Procedures

Stereotactic Radiosurgery
Minimally Invasive Procedures
Surgeries

Stereotactic Radiosurgery

• SRS is a technique for delivering a high dose of radiation to a specific target while delivering a minimal dose to surrounding tissues.
• SRS means the use of external radiation in conjunction with a stereotactic guidance device to very precisely deliver a therapeutic dose to a tissue volume.
  
• SRS can be used as a treatment for lung, liver, kidney, adrenal gland, or pancreas as well as for pelvic and head & neck tumors that have recurred after primary irradiation.

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Minimally Invasive Procedures

1) Epidural Steroid Injections are most commonly used for either nerve root generated pain or discogenic pain. The most pertinent reason for injections is to relieve pain and hopefully facilitate participation in a therapeutic exercise program. Also, it is hoped that recovery will be hastened by obtaining diagnostic information with each injection. Ultimately, spinal surgery may be avoided if the injections are successful.

2) Kyphoplasty is a medical procedure used to treat a condition known as Vertebral Compression Fractures (VCF). VCF a condition in which a fracture in the body of the vertebrae causes it to collapse. The spinal column is then pushed out at that point resulting in severe pain in the back. The remedy is to restore the height and angle of the fractured vertebrae. VCF is a common complication of osteoporosis. It may also be the result of a tumor or certain forms of cancer which cause softening of the bone. What does Kyphopasty entail? The patient lies face down on the operating table. The surgeon makes two 3 cm incisions, in the back. Guided by two X-Ray machines, a tube is inserted into the spinal column to the location of the fractured vertebrae. A device called a balloon tamp is pushed down the tube and inflated. This causes the collapsed vertebrae to be lifted and a space created between it and the adjoining vertebrae. Bonecement is inserted into the cavity. It dries in about 15 minutes. The balloon and tube are removed, the incisions in the back stitched up with the result being the restoration of the height and shape of the vertebral body.

3) Spinal cord stimulation (SCS) is a procedure that uses an electrical current to treat chronic pain. A small pulse generator, implanted in the back, sends electrical pulses to the spinal cord. These pulses interfere with the nerve impulses that make you feel pain.

Implanting the stimulator is typically done using a local anesthetic and a sedative. Your doctor usually will first insert a trial stimulator through the skin (percutaneously) to give the treatment a trial run. (A percutaneous stimulator tends to move from its original location, so it is considered temporary.) If the trial is successful, your doctor can implant a more permanent stimulator. The stimulator itself is implanted under the skin of the belly (abdomen), and the small coated wires (leads) are inserted under the skin to the point where they are inserted into the spinal canal. This placement in the abdomen is a more stable, effective location. After this outpatient procedure is complete, you and your doctor determine the best pulse strength. You are then told how to use the stimulator at home. A typical schedule for spinal cord stimulation is to use it for 1 or 2 hours, 3 or 4 times a day. When in use, the spinal cord stimulator creates a tingling feeling, rather than the pain you have felt in the past.

4) Discectomy this procedure removes a disc herniation (bulging disc) to relieve pressure on an adjoining nerve. Surgeons are able to precisely locate, see and remove herniated discs in the spine through tunnels created by tubes that split back muscle, much like a sewing needle splits the weave of fabric, along natural divisions. No muscle fiber is cut, only separated. This unique muscle-splitting approach allows surgeons to access the spine with a posterior approach without cutting or removing muscle from the spine.
How It Works

• Using a special “live-action” x-ray called a fluoroscope to visualize the spine, the surgeon precisely locates the herniated disc.
• Guided by the fluoroscope, a small needle is inserted through the skin and muscle to the affected area.
• The needle is withdrawn, a ½-inch skin incision is made, and dilators are inserted, one around the other, to gradually “split the weave” of the muscle until a ¾-inch tunnel to the disc is created.
• The retractor holds the tunnel open to allow for the microscope (or endoscope), surgical tools and instruments to be inserted.
• While viewing the herniated disc through the microscope, the surgeon uses special instruments to remove the herniated disc.
• Once the procedure is completed, the tube is withdrawn, and the separated muscle fibers flow back together.
• A small adhesive bandage is applied to cover the incision.

