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Minimally invasive surgery is used by Dr. Purav Patel for non-invasive treatments whenever these techniques can achieve comparable or better results compared to standard open surgical procedures. State-of-the-art, minimally invasive neuronavigation technology minimizes incisions and often allows surgeons to cosmetically hide scars. Minimally Invasive Procedures Some of the minimally invasive surgery techniques used by him are listed below: Microcraniotomy - For certain brain tumors deep under the surface of the brain, a narrow opening (about half an inch in diameter) can be used to reach the tumor.The narrow, minimally invasive surgery opening minimizes damage to normal brain tissue overlying the tumor.In other cases, precise stereotactic neuronavigation may allow very small skin incisions and bony openings (craniotomy) for removal of brain tumors. Neuroendoscopy - This minimally invasive surgery technique uses specialized endoscopes with high resolution video cameras to perform surgery of the brain. Smaller incisions and bony openings often result in less pain and shorter hospital stays. Many brain tumor operations that previously required a large scalp incision and large bony opening (craniotomy) can be performed as minimally invasive surgery - using smaller incisions and craniotomy openings.
Skull base tumors grow primarily on the inside of the skull, but occasionally on the outside. Some tumors originate in the skull base, while others spread there from a cancer elsewhere in the body . The many types of skull base tumors and conditions are classified by the type of tumor and its location in the skull base. Common symptoms of skull base tumors and conditions include:
Diagnosis of skull base tumors and conditions may involve: A physical exam: This includes questions about the patient's symptoms, and personal and family health history. A neurological exam: This test checks vision, hearing, balance, coordination, reflexes and ability to think and remember. Imaging of the brain: Magnetic resonance imaging (MRI) or computed tomography (CT or CAT scan), which use computers to create detailed images of the brain, are the most common scans used to diagnose brain tumors. Treatment Treatment for skull base tumors and conditions may include surgery, radiation therapy, chemotherapy and/or observation. The treatment for a skull base tumor or condition depends on many factors, including:
If the patient's tumor is benign and in a part of the skull base where Dr. Patel can safely remove it completely, surgery may be the only treatment needed. Although many tumors are amenable to minimally invasive endonasal endoscopic surgery, there are in fact a variety of approaches to surgery for skull base tumors.
A brain tumor is a group (or mass) of abnormal cells in your brain. Many different types of brain tumors exist, and their clinical behavior can vary from benign (noncancerous) to malignant (cancerous).
Treatment for a brain tumor depends on the type, size, and location of the tumor, as well as your overall health and your preferences. Surgery If the brain tumor is located in a place that makes it accessible for an operation, your neurosurgical oncologist will work to remove as much of your brain tumor as possible. Radiation therapy Radiation therapy uses beams of high-energy particles, such as X-rays, to kill tumor cells. Radiation therapy can come from a machine outside your body (external beam radiation), or, in very rare cases, objects that release radiation can be placed inside your body close to your brain tumor (brachytherapy). Radiosurgery Stereotactic radiosurgery is not a form of surgery in the traditional sense. Instead, radiosurgery uses multiple beams of radiation to give a highly focused form of radiation treatment to kill the tumor cells in a very small area. By itself, each beam of radiation is not particularly powerful, but at the point where all the beams meet—the brain tumor—a very large dose of radiation is delivered, killing the tumor cells. Chemotherapy Chemotherapy uses drugs to kill tumor cells. Chemotherapy drugs can be taken orally in pill form or injected into a vein (intravenously). Targeted Drug Therapy Targeted drug treatments focus on specific abnormalities present within cancer cells.
