Neuro-anatomy: Neurosurgeons perspective. A guest lecture delivered on 11th January 2017 at Regional CME on Role of Neuroanatomy in Clinical Practice at JNMC Sawangi (M), Wardha. By- Dr. Shailendra Anjankar, Assistant Professor in Department of Neurosurgery. (CME code- MMC/MAC/2017/F-006680)

1. CME – Neuroanatomy: Neurosurgeon's perspective

2. Neuroanatomy: Neurosurgeon's
perspective
Dr. Shailendra

3.  Anatomy to the surgeon is like the sun for our
planet. Anatomy gives us the life-sustaining
knowledge to traverse the intricate pathways
throughout the brain. As our anatomic
knowledge has grown, our entire specialty has
evolved.
 Robert F. Spetzler

4.  Through the centuries, knowledge of anatomy
has been basis of medical practice.
 With increase in our comprehension of human
anatomy and disease pathology; surgical
outcome has greatly improved.
 The use of operating microscope in 1970s
and refined modes of imaging in 1980s has
brought modern Neurosurgery to this zenith
height.

5.  Basic (Anatomy) is the same, but our
understanding of it has somewhat developed
 Nuances in Medical Science.
 But vast area is still unexplored.
 Better understanding of the Basic and Re-
revision of the basics are the cornerstone of
better patient care and further research and
advancement in medical sciences.

6. Outlin
e
Case 1: Vertebral artery injury
5min
Case 2: Aneurysm 5min
Case 3: Moya-moya 5min
Case 4: VP Shunt 5min
Case 5: Lipomeningiomyelocele
5min
Case 6: Cervical spine surgeries
5min
Case 7: Spinal tumor
5min
Case 8: Cranial Tumor
5min
Case 9: Extradural hemorrhage
Time
(approx
.)
vascul
ar
spine
pediatric
s
neoplas
m
trauma
55
min

7. Case 1
Nov 2014

10. Expired

11. or bleed
or bleed
Reason

15. Case 2
 50 year female
 Sudden onset, most severe Headache of her life.
 Known diabetic and hypertensive
 Conscious, GCS 15/15, BP -150/90 mmHg, HR-
76/min

17. Left ICA
Giant
Aneurysm
Post-
op
B
&
W

18.  Radiological Imaging can only be understood on
the basis of thorough knowledge of anatomy with
some basic knowledge of Imaging modalities.

19. Case 3
 4 year old male
 Sudden severe headache
 Weakness in left side of body

22. Puff of
smoke
(moyamoy
a)

24. EDAS

26. Case 4
 5 year old male
 Increase in size of head
 Delayed developmental milestones

28. Option 1

29. Option 2

32. Case 5
 2 year female
 Swelling over back

36. Anjankar SD, Subodh R. Spondylocostal dysostosis with
lipomyelomeningocele: Case report and review of the literature. Journal of
3 -4
weeks of
gestation
al age
Before
mother
knows
that she
is
pregnant
Folic acid supplementation at least a month before she plans
to conceive.

37. Case 6
 32 year old male
 H/o trauma with cervical
spine injury
 Weakness in all limbs
 Decreased sensation
below chest level
 Bowel and bladder
dysfunction

38. Posterior
approach

40. Case 6
Anterior
approac
h

41. Case 6

43. Case 6

44. Case 6

45. MyelopathyRadiculopathy

47. Signs and symptoms of
radiculopathy

48. Case 7
 45 year old male
 Weakness in both lower limb
 Bowel and bladder dysfunction
 No comorbidities, no visible swelling over body
 Power – B/L UL -5/5
B/L LL – 3/5

56. Metastasis ??
Blood  Right
Heart  Lung 
Left Heart  Body
(spine/brain)
How it bypassed
lung vasculature?
 Batson's plexus

57. Case 8
 60 year female
 H/o headache and vomiting
 Imbalance while walking
 GCS 15/15, Pupils- B/L NS RTL
 Power 5/5 in all limbs
 Cerebellar signs+

63. Tumor

64. HPE – Rhabdoid Meningioma

65. Case 9
 32 year old male
 H/o RTA 4 hours back
 H/O LOC +
 Left Black eye +
 GCS E1V3M5, Pupils -NSRTL
 No other long bone injury
 Vitals stable

73. Past, present & Future
 Lets discuss about the contribution of Anatomy in
past, present and future development in
Neurosurgery
Timeline
>3300
BC
1600 BC
600 BC
400
BC
1500
AD
1540
1840
1900
1970-90s
200
0
Presen
t
Futur
e

74. Timeline
>3300
BC
1600 BC
600 BC
400
BC
1500
AD
1540
1840
1900
1970-90s
200
0
Presen
t
Futur
e
Evidence of trephination is seen from Neolithic period
onwards

75. Timeline
>3300 BC
1600
BC
600 BC
400
BC
1500
AD
1540
1840
1900
1970-90s
200
0
Presen
t
Futur
e
Edwin
Smith
Papyr
us
from
Egypt

76. Timeline
>3300 BC
1600 BC
600
BC
400
BC
1500
AD
1540
1840
1900
1970-90s
200
0
Presen
t
Futur
e
Sushrut
samhita
Sushruta – Father of Indian Surgery

77. Timeline
>3300 BC
1600 BC
600 BC
400
BC
1500
AD
1540
1840
1900
1970-90s
200
0
Presen
t
Futur
e
Hippocrates and Galen.