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Surgeries

Ventriculoperitoneal Shunt

Before the procedure, in order to help prevent infection, some of the hair on your head may need to be shaved. The medical team will wash your head and body with special soap. They will cover you with sterile linen to maintain a sterile environment throughout the procedure.

During the procedure, the neurosurgery team performs the surgery in sterile conditions in an operating room under general anaesthesia. The operation usually takes less than an hour. It involves the following steps:

A small incision will be made in the scalp. A small hole will then be made in the skull.
A tiny opening will be made in the protective coverings of the brain. These openings accommodate the catheter placement in the lateral ventricle.
The neurosurgeon will make two or three small incisions to place the shunt valve (usually above or behind the ear).
The catheter will be tunneled under the skin.
The end of the catheter will be carefully placed in the appropriate receiving cavity (usually the abdomen).
Following the operation, small sterile bandages will be applied to each incision.

Immediately after surgery, you will go to the post-anaesthesia care unit. You’ll stay there for close observation for an hour or so and then go to your room. Most people leave the hospital within 2 to 7 days, depending on their clinical progress.

Spine Fusion Using TLIF Technique

Spinal fusion (such as a TLIF) is a surgical technique to stabilize the spinal vertebra and the disc or shock absorber between the vertebra. Lumbar fusion surgery is designed to create solid bone between the adjoining vertebra, eliminating any movement between the bones. The goal of the surgery is to reduce pain and nerve irritation.

Spinal fusion may be recommended for conditions such as spondylolisthesis, degenerative disc disease or recurrent disc herniations. Surgeons perform lumbar fusion using several techniques. This article describes the transforaminal lumbar interbody fusion (TLIF) fusion technique.

Spine Fusion Using ALIF Technique

Spinal fusion (such as an ALIF) is a procedure performed by approaching the spine through the abdomen. It involves the insertion of a bone graft into the disc space to help the vertebrae to fuse together. While the ALIF is still a widely available spine fusion technique, this type of procedure is often combined with a posterior approach (anterior/posterior fusions) because of the need to provide more rigid fixation than an anterior approach alone provides. In cases where there is not a lot of instability, an ALIF alone can be sufficient. Generally, this is true in cases of one level degenerative disc disease where there is a lot of disc space collapse.

Craniotomy

A craniotomy is the surgical removal of part of the skull to expose the brain. A craniotomy is the most commonly performed surgery for brain tumor removal. It may also be done to remove a blood clot and control hemorrhage, inspect the brain, perform a biopsy, or relieve pressure inside the skull.

Before the operation, the patient will have undergone diagnostic procedures such as computed tomography scans (CT) or magnetic resonance imaging (MRI) scans to determine the underlying problem that required the craniotomy and to get a better look at the brain's structure. Cerebral angiography may be used to study the blood supply to the tumor, aneurysm, or other brain lesion.

Burr Hole

A burr hole for subdural hematoma is performed to remove a hemorrhage (blood clot) from around the surface of the brain. The location of the blood clot is beneath the firm covering of the brain known as the dura mater, and is therefore called subdural hematoma. Generally, when a blood clot is moderately old (at least two to three weeks), it may be drained through a small hole in the skull, and a large craniotomy flap (opening in the skull) might be avoided. 

The patient will be taken to the operating room and put to sleep under general anesthesia. The head will be partially shaved, to expose the area of operation. The head may simply rest on towels, or it may be placed in three fixation points (Mayfield head pins). The area where surgery is to be performed is then "prepped and draped" using an antibiotic solution. Next, the surgeon will make an incision, and reflect the scalp over the area of the hematoma. Then, an air powered drill is used to make a hole in the skull. The dura mater (tough covering of the brain) is then opened. The hematoma (blood clot) is now seen, and the surgeon will irrigate some of it out, and may pass a drain around the brain to provide post-operative drainage. The surgeon will then close the scalp.

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