Neurosurgery in india

Dr. Dheeraj Bojwani Your Medical Tour Consultant in India

Dr.DheerajBojwani Consultants Website : www.dheerajbojwani.com

Neurosurgery in India Most people think of neurosurgery as brain surgery but it is much more! It is the medical specialty concerned with the diagnosis and treatment of patients with injury to or diseases/disorders of the brain, spinal cord and spinal column, and peripheral nerves within all parts of the body. The specialty of neurosurgical care includes both adult and pediatric patients. Dependent upon the nature of the injury or disease a neurological surgeon may provide surgical and/or non-surgical care.

What is Neurosurgery?

Neurosurgery (or Neurological Surgery) is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the brain, spinal column, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system. Neurosurgery is a branch of the surgery discipline which focuses on the brain and spinal cord. It is an extremely advanced form of surgery, requiring many years of training, and a high level of precision and experience on the part of the surgeon.

Neurological disorders: • • • • • • • • • • • • • • • • • • • • •

Amyotrophic Lateral Sclerosis Aphasia Asperger Syndrome Arachnoiditis Dystonia Encephalitis and Meningitis Encephalopathy Facial Nerve Problems Fainting Guillain-Barre Syndrome Head Injury Hematoma Huntington Disease Internal Bleeding Lead Poisoning Learning Disabilities MELAS Syndrome Meralgia Paresthetica Motion Sickness Multiple Sclerosis Myasthenia Gravi

• • • • • • • • • • • • • • • • • •

Arteriovenous Malformation Autism Blood Clots Brain Aneurysm Brain Concussion Brain Hemorrhage Brain Tumor Canavan Disease Cauda Equina Syndrome Cerebral Palsy Charcot-Marie-Tooth-Disease Compartment Syndrome Complex Regional Pain Syndrome Creutzfeldt-Jakob Disease Devic's Syndrome Dizziness Pick Disease Pinched Nerve

• • • • • • • • • • • • • • • • • • • • •

Stroke Stroke Prevention Thoracic Outlet Syndrome Tourette Syndrome Tremor Trigeminal neuralgia Vertigo Ramsay Hunt Syndrome Restless Leg Syndrome Reye Syndrome Seizure Seizures Symptoms and Types Sinus Headache Spinal Cord Injury Stem Cells Peripheral Neuropathy Neuropathic Pain Parkinson's Disease Narcolepsy Pseudotumor Cerebri Progressive Supranuclear Palsy

Types of Neurosurgery procedures:

• • • • • • • • •

Laminectomy Craniotomy Rhizotomy Corpus Callosotomy Stereotactic Radiosurgery Hemispherectomy Endotracheal Intubation Deep Brain Stimulation Meningocele Repair

• • • • • • • •

Sympathectomy Vagal Nerve Stimulation Pallidotomy Sacral Nerve Stimulation Ventricular Shunt Cerebral Aneurysm Repair Anterior Temporal Lobectomy Human Leukocyte Antigen Test

Common Neurological Diagnostic methods: Neurological diagnostic tests and procedures are designed to locate and diagnose nervous system issues and disorders.

Some of the most common screening tests include: Neurological examinations - these help determine function and status of speech, balance, coordination, reflexes, mental status as well as tumors or infections such as meningitis or encephalitis.

Fluoroscopy -a type of x-ray that utilizes pulsed low dose radiation beams to create continuous images of body parts.

Pictures can be sent to a monitor for immediate viewing or videotaped. In some cases, contrast mediums or dyes may be used to provide specific focus to certain areas of the body.

Cerebral angiogram - often utilized to diagnose and pinpoint narrowing or obstruction of arteries or blood vessels in the brain or neck. They may also be used to determine size and location of brain aneurysms, tumors or vascular malformations.

Brain scans - include but are not limited to MRIs (magnetic resonance imaging), computed tomography (CT) and positron emission tomography (PET). Brain scans can diagnose location of brain hemorrhages, malformations in blood vessels, and be used to locate and diagnose tumor growth.

Electroencephalography - also known as an EEG, this test monitors brain activity. It's often used to diagnose brain damage caused by head injuries, seizure disorders, or inflammation in the spinal cord or brain caused by degenerative disorders, metabolic disorders and some psychiatric disorders.

Electromyography - also known as EMG, this test is utilized to diagnose muscle dysfunction, spinal cord disease processes and diagnose nerve damage or dysfunction. The test measures and records electrical activity from the spinal cord or brain to peripheral nerve roots located in the legs or arms.

