This document outlines various neurosurgeries performed by Dr. Niyati N Patel including craniotomies, cranioplasties, stereotactic surgeries, deep brain stimulation, burr hole shunting, laminectomies, hemilaminectomies, rhizotomies, microvascular decompressions, endarterectomies, embolizations, pituitary surgeries, ablative surgeries, coiling of aneurysms, clipping of aneurysms and post-operative physiotherapy. It describes the indications, procedures and goals of each surgery type.

1. NEURO SURGERIES
DR NIYATI N PATEL
MPT IN NEUROLOGICAL CONDITIONS

2. INTRODUCTION
1. CRANIOTOMY
2. CRANIOPLASTY
3. STERIOTECTIC SURGERY
4. DEEP BRAIN
STIMULATION
5. BURR HOLE SHUNTING
6. LAMINECTOMY
7. HEMILAMINECTOMY
8. RHIZOTOMY
9. MICRO VASCULAR
DECOMPRESSION
10. ENDARTERECTOMY
11. EMBOLIZATION
12. PITUITARY SURGERY
13. ABLATIVE SURGERY
(THALAMOTOMY &
PALLIDOTOMY)
14. COILING OF ANEURYSM
15. CLIPPING OF ANEURYSM

3. INDICATIONS
• HEAD INJURY
• CEREBRAL TUMOR
• CEREBELLAR TUMOR
• INTRA-CRANIAL ANEURYSM
• AV MALFORMATION
• PARKISNSONISM
• CEREBRAL ABSCESS
• SKULL DEFECTS
• INTRACTABLE PAIN

4. COMPLICATIONS OF CRANIAL
SURGERIES
• CSF LEAK
• POST OPERATIVE EDEMA
• ARTERIAL SPASM
• PULMONARY EMBOLUS/THROMBUS
• EPILEPSY
• INFECTION
• RESPIRATORY INFECTION
• DEATH

5. CONDITIONS SURGERY
• INTRA CRANIAL TUMOR 1. SURGICAL EXCITION
• SAH 1. OCCLUSION OF ANEURYSM
• AV ANOMALIES 1. INTRACRANIAL APPROACH
WITH EXCISION OF LESION
• CAROTID ARTERY STENOSIS 1. ENDARTERECTOMY
• HYDROCEPHALUS 1. SHUNTING
• CEREBRAL ABSCESS 1. ASPIRATION OF PUS
• PARKINSONISM 1. ABLATIVE SURGERY
2. DEEP BRAIN STIMULATION
3. NEURAL TRANSPLANTATION

6. CONDITIONS SURGERY
• EPILEPSY 1. LOBECTOMY
2. CORTICAL EXCISION
3. HEMISPHERECTOMY
4. CALLOSAL SECTION
• INTRACABLE PAIN 1. LOCAL SURGERY
2. POSTERIOR RHIZOTOMY
3. NEURO VASCULAR
DECOMPRESSION
4. TRIGEMINAL THERMAL
COAGULATION
5. DORSAL ROOT ENTRY ZONE
6. CORDOTOMY
7. MYELOTOMY
8. THALAMOTOMY
9. SACRAL NEURECTOMY

7. CRANIOTOMY
• A "Craniotomy" is the surgical removal of part of
the bone from the skull to expose the brain.
• Specialized tools are used to remove the section of
bone called the bone flap.
• The bone flap is temporarily removed, then
replaced after the brain surgery has been done.
• A "Craniectomy" refers to an operation wherein
the bone flap is removed but not replaced

8. INDICATIONS OF CRANIOTOMY
• Clipping of cerebral aneurysm (both ruptured and unruptured)
• Resection of arteriovenous malformation (AVM)
• Resection of brain tumor
• Biopsy of abnormal brain tissue
• Removal of brain abscess
• Evacuation of hematoma (eg, epidural, subdural and
intracerebral)
• Insertion of implantable hardware (eg, VPS , deep brain
stimulators [DBS], subdural electrodes for seziure monitoring,
Ommaya reservoir)
• Resection of epileptogenic focus/tissue
• Microvascular decompression (eg, for trigeminal neuralgia)
• Relieving elevated intracranial pressure (craniectomy)

9. CRANIOPLASTY
• Cranioplasty, the repair of a skull vault defect by
insertion of an object (bone or nonbiological
materials such as metal or plastic plates), is a well-
known procedure in modern neurosurgery

10. INDICATIONS OF CRANIOPLASTY
• Cranioplasty can avoid the recurrence of brain
damage
• Can achieve the plastic effect,
• Can protect the patient from cerebral seizures,
• Increase the brain blood flow
• Improve the brain energy metabolism
• Promote the resumption of brain tissue
• Treat the encephalocele skull defects with
neurological cognition and mental syndrome.

11. STEREOTACTIC SURGERY
• Stereotactic surgery is a minimally invasive form
of surgical intervention which makes use of a three-
dimensional coordinate system to locate small targets
inside the body and to perform on them some action
• Indications
1. Ablation,
2. Biopsy,
3. Lesion,
4. Injection,
5. Stimulation,
6. Implantation,
7. Radiosurgery

12. DEEP BRAIN STIMULATION
• surgical treatment of movement disorders primarily
involved neuroablative lesion surgeries that destroyed
abnormally hyperactive deep brain nuclei.
• However, the observation that high-frequency
electrostimulation in the ventral lateral nucleus (VL) of
the thalamus eliminates tremors in patients undergoing
thalamotomy led to investigation of long-term deep
brain stimulation (DBS) as a reversible alternative to
neuroablation.
• DBS has become the surgical procedure of choice for
Parkinson disease (PD) because it does not involve
destruction of brain tissue

