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!

If you are being treated for Parkinson's disease. How can you maximize the effect of Levodopa? The effect of levodopa can be maximized by increasing its absorption from the digestive system. In particular, taking levodopa on an empty stomach is very important. 

Take on an empty stomach: Do not eat anything 1 hour before taking levodopa. Do not eat anything for at least 30 minutes and if possible 1 hour after taking it. Take the pill with 2 glasses of water so that it can dissolve. If taking the levodopa on an empty stomach makes you nauseous, confirm that your medication has the right amount of carbidopa in relation to the levodopa (25%). If you continue to feel nauseous, you can eat a piece of white bread around the time that you take levodopa. Do not apply any butter, yogurt, cheese or similar high protein spreads. Protein can drastically decrease the absorption of levodopa. 
Get your constipation treated: This is critically important too. Being constipated can slow down the passage of levodopa through the digestive system. In most patients, drinking adequate water and taking stool softeners is helpful. 
Get your ulcer treated: It can be difficult to recognize that you have a gastric ulcer. However, if you have a burning sensation in your stomach at any time, or belch frequently, you may have a gastric ulcer. If you think you have an ulcer you should get tested (there is a simple breath test now) and treated with antibiotics (not antacids!) 
Do not take levodopa with iron tablets: The iron binds to levodopa and prevents its absorption. Keep a gap of at least two hours between these two medications. 
Try taking levodopa with orange juice and carbonated water (soda): Mix equal quantities of orange juice and carbonated water (soda). Take your regular levodopa with a glass of this preparation instead of water. The carbonated water hastens disintegration of the tablet, and the acidity of both things helps in levodopa absorption. There are special tablets of levodopa (dispersible levodopa, Madopar) which can be dissolved in this preparation. Talk to your doctor about it.

Suffering From Parkinson's Disease - How You Can Maximise The Effect Of Levodopa? 

Cerebral palsy refers to a medical condition where a child suffers from certain disabilities as a result of damage caused to his or her brain during or before birth. If a child is diagnosed with cerebral palsy then he or she may experience problem with body movement and brain development may also get affected. Along with difficulties in body movements, there are many other problems that he or she may encounter, such as difficulties in hearing or vision, intellectual disabilities, learning disorder, impaired speech and seizure problems, etc.

There are many causes responsible for cerebral palsy; they are stated as follows

If the brain of the child is deprived of oxygen during birth
Premature birth
Severe head injury
A brain infection
Regular exercises and physiotherapy can help the child to cope up with the condition better. Following are few exercises which may prove to be helpful:

Joint exercises: Joint exercises will help a C.P. child to increase flexibility.
Muscle exercises: Muscle exercises can help to get rid of muscle tightness which is a common disorder seen in a C.P. child.
Stretching exercises: Stretching exercises can prove to be very helpful in dealing with the problem of body movement which is one of the most potent symptoms observed in a C.P child.
Balancing exercises: Balancing exercises can help the C.P. child to improve his or her balance.
Spine stabilization exercises: Exercising the upper and lower part of the spine can help the C.P. child to strengthen his or her spine which will in turn, help him or her to improve balance.
Wrist and knee exercises: Wrist and knee exercises work on the affected wrists and knees, thus improving flexibility and bettering body motions.
Swimming exercise: Swimming, as an exercise, involves the movement of many muscles and joints. It can thus help to improve body movement disorder.
Exercises with proper assistance can prove to be very beneficial for a child suffering from cerebral palsy.

Cerebral Palsy - Exercises That Can Help Your Child!

Living with epilepsy can be highly challenging. This is a medical condition that can be controlled with medications in most cases, but it might not be useful for all patients due to severe side effects. It is estimated that up to 30% people who have epilepsy face this issue, and in such cases, surgery might be considered as an option.

This condition typically results in seizures which is a result of sudden electrical activity in the brain. So, certain complicated epilepsy operations on the brain can help patients with their seizures and contain their symptoms.