Common Neurological procedures: Laminectomy: A laminectomy is a surgical procedure in which the surgeon removes a portion of the bony arch, or lamina, on the dorsal surface of a vertebra, which is one of the bones that make up the human spinal column. It is done to relieve back pain that has not been helped by more conservative treatments. In most cases a laminectomy is an elective procedure rather than emergency surgery. A laminectomy for relief of pain in the lower back is called a lumbar laminectomy or an open decompression.

Craniotomy: A craniotomy is a procedure to remove a lesion in the brain through an opening in the skull (cranium). A craniotomy is a type of brain surgery. It is the most commonly performed surgery for brain tumor removal. It also may be done to remove a blood clot (hematoma), to control hemorrhage from a weak, leaking blood vessel (cerebral aneurysm), to repair arteriovenous malformations (abnormal connections of blood vessels), to drain a brain abscess, to relieve pressure inside the skull, to perform a biopsy, or to inspect the brain. Craniotomy is distinguished from craniotomy (in which the skull flap is not immediately replaced, allowing the brain to swell, thus reducing intracranial pressure) and from trepanation, the creation of a burr hole through the cranium in to the durra mater.

Rhizotomy: Rhizotomy is the cutting of nerve roots as they enter the spinal cord. Rhizotomy (also called dorsal Rhizotomy, selective dorsal Rhizotomy, and selective posterior Rhizotomy) is a treatment for spasticity that is unresponsive to less invasive procedures. Rhizotomy is performed under general anesthesia. The patient lies face down. An incision is made along the lower spine, exposing the sensory nerve roots at the center the spinal cord. Individual nerve rootlets are electrically stimulated. Since these are sensory nerves, they should not stimulate muscle movement. Those that do (and therefore cause spasticity) are cut.

Typically, one quarter to one-half of nerve rootlets tested are cut.

Corpus Callosotomy: Corpus Callosotomy is a treatment for epilepsy, in which a group of fibers connecting the two sides of the brain, called the corpus callosum, is cut. It is used to treat epilepsy that is unresponsive to drug treatments. A person with epilepsy may be considered a good candidate for one type of epilepsy surgery or another if he or she has seizures that are not adequately controlled by drug therapy, and has tried at least two (perhaps more, depending on the treatment center's guidelines) different anti-epileptic drugs. The purpose of this treatment is to prevent spreading of seizure activity from one half of the brain to the other. The brain is divided into two halves, or hemispheres, that are connected by a thick bundle of nerve fibers, the corpus callosum. When these fibers are cut, a seizure that begins in one hemisphere is less likely to spread to the other. This can reduce the frequency of seizures significantly.

Stereotactic Radiosurgery: Stereotactic radiosurgery is the use of a precise beam of radiation to destroy tissue in the brain.

This procedure is used to treat brain tumors, arteriovenous malformations in the brain and in some cases, benign eye tumors or other disorders within the brain. It works the same as all other forms of radiation treatment. It does not remove the tumor or lesion, but it distorts the DNA of the tumor cells. The cells then lose their ability to reproduce and retain fluids. The tumor reduction occurs at the rate of normal growth for the specific tumor cell. In lesions such as AVMs (a tangle of blood vessels in the brain), radiosurgery causes the blood vessels to thicken and close off. The shrinking of a tumor or closing off of a vessel occurs over a period of time. For benign tumors and vessels, this will usually be 18 months to two years. For malignant or metastatic tumors, results may be seen in a few months, because these cells are very fast-growing.

Meningocele repair: is surgery to repair birth defects of the spine and spinal membranes. Meningocele and myelomeningocele are types of spinal bifida. The surgery is necessary to close this abnormal opening to decrease the risk of infection and protect the integrity of the spina column and the tissue inside. A myelomeningocele is the most severe type of spina bifida because the spinal cord has herniated into the protruding sac. Neural tissue and nerves may be exposed. About 80% of myelomeningoceles occur at the lower back, where the lumbar and sacral regions join. Some people refer to myelomeningocele as spina bifida.

Because of the exposed neural tissue, significant symptoms may be present.

