Dr. Murali Mohan S

The stress of a Neurosurgical procedure is enormous, on the family and particularly the individual. Effective communication with empathy is the key for successful establishment of rapport and infusing confidence in the patient. Today, anesthesia has become safe. Technical advancements and expertise has made Neurosurgery, a very safe procedure. Neurosurgery includes surgery to brain ( cranial surgery), surgery involving the spine and spinal cord ( Spinal surgery) and surgery of the Peripheral Nerves!

Brain tumours are a daunting reality that affects thousands of lives every year. These tumours can impact anyone, regardless of age, gender, or background, bringing with them not just physical challenges, but emotional and psychological burden as well. However, with advancements in medical science, early detection, innovative treatments, and comprehensive care, the prognosis for many patients have transformed over the years.As a neurosurgeon, I have the profound honour of working on the front lines of brain health, where I witness the incredible strength and resilience of patients facing the formidable challenge of a brain tumour diagnosis, on a day to day basis. further reading: 'from Brace to Embrace' https://drmurali.blog/2024/06/07/from-brace-to-embrace/

A meningioma is a tumour that grows from the meninges — the protective membranes that cover the brain and spinal cord. Most meningiomas are benign (not cancer) and slow growing; however, some can be cancerous. They are slow growing and often take a long time to cause clinical symptoms. Brain scan such as an CT scan and MRI scan clinches the diagnosis. Surgical excision of the tumour is the first line of treatment, which often offers cure. Surgery is safe today, with use of high end operating microscopes, neuro navigation, intra-operative neurological monitoring and safe neuro-anesthesia.

Pituitary is the master gland of the body which controls all the other glands secreting hormones in our body. It is under the direct influence of the brain. This small pea sized gland can become a seat for tumour, known as pituitary adenoma. These tumours can cause visual field defects including blindness, headache, hormonal imbalance which includes infertility, cushing's disease, gigantism, acromegaly, galactorrhea, obesity or anemia. They can also cause sudden severe headache with sudden blindness including endangering life when they bleed within - known as pituitary apoplexy. These tumours can be cured by total surgical excision which are performed endoscopically through the nose - often referred to as transsphenoidal endoscopic excision. It is a safe, scar less procedure. With surgical treatment and often adjuvant hormonal replacement, a person with pituitary adenoma can lead a near perfect life, today!

Acoustic neuroma is a benign (non cancerous) tumour that occurs from the hearing nerve. These tumours grow to a big size and can press upon vital neuro structures such as the cerebellum and brainstem. They can also cause hydrocephalus, a condition where there is excess water within the brain. Early diagnosis offers excellent non surgical options such as radiosurgery. However, in large size tumours, surgical excision is required. Safe surgical excision with preservation of neurological functions including facial nerve functions and hearing preservation is possible with use of IONM (intra operative neuro monitoring).

Stroke can be reversed if you reach hospital with in ‘golden hour‘.Stroke is a devastating disease that cripples not only the person but the family. If untreated or once the stroke is complete – the person is left disabled for life, with paralysis and or difficulty to speak & communicate. In other words, this amounts to professional discontinuity, disconnect from social life and life long dependency.Clot dissolving drugs can be used within 4.5 hours of the onset of stroke, up-to 6 hours, the clot can be mechanically removed by Intervention. Depending on specific cases this intervention can be performed up-to 12 hours.

A brain aneurysm (also called a cerebral aneurysm or an intracranial aneurysm) is a ballooning arising from a weakened area in the wall of a blood vessel in the brain. If the brain aneurysm expands and the blood vessel wall becomes too thin, the aneurysm will rupture and bleed into the space around the brain. Treatment includes Surgical clipping or Neuro-interventional coiling of the aneurysm, followed by treatment of vasospasm, cerebral edema and supportive care.

