Aneurysm Surgery – FAQs

Aneurysm Surgery

Aims of the surgery include clipping the neck of the aneurysm to prevent re bleeding, to remove the clots – which decreases the severity of vasospasm and to do third ventriculostomy [alternative opening for CSF pathway] to decrease the chances of hydrocephalus.

Neuroanesthesia specialist and internal medicine consultants will pay visit to you and assess fitness with test including blood tests, X- rays and other radiological tests, Dobutamine stress echocardiogram for cardiac fitness, cerebral angiogram to access the anatomy of aneurysm and like. Other specialist may also see you on as and when required basis. Blood grouping and typing will be done so as to be ready for blood transfusion if you so need. Blood may be required to be reserved but transfusion will depend upon the intraoperative blood loss.

Once fit for procedure, a fasting period of 6 hours will be required for anesthesia.

Surgery will be done under general anesthesia. Informed consent will need to be signed so as to permit the surgeon and anesthetist to undertake procedure in good faith. Consent form enumerates the disease process, reasons for undergoing surgery, benefits to expect, risks involved, alternative procedures if any, identifies operating surgeon and needs your informed consent along with a witness signature.

Once in operation theatre, general anesthesia will be introduced by asking you to breath through a mask. Procedure involves a skin incision on the part of head corresponding to the aneurysm, creating a window through the skull bone, localizing the aneurysm and safe clipping of aneurysm.

Bone flap will be replaced and fixed. The wound is closed with or without drainage tube which is subsequently removed next morning. Anesthesia may be reversed in operation theatre or continued in the I.C.U. for brain protection.

Breathing exercises and anti- embolic stockings help in healthy recovery. Subsequently with a physiotherapist mobilization will be done. After a day or two stay under observation in ICU transit to ward will happen. Discharge from hospital will happen by four- five days after surgery. Physiotherapist will assist and teach you maneuvers which are to be continued even after discharge. Stitches may either be self dissolving, subcuticular (buried) or may require to be removed six to eight days after surgery. Check CT scan will be done in post-operative period to confirm post operative status.

Although surgery is relatively safe, it dose carries certain associated risks. The incidence of risks this surgery in our hospital are low and are comparable to any other advanced neurosurgical centre.

Surgical complications include but are not restricted to:

1.1) Operative site bleeding – can produce haematoma and may require further surgery for removal if patient shows worsening in consciousness level or if the clot is significant.

1.2) Post-operative seizures – prevented by adequate anti-convulsants drugs.

1.3) Infection – meningitis – which may require injectable antibiotics for few weeks and prolong the hospital stay.

1.4) Developing fresh neurological defects – may not be related to surgery but more due to vasospasm. It is prevented post-clipping by maintaining adequate blood pressure to increase the blood supply to the brain. Inspite of all the efforts the chances of postoperative deficits is seen in nearly one-third patients which usually recovers over time in significant number of patients.

1.5) Chest infections – particularly in elderly or patients who are bed ridden for long time.

1.6) Secondary complications due to bed ridden state.

1.7) Local wound infections – rare require antibiotics and local dressings.

1.8) Hydrocephalus – which may require a CSF diversion procedure like VP shunt.

1.9) Prolonged ICU may be required as delayed neurological complications may occur because of spasm of the blood vessels of the brain or hydrocephalus.

Generally life risk for patients undergoing surgery without any previous medical illness is 2 – 5 % and risk of complications is 10 to 15 % depending upon location of aneurysm and severity of bleed. The risk to life and complications increase depending upon the above factors or if patient is in poor neurological status before surgery.

Cervical Discectomy

Neuro-anesthesia specialist and internal medicine consultants will pay visit to you and assess fitness with test including blood tests, X- rays and other radiological tests, Dobutamine stress echocardiogram for cardiac fitness and like. Other specialist may also see you on as and when required basis. Blood grouping and typing will be done so as to be ready for blood transfusion if you so need. Blood will not be routinely required to be reserved for this surgery exception being rare blood groups. Once fit for procedure, a fasting period of 6 hours will be required for anesthesia. Surgery will be done under general anesthesia.

