Although surgery is considered to be the first step of treatment in any form of tumor, but its feasibility depends upon the type, size and location of the tumor. It is not necessary that every kind of brain tumor might require surgery.

Indications of Brain Tumor Surgery
- Diagnosis of the type of tumor by taking a sample of the tumor for laboratory examination
- Complete resection of tumor
- Removal of the tumor as much as possible to slow down its growth and improve the symptoms
- Remove the tumor in order to help other treatment
- Provide direct access for other forms of treatment like chemotherapy, radiotherapy etc.
- To relieve pressure caused by tumor on surrounding structures

Types of Brain Tumor Surgery
The different types of surgery that are performed in cases of brain tumor include the following:

Craniotomy: Craniotomy is the most commonly performed procedure to remove brain tumor along with a piece of bone. The removed bone is replaced and the tumor is sent for histopathology (biopsy). The surgery is performed using a high end microscope by any of the following techniques:
- Extended bifrontal craniotomy
- "Eyebrow" craniotomy (supraorbital craniotomy)
- "Keyhole" craniotomy (retro-sigmoid craniotomy)
- Orbitozygomatic craniotomy
- Translabyrinthine craniotomy

Shunt: A narrow piece of flexible tube with a pressure regulated valve in between is called a shunt. This is used to relieve the intracranial pressure caused by obstruction of the natural brain fluid, Cerebrospinal fluid (CSF) pathway by tumor mass. The procedure involves insertion of a drainage system into the brain to remove or drain excess of blocked fluid into the peritoneal cavity.

Stereotactic surgery: This surgery is done by creating a three dimensional image called stereotaxy using computers. It aims to find out the location and position of the tumor. In fact it can also be done to aid tumor removal, implant radiation pellets or for other treatments.

Embolization: It is a procedure used to reduce the amount of blood supply to a tumor by blocking the blood flow in the selected arteries. It is generally performed before the main surgery.

Endoscopy and endoscope assisted surgery: Endoscope is a tool, which helps to closely visualize the tissue through small openings in difficult to reach areas. This tool can be used in various brain surgeries to precisely reach the target location without damaging the adjacent structures.

Adjuvant modalities to improve outcome: In addition to above mentioned surgeries, following surgeries may also be performed in relation to brain tumor treatment:
- Laser surgery
- Photodynamic laser surgery
- Ultrasonic aspiration
- Fluorescence guided surgery (FGS)
- Electrophysiological monitoring

Brain Tumor Surgery

Study of the brain has fascinated specialists all over the globe since time immemorial. The brain being the most vital organ for survival and coordination is perhaps the most complex of them all too. This has led to a limited understanding of its working in spite of the available advanced technology. However, with the advent of techniques for diagnosis and treatment, therapeutic strategies are evolving. This is a major step towards rendering Neurosurgery safer than ever in the history of mankind.

Neurosurgery through the 20th Century-

During the beginning of the 20th century, Neurosurgery was considered as a specialty. The clinical-neurologist would draw conclusions related to lesions in the brain through neurological examination and clinical history. It enabled diagnosis of vascular lesions, spinal disorders, and brain tumors. During the second and third decades of the 20th century, vascular pathologies and brain tumors could be diagnosed indirectly through techniques like angiography, ventriculography, and pneumoencephalography. But since the operative techniques were too crude and the lack of skilled professionals were rampant, there were high rates of morbidity and mortality due to neurological conditions. Generally, after diagnosing the nature of brain lesion and its site, surgery was performed with inadequate maintenance and control of intracranial pressure and through not too sophisticated surgical instruments.

During the fifth and sixth decades of the 20th century, chemotherapy and radiation treatment came into the picture for treating malignant brain tumors, thereby reducing mortality to a good extent.

During the seventh decade of the 20th century, Computed Tomography (CT) scan provided a better understanding of the location of lesions in the brain which slightly substantiated the earlier techniques. Then, the procedures for cerebrospinal fluid diversion significantly improved management of intracranial pressure during surgery.

It was only during the last decade of the 20th century that the Neurology saw a giant progressive leap through the introduction of Magnetic Resonance Imaging (MRI) and powerful high magnification microscopes. Combined with Neuroanesthesia and Intracranial Pressure Management, this aided surgeons to work on a relaxed brain. This promoted safe removal of the brain tumor and better management of vascular lesions. Moreover, the understanding of micro-surgical anatomy improved drastically, leading to a boost in confidence levels of the micro-neurosurgeons performing the operation.