Brain injury results from an impact to the head that disrupts normal brain function. Brain injury may affect a person’s cognitive abilities, including learning and thinking skills. Falls are the leading cause of traumatic brain injury for all ages. Doctors classify traumatic brain injury as mild, moderate or severe, depending on whether the injury causes unconsciousness, how long unconsciousness lasts and the severity of symptoms. Although most traumatic brain injuries are classified as mild because they're not life-threatening, even a mild traumatic brain injury can have serious and long-lasting effects. If a Head Injury Occurs If you or someone you're with experiences an impact to the head and develops any symptoms of traumatic brain injury, seek medical advice even if symptoms seem mild. Symptoms of a brain injury include:
Treatment The most serious head injuries require specialized hospital care and can require months of inpatient rehabilitation. Most traumatic head injuries are mild and can be managed with either a short hospital stay for observation or at-home monitoring followed by outpatient rehab, if needed. Initial focus of treating a head injury is to stabilize the injured person in order to minimize secondary complications. As a patient is admitted, initial medical treatment goals include ensuring proper oxygen and blood flow to the brain and body, stabilizing blood pressure, and treating any problems or conditions affecting other parts of the body (besides the brain) that have arisen because of the injury. After individuals with head injury have been stabilized, the treatment plan generally involves rehabilitation efforts to teach patients how to cope with their specific injury-related symptoms. Each head injury and its recovery is different, and the brain has a remarkable way to adjust after injury. It is critical to know the symptoms and to seek treatment before there is a chance for additional, more serious complications to occur.
A brain aneurysm is a balloon-like bulge in the wall of a brain artery. If this balloon bursts and bleeds, the surrounding brain cells may be damaged. What are the causes of a brain aneurysm? A brain aneurysm usually occurs in an artery wall that has a defect or is weak. It is often associated with the hardening of the arteries. High blood pressure, heredity factors, or head injury are possible causes that might have led to a brain aneurysm. What are the symptoms? Most people will not have any symptoms until the aneurysm bleeds. When the aneurysm bleeds, symptoms experienced include:
How do we diagnose a brain aneurysm? Brain aneurysms need to be treated as soon as possible – otherwise, they can be fatal. A fast and accurate diagnosis is essential for recovery. The following tests may be performed: Cerebral Angiogram o A special dye that is visible on X-ray is injected into an artery that supplies blood to the brain. The dye will show any obstruction and bleeding in the X-ray images taken MRA o A Magnetic Resonance Angiogram (MRA) is done with the use of an MRI scanner to show the 3-dimensional structure of the blood supply in the brain. CT Scan o A CT Scan will be able to detect any bleeding in the brain after a burst aneurysm. What are the treatments available? If the aneurysm has already ruptured, the goal of treatment is to prevent bleeding/another rupture while preserving the artery from which the aneurysm originated. If the aneurysm has not burst, the goal will be to prevent it from bursting. Surgery (Microsurgical Clipping of Aneurysm) The neurosurgeon puts a clip on the aneurysm where it bulges from the artery. This prevents the blood from entering the aneurysm. As a result, further bleeding is avoided and the surrounding brain tissue is protected from additional damage. Occlusion and Bypass It may be best to stop blood flow through the artery leading to the aneurysm. This is called occlusion and is usually done as open surgery. Sometimes occlusion is done together with a bypass. A bypass re-routes blood around the occlusion. It brings blood to the part of the brain that has been fed by the damaged artery. A small blood vessel is used for the bypass. Endovascular Procedure An endovascular procedure may be the best option for some aneurysms. This is done in the X-ray Lab by the interventional Neuroradiologist. During this procedure, a catheter is guided from the groin to the brain arteries. Platinum coils are released into the aneurysm causing a blood clot to form within and sealing it off.
Arteries normally carry oxygenated blood from the heart to the brain while the veins carry de-oxygenated blood away from the brain and back to the heart. An arteriovenous malformation (AVM) is a tangle of blood vessels in the brain which divert blood directly from the arteries to the veins, bypassing the normal brain tissue. What are the symptoms of a brain AVM? The symptoms of an AVM depend on where it occurs within the brain. Over 50% of patients with an AVM present with intracranial haemorrhage. 20% - 25% of patients with an AVM have either focal or generalised seizures. Patients may experience localised pain in the head because of increased blood flow around an AVM. 15% of patients may have difficulty with movement, vision, or speech. What is the best treatment for an AVM? Treatment usually depends on the type of AVM (location and size) and the symptoms that it may be causing. Medical Therapy If the patient has no symptoms, or if the AVM occurs in a region of the brain that cannot be easily treated, conservative medical management may be necessary. The AVM patient will be advised to avoid blood thinners (Warfarin), and any activities that may excessively raise blood pressure (e.g. carrying heavy things or strenuous exercise). Surgery If an AVM has bled and/or is in an area that can be easily operated upon, then surgical removal may be recommended. The patient is put to sleep with anaesthesia, a portion of the skull is removed, and the AVM is surgically removed. With the AVM completely removed, there will be no possibility of further bleeding Stereotactic Radiosurgery (Gamma Knife) An AVM that is not too large, but is in an area that is difficult to reach by regular surgery may be treated by performing Gamma Knife Radiosurgery. Interventional neuroradiology/endovascular neurosurgery It may be possible to treat part – or all – of the AVM by placing a catheter (small tube) inside the blood vessels that supply the AVM, and blocking off the abnormal blood vessels with a variety of different materials.
