.
c) No Swimming for 12 weeks
d) Avoid Nose-picking
e) No Smoking / Drinking for 4 weeks; if you are nicotine dependant, you will be advised accordingly. Take this operation as an opportunity to stop smoking and drinking for good.
f) Don’t forget to come for review after 2 weeks and at 3 months and one year for follow up MRI. Please remember surgery and discharge is not end of your treatment which continues for a minimum of one year. Residual tumors will need additional treatment. You should be sure that you are cured of this disease for ever.
There are 5 bony lumbar vertebrae and a large sacrum in our lower back which bear the weight of the body in upright posture. The bony vertebrae are separated by cushiony discs, which not only transmit weight but also permit movement between the vertebrae; hence the discs are under greater stress than the bone itself. On the back side of the adjacent vertebrae, there is a pair of facet joints on each side permitting movement and transmitting some of the body weight especially in extended posture (bending backward). When we are up, there is constant wear and tear in the disc and the joints and at night when we sleep, the cells (Chondrocytes) repair the wear and tear. When the wear and tear is more (due to overweight, sudden abnormal movement, poor power in core muscles), repair process is unable to cope up, degenerative changes occur. The efficiency of chondrocytes varies from individual to individual and is probably influenced by genetic factors. A herniated disc occurs when the gel-like center of the disc ruptures out through a tear in the tough outer disc wall. The gel material causes chemical irritation and compression of adjacent spinal nerve roots and produces low back pain, radiation of pain along lower limbs (sciatica). Sometimes it causes weakness and numbness of the leg, numbness of private parts and difficulty in passing urine & motion depending on which roots are affected.
In the majority of cases, lumbar disc prolapse doesn't require surgery and can be treated by medicines, physiotherapy and lifestyle modification. The inflammation subsides in 2-3 weeks and the prolapsed fragment can shrink to some extent. Surgery has been advised to you because of refractory leg pain, progressive weakness/ sensory loss in legs and/or bladder/bowel disturbances. If your pain is tolerable and not affecting your daily routine, you can continue to try non-operative measures. Please remember surgery is not a cure for disc disease. It is to get relief of current pain. Whether you will get pain in future depends on you: Improving the muscle power in the lower back, weight control, avoiding forward bending are all more important than surgery itself.
Microdiscectomy is a minimally invasive surgical procedure (key-hole surgery) in which a portion of a prolapsed nucleus pulposus is removed by using surgical instrument while under magnified vision. The operation takes 1 to 2 hours. You will be given anesthesia and you will fall asleep and will not feel pain. You will be turned prone. The surgeon makes a 1–2 inch incision in the middle of your back. To reach the damaged disc, the spinal muscles are pushed aside to expose the space between vertebrae. The space is widened and we work between the vertebrae to reach the prolapsed disc. The portion of the disc which has come out and pressing on the nerve is carefully removed using appropriate instruments. The aim of the operation is to remove the pressure on the nerve. The gap in the tough outer disc (annulus) through which the inner softer disc material prolapsed out remains open and heals over several months. We use microscope or sometimes endoscope which magnify structures so that we can easily see and differentiate normal from abnormal.
For any treatment whether it is oral medication, injection or operation, there is a small risk. Before surgery, we will do thorough check up by blood test, urine tests, nasal swab, ECG, X-ray Chest, Echo; get anesthesiologist to see and then only plan surgery. The success rate for microdiscectomy surgery is approximately 90% to 95%. Some of the risks are given below:
1) The defect in the tough outer disc remains open and remains a weak spot for several years. 5% to 10% of patients will develop a recurrent disc herniation and similar pain at some point in the future.
2) Injury to nerve roots: in 5 to 10% of cases, there may be transient weakness or numbness of part of the foot. Very rarely, the instrument may press nerves to the bladder and anal canal. In < 1% of cases, there can be accidental injury to dura with CSF leak. It will be recognized during surgery and will be repaired. If there is postoperative CSF leak, it is a serious matter because of the risk of infection – meningitis.
3) Wound complications like bleeding, infection occur very rarely.
4) Post operative discitis is a very rare condition in which the pain gets aggravated several times due to inflammation of the disc with or without infection. If that happens, you will need prolonged bed rest and pain killers for several weeks and sometimes revision surgery and stabilization.
All these complications are rare and in >90% there are no complications.
1) The defect in the tough outer disc remains open and remains a weak spot for several years. 5% to 10% of patients will develop a recurrent disc herniation and similar pain at some point in the future.
2) Injury to nerve roots: in 5 to 10% of cases, there may be transient weakness or numbness of part of the foot. Very rarely, the instrument may press nerves to the bladder and anal canal. In < 1% of cases, there can be accidental injury to dura with CSF leak. It will be recognized during surgery and will be repaired. If there is postoperative CSF leak, it is a serious matter because of the risk of infection – meningitis.
3) Wound complications like bleeding, infection occur very rarely.
4) Post operative discitis is a very rare condition in which the pain gets aggravated several times due to inflammation of the disc with or without infection. If that happens, you will need prolonged bed rest and pain killers for several weeks and sometimes revision surgery and stabilization.
All these complications are rare and in >90% there are no complications.
You will be admitted the evening before surgery. After the operation, you will be observed in recovery room or neuro ICU for 1 to 2 hours and when all parameters are normal, you will be shifted to Room. Usually you can have liquid diet after few hours and normal diet from that night. You will be able to walk on the same day evening. You will be discharged from hospital on next day of surgery. At home, better take rest for 2-3 weeks; you can sit and eat. Walk to toilet. See TV. Talk to visitors. Can use laptop, mobile, iPod and all routine activites. Walking for atleast 5 minutes every hour except at bedtime is encouraged to prevent deep vein thrombosis. Do not strain yourself. About 95% of patients successfully recover from a discectomy and are able to return to their normal job in approximately 4 weeks.
Do-s:
a) Fall prevention: Be careful; when you get up, move your feet up and down, make fists a few times, do deep breathing exercises for a few seconds, make sure you are not giddy and then walk. Request your family member to be with you when you go to toilet ever at night time. Fall in the bathroom is very common and can be easily avoided.
b) DVT-PE prevention: try to walk for a minimum of five minutes every hour except at night time 10 to 6. If you are not able to walk, please move your feet and legs for at least five minutes every hour. If you are not able to do this you will need Ted stock and SCD devices for a few weeks.
c) 7 to 8 hours sleep is essential after any major surgery.
d) Eat healthy diet.
e) Take medications as prescribed and follow the advice in discharge summary.
f) Our team member (Non-medical) will call you 2nd and 7th day of discharge. Please feel free to tell your problems to them and whenever needed, please ask for junior doctor or consultant doctor to clarify your doubts.
g) The key to avoiding recurrence is prevention: Appropriate exercise program after 3 weeks to strengthen weak core muscles in the back which will take away the excess strain from disc and joints so that remaining central gel disc does not prolapse out again. It takes several months for the defect in the outer tough disc to heal. Please get the pamphlet from Physiotherapy dept to learn proper lifting techniques and to learn good posture maintenance while sitting, standing, walking and sleeping. Body weight reduction by intelligent dieting and exercise program. Back care program is a life long program.
Don’t-s:
• Avoid bending forward for 6 – 9 months.
• Avoid lifting heavy object of >5kgs for 6 – 9 months.
• Avoid using Indian toilet; use commode.
• Avoid two wheeler for 6 weeks.
• No smoking / Drinking for 4 weeks; if you are nicotine dependent, you will be advised accordingly. Take this operation an opportunity to stop smoking and drinking.
• When you get a doubt whether a particular action is permitted or not, ask yourself if that action will involve bending forward of the back; if so, it should be avoided.
