FAQ's on Head Surgery

Q- What are the exam and tests for Head Injury?
Ans- The physical examination and the history of the exact details of the injury, the person's past medical history, and the symptoms are often the most important information the doctor uses to make treatment decisions.
Skull x-rays to look for any fracture or penetrating injuries is important. The fracture itself will seldom need treatment, but an underlying brain injury may.
It may be easier to see where foreign bodies are located and how many there are with a regular x-ray than with a CT scan.
One reason for doctors to order skull x-rays for a child is in anticipation of a possible leptomeningeal cyst. Also known as growing skull fractures, this is a rare complication of skull fracture seen in children younger than 3 years. It occurs when a skull fracture fails to heal properly. Six or more months after the initial injury, the fracture may begin to widen instead of healing. Usually parents will notice swelling, which gradually increases in size. This is not predictable or preventable but should be treated by a neurosurgeon if it occurs. Swelling or masses noted in the first few weeks to months after a head injury in children are referred to as a "pseudo-growing fracture." They do not need treatment and will go away on their own but should be brought to your pediatrician's attention so it can be watched.
CT scan is the test used most often to evaluate acute head injuries. Even small spots of blood may be seen as little white dots.
MRI scans are also used for additional information about a brain and spine injury.
In some cases of bleeding in or around the brain, angiography may be performed to visualize the blood vessels which involve injecting dye into the arteries of the head. X-rays are taken that show the blood vessels and may show exactly where bleeding is occurring. In some cases it is possible to stop the bleeding following angiography. This involves injecting special materials, which are released into the bleeding blood vessel and cause a clot to form.
Other x-rays and lab tests may be performed to look for other illnesses or injuries. For example, neck injuries are common in people with severe head trauma. Spine x-rays are usually ordered before the head is moved if there is any neck pain or other symptoms of a neck injury. In a car accident, there may also be chest or abdominal injuries.

Q- What are the treatments for Head Injury?
Ans- (A) Self-Care at Home
PFE (Neuro) # 86
Minor head injuries may be cared for at home.
Bleeding under the scalp, but outside the skull, creates "goose eggs" or large bruises at the site of a head injury. They will go away on their own wit time. Using ice immediately after the trauma may help decrease their size and ice should be applied for 20-30 minutes at a time and can be repeated about every 2-4 hours as needed. There is little benefit after 24 hours.
When a minor head injury results from a fall onto carpet or other soft surface and the height of the fall is less than the height of the person who fell and there is no loss of consciousness, a doctor's visit is not usually needed. Apply ice to lessen swelling.

(B) Medical Treatment
Treatment varies widely depending on the type and severity of injuries.

Minor head injuries are often treated at home as long as someone is available to watch the person.

Bed rest, fluids, and a mild pain reliever such as acetaminophen may be prescribed. Ice may be applied to the scalp for pain relief and to decrease swelling.
Cuts will be numbed with a medication usually given by injection. They will then be cleansed. The doctor will then look for foreign matter and hidden injuries. The wound usually is closed with skin staples, stitches (sutures), or special skin glue. An immunization to prevent tetanus will be given if needed.

People with  serious closed head injuries  are always admitted to the hospital for observation and repeated studies to assure that the condition does not worsen.

Occasionally a head injury may cause elevated pressure within the skull. An intracranial pressure (ICP) monitor probe may be surgically inserted into the brain through the skull to measure the pressure. If the pressure rises too high, it may be necessary to do surgery to decompress the brain. Death is possible.
Medication to prevent seizures may be given to prevent or treat seizures that occur from the head injury.
Antibiotics are usually not required in closed head injuries.

 PFE (Neuro) # 86
   When there is a closed head injury with bleeding inside the skull or penetrating head injuries, the doctor must consider the location of the bleeding, severity of the symptoms, any other injuries, and progression of symptoms. Surgery may be needed along with antibiotics to prevent infection and a breathing tube inserted (intubation) to help prevent further brain injury. Angiography may be performed.