78. Timeline
>3300 BC
1600 BC
600 BC
400
BC
1500
AD
1540
1840
1900
1970-90s
200
0
Presen
t
Futur
e
Leonardo da Vinci

79. Timeline
>3300 BC
1600 BC
600 BC
400
BC
1500
AD
154
0
1840
1900
1970-90s
200
0
Presen
t
Futur
e
Medical
Renaissance
Ambroise Pare
William Harvey
Andreas
Vesalius
The cerebral circulation from
Vesalius’
De Humani Corporis Fabrica
(1543). Courtesy, Yale Medical

80. Timeline
>3300 BC
1600 BC
600 BC
400
BC
1500
AD
1540
184
0
1900
1970-90s
200
0
Presen
t
Futur
e
Anesthe
sia
&
Antiseps
is
Crawford
Long
&
Joseph Lister

81. Timeline
>3300 BC
1600 BC
600 BC
400
BC
1500
AD
1540
1840
190
0
1970-90s
200
0
Presen
t
Futur
e
Greatest Names in World of
Neurosurgery
1.Harvey Cushing

82. Timeline
>3300 BC
1600 BC
600 BC
400
BC
1500
AD
1540
1840
1900
1970-
90s
200
0
Presen
t
Futur
e
Godfrey
Hounsfield
&
Paul Lauterbur
CT Scan
&
MRI

83. Timeline
>3300 BC
1600 BC
600 BC
400
BC
1500
AD
1540
1840
1900
1970-90s
200
0
Presen
t
Futur
e
1.The first Stem Cell Therapy
2.The da Vinci Surgical
System approved by the
FDA.
3.The first remote surgery,
using the ZEUS robotic
surgical system

84. Timeline
>3300 BC
1600 BC
600 BC
400
BC
1500
AD
1540
1840
1900
1970-90s
200
0
Prese
nt
Futur
e
3D Printing
Stereotax
y
Intraoperative MRI and Navigation
system

85. Timeline
>3300 BC
1600 BC
600 BC
400
BC
1500
AD
1540
1840
1900
1970-90s
200
0
Presen
t
Futur
e
Robotics
AI (Artificial
Intelligence)
VR (Virtual Reality)
Nanobots
(miniaturized robots)
Avicenna
Genetic engineering
It can identify anatomical
features and abnormalities in
CT scans,
suggest possible diagnoses
May integrate with our brain
matter
Merge our minds with
machines & computers

86. Timeline
>3300 BC
1600 BC
600 BC
400
BC
1500
AD
1540
1840
1900
1970-90s
200
0
Presen
t
Futur
e
A million billion TB data
storage – IBM Watson
Health
IBM is applying its cognitive
computing AI technology to
recommend cancer
treatment in rural areas in
the U.S., India, and China,
where there is a dearth of
oncologists.
For example, IBM Watson
could read a patient's
electronic medical record,
analyze imagery of the
cancer, and even look at
gene sequencing of the

87. Timeline
>3300 BC
1600 BC
600 BC
400
BC
1500
AD
1540
1840
1900
1970-90s
200
0
Presen
t
Futur
e
It is estimated that the doubling time of medical
knowledge in 1950 was 50 years; in 1980, 7 years;
and in 2010, 3.5 years.
In 2020 it is projected to be 0.2 years—just 73 days.
Once nanotechnology, stem cells, and genetic
engineering, come on board, the world as we know it
will be unrecognizable.

88. Conclusion
 Homosepian (homo = human being; sapiens =
wise)
 We use brain to understand our Brain!
 It is as obvious now, that increase in our
comprehension of Neuroanatomy has led to the
development in Neurosurgery and its detailed
discquisition itself will lead to further nuances.
 But will this tremendous development, will one
day, can make a person immortal?

89. Bhagawad Gita. Chapter 2;
verse 20
Soul is never born and it never dies. Soul is birthless, eternal, imperishable
and timeless.
We have tried to understand & developed a lot of
technology to treat this perishable body; now it is high
time to understand and treat the soul (character). So
that, this world becomes safer and a better place to
live!