• Don’t forget to come for review after 2 weeks. Please remember surgery and discharge is not the end of your treatment, you should always continue daily exercises.
a) Fall prevention: Be careful; when you get up, move your feet up and down, make fists a few times, do deep breathing exercises for a few seconds, make sure you are not giddy and then walk. Request your family member to be with you when you go to toilet ever at night time. Fall in the bathroom is very common and can be easily avoided.
b) DVT-PE prevention: try to walk for a minimum of five minutes every hour except at night time 10 to 6. If you are not able to walk, please move your feet and legs for at least five minutes every hour. If you are not able to do this you will need Ted stock and SCD devices for a few weeks.
c) 7 to 8 hours sleep is essential after any major surgery.
d) Eat healthy diet.
e) Take medications as prescribed and follow the advice in discharge summary.
f) Our team member (Non-medical) will call you 2nd and 7th day of discharge. Please feel free to tell your problems to them and whenever needed, please ask for junior doctor or consultant doctor to clarify your doubts.
g) The key to avoiding recurrence is prevention: Appropriate exercise program after 3 weeks to strengthen weak core muscles in the back which will take away the excess strain from disc and joints so that remaining central gel disc does not prolapse out again. It takes several months for the defect in the outer tough disc to heal. Please get the pamphlet from Physiotherapy dept to learn proper lifting techniques and to learn good posture maintenance while sitting, standing, walking and sleeping. Body weight reduction by intelligent dieting and exercise program. Back care program is a life long program.
Don’t-s:
• Avoid bending forward for 6 – 9 months.
• Avoid lifting heavy object of >5kgs for 6 – 9 months.
• Avoid using Indian toilet; use commode.
• Avoid two wheeler for 6 weeks.
• No smoking / Drinking for 4 weeks; if you are nicotine dependent, you will be advised accordingly. Take this operation an opportunity to stop smoking and drinking.
• When you get a doubt whether a particular action is permitted or not, ask yourself if that action will involve bending forward of the back; if so, it should be avoided.
• Don’t forget to come for review after 2 weeks. Please remember surgery and discharge is not the end of your treatment, you should always continue daily exercises.
Brain tumor is a broad term for any space occupying disease inside the skull. Your tumor has been confirmed by CT / MRI which tell us where exactly it is situated inside the skull but does not tell us what type of tumor it is. The radiologist has tried to guess the type of tumor but the radiologist request for clinical and histo pathological correlation. Only after analyzing the tumor the pathologist will tell us what type of tumor it is and whether it is benign or malignant. We do not know the exact reasons for any individual getting brain tumor; there are many theories. It is not related to your food habits or work or environment or character.
Though some of these tumors respond to a very small extent to medications, surgery is the best option to bring down the size of tumor so that the pressure in the skull cavity and pressure on the adjoining structures are brought down. Many of these tumors will need radiotherapy after some time. Surgery is the best option for you. We encourage you to do Google Search on this and you are welcome to discuss further for any clarification.
It is a major operation taking 4 to 8 hours. There is no need to remove your hair. On the day of surgery you will be required to have a special shampoo bath. Once inside the operating room, you will be given anesthesia and you will fall asleep and will not feel any pain. A curved skin incision will be made – hair removed over 2 cms of 7-8 cms long incision. 4 – 8 cms diameter bone will be removed; dura mater (Covering of brain) opened to expose the brain surface. We use surgical microscope so that with magnification and enhanced illumination, we can differentiate normal nerves and blood vessels from tumor. We will take all efforts to remove only the tumor without damaging normal brain. Our primary aim is preserving and improving the function of nerves; removing the tumor is only secondary to it. If we feel removal of a particular part of tumor can injure the normal nerves or blood vessels, we will leave behind such portions of tumor. After removing the whole or part of the tumor, we wait till the bleeding is controlled; we stitch the dura mater, put back the bone usually and stitch the muscles and the skin. Sometimes we have to take fat from the thigh or abdomen to fill the gaps in bone and support the inner stitches. After the operation, you will be moved to postoperative ward / Neuro ICU for close observation and care. The anesthesiologist will usually decide on the need for giving oxygen and artificial breathing (ventilator support) depending on your BP, Pulse, breathing, conscious level and brain recovery. The close family members will be allowed to see you after the operation in the Neuro ICU.
Any treatment whether it is oral medication, injection or operation, there is a small risk. We have to understand the risk of the disease and its natural course and weigh against the risks of treatment. Before surgery, we will do thorough check up by blood test, urine tests, nasal swab, ECG, X-ray Chest, Echo; get anesthesiologist to see and then only plan surgery. If left alone, there is high risk of the tumor growth affecting the functions of nerves of the brain which can cause paralysis of limbs, blindness, dementia, difficult in carrying out activities of daily life, seizures etc. There is no doubt brain surgery like heart surgery is a high risk surgery and cannot be taken lightly. There is 5-10% risk of complications during surgery and immediate post operative period. While removing the tumor, we are required to gently separate the normal nerves and blood vessels and protect them. The nerves of the brain are very delicate structures and even with gentle handling, may stop functioning for a variable time. In fact you will be required to give consent for this surgery before operation. The risks include paralysis of hands and legs, blindness, dementia, risks of blood transfusion, infection, prolonged ICU care, prolonged hospitalization, inability to return to work. Though there is very little direct risk of death, the complications mentioned above can endanger life during the postoperative period. As mentioned earlier, we have to understand the risk of the disease at its natural course is very much higher than the risk of treatment.
You will be admitted the evening before surgery. After the operation, you will be observed in Neuro ICU for 24 hours and when all parameters are normal, you will be shifted to Room. Though not mandatory, we usually take CT brain to confirm that everything is OK. Your diet, medications will be the responsibility of Nurses. Usually you can have liquid diet after a few hours and normal diet from next day provided your lower cranial nerves are intact. You will be able to walk next day. You will be discharged from hospital on 5th day. You should be safe for discharge and should feel comfortable to get discharged. We recommend 2 week’s rest at home after any major surgery like this one. You can walk to toilet, sit and eat, talk to family and friends, see TV, use your mobile but do not strain too much as you may develop a few side effects even after discharge: Low sodium, Excess urination, CSF leak, fever, deep vein thrombosis, wound complications, systemic infections, poor control of diabetes. These are very rare but may need readmission for treatment – It is the responsibility of you and your family to come to hospital Emergency in such circumstances. You can go back to your work after 3 or 4 weeks from the date of surgery but this is highly variable and will depend on your recovery and also the need for any further treatment like radiotherapy.
Do-s:
a) Fall Prevention: After any surgery, your body systems are suboptimal and one can easily feel giddy when you get up and walk. Be careful; when you get up, move your feet up and down, make fists a few times, do deep breathing exercises for a few seconds, make sure you are not giddy and then walk. Request your family member to be with you when you go to toilet even at night time. Fall in the bath room is very common complication we have seen and can be easily avoided.
b) DVT-PE prevention: Try to walk for a minimum of 5 minutes every hour except at night time 10 to 6. If your are not able to walk, please move your feet and legs at least 5 minutes every hour. If you are not able to do this, you will need Ted stock and SCD devices for a few weeks. If you are in the high risk group for DVT-PE (past h/o DVT.PE, on certain medications like Oral contraceptives, you will be advised Injections / tablets to prevent this complication.
c) 7 to 8 hours Sleep is essential after any major surgery.
d) Eat healthy diet.
e) Take medications as prescribed and follow the advice in discharge summary including Solespray for a week and then steam inhalation through the nose for 2 weeks.
f) Our team member (Non-medical) will call you on 2nd and 7th day of discharge, Please feel free to tell your problems to them and whenever needed, please ask for junior doctor or consultant doctor to clarify your doubts.