Pre-operative Necessities: The usual preoperative things that need to be done include bloodwork, heart function evaluation (e.g. EKG), medical clearance by your internist, a chest X-Ray, and possibly a localizing MRI or CT scan to help minimize the surgery. (A kind of "X marks the spot" idea). If you are undergoing stereotactic surgery, you may require an MRI with localization markers (usually felt-tip pen marks) on your scalp, or the placement of a sort of medieval "frame" that is literally screwed onto your skull, using local anesthetics.

Certain problems may require a cerebral angiogram to be performed, so that the surgeon has a "blood vessel" road map prior to surgery. Functional studies (special MRI, EEG, or magnetoencephalography) also might be necessary to guide the surgeon where not to go.

Cerebral blood flow studies (SPECT, Xenon studies or transcranial doppler studies) may be important to show the surgeon the state of your brain's blood supply reserves. You'll get an IV catheter the night before surgery; you'll be given various medications to prevent seizures, temporarily remove brain water (like medically squeezing a sponge), so the surgeon doesn't need to retract too much during surgery. You'll also be given antibiotics (to prevent infection). If you have an allergy to an antibiotic, make sure everyone knows it.

The night before surgery is usually full of anticipation. More often than not, you'll be the one comforting your family and friends. If you're afraid, thats only normal. Sometimes, sleep is difficult, so don't hesitate to ask for sleeping medication, if you want it.

After surgery: The next twenty-four hours will be spent in either the recovery room or in an intensive care unit setting. Usually a postoperative CAT scan will also be performed during this time, and nurses will stand by you, repeating the neurologic examination every hour or so, while administering the usual post-operative medications. These usually include pain medications (not too much, because they all want to see you bright and alert), steroids, antibiotics and anticonvulsants. You will usually be allowed to drink after a few hours, and "advance" your diet with each subsequent meal. If all is well, you will return to a regular room the following morning. Depending upon circumstances, a physical therapist will visit you and begin to work with you. Over the next couple of days, you will increase your activity until you are ready to go home. During that time you may be seen by various ancillary physicians, such as interns, residents, psychiatrists, radiation oncologists, internists, neurologists, and possibly oncologists. They will all confer with your neurosurgeon and come up with some sort of game plan prior to your discharge.

Advance Neurological procedures: Gamma Knife surgery: Patients with certain types of brain tumors and disorders no longer need to "go under the knife" or endure physically draining radiation therapy to find relief. With Gamma Knife technology, doctors are able to deliver over 200 beams of radiation with scalpel-like precision directly to tumors and lesions. Although many people have never heard of Gamma Knife, the procedure has been around for a long time. The Food and Drug Administration approved it nearly 30 years ago, and University of Maryland doctors have been administering Gamma Knife treatments for over a decade. Unlike traditional surgery, Gamma Knife procedures don't actually involve the use of a "knife" or scalpel. In fact, no incisions are made at all. The skull never has to be opened up.

Neurosurgery in India: Of late, India has embarked by all its leaps and bounds in catering various Neurosurgery procedures. Every year we see thousands of international patients coming down to India from various parts of the world. The factor behind this haul is certainly the presence of rich medical infrastructure with state of the art hospitals unlike we find in developed nations of US and UK wherein, the patients get medical services through cutting edge technology and staffed by well-experienced, trained and qualified multinational team.

The Indian Neurosurgeons and the Neurological team are of highest quality and deliver state-of-art medical and surgical care in these highly specialized fields of neurosurgery. They are known to cater personalized care and attention with value added services besides results of world class standard at a very low cost affordable to all sections of society.

The various Neurological procedures in India are available at various hospitals in the following cities:

Mumbai

Hyderabad

Kerala

Delhi

Pune

Goa

Bangalore

Nagpur

Jaipur

Chennai

Gurgaon

Chandigarh

Cost of Neurosurgery in India: A huge cost difference is evident in India when it comes to Neurosurgery in India. India is cheaper along with zero patient wait lists. Interestingly, the quality delivered at such a low cost doesn’t compromise the quality of treatment, as the foreign patients are accustomed to get in their respective country. This is due to the outburst of the private sector which is comprised of hospitals and clinics with the latest technology and best practitioners. The following cost comparison can give a right picture of the claim behind low cost treatment with quality:

Procedure Neurosurgery with Hypothermia Brain tumor surgery DBS

USA ($) 23,000 12,000 28,500

UK($) 21,000 10,000 26,000

India ($) 6,800 4,600 17,000

Some of the common countries from which patients travel to India for surgery are: USA

