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Neurology Surgery


Neurological Surgery is a discipline of medicine and that specialty of surgery that provides the operative and nonoperative management (i.e., critical care, prevention, diagnosis, evaluation, treatment, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify the function or activity of the nervous system, including the hypophysis; and the operative and nonoperative management of pain. As such, neurological surgery encompasses treatment of adult and pediatric patients with disorders of the nervous system: disorders of the brain, meninges, and skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland, disorders of the spinal cord, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution.

Neurosurgery for mental disorders (NMD, formerly psychosurgery). This is rarely used, but can be performed for cases of severe, intractable depression using strict controls under the Mental Health Act, including fully informed consent and a second opinion. There are several techniques, including the use of diathermy and radioactive iridium implants in operations such as subcaudate tractotomy. Approximately one-third of patients are reported to gain marked benefit, one-third mild benefit and one-third no benefit. Side-effects can include personality changes of a frontal lobe nature and epilepsy. Deep brain stimulation is a recently developed neurosurgical procedure in which functional (and reversible) lesions can be induced. Its use in depression remains experimental only.

Types of Neuro Surgery

neurosurgery is divided into different categories, including general neurosurgery and a host of specialized branches.
General neurosurgery – General neurosurgery is involved with most conditions that are of neurological in nature particularly neurological trauma and neurological emergencies, one example of which is intracranial haemorrhage.
Vascular and endovascular neurosurgery – This involves the diagnosis and treatment of aneurysms, carotid stenosis, strokes, vasospasms, and spinal malformations. Surgical treatments of such conditions are now conducted using minimally invasive techniques such as angioplasty, stenting, and embolization.
Spine neurosurgery – This involves the treatment of disorders affecting the cervical, thoracic, and lumbar spines; these problems include arthritis in the spinal discs, spinal cord compression caused by trauma, or spondylosis. Symptoms of spinal problems include balance deficiency, numbness and tingling in the hands and the feet.
Peripheral nerve surgery – Common peripheral nerve surgeries include carpal tunnel decompression for the treatment of carpal tunnel syndrome as well as peripheral nerve transposition; this branch of neurosurgery is responsible for the treatment of nerve entrapment conditions.
Aside from these specialized branches, neurosurgery also involves the use of different surgical methods for diagnosing and treating neurological conditions. In recent years, there has been a shift from conventional neurosurgical methods to more modern alternatives. While the conventional method requires open surgery where the surgeon opens up the skull to access the brain, newly developed methods now allow specialists to surgically treat neurological conditions through smaller openings. These methods make use of microscopes, endoscopes, and most recently, neuroradiology methods. Open surgery techniques are now usually reserved for traumatic cases or emergencies.
Microsurgery, or microscopic neurosurgery, makes use of microscopic technology to enable surgeons to treat affected areas of the brain through a smaller opening, simply by magnifying the treatment area. Nowadays, even complex procedures such as clipping an aneurysm or complex spine surgeries such as microdiscectomy and laminectomy can be performed through microscopic surgery, making neurosurgical treatment less invasive.
Endoscopic neurosurgery is also widely in use today in the treatment of pituitary tumours, cerebrospinal fluid leakage, hydrocephalus, colloid cysts, and many others.

Risk Factors

Risk factors include:

  • A risk factor is anything that increases a person’s chance of developing a brain tumor. Although risk factors often influence the development of a brain tumor, most do not directly cause a brain tumor. Some people with several risk factors never develop a brain tumor, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed decisions. But, at this time, there are no known ways to prevent a brain tumor through lifestyle changes.
  • Infection with the Epstein-Barr virus (EBV) increases the risk of CNS lymphoma. EBV is more commonly known as the virus that causes mononucleosis or “mono”. In other research, high levels of a common virus called cytomegalovirus (CMV) have been found in brain tumor tissue. The meaning of this finding is being researched. Several types of other viruses have been shown to cause brain tumors in research on animals. More data are needed to find out if exposure to infections, other viruses, or allergens increase the risk of a brain tumor in people. Of note, studies have shown that patients with a history of allergies or skin conditions have a lower risk of glioma.
  • Retrospective analysis of a prospective database to create a Risk Score. Post-operative neurosurgery complications recording (Hyponatremia > 135mmol/l,Insulin administration, Nausea-Vomiting, Glasgow Coma Score, Inhalation, Post-operative intra-cranial bleeding requiring neurosurgery, Intra-cranial hypertension, Use of osmotherapy, Status epilepticus, Brain death, Death). Collection of datas as Duration of mechanical ventilation, Length of ICU stay, Length of hospital stay. Validation of this score on an independent prospective cohort.
  • All patients underwent the same protocol regarding preparation for surgery, which include at least showering (with 4% clorhexidine gluconate detergent solution) on the day before and on the morning of the operation, head included. In the surgical area, the hair was cut with a sterile electric clipper. Pre-operative skin preparation involved standardized application of at least three swabs, soaked with povidone-iodine solution. Antibiotic prophylaxis involved pre-operative intravenous cefuroxime 1500mg 30–60min prior to incision and re-administration every 3h during the operation. The skin was closed using a skin stapler and the head was washed with povidone-iodine solution. Post-operatively, the surgical wound was draped with a sterile impermeable towel for the first 24h post-surgery. Afterwards, a head wash was performed every 12h with povidone-iodine soap the first 72 h and surgical wound-care was carried out every 24h under strict aseptic conditions. Povidine-iodine was used instead of 2% clorhexidine because of neurotoxicity
  • Health professionals can modify some of the risk factors, such as infection. Others, such as the need for oxygen supplementation or nutritional support, cannot be modified; but their presence can identify patients "who could benefit from discharge planning or direct efforts to facilitate safe hospital discharge without readmission."


