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!

Migraine headache is characterized by a severe headache usually affecting one side of the head. There are other symptoms along with headache like nausea/vomiting, sensitivity to light and sound. Some patients experience neurological phenomena like changes in vision, temporary loss of sensation and altered sensation, a phenomenon known as an aura (flashes of light, zigzag patterns, bright spots, tingling in the arms and the legs). Migraine headache can last for 2 to 3 days. 

Symptoms: The symptoms depend on the stage of a migraine attack. The stages of a migraine attack can be: 

Prodrome, Aura, Headache or attack, and Postdrome. 
Prodorme: One to two days prior to the migraine attack, patient may experience; 
Mood swings. 
Cravings for food. 
Increased yawning. 
Stiff neck. 
Constipation and frequent thirst and urination. 
In case of an aura (during or before a migraine), there may be visual, motor, speech, and sensory illusions and disturbances such as, 

Loss of vision. 
A strange sensation of needles pricking an arm or a leg. 
One side of the body becomes weak and numb. 
There are visual illusions such as the appearance of flashes of light, zigzag patterns, bright spots. 
There is a problem in hearing and speaking. 
In some cases, there may be a hemiplegic migraine (the limb becomes weak). 
During a Migraine Attack (lasts for 4 to 72 hours), there may be 

A throbbing pain on either one or both sides of the head 
Blurred vision, light-headedness. 
Nausea and vomiting 
Sensitivity to light and sound 
Sensitivity to touch and smell (though rare) 
In Postdrome (after a migraine), there can be 

Mood swings. 
A person may be sensitive to light and sound. 
Dizziness and weakness 
Confusion 
Extreme fatigue 
An amalgamation of environmental and genetic factors may be responsible for a migraine. Trigger varies for each patient: 

Stress and extreme physical exertion 
Obesity 
Alcohol and caffeinated drinks and beverages 
Salty and processed foods 
Altered sleeping habits 
Hormonal alterations in women (Constant fluctuation in the level of oestrogen) 
Oral contraceptives and certain vasodilators (nitroglycerin) 
Preservatives like MSG (monosodium glutamate) and Aspartame (sweetener) 
Sunshine, certain odours, travel, etc can trigger migraine. 
Treatment and Prevention: 

Medicines under supervision to abort an attack of migraine and special drugs to stop attacks. 
Lifestyle changes are helpful to decrease attacks: 
Avoid your trigger for migraine. 
Follow regular sleep -wake cycle. 
Regular exercise, meditation. 
Avoidance of alcohol, caffeine containing beverages. 
Other treatment options that can be availed from pain specialist: 
Transcutaneous supraorbital nerve stimulation 
Intramuscular stimulation. 
Botulinum toxin injection. 
Occipital nerve block.

Migraine Pain - Facts About It!

Cochlear Implant is an electronic device replaced with the inner ear (cochlea) of the patients who are unable to send sound waves to the brain.

The surgery is performed on the patients who have the problem of hearing loss due to the damaged hair cells in the inner ears. The implant helps the patient to hear which are not responding to other hearing aids.

Conditions for Cochlear Implant:

Cochlear implants help people to hear with clarity. They are not like hearing aids, which make the sound louder, but it helps send sound waves to the brain and replaces the damaged hair cells in the inner ear. Following are cases where it is beneficial:

People who find it difficult to hear clearly with hearing aids.

Those with moderate hearing loss in both ears.

Patients with 50% or fewer score in the sentence recognition test.

Patients with 60% or less score in sentence recognition test with hearing aids on.

It is suggested to opt for cochlear implants in both ears. The reason is to give the patient a better perspective of sound direction and clarity in understanding the words.

How does the Cochlear Implant work?

Cochlear Implant is an electronic device with an embedded sound processor that has to be worn outside ears or on the body. Following steps are involved in cochlear implant:

The sound captured by the processor is converted digitally by the processor and sent to the coil inside the ears of the patient.