Informed consent will need to be signed so as to permit the surgeon and anesthetist to undertake procedure in good faith. Consent form enumerates the disease process, reasons for undergoing surgery, benefits to expect, risks involved, alternative procedures if any, identifies operating surgeon and needs your informed consent along with a witness signature.

Once in operation theatre, general anesthesia will be introduced by asking you to breath through a mask. Procedure involves a skin crease cut across the side of neck, access to the spine between the carotid artery (artery supplying blood to brain) and the trachea (wind pipe) and the esophagus (food pipe). An X-ray will be taken to confirm the correct level of surgery.

Intervertebral disc will be incised and microscopically removed decompressing the spinal cord and/ or nerve roots. Occasionally an additional incision is made over the anterior aspect of hip to remove small bone piece (7- 8 mm) for use in fusion of adjacent vertebra, alternatively metal case with or without plate is used for fusion. Artificial disc replacement is an alternative to fusion. The wound is closed with or without drainage tube in front of vertebra, which is subsequently removed next morning. Anesthesia will be reversed in operation theatre and you will come out wide awake.

Breathing exercises and anti- embolic stockings help in healthy recovery. Subsequently with a cervical collar and physiotherapist mobilization will be done. After overnight stay under observation in ICU transit to ward will happen. Discharge from hospital will happen by twothree days after surgery. Physiotherapist will assist and teach you maneuvers which are to be continued even after discharge. Stitches may either be self dissolving, subcuticular (buried) or may require to be removed six days after surgery.

Cervical collar needs to be worn for a period of three months, whenever sitting or ambulant. Check X-Rays will be done on follow –up there after to confirm bony healing.

Cervical disc prolapse

Although surgery is relatively safe, it dose carries certain associated risks. The incidence of risks this surgery in our hospital are low and are comparable to any other advanced neurosurgical centre.

Surgical complications include but are not restricted to:

1.1) Injury to larynx (vocal box) and/or nerves to larynx leading to hoarseness of voice which is mostly transient.

1.2) Movement of graft or loosening of instrumentation leading to difficulty in swallowing

1.3) Injury to spinal cord/ nerve root resulting in weakness of arm or legs (< 1%)

1.4) Injury to coverings of spinal cord/ nerves(dura) leading to cerebro- spinal fluid leak predisposing to meningitis and poor wound healing

1.5) Abnormal sensations or numbness in limbs

1.6) Blood clot at operative site leading to breathing difficulties

1.7) Pain in the hip wound ( only if graft is taken)

1.8) Infection of wound causing redness and/ or pain with increased incidence in diabetics.

1.9) Injury to the esophagus(food pipe) causing difficulty in swallowing and throat irritation

1.10)Increased risk of chest infection and breathing difficulty especially in obese and smokers.

1.11)Bedridden and those with decreased movements of limbs are at maximum risk of complications.

After discharge from hospital, for further assistance please contact at following phone numbers: 26825558 / 26925858 or 5801 on ext. no. 2001 and 2012.

Cervical Laminectomy

Neuro-anesthesia specialist and internal medicine consultants will pay visit to you and assess fitness with test including blood tests, X- rays and other radiological tests, Dobutamine stress echocardiogram for cardiac fitness and like. Other specialist may also see you on as and when required basis. Blood grouping and typing will be done so as to be ready for blood transfusion if you so need. Blood will not be routinely required to be reserved for this surgery exception being rare blood groups. Once fit for procedure, a fasting period of 6 hours will be required for anesthesia. Surgery will be done under general anesthesia.

Informed consent will need to be signed so as to permit the surgeon and anesthetist to undertake procedure in good faith. Consent form enumerates the disease process, reasons for undergoing surgery, benefits to expect, risks involved, alternative procedures if any, identifies operating surgeon and needs your informed consent along with a witness signature.

