Neurosurgery treats conditions and diseases of the brain and nervous system. Endovascular neurosurgery is a subspecialty within neurosurgery that involves passing thin instrument (catheter) and wires through an artery in the groin, arm or sometimes the neck and guiding them to blood vessels in the brain. After reaching the brain, the endovascular neurosurgeon can use number of platinum coils or a glue-like substance to repair problems in arteries and veins within the head.
Endovascular neurosurgery surgery is used to treat many disorders of the blood vessels in the head. The main purpose of endovascular neurosurgery is to avoid open surgery. This treatment procedure may give better results for medical conditions like aneurysm, stenosis such as carotid artery diseases (CAD), arteriovenous malformation (AVM), acute ischemic stroke, hemorrhagic etc. there are different types of endovascular treatment for brain aneurysm such as:
1. Coiling of aneurysm – A brain aneurysm is a bulging and weakened area in the wall of an artery in the brain which causes an abnormal widening or ballooning. The artery wall has a weakened spot due to which the aneurysm is at risk for bursting if blood flow isn’t blocked or stopped. Aneurysm can be treated by coiling or clipping it closed. In this procedure, doctor can access brain through the bloodstream via arteries to diagnose and treat brain aneurysms. A surgeon will insert a very thin metal wire that forms a coil inside a brain aneurysm to block blood flow.
2. Carotid artery angioplasty/ stent placement – stenosis also known as narrowing is a condition in arteries of the brain that includes carotids, vertebral and intracranial arteries which can lead to brain stroke. It can be treated by angioplasty or stent placement procedure in which the affected arteries can be treated non- invasively by endovascular route. This procedure is done under local anesthesia and uses a small balloon and/or a tiny metal scaffold called a stent to open a narrowed carotid artery that supply blood to the brain.
3. Arteriovenous Malformation of Brain – AVM is a condition in which malformed swollen blood vessels causes intracranical hemorrhage, bleeding that occurs inside the cranium (skull) creating seizures and headache. It can be treated by injecting glue like substance through a small and thin catheter placed correctly into these defected blood vessels.
4. Thrombolytic therapy – In this procedure doctor will give “clot-busting” medicine to dissolve a clot in a blood vessel in the brain or in other areas of the body.
5. Cerebral angiography – Cerebral angiography is a radiology procedure that looks at how blood is flowing in the brain.
6. Chemoembolization – giving cancer treatment directly to a tumor through its blood supply
7. Biopsy – taking of a tissue sample from the specific area for pathological examination
8. Radiofrequency – ablation for destruction of tissue by heat
9. Drain insertions –placing drainage tubes into different parts of the body to drain fluids
Endovascular neurosurgery is a minimally invasive technique to treat patients for whom traditional surgical treatments are not much successful. Some of the advantages of this procedure are:
• Minimal injury to the brain
• Less risk and complications with better results
• Shorter stay at hospital
• Shorter recovery time
• Less discomfort
• Less risk for patients with other medical problems.
• Treatment of untreatable diseases in the past
• Endovascular Neurosurgery In India
Endovascular neurosurgery uses tools which pass through blood vessels to diagnose and treat several medical conditions and diseases. This is much preferable option over the traditional open surgery method. With the help of radiology images during endovascular neurosurgery, surgeons can see brain and other parts of the body that are involved in the treatment procedure. Surgeons can also treat various medical conditions of spinal cord using the similar method but may not do through a blood vessel. These techniques are known as minimally invasive as they require a small incision instead of larger incisions needed in open surgery method. Doctors require a particular training in both radiology and neurosurgery for specializing in endovascular neurosurgery. After completing radiology residency they will required to complete the fellowship program in interventional neuroradiology to get qualified as an endovascular neurosurgeon.
Endovascular neurosurgery can treat some conditions and diseases like carotid – cavernous fistula, brain arteriovenous fistula, head/neck tumors, stroke, vasospasm, bleeding of nose, vertebral body tumors, traumatic vascular lesions, vertebral body compression fracture, spinal vascular malformations, intracranial atherosclerosis, meningiomas, dural arteriovenous fistula etc.
Some of the endovascular procedure performed by doctors as following:
• Thrombolytic therapy
• Endovascular coiling
• Minimally invasive spine surgery
• Cerebral Angiography
• Carotid artery angioplasty/ stenting
India has many affiliated brain and neurosurgery hospitals equipped with the advance and high end technology at an affordable cost at par with global medical standards. These specialized hospitals in India provides excellent opportunity and results for patients coming from abroad seeking high quality advanced treatment for brain tumors, aneurysm, tumor embolisation, vascular tumor, spinal cord disorders, stroke, epilepsy, movement disorder of the body parts etc. at much lower costs. Doctors, surgeons and healthcare professional in India can provide best solutions to complex and serious health issues. Hospitals in India have most advanced technology infrastructure such as 24 hr blood bank, advanced laboratory, microbiology support, advanced cardiology, interventional radiology, liver fibro-scan , 64 slice CT scan, 3 T MRI and more. Indian doctors are very skilled, well known all over the world and have the experience of studying and working at the best neurosurgery hospitals and institutions.