The implant converts digitally coded sound waves to electrical impulses.

The electric impulse simulates the hearing nerve of the patient.

Then sends these impulses to the brain.

Benefits of Cochlear Implants:

The cochlear implant is a blessing for people who have been suffering from hearing loss for a very long time. It provides aid to people who have not benefited from hearing devices. The benefits of the cochlear implant are:

Hear better.

Studies have shown that people with cochlear implants have better sentence recognition scores instead of hearing aids.

The patient can concentrate better in the crowd and can hear conversations across the table.

Reconnect with the missed sounds.

Enjoy music on the phone.

Cochlear Implant improves the quality of life of people with hearing loss. It gives them an aid to understand and engage themselves in a conversation. However, it takes time to learn the interpretation of the sound signals that are received from cochlear implants. But, the patient can learn and lead a normal life with the implant. The factors which affect the benefits of Cochlear implants are:

The extent of hearing loss

The duration of the hearing loss and the condition before implantation

Damage to inner hair cells

Other health issues

The practice and rehabilitation time have been done in practice after implantation

The cochlear implant is performed in the patients after taking extensive tests determining the condition of the patients. It is activated after 2-6 weeks of surgery to give the surgery site a time to heal. Most people are discharged from the hospital after surgery and are prepared for the use of an implant. There are training sessions and classes for patients who have just gone for cochlear implants.

Cochlear Implant - How Do They Help?

Hearing is one of the five senses that you or anyone else relies on for communication and a whole host of other things. Among the five senses, touch, smell, taste, hearing and sight, it is often hearing, which is the most easily affected. You don't have to be a senior citizen to experience hearing loss as it is quite common among younger people as well. This problem is also getting widespread with each passing day.

Before coping with hearing loss, the first job is to detect it
If you have a hunch that you or any of your loved ones is suffering from hearing loss, it is important that you get it diagnosed. Some of the common symptoms of hearing loss will be:

 Hearing difficulties while talking to someone over the phone
 Straining to hear conversations with family members or friends in household situations 
 People usually need to repeat what they talk to you with a louder voice
 You often hear complaints that you keep the tv too loud.
 In crowded situations, such as family gatherings or a restaurant, you have problems listening to people.

Although this condition tends to affect senior citizens, an increasing trend shows younger people i. E. People mostly in their 40 and 50s and even younger than that suffer from this condition.

How to deal with hearing loss?
Some of the options to deal with hearing loss are mentioned below.

 Once diagnosed with hearing problems, change your ways of communication: if you or your loved ones have been diagnosed with hearing problems, it is important that both adjust your ways to deal with the problem. Rather than getting angry at the other for not being able to communicate effectively, develop and strategize ways to make communication less problematic and erratic.
 Cochlear implants: this is a newer technology, which has gained popularity in the past decade or so. These are directly implanted into the inner ear and are designed to bypass the damaged areas of the ear and directly stimulate the auditory nerve. These have become very popular, although, are not a replacement of natural hearing. It is only prescribed for people who have severe hearing loss or are deaf.
 Hearing aids: although selecting a hearing aid is difficult as the patient needs to be comfortable, once selected it is one of the best solutions for the hearing impaired. The functionality of these devices can be extended with the hearing assistive technology or hat devices that can focus the audio waves depending on the situations and give a more tailored approach for every individual's needs.

Dealing With Hearing Loss

Insomnia is a disorder where a person has difficulty sleeping. One can have problem falling asleep or staying asleep for long. Some people also have disturbed sleep. This can be a major problem as due to lack of sleep one feels tired and fatigued all day.

Recurring cases of insomnia hamper your daily activities and interfere with the smooth functioning of your life. Therefore, this condition should not be ignored and treated immediately.

Here are the various ways to treat insomnia:
Non-Medical (Cognitive and Behavioral treatment)
Several psychological and behavioral techniques can be used for the treatment of insomnia. Many of these methods can be easily self-taught and others require a therapist to be carried out properly. 