Don’t-s:
a) Avoid prolonged coughing and straining at stools as these can cause CSF leak. Avoid constipation; can take mild laxatives.
b) Driving not allowed for many months or even years depending on your vision, hearing, mental function and seizure risk.
c) No Smoking / Drinking for 4 weeks; if you are nicotine dependant, you will be advised accordingly. Take this operation as an opportunity to stop smoking and drinking for good.
d) Don’t forget to come for review after 2 weeks and at 3 months and periodic follow up MRI. Please remember surgery and discharge is not the end of your treatment which continues for a long time. Residual tumors will need additional treatment. You should be sure that you are cured or controlled of this disease forever.
a) Fall Prevention: After any surgery, your body systems are suboptimal and one can easily feel giddy when you get up and walk. Be careful; when you get up, move your feet up and down, make fists a few times, do deep breathing exercises for a few seconds, make sure you are not giddy and then walk. Request your family member to be with you when you go to toilet even at night time. Fall in the bath room is very common complication we have seen and can be easily avoided.
b) DVT-PE prevention: Try to walk for a minimum of 5 minutes every hour except at night time 10 to 6. If your are not able to walk, please move your feet and legs at least 5 minutes every hour. If you are not able to do this, you will need Ted stock and SCD devices for a few weeks. If you are in the high risk group for DVT-PE (past h/o DVT.PE, on certain medications like Oral contraceptives, you will be advised Injections / tablets to prevent this complication.
c) 7 to 8 hours Sleep is essential after any major surgery.
d) Eat healthy diet.
e) Take medications as prescribed and follow the advice in discharge summary including Solespray for a week and then steam inhalation through the nose for 2 weeks.
f) Our team member (Non-medical) will call you on 2nd and 7th day of discharge, Please feel free to tell your problems to them and whenever needed, please ask for junior doctor or consultant doctor to clarify your doubts.
Don’t-s:
a) Avoid prolonged coughing and straining at stools as these can cause CSF leak. Avoid constipation; can take mild laxatives.
b) Driving not allowed for many months or even years depending on your vision, hearing, mental function and seizure risk.
c) No Smoking / Drinking for 4 weeks; if you are nicotine dependant, you will be advised accordingly. Take this operation as an opportunity to stop smoking and drinking for good.
d) Don’t forget to come for review after 2 weeks and at 3 months and periodic follow up MRI. Please remember surgery and discharge is not the end of your treatment which continues for a long time. Residual tumors will need additional treatment. You should be sure that you are cured or controlled of this disease forever.
Pituitary gland is situated in the centre of the head below the brain, behind the eyes and above the back of the nose. It controls other endocrine glands – Thyroid, adrenal glands, ovaries, breast in women and testes in men. It also secretes growth hormone and anti-diuretic hormone. 
A tumor from this gland may secrete hormones excessively (even when <10mm, called Microadenoma) causing conditions like Acromegaly, Cushing’s disease, or infertility-related syndromes. Non-functioning tumors can grow and compress nearby structures, leading to vision problems or hormone deficiency. Many are detected incidentally during scans.
A tumor from this gland may secrete hormones excessively (even when <10mm, called Microadenoma) causing conditions like Acromegaly, Cushing’s disease, or infertility-related syndromes. Non-functioning tumors can grow and compress nearby structures, leading to vision problems or hormone deficiency. Many are detected incidentally during scans.
Only a specific type of tumor, Prolactinoma, can often be treated medically using Cabergoline. This is identified through a blood test (Serum Prolactin > 200ng/ml). Other types usually require surgery. Rarely, radiotherapy is considered if surgery is not feasible.
The surgery is done through the nose using an endoscope (UniNostril technique). Through the sphenoid sinus, the surgeon accesses the pituitary gland. Using specialized tools, the tumor is removed under magnification on a monitor. CSF leak occurs in ~50% cases, managed using fat/fascia grafts from the thigh. Rarely, a lumbar drain is used to support healing.
Side effects are rare and usually temporary:
- Blocked nose or CSF leak (5%)
- Temporary or permanent diabetes insipidus (Minirin helps)
- Meningitis (<1%) – precautions include vaccine, antibiotics, antiseptic cleaning
- Incomplete tumor removal (20%) – follow-up MRI, possible radiotherapy
- Serious complications or death (<1%) – risks explained with care plans
- Blocked nose or CSF leak (5%)
- Temporary or permanent diabetes insipidus (Minirin helps)
- Meningitis (<1%) – precautions include vaccine, antibiotics, antiseptic cleaning
- Incomplete tumor removal (20%) – follow-up MRI, possible radiotherapy
- Serious complications or death (<1%) – risks explained with care plans
You’ll be admitted the day before surgery and discharged by Day 4. You may walk, eat and talk with assistance from Day 1. Nasal packs are removed after 2–7 days based on CSF leak status. Recovery includes 2 weeks home rest, with a return to work after 3–4 weeks. Watch for rare side effects like CSF leak, infection, or sodium imbalance.
Do-s:
a) Fall Prevention: After any surgery, your body systems are suboptimal and one can easily feel giddy when you get up and walk. Be careful; when you get up, move your feet up and down, make fists a few times, do deep breathing exercises for a few seconds, make sure you are not giddy and then walk. Request your family member to be with you when you go to toilet even at night time. Fall in the bathroom is a very common complication we have seen and can be easily avoided.
b) DVT-PE prevention: Try to walk for a minimum of 5 minutes every hour except at night time 10 to 6. If you are not able to walk, please move your feet and legs at least 5 minutes every hour. If you are not able to do this, you will need Ted stock and SCD devices for a few weeks. If you are in the high risk group for DVT-PE (past h/o DVT.PE, on certain medications like Oral contraceptives), you will be advised injections/tablets to prevent this complication.
c) 7 to 8 hours sleep is essential after any major surgery.
d) Eat healthy diet
e) Take medications as prescribed and follow the advice in discharge summary including Solespray for a week and then steam inhalation through the nose for 2 weeks.
f) Our team member (Non-medical) will call you on 2nd and 7th day of discharge. Please feel free to tell your problems to them and whenever needed, ask for junior doctor or consultant doctor to clarify your doubts.
Don’t-s:
a) Avoid prolonged coughing, sneezing and straining at stools as these can cause CSF leak. Sneezing can be avoided by firm pressure over anterior nasal spine (bone immediately above the upper lip over midline). Avoid constipation; take mild laxatives.
b) Avoid driving for 3 weeks unless it is very essential.
c) No swimming for 12 weeks
d) Avoid nose-picking
e) No smoking/drinking for 4 weeks; if you are nicotine dependent, you will be advised accordingly. Take this operation as an opportunity to stop smoking and drinking for good.
f) Don’t forget to come for review after 2 weeks, at 3 months and one year for follow up MRI. Please remember surgery and discharge is not the end of your treatment, which continues for a minimum of one year. Residual tumors will need additional treatment. You should be sure that you are cured of this disease forever.
a) Fall Prevention: After any surgery, your body systems are suboptimal and one can easily feel giddy when you get up and walk. Be careful; when you get up, move your feet up and down, make fists a few times, do deep breathing exercises for a few seconds, make sure you are not giddy and then walk. Request your family member to be with you when you go to toilet even at night time. Fall in the bathroom is a very common complication we have seen and can be easily avoided.
b) DVT-PE prevention: Try to walk for a minimum of 5 minutes every hour except at night time 10 to 6. If you are not able to walk, please move your feet and legs at least 5 minutes every hour. If you are not able to do this, you will need Ted stock and SCD devices for a few weeks. If you are in the high risk group for DVT-PE (past h/o DVT.PE, on certain medications like Oral contraceptives), you will be advised injections/tablets to prevent this complication.
c) 7 to 8 hours sleep is essential after any major surgery.
d) Eat healthy diet
e) Take medications as prescribed and follow the advice in discharge summary including Solespray for a week and then steam inhalation through the nose for 2 weeks.
f) Our team member (Non-medical) will call you on 2nd and 7th day of discharge. Please feel free to tell your problems to them and whenever needed, ask for junior doctor or consultant doctor to clarify your doubts.
