The human skull is composed of several plates and pieces of bones. The roof of the skull is the top of your head. The base of the skull is, however, a complex area. It consists of 5 bones. These bones are also linked to your eye socket, the cavity of the nose, the sinuses and the bones of the inner ear. Surgery through the skull base can be quite complicated as quite a few nerves, blood vessels and opening of the spinal cord pass through this region.

When does Endoscopic Skull Based Surgery become necessary?
An endoscopic skull based surgery is performed to remove tumours of the brain. The tumour might be benign or malignant - this procedure is effective against both. This surgery can also be performed to cure any abnormality on the underside of the brain, the upper vertebrae of the spinal cord or the base of the skull.

Other conditions that may necessitate an endoscopic skull base surgery are -
  Cysts in the brain
  Swelling caused by infections
  Pituitary tumours
  Meningioma
  Chordomas
  Trigeminal neuralgia
  Cerebrospinal fluid fistulas
  Cerebral aneurysm

What to expect during this Surgery?
Since the base of the skull is a complicated region, surgery requires a delicate approach. That is why endoscopy is used. It is a minimally invasive procedure.
Right before the surgery, you will be put under general anaesthesia. Your skull has two natural openings- the nose and the mouth. Usually, the surgeon inserts the minute surgical instruments through the nose or the mouth. Sometimes, a tiny hole is drilled right above the eyebrows. A tiny camera mounted on a lighted tube will be led into your brain through the cavity that will send a live feed from the inside. This will direct the surgeons who will gently remove the growth or fix the abnormalities.
A team of doctors with different specializations such as ENT, radiology, neurosurgery come together to perform this surgery.

Complementary Procedures -
Depending on the kind of tumour being removed or the stage it was detected in, you might have to undergo any of the following in addition to endoscopic surgery-
  Chemotherapy
  Radiation
  Particle Therapy
  Proton Beam Therapy

Post Surgery Care -
After the surgery, you will have to stay in the clinic or hospital for a number of days where your progress will be constantly monitored. You will require therapy and undergo MRI scans.
Endoscopic skull base surgery is very effective in dealing with tumours and abnormalities of the brain or the upper spinal cord. Keep your family and friends around you during the recovery phase as their love and support will help you get back to your normal lifestyle in no time.

Know More About Endoscopic Skull Base Surgery Through Brain!

Chemotherapy has been the remedy for cancer since the late 90s. But in today s world the medical field has been improved so much that new methods have been invented. One of them is Hormonal therapy. It is used to cure some types of breast cancer that are affected by hormones. Receptor proteins in the breast cancer cells attach to estrogen and help the cells grow. This therapy stops the receptors attaching to estrogen in various ways.

When it is used?
Hormonal breast cancer therapy is performed after surgery to prevent the cancer from coming back. It is also applied to treat the cancer that has come back or to prevent the cancer from spreading to other parts of the body. Sometimes, if needed, it starts before the surgery. It takes five years, generally.

How it works?
Hormonal therapy mainly stops estrogen from acting on the cancer cells or lowers the estrogen level. There are different ways to do that.

Blocking Estrogen Receptors: These drugs stop estrogen from helping breast cancer cells.
Tamoxifen: It acts as anti-estrogen in the breast cells, but acts like estrogen in other cells. It lowers the risk of breast cancer and also stops cancer from coming back.
Toremifene: It works in a similar way, but it is only used in metastatic breast cancer. It also decreases the pain and swelling in the muscles and bones.
Fulvestrant: It blocks and damages estrogen receptors. It is given by injections after other drugs stop working.
Lowering Estrogen Levels: These drugs slow the growth of cancer by lowering estrogen levels.
Aromatase Inhibitors: These drugs stop estrogen production in women whose ovaries are not working due to menopause or other treatments. There are three types of this drug- Letrozole, Anastrozole and Exemestane.
Ovarian Suppression: In this method, ovaries are removed or shut down to turn pre-menopausal women to post-menopausal. There are several ways to do this, and they are- Oophorectomy or surgery, LHRH analogs and applying chemotherapy drugs.
There are some other types of hormone therapy that are less common. They were used more in the past. They are:

Megestrol acetate
Androgens
High doses of estrogen
Side Effects:
Unfortunately, Hormonal breast cancer therapy has lots of side effects. They are-

Hot flashes
Mood swings
Vagina discharge or dryness
Developing uterine cancer
Blood clots
Stroke
Night sweat
Headache
Mild nausea
Bone pain
Injection site pain
Muscle pain and joint stiffness and pain
Bone thinning
Menopause
Although hormonal therapy has lots of side effects, they are limited to different kinds of hormonal therapies and it is not necessary that they will surely happen. But it is best to undergo any kind of treatment with a doctor s advice. So patients should consult the doctor first.

