Dr. Dhruv Chaturvedi

Good morning, I am Dr Dhruv Chaturvedi I am a neurosurgeon, I get my training from the esteemed All India Institute of Medical Sciences and the following which I have done training in brain and spine surgeries at many years Centre which include UK, Germany, Singapore and Bangkok. I have been practicing neurosurgery in the city of Delhi for more than 15 years now rather that I was working at All India Institute of Medical Sciences. I deal with various ailments involving the brain and spine but today I am going to talk about a much dreaded ailment in the brain, which is brain tumor. As you all know brain tumors are increasing rather all the cancers in the human body are increasing, this has partly to do with the type of exposure that we get from various environmental agents and partly to do with the lifestyle. As soon as the brain tumors are concerned, we have an incidence of almost 1-million in India itself in a year. The brain tumor can affect any age group but most commonly they affect people who are beyond 60’s. This is so because tumors or the cancers arising from any other part of body make in access to look brain structures and hence form secondary tumor there also. So if we have to categorise the brain tumors, they can be categorised into benign or non cancerous and cancerous. This is the primary division of brain tumors, then we talk about the cancerous tumors, the cancerous tumors may arise from within the brain or from the cells within the brain or they can arise as a metastasis from some other tumor in other portions of the body. Brain tumors are fairly common and they are fit all the age groups, the most common tumor that we see in adults as I say are seen beyond 60 years of age and the metastasis or secondary tumors. In which the tumor has come or the cancer has come from the other portion in the body. Where is the benign tumors if we see they are more commonly merinduimu. In the children however the most common tumors are neuroblastoma . The what we should know about brain tumor is what are the signs or what are the problems that a person will have they have a brain tumor. Well, the most common problems then that person will have is a headache, which is generally a morning headache and may be associated with vomiting, which can be frodectile. In addition to that a person may have seizures which commonly known as fits or various neurological deficits like weakness of one of the Limbs in the body, the person can have problems in the vision, the person can have memory deficits or behavioral changes these are the most commonly seen symptoms which are associated with brain tumor. These days with the aquant of new techniques in Radiology, it is very easy for us to diagnose the brain tumor and these are the generally diagnosed with the help of contrast-enhanced imaging. Which may be a contrast-enhanced CT Scan or a contrast-enhanced MRI, MRI obviously scores above the CT Scan. As well as the treatment is concerned most of the brain tumors have to be removed surgically, now why it is essential firstly because it gives us a tissue for diagnosis as to what type of the brain tumor it is. Secondly to relieve a patient of its symptoms it is very essential. Now depending upon whether the Biopsy what we get is cancerous or non cancerous, further treatment is going to be decided on that. If it's cancerous tumor a patient may require in addition to surgery radiotherapy or chemotherapy or both. We also have immunotherapy coming up and research is directed towards that. Where is in benign tumors generally the surgery is sufficient. Here I would like to emphasize that not all brain tumors are cancerous rather many of them are benign and a person can have a normal life expectancy following the surgery for these brain tumors. Whereas in cancers the outcome is generally not so good, the tumors are graded as per the gradings, they can be from grade 1 to grade 4, grade 4 have a poor outcome, whereas great 1 has an outcome where a person can have the survival of around 10 years. If it present to us on time. So if you have any further queries regarding brain tumors, you can contact me either on Lybrate or at Vimhans PrimaMed Super Speciality Hospital, which is based in Nehru Nagar, or as you can visit my clinic which is there in Tagore Garden. Wishing you all the best. Thank you.

The primary aim of the treatment in patients suffering from seizure is leasing a seizure-free life without giving way to any adverse effects. This goal can be accomplished in over 60 percent people with the help of anticonvulsants. Some patients also experience adverse effects since they suffer from a seizure which is refractory to medical therapy. Here are some of the common treatment options for seizures:

1. Monotherapy: Sometimes, monotherapy is given as it reduces the chance of all sorts of adverse effects and even avoids drug interactions. Moreover, this type of treatment approach is much less expensive than polytherapy since many older generation of the anticonvulsant agent comprises of hepatic enzyme which is responsible for reducing the serum level of the concomitant drug which leads to an increase in the dosage level of such medicines.
2. Social And vocational rehabilitation: People suffering from problems in psychosocial adjustments after the diagnosis may also need social and vocational rehabilitation. Many physicians do not pay enough attention to the consequences that an epilepsy diagnosis may leave on the patient. For instance, people with epilepsy may have a fear of experiencing next attack of seizure and they may be unable to work at heights or drive.
3. Consulting an expert: It is important to refer patients with intractable spells to epileptologist or neurologist for subsequent workup. A neurosurgical consultation may also be needed when the patient has to be treated surgically.