Q- What are the prevention for Head Injury?
Ans- Wearing helmets when bike riding, inline skating, driving motorcycles, and other similar activities.
Safety belts, car seats, and airbags when used properly can prevent head injuries in motor vehicle accidents.
Drinking while driving should be avoided strictly.
Fall-proofing includes checking your home for areas where someone may fall: stairs, bathtubs, throw rugs, and furniture.

Q- What is the prognosis for Head Injury?
Ans- Prognosis varies and depends on the severity of the injury. It is now commonly recognized that even minor head injuries can have long-term consequences (usually psychological or learning disabilities). Serious head injuries can result in anything from full recovery to death or a permanent coma.

FAQ's on Head Surgery

Q- What is Head Injury?
Ans- Head injury is a general term used to describe any trauma to the head, and most specifically to the brain itself.

Q- How many types of head injury?
Ans- Skull fracture: A break in the bone surrounding the brain and other structures within the skull.
Linear skull fracture:  Common in children. It is a simple break in the skull that follows a relatively straight line which can occur after minor head injuries (falls, blows such as being struck by a rock, stick, or other object; or from motor vehicle accidents).
Depressed skull fractures:  These are common after forceful impact by blunt objects which cause “dents” in the skull—most commonly, ammers, rocks, or other heavy but fairly small objects. If the depth of a depressed fracture is at least equal to the thickness of the surrounding skull bone (about 1/4-1/2 inch), surgery is often required to elevate the bony pieces, to remove dirt and other debris and to inspect the brain and its coverings for evidence of injury.
Basilar skull fracture:  A fracture of the bones that form the base (floor) of the skull and results from severe blunt head trauma of significant force. It commonly connects to the sinus air cavities. This connection may allow CSF fluid to leak through the nose or ears and allow for air and bacteria to enter into the inside of the skull and may cause infection. Surgery is usually not necessary unless other injuries are also involved or for persistent CSF leak.
Intracranial (inside the skull) hemorrhage (bleeding)
Subdural hematoma:  It is the bleeding between the brain tissue and the dura mater (a tough fibrous layer of tissue between the brain and skull). The stretching and tearing of "bridging veins" between the brain and dura mater causes this type of bleeding. It may be acute, developing suddenly after the injury, or chronic, slowly accumulating after injury. They are potentially serious and often require surgery.
Epidural hematoma:  It is the bleeding between the dura mater and the skull bone. These occur when arteries are injured after skull fractures PFE (Neuro) # 86 particularly after injury in the temple area. It is potentially serious and often requires surgery.
Intraparenchymal hemorrhage/cerebral contusion:  It is the bleeding into the brain tissue itself. A contusion is like a bruise to the brain tissue and usually requires close observation in hospital for increase in size over time. An intraparenchymal hemorrhage is a pool of blood within the brain tissue. Minor bleeding may stop without any surgical treatment. More serious or large bleeds usually require intracranial pressure monitoring and surgery.
Closed head injuries: It is an injury to the brain or structures within the skull that are not caused by a penetrating injury (such as a gunshot wound or stab wound). They range from very minor to potentially fatal injuries.
 Q- What are the causes of Head Injury?
Ans- All types of head injuries can be caused by trauma. In adults such injuries commonly result from motor vehicle accidents, assaults, and falls. In children falls are the most common cause followed by recreational activities such as biking, skating, or skateboarding. A small but significant number of head injuries in children are from abuse.
Penetrating trauma:  Missiles such as bullets or sharp instruments (also knives,screwdrivers, ice picks) may penetrate the skull. This often require surgery toremove debris from the brain tissue. The initial injury itself may cause immediatedeath, especially if from a high-energy missile such as a bullet.
Blunt head trauma:  These injuries may be from direct blow (a club or large missile) or from a rapid deceleration force (a fall or striking the windshield in a car accident).

Q- What are the symptoms of Head Injury?
Ans- Symptoms of head injuries vary with the type and severity of the injury.