UK

Canada

Australia

New Zealand

Nigeria

Kenya

Ethiopia

Uganda

Tanzania

Zambia

Congo

Sri Lanka

Bangladesh

Pakistan

Afghanistan

Nepal

Uzbekhistan

ABOUT INDIA Located in South Asia, bordered by Pakistan, Nepal, China and Bangladesh, India is South Asia's largest, sovereign, democratic republic. India has an edge over other countries when it comes to offering comprehensive, cost-effective and timely medical care: it also offers an exotic, adventure-filled or cultural -if you wish array of destinations to discover and revel in for the travelers. Indian cities like Mumbai, Hyderabad, Goa, Bangalore, Nagpur, Kerala, Delhi, Pune, Jaipur, Chennai, Gurgaon, and Chandigarh offers best medical tourism service.

Mumbai - Formerly known as Bombay, is the commercial & financial capital city of India. Mumbai is famous for many things, including its thriving Bollywood film industry, teeming bazaars, colonial-style buildings, Art Deco structures and a superb choice of restaurants, often being rated as the dining capital of India. The tourist district of Colaba in Mumbai is a great place to start exploring this great city.

Hyderabad – Hyderabad city is a great place to visit in the state of Andhra Pradesh. The place has witnessed a continuous growth for last many years. Hyderabad has become a tourist hotspot following ever increasing number of tourists during past few years. Hyderabad has a well-founded reputation as one of the safest cities in the world.

Goa - The country's smallest state and famed for its colonial Portuguese and Catholic past, most tourists visit Goa for its endless selection of sandy beaches and coastal attractions. Standing proudly next to the Arabian Sea, Goa is a particularly compact state and often feels like a large town, being easy to travel. Around Goa, tourists will soon realize that the state has much more to offer than simply stunning beaches, fishing, water scooters, windsurfing and scuba diving.Bangalore - Beauty lies in the eyes of beholder and if you want to see one of the most beautiful places in India then Bangalore is the word for it.

Bangalore has earned sobriquets like 'Silicon Valley of India', 'Pub Capital of India', and 'City of Gardens'. Pleasant climate with colorful gardens with lakes and glittering nightlife, Bangalore has made its own attraction for travelers as one of the most charming cities in India, Nagpur - Nagpur is the largest city in central India, but with its friendly atmosphere and dependable transportation, you’ll instantly feel at home. The city of Nagpur has a well-built infrastructure, is a clean and affluent city which makes a good jumping-off point for a series of trips into the far eastern corner of Maharashtra.

Kerala - Natural beauty, clean air and primordial greenery amidst the vast expanse of water and sky, typifies the state of Kerala – better known as God's own country. Kerala is famous for its alternative medical therapies such as Ayurveda, which help to rejuvenate and revitalize the body. The region is also home to India’s only virgin tropical rain forest – the Silent Valley National Park, supporting an overwhelming range of life forms, many of which are highly endangered, and endemic to this part of the planet.

Delhi - "Welcome to The Capital City of India - New Delhi" Delhi is famous as Capital city of India is located in North India. Delhi is truly a symbol of the old and the new; a blend of ancient well preserved monuments and temples along with jam-packed burger joints and up market shopping malls. Delhi has state of the art Hospitals and the best qualified doctors.

Pune - Once referred to as the Oxford of the east, Pune continues to be a stronghold for academics and culture. An array of factors like availability of efficient and experienced doctors, comparatively low treatment costs, hospital facilities of international standards and many more have made Pune one of the top destinations for medical tourism.

Jaipur - Jaipur is one of the most popular destinations on a tourist's itinerary. The magnificent forts, beautiful havelis and colourful bazaars make Jaipur a popular tourist destination among tourists. Jaipur has pioneered health and medical tourism in India.

Chennai - Chennai is one of the most developed urban centers in the Indian subcontinent. The city forms the capital of Tamil Nadu state and is the fourth largest metropolitan city in India. They have some of the very best hospitals and treatment centers in the world. Each hospital is equipped with state of the art facilities. The technology brought into practice is the very latest, including robotic surgery.