Alleevia medical services, a well known medical tourism company in India provides best assistance and advance treatment with great hospitality to international patients. They can avail an advantage of lowest and best treatment package for Brain and Endovascular Neurosurgery treatment with highest quality of medical care. Our team has thorough knowledge about the services and medical branches provided by the Indian Hospitals and can guide the patients to the best doctors and specialized hospitals with better services at lower cost. We are associated with top most doctors and surgeons who have more than 20 years of experience in their respective fields and are qualified members of medical boards in India, America, UK, and Australia.
Weight loss surgery also known as bariatric surgery is the treatment for people suffering with obesity. This will help people to lose weight and lower the risk of medical problems caused by obesity by maintaining the weight for longer period of time. Bariatric surgery can also help in improving morbid conditions like type 2 diabetes, hypertension, pain in the joints, sleep apnea, cardiac diseases, infertility problem etc. Bariatric surgery mainly contributes to weight loss in two ways:
1. Restriction – it helps in limiting the amount of food stomach can hold which limits the calories consumed.
2. Mal-absorption - operation is used to bypass part of the small intestine that reduces the amount of calories that body absorbs.
Most surgeons use laparoscopic surgery method over traditional open surgery. Open surgery involves one single large incision in the stomach whereas in laparoscopic surgery, many tiny incisions are made and thin surgical tools are inserted through the cuts. Small scope attached to a camera that projects images onto a video monitor is also inserted in the body. Laparoscopic treatment involves less risk and complications and causes less pain and scarring than open surgery method. It may also lead to speedy recovery. But patient having a high level of obesity, had abdomen surgery before, or having any complex medical conditions may need open surgery which is a better option for them.
Bariatric surgery can be done in four ways:
1. Gastric bypass – also called Roux –en- Y gastric bypass are divided into two parts: 1) surgeon will create a small pouch in the upper section of the stomach which will make stomach much smaller in size. This way patient will eat less and feel satiated sooner. 2) Surgeon will cut the small intestine and attaches the lower part directly to the stomach pouch. Food will bypasses most part of the stomach and the upper part of small intestine so the body will absorb fewer calories. The surgeon will connect the bypassed part farther down to the lower part of the small intestine while the main part of the stomach will continue to make digestive juices. The bypass can also change gut hormones, bacteria, and suppress hunger by keeping satiated. This surgery is difficult to reverse. Some of the advantages of gastric bypass surgery are as follows:
a) Significant weight loss for longer period
b) Limits the amount food consumed
c) Conditions that increase energy consumed
d) Maintenance of excess weight loss
e) Makes person feel satiated and fuller
Apart from few advantages, gastric bypass surgery is more complex operation and can result in further complications. This also requires a restricted diet along with lifelong intake of vitamins and mineral supplements as gastric surgery can lead to long term vitamins/mineral deficiencies especially B12, folate, calcium and iron.
2. Sleeve Gastrectomy - surgeon will remove major part of the stomach leaving behind only a narrow banana shaped section of the upper part of the stomach that is closed with staples called gastric sleeve. The amount of food that can be fit in the stomach is reduced, making the patient feel more satiated sooner. This surgery has impact on gut hormones including hunger, satiety and blood sugar level. This surgery is quiet similar to gastric bypass surgery and effective in improving type 2 diabetes. Sleeve gastrectomy has some following advantages:
a) Limits the amount of food stomach can store.
b) Significant rapid weight loss
c) Requires no bypass or re-routing of the food path
d) Shorter stay at the hospital
e) Suppress hunger, appetite and keeps person satiated
This surgery is irreversible procedure and can cause long term vitamin deficiencies and early complications.
3. Laparoscopic adjustable gastric band – this surgery is performed using a laparoscope. The surgeon places a small band or a ring around the top of the patient’s stomach. The band has a small circular balloon inside filled with salt solution that controls how tight or lose the band is. Surgeon can adjust the size of the opening from the pouch to the rest of the patient’s stomach by injecting or removing the solution through a port (a small device) inserted under the patient’s skin. This band will restrict the amount of food in the stomach making the patient feel more satiated. Post surgery, patient may require several follow visits to adjust the size of the band opening and surgeon can also remove the band if it is not proving helpful in loosing enough weight or causing other problems.