Don’t-s:
a) Avoid prolonged coughing, sneezing and straining at stools as these can cause CSF leak. Sneezing can be avoided by firm pressure over anterior nasal spine (bone immediately above the upper lip over midline). Avoid constipation; take mild laxatives.
b) Avoid driving for 3 weeks unless it is very essential.
c) No swimming for 12 weeks
d) Avoid nose-picking
e) No smoking/drinking for 4 weeks; if you are nicotine dependent, you will be advised accordingly. Take this operation as an opportunity to stop smoking and drinking for good.
f) Don’t forget to come for review after 2 weeks, at 3 months and one year for follow up MRI. Please remember surgery and discharge is not the end of your treatment, which continues for a minimum of one year. Residual tumors will need additional treatment. You should be sure that you are cured of this disease forever.
Vestibular Schwanomma is a benign (not cancer) tumor located within the skull behind the ear but outside the brain itself. This part of head is known as Cerebello-Pontine angle. Vestibular Schwanomma arises from the 8th cranial nerve – The nerve of hearing and balance. (Vestibulo –Cochlear nerve). The tumor arises usually within the inner portion of ear bone (IAC of tempopral bone) and gradually expands over several months/ years pressing on the surrounding vital nerves – 7th, 5th, & 9-10-11 nerves and grows towards the brainstem, pushing it slowly to opposite side and causing many symptoms. Left alone it will block the flow of CSF with resultant fluid collection in the brain leading to raised intracranial pressure – HA, Vomiting & visual problems. If neglected it leads to total irreversible blindness.
The exact cause of this tumor in not known. Some genetic changes have been found but we do not know why you got this tumor. It is not related to your food habits or work or environment or character. Anyone can get it. Rarely it runs in families- NF2 when it can be on both sides. So we really cannot say why you got it but you should be happy that it is not cancer and once removed completely, it will not come back.
The exact cause of this tumor in not known. Some genetic changes have been found but we do not know why you got this tumor. It is not related to your food habits or work or environment or character. Anyone can get it. Rarely it runs in families- NF2 when it can be on both sides. So we really cannot say why you got it but you should be happy that it is not cancer and once removed completely, it will not come back.
No; there are no drugs to control or cure this condition. When the tumor is small and not pressing on the brain stem, we advise Gamma knife or Cyber Knife therapy. When the tumor is really very small, sometimes we advise Observation especially elderly people.
It is a major operation taking 4 to 8 hours. There is no need to remove your hair. On the day of surgery you will be required to have a special shampoo bath. Once inside the operating room, you will be given anesthesia and you will fall asleep and will not feel any pain.
A curved skin incision will be made – hair removed over 2 cms of 7-8 cms long incision. 4 – 5 cms diameter bone will be removed from behind the ear. We will work between the brain and skull bone, carefully separate the tumor from normal structures and remove the tumor alone. We use microscope so that we can easily see what is normal and what is tumor. We cannot go around the tumor; we open the tumor, remove the inside pure tumor so that the outer shell (capsule) of tumor falls away from normal brain and then we dissect the capsule and remove it. We use many high tech modern adjuncts in this type of surgery: High speed drill, VII nerve monitoring, CUSA, Endoscope. After removing the tumor, we put back the bone usually and stich the muscles and the skin. Sometimes we have to take fat from the thigh or abdomen to fill the gaps in bone and support the inner stiches. Had there been excess fluid collection and if shunt has not been done earlier, we will insert a fine tube to let out the excess fluid for 2 or 3 days.
Any treatment whether it is oral medication, injection or operation, there is a small risk. We have to understand the risk of the disease and its natural course and weigh against the risks of treatment. Before surgery, we will do thorough check up by blood test, urine tests, nasal swab, ECG, X-ray Chest, Echo; get anesthesiologist to see and then only plan surgery. If left alone, the tumor will cause imbalance on walking, cause falls with possible fractures of bones and other complications. As mentioned earlier, it can lead to irreversible blindness.
There is no doubt it is a high risk surgery and cannot be taken lightly.
1) The Nerve of hearing is already affected and hearing loss is permanent. Even if you have useful hearing, the chances of losing hearing is > 50%. We’ll make every attempt to preserve or get back earing but you should be mentally prepared total hearing loss on the side of the operation and you will not be able to use your mobile from that ear. As long as your hearing is OK on the opposite side, it is not a major disability.
2) The real risk is the risk of Facial palsy – about 50% temporary and <5% permanent. We use Facial nerve monitor to identify the nerve and we will carefully preserve the nerve anatomically. However these are slender nerves and even after very gentle handling, they do not work for a few days. It can be 3 weeks or 3-6 months or 3v3n one year before it recovesr completely or partly. When facial palsy occurs, your facial muscles on the side of operation will not move – you cannot close your eyes properly, your mouth will deviate to opposite side. You have to take care of the eyes : putting eye drops and ointment regularly, get physiotherapy to facial muscles and sometimes will need simple surgery to close the eye lid on the side temporarily. Remember these are temporary and you will recover in > 95% of times in a few months.
3) Risk of Lower Cranial nerve palsy is really very low but if it happens it can be very serious as it can cause difficulty in swallowing and risk of aspiration and may necessitate tube feeding or trachestomy for airway protection. The risk of this complication is very low
4) There can be temporary numbness of face due to 5th nerve deficit ; it can cause corneal ulcer if eye is not taken care of.
5) The other concern of the operation one should know is: in 10% of patients, total excision may not be possible especially if the tumor is densely adherent to nerves or blood vessels or brain stem. We make every attempt to remove the whole tumor but if the tumor is adherent to important blood vessels or nerves, we will leave behind such small portions of the tumor as removal of such portions of tumor will carry high risk to life or nerve damage. In all patients, we do Repeat MRI after 3 months and again after 1 year to confirm if the whole tumor has been removed or not. If there is residual tumor and if it is likely to grow, radiotherapy will be indicated. Very rarely in 2% of patients revision surgery will be needed.
6) There is very very low risk of death or disabling brain damage during or after this surgery – Severe bleeding, Injury to brainstem, infection and complications due to blood transfusion, allergies to drugs, etc. Such overall risk is <2% (please remember in 98% there is no serious risk). We have to weigh this small risk against the high risks of untreated tumor.
In Brain surgery, the experience of the surgeon and infrastructure of the operating room and ICU are very important to get consistent good outcome; SIMS Hospital Neuro team has vast experience in this type of surgery with internationally comparable good results
There is no doubt it is a high risk surgery and cannot be taken lightly.
1) The Nerve of hearing is already affected and hearing loss is permanent. Even if you have useful hearing, the chances of losing hearing is > 50%. We’ll make every attempt to preserve or get back earing but you should be mentally prepared total hearing loss on the side of the operation and you will not be able to use your mobile from that ear. As long as your hearing is OK on the opposite side, it is not a major disability.
2) The real risk is the risk of Facial palsy – about 50% temporary and <5% permanent. We use Facial nerve monitor to identify the nerve and we will carefully preserve the nerve anatomically. However these are slender nerves and even after very gentle handling, they do not work for a few days. It can be 3 weeks or 3-6 months or 3v3n one year before it recovesr completely or partly. When facial palsy occurs, your facial muscles on the side of operation will not move – you cannot close your eyes properly, your mouth will deviate to opposite side. You have to take care of the eyes : putting eye drops and ointment regularly, get physiotherapy to facial muscles and sometimes will need simple surgery to close the eye lid on the side temporarily. Remember these are temporary and you will recover in > 95% of times in a few months.
3) Risk of Lower Cranial nerve palsy is really very low but if it happens it can be very serious as it can cause difficulty in swallowing and risk of aspiration and may necessitate tube feeding or trachestomy for airway protection. The risk of this complication is very low
4) There can be temporary numbness of face due to 5th nerve deficit ; it can cause corneal ulcer if eye is not taken care of.
