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  • Robotic Urological Surgery: 15 years journey 
    Dr. Rahul Yadav, Dr. Anant Kumar
  • Robotic surgery is the latest in advanced onco surgical procedures 
    Dr. Harit Chaturvedi
  • Percutaneous balloon aortic valvuloplasty & balloon dilatation of aortic coarctation in a 10 year old child 
    Dr. Neeraj Awasthy, Dr. Sushil Shukla
  • Role of CT/MR imaging and echocardiography in evaluation of valsalva sinus aneurysm 
    Dr. Reena Anand, Dr. Raj Kumar, Dr. Divya Malhotra, Dr. Bharat Aggarwal
  • Risk factors for patients undergoing treatment for Breast Cancer
    Ms. Kanika Arora, Ms. Ritika Samaddar
  • Radiology Case of The Month 
    Dr. Nafisa Shakir Batta, Dr. Dhruv Jain
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October, 2015 :15
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Month Red Autoclave(Infected Plastic Waste) Yellow- Incineration(AnatomicalWaste & Soiled Waste) Blue Autoclave (Glass- Bottles) Black Cytotoxic- Incineration( Cytotoxic Contaminated Items) White- Sharp Total Bags Total Weight(In KG's)
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Apr-17 924 2963.50 954 2994.10 239 1017.30 103 279.20 1645 606.40 3865 7861.00
May-17 1175 4624.12 1028 3498.40 276 1524.34 87 195.01 1803 823.85 4369 10665.71
Jun-17 1060 4511.45 902 2886.66 293 1324.05 76 194.00 2057 1100.69 4388 10016.85
Jul-17                     0 0.00
Aug-17                     0 0.00
Sep-17                     0 0.00
Oct-17                     0 0.00
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Neurosciences

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Neurosciences

Watch Out for the 6 Common Symptoms of Stroke!

July 17, 2017 0 19 1 minute, 38 seconds read

According to WHO statistics, the 3rd most common cause of death after heart disease and cancer is STROKE. Like a heart attack, every minute after the onset of stroke counts. It is one of the important causes of death and disability.

Dr. Deepak Gupta says do not wait for the symptoms to recover as they commonly progress. Moreover, the most common type of stroke, Ischemic Stroke that primarily occurs due to a clot in the brain can be treated with a simple intravenous drug called tissue plasminogen activator (t-PA), commonly called “clot buster” drug. It dissolves the clot blocking the blood flow in the artery. This should be given in the first 4 ½ hours of the stroke onset (the window period). Of these 4 ½ hours the chances of recovery are best if the drug can be started in the first one hour of stroke onset. So it is important to recognise a stroke early and treat it as fast as possible.

What are the Symptoms of Stroke?

Mild or severe, the symptoms of stroke depend on the region of the brain affected. The most common symptoms of stroke are:

  • Sudden numbness of the face, arm, or leg (especially on one side of the body)
  • Sudden weakness of arm or leg (paralysis)
  • Sudden difficulty in speaking or understanding speech; patient may look confused
  • Sudden trouble in vision with one or both eyes
  • Sudden trouble walking or loss of balance or dizziness
  • Sudden severe headache with no known cause

If a patient presents to any doctor with symptoms suggestive of stroke, the patient should be immediately referred to the nearest emergency for a plain CT of the head and examination by a neurologist. The neurologist after seeing the patient and the scan should be able to decide whether the patient can be given the t-PA. Contrary to popular belief, lengthy tests as blood work or MRI brain are NOT needed, except in special circumstance, to give t-PA.

Remember “Seconds save lives”

 

 

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Fragile Patient with Broken Spine Regains Painless Movement Within 24 hours

July 14, 2017 0 52 2 minutes, 35 seconds read

A Minimally invasive spine surgery is a boon for patients with spine disorders!

Serious injuries due to accidents are unpredictable but with newer advancements in medical treatments, it is now possible to get cure faster, safer and with the least hospital stay.

A 66-year-old osteoporotic male patient with weak bones presented in Max Hospital after a fall from a tree with the inability to move. On investigations, he was found to have 2 fractures in the backbones, one in lower chest region another in the lower back region.

Dr Ashish Gupta, Senior Consultant, Neurosurgery,  Max Super Speciality Hospital, Mohali said that “Initially he was tried with conservative (MEDICAL) management for his fractures spine in the form of intravenous pain killers and bed rest, but there was no relief in his symptoms. Open surgery at old age could have had its own set of possible complications in form of blood loss and chances of wound complications. He was advised for minimally invasive spine surgery, which has minimal blood loss with almost nil chances of wound complications.”