Importance of anticonvulsant therapy
Patients who have had already suffered from recurrent attacks of unprovoked seizure may need treatment with an anticonvulsant. This treatment is not recommended until the person has risk factors for suffering from the problem yet again. The primary means of treating seizure is anticonvulsant therapy where the most suitable drug is chosen based on accurate diagnosis of the syndrome as a response to specific anticonvulsants may vary from one patient to another. The difference in response may reflect the various pathophysiologic mechanisms in different types of seizures.

Types of anticonvulsant therapy
Some of the anticonvulsant therapy medication may have multiple action mechanism while some have an only single mechanism of action. Some of the most common variants of the therapy include:

1. Neuronal potassium channel referred to as KCNQ opener
2. Blockers of unique binding sites such as perampanel, gabapentin, and levetiracetam
3. H-current modulators such as lamotrigine and gabapentin
4. Carbonic anhydrase inhibitors such as zonisamide and topiramate
5. Alpha-amino 3-hydroxy 5-methyl 4-isoxazole propionic acid receptor blockers like topiramate and perampanel.
6. N and L-calcium channel blockers like zonisamide, valproate, topiramate, and lamotrigine

Even though there are so many types of drugs available, all of them cannot be used for the treatment of seizures. Doctors would evaluate the condition thoroughly before prescribing a medication that can be helpful in reducing the severity of the condition.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Sciatica pain can be mild to intense. Many with lumbar herniated disc and sciatica often wonder whether or not they require a surgery. Needless to say, it is never an easy decision. But the good news is that micro discectomy surgery has a higher rate of success when it comes to relieving sciatica pain. When compared to many other options, this one is relatively minimally invasive. It doesn’t alter the structure of the spine permanently since it works by removing a small portion of the disc, which has herniated or extruded out of the disc.

When your sciatica pain stems from lumbar disc herniation, a small open surgery with the help of magnification is the prevalently opted surgical approach. On the other hand, a laminectomy is done when the bone or disc pinching the nerve root is required to be removed.

When should you consider undergoing surgery for sciatica?
Typically, neurosurgeons recommend considering surgery for sciatica in a host of situations which include the following:

1. Severe pain in the leg lingering for more than six weeks, which mainly affects one side of the leg or buttock
2. Intense pain in the low back and buttock, which continues through the course of the sciatic nerve andextends to the lower leg and even foot. This pain can be described as sharp and searing rather than a dull thud.
3. When pain has not alleviated even after non-surgical treatments that may include non-steroidal anti-inflammatory drugs (NSAIDs),oral steroids, injections, manual manipulations, and physical therapy
4. When the patient is not able to take part in the day to day activities due to intense lower back pain and the symptoms tend to become severe during movements like sneeze and cough.
5. When the symptoms are continuing to worsen, thereby indicating nerve damage, particularly when the progressive signs have their root in neurological issues
6. It is important to note here that surgical intervention may only be needed when the patient experiences progressive weakness in the lower portion of the body or sudden loss of bladder or bowel movement, which may stem from cauda equina syndrome. Two surgeries, namely lumbar laminectomy and microdiscectomy are performed on the basis of the cause as well as the duration of the sciatica pain.
7. In some cases, the symptoms are unique on the basis of the underlying causes of sciatica. For instance, trying to bend the body backward or walking a longer distance than normal may trigger unbearable symptoms. On the other hand, when the affected individual tries to bend the body forward, it can lead to symptoms stemming from the lumbar herniated disc.
8. In case sciatica occurs after an accident, injury or trauma, or if it happens in tandem with other symptoms, then it requires an immediate medical attention.

Thus, choosing to go for a surgery depends on several factors that only your doctor can assess and decide upon.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Even though brain aneurysms are becoming common these days, not all of them are required to be treated. In some cases, the physician may choose to observe an aneurysm closely before adopting any treatment measure. But in patients in whom an aneurysm has progressed to a severe level, there are two treatment options:

1. Open surgical clipping
2. Endovascular therapy or coiling

Open surgical clipping for brain aneurysms:
This procedure is typically performed by a neurosurgeon who makes an incision in the head. An opening in the bone is made, and then a clip is positioned by dissecting through the spaces of the brain. This aids in preventing the flow of blood into an aneurysm. In this procedure, the patient is required to stay in the hospital for two to three nights after which he or she is discharged.