Neurosurgery in the 21st Century-

The 21st century is actually a revolutionary era that uses powerful computers in almost all the fields possible. Computer-based applications such as Neuro-imaging, Neuronavigation, Intra-operative Neuro-monitoring, and Neuro-modulation are now used in standard neurosurgical practice as a part of the routine. Extremely powerful CT scans and MRIs are used for diagnosis before surgery. The advent of nanotechnology and its application in Neurosurgery is doing great and has a promising future ahead based on the current study of scenarios. Moreover, there is a possibility of most of the Neurosurgical procedures becoming minimally invasive. Frameless Stereotaxy is another technique that helps in locating the exact position of the tumor, which further helps the neurosurgeon in navigating with great precision the very sensitive, high-risk areas of the brain. Such techniques, to a great extent, have lowered mortality and morbidity, lessened the rate of recovery, and chances of infection related to Neurosurgery.

Take Away-

A number of techniques for diagnosis and precise location of the tumor in the brain have made Neurosurgery much safer today, due to advancement in science and technology, than it ever had been in the history of mankind.

Advancements In Neurosurgery - Know How Safe It Is!

Sleep-Wake Disorder is a very uncommon syndrome which causes irregular sleeping patterns without any real schedule.

Causes
Persons with brain malfunctioning and those who do not have a regular routine during the day experience such disorders. People with changing work shifts often experience such disorder. Also, travellers who often move from one country to another with different time zones may also have these symptoms.
There's no cure for this disorder, but treatments, including hormones, medicine, and light therapy, can help get you closer to a normal sleeping pattern.

Symptoms

Symptoms may include any of the following:

Sleeping or napping more than usual during the day
Trouble falling asleep and staying asleep at night
Waking up often during the night
Exams and Tests
A person must have at least three abnormal sleep-wake episodes during a 24-hour period to be diagnosed with this problem. The time between each such episode varies from 1 to 4 hours. The doctor may advise you to go ahead with a device called actigraph in case the diagnosis is unclear. The device looks like a wristwatch, and it can tell when a person is sleeping or awake.

Treatment
Though there is no simple cure for irregular sleep-wake syndrome, however, several therapies and lifestyle changes may help a person return to a normal sleep-wake cycle. These include:

A regular daytime schedule of activities and mealtimes need to be fixed.
You should not stay in bed during the day for long.
Use bright light therapy in the morning like those from computer screens and television. The period of exposure should also be increased. Exposure to blue light should be minimized at night.
You should take melatonin at bedtime. This is a hormone that controls the sleep-wake cycle. By taking doses at the right times, you might be able to shift your body clock earlier or later.
Make sure to make the room dark, quiet, and as comfortable as possible at night.
Also one should try to minimize the amount of noise in the sleep environment.
Add more structure to the patient s day by scheduling social interaction, exercise, and other activities.
Your doctor may prescribe drug to control the timing of the sleep-wake cycle.
Finally, you should take proper care of yourself. Make positive changes in your lifestyle. You can even ask your boss to make your work schedule a bit flexible.

The ultimate goal of these lifestyle changes is to help the person sleep longer at night and make him feel active and awake during the day. Most people have sleep disturbances on occasion. But you need to see your doctor if such sleep disorders occur regularly.


Sleep Wake Disorder - Irregular Sleeping Patterns

Sleep disorder is a serious problem which a large number of people are facing due to multiple reasons. Almost every other person complains of having some sort of sleep disorder, irrespective of his/her age. Sleep disorders may come across as something which can be overlooked, but this shouldn t be the case, as when the problem aggravates it can take quite a scary turn. You need to be aware of the different kinds of sleep disorders which affect a vast number of people, on a daily basis. Given below are some of the most common ones which affect the majority of the crowd.

1. Insomnia
Insomnia, a worldwide epidemic, is the most common type of sleep disorder today. A number of factors can cause insomnia and affect even the healthiest being. From stress, anxiety or depression, substance and alcohol abuse to certain types of medication, a lot of factors can cause this issue. People who have insomnia have difficulty in sleeping and then maintaining that sleep. A cognitive behavioral therapy can help people suffering from this disorder. Often medications are also prescribed.

2. Sleep Apnea
If you have a partial or complete blockage of the throat then, you might be suffering from sleep apnea. This disorder is the second most prevailing sleep disorder in the world today. People who suffer from this disorder hardly realize it until someone informs them about having the trouble. Some of the common symptoms of Sleep apnea are morning headaches, daytime sleepiness, and excessively loud snoring as well. People suffering from apnea may also face trouble breathing multiple times per night. Continuous Positive Airway Pressure machine is a common treatment for this disorder.

3. RLS or Restless Leg Syndrome
The real reason behind RLS is still not known by experts, however, most believe the real cause of the disorder is hereditary. Some medications can also be a cause of restless leg syndrome. In this disorder, an urge to move your legs and hands precedes the need to sleep. RLS usually occurs when the patient is resting. In order to treat the restless leg syndrome, one must reduce the consumption of alcohol and caffeine along with doing regular exercises. For more severe cases, often medications are prescribed. RLS is observed more in women than in men.