The Skull Growth Defects and Deformities typically affect the bone and soft tissue in the head and spine. There are many different types of these malformations. They can vary greatly from mild to severe conditions. A congenital skull defect usually occurs due to an interruption in the normal growth of the nervous system. When this process is disturbed, it can cause structural defects in the brain and skull. Normal brain function can be impaired even if only the skull’s growth is upset. Types of Congenital Brain Defects Several types of congenital brain defects are caused by neural tube defects. They are: Anencephaly: This occurs when the head end of the neural tube fails to close. A major portion of the skull and brain is missing. Existing brain tissue is exposed. Encephalocele: This occurs when a portion of the brain bulges through an opening in the skull. It typically is located along the front-to-back midline at the back of the skull. Spina bifida: This occurs when the neural tube doesn’t close below the level of the brain. This prevents the surrounding vertebrae from fully developing. It leaves the spinal column divided. Other types of congenital brain defects develop within the structure of the brain. Hydrocephalus, or fluid on the brain, is an excessive buildup of cerebrospinal fluid (CSF) due to impaired circulation of the CSF. When there is excess fluid, it can put too much pressure on the brain. Dandy-Walker syndrome is a defect that involves the absence or defective growth of the central section of the cerebellum. Holoprosencephaly is a condition in which the brain doesn’t divide into two halves, or hemispheres. Megalencephaly, also called macrencephaly, is a brain that is abnormally large or heavy. Microcephaly, or a small brain, occurs when the brain doesn’t develop to full size Symptoms Symptoms of congenital brain defects vary. Each defect has a distinct set of symptoms and impairments. Some of these symptoms may not be apparent until after birth when the child exhibits developmental or growth delays. Treatment Available treatment of congenital brain defects varies according to the type and severity of defect. Anticonvulsant medications can help with seizures. Many defects only can be treated with symptom relief. Surgical techniques can provide improvement for some conditions. Decompression surgery can create more space for brain and cerebrospinal fluid in conditions where there is not enough space for brain growth. Surgery to correct defective skulls can give the brain space to grow normally. Shunts can be inserted to drain the cerebrospinal fluid that builds up with hydrocephalus.
Shunt operation is generally performed to treat Hydrocephalus. Hydrocephalus is a condition in which excess cerebrospinal fluid (CSF) builds up within the ventricles (fluid-containing cavities) of the brain and may increase pressure within the head. Hydrocephalus can occur at any age, but is most common in infants and adults aged 60 and older. Shunt Procedure In this procedure, a ventricular catheter is placed in the cerebral ventricles. This allows the bypass and drainage of the excess fluid to other cavities in the body. The fluid may be drained into cavities such as the peritoneal cavity, the right atrium, pleural cavity and gallbladder. A shunt is a tube that is soft and flexible, and is usually made up of plastic or silicone rubber. It contains a valve that allows drainage and a catheter that joins the drainage and deposit sites. A small sensor may be placed near the valve to check pressure levels if the intracranial pressure is high. A ventriculoperitoneal shunt is permanently placed with one end inserted in a ventricle of the brain and another end in the peritoneal cavity. Other drainage sites may be the gall bladder, the heart’s right ventricle and the pleural area surrounding the lungs. According to the location of obstruction, fluid drainage may be done from the subarachnoid space around the brain. The shunt is usually replaced after 10 years in adults. In children, the shunts may need to be replaced sooner. While there is no permanent cure for hydrocephalus, Dr. Purav Patel is committed to the most comprehensive care for those who come to him. He offers expert treatment of hydrocephalus and can advise patients and their families of the most advanced treatment options.