5) The other concern of the operation one should know is: in 10% of patients, total excision may not be possible especially if the tumor is densely adherent to nerves or blood vessels or brain stem. We make every attempt to remove the whole tumor but if the tumor is adherent to important blood vessels or nerves, we will leave behind such small portions of the tumor as removal of such portions of tumor will carry high risk to life or nerve damage. In all patients, we do Repeat MRI after 3 months and again after 1 year to confirm if the whole tumor has been removed or not. If there is residual tumor and if it is likely to grow, radiotherapy will be indicated. Very rarely in 2% of patients revision surgery will be needed.
6) There is very very low risk of death or disabling brain damage during or after this surgery – Severe bleeding, Injury to brainstem, infection and complications due to blood transfusion, allergies to drugs, etc. Such overall risk is <2% (please remember in 98% there is no serious risk). We have to weigh this small risk against the high risks of untreated tumor.
In Brain surgery, the experience of the surgeon and infrastructure of the operating room and ICU are very important to get consistent good outcome; SIMS Hospital Neuro team has vast experience in this type of surgery with internationally comparable good results
You will be admitted the evening before surgery. After the operation, you will be observed in Neuro ICU for 24 hours and when all parameters are normal, you will be shifted to Room. We take CT brain to confirm that everything is OK. Your diet, medications will be the responsibility of Nurses. Usually you can have liquid diet after a few hours and normal diet from next day provided your lower cranial nerves are intact. You will be able to walk next day. You will be discharged from hospital on 5th day. You should be safe for discharge and should feel comfortable to get discharged.
We recommend 2 week’s rest at home after any major surgery like this one. You can walk to toilet, sit and eat, talk to family and friends, see TV, use your mobile but do not strain too much as you may develop a few side effects even after discharge: Low sodium, Excess urination, CSF leak, fever, deep vein thrombosis, thigh wound complications, systemic infections, poor control of diabetes. These are very rare but may need readmission for treatment – It is the responsibility of you and your family to come to hospital Emergency in such circumstances.
You can go back to your work after 3 or 4 weeks from the date of surgery.
We recommend 2 week’s rest at home after any major surgery like this one. You can walk to toilet, sit and eat, talk to family and friends, see TV, use your mobile but do not strain too much as you may develop a few side effects even after discharge: Low sodium, Excess urination, CSF leak, fever, deep vein thrombosis, thigh wound complications, systemic infections, poor control of diabetes. These are very rare but may need readmission for treatment – It is the responsibility of you and your family to come to hospital Emergency in such circumstances.
You can go back to your work after 3 or 4 weeks from the date of surgery.
Do-s:
a) Fall Prevention: After any surgery, your body systems are suboptimal and one can easily feel giddy when you get up and walk. Be careful; when you get up, move your feet up and down, make fists a few times, do deep breathing exercises for a few seconds, make sure you are not giddy and then walk. Request your family member to be with you when you go to toilet even at night time. Fall in the bathroom is very common complication we have seen and can be easily avoided.
b) DVT-PE prevention: Try to walk for a minimum of 5 minutes every hour except at night time 10 to 6. If your are not able to walk, please move your feet and legs for at least 5 minutes every hour. If you are not able to do this, you will need Ted stock and SCD devices for a few weeks. If you are in the high risk group for DVT-PE (past h/o DVT.PE, on certain medications like Oral contraceptives, you will be advised Injections / tablets to prevent this complication.
c) 7 to 8 hours Sleep is essential after any major surgery.
d) Eat healthy diet
e) Take medications as prescribed and follow the advice in discharge summary
f) Our team member (Non-medical) will call you on 2nd and 7th day of discharge, Please feel free to tell your problems to them and whenever needed, please ask for junior doctor or consultant doctor to clarify your doubts.
Don’t-s:
a) Avoid prolonged coughing and straining at stools as these can cause CSF leak. Avoid constipation; can take mild laxatives.
b) Avoid Driving for 3 weeks unless it is very essential.
c) No Smoking / Drinking for 4 weeks; if you are nicotine dependant, you will be advised accordingly. Take this operation as am opportunity to stop smoking and drinking for good.
d) Don’t forget to come for review after 2 weeks and at 3 months and one year for follow up MRI. Please remember surgery and discharge is not the end of your treatment which continues for a minimum of one year. Residual tumors will need additional treatment. You should be sure that you are cured of this disease forever.
a) Fall Prevention: After any surgery, your body systems are suboptimal and one can easily feel giddy when you get up and walk. Be careful; when you get up, move your feet up and down, make fists a few times, do deep breathing exercises for a few seconds, make sure you are not giddy and then walk. Request your family member to be with you when you go to toilet even at night time. Fall in the bathroom is very common complication we have seen and can be easily avoided.
b) DVT-PE prevention: Try to walk for a minimum of 5 minutes every hour except at night time 10 to 6. If your are not able to walk, please move your feet and legs for at least 5 minutes every hour. If you are not able to do this, you will need Ted stock and SCD devices for a few weeks. If you are in the high risk group for DVT-PE (past h/o DVT.PE, on certain medications like Oral contraceptives, you will be advised Injections / tablets to prevent this complication.
c) 7 to 8 hours Sleep is essential after any major surgery.
d) Eat healthy diet
e) Take medications as prescribed and follow the advice in discharge summary
f) Our team member (Non-medical) will call you on 2nd and 7th day of discharge, Please feel free to tell your problems to them and whenever needed, please ask for junior doctor or consultant doctor to clarify your doubts.
Don’t-s:
a) Avoid prolonged coughing and straining at stools as these can cause CSF leak. Avoid constipation; can take mild laxatives.
b) Avoid Driving for 3 weeks unless it is very essential.
c) No Smoking / Drinking for 4 weeks; if you are nicotine dependant, you will be advised accordingly. Take this operation as am opportunity to stop smoking and drinking for good.
d) Don’t forget to come for review after 2 weeks and at 3 months and one year for follow up MRI. Please remember surgery and discharge is not the end of your treatment which continues for a minimum of one year. Residual tumors will need additional treatment. You should be sure that you are cured of this disease forever.
Cerebral Aneurysms are abnormal balloon like out-pouching of blood vessel wall usually at the site of branching of arteries at the base of the brain inside the skull. It is a weak spot and over a period of time it expands and blood can leak - called subarachnoid hemorrhage.
It is a very serious condition; though the bleeding has probably stopped at this moment, the weak spot can again bleed which can be fatal or cause severe damage to brain. The Rebleed can occur anytime - the same day or week or month. Most aneurysms rebleed within 3 to 6 months.
Another important sequel of initial aneurysmal bleed is what is known as Vasospasm in which the blood vessels carrying blood to the brain contract – a nature’s response to prevent rebleed; however, it can over-contract with the result that normal brain does not get adequate blood supply and get infarcted leading to drowsiness, hemiplegia and other neuro deficits. This Vasospasm usually starts 4-5 days after the initial bleed and lasts for 2-3 weeks. It is the commonest cause of prolonged hospital / ICU stay, morbidity and mortality in patients with ruptured aneurysm. If the weak spot has been strengthened by coiling or clipping, the treatment can be given more effectively. We give more fluids and increase the BP so that adequate blood goes to the brain. It is very important that the patient’s heart is strong enough to respond to such treatment modalities.
Apart from Rebleed and Vasospasm, other complications of SAH are hydrocephalus, seizures, hyponatremia (low sodium in blood), prolonged unconscious bedridden state leading to other complications like deep vein thrombosis, pneumonia, infection, etc.
Another important sequel of initial aneurysmal bleed is what is known as Vasospasm in which the blood vessels carrying blood to the brain contract – a nature’s response to prevent rebleed; however, it can over-contract with the result that normal brain does not get adequate blood supply and get infarcted leading to drowsiness, hemiplegia and other neuro deficits. This Vasospasm usually starts 4-5 days after the initial bleed and lasts for 2-3 weeks. It is the commonest cause of prolonged hospital / ICU stay, morbidity and mortality in patients with ruptured aneurysm. If the weak spot has been strengthened by coiling or clipping, the treatment can be given more effectively. We give more fluids and increase the BP so that adequate blood goes to the brain. It is very important that the patient’s heart is strong enough to respond to such treatment modalities.