Minor blunt head injuries  may involve only symptoms of brief loss of consciousness. They may result in headaches or blurring of vision or nausea and vomiting.
Severe blunt head trauma  involves a loss of consciousness lasting from several minutes to many days or longer. Seizures may result. The person may suffer from severe and sometimes permanent neurological deficits like paralysis, seizures, PFE (Neuro) # 86 difficulty in speaking, seeing, hearing, walking, or understanding or may even die.
Penetrating trauma  may cause immediate, severe symptoms or only minor symptoms despite a potentially life-threatening injury. Death may follow from the initial injury.

Q- When to seek medical care?
Ans- (A) Call the doctor  to ask about any of the following situations. Your doctor will recommend home care, set up an appointment to see you, or direct you to go to a hospital's Emergency Department.
A person is pushed to the ground or struck a hard object with the head but did not lose consciousness, vomiting more than once, confusion or speech difficulty after trauma, drowsiness, weakness or inability to walk and severe headache
(B) Go to the Emergency Department  by ambulance in the following situations. People with less severe injuries may be taken by car.

Severe head trauma or a fall from more than the height of the person or a hard fall onto a hard surface or object
Loss of consciousness for more than 1 minute, vomiting more than once, confusion, drowsiness, weakness or inability to walk, or severe headache
Prevent movement of the neck in severe head injury or if the injured person has any neck pain. If the person needs to vomit, carefully roll them onto their side without turning the head.
Should an injured person be allowed to fall asleep? Many people mistakenly believe that it is important to keep a person awake after they have been struck on the head.
You do not need to keep a head injury victim awake. In many cases it is even helpful to the emergency doctor to be able to awaken a person who is now calm and rested and able to behave normally. This gives the doctor a much better assessment of the severity of the head injury.
If a person who was initially normal after a head injury cannot be awakened or is extremely difficult to awaken, he or she may have a more serious head injury and should be evaluated by a doctor.

FAQ's on Aneurysm Surgery

Q- What is Removal of Pituitary Adenoma?
Ans- Pituitary tumor
Neuroanesthesia specialist and internal medicine consultants will pay visit to you and assess fitness with test including blood tests, endocrine assays, X- rays and other radiological tests, Dobutamine stress echocardiogram for cardiac fitness and like. Other specialist may also see you on as and when required basis. Blood grouping and typing will be done so as to be ready for blood transfusion if you so need. Blood may be required to be reserved but transfusion will be depend upon the intra-operative blood loss.
Once fit for procedure, a fasting period of 6 hours will be required for anesthesia. Surgery will be done under general anesthesia. Informed consent will need to be signed so as to permit the surgeon and anesthetist to undertake procedure in good faith. Consent form enumerates the disease process, reasons for undergoing surgery, benefits to expect, risks involved, alternative procedures if any, identifies operating surgeon and needs your informed consent along with a witness signature.
Once in operation theatre, general anesthesia will be introduced by asking you to breath through a mask. Procedure will be done endoscopically or microscopically through the nose without an outside wound. Sella is reached through the nose, opened into and pituitary tumor decompressed.
Nasal pack will be inserted and kept for two to three days. You can breathe through mouth during that period. Large tumors may require craniotomy. There may be fluid and electrolyte disturbances in immediate post operative period which settles down gradually.
Long term hormonal replacement may be required. After a day or two stay under observation in ICU transit to ward will happen. Discharge from hospital will happen by four- five days after surgery. Histopathology report should be ready Pituitary Tumor by fifth post operative day, thus enabling us to decide on need for adjuvant therapy i.e. radiotherapy and/ or chemotherapy. Check CT scan will be done in post-operative period to confirm post operative status.
Although surgery is relatively safe, it dose carries certain associated risks. The incidence of risks this surgery in our hospital are low and are comparable to any other advanced neurosurgical centre.
Surgical complications include but are not restricted to:
1.1) Operative site bleeding – uncommon but may require re-surgery [craniotomy] is compromising the vision.
1.2) Local bleeding – usually settles down on its own.
1.3) Visual deterioration if any unintended damage occurs during or post-operative bleeding – rare may require high dose steroids or re-surgery.
1.4) CSF leak from nose for which the lumbar drain is kept for a day or two more – may require re-surgery to repair the leak.
1.5) Endocrinal disturbances which are taken care by adequate pre-operative and postoperative estimation of the hormonal levels and replacement.
1.6) Increase urination – [diabetic insipidus] – usually temporary for a few days, sometimes permanent.
Generally life risk for patients undergoing surgery without any previous medical illness is 1- 2 % and risk of complications is 5 to 10 % depending upon size of the tumor. The risk to life and complications increase depending upon the above factors or if patient is in poor neurological status before surgery.
After discharge from hospital, for further assistance please contact at following phone numbers: 26825558 / 26925858 or 5801 on ext. no. 2001 and 2012.