Breast Cancer - New Advancements That Can Help!

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc element
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Results / Outcome

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are Metastatic VB, Multiple myeloma VB, VB haemangioma, Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF) which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis. Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc elements.
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics.
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Morbidity and complication of spinal surgery 

Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

Cementing of fragments.
Thermal neurolysis of VB nerve ending due to heat of polymerization.
Washing away of nociceptor chemicals.
Neurolytic action of liquid monomer.
By allowing early ambulation decreasing pains of immobility & bed rest.
Complications 

PVP is generally safe with low risk.
Ectopic cement leak is frequent but generally inconsequential.
Outcome 

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty.
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

Cerebral ischaemia or brain ischemia is a medical condition that restricts the flow of blood to the brain, resulting in an unmet metabolic demand. This leads to limited oxygen supply in the brain, which could result in death of brain tissues, cerebral infarction or an ischemic stroke. Thus, a cardiorespiratory arrest, a stroke, and irreversible brain damage are few possible consequences of cerebral ischaemia.

People with compressed blood vessels, low blood pressure, congenital heart defects or sickle cell anaemia have a high risk of developing cerebral ischaemia, since compressed blood vessels or very low pressure can lead to restricted blood flow. Also, sickle-shaped cells have a greater tendency to clot, causing obstructed blood flow.

Patients with cerebral ischaemia experience a host of symptoms, such as weakness in the body, problems in coordination and movement, vision and speech impairment and unconsciousness.

Cerebral congestion, on the other hand, refers to excessive quantity of blood in the brain vessels, causing pressure on the cerebral substance. Cerebral congestion is of two types. It is termed as active when there is too much arterial blood flow and passive when there is undue quantity of venous blood in the veins of the brain. Both conditions cause symptoms, such as severe headache, insomnia, irritability and unconsciousness. The patient gets little sleep and is disturbed, often followed by dreams. When awake, the patient s mental activity in the brain is very high.

Homeopathy is now a well-established school of medicine backed with years of research and practice. Gone are the days when homeopathy was considered no more than an extension of herbal home remedies. Homeopathic laboratories around the world produce large number of medicines covering almost all ailments. The benefits of homeopathic treatment are now well established due to its holistic approach and minimal side effects. Homeopathy is undoubtedly a ray of hope for patients with cerebral ischaemia and cerebral congestion, as it delivers a comprehensive treatment plan designed to target the signs and symptoms of the disease and address its non-occurrence.

The medications deal with mild to severe symptoms, including inflammation of the brain, headache, vomiting, insomnia, stroke/convulsions and seizures. The stramonium drug, for example, deals with seizures. Belladonna is an effective remedy for sharp shooting headaches, a common symptom of cerebral congestion. Ferrum is believed to be a valuable remedy for brain ischaemia. Few drugs deal with the symptoms of both ischaemia and congestion nux is a suitable drug for the treatment of ischaemia as well as for passive cerebral congestion. Similarly, phosphorus can be used to treat brain ischaemia and congestion. Zincum metallicum is a highly recommended drug for chronic cases of ischaemia.

The treatment is comprehensive and long term and shows substantive results. Regular follow-ups and consultation with a homeopath specialist is the key to an effective treatment.

Best Homeopathy Treatment of Cerebral Ischaemia & Congestion

The human body has 206 bones and bone cancer can affect any of these bones. This condition starts when healthy bone marrow cells mutate and grow out of control to form a tumor. There are many different types of bone cancer. Treatment of bone cancer varies from case to case and depends on factors such as, type of cancer, stage at which it is diagnosed and the patient s overall health amongst other factors.

Surgery, chemotherapy, and radiation are the three most common types of treatments favored for bone cancer. Surgery is usually used for low-grade tumors. This involves the removal of tumor and the surrounding healthy cells and tissues to ensure that that cancer does not recur. For high-grade tumors, surgery may be accompanied by chemotherapy, radiation or a combination of the two. 