Apart from Rebleed and Vasospasm, other complications of SAH are hydrocephalus, seizures, hyponatremia (low sodium in blood), prolonged unconscious bedridden state leading to other complications like deep vein thrombosis, pneumonia, infection, etc.
The primary aim of treatment is to prevent further bleeding from the aneurysm as risk of death is very high if it bleeds again. The secondary aim is to enable treatment of vasospasm.
Patient should be stable clinically and by investigations and conscious enough to proceed further. Patient will be initially investigated with CT angiogram which can give a good information about the location and characteristics of the aneurysm and can guide further treatment. On a few occasions, DSA will be needed
There are 2 ways to obliterate the aneurysm:
A. Clipping: This is the time tested Open Microsurgery technique wherein an opening is made in the skull. With operative microscope the aneurysm will be clipped across the neck so that blood does not flow into the weak spot and at the same time we preserve the blood flow in the main vessels. The duration will be around 4 to 5 hours, at the end of the surgery angiogram will be done with dye to confirm successful clipping of aneurysm.
B. Coiling: This is a relatively new procedure which is practiced for the past 20 years wherein a needle is placed in the thigh and a delicate catheter is taken through the aorta and brain arteries to the weak spot; coils will be stuffed inside the aneurysm so that the weak spot is strengthened and catheter is removed. This does not involve any opening of the skull. The duration will be around 3 hours.
A. Clipping: This is the time tested Open Microsurgery technique wherein an opening is made in the skull. With operative microscope the aneurysm will be clipped across the neck so that blood does not flow into the weak spot and at the same time we preserve the blood flow in the main vessels. The duration will be around 4 to 5 hours, at the end of the surgery angiogram will be done with dye to confirm successful clipping of aneurysm.
B. Coiling: This is a relatively new procedure which is practiced for the past 20 years wherein a needle is placed in the thigh and a delicate catheter is taken through the aorta and brain arteries to the weak spot; coils will be stuffed inside the aneurysm so that the weak spot is strengthened and catheter is removed. This does not involve any opening of the skull. The duration will be around 3 hours.
It is but natural for anyone to opt for non-operative method of treatment. In every patient with aneurysm we consider first the possibility of coiling. Team of doctors including surgeons and interventionists will discuss and decide depending on the size of neck, presence of small important blood vessels arising from the neck, presence of clot, age and comorbidities and will decide which procedure is best suited for the patient and the pros and cons will be conveyed to you. Ultimately the final decision will have to be made by the patient and the relatives as Cost factor is involved. In many situations either is possible and carry comparable risks.
Any treatment whether it is oral medication, injection or operation, there is a risk. We have to understand the risk of the disease and its natural course and weigh against the risks of treatment. Before surgery, we will do thorough check up by blood test, urine tests, nasal swab, ECG, X-ray Chest, Echo; get anesthesiologist to see and then only plan surgery. If left alone, the aneurysm is very likely to bleed with all possible sequels as explained earlier. There is no doubt brain surgery especially aneurysm clipping surgery is a high-risk surgery and cannot be taken lightly. Only a handful of neurosurgeons in Chennai accept to do this type of operation. The aneurysm can bleed anytime during the surgery. There may be a need to temporarily occlude the blood flow thro the main artery harboring the aneurysm. Clip may sometimes partly / permanently occlude blood flow to critical areas of brain leading to brain infarcts. Rarely clipping may not be possible and alternate procedures like wrapping, trapping with or without bypass may be required. If obliteration of aneurysm is incomplete, recurrent bleeding can occur. On very rare occasions, if the brain is full, surgeon may not have access to the site of aneurysm and surgeon may have to stop and withdraw and plan a second stage procedure at a later time. In fact you will be required to give high-risk consent for this surgery before operation. The risks include paralysis of hands and legs, partial or total blindness, dementia, loss of memory, loss of comprehension skills, loss of spoken language and writing skills, emotional imbalance, risks of blood transfusion, infection, prolonged ICU care, prolonged hospitalization, readmission, inability to return to work. Though there is low risk of death during surgery, the complications mentioned above can endanger life during the postoperative period in 5 – 10%. As mentioned earlier, we have to understand the risk of the disease and its natural course and weigh against the risks of treatment.
Coiling will be done by Neurointerventionist (Dr Rithesh) in our team. As explained earlier, it is without any skin incision in the head and there is no risk of wound complications. However the risks of aneurysm rupture, occlusion of vessels, catheter-related complications, coil impaction, coil migration are similar to clipping. The risk of recurrence of aneurysm is slightly higher after Coiling than after Clipping.
No; surgery is mainly to prevent re bleeding from aneurysm. Many sequel of initial bleed start after 3 to 5 days. The blood vessels will start shrinking slowly from third day onwards and the risk will continue till three weeks[ Max 7th to 11th day after bleed]. As explained earlier, this is called vasospasm and will require intensive medical treatment by keeping the blood pressure at higher level and giving lot of i.v fluids to maintain good blood flow to the brain. Patient will remain in the ICU till medical team feels that the patient is safe to be shifted to the room. Apart from Rebleed and Vasospasm, other complications of initial subarachnoid bleed are hydrocephalus, seizures, hyponatremia, prolonged unconscious bedridden state leading to other complications like deep vein thrombosis, pneumonia, infection, etc.
Yes. If the vasospasm progresses despite medical treatment the patient will require invasive angiogram in the cath lab and intervention may be required. If there is large infarct of the brain with increasing pressure inside the skull cavity, decompression may be needed to decrease the brain shift and the brain pressure. If there is excess accumulation of cerebrospinal fluid, shunt operation may be needed. Rarely wound complications may need surgical interventions. In addition, in any prolonged unconscious state, procedures like tracheostomy, PEG (percutaneous endoscopic gastrostomy) may be indicated.
Patient can develop sodium loss, hydrocephalus [increased water in the brain], seizures, memory disturbances, weakness of limbs etc. All these can be treated by medical measures and physiotherapy except for hydrocephalus which if persists will require CSF drainage by a procedure called VP shunt.
Depends on the post operative vasospasm and other complication if there are no complication the patient will be discharged after 7 days, if there is vasospasm or other complication, hospitalization may get prolonged for a few weeks depending on the medical condition of the patient.
Generally no. There is 15% incidence of multiple aneurysm in an individual. Smoking and uncontrolled hypertension are considered as risk factors for development of another aneurysm.
Generally aneurysms are acquired and do not occur by birth, hence there is no requirement of screening other family members. However 5% of aneurysms run in families with certain congenital anomalies like Marfans syndrome, polycytic kidney etc. in these patients screening of family members is warranted.
All currently used clips and coils are compatible with MRI and the patient can undergo MRI safely.
You may have a mild headache or feel discomfort from your incision lines for the first few days after your surgery. Your nurse will give you pain medication. Please tell your nurse if the medication is not helping your pain. You may have a sore throat after your surgery. This is caused by the breathing tube that was used during your surgery. You will be given cool liquids to drink and lozenges to suck on to help with the discomfort.
Most people stay in the hospital 1 to 3 days, but this will depend on your recovery.
Your parents, other family members and friends are welcome to visit you during your hospital stay as long as they are in good health. Visitors inside ICU will be limited as a protocol.
You will be given some water to drink within 2hrs of surgery. You will start with a semi-solid diet and then progress to solid food.
Mostly, your sutures would be inside the skin and not visible from outside and they are absorbable ones hence will not require removal. If routine stitches or staples are used then they will be removed after 7 days of your surgery. They may need to stay in longer if this is a repeat surgery. Your doctor or Physician assistant will remove them during your follow-up visit at the clinic.
- Check your incisions daily for any signs of redness, swelling, or drainage.
- Keep your incisions clean and dry for 5 days after your surgery.