Q- What is Surgery for Brain Tumours?
Ans- Surgery for Brain Tumours
Aims of the surgery include getting histopathology diagnosis, decompress the tumor to decrease the tumor load so that subsequent therapies like radiotherapy and chemotherapy are more effective and to decrease the raise intracranial pressure by removing as much tumor as possible without causing much damage to the surrounding brain.
You will undergo pre-operative check up to ensure fitness for the surgical procedure. Neuroanesthesia specialist and internal medicine consultants will pay visit to you and assess fitness with test including blood tests, X- rays and other radiological tests, Dobutamine stress echocardiogram for cardiac fitness and like. Other specialist may also see you on as and when required basis. Blood grouping and typing will be done so as to be ready for blood transfusion if you so need. Blood may be required to be reserved but transfusion will depend upon the intra-operative blood loss.
Once fit for procedure, a fasting period of 6 hours will be required for anesthesia. Surgery will be done under general anesthesia. Informed consent will need to be signed so as to permit the surgeon and anesthetist to undertake procedure in good faith. Consent form enumerates the disease process, reasons for undergoing surgery, benefits to expect, risks involved, alternative procedures if any, identifies operating surgeon and needs your informed consent along with a witness signature.
Once in operation theatre, general anesthesia will be introduced by asking you to breath through a mask. Procedure involves a skin incision on the part of head corresponding to the lesion, creating a window through the skull bone, localizing the tumor and safe excision thereof to the maximum limit possible. Bone flap will be replaced and fixed. The wound is closed with or without drainage tube, which is subsequently removed next morning. Anesthesia will be reversed in operation theatre and you will come out wide awake.
Breathing exercises and anti- embolic stockings help in healthy recovery. Subsequently with a physiotherapist mobilization will be done. After a day or two stay under observation in ICU transit to ward will happen. Discharge from hospital will happen by four- five days after surgery. Physiotherapist will assist and teach you maneuvers which are to be continued even after discharge. Stitches may either be self dissolving, subcuticular (buried) or may require to be removed six to eight days after surgery. Histopathology report should be ready by fifth post operative day, thus enabling us to decide on need for adjuvant therapy i.e. radiotherapy and/ or chemotherapy.
Brain tumors
Check CT scan will be done in post-operative period to confirm post operative status.
Although surgery is relatively safe, it dose carries certain associated risks. The incidence of risks this surgery in our hospital are low and are comparable to any other advanced neurosurgical centre.
Surgical complications include but are not restricted to:
Potential Complications include :
1.1) Operative site bleeding – uncommon but may require re-surgery [craniotomy] is compromising the vision.
1.2) Local bleeding – usually settles down on its own.
 1.3) Visual deterioration if any unintended damage occurs during or post-operative bleeding – rare may require high dose steroids or re-surgery.
 1.4) CSF leak from nose for which the lumbar drain is kept for a day or two more – may require re-surgery to repair the leak.
 1.5) Endocrinal disturbances which are taken care by adequate pre-operative and postoperative estimation of the hormonal levels and replacement.
1.6) Increase urination – [diabetic insipidus] – usually temporary for a few days, sometimes permanent.
Generally life risk for patients undergoing surgery without any previous medical illness is 1% and risk of complications is 5 to 8 % depending upon location and size of the tumor. The risk to life and complications increase depending upon the above factors or if patient is in poor neurological status before surgery.
After discharge from hospital, for further assistance please contact at following phone numbers26825558 / 26925858 or 5801 on ext. no. 2001 and 2012.

