Dr. Nigel Peter Symss

Children are not small adults, and paediatric neurosurgery is a distinct speciality within neurosurgery for reasons that are both technical and clinical. On the technical side, children's anatomical structures are smaller, their blood volume is substantially lower - meaning even modest blood loss during surgery can be haemodynamically significant - and their anaesthetic requirements differ from adults in ways that affect both safety and brain physiology during the procedure. Instruments are sized and techniques adapted accordingly. On the clinical side, the conditions that bring children to a neurosurgeon are often different from those affecting adults. Hydrocephalus in newborns and infants is a leading indication for paediatric neurosurgery, as are congenital brain and spine malformations, paediatric brain tumours with histological types not commonly seen in adults (medulloblastoma, ependymoma, choroid plexus tumours), and Moyamoya disease, a rare cerebrovascular condition of childhood causing progressive stroke that can be treated with indirect bypass surgery. Epilepsy surgery in children also requires assessment of developmental considerations that do not apply to adults. There is also a dimension specific to treating children that goes beyond technique: the developmental implications of both the condition and the treatment must inform every decision, because a deficit acquired in a young brain affects a lifetime of learning, independence, and quality of life in a way that the same deficit in an elderly patient does not. My paediatric neurosurgery fellowship at Jikei University School of Medicine, Tokyo, under Professor Oi - one of the world leaders in paediatric hydrocephalus and neuroendoscopy - gave me specific training in this area.

Open spine surgery involves a single long incision over the spine with retraction of the paraspinal muscles away from the spine's bony structures. This approach provides excellent visibility but causes significant muscle trauma, blood loss, and postoperative pain, and typically requires a hospital stay of five to seven days with a recovery period of six to twelve weeks before return to normal activity. Minimally invasive spine surgery achieves the same surgical goals - decompression of nerves, stabilisation of the spine, removal of disc material - through one or more small incisions of approximately one to two centimetres, using specialised tubular retractors that separate rather than cut through the muscle, or through endoscopic instruments that access the spine through even smaller portals. The result is dramatically less tissue disruption, shorter hospital stay of one to two days, faster recovery of two to four weeks, and comparable or superior outcomes in appropriately selected cases. My spinal fellowship at Flinders Medical Centre, Adelaide, trained me specifically in minimally invasive techniques, and at Gleneagles Fortis Hospital, Chennai, I use these approaches for disc prolapse, decompression for spinal stenosis, and selected fusion procedures. You should ask your neurosurgeon directly which approach they are planning and why - understanding whether your procedure is minimally invasive or open, and what the rationale is for that choice given your specific anatomy and pathology, is a reasonable and important question.

Deep brain stimulation (DBS) is a functional neurosurgical procedure in which electrodes are implanted with millimetre-level precision into specific target structures deep within the brain. These electrodes are connected to a pulse generator (similar to a cardiac pacemaker) placed beneath the skin, which delivers continuous electrical stimulation that modulates abnormal neural circuit activity. I completed a fellowship in functional neurosurgery at Flinders Medical Centre and DBS is one of the central pillars of my practice at Gleneagles Fortis Hospital, Chennai.
DBS is most effective for movement disorders where specific brain circuits are dysregulated. The conditions with the strongest evidence for DBS are Parkinson's disease (where it controls tremor, rigidity, and dyskinesias), essential tremor (where stimulation of the thalamus dramatically reduces tremor), and dystonia (where it reduces abnormal sustained muscle contractions). Selected cases of obsessive-compulsive disorder also respond to DBS.

• Parkinson's disease: Patients who have good initial response to levodopa but develop motor fluctuations or dyskinesias on long-term medication are typically the best candidates
• Essential tremor: Patients with tremor that is significantly disabling and not controlled by medication
• Dystonia: Particularly generalised and cervical dystonia, especially in younger patients
  Patients should not have significant cognitive impairment, active psychiatric conditions, or surgical contraindications
  DBS does not cure the underlying condition, but it can produce dramatic, sustained improvement in quality of life for appropriate patients. A formal functional neurosurgery assessment determines candidacy at Gleneagles Fortis Hospital, Chennai.

Deep brain stimulation (DBS) is a functional neurosurgical procedure in which electrodes are implanted with millimetre-level precision into specific target structures deep within the brain. These electrodes are connected to a pulse generator (similar to a cardiac pacemaker) placed beneath the skin, which delivers continuous electrical stimulation that modulates abnormal neural circuit activity. I completed a fellowship in functional neurosurgery at Flinders Medical Centre and DBS is one of the central pillars of my practice at Gleneagles Fortis Hospital, Chennai.
DBS is most effective for movement disorders where specific brain circuits are dysregulated. The conditions with the strongest evidence for DBS are Parkinson's disease (where it controls tremor, rigidity, and dyskinesias), essential tremor (where stimulation of the thalamus dramatically reduces tremor), and dystonia (where it reduces abnormal sustained muscle contractions). Selected cases of obsessive-compulsive disorder also respond to DBS.

• Parkinson's disease: Patients who have good initial response to levodopa but develop motor fluctuations or dyskinesias on long-term medication are typically the best candidates
• Essential tremor: Patients with tremor that is significantly disabling and not controlled by medication
• Dystonia: Particularly generalised and cervical dystonia, especially in younger patients
  Patients should not have significant cognitive impairment, active psychiatric conditions, or surgical contraindications
  DBS does not cure the underlying condition, but it can produce dramatic, sustained improvement in quality of life for appropriate patients. A formal functional neurosurgery assessment determines candidacy at Gleneagles Fortis Hospital, Chennai.