13. INDICATIONS OF DEEP BRAIN
STIMULATION
• Dystonia
• Tremor in movement disorders;
• Depression,
• Obsessive-compulsive disorder
• Tourette's syndrome in psychiatry;
• Epilepsy,
• Cluster headache
• Chronic pain, including pain from stroke, amputation,
trigeminal neuralgia and multiple sclerosis

14. BURR HOLE SHUNTING
• Quite simply, a burr hole is a small hole made in
the skull with a surgical drill.
• The burr hole can be made for a variety of reasons,
such as to make a larger craniotomy, to pass
drainage catheters that allow for cerebrospinal fluid
drainage or evacuation of chronic blood

15. Indications of burr hole shunt
• To relieve pressure on the brain.
• To begin a larger incision, such as a craniotomy.
• To place a monitor that reads the pressure inside
the skull.
• To remove a blood clot.
• To remove a tumor.
• To treat seizures.
• To remove a foreign object.
• To place a medical device, such as a shunt

16. LAMINECTOMY &
HEMILAMINECTOMY
• Laminectomy is surgery that creates space by
removing the lamina — the back part of a vertebra
that covers your spinal canal. Also known as
decompression surgery, laminectomy enlarges your
spinal canal to relieve pressure on the spinal cord
or nerves
• Hemilaminectomy is where only part of the Lamina
and only a portion of the Facet Joint is removed to
allow more common for the Lumbar Nerve. This
nerve is usually compressed due to a progressive
degeneration in the spine

17. INDICATIONS FOR LAMINECTOMY
& HEMILAMINECTOMY
• Ankylosing spondylitis
• Degenerative disc disease
• Disc herniation
• Spinal stenosis
• Spinal tumor

18. RHIZOTOMY
• A selective dorsal rhizotomy (SDR), also known as
a rhizotomy, dorsal rhizotomy, or a selective
posterior rhizotomy, is a neurosurgical procedure
that selectively destroys problematic nerve roots in
the spinal cord.
• INDICATIONS
• Trigeminal neuralgia
• Spinal pain : Lumbar facet syndrome, Chronic discoid
back pain, Pain in the neck (CS), Spinal pain due to
cancers
• Spasticity

19. MICRO VASCULAR
DECOMPRESSION
• Microvascular decompression (MVD) is a surgery
to relieve abnormal compression of a cranial nerve
causing trigeminal neuralgia, glossopharyngeal
neuralgia, or hemifacial spasm.
• MVD involves opening the skull (craniotomy) and
inserting a sponge between the nerve and
offending artery triggering the pain signals
• INDICATIONS
• Trigeminal neuralgia
• Glossopharyngeal neuralgia

20. ENDARTERECTOMY
• Endarterectomy (EA) is a surgical procedure
performed by vascular surgeons to reduce the risk
of stroke by correcting stenosis (narrowing) in the
internal carotid artery.
• Endarterectomy is the removal of material on the
inside of an artery
• INDICATIONS
• Carotid artery stenosis
• Carotid revascularization
• Carotid atherosclerosis

21. EMBOLIZATION
• Endovascular embolization is a procedure to treat
abnormal blood vessels in the brain and other parts
of the body. It is an alternative to open surgery.

22. PITUITARY SURGERY
• Endoscopic pituitary surgery, also called
transsphenoidal endoscopic surgery, is the most
common surgery used to remove pituitary tumors.
• The pituitary gland is located at the bottom of your
brain and above the inside of your nose
• A hypophysectomy is the surgical removal of
the pituitary gland to treat cancerous or benign tumors
• INDICATION
• Macro adenoma
• Micro adenoma
• Functional adenoma
• Non functional adenoma

23. ABLATIVE SURGERY (THALAMOTOMY
& PALLIDOTOMY)
• Thalamotomy is the precise destruction of a tiny area
of the brain called the thalamus that controls some
involuntary movements. Before surgery, detailed brain
scans using a CT scan or MRI are done to identify the
precise location for treatment. The cold probe destroys
the targeted brain tissue
• Pallidotomy is a neurosurgical procedure whereby a
tiny electrical probe is placed in the globus pallidus
(one of the basal nuclei of the brain), which is then
heated to 80 °C (176 °F) for 60 seconds, to destroy a
small area of brain cells
• INDICATIONS
• Tremors
• Parkinson’s disease

24. COILING OF ANEURYSM
• Endovascular coiling is a procedure performed to block
blood flow into an aneurysm (a weakened area in the
wall of an artery).
• During endovascular coiling, a catheter is passed
through the groin up into the artery containing
the aneurysm
• INDICATIONS
• Cerebral aneurysms.
• In unruptured aneurysms (main goal is prevention of rupture
)
• In ruptured aneurysms (prevention of rebleeding )by limiting
blood circulation to the aneurysm space.

25. CLIPPING OF ANEURYSM
• A neurosurgeon opens the skull (craniotomy) and
places a tiny clip across the neck of
the aneurysm to stop or prevent it from bleeding
• INDICATIONS
• Any small perforating arteries aneurysm
• Cerebral arteries aneurysm

26. POST OPERATIVE PHYSIOTHERAPY
• TO PREVENT RESPIRATORY COMPLICATION
• PD is contraindicated immediately after the surgery bcoz
it will increase the intracranial pressure
• Avoid turning & sitting quickly as it will cause fluctuation
in blood pressure
• Respiratory facilitation techniques s/a pressure on upper
& lower thoracic vertebra, stretch of isolated intercostals
muscles, moderate manual pressure on ribs, peri oral
stimulation by firm pressure applied on the top lip,
stretch of anterior chest wall by lifting basal area of the
supine patient
• Suctioning

27. • To assess any neurological deficits & treat
appropriately
• To prevent the develpoment of pressure sores &
contractures