FAQ's on Aneurysm Surgery

Q- What is Lumbar Decompression?
Ans- Lumbar Decompression
Neuro-anesthesia specialist and internal medicine consultants will pay visit to you and assess fitness with test including blood tests, X- rays and other radiological tests, Dobutamine stress echocardiogram for cardiac fitness and like. Other specialist may also see you on as and when required basis. Blood grouping and typing will be done so as to be ready for blood transfusion if you so need. Blood may be required to be reserved but transfusion will be depend upon the intra-operative blood loss.
Once fit for procedure, a fasting period of 6 hours will be required for anesthesia. Surgery will be done under general anesthesia.
Informed consent will need to be signed so as to permit the surgeon and anesthetist to undertake procedure in good faith. Consent form enumerates the disease process, reasons for undergoing surgery, benefits to expect, risks involved, alternative procedures if any, identifies operating surgeon and needs your informed consent along with a witness signature.
Once in operation theatre, general anesthesia will be introduced by asking you to breathe through a mask. Procedure involves surgery to be done in face down position with a midline skin incision in the back, the incision will be deepened through a avascular plain upto the spinous process of vertebrae, paraspinal muscles will be separated and posterior bony elements will be removed / repositioned so as to create space in the spinal canal thus decompressing the spinal cord and / or nerve roots. Stabilization using rod and screws may be done if instability is encountered. Any abnormal tissue or mass, if encountered will be sent for further tests so as to determine the cause and thus helping in further management. The wound is closed with or without drainage tube, which is subsequently removed next morning. Anesthesia will be reversed in operation theatre and you will come out wide awake.
Breathing exercises and anti-embolic stockings help in healthy recovery. Subsequently with a lumbosacral belt and physiotherapist mobilization will be done. After overnight stay under observation in ICU transit to ward will happen. Discharge from hospital will happen by two three days after surgery. Physiotherapist will assist and teach you maneuvers which are to be continued even after discharge. Stitches may either be self dissolving, subcuticular (buried) or may require to be removed eight days after surgery. Lumbosacral belt needs to be worn for a period of three months, whenever sitting or ambulant.
Check X-Rays will be done on follow up thereafter to confirm bony healing.
Lumar decompression
Although surgery is relatively safe, it dose carries certain associated risks. The incidence of risks this surgery in our hospital are low and are comparable to any other advanced neurosurgical centre.
Surgical complications include but are not restricted to:
Minor Complications :
1.1) Blood collection at the operative site.
1.2) Abnormal sensations or numbness in lower limbs.
1.3) Infection in the wound causing redness or pain. Risk is slightly higher in patients with history of diabetes. Major Complications :
2.1) Injury to the nerve covering (dura with leakage of cerebro-spinal fluid that can cause meningitis and poor wound healing).
2.2) Injury to the spinal cord / nerve root resulting in weakness of legs, impaired sensations, sexual dysfunctions and loss of control of bladder / bowel movements.
2.3) Increase risk in obese people / smoker of wound infection, chest infection, partial lung collapse resulting in post operative breathlessness / difficulty in breathing.
2.4) Highest risk and rate of complications occur in patients who are bed ridden or have no movement in the lower limbs.
2.5) Displacement of adjoining vertebrae to the level of surgery may occur after few years.
2.6) Implant related complications, if used viz. implant loosening, mal-positioning of screws, infection in implant requiring reoperation.
2.7) Rarely blood may clot in the legs (deep vein thrombosis) casing pain and swelling in the calf due to lack of leg movements by the patient or due to weakness in the legs.
Rarely part of this clot may break-off and go to the lungs which can severely affect oxygen exchange and heart function.
After discharge from hospital, for further assistance please contact at following phone numbers:
26825558 / 26925858 or 5801 on ext. no. 2001 and 2012