Chemotherapy involves the delivery of medication to destroy cancer cells orally or intravenously. Radiation involves the use of high energy X rays to kill cancer cells. This is often used to treat patients with a tumor that cannot be surgically removed.

Apart from these standard forms of treatment, bone cancer patients are often advised to take part in clinical trials for their treatment. This can be described as a research study to test the efficiency of new approaches to the treatment of bone cancer. A clinical trial can be used to treat the safety and efficacy of a new drug, the new dosage of standard drugs or a new combination of treatment types. As a member of a clinical trial, you may be one of the first few people to benefit from treatment even before it is available to the general public. 

Some of the new options available through clinical trials are:

Immunotherapy: This is also known as biologic therapy. It is designed to boost the patient s immune system to fight cancer cells. Mifamurtidesi one of the types of immunotherapy being tested. Immune checkpoint inhibitors such as monoclonal antibodies are also being tested for their ability to block specific molecules.
Targeted therapy: This type of therapy targets the genes and proteins that contribute towards the growth and survival of cancer cells. Targeted therapy limits the damage caused to healthy cells and tissues and only blocks the growth of cancer cells.
Myeloablative therapy: This involves an intense regimen of chemotherapy. High doses of chemotherapy aim at destroying all the cancer cells. Unfortunately, in the process, healthy cells may also be killed. This may be followed by introducing stem cells through a bone marrow transplant to the patient s body to renew blood cells.
Intraoperative radiation therapy: These trials evaluate the use of radiation given inside the patient s body during a surgery. In cases where tumor is in a distant location of the body, stereotactic body radiotherapy and radiofrequency ablation may be used.


Bone Cancer - Understanding The New Approaches For Treatment!

The uterus is set up inside the pelvis with different muscles, tissue, and tendons. Due to pregnancy, labour or complicated delivery, in a few ladies, these muscles tend to weaken. Additionally, as a woman ages and with a loss of the hormone oestrogen, her uterus can drop into the vaginal canal, bringing about the condition known as a uterine prolapse.

The following conditions can bring about a prolapsed uterus:

Pregnancy with complicated or even ordinary delivery through the vagina.
Weakness in the pelvic muscles with the increase in age.
Weakening and loss of tissue after menopause and loss of normal oestrogen.
Conditions leading to increased weight in the abdomen, for example, constant coughing (with bronchitis and asthma), straining along with constipation, pelvic tumours (uncommon), or clogging of liquid in the abdomen.
Being overweight puts extra strain on pelvic muscles.
Previous surgery in the pelvic region leading to loss of outer support
Smoking
However, this condition can be treated effectively:

Self care at Home: You can strengthen your pelvic muscles by performing Kegel workouts. You do these by contracting your pelvic muscles, as though attempting to stop the stream of urine. This exercise makes the pelvic muscle strong and gives some support. Have your specialist train you on the best possible approaches to exercise your muscles.
Medications: Oestrogen (a hormone) cream or suppository ovules or rings embedded into the vagina help in strength and endurance building of the tissues in the vagina. However, oestrogen is just for use in some of the postmenopausal ladies.
Surgery: Based on your age and whether you wish to conceive a child naturally, surgery can repair the uterus or remove it. The uterus as in many cases can be expelled with a hysterectomy. During the surgery, the specialist can repair the hanging or saggy vaginal dividers, urethra, bladder, or rectum. The surgery might be performed by an open abdomen procedure, through the vagina, or through little cuts in the abdomen or vagina with particular instruments.
Other Therapy: In case that you do not need surgery or have a poor possibility for surgery, you may choose to wear a steady gadget, called a pessary. It is worn in the vaginal tract to strengthen the falling uterus. It can be utilised briefly or can be long-lasting. They come in different shapes and sizes and should be fitted according to the person. In case that the prolapse is extreme, a pessary may not work. Prolapse surgery is always preferred by vaginal route. Likewise, pessaries can disturb the insides of the vagina and may bring about a noxious release.
It can be prevented in the following manner:

Decrease your weight.
Try to avoid constipation by consuming a high-fiber diet.
Do Kegel exercises to strengthen the pelvic muscles.
Stay away from heavy lifting or straining.

Prolapsed Uterus -  7 Conditions That Can Cause It!

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