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One of the common ailments in the elderly people is the Parkinson’s. A progressive disorder, when left untreated, results in worsening of the symptoms. Hence, it is essential to understand the treatment options available to manage the condition effectively. You may be suggested surgical therapies if medication is not effective enough to treat the symptoms.
Surgical treatment options can be beneficial for patients who are suffering from symptoms, but they do not help with treating the disease. In the past, surgical methods like Thalamotomy and Pallidotomy were used to destroy brain cells that contributed to the symptoms. While these methods are still used, they are very rare and situational.
Deep Brain Stimulation (DBS), an FDA-approved procedure, has become much more popular as it is much safer and does not involve invasive surgery. Instead of destroying brain cells like traditional methods, DBS involves sending electric pulses to the affected brain cells to reduce the symptoms. It is not a treatment procedure, but a means of bringing down the severity of Parkinson’s to allow better and more comfortable treatment.
Deep Brain Simulation – Who are the right candidates?
Deep Brain Simulation is commonly used for Parkinson ’s disease, but it is not recommended for everyone. It is a preferred method of treatment for people who have had Parkinson’s for at least four years but have complications which include long periods of time where medications do not work, or symptoms return, uncontrolled and involuntary movements or the freezing/stiffness in the body.
Deep Brain Simulation is not recommended for those who have Dementia as it can lead to memory problems. The general rule of thumb that neurosurgeons follow is that Deep Brain Simulation can help with symptoms that do not get better with medication. DBS can help reduce medication requirements for patients as well as reduce the side effects that may occur due to medication.
Disorder specialists and neurosurgeons can conduct tests to determine if DBS is going to be effective for a patient before going ahead with such a procedure. An extensive assessment is necessary to understand the symptoms, the effect of Parkinson's drugs and also brain imaging is done. All of the expected benefits are then evaluated for the patients, and if the procedure can help alleviate the symptoms, DBS is given a green signal by neurosurgeons and patients can undergo the procedure.
How Does Deep Brain Simulation Work?
Deep Brain Simulation is a very complex procedure. Brain cells communicate with the rest of the body through electric signal, and these become irregular and do not work properly when affected by Parkinson's. DBS smoothens the functioning of these brain cells and reduces symptoms through electric pulses through the implantation of a medical device known as neurostimulator which is also referred as brain pacemaker.
But, as with any treatment procedure, DBS has potential risks and side effects, hence discuss with neurosurgeon thoroughly to access the suitability.
Neurosurgery mainly deals with treating of functional disorders that affect the nerves, brain and muscles through major or minor surgery. The field of neurosurgery makes use of advanced surgical procedures. The different techniques are used to treat brain tumors, trauma to the head, cerebral hemorrhages, spinal disc herniation, brain aneurysms and peripheral neuropathy.
The main aim of neurosurgery treatment in patients suffering from stoke is to prevent neurologic deterioration as well as the recurrence of stroke. The advancement in medical treatment has increased to a great extent, however the mortality and morbidity in stroke patients is very high. The second leading cause of death all over the world is stroke, and hence, through neurosurgery stroke can be managed. Each year in the U.S there are about 800,000 people who suffer from stroke which causes disability.
Symptoms of Stroke and its Effects
The main symptoms of stroke are not identified easily by people. However, the symptoms that are caused on delay of treatment include difficulty in speaking, weakness on one side of the body, drooping on one side of the face and difficulty in walking.
Stroke at times is life threatening and it is also referred to as brain attack and can occur at any time to an individual. It is caused when the flow of blood supply to the brain is cut off and oxygen is deprived to the brain cells. Brain dysfunction occurs due to the dead brain cells and hence some patients lose their memory and control over their muscle movement. The treatment of stroke in such cases includes a neurosurgery by a neurological specialist.
Types of Stroke
The abrupt interruption to the flow of blood that causes hindrance in the neurological function can be best treated if detected early and by accurate diagnosis by a neurosurgeon. There are 3 different types of stroke that can occur and these include Hemorrhagic stroke, Ischemic stroke and Transient ischemic attack. The Ischemic stroke mainly occurs when blood vessels that supply blood to the brain are blocked. It is a common form of stroke and its underlying cause is known as atherosclerosis. The main procedures that are used for treating ischemic stroke include tissue plasminogen activator and endovascular procedure.
In the tissue plasminogen activator procedure, the patient is given medicine intravenously. The blood flow to the affected area of the brain is improved when the blood clot dissolves through this method. The medication is given immediately after 3-4 hours on occurrence of the stroke symptoms. In the second procedure, a catheter is used, which is injected in the area of the obstructed blood vessel. The blood flow to the area is restored by the endovascular procedure. Even anticoagulants are given to thin the blood and prevent clogging. In case you have a concern or query you can always consult an expert & get answers to your questions!
The medical term ‘spina bifida’ or spinal bifida refers to a congenital defect in the spine. In simpler terms, spinal bifida is a defect in the neural tube. Based on the severity of this disease, spinal bifida can be divided into three different types:
The symptoms of spinal bifida vary depending on each of these three types. Let's take a closer look at its symptoms here:
Myelomeningocele is the most severe form of spinal bifida. In this type of neural defect, the 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 spinal bifida are:
- Presence of uneven hips
- Deformed feet
- Curved spine or scoliosis
- Bladder and bowel problems
- Muscle weakness
- Paralyzed leg muscles.