You can shower from third day onwards after we have checked your wound. Try to avoid application of oil in hair as it lets the dirt to stick around the wound. When you wash your hair, use a gentle shampoo. Keeping your wound clean is your responsibility.
It is usually 2 to 4 weeks but we will tell you when you can go back to work. This depends on your age, type of work, medical condition and other factors.
You can go back to school as soon as you feel ready. Tell your school nurse that you have a VP shunt.
You can participate in all noncontact sports (i.e., swimming, running), exercise and go to the gym 2 weeks after your surgery. You cannot participate in any contact (collision) sports (i.e., football, boxing, wrestling). Remember to wear a helmet to decrease the risk of head injury, if needed.
Do not travel on an airplane until we give you fitness.
You will have regular visits with your neurosurgeon. They will monitor the function of your VP shunt over time.
All of us have seven bones in the neck called cervical vertebrae. Discs are special joints with pulpy centre surrounded by fibrous ring permitting limited movement between adjacent vertebrae. When we grow older and also due to wear and tear or injury, the discs dry up. Sometimes they can bulge or protrude behind where the nerves and spinal cord are situated. This condition known as disc prolapse can give rise to severe pain and numbness in the arm or sometimes weakness of hands and legs. For selected patients, the above surgery is advised.
Disc prolapse is in general treated by non-operative methods:
1) Medications 2) Physical therapy 3) Spinal injections
When the patient has only nerve root compression without evidence of spinal cord compression, then conservative measures are often successful. Surgery is advised only when the conservative measures tried for 2-3 weeks have not given satisfactory pain relief. But, when the patient has evidence of spinal cord compression surgery is the treatment of choice.
1) Medications 2) Physical therapy 3) Spinal injections
When the patient has only nerve root compression without evidence of spinal cord compression, then conservative measures are often successful. Surgery is advised only when the conservative measures tried for 2-3 weeks have not given satisfactory pain relief. But, when the patient has evidence of spinal cord compression surgery is the treatment of choice.
After general anesthesia is given, a small skin incision of 1-1.5 inches is made in front of the neck – it usually merges with the skin crease with time. The wind pipe and food pipe are pushed to one side and the disc space is reached. The level is identified with intra operative x ray (C arm). Then the disc is removed microsurgically. Sometimes abnormal bony growth may be drilled out using high speed drill. The nerves and the spinal cord are released off all the compression.
After removing the disc, the space is usually filled with patient’s own bone from the hip or sometimes, a spacer (cage) filled with bone chips or artificial bone. This is called fusion. New bone grows through the grafted bone or the spacer and the space becomes rigid in usually 12 to 24 weeks time.
After removing the disc, the space is usually filled with patient’s own bone from the hip or sometimes, a spacer (cage) filled with bone chips or artificial bone. This is called fusion. New bone grows through the grafted bone or the spacer and the space becomes rigid in usually 12 to 24 weeks time.
Mild neck pain may persist following the operation which usually improves with time. Also, there may be mild discomfort in the throat due to anesthesia.
This operation releases the compression on the nerves and spinal cord. So, all the arm pain due to compression on the nerve will improve after this operation (success rate of 90–95%). But, the degenerative neck pain may persist for some weeks. The nerves, once damaged will take long time to recover and rarely may not recover at all. So, the existing numbness and weakness, if any, may not improve immediately. The weakness will slowly improve with physiotherapy. It all depends on whether the nerves are just pressed by the prolapsed disc or the nerves are pressed and already damaged. If the nerves are already damaged, even after the release of compression, the symptoms will persist.
ACDF is an open microsurgery done on the front side of the neck; the disc is removed and bone growth is promoted between adjacent vertebrae. There are other options like Posterior Micro / Endoscopic Discectomy, Anterior or Posterior Microforaminotomy. Young patient with a diseased disc may be a candidate for an artificial disc (Disc Replacement). This implant is expected to preserve the motion across the two vertebrae. Over the years, ACDF with patient’s own iliac crest bone graft continues to be the ‘gold standard’ and most effective method of treatment.
Sometimes, a metal plate is inserted to fix the bones. It helps the bone to heal, helps decrease neck pain after surgery and may allow you to return to work and other activities sooner. A plate is not always necessary for ACDF using iliac crest for one or two level discectomy, but may be used for surgery on more than two level discs or when we use spacers or if there is instability. The plate does not need to be removed later.
Sometimes, a metal plate is inserted to fix the bones. It helps the bone to heal, helps decrease neck pain after surgery and may allow you to return to work and other activities sooner. A plate is not always necessary for ACDF using iliac crest for one or two level discectomy, but may be used for surgery on more than two level discs or when we use spacers or if there is instability. The plate does not need to be removed later.
As a whole, the complication rate is less than 5%. As for any other operation, this operation also carries risk of infection, bleeding and injury to vital structures at the site of operation. All operations in the brain and spine are considered as major operations and should not be taken lightly. As we are operating close to nerves supplying voice box, wind pipe and food pipe, some patients may have hoarseness of voice or difficulty in swallowing for transient period of time.
If the injury to food pipe or wind pipe are large, it can lead to fistulous connection through skin and may require prolonged hospitalisation and ICU care. The worst complications of nerve or spinal cord damage, though extremely rare (<1%), can lead to serious weakness or paralysis of limbs / sensory loss over limbs / incontinence of urine and motion. Rarely, there may be CSF leak, implant failure or graft migration which may or may not warrant another operation or procedure.
Every effort is made to avoid any of these complications and in the event of its occurrence, they will be promptly treated. There is very little risk of death due to surgery. However, the above-mentioned complications can certainly endanger life if the body does not respond to treatment.
If the injury to food pipe or wind pipe are large, it can lead to fistulous connection through skin and may require prolonged hospitalisation and ICU care. The worst complications of nerve or spinal cord damage, though extremely rare (<1%), can lead to serious weakness or paralysis of limbs / sensory loss over limbs / incontinence of urine and motion. Rarely, there may be CSF leak, implant failure or graft migration which may or may not warrant another operation or procedure.
Every effort is made to avoid any of these complications and in the event of its occurrence, they will be promptly treated. There is very little risk of death due to surgery. However, the above-mentioned complications can certainly endanger life if the body does not respond to treatment.
Follow these steps to help your surgery go better:
• Stop smoking. If you smoke, try to stop before your surgery. Non-smokers have fewer complications related to surgery. More importantly, smoking slows bone growth and could cause your surgery to fail.
• Stop certain medications. Stop taking aspirin and clopidogrel 1 week before surgery. Stop taking anti-inflammatory medications such as ibuprofen and naproxen 1 week before surgery. If you take blood thinners, ask your doctor when to stop taking them. You can continue to take most of your other regular medications. Tell your doctor everything you’re taking so your doctor can help you know what to stop.
• Stop smoking. If you smoke, try to stop before your surgery. Non-smokers have fewer complications related to surgery. More importantly, smoking slows bone growth and could cause your surgery to fail.
• Stop certain medications. Stop taking aspirin and clopidogrel 1 week before surgery. Stop taking anti-inflammatory medications such as ibuprofen and naproxen 1 week before surgery. If you take blood thinners, ask your doctor when to stop taking them. You can continue to take most of your other regular medications. Tell your doctor everything you’re taking so your doctor can help you know what to stop.
You will be admitted to the hospital on the day of the surgery or the previous day evening.
• Do not eat anything for 8 hours before the surgery. Clear liquids (plain water, tender coconut water, clear fruit juice) are allowed up to 2 hours before surgery.
• Prepare a list of all your current medications and bring it with you to the hospital. It includes over-the-counter medications and vitamins.
• You have to sign a consent form for the surgery.
• Do not eat anything for 8 hours before the surgery. Clear liquids (plain water, tender coconut water, clear fruit juice) are allowed up to 2 hours before surgery.
• Prepare a list of all your current medications and bring it with you to the hospital. It includes over-the-counter medications and vitamins.