Explaining the process Dr Gupta said “Once he consented to it, he was operated with putting bone cement in his backbones after restoring height of fractured vertebral bones ,in which collapsed and fractured vertebral bodies were inflated with special balloons and when they were elevated to their normal height ,they were filled with bone cement to strengthen the fractured bone and relieve pain. As the patient had weak bones, because of osteoporosis, his cemented vertebral fracture was further stabilised with pedicle screws and rods above and below the fracture site with few 2-3 mm stab incisions to put vertebral bodies, screws and rods in a very minimal way.”

The surgery lasted for 1.5 hours and the patient was able to move independently next day itself and discharged

Dr. Ashish Gupta asserts “It’s a new beginning in spine surgery. Technological advances have made strides in the treatment of spinal conditions by using a minimally invasive surgical technique. Open spine surgery might be the best surgical approach for specific conditions. The minimally invasive approach is an appropriate option for you, with huge benefits over traditional surgery. Smaller incision and scar, decreased blood loss, less length of stay in the hospital, lesser pain medication. “In a traditional, open spine surgery, an incision is made and muscles are pulled or retracted to the side to get a clear view of the spine. The surgeon then accesses and removes diseased and damaged bone or intervertebral discs. With minimally invasive spine surgery, surgeons can achieve the same operative goals as an open procedure, but in a less invasive way. Minimally invasive surgery can be percutaneous (through the skin) or mini-open (operating through a small incision)” he explained.

Risks Associated with the Procedure

Talking about Potential risks associated with minimally invasive spine surgery include:

  • Anaesthesia complications
  • Blood clots
  • Allergic reactions
  • Adverse effects due to undiagnosed medical problems, such as silent heart disease
  • Injury to nerves and blood vessels can also occur.

In addition, during minimally invasive spine surgery, the surgeon may have to convert to an open surgery if circumstances require.”

 

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CEREBRAL ANEURYSM RUPTURE- AN EMERGENCY

July 10, 2017 0 20 3 minutes, 37 seconds read

Have you heard of Circle of Willis?

Our brain has a larger brain in the front and a smaller but critical brain at the back; hence 2 arteries supply blood to the brain in the front and then 2 at the back each on the left and right side respectively. The 4 arteries are connected to each other through communicating arteries and hence form a circle within the brain called “Circle of Willis”.

As the arteries course through the brain, it tends to divide to supply different regions of the brain. All the potential areas of division and communication of the arteries behave as potential weak areas. These lead to a formation of a bulge in the wall that slowly takes the shape of a balloon. These balloons are potential sites for the leaking of blood running within the arteries.

Who are at a risk of Brain Haemorrhage?

People who are at the risk of brain haemorrhage are primarily due to their:

  • Genetic Predisposition
  • Family History
  • Male Gender
  • Hypertension
  • Smoking
  • Alcohol Consumption
  • Drug Abuse

The most common age is above 50 years, however, it is seen across all age groups even young adults.

When does it call for an Emergency?

Once the blood leaks within the arteries, it feels like acid is thrown on the surface. It causes a sudden intense pain, which most people call as “Thunder Clap” Headache. You can feel:

  • Nausea
  • Vomiting
  • Seizures
  • Loss of consciousness

The presentation of the person to an emergency department is because of a persistent headache which is life disabling. Depending on the nature and location of underlying leakage of blood, the patient is examined thoroughly and a clinical score is used to predict the outcome. After the clinical score, a CT scan of the brain is done to know the extent and location of haemorrhage. The gold standard investigation to know the extent of haemorrhage under the brain coverings is Angiography of brain vessels. It will help the surgeon to know the exact cause of haemorrhage, the location of the balloon in the wall of an artery- called as Aneurysm, the relationship of an aneurysm to parent artery, its shape, and measurement at head, body and neck. Based on this the treatment will be decided.

The treatment is then decided on securing the leak of an aneurysm by occluding it. This is performed using 2 surgeries:

  • Clipping
  • Coiling

Clipping is where a metallic clip is applied to the neck of an aneurysm so that an aneurysm is excluded from normal circulation and the risk of aneurysm re-rupture is reduced. This requires the skull bone over the brain to be opened and the brain covering to be deflected and then isolate the neck of an aneurysm from the surrounding parent artery and apply the metallic clip on the neck itself.