Cransynostosis is the premature closure of one or more of the gaps between the developing bones of the skull. This condition is typically discovered by the pediatrician or parents within the first few months of life. For some babies, this diagnosis can best be determined by a trained craniofacial surgeon. In this birth defect, some or all of the sutures in the skull close too early, causing problems with normal brain and skull growth--which potentially can result in increased intracranial pressure and the head becoming irregular in shape. The earlier this fusion occurs, the greater its effects. Craniosynostosis Causes Craniosynostosis is usually an isolated finding in an otherwise normal child. The precise causes vary and are incompletely understood. Most cases of craniosynostosis occur in families with no history of the condition. Its heredity form has been associated with various genetic disorders. In addition, mutations in several genes have recently been identified in certain forms of craniosynostosis. A geneticist examines all infants and discusses the chances of having another infant with craniosynostosis with each family. Several non-genetic factors have also been implicated in the origins of craniosynostosis, including fertility treatments, paternal profession and such environmental exposures as maternal smoking and certain drugs (sodium valproate). Craniosynostosis Treatment Most cases require early surgery to prevent distortion of other craniofacial structures. However, mild degrees of craniosynostosis may not require surgery. Early diagnosis and treatment can have a great impact on the outcome of the child's brain development and vision development.
A stroke occurs when blood supply to a part of the brain is disrupted. As a result, the brain cells are starved of oxygen, causing some to die, and damaging others. What are the types of stroke and how do they occur? There are two types of strokes: Ischemic Strokes are caused by the blockage of arteries supplying blood to the brain (e.g. due to High Cholesterol) Hemorrhagic Strokes are caused by the rupturing of blood vessels in the brain (e.g. due to High Blood Pressure) What are the risk factors?
How do we diagnose stroke? The following tests may be performed:
What are the treatments available for stroke? Patients suffering stroke will be closely monitored, with special attention paid to their blood pressure, blood sugar and cholesterol levels. Blood thinners like Aspirin may be used for Ischemic Stroke patients to allow for easier blood flow, while surgery may be needed for Hemorrhagic stroke patients. The next phase of treatment is rehabilitation, which involves the help of a Physiotherapist/Speech Therapist. They will help train stroke patients to be independent in their daily activities.
Your entire body is powered by nerves, but those nerves can be damaged by injury or an illness such as diabetes. Nerve damage can affect your ability to feel and move. The cranial nerves are those that arise directly from your brain or brainstem and often affect areas like the face and eyes.Your entire body is powered by nerves, but those nerves can be damaged by injury or an illness such as diabetes. Nerve damage can affect your ability to feel and move. The cranial nerves are those that arise directly from your brain or brainstem and often affect areas like the face and eyes. The most common Cranial Nerve Lesions are Trigeminal Neuralgias and Hemifacial Spasm. Hemifacial spasm is a neuromuscular disorder characterized by frequent involuntary contractions (spasms) of the muscles on one side (hemi-) of the face (facial). The first symptom is usually an intermittent twitching of the eyelid muscle that can lead to forced closure of the eye. The spasm may then gradually spread to involve the muscles of the lower face, which may cause the mouth to be pulled to one side. Eventually the spasms involve all of the muscles on one side of the face almost continuously. Both conditions may be caused by a nerve injury, or a tumor or it may have no apparent cause. Most often hemifacial spasm and trigeminal neuralgia are caused by a blood vessel pressing on a nerve at the place where it exits the brainstem. Both conditions can be surgically treated through a procedure called Microvascular Decompression (MVD). MVD involves microsurgical exposure of either the trigeminal nerve root or facial nerve root, identification of a blood vessel that may be compressing the nerve, and gentle displacement of it away from the point of compression. “Decompression" may allow the nerve to recover. This often results in pain relief (trigeminal neuralgia) or resolution of spasm (hemifacial spasm). Dr. Purav Patel is recognized around the world for excellence in state of the art medicine and neurosurgery for the treatment of trigeminal neuralgia and hemifacial spasm.