1. Relaxation training, which is also called progressive muscle relaxation involves the patient to tense and relax his muscles systematically in various parts or regions of the body. Relaxation techniques, such as breathing exercises, various forms of meditation, mindfulness and guided imagery are used for treating insomnia people. The use of audio recordings for guidance in these techniques is quite popular.

2. Stimulus control enables building an association between the bedroom and sleep. This is done by limiting several kinds of activities done in a bedroom. This may include going to bed only when very sleepy and leaving bed if you cannot sleep within twenty minutes. A strict bedtime and wake up time schedule has to be maintained.

3. Cognitive behavioral therapy or CBT involves changes in behavior like maintaining a strict sleep time schedule, elimination of afternoon naps and other habits related to sleep. A cognitive component is also added to this method. Unhealthy beliefs and fear regarding sleep are challenged and positive, rational thinking is encouraged. CBT is a very effective procedure for treating insomnia and the track record regarding success is high.

4. Changes in lifestyle are required to treat insomnia and prevent recurrence of insomnia, you should change certain habits and start some new practices. You should limit your intake of caffeine, alcohol and nicotine. Do not consume coffee or tea before going to sleep and avoid smoking. The habits may be stimulating and will keep you awake. Your diet should be balanced. You should avoid having rich and spicy food before going to bed. Avoid late meals and maintain a proper schedule for meals. Regular exercise can improve the symptoms of insomnia and you should try to work out every day.

Medical Treatment
There are many forms of medicines, which can treat insomnia. This includes over-the-counter medicines, as well as prescribed medicines. The type of medicine required completely depends on the severity and symptoms of your insomnia and other factors related to health. Therefore, you must consult a doctor before having any kind of medicine for treating insomnia.

The most common medicines for insomnia, which are usually prescribed by doctors are benzodiazepine hypnotics, non-benzodiazepine hypnotics and melatonin receptor agonists. However, medicines should only be taken after consulting with a specialist. Insomnia not only affects your health but also interferes with all your daily activities. Proper treatment should be taken to treat the same.

Ways to Treat Insomnia

The most powerful and amazing organ in our body is the brain. It differs from many other organs of our body not only by its shape, but also by its special type of cell called neurons. When these cells gets affected or dead it can never be reverted or regenerated which is the most exclusive nature found only in brain cells. The cells in other parts of our body has the capacity to regenerate (can be replaced or new one can be grown or produced), but brain cells are exception. Hence any damage to the brain, injury or trauma is really a crucial thing to be considered with utmost care.

Brain surgeries really need skill, proper training, confidence and intelligence to perform this highly complicated and risky surgery.

Purpose:
Brain surgeries are performed to:

Remove the brain tissues that are grown abnormally
Aneurysm is clipped to prevent flow of blood cliff off an aneurysm
Biopsy purpose or to remove the tumour
Make a nerve free
Drain the abnormal blood or clot collection or to drain any excessive fluid collection caused by infection.
To implant artificial electronic device as a treatment for conditions like Parkinson's disease
Types:

Biopsy: A part of brain tissue is removed for the brain or whole tumour is removed.
Craniotomy: The skull bone is opened to remove tumour, an aneurysm and drain fluid or blood from infection.
Minimally invasive endonasal endoscopic surgery: Endoscopic devices are inserted through the nose to remove the lesions or tumour.
Minimally invasive neuroendoscopy: Similar to endonasal surgery but small incision is made.
Risks:

Anaesthesia risks like breathing difficulty, allergic reaction to medications, excessive bleeding or clots and infection.
Risk related to the brain surgeries are seizures, coma, swelling of brain, infection to brain or meanings, surgical wound infection that intrudes to the brain structures, abnormal clot formation and bleeding.
General risks include muscle weakness, disturbances in memory, speech, vision, coordination, balance and other functions that are controlled by the brain.

Brain Surgery - Know The Purpose Behind It!

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