Once in operation theatre, general anesthesia will be introduced by asking you to breathe through a mask. Procedure involves surgery to be done in face down position with a midline skin incision in the neck, the incision will be deepened through a avascular plain upto the spinous process of vertebrae, paraspinal muscles will be separated and posterior bony elements will be removed / repositioned so as to create space in the spinal canal thus decompressing the spinal cord and / or nerve roots. Stabilization using rod and screws may be done if instability is encountered. The wound is closed with or without drainage tube, which is subsequently removed next morning. Anesthesia will be reversed in operation theatre and you will come out wide awake.

Breathing exercises and anti-embolic stockings help in healthy recovery. Subsequently with a cervical collar and physiotherapist mobilization will be done. After overnight stay under observation in ICU transit to ward will happen. Discharge from hospital will happen by twothree days after surgery. Physiotherapist will assist and teach you maneuvers which are to be continued even after discharge. Stitches may either be self dissolving, subcuticular (buried) or may require to be removed eight days after surgery.

Cervical collar needs to be worn for a period of three months, whenever sitting or ambulant.

Check X-Rays will be done on follow up thereafter to confirm bony healing.

Cervical laminectomy foramintomy

Although surgery is relatively safe, it dose carries certain associated risks. The incidence of risks this surgery in our hospital are low and are comparable to any other advanced neurosurgical centre.

Surgical complications include but are not restricted to:

1.1) Blood collection at the operative site.

1.2) Abnormal sensations or numbness in upper / lower limbs.

1.3) Infection in the wound causing redness or pain. Risk is slightly higher in patients with history of diabetes.

2.1) Injury to the nerve covering (dura with leakage of cerebro-spinal fluid that can cause meningitis and poor wound healing).

2.2) Injury to the spinal cord / nerve root resulting in weakness of arms / legs.

2.3) Increase risk in obese people / smoker of wound infection, chest infection, partial lung collapse resulting in post operative breathlessness / difficulty in breathing.

2.4) Highest risk and rate of complications occur in patients who are bed ridden or have no movement in the lower limbs.

2.5) Persistent neck pain even after wound healing.

2.6) Movement or loosening of graft due to instrumentation resulting in swallowing difficulties.

After discharge from hospital, for further assistance please contact at following phone numbers: 26825558 / 26925858 or 5801 on ext. no. 2001 and 2012.

Lumbar Decompression

Neuro-anesthesia specialist and internal medicine consultants will pay visit to you and assess fitness with test including blood tests, X- rays and other radiological tests, Dobutamine stress echocardiogram for cardiac fitness and like. Other specialist may also see you on as and when required basis. Blood grouping and typing will be done so as to be ready for blood transfusion if you so need. Blood may be required to be reserved but transfusion will be depend upon the intra-operative blood loss.

Once fit for procedure, a fasting period of 6 hours will be required for anesthesia. Surgery will be done under general anesthesia.

Informed consent will need to be signed so as to permit the surgeon and anesthetist to undertake procedure in good faith. Consent form enumerates the disease process, reasons for undergoing surgery, benefits to expect, risks involved, alternative procedures if any, identifies operating surgeon and needs your informed consent along with a witness signature.

Once in operation theatre, general anesthesia will be introduced by asking you to breathe through a mask. Procedure involves surgery to be done in face down position with a midline skin incision in the back, the incision will be deepened through a avascular plain upto the spinous process of vertebrae, paraspinal muscles will be separated and posterior bony elements will be removed / repositioned so as to create space in the spinal canal thus decompressing the spinal cord and / or nerve roots. Stabilization using rod and screws may be done if instability is encountered. Any abnormal tissue or mass, if encountered will be sent for further tests so as to determine the cause and thus helping in further management. The wound is closed with or without drainage tube, which is subsequently removed next morning. Anesthesia will be reversed in operation theatre and you will come out wide awake.

Breathing exercises and anti-embolic stockings help in healthy recovery. Subsequently with a lumbosacral belt and physiotherapist mobilization will be done. After overnight stay under observation in ICU transit to ward will happen. Discharge from hospital will happen by two three days after surgery. Physiotherapist will assist and teach you maneuvers which are to be continued even after discharge. Stitches may either be self dissolving, subcuticular (buried) or may require to be removed eight days after surgery. Lumbosacral belt needs to be worn for a period of three months, whenever sitting or ambulant.