Injury to the Spinal Cord can occur due to trauma to any part of the spine from the cranium to the upper lumbar region where the spinal cord terminates. Trauma to the spinal cord is commonly associated with damage to the spine itself. Symptoms Spinal cord injury presents with severe pain, limited mobility, or paralysis after a specific accident or trauma to the spine. Diagnosis Patients with spinal cord injury need to be thoroughly examined by Dr. Purav Patel to assess any preservation of function, including peri-anal and rectal examinations and testing of all reflexes and motor and sensory functions. Wherever possible, radiographic studies (x-rays, CT scan) need to be performed in a timely manner. An MRI is indicated wherever possible to identify the injured spinal cord and any foreign tissues in the spinal canal, such as a fragment of bone or disc material. Treatment Surgery to correct a spinal deformity that narrows the spinal canal is often performed but is unlikely to reverse any major spinal cord dysfunction; however, removing bone or disc material from the spinal canal in a timely basis can promote the recovery of an incompletely injured cord. Patients with cervical spinal fractures are often placed in traction to try to realign the spinal canal to relieve any ongoing pressure on the spinal cord. Some spinal injuries, that result in spinal cord trauma, are stable and do not require surgery. In the cervical spine, fractures are sometimes treated with immobilization devices such as a halo external fixation device. Unstable fractures in the thoraco-lumbar region may require instrumented fusion.
Spinal tumors are any type of neoplasm or growth on the spinal cord. Spinal tumors may be cancerous or benign. Cancerous spinal tumors may be a metastasis from cancer elsewhere in the body or it may be a primary tumor (that is, the first cancerous tumor in the body). Benign spinal tumors are also dangerous, in that they can place pressure on the spinal cord and nearby structures, causing pain, lead to paraplegia or tetraplegia and other symptoms. Any type of spinal tumor is a serious medical condition requiring immediate and expert medical intervention. Treatment Spinal tumors are serious medical conditions that require the expert care offered by Dr. Purav Patel. Steroids can be administered to reduce inflammation caused by spinal cord compression. This may decrease pressure and reduce pain, but it does not affect the tumor itself. In some instances, the tumor may be treated with radiation therapy. Surgery is sometimes possible, during which all or a portion of the tumor can be removed. In some cases, the tumor can destabilize the vertebral column. Further surgery may be appropriate in such patients to help stabilize and strengthen the spine. Since every patient is unique and tumors can vary greatly depending on their size, location, effect, and origin, Dr. Purav Patel will discuss treatment options and prognoses on an individual basis.
Our spine is subjected to wear and tear, and the degeneration of the disc may cause it to bulge, thereby compressing the spinal cord. This will produce pain in the neck, back, or leg, and even numbness and weakness. These degenerative disorders are diagnosed by imaging studies taken using a Magnetic Resonance Imaging (MRI) machine. Treatment Treatment varies based on the severity of the condition. Conservative treatment, like medication, rest, and physiotherapy, will be the first line of treatment used. Surgical intervention is only used for people with severe and painful symptoms so as to provide relief from pain. Options include:
Anterior Cervical Discectomy & Fusion Anterior cervical discectomy and fusion (ACDF) is a procedure used to treat neck problems such as cervical radiculopathy, disc herniations, fractures, and spinal instability. In this procedure, the surgeon enters the neck from the front (the anterior region) and removes a spinal disc (discectomy). The vertebrae above and below the disc are then held in place with bone graft and sometimes metal hardware. The goal is to help the bones to grow together into one solid bone. This is known as fusion. The anterior approach of this surgery, which means that the surgery is done through the front of the neck as opposed to the back of the neck, has several typical advantages: Better access to the spine. The anterior approach can provide access to almost the entire cervical spine, from the C2 segment at the top of the neck down to the cervico-thoracic junction, which is where the cervical spine joins with the upper spine (thoracic spine). Less postoperative pain. Spine surgeons often prefer this approach because it provides good access to the spine through a relatively uncomplicated pathway. All things being equal, the patient tends to have less incision pain from this approach than from a posterior operation. A small cervical plate is used to stabilize the spine immediately after surgery, and also to decrease the chance that the bone graft might be dislodged or moved slightly from the position that it was placed in by the surgeon. Today, collars are typically worn for a shorter period of time after surgery than in the past, because of the use of the plates.