Brain tumours when they occur in very vital regions of the brain, can pose formidable challenge to the surgeon. Many a times, complete removal of the tumour can result in paralysis or loss of speech! Awake craniotomy is a technique, where the patient stays awake during the surgical procedure. Before the tumour is removed, the surface function of the brain is mapped by IONM - intra operative neuro monitoring. While the tumour is being operated and removed, the patient engages in conversation with surgical team, and is able to move the hands and legs. This way, the marked vital areas are avoided and only the safe zones are resected!

The main symptom of trigeminal neuralgia is sudden attacks of severe, sharp, shooting facial pain that last from a few seconds to about 2 minutes. The pain is often described as excruciating, like an electric shock. The attacks can be so severe that you're unable to do anything while they're happening. Evidence suggests that in up to 95% of cases, the cause of trigeminal neuralgia is pressure on the trigeminal nerve close to where it enters the brain stem. MVD ( Micro -vascular decompression) is the best choice of treatment. Its a day care / short stay procedure. In MVD, the offending vessel which is compressing the trigeminal nerve is dissected off from the nerve and is kept away by inter-positioning a teflon material.

Deep brain stimulation (DBS) is a surgical therapy used to treat certain aspects of Parkinson’s disease (PD). It mostly addresses the movement symptoms of Parkinson’s and certain side effects caused by medications. DBS may also improve some non-motor symptoms, including sleep, pain, and urinary urgency. It is important to understand that DBS can only help relieve symptoms, not cure or stop disease progression.

Head Injuries are unfortunate incidents. They not only affect the person, but also deeply involve the family and extended contacts: financially, emotionally and physically.It is a social problem. Good governance can ensure good roads and enforcement of strict law can avoid road traffic accidents. Other reasons could be fall, assault or sports injuries. The sad truth is that the population that is involved in majority of the head injuries fall in young and socially productive age group, who often are bread winners for their family and cream of the Nation. TIME IS BRAIN. If treatment is sought in timely manner, majority of the head injury patient can not only be saved, but can recover to full functional potential!

Hydrocephalus is water filled in the brain! This causes increased intracranial tension resulting in death. This condition can either occur as primary problem, or at times it occurs as a consequence to brain tumours or neuro infection. Traditional treatment involves placing the shunt tube connecting the ventricular cavity to the peritoneal cavity in the abdomen. Modern day alternatives includes Endoscopic surgeries such as third ventriculostomy, septostomy and aqueductoplasty. All are safe procedures, and can be done as daycare or short stay procedure.

Craniosynostosis is a condition where the skull bones fuse very early in life, resulting in small sized skull. This would impede the growth of the developing brain resulting in developmental delay, mental retardation, blindness, deafness and even can pose risk to life, apart from presenting as obvious deformity raising aesthetic concerns. Surgery is the only option here. Pediatric surgeries today are very safe. There are several procedures that are available today. From creating space between the bones, expand the skull to advancing the orbital sockets forwards, the surgical options are many. With the advent of absorbable screws and plates, there is no interference in future growth of the skull following surgical correction. A single sitting, safe, functional and aesthetic correction is a reality, today!

Surgeries for AAD are considered to be very tricky, difficult and challenging. Over the years, the implants and techniques have evolved to a considerable safe surgical experience today. AAD is a serious threat to life, hence swift surgical treatment is imperative for positive outcome. C1/C2 instrumentation and distraction can stabilise the cranio vertebral junction (CVJ), resulting in correction of AAD.

Chiari Malformation is a congenital condition where there is herniation of brain matter into the cervical Spine ( Neck). Often this condition is associated with water accumulation within the Spinal Cord, known as Syringomyelia. This can lead to severe disability, paralysis and loss of muscle bulk in the hands along with loss of touch, pain and other sensory disturbance. This condition is essentially treatable. Foramen magnum decompression, along with C1/C2 fusion and Obexoplasty are choice of treatment. Early surgery can ensure reversal of symptoms and structural damage. Awareness is the key here.