The goal of epilepsy surgeries involves removing part of the brain that causes these seizures and disrupting parts of the nervous system in the brain that contribute to the same. The procedure also involves the installation of a device that helps control the side effects of epilepsy.

When is surgery not an option for epilepsy?
Doctors would accurately identify the part of the brain that is causing seizures as the first step. These parts are known in medical terms as the  seizure  focus. This area should not be related critical functions of the brain like movement, sensation, and language involved   else surgery would not be possible.

Surgery is not viable when seizures are severe and impair bodily movement or if the patient has serious medical conditions (like cancer or heart diseases).

Common Surgery Options Available

Lesionectomy: This is one of the most commonly used procedures. This form of surgery involves the surgeon removing brain lesions from the brain or areas of injury due to malformed blood vessels or tumors. These injuries can often cause seizures and epilepsy and can be treated effectively with lesionectomy.
Lobe resection: This is another form of treatment which is possible only if the epilepsy is located in one of the four parts of the brain   the temporal lobe. It is quite common in younger people and can easily be treated by expert neurosurgeons by removing the brain tissues that are causing epilepsy.
Multiple Subpial Transections: While the above methods involve cutting out brain tissues, sometimes such surgeries just might not be possible due to other complications. If the parts of the brain cannot be cut out, surgeons tend to adopt Multiple Subpial Transections. This procedure can help control seizures without requiring cutting out parts of the brain. Small intersections are made in the brain to disrupt the impulses from affected brain cells that cause seizures, and they do not affect normal brain activity. It helps leave all abilities intact in patients and aids in treatment very effectively.
So, if you are just fed up with dealing with the seizures, consult your doctor who will be able to advise on the course of action depending on the history and medical condition.

Epilepsy - Is Surgery An Option?

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

We're all guilty of making fun of snorers, but sometimes this snoring can be a symptom of sleep apnea. Sleep apnea is a condition where breathing is not continuous and may start and stop many times while asleep. This affects the quality of your sleep and in turn can affect many aspects of your health including your cardiovascular health. Here's how:

High blood pressure
When a sleep apnea patient's breathing stops, the oxygen levels in the blood also suddenly fall. This can increase your blood pressure. High blood pressure means that the heart muscles need to work harder to pump blood through the body.

Cardiomyopathy
As a result of high blood pressure, the heart walls may become thicker and the heart muscles become stiffer. This is known as cardiomyopathy. As this condition worsens, the heart becomes weaker and is unable to maintain a regular rhythm. This can eventually lead to heart failure.

Arrhythmia
An irregular heartbeat is also known as arrhythmia. This may also be related to the changes in the heart's structure that follow the drop in blood oxygen levels. In many cases, arrhythmia has no visible symptoms and can often go undiagnosed. This can result in the formation of blood clots in the atria which can lead to a stroke.

Sleep apnea is easy to diagnose. If the doctor feels that you show symptoms of sleep apnea, you may be asked to stay on the hospital overnight and undergo a sleep evaluation. This tests a variety of body functions including brain activity, eye movements, heart rate, breathing patterns and blood oxygen levels.

Treatment for sleep apnea depends on the causes for this condition. If you are overweight, regular exercise and a change in diet can help you lose the excess weight and cure sleep apnea. Similarly, if your sleep apnea is triggered by an allergy, treating the allergy can help cure the sleep apnea. Other forms of treatment for sleep apnea may include:

Continuous positive airway pressure (cpap)
This is a machine which pumps air into the body through a nasal mask. By keeping the pressure in the machine higher than normal air pressure the upper airway passages are kept open and hence the quality of your sleep is improved. An auto cpap machine can modulate the air pressure such that it is higher when you inhale and lower when you exhale.;

Oral devices
Your doctor may suggest oral devices that allow you to keep your mouth open while you sleep. This is easier to use than cpap machine but less effective. Surgery is the last resort when it comes to treatment for sleep apnea.

Sleep Apnea and Its Link to Heart Failure

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