Physical deformities from moderate to severe levels are also very common in this type of spinal bifida.
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 spinal bifida are:
o Membranes forming a visible sack on the back at birth
o 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.
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:
- Presence of a gap between the vertebrae
- An area on the back formed with extra fat
- Acluster or small group of hair on the back
- A dimple or birthmark on the back.
In this kind of spinal bifida, neither any sack of fluid is formed, nor are there any visible opening in the back. Sometimes, people who have spinal bifida are not aware of it due to its minimal symptoms.
Spinal 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.
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:
- 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.
- 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.
- 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:
- Neuronal potassium channel referred to as KCNQ opener
- Blockers of unique binding sites such as perampanel, gabapentin, and levetiracetam
- H-current modulators such as lamotrigine and gabapentin
- Carbonic anhydrase inhibitors such as zonisamide and topiramate
- Alpha-amino 3-hydroxy 5-methyl 4-isoxazole propionic acid receptor blockers like topiramate and perampanel.
- 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:
- Severe pain in the leg lingering for more than six weeks, which mainly affects one side of the leg or buttock
- 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.
- 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
- 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.
- When the symptoms are continuing to worsen, thereby indicating nerve damage, particularly when the progressive signs have their root in neurological issues
- 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.
- 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.
- 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!
A headache is the most common ailment to affect men and women. Did you know that there are over 150 different types of headaches? Each of these different types of headaches has its own symptoms, triggers and needs to be treated in a different way. In some cases, you may even require surgery. This is often recommended for severe migraines and cluster headaches.
The different types of surgeries that may be performed to treat such headaches include:
- Neurostimulation: For this procedure, a wire electrode is inserted through the skin at the back of the neck near the occipital nerve and used to provide electrical stimulation. This form of surgery is best suited to patients who have benefited positively from an occipital nerve block.
- Radiofrequency thermocoagulation: This is one the most common forms of surgical treatment for cluster headaches. For this procedure, a radiofrequency current is used to heat tissue of a certain area. By doing this, the passage for pain is obstructed and headaches are relieved. Some of the side effects of this surgery could include corneal sensory loss, severe facial dysesthesias and reactions to anesthesia. In rare cases, it could also cause a stroke, infections or motor weakness. Thankfully, these effects typically are resolved within 6 months.
- Microvascular decompression: This is an invasive procedure that is performed while the patient is under general anesthesia. It also involves a craniectomy. The aim of this procedure is to remove a vascular loop that compresses a nerve and thereby restore normal anatomy. Hospitalization is typically required for a few days after the procedure
- Gamma knife radiosurgery: This is the type of neurosurgery where the trigeminal nerve is hit by radiation. This procedure can be performed as an outpatient procedure and can be completed in a few hours. It has a very low rate of complications but the long term effects of this form of treatment are not yet clear. There may also be a high rate of relapses associated with this form of treatment.
- Septoplasty: In the case of migraines, a deviated septum may be contributing to your headache. In such cases, surgical correction of the septum can help relieve pressure on the nerves that pass through it and in turn reduce the frequency and intensity of your headaches. Septoplasty addresses common issues concerning the septum such as a bent cartilage or deviated cartilage. This procedure can be performed under local or general anesthesia.
When asked to go for surgery, be it for any problem, it can be really scary. This is pretty understandable!. If you are confronted with such a decision whether to go for surgery for your herniated disc problem, then read on to gain an understanding in this regard.
What is a herniated disc?
The bones which form our spine also known as the vertebrae are cushioned by small spongy discs. When these discs are in healthy condition, they help to keep our spine flexible by acting as a shock absorber for the spine. But whenever a disc gets damaged, it might break open or bulge. This is known as a herniated disc. It is also known as ruptured or slipped disc.
When there is a herniated disc, it does not always show any symptom, but when it presses on the roots of the nerves, it causes numbness, pain, and weakness in that area of the body where that nerve travels. The common cause for leg pain and back pain is a herniated disc in the lower back portion. It can also cause numbness down the leg and in the buttock.
Surgical treatment or non-surgical treatment – Which is better?
In case of a herniated disc, surgery works well for most but not all. In case of herniated disc surgery, patients often experience 6 to 12 weeks of severe numbness in the lower portion of the body caused due to a herniated disc, one group of people was advised to have surgery soon, and the other group of people was asked to go for the non-surgical treatment. After two months, the group of people who had surgery felt better than the non-surgical group. Surgery works best when one opts for it within 6 months after the symptoms show up.
Many people are also able to manage their symptoms by opting for non-surgical treatment as well. It includes changing the way in which they do their activities. For example, if sitting longer worsens the condition, the person is advised to stand and do his/her work. Or one can also switch between standing and sitting. Exercise is also a part of the non-surgical treatment. Aerobic exercises are beneficial to reduce the symptoms of a herniated disc. Steroid injections are also included in the non-surgical treatment.
What are the risks of surgery?
At the time of surgery, there might be a slight risk of damaging the spine or the nerves, but it is very rare. If not cared for properly, the patients have slight chances of infection in the surgical site.
To make an informed decision, discuss the options with your doctor, analyze the pros and cons of your situation and decide accordingly.
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:
- Open surgical clipping
- 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.
- 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.