Patients Testimonial:

Mr. Zang, Nigeria Brain Haematoma Surgery in India

Hello. I am Mr. Zang from Nigeria. I came to India for my neurosurgery about a month ago. It was a pleasant experience. I am very thankful to my coordinators - The Dheeraj Bojwani group for their support. Because of them, I got my neurosurgery in India at an affordable price under the best neuro surgeons of India. I came to know about Dheeraj Bojwani Group from a family friend. I checked out their website and the information provided there was sufficient. I was glad to see so many testimonials from so many international patients. It only proved that people have nothing but praise for Dheeraj Bojwani Group. I sent them my query through email. And within 24 hours I got a call from one of their executives. I am overwhelmed by the response. There are certainly a lot of benefits of getting your neuro surgery in India. Cost is the major factor. Neurosurgery in any Western country will cost a fortune. But in India it is not only affordable but the medical facilities are also equivalent to the West. The hospital where I got my neuro surgery in India was without a doubt one of the best hospitals I have ever seen in my life. The hospital staff was so friendly that it was as if I am in a luxurious five star hotel rather than a hospital. The neurosurgeons who performed my neuro surgery in India were experienced and professional. They were very responsive; they answered all my questions patiently and encouraged me throughout my treatment. All this couldn’t have been possible without The Dheeraj Bojwani Group.

Mrs. Zang, Nigeria Complex Neurosurgery for her husband in India

Hi. I am Mrs. Zang form Nigeria. Recently, my husband got his Brain Surgery in India with the assistance of Dheeraj Bojwani Group. We decided to get my husband’s Brain Surgery in India after we saw the website of Dheeraj Bojwani Group. The information provided at their website was satisfactory. We then sent them our query and in just a few hours, we got a call from them. They had been very supportive and attentive to us. They could understand the apprehensions of foreign patients. All the arrangements for me and my husband were absolutely perfect. From the day we arrived to the day we left, we were in awe of the professionalism that Dheeraj Bojwani Group exhibited. And not only our coordinators, but the hospital where my husband got his Brain Surgery in India was marvelous. The entire hospital staff was extremely kind and receptive. My husband’s Brain Surgery in India was performed successfully by a team of certified Neuro Surgeons. The surgeons were highly skillful. They were very hard working and professional. In fact the entire hospital staff was very hard working. My husband is recovering fast after getting his Brain Surgery in India. We are very thankful to everyone who supported us.

Thank you, Mrs. Zang

Knee Replacement Surgery in India Knee replacement surgery also known as knee arthroplasty is procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. The procedure has been proven to help individuals return back to moderately challenging activities such as golf, bicycling, and swimming. Total knees are not designed for jogging, or sports like tennis and skiing (although there certainly are people with total knee replacements that participate in such sports). Knee replacement is a routine surgery performed on over 600,000 people worldwide each year. Over 90% of people who have had Total Knee Replacement experience an improvement in knee pain and function.

Knee Replacement Surgery Candidates A person would be considered a candidate for knee replacement if there is: • • • • • •

Daily pain The pain is severe enough to restrict work, recreation and ordinary activities of daily living Significant stiffness in the knee Significant instability (constant giving way) of the knee Significant deformity (knock-knees or bow-legs) that hinders normal function of the knee Damage from arthritic conditions, such as osteoarthritis, rheumatoid arthritis or post-traumatic arthritis

Success Rate of Knee Replacement Surgery: Knee replacement surgery is recognized as a miracle of modern surgery. Most orthopedic experts consider replacement to be the best method of handling arthritis in the knee. Knee replacements have literally put hundreds of thousands of Americans back on their feet and allowed them to enjoy their golden years.

Knee Replacement Surgery Preparations: • • • •

• • •

If you smoke, cut down or quit. Smoking changes blood flow patterns, delays healing and slows recovery.

If you drink, don't have any alcohol for at least 48 hours before surgery.

Ask your doctor for pre-surgical exercises. If you are having hip or knee replacement surgery, doing exercises to strengthen your upper body will help you cope with crutches or a walker after surgery.

Your primary care physician or an internist will conduct a general medical evaluation several weeks before surgery.

This examination will assess your health and your risk for anesthesia. The results of this examination should be forwarded to your orthopaedic surgeon, along with a surgical clearance.

Shortly before your scheduled surgery, you will probably have an orthopedic examination to review the procedure and answer any last-minute questions.

You may need to take several types of tests, including blood tests, a cardiogram, a urine sample and a chest X-ray.

Advice your surgeon of any medical conditions you have and of all the medications you are taking. You may need to stop taking certain medications or your surgeon may recommend substitute medications until your surgery.

Medications such as corticosteroids, insulin or anti-coagulants will need to be managed before and after surgery.