4. Duodenal switch – is also known as biliopancreatic diversion with duodenal switch is more complicated than the other surgeries. This involves two separate operations. First surgery is similar to that of gastric sleeve surgery and in second surgery food is redirected to bypass most part of the small intestine. Surgeon will also reattach the bypassed part to the last section of the small intestine letting the digestives juices to mix with food. This can result in significant decrease in absorption of calories and nutrients. Similarly like in gastric bypass and sleeve gastrectomy, this surgery also affects gut hormones impacting hunger and blood sugar. This is the most effective surgery for controlling diabetes.
Patient needs to consult dietician, psychiatrists, psychologist and bariatric surgeon before undergoing the weight loss or bariatric surgery. Doctor will seek medical history of the patient, examine the patient physically and suggest few blood tests. Patient need to give up on smoking at least 6 weeks before the surgery and have to follow proper healthy diet recommended by dietitian. In some cases, patient need to lower their blood sugar level to normal and may also require to lose some weight that can cause problems related to surgery.
Patient may require a proper rest and medications or supplements like vitamins and minerals prescribed by doctors along with follow up visits. Moderate walking and movements as suggested by the doctor may help the patient to recover faster. The amount of weight loss after a bariatric surgery depends on person to person and the type of surgery performed.
Advanced Technology Treatement
Back pain is one of the most common health problems faced by a large number of people especially with increased weight, improper body mechanism, trauma, age and structural abnormalities leading to other symptoms such as leg pain, numbness or leg weakness. Generally, back pain can be treated with simple medications or physical therapy. But if the person is struggling with prolonged back pain and all other treatments fail to provide any relief from pain, doctors recommend surgery as a treatment option. Surgery is specifically considered in case of severe pain that occur from the problems like herniated disc, scoliosis or spinal stenosis. Conservatively, spine surgery is performed as open surgery that requires a large incision on the area to be treated so that surgeon can view and access the spine. But now, with the advancement in technology, spine problems can be treated with minimally invasive techniques which don’t require a long incision, can prevent damaging the muscles and tissues surrounding the spine, requires shorter operative time and faster recovery time.
Doctor will perform several tests for spine surgery such as CT scan, MRI, intra-operative fluoroscopy that enables surgeons to operate with a high level of precision and safety. Computer assisted image guidance allows surgeon to see inside the part to be treated with finer clarity than other traditional visualization techniques. Not all patients are good candidates for minimally invasive spine surgery procedures. There are different surgical approaches to access the spine such as:
• Anterior approach – the surgeon accesses the spine from the front of the body through the abdomen.
• Posterior approach – spine approached through the incision made in the back
• Lateral approach – approach to the spine made through the side of the body.
There are different kinds of spinal surgeries that the doctors may recommend after evaluating the medical conditions of the patient. Some common procedures include:
• Discectomy or Microdiscectomy – is used to treat the herniated disc in the vertebrae by removing all or part of the disc. A disc separates two vertebrae and if it herniated inwards it put pressure on the spinal nerves causing pain. Surgeon may have to make a large incision in the back to perform the surgery. Microdiscectomy is a minimally invasive spine surgery procedure.
• Laminectomy – this type of surgery is considered for the spinal conditions caused by spondylolistheis and stenosis. In this procedure, surgeon will remove parts of the bone, bone spurs or ligaments in the back to relive pressure on the spinal nerves and can ease pain or weakness. In some cases, it can make the spine less stable and required to perform in combination with spine fusion surgery.
• Laminotomy – in this procedure, a portion of the vertebral arch (lamina) that covers the spinal cord is removed. Laminotomy removes less bone than in a laminectomy. Both these procedures are decompression procedures in which a tissue compressing a spinal nerve is removed.
• Foraminotomy – this surgical procedure involves removing the tissues that compress the nerves in the back. During this, surgeon removes parts of the bone that constricts the nerves in the spine. Like a laminectomy, this procedure can make the spine less stable. Surgeon may require performing a spinal fusion surgery at the same time.
• Disc replacement – it is an alternative method to fusion and is not very common. In this, surgeon removes the injured or damaged disc and replaces it with an artificial disc between the vertebrae. This surgery let the patient continue to move his/her spine. Recovery time is also shorter but there is the slight risk of the new slip disc.
• Spinal fusion – a surgical technique that involves joining of the vertebrae that can result in restricted movements and limits stretching of nerves. Spinal fusion may include the use of bone graft (autograft or allograft) with or without instrumentation like rods, screws etc.
• Interlaminar implant – the surgeon implants a U-shaped device between two vertebrae in the lumbar spine (lower back) that helps in keeping the space open between the vertebrae and releases the pressure on the spinal nerves. This can be done along with a laminectomy. This procedure also provides stability in the spine and let the patient move their back more easily but may not be able to bend backward with much ease.