Coiling is a procedure where an aneurysm is accessed through the inside of blood vessel without opening the skull bone or covering of the brain. A very small tube is used to access an aneurysm and is placed on the neck after which multiple spring-like coils made up of platinum are used to close an aneurysm from circulation.

Are there any risks involved with the two surgeries?

Dr. Amit A Khan, Senior Consultant, Interventional Neuroradiology says, both clipping and coiling are done using general anaesthesia and both of them have risks involved. An aneurysm can re-rupture in both the types of surgeries. A second rupture may prove detrimental to the survival of the patient. The blood leaked below the brain coverings can lead to narrowing of the arteries of the brain thereby leading to stroke due to a decrease in blood supply to the brain. This is common in the young and within the first 2 weeks of haemorrhage. The water sac within the brain can also become larger - needing a tube to be put within so that it can stop putting pressure on the brain from inside.

The patient is kept in the ICU till he is seen to recover the above and is ready to be ambulant. This may take several days and weeks depending on the patient and his present clinical condition. Hence it is imperative that factors like blood pressure, smoking, alcohol need to be controlled.

Get yourself screened if you are above 40 years of age and have a history of a cerebral aneurysm, and uncontrolled hypertension.  

 

 

 

 

 

 

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Frequently Asked Questions on Brain Aneurysms

July 5, 2017 0 354 4 minutes, 49 seconds read

What is an aneurysm?

An aneurysm is a weak spot in the blood vessel that expands into a balloon shaped structure over time. As the heart keeps pumping blood in the blood vessels of the brain this balloon (a saccular aneurysm) keeps getting bigger and may rupture. Some aneurysms may not look like balloons but, rather look like elongated tubes (fusiform).

Do all aneurysms need treatment?

No, all aneurysms don’t need to be treated. Treatment depends on the site, size and anatomy of an aneurysm.

What are the symptoms of an aneurysm?

Aneurysms usually cause headaches or blurred vision but, most of them remain silent till they are discovered incidentally on brain imaging.

If an aneurysm ruptures it is a medical emergency called subarachnoid haemorrhage, a kind of brain stroke. This condition presents with sudden, severe headache and sometimes the patient becomes unconscious and may even die.

Does a ruptured aneurysm need treatment?

Yes, always.

How are the aneurysms treated?

Aneurysms can be treated by coiling (minimally invasive) or by clipping (open surgery). Minimally invasive endovascular coiling is currently the preferred method for treatment all over the world.

How do we decide the modality of treatment (clipping versus coiling)?

Dr. Chandril Chugh, says the decision regarding the modality of treatment is dependent on many factors, including the age and condition of the patient, the size of an aneurysm, the shape of an aneurysm, and the location of an aneurysm. In our cerebrovascular centre, imaging (MRI/MRA, CTA and/or angiography) is reviewed by a multidisciplinary team including neurosurgeons and interventional neurologists. They will review the films and then decide on the appropriate treatment modality, specifically for each patient and with each patient.

Is there any scar with coiling?

No, there is no scar with coiling.

How long should I expect to be hospitalised?

The length of hospitalisation is significantly different for patients with ruptured (subarachnoid haemorrhage or (bleeding) versus unruptured aneurysms.  Patients with unruptured aneurysms typically have a shorter hospital stay of approximately 2 – 3 days with endovascular coiling.  The length of hospitalisation of patients who have suffered subarachnoid haemorrhage is variable and is dependent on the condition of the patient on admission and the treatment of concomitant issues such as cerebral vasospasm, hydrocephalus, and ventilatory issues. In patients with severe subarachnoid haemorrhage, hospitalisation may be up to 3 – 4 weeks.

Do my relatives have to be checked for the presence of aneurysms?

Cerebral aneurysms are generally not a familial or genetic disease and in most cases, it is not recommended that family members are screened. In cases where there is a family history of aneurysms (two or more family members), it is recommended that all family members should consult a specialist Interventional Neurologist.

What can I do to have the most successful recovery?

Follow all postoperative instructions regarding medications and postoperative therapy. Call your doctor immediately if there are any issues. Have a positive outlook!

Could I have known about this aneurysm before the haemorrhage?

In most situations, no. If there is a strong family history (two or more first-degree relatives with a known a cerebral aneurysm), it is possible to detect aneurysms in patients with non-invasive means prior to a rupture. Most aneurysms are asymptomatic.