Procedure include:

  • Craniotomy In this brain surgery type, a cut has to be made to the scalp bone that exposes the brain tissue. That is why it is also called open brain surgery. A hole called the bone flap is created and the issue to be addressed through the brain surgery procedure such as an aneurysm, or fluid draining, is performed. The bone flap is then either removed in cases where postoperative swelling is expected or where tumor growth is possible to prevent further pressure and trauma to the brain. It is called craniectomy since a portion of the cranium is being removed. In most cases, the bone flap is secured back on the skull after the brain operation is complete through screws and plates.
  • Neuroendoscopy-In some cases, it may be possible for the brain surgery to happen through the use of an endoscope, where small holes may be made to the cranium and the endoscope is fed through them to guide the brain surgery procedure. This is considered minimally invasive as compared to open brain surgery and reduces the trauma on the patient's health while speeding up recovery time. Endoscopic brain surgery is usually used to address tumor formations in the brain and is also known as keyhole surgery since the holes made during this type of brain surgery are very small.
  • Deep brain stimulation Deep brain surgery involves the placement of electrodes deep within the brain to stimulate nervous signals ordinarily missing in a patient. This is more usually carried out through minimally invasive brain surgery procedures that allow the neurosurgeon to place the electrode leads within the brain tissue. The pulse generator that will create the electrical impulses to signal the brain is placed in a box device similar to a pacemaker in the chest area. This type of brain surgery typically aids patients of neurodegenerative disorders such as Parkinson's disease, tremors and epilepsy.

Range of Treatment Cost

Procedure Duration In Hospital Min Cost
Max Cost
Spinal Fusion- 1 level 7 450000₹/6190$ 750000₹/10350$
Spinal Fusion - 2 Level 7 480000₹/6650$ 750000₹/10350$
Disc Repalcement - 1 Level 3 470000₹/6450$ 800000₹/11000$
Disc Replacement- 2 Level 3 600000₹/8250$ 800000₹/11000$
Kyphoplasty 2 520000₹/7150$ 700000₹/9650$
Laminectomy 5 200000₹/2750$ 450000₹/7000$
Discectomy 3 250000₹/3450$ 500000₹/6850$
Deep Brain Stimulation 7 1200000₹/16500$ 1600000₹/22000$
Anterior cervical discectomy and fusion 4-7 days 360000₹/4950$ 660000₹/9500$
Spinal fusion surgery 4-7 days 360000₹/4950$ 760000₹/10455$
Cervical spine surgery 4-7 days 400000₹/5500$ 750000₹/10350$
Lumbar Spine Surgery  4-7 days 400000₹/5500$ 750000₹/10350$
Spinal Decompression Depends upon the treatment 360000₹/4950$ 1590000₹/21850$
Cervical Disc Replacment Surgery 7 750000₹/10350$ 1000000₹/13750$
Disc Nucleoplasty 4 350000₹/4850$ 450000₹/6500$
Laminoplasty  4 504000₹/6850$ 705000₹/9650$
Percutaneous Endoscopic lumbar Discectomy 5 360000₹/4950$ 560000₹/7750$
Posterior Lumbar Interbody Spinal Fusion 5 450000₹/6500$ 480000₹/6690$
Brain Tumor Treatment 2- 5 days 390000₹/5350$ 550000₹/7655$
Brain Cancer Surgery - Craniotomy Depends upon the treatment 540000₹/7450$ 750000₹/10350$
Brain Cancer Surgery - Micro Surgery Depends upon the treatment 750000₹/10350$ 1150000₹/15820$
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