Inborn Defects of Spine refers to neurological disorders related to malformations of the spinal cord. Tethered spinal cord syndrome is a type of spinal dysraphism. In this congenital malformation of the spine, the spinal cord is attached to surrounding tissue. Failure to detect a tethered spinal cord can lead to a sudden catastrophic injury during childhood or adolescence, such as paralysis. Tethered spinal cord can be diagnosed through the detection of certain skin abnormalities along the midline of the back. Diagnosis may be confirmed by magnetic resonance imaging (MRI), and surgery is usually indicated to prevent any future neurological damage. The purpose of surgery is to correct the physical malformation. As these children are born with their spinal cord exposed to the skin, this must be repaired early to prevent infection and neurological deficits Dr. Purav Patel will perform surgery to release the tether. In some cases, fat is intertwined within the nerves and during surgery it will be removed. Adult Tethered Cord is characterized by a spinal cord that is located at an abnormally low position within the spinal canal. The position in which it comes to rest in an adult (L1 or L2) is caused by the growth of the individual. Tethered cord results when the spinal cord cannot normally ascend with growth, which causes it to stretch or become damaged. Treatment: How tethered cord is treated is based on the underlying cause. If the only abnormality is a thickened, shortened filum, then a limited lumbo-sacral laminectomy with division of the filum may be sufficient to relieve the symptoms.
Dr. Purav Patel treats patients with all types of brachial plexus and peripheral nerve injuries. He provides the highest quality surgical care for peripheral nerve diseases and generates new understanding of the diagnosis and treatment of nerve diseases through research. The peripheral nervous system is a complex system of 43 pairs of motor and sensory nerves that connect the brain and spinal cord to the entire human body.
Brachial plexus injury refers to any damage to the bundle of connected nerves in the neck region of your spinal cord which send branches down into your shoulders, arms, and hands. Nerve injury surgery to repair damaged nerves is complex, requiring a specialized experienced surgeon. 1. Confirmation of diagnosis 2. Repair of injury Several factors determine the type of intervention performed including:
Procedures to restore function include neurolysis, neurotization, tendon transfers, and free muscle transfers.
Nerve Entrapment Syndromes are nerve impingement conditions in which nerves or nerve roots are placed under abnormal pressure by soft tissues such as muscles, tendons, ligaments, or fascia. The abnormal pressure on the nerves or nerve roots creates pain locally or radiating outward, numbness or tingling in the area supplied by the nerve and possibly weakness or twitching of affected muscles. Nerve entrapment syndromes are fairly common and you may have heard of some of them like Carpal Tunnel Syndrome. What Are The Causes Of Nerve Entrapment Syndromes? There are a number of causes for Nerve Entrapment Syndromes. Direct trauma to the muscles or tendons, are a common cause and this includes injuries which quickly overstretch and damage soft tissues like whiplash does. Overworking muscles and tendons through excessive exercise, or through incorrect repetitive motions (Repetitive Stress Injuries) including typing and assembly line work can cause several Nerve Entrapment Syndromes. Additionally, postural distortions such as Forward Head Posture, Leg Length Discrepancy, or Lower Crossed Syndrome often lead to entrapment conditions. In rare cases certain genetic factors can lead to Nerve Entrapment Syndromes. Carpal tunnel syndrome (CTS) is a relatively common condition that causes pain, numbness and a tingling sensation in the hand and fingers. Carpal tunnel syndrome is caused by compression of the nerve that controls sensation and movement in the hands (median nerve). Treatment In some cases CTS will disappear without treatment, or simple self-care measures will reduce the symptoms. Non-surgical treatments, such as wrist splints and corticosteroid injections, are used to treat mild or moderate symptoms. In more severe cases of CTS, surgery is usually required to reduce the pressure on the median nerve. Surgery relieves the symptoms of CTS instantly, but it can take a while to recover. Depending on which hand was operated on and what your job involves, you will usually be able to return to work within a few weeks of surgery.