Can I develop another aneurysm?

If you are a heavy smoker and continue smoking, it is possible. If you have polycystic kidney disease, fibromuscular dysplasia, or any other type of elastic tissue disorder, you may warrant screening throughout your lifetime. Otherwise, it is extremely unlikely you would develop another aneurysm. Patients who are quite young (under 40) may be candidates for follow-up imaging later in life. Please discuss with your Interventional Neurologist.

Can I have an MRI after coiling?

Yes, all titanium and platinum coils are MRI compatible. 

When can I be physically active again?

A physical therapy program is tailored for each individual patient. Moderate activity after discharge is encouraged. 

How soon can I return to work?

This is specific for each patient, their pre-treatment and post-treatment condition, and, of course, the demands of their job.

Are children at risk for aneurysms?

Aneurysms are rare in children.

If an aneurysm has been discovered, for how long has it typically been present?

That is unknown. Aneurysms may slowly enlarge over time, yet the rate of growth is not completely understood. Some aneurysms, typically smaller aneurysms, may remain quiescent for decades.

How long does the coiling procedure take?

Approximately 1½ – 3 hours.

Is general anaesthesia used for surgery and coiling?

General endotracheal anaesthesia is always used for coiling procedures.

How long do I need to be on anti-convulsant medications (Dilantin, Keppra etc.) after endovascular coiling?

You do not need to be on anticonvulsants after endovascular coiling unless you have suffered a seizure.

Will an Intensive Care Unit (ICU) stay be necessary?

All treated aneurysm patients (endovascular coiling or microsurgical clipping) are monitored in the Intensive Care Unit in the immediate post-treatment period. The length of stay is dependent on whether or not the patient has had a subarachnoid hemorrhage and additionally in the presence of other medical and neurosurgical issues. Uncomplicated, unruptured aneurysms are usually in the ICU for 1 – 2 days after treatment.

Will the coils set off a metal detector at an airport?

No

Can I fly?

Yes. Patients diagnosed with an aneurysm can fly. Always consult your Interventional Neurologist before doing so though.

Do I need a long-term follow-up after my treatment and discharge from the hospital?

This depends on your personal experience including medical and family history. After coiling, imaging follow-up is necessary to confirm persistent occlusion after treatment. Sometimes long-term follow-up is recommended.

A blood relative of mine has had an aneurysmal bleed. Does this increase my chance of having a subarachnoid haemorrhage?

It may. A positive family history of aneurysms or subarachnoid haemorrhage increases the statistical risk associated with unruptured cerebral aneurysms.

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BRAIN TUMORS: WHAT DO YOU NEED TO KNOW?

July 4, 2017 0 103 3 minutes, 57 seconds read

The brain is the seat of all functions of the human body, working every day and every night, flawlessly and immaculately. Besides, controlling all simple functions in the body, it is also responsible for formulating theories and making groundbreaking inventions. No matter how perfect this organ is, it is still exposed to imperfections of human genetics and that is where the Brain Tumours come in.

Dr. Prakash Singh says, brain tumours although uncommon and treatable are still a cause of anxiety and fear to the patient. It is a big relief to know that surgery of brain tumours has now become very safe and gives good results in able and experienced hands. In the succeeding lines, he has answered some of the important questions and concerns that a patient with a brain tumour might have:

What is a brain tumour?

A brain tumour is a tissue mass that is formed by uncontrolled/abnormal growth due to changes in the genes/DNA (mutations) of cells of the brain or its membranes.

What are different types of a brain tumour?

Brain tumours when they come from the cells of brain its membranes are known as a primary brain tumour. These can be benign (Non-cancerous) or malignant (cancerous). The most common tumour arises from the supporting cells of the brain (Glial cells) are known as Gliomas and those arising from the membranes of the brain are called Meningiomas. Some others arise from the nerve sheaths are known as Schwannomas. Tumours arising from the pineal and pituitary glands (both are parts of brain} are known as Pineal and Pituitary tumours respectively. Some time tumours from other parts of body metastasise (reach) to the brain, such tumours are known Secondary (Metastatic) brain tumour.

What are the symptoms?

Symptoms of brain tumours are caused either by an increase in the intracranial pressure or dictated by the location of the tumour in the brain. Common symptoms of brain tumour are as follows:-

1. Symptoms by Raised Pressure in the Cranium (Head): A headache is the most common symptoms of brain tumours. It is generally throbbing, progressive and worse in the morning.