There are some risk and complications involved with the spine surgery:
• Reaction to anesthesia or any other drugs
• Unexpected bleeding
• Infection at surgery site
• Thrombophlebitis (Blood clots)
• Heart attack
• Herniated disc
• Damage to nerves that can cause weakness, paralysis, pain or loss of bowel or bladder control
• Lung problems
• Persistent pain
• Sexual dysfunction
Urology focuses on the diseases of male and female urinary tract (kidneys, ureters, adrenal glands, bladder and urethra) and male reproductive organs (testes, penis, scrotum, epididymis, vas deferens, seminal vesicles and prostate). Both urinary and reproductive tracts are closely linked to each other and disorders of one can affect the other. Urology problems can be managed with both non surgical treatment for medical conditions like urinary tract infections and benign prostatic hyperplasia and surgical treatment for conditions like bladder or prostate cancer, kidney stones, congenital abnormalities, traumatic injury etc. There are many advance techniques for treating urological problems such as minimally invasive robotic and laparoscopic surgery, laser assisted surgeries or scope guided surgeries performed by highly trained and experienced urologists.
Some urologists specialize in a particular type of urology problems such as:
• Female urology - focuses on medical conditions of a woman’s reproductive and urinary tract
• Male infertility - focuses on problems related to male reproductive organs
• Neurourology – focuses on conditions of the nervous system that leads to urinary problems.
• Pediatric urology - focuses on children’s urinary tract problems
• Urologic oncology - focuses on urinary cancers, including the bladder, kidneys, prostate, and testicles.
Other medical streams like oncology, nephrology, gynecology, andrology, pediatric surgery, colorectal surgery, gastroenterology and endocrinology are closely related to urology. The most common urologic surgical procedures includes nephrectomy, ureteral implants, ureteral stent replacement, cystoscopy, inguinal hernia repair, meatoplasty, scrotoplasty, laparoscopic varicocelectomy, radical prostatectomy, laser lithotripsy, laparoscopic urology etc.
Many people have a strong desire to start a family at some point during their lifetime. Most of the people achieve pregnancy within one year of trying but couples, who still cannot conceive even after many years of trying lose hope, feel dejected, or depressed. There are many reasons of infertility that may involve male, female or a combination of factors which includes problems with the production of sperms or eggs, structural or functional problems of male or female reproductive systems or hormonal and immune conditions. A fertility specialist may conduct some fertility tests to know what exactly the current condition is, explore all the options and help couple conceive sooner.
A vascular disease affects the arteries and veins by damaging the valves in the veins or by affecting the blood flow wither by blocking or weakening blood vessels. Other body structures and organs may be damaged by vascular disease as a result of decreased or completely blocked blood flow. Some of the causes of vascular disease include:• Trauma or injury – inflammation or infection in blood vessels can cause damage to them and may lead to blockage or narrowing of blood vessels. • Genetic – some vascular diseases are inherited by the family. • Blood clots – an embolus or a thrombus can block the blood vessels. • Inflammation – vasculitis is an inflammation of blood vessels that may include various disorders. Inflammation can also cause narrowing and blockage of blood vessels. • Atherosclerosis – atherosclerosis occur when fatty deposits buildup along the innermost layer of the arteries. It is most common cause of vascular disease and is a slow and progressive that may start since childhood. Vascular surgery is one of the treatment procedures for the diseases of the vascular system, or arteries, veins and lymphatic circulation that cannot be treated by less invasive, non-surgical treatments. Blood clots, arteriosclerosis and vascular conditions occurring in the arteries are known as arterial disease. Veins diseases and problems are known as venous diseases. Some vascular diseases occur in arteries, other in veins and some affect both veins and arteries. Vascular diseases are very common in older age. It is not easy to detect the symptoms of the vascular diseases in the early stages. Some of the factors that increase the chances of vascular diseases may include:• Genetic or family history of heart and vascular disease• Excessive smoking• Over weight• Any illness, injury or trauma• Pregnancy• Inactive lifestyle• Old age• Conditions affecting cardiovascular system such as hypertension, diabetes, high cholesterol etc.Balloon angioplasty, aortic and peripheral vascular endovascular grafting, thrombolysis, stenting are some of the techniques used in vascular surgeries. Some common diseases affects the arteries are peripheral vascular disease (PVD), carotid artery disease, and aortic aneurysms (AAA). Surgeries are done to treat atherosclerosis to prevent heart attacks and strokes, to relieve hypertension, remove aneurysms, repairing, bypassing or replacing the artery to prevent amputation.