4. Narcolepsy
People with narcolepsy often complain about falling asleep during odd times and feeling weak quite often. An abnormality in the brain is usually the reason behind this sleep disorder. Patients of narcolepsy often develop cataplexy which is a condition where patients feel faintish as an emotional reaction to any situation. People suffering from narcolepsy are given medications as a treatment.


4 Most Common Sleep Disorders


Autism is defined as a neurobiological pervasive development disorder that includes lack of social skills and inability to reciprocate to social interactions. The patient may also have intellectual and cognitive deficits and problems in communication (verbal as well as non-verbal).

Ayurveda is the oldest study of medicine and has proved to be very effective when it comes to managing and treating those affected by autism. The earlier an autistic person resorts to ayurveda, the more effective it is.

Ayurvedic drink recipe for treating the symptoms of autism: (should be taken daily)
1.1/3 cup of yogurt
2.3/4 cup of water
3. Cumin
4. Coriander and
5. Ginger
Or
Diluted fresh pomegranate juice

Ayurveda in curbing aggression:
Autism includes heightened aggression and aversion from social interaction due to a neurological condition that impairs the functioning of the brain. Not all autistic patients are violent towards others, but may express their frustration by self-harm and emotional outbursts. One can curb these emotional outbursts by taking herbal supplements. An ayurvedic herb called brahmi (bacopa monnieri) which is known for its, anti-anxiety, neuroprotection and antioxidant properties can help considerably.

Regular massages using sandalwood, rose, lavender and gotu kola oils are also very calming and relieving, because it stimulates the blood flow and neuronal responses. Massage also helps in increasing eye contact and social relatedness, less stereotypical behavior and improved sleep.

Ayurvedic herbs for autism:
1. Brahmi- scientifically known as bacopa monnieri, brahmi is an important herb that delays the process of forgetting and improves memory. Not only does brahmi improve memory, but also increases the grasping power, intellect and speech and also corrects the abnormality of emotions, personality and mood of an autistic individual. It also helps in performing complex tasks such as comprehension, reasoning and learning.

2. Ashwagandha- scientifically known as withania somnifera, ashwagandha has high affinity for gamma aminobutyric acid (gaba) receptors. Low gaba activity is related to cognitive impairment.

3. Shankhapushpi- scientifically known as convolvulus pluricaulis, shankhapushpi is very effective in improving learning and memory and is highly effective in treating insanity and epilepsy. 

4. Centella asiatica- this ayurvedic herb is used as a medication for insanity, speech disorders and epilepsy, making it a very useful drug for treating autism.

Top 5 Ayurvedic Medicine for Autism Treatment

A neurological disorder is characterized by sudden recurrent episodes of sensory disturbance, loss of consciousness, and convulsions associated with abnormal electrical activity in the brain.

Role of Physiotherapy in Epilepsy

It helps improve strength, mobility, and increases the range of motion and sphere of movement.
It helps improve sensory awareness, response, balance, and coordination.
It helps to improve quality of movement and physical performance.
The Goals of Physiotherapy

To develop strength enough to support one s head upright
To have balance and motor control to maintain their trunk at midline
To use many different muscle groups
To assist necessary motion in their trunk and extremities
The physiotherapists write short-term goals for each of the items on the problem list that need to be covered to help the patient achieve the long-term goals
To understand what the patient is good at and does well
To focus on what he or she capable of doing rather than on what they can t do
To educate and provide awareness with a view to prevent injury. For example, advice on special swimming equipment to prevent drowning if he/she gets seizures in the pool
Physiotherapy treatment for a healed fracture consists of strengthening muscles that have got weak from being immobilized and stretching muscles that are stiff owing to being in the cast for a long period of time.

Physical exercise improves fitness, energy, and mood and even relieves stress. Improving overall health and wellbeing in this way can help reduce seizures. It can also help people feel more in control of their health. It also helps release  feel good  hormones into the brain, helps keep the muscles active, reduces fat levels in the body, and increases oxygen flow to the brain. It can also increase the bone density. A research showed that regular sessions of aerobic exercise (for example running, walking, swimming, cycling) for 60 minutes, twice a week, for 15 weeks resulted in a significant reduction in the number of seizures they had.

Drink water, diluted fruit juice, or squash while exercising to help replace the fluids and body. Do not exercise straight after a meal.

Team sports or group activities such as walking or gardening groups can also be a good way of increasing self-confidence. Making new friends may help with any feelings of isolation. Most sports, including contact sports like football, hockey, basketball and rugby, have not shown to increase the chance of someone having a seizure, but contact sports come with an increased risk of head injuries, which could affect people with a history of epilepsy. Protective sports headgear helps to reduce this risk. 

Role Of Physiotherapy In Treating Epilepsy!

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