• You have to sign a consent form for the surgery.
• You will wake up from surgery in a recovery area of the hospital. A nurse will monitor your vital signs until you are ready to leave the area.
• You may have sore throat and difficulty in swallowing for a few days. You may also feel pain between your shoulder blades. It will gradually go away.
• The pain in your arm will likely be gone.
• Most patients will be walking on the day of the surgery. If a drainage tube has been kept either in the neck or at iliac graft site, it will be removed next day. Most patients go home the day after surgery. If you’ve had surgery on several discs, you may need to stay longer. You will be allowed to go home as soon as your surgeon approves.
• Patients are offered a collar to wear for 4 to 6 weeks.
• You may have sore throat and difficulty in swallowing for a few days. You may also feel pain between your shoulder blades. It will gradually go away.
• The pain in your arm will likely be gone.
• Most patients will be walking on the day of the surgery. If a drainage tube has been kept either in the neck or at iliac graft site, it will be removed next day. Most patients go home the day after surgery. If you’ve had surgery on several discs, you may need to stay longer. You will be allowed to go home as soon as your surgeon approves.
• Patients are offered a collar to wear for 4 to 6 weeks.
ACDF can usually be done in 1 to 2 hours, but may take up to 3 or more hours. The time depends on how many discs will be removed, how badly the discs or bones (vertebrae) are diseased and other factors. Your surgeon will give you a general idea about surgical time.
Your spine team will go to great lengths to ensure that this is the right operation for you. They will also ensure that your surgery is done with the utmost care, to give you the best chance of a successful outcome. In general:
• ACDF is most effective in relieving arm pain from a pinched nerve root. When pressure is removed from the painful nerve, the nerve pain almost always disappears immediately. Most patients are very satisfied with the improvement in arm pain.
• ACDF is much less effective in relieving neck pain if the discs at adjacent levels are degenerated. About half of patients feel relief from neck pain.
• ACDF is most effective in relieving arm pain from a pinched nerve root. When pressure is removed from the painful nerve, the nerve pain almost always disappears immediately. Most patients are very satisfied with the improvement in arm pain.
• ACDF is much less effective in relieving neck pain if the discs at adjacent levels are degenerated. About half of patients feel relief from neck pain.
You will lose the movement between the bones (vertebrae) that are fused. Whether you notice the change in your day-to-day life will depend on how many vertebrae were fused and the types of activities you are used to doing. Most patients do not notice any significant change. In fact, some patients are able to do more than they could before surgery, as movements are less painful.
a) Fall Prevention: After any surgery, your body systems are suboptimal and one can easily feel giddy when you get up and walk. Be careful; when you get up, move your feet up and down, make fists a few times, do deep breathing exercises for a few seconds, make sure you are not giddy and then walk. Request your family member to be with you when you go to toilet even at night hours. Fall in the bathroom is very common complication we have seen and can be easily avoided.
b) DVT-PE prevention: Try to walk for a minimum of 5 minutes every hour except at night hours 10 to 6. If you are not able to walk, please move your feet and legs for at least 5 minutes every hour. If you are not able to do this, you will need Ted stock and SCD devices for a few weeks. If you are in the high risk group for DVT-PE (past h/o DVT.PE, on certain medications like Oral contraceptives, you will be advised Injections / tablets to prevent this complication. When you’re comfortable, start taking short walks every day. The right kind of movement can help you heal better.
c) 7 to 8 hours of Sleep is essential after any major surgery.
d) Eat healthy diet.
e) Take medications as prescribed and follow the advice in discharge summary. You may have a sore throat and trouble swallowing for a few days, or even a few weeks. You may also feel pain in your shoulder blades. The pain should gradually go away.
f) No smoking for 4 weeks; if you are nicotine dependant, you will be advised accordingly. Avoid drinking for a few weeks. Take this operation as an opportunity to stop smoking and drinking for good.
g) Our team member (Non-medical) will call you on 2nd and 7th day of discharge, Please feel free to tell your problems to them and whenever needed, please ask for junior doctor or consultant doctor to clarify your doubts.
h) Once you go home from the hospital, you’ll need to take it easy until the bone graft heals solidly. This can take from 2 to 6 months, sometimes even longer.
i) Talk with your doctor about how to manage the pain. Do not take any pain medication that your doctor has not prescribed. Avoid strenuous activity. You should be able to resume many of your regular activities within just a few weeks of surgery. However, don’t do any strenuous physical activity until your bone fusion heals solid. It can take from 2 to 6 months. Your doctor will advise you when it is safe for you to resume all activities. He or she will determine this by looking at x-rays of your spinal fusion to see whether the bone has healed solid.
j) Talk with your doctor about when you can resume activities, including driving. Return to work when your doctor advises. When you can return to work depends on how physically strenuous your work is. If you work at a desk, you may be able to return to work within a week. If your work is physically strenuous and you do not have the option of a light-duty assignment, you may need to be out work until the bone has healed completely. In some cases this may take up to 6 months, although most patients have a solid fusion much sooner. Your doctor will advise you when it is safe to return to work.
k) Neck-Care Program: To slow down the degenerative changes in the adjacent vertebrae in the neck, you need to maintain the correct posture of neck and body while awake and at sleep, improve the muscle power of neck, back and limb muscles, keep the neck & back joints supple. Please get pamphlet from our Physiotherapy Department describing the neck exercise. Avoid sudden and extreme movements of neck.
b) DVT-PE prevention: Try to walk for a minimum of 5 minutes every hour except at night hours 10 to 6. If you are not able to walk, please move your feet and legs for at least 5 minutes every hour. If you are not able to do this, you will need Ted stock and SCD devices for a few weeks. If you are in the high risk group for DVT-PE (past h/o DVT.PE, on certain medications like Oral contraceptives, you will be advised Injections / tablets to prevent this complication. When you’re comfortable, start taking short walks every day. The right kind of movement can help you heal better.
c) 7 to 8 hours of Sleep is essential after any major surgery.
d) Eat healthy diet.
e) Take medications as prescribed and follow the advice in discharge summary. You may have a sore throat and trouble swallowing for a few days, or even a few weeks. You may also feel pain in your shoulder blades. The pain should gradually go away.
f) No smoking for 4 weeks; if you are nicotine dependant, you will be advised accordingly. Avoid drinking for a few weeks. Take this operation as an opportunity to stop smoking and drinking for good.
g) Our team member (Non-medical) will call you on 2nd and 7th day of discharge, Please feel free to tell your problems to them and whenever needed, please ask for junior doctor or consultant doctor to clarify your doubts.
h) Once you go home from the hospital, you’ll need to take it easy until the bone graft heals solidly. This can take from 2 to 6 months, sometimes even longer.
i) Talk with your doctor about how to manage the pain. Do not take any pain medication that your doctor has not prescribed. Avoid strenuous activity. You should be able to resume many of your regular activities within just a few weeks of surgery. However, don’t do any strenuous physical activity until your bone fusion heals solid. It can take from 2 to 6 months. Your doctor will advise you when it is safe for you to resume all activities. He or she will determine this by looking at x-rays of your spinal fusion to see whether the bone has healed solid.
j) Talk with your doctor about when you can resume activities, including driving. Return to work when your doctor advises. When you can return to work depends on how physically strenuous your work is. If you work at a desk, you may be able to return to work within a week. If your work is physically strenuous and you do not have the option of a light-duty assignment, you may need to be out work until the bone has healed completely. In some cases this may take up to 6 months, although most patients have a solid fusion much sooner. Your doctor will advise you when it is safe to return to work.
k) Neck-Care Program: To slow down the degenerative changes in the adjacent vertebrae in the neck, you need to maintain the correct posture of neck and body while awake and at sleep, improve the muscle power of neck, back and limb muscles, keep the neck & back joints supple. Please get pamphlet from our Physiotherapy Department describing the neck exercise. Avoid sudden and extreme movements of neck.