Check X-Rays will be done on follow up thereafter to confirm bony healing.

Lumar decompression

Although surgery is relatively safe, it dose carries certain associated risks. The incidence of risks this surgery in our hospital are low and are comparable to any other advanced neurosurgical centre.

Surgical complications include but are not restricted to:

1.1) Blood collection at the operative site.

1.2) Abnormal sensations or numbness in lower limbs.

1.3) Infection in the wound causing redness or pain. Risk is slightly higher in patients with history of diabetes. Major Complications :

2.1) Injury to the nerve covering (dura with leakage of cerebro-spinal fluid that can cause meningitis and poor wound healing).

2.2) Injury to the spinal cord / nerve root resulting in weakness of legs, impaired sensations, sexual dysfunctions and loss of control of bladder / bowel movements.

2.3) Increase risk in obese people / smoker of wound infection, chest infection, partial lung collapse resulting in post operative breathlessness / difficulty in breathing.

2.4) Highest risk and rate of complications occur in patients who are bed ridden or have no movement in the lower limbs.

2.5) Displacement of adjoining vertebrae to the level of surgery may occur after few years.

2.6) Implant related complications, if used viz.,: implant loosening, mal-positioning of screws, infection in implant requiring reoperation.

2.7) Rarely blood may clot in the legs (deep vein thrombosis) casing pain and swelling in the calf due to lack of leg movements by the patient or due to weakness in the legs.

Rarely part of this clot may break-off and go to the lungs which can severely affect oxygen exchange and heart function.

After discharge from hospital, for further assistance please contact at following phone numbers: 26825558 / 26925858 or 5801 on ext. no. 2001 and 2012.

Pituitary tumor

Neuroanesthesia specialist and internal medicine consultants will pay visit to you and assess fitness with test including blood tests, endocrine assays, X- rays and other radiological tests, Dobutamine stress echocardiogram for cardiac fitness and like. Other specialist may also see you on as and when required basis. Blood grouping and typing will be done so as to be ready for blood transfusion if you so need. Blood may be required to be reserved but transfusion will be depend upon the intra-operative blood loss.

Once fit for procedure, a fasting period of 6 hours will be required for anesthesia. Surgery will be done under general anesthesia. Informed consent will need to be signed so as to permit the surgeon and anesthetist to undertake procedure in good faith. Consent form enumerates the disease process, reasons for undergoing surgery, benefits to expect, risks involved, alternative procedures if any, identifies operating surgeon and needs your informed consent along with a witness signature.

Once in operation theatre, general anesthesia will be introduced by asking you to breath through a mask. Procedure will be done endoscopically or microscopically through the nose without an outside wound. Sella is reached through the nose, opened into and pituitary tumor decompressed.

Nasal pack will be inserted and kept for two to three days. You can breathe through mouth during that period. Large tumors may require craniotomy. There may be fluid and electrolyte disturbances in immediate post operative period which settles down gradually.

Long term hormonal replacement may be required. After a day or two stay under observation in ICU transit to ward will happen. Discharge from hospital will happen by four- five days after surgery. Histopathology report should be ready Pituitary Tumor by fifth post operative day, thus enabling us to decide on need for adjuvant therapy i.e. radiotherapy and/ or chemotherapy. Check CT scan will be done in post-operative period to confirm post operative status.

Although surgery is relatively safe, it dose carries certain associated risks. The incidence of risks this surgery in our hospital are low and are comparable to any other advanced neurosurgical centre.

Surgical complications include but are not restricted to:

1.1) Operative site bleeding – uncommon but may require re-surgery [craniotomy] is compromising the vision.

1.2) Local bleeding – usually settles down on its own.

1.3) Visual deterioration if any unintended damage occurs during or post-operative bleeding – rare may require high dose steroids or re-surgery.

1.4) CSF leak from nose for which the lumbar drain is kept for a day or two more – may require re-surgery to repair the leak.