Considerable modifications have been made in the open surgery techniques in the recent years. Neurosurgeons are now able to perform eye brow incisions or mini craniotomies for clipping an aneurysm. In these procedures, a small incision is cut out in the skin above the eyebrow for making a window. A tiny clip is placed across the mouth of an aneurysm to help it heal. But it is worthy of mention here that these are all invasive procedures and take relatively longer time to recover compared to the coiling process.

Endovascular coiling:

• This treatment is also performed by a neurosurgeon, and it has been proved that this process is exceptionally suitable for patients with a ruptured aneurysm. Endovascular coiling is often done in coalesce with an angiogram, where a catheter is inserted into the vessel over the hip, which is then gradually carried to the vessels of the brain and finally to an aneurysm.
• Then the coils are packed to the point where it rises from the blood vessel, which prevents the blood from flowing intothe blood vessel. Most patients undergoing this minimally invasive procedure can go home the day following the surgery. The success rate of this process is very high, and over 125,000 patients have been treated all across the globe with the help of detachable platinum coils.
• Over the last few years, a substantial amount of advancements have taken place in the endovascular techniques. Recent developments show the use of flow diverting embolization devices, which are similar to a stent and are placed in the primary vessel, adjacent to an aneurysm. It diverts the flow away from an aneurysm and therefore, allows the neurosurgeons to treat the brain aneurysms, which were previously considered inaccessible and untreatable.

Both the procedures are quite efficient in treating a brain aneurysm. The most suitable option is dependent on a host of factors such as size, shape, location and overall health condition of the patient. If you wish to discuss about any specific problem, you can consult a Neurosurgeon.

The medical term ‘spina bifida’ or spinal bifida refers to a congenital defect in the spine. In simpler terms, spina bifida is a defect in the neural tube. Based on the severity of this disease, spina bifida can be divided into three different types:

• Myelomeningocele
• Meningocele
• Occulta

The symptoms of spina bifida vary depending on each of these three types. Let's take a closer look at its symptoms here:

Myelomeningocele

Myelomeningocele is the most severe form of spina bifida. In this type of neural defect, spinal canal of the baby remains open in the middle or lower back along a few vertebrae. Due to this opening, a sac is formed at the back of the baby at birth, which exposes the baby to several life-threatening infections.

Some of the common symptoms of this type of spina bifida are:

1. Seizures
2. Presence of uneven hips
3. Deformed feet
4. Curved spine or scoliosis
5. Bladder and bowel problems
6. Muscle weakness
7. Paralyzed leg muscles.

Physical deformities from moderate to severe levels are also very common in this type of spina bifida.

Meningocele

Meningocele is a ratherrare form of spinal bifida in which a sack of fluid stays in open at the back of the baby. Here the protective membranes that usually stay around the spinal cord push out through the vertebrae’s opening. Though this sack contains no part of the spinal cord, it may cause minor disabilities.

Some common symptoms of this kind of spina bifida are:

1. Membranes forming a visible sack on the back at birth
2. Presence of a small opening in the baby's back

The good news is that this sack can be removed through surgery without hampering the normal development of the spinal cord.

Occulta
Spina bifida occulta is the mildest form of spina bifida, which, in majority of the cases, often stays hidden as its symptoms are rarely visible. As it doesn’t even cause any form of disabilities, it generally goes unnoticed. It doesn’t cause any damages to the nerves or the spinal cord.

Some common symptoms of occulta are:

1. Presence of a gap between the vertebrae
2. An area on the back formed with extra fat
3. Acluster or small group of hair on the back
4. A dimple or birthmark on the back.

In this kind of spina bifida, neither any sack of fluid is formed, nor are there any visible opening in the back. Sometimes, people who have spina bifida are not aware of it due to its minimal symptoms.
Spina bifida usually affects a child before birth, when the brain or the cord or the protective covering over them fails to develop completely. Knowing about the symptoms can be one of the best ways to identify and diagnose this disease and opt for proper treatment solutions. If you wish to discuss about any specific problem, you can consult a Neurosurgeon.