Tumours of the spinal cord can either arise from within or outside of the cord. They often present with pain, sensory issues and sometimes paralysis. A spinal tumor can be life-threatening and cause permanent disability. Microsurgical excision under IONM ( intra-operative neuro monitoring) is the mainstay of treatment. Complete functional recovery is practical, today. Along with surgery, radiation therapy & chemotherapy are adjuvant therapeutic options depending upon the nature of the tumour

Tuberculosis of the spine is still a major endemic issue in the developing world. Often these patients do not present with active chest tuberculosis. The caseation necrosis of tissues here, results in destruction of the spine resulting in gross instability. The granulomatous material and cold abscess can cause severe compression of the spinal cord. Effective treatment is decompression of the spinal cord, stabilisation of the spine, obtaining tissue for histopathological confirmation and followed by long term course of anti tubercular medications, with periodical followups.

The incidence of NTD's ( Neural tube defects) has largely reduced, today. This can be attributed to folic acid supplementation in early pregnancy. The NTD's include: Open defects such as Myelocele, Meningolcele, Myelomeningocele, and closed defects such as Spina Bifida, Lipomyelomeningocele and Diastematomyelia. Surgery can be safely performed in as early as first day of the baby's life, today. Often these condition causes tethering of the cord. Closure of the exposed wound with internalisation of the neural tissue, de-tethering of the tethered cord and neural tissue are main goals of the surgery. Early surgery can often restore neurological function.

Discogenic pain and associated Slip Disc issue has an high life time incidence in any given individual. This is largely attributed to the changing sedentary lifestyle, poor food habits, smoking and obesity that is prevalent in the current society! The discs in humans are avascular, and are dependent on mobility for nourishment. In other words, Movement is Life. Prevention involves adopting healthy lifestyle. No more anyone has to endure pain and suffering from disc disorders. There is definite cure for slip disc. In lumbar spine, the treatment options are simple micro & endoscopic lumbar discectomy (MLD), transforaminal lumbar interbody fusion (TLIF). While in cervical spine, the options are anterior cervical discectomy and fusion (ACDF) and artificial disc replacement (arthroplasty). all of these can be performed as day care surgeries or very short stay surgeries.

Scoliosis is a medical condition characterised by an abnormal sideways (lateral / coronal) curvature of the spine. While it can affect people of all ages, it is most commonly diagnosed in children and adolescents.Parents should watch for early signs of scoliosis in their children, especially during growth spurts. If any asymmetry is noticed in child’s shoulders, hips, or waist, a doctor consult for further evaluation is a must. Surgical correction of scoliosis, kyphosis and Spinal deformities are safe today. Advances in Neuro - anesthesia and intraoperative neuro monitoring have revolutionised this sphere. In today's world, Scoliosis need not hinder one’s quality of life if timely management is undertaken. This requires a larger awareness about this condition. By understanding the signs, seeking timely medical advice, and supporting awareness initiatives, we can make a significant impact on the lives of those affected by scoliosis.

Osteoporosis or weak bones, is a natural phenomenon that happens with aging. The word ‘osteoporosis’ means ‘porous bone.’Weak bones results in fractures, delayed healing of fractures and often progression of fractures into non-union and deformity, especially in geriatric age group. Osteoporosis is called a “silent disease” because people who develop it may not notice any changes until a bone breaks — usually a bone in the hip, spine, or wrist.Spinal fractures do not heal as easily as elsewhere.The larger issue is instability of the spine, which in turn can result in injury to the spinal cord and consequent paralysis. An irreversible & miserable condition. Best treatment option would be kyphoplasty, a quick, simple, day care procedure, where the patient can return home in the same evening – pain free and walking! followed by appropriate medical management of Osteoporosis.

Back pain, spinal and disc disorders are one of the leading cause for poor quality of life. The pain, suffering and socio economic implications are tremendous. A lot of people suffer silently out of fear of treatment !!!! Back to back Pandemics has worsened our spinal health and a lot more youngsters today are developing serious spinal issues restricting their quality of life. The risk and side effects of treatment that are commonly believed in public need to be addressed by constant efforts to create awareness towards safe Spinal Surgery. One need not suffer and endure weakness & pain in current era of medical sophistication. Prevention is better than cure! Adopting healthy lifestyle is the key to stay pain free and fit.