1.5) Endocrinal disturbances which are taken care by adequate pre-operative and postoperative estimation of the hormonal levels and replacement.

1.6) Increase urination – [diabetic insipidus] – usually temporary for a few days, sometimes permanent.

Generally life risk for patients undergoing surgery without any previous medical illness is 1- 2 % and risk of complications is 5 to 10 % depending upon size of the tumor. The risk to life and complications increase depending upon the above factors or if patient is in poor neurological status before surgery.

After discharge from hospital, for further assistance please contact at following phone numbers: 26825558 / 26925858 or 5801 on ext. no. 2001 and 2012.

Surgery for Brain Tumours

Aims of the surgery include getting histopathology diagnosis, decompress the tumor to decrease the tumor load so that subsequent therapies like radiotherapy and chemotherapy are more effective and to decrease the raise intracranial pressure by removing as much tumor as possible without causing much damage to the surrounding brain.

You will undergo pre-operative check up to ensure fitness for the surgical procedure. Neuroanesthesia specialist and internal medicine consultants will pay visit to you and assess fitness with test including blood tests, X- rays and other radiological tests, Dobutamine stress echocardiogram for cardiac fitness and like. Other specialist may also see you on as and when required basis. Blood grouping and typing will be done so as to be ready for blood transfusion if you so need. Blood may be required to be reserved but transfusion will depend upon the intra-operative blood loss.

Once fit for procedure, a fasting period of 6 hours will be required for anesthesia. Surgery will be done under general anesthesia. Informed consent will need to be signed so as to permit the surgeon and anesthetist to undertake procedure in good faith. Consent form enumerates the disease process, reasons for undergoing surgery, benefits to expect, risks involved, alternative procedures if any, identifies operating surgeon and needs your informed consent along with a witness signature.

Once in operation theatre, general anesthesia will be introduced by asking you to breath through a mask. Procedure involves a skin incision on the part of head corresponding to the lesion, creating a window through the skull bone, localizing the tumor and safe excision thereof to the maximum limit possible. Bone flap will be replaced and fixed. The wound is closed with or without drainage tube, which is subsequently removed next morning. Anesthesia will be reversed in operation theatre and you will come out wide awake.

Breathing exercises and anti- embolic stockings help in healthy recovery. Subsequently with a physiotherapist mobilization will be done. After a day or two stay under observation in ICU transit to ward will happen. Discharge from hospital will happen by four- five days after surgery. Physiotherapist will assist and teach you maneuvers which are to be continued even after discharge. Stitches may either be self dissolving, subcuticular (buried) or may require to be removed six to eight days after surgery. Histopathology report should be ready by fifth post operative day, thus enabling us to decide on need for adjuvant therapy i.e. radiotherapy and/ or chemotherapy.

Brain tumors

Check CT scan will be done in post-operative period to confirm post operative status.

Although surgery is relatively safe, it dose carries certain associated risks. The incidence of risks this surgery in our hospital are low and are comparable to any other advanced neurosurgical centre.

Surgical complications include but are not restricted to:

Potential Complications include :

1.1) Operative site bleeding – uncommon but may require re-surgery [craniotomy] is compromising the vision.

1.2) Local bleeding – usually settles down on its own.

1.3) Visual deterioration if any unintended damage occurs during or post-operative bleeding – rare may require high dose steroids or re-surgery.

1.4) CSF leak from nose for which the lumbar drain is kept for a day or two more – may require re-surgery to repair the leak.

1.5) Endocrinal disturbances which are taken care by adequate pre-operative and postoperative estimation of the hormonal levels and replacement.

1.6) Increase urination – [diabetic insipidus] – usually temporary for a few days, sometimes permanent.

Generally life risk for patients undergoing surgery without any previous medical illness is 1% and risk of complications is 5 to 8 % depending upon location and size of the tumor. The risk to life and complications increase depending upon the above factors or if patient is in poor neurological status before surgery.

After discharge from hospital, for further assistance please contact at following phone numbers: 26825558 / 26925858 or 5801 on ext. no. 2001 and 2012.