Impairment of Consciousness: As the tumour grows bigger patient develops drowsiness (sleepiness) and with further progression of the tumour can lead to unconsciousness.

 2. Symptoms due to Location of Tumour

Seizure (Fits) is the second common feature of brain tumour, they can major fit with the loss of consciousness or subtle/minor (focal) such as jerky movement of one side of the face, arm or leg or transitory tingling sensation or a blank look.

The weakness of Body develops opposite to the side of tumour in the head when part of the brain controlling the movement gets involved.

Disturbances of Speech when a tumour occurs in the speech area or in its vicinity, speech is affected and the patient presents with disturbances of speech. Speech can also be affected if coordination system (cerebellum) is affected by the tumour.

The clumsiness of movement, difficulty in body balance and coordination develops when balancing system (Cerebellum) gets affected.

What tests do I need?

Though a good clinical examination will definitely point to the diagnosis, this is confirmed by Contrast-enhanced MRI or Contrast-enhanced CT scan of the brain. Availability of these investigations in the last few decades has tremendously helped in the early diagnosis of brain tumours, early treatment and thus better outcomes.

What are different treatment modalities?

Surgery is the mainstay of the treatment. It will be needed for complete excision, debulking (reducing the volume of tumour) or stereotactic biopsy depending on the indication and therefore has a major role in the treatment of brain tumour. With development microsurgical techniques, modern infrastructure (intraoperative CT/MRI, Image guided surgery etc), safe anaesthesia and improved postoperative ICU care; surgery have become quite safe in good neurosurgical centres and experienced hands.

Radiosurgery: Actually no surgery is done but a precise concentrated radiation dose is given by special machines (Gamma Knife) to the tumour with the help of computerised planning, in such a way that it does not harm the normal surrounding brain structures. But it can be given to some tumours when they are of small size(less than 3 cms) whether benign and malignant. Radiosurgery can also be done surgically difficult to remove tumours or residual part of the tumour. Effect on tumour takes some years show.

Radiotherapy and chemotherapy are needed for many malignant tumours of the brain and help in controlling the progression of the disease.

Are all brain tumours life threatening? Is complete treatment of brain tumour possible?

Not all Brain tumours are threatening and a complete treatment of the tumour is possible. However, you can visit Dr. Prakash Singh, Head, Neurosciences at Max Smart Super Speciality Hospital, Saket for the best treatment.  

 

 

 

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A Harmless Neck Massage Could Cause Stroke!

June 20, 2017 0 1245 3 minutes, 34 seconds read

How many times have we gone to a salon for a hair cut or to a parlour for a beauty treatment and received a complimentary head and neck massage? Little do we know that a harmless neck massage could be a harbinger of something much worse, like a stroke?  Yes, you read it right and your eyes and brain are serving you well.

Our brain is by far the most important organ of the body and that is probably a good reason that God decided to keep it at the top, well protected on all sides by a strong skull. However smart the guy upstairs may have been he had to find a way to connect the brain to the body and that’s where the whole problem started.

The brain communicates with the whole body as the nerves fibres descend down through the neck and then spread all over. The blood supply to the brain also comes up from the neck in the form of four big tubes, two in the front and two at the back. Neck thus is kind of important. As these blood vessels travel north to the brain they are vulnerable to injury and damage. Any vigorous neck movement that pulls the neck backward or pushes it forward can injure the blood vessels. Injury to the blood vessel is known as dissection in medical terms and can lead to the devastating paralytic attack or brain attack.

You will be surprised to know that even though it may seem unlikely but we are subjected to such movements on a daily basis. A massage therapist, a chiropractor, a beauty therapist, a barber, or anyone who have their hands on your neck can literally kill you (no pun intended).  Neurology literature is filled with such case reports where neck manipulation or wrong positioning of the neck has led to injury to the blood vessels leading to a stroke or paralytic brain attack. Terms like “Barber Chair stroke” or “Beauty parlour stroke” have been coined for the same reason.  As the blood vessel gets injured the blood supply to the brain may get blocked or reduced leading to neurological deficits like paralysis.

Simple Steps that can keep you out of danger

The first step in making a change for good is the awareness of the situation. Now that you are aware of the danger, simple steps can prevent such disastrous outcomes.  Just follow the precautions mentioned below and you should be safe and ready for a good relaxing massage (Don’t touch the neck).

  • Avoid any vigorous movements or overextension of the neck.
  • Any movement that creates pain should be avoided.
  • Do not crack your neck or go for neck manipulation unless under the supervision of well qualified professional. Avoid it, if possible.
  • Injury to a blood vessel causes neck pain may cause dizziness, vertigo, nausea or vomiting. Do not ignore these symptoms. Rush to the hospital.
  • Avoid neck massages by unqualified staff.

How would you know if you were having a stroke due to vessel injury/dissection?

STROKE: REMEMBER THE 6 S METHOD TO DIAGNOSE STROKE

  • SUDDEN (symptoms start suddenly)
  • SLURRED SPEECH ( speech is not clear, as if drunk)
  • SIDE WEAK ( face, arm or leg or all three can get weak)
  • SPINNING ( VERTIGO)
  • SEVERE HEADACHE/NECK PAIN
  • SECONDS ( note the time when the symptoms start and rush to the hospital)

ANY OF THESE SYMPTOMS CAN BE PRESENT IN ANY COMBINATION. YOU DONT NEED ALL SYMPTOMS TO DIAGNOSE STROKE.

What to do next?

Rush to the hospital. STROKE OR BRAIN ATTACK IS TREATABLE. Every minute counts. According to a study done by researchers in 2006 in the USA, a patient with ischemic stroke loses 190,0000 brain cells every minute. Every 10 minutes the brain loses brain cells equal to the population of Delhi.

Can a patient recover from paralysis?

Yes, stroke is treatable and patients can recover very well IF the treatment is given in time.

What is the single most important factor in stroke care?

The most important part of stroke care is the patient. Patients tend to ignore their symptoms and delay the treatment which can lead to irreversible paralysis and even death. If the patient and the family are aware of stroke symptoms they can reach the hospital in time and can get treated.

 

 

 

 

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Is Brain Attack or Stroke An Emergency?

June 12, 2017 0 301 2 minutes, 11 seconds read

Yes, it is a medical emergency. A brain attack occurs due to a blocked vessel (medically known as ischemic stroke) or due to a ruptured blood vessel (medically known as hemorrhagic stroke or a subarachnoid haemorrhage).

Dr. Chandril Chugh, Senior Consultant and Head of Interventional Neurology of Max Super Speciality Hospital, Saket, says that stroke/brain attack may cause these following symptoms:

  • Weakness and numbness on one side of the body
  • Difficulty in speaking and understanding the words
  • Drowsiness
  • Loss of vision
  • Severe headaches or in some cases Death.

*Symptoms depend on which part of the brain is affected and if not treated well in time, the weakness and other neurological defects may become permanent and extremely disabling.

How severe can be a stroke?

If I were to say stroke is really bad, you will probably not believe me. Luckily, some studies have made my job easier. According to a study done by researchers in 2006 in the USA, a patient with ischemic stroke loses 190,0000 brain cells every minute, about 14000,000,000 nerve connections are destroyed every minute and 12 km (7.5 miles) of nerve fibers are lost every minute. The end result is the patient is paralysed for life and becomes dependent. That's pretty scary!!!

How do you recognise stroke?

STROKE: REMEMBER THE 6 S METHOD TO DIAGNOSE STROKE

  • SUDDEN (symptoms usually start suddenly)
  • SLURRED SPEECH ( speech is not clear, as if drunk)
  • SIDE WEAK ( face, arm or leg or all three can get weak)
  • SPINNING ( VERTIGO)
  • SEVERE HEADACHE
  • SECONDS ( note the time when the symptoms start and rush to the hospital)

Is there any treatment for stroke?

Since 85% of all strokes are ischemic (blocked blood vessel), the treatment depends on which kind of stroke the person has had. There is an option of intravenous medication called tPA (recombinant tissue plasminogen activator), which is given to the patient 3 to 4.5 hours before the symptoms onset. The patients who have a blockage in a large blood vessel are offered a procedure called as Mechanical Thrombectomy, which involves removing the blockage in the blood vessel and restores the blood supply. This procedure is performed using a small nick in the groin and there is no open surgery involved. Recent trials have shown that patients do exceedingly well post mechanical thrombectomy and have a greater chance to live life independently.

The most important of stroke care is not the doctor or hospital, it is the Patient. As most stroke attacks that occur are painless, patients tend to ignore their symptoms and delay their treatment. If the patient and family are aware of the stroke symptoms they can reach the hospital in time and can get themselves treated. 

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Bi-Plane Labs-Advanced Technology for Neurovascular Procedures!

June 12, 2017 0 158 3 minutes, 20 seconds read

Time is of the essence when it comes to neurological ailments. Be it a stroke, aneurysm or head trauma, fast, safe and timely intervention is essential for a good outcome of the patient. Keeping this in mind, the best hospitals in India are investing in Biplane Cath Labs for Neuro-intervention.

This technology aids in the Diagnosis as well as treatment of disorders related to brain spinal cord, neck and face. 

Diagnostic:

  • Digital subtraction cerebral angiography
  • Digital subtraction spinal angiography

Therapeutic:

  • Cerebral aneurysm,
  • Subarachnoid hemorrhage
  • Stroke/ Paralytic attack
  • Intracranial hemorrhage
  • Carotid Stenosis/blockage
  • Brain arteriovenous malformation (AVM)
  • Spinal arteriovenous malformation and fistula
  • Cerebral Venous Sinus Thrombosis
  • Inferior Petrosal Sinus Sampling
  • Carotid-cavernous fistula (CCF)
  • Dural arteriovenous fistula
  • Extracranial (brachiocephalic) atherosclerosis
  • Extracranial (head and neck) and paraspinal vascular malformations
  • Head and neck tumors(paraganglionomas, acoustic neuromas)
  • Intracranial atherosclerosis
  • Tumor embolization of Meningiomas and brain tumors.
  • Nosebleeds
  • Nasal angiofibromas embolization
  • Facial AVM  embolization
  • Intraocular chemotherapy
  • Traumatic vascular lesions
  • Vasospasm
  • Traumatic Brain Injury

How does the Biplane system work?

Dr. Chandril Chugh, Senior Consultant and Head of Interventional Neurology of Max Super Speciality Hospital, Saket says, The biplane system produces high-resolution 3D images of the blood vessels to the brain. As the brain blood vessel is highly complex high-quality imaging ensures safety to the patient and is paramount in delivering good results.

This system uses 2 sets of imaging sources & rotating cameras, each moving freely and independently, capturing the image at the rate of 30 frames/ second and from 2 regions of the patient’s head – front to back & side to side. Colourful, detailed, real-time images of the blood vessels are shown on a monitor, where the neuro-interventionalist rotates the image, to plan for further intervention.

 This system works like a GPS for the neuro interventionist by providing a road map to reach the desired location in the brain. Good image quality enables the doctor to perform the procedure both expeditiously and safely at the same time. Interventional Neurologist can safely treat disorders like aneurysms, arterio-venous malformations (AVM), stroke, nose bleeds etc. using minimally invasive techniques and thus eliminating the need for open surgery.  Using specialised microscopic tools, the neuro-interventionalist can coil and repair aneurysms, place scaffolds/stents in blood vessels to maintain a proper blood flow, cut off blood supply to tumours or AV malformations to stop further growth.  Neuro interventionist also helps the neurosurgeons to treat complicated vascular tumours and intracranial haemorrhage. Due to the simultaneous imaging of 2 different areas, the amount of time to get the image & the amount of dye required is reduced significantly.

Advantages of biplane system:

  • The advanced software technology that creates the detailed images of soft tissue and the blood vessels. This imaging helps visualise brain vessels, detect the primary site of haemorrhage & help the neuro-interventionalist make accurate and lifesaving decisions
  • Minimally invasive endovascular procedures have revolutionised the field of brain and spine interventions and are replacing the need for open surgery. All over the world, these procedures are being done on a bi-plane machine due to it’s enhanced safety profile.  
  • In a biplane system, the images are captured simultaneously from 2 regions –frontal view, lateral view, oblique view- which makes the positioning and re-positioning of the patient less time-consuming. This ergonomic system is preferred over a single plane, where the positioning of the patient takes significantly longer.
  • As mentioned before, the amount of radio-opaque dye used in a biplane system is considerably less compared to a single plane system. Therefore it decreases the risk of complications due to high volume dye usage.
  • Biplane labs provide decreased radiation in comparison to single plane labs, thus are helpful in limiting radiation to the paediatric population. CT scan can be obtained in a minute during the procedure without shifting the patient to the neuroradiology department thus saving a significant time which is very crucial in neuro- intervention.

Biplane labs for neuro-intervention, while more expensive, are preferred by the best hospitals in India due to its advantage. For more information, please visit the neuroscience department of Max Hospitals.

 

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