FAQ's on Aneurysm Surgery

Q- What is Cervical Laminectomy?
Ans- Cervical Laminectomy
Neuro-anesthesia specialist and internal medicine consultants will pay visit to you and assess fitness with test including blood tests, X- rays and other radiological tests, Dobutamine stress echocardiogram for cardiac fitness and like. Other specialist may also see you on as and when required basis. Blood grouping and typing will be done so as to be ready for blood transfusion if you so need. Blood will not be routinely required to be reserved for this surgery exception being rare blood groups. Once fit for procedure, a fasting period of 6 hours will be required for anesthesia. Surgery will be done under general anesthesia.
Informed consent will need to be signed so as to permit the surgeon and anesthetist to undertake procedure in good faith. Consent form enumerates the disease process, reasons for undergoing surgery, benefits to expect, risks involved, alternative procedures if any, identifies operating surgeon and needs your informed consent along with a witness signature.
Once in operation theatre, general anesthesia will be introduced by asking you to breathe through a mask. Procedure involves surgery to be done in face down position with a midline skin incision in the neck, the incision will be deepened through a avascular plain upto the spinous process of vertebrae, paraspinal muscles will be separated and posterior bony elements will be removed / repositioned so as to create space in the spinal canal thus decompressing the spinal cord and / or nerve roots. Stabilization using rod and screws may be done if instability is encountered. The wound is closed with or without drainage tube, which is subsequently removed next morning. Anesthesia will be reversed in operation theatre and you will come out wide awake.
Breathing exercises and anti-embolic stockings help in healthy recovery. Subsequently with a cervical collar and physiotherapist mobilization will be done. After overnight stay under observation in ICU transit to ward will happen. Discharge from hospital will happen by twothree days after surgery. Physiotherapist will assist and teach you maneuvers which are to be continued even after discharge. Stitches may either be self dissolving, subcuticular (buried) or may require to be removed eight days after surgery.
Cervical collar needs to be worn for a period of three months, whenever sitting or ambulant.
Check X-Rays will be done on follow up thereafter to confirm bony healing.
Cervical laminectomy foramintomy
Although surgery is relatively safe, it dose carries certain associated risks. The incidence of risks this surgery in our hospital are low and are comparable to any other advanced neurosurgical centre.
<h3>Surgical complications include but are not restricted to:
Minor Complications :
1.1) Blood collection at the operative site.
1.2) Abnormal sensations or numbness in upper / lower limbs.
1.3) Infection in the wound causing redness or pain. Risk is slightly higher in patients with history of diabetes.
Major Complications :
2.1) Injury to the nerve covering (dura with leakage of cerebro-spinal fluid that can cause meningitis and poor wound healing).
2.2) Injury to the spinal cord / nerve root resulting in weakness of arms / legs.
2.3) Increase risk in obese people / smoker of wound infection, chest infection, partial lung collapse resulting in post operative breathlessness / difficulty in breathing.
2.4) Highest risk and rate of complications occur in patients who are bed ridden or have no movement in the lower limbs.
2.5) Persistent neck pain even after wound healing.
2.6) Movement or loosening of graft due to instrumentation resulting in swallowing difficulties.
After discharge from hospital, for further assistance please contact at following phone numbers: 26825558 / 26925858 or 5801 on ext. no. 2001 and 2012.

FAQ's on Aneurysm Surgery

Q- What is Cervical Discectomy?
Ans- Cervical Discectomy
Neuro-anesthesia specialist and internal medicine consultants will pay visit to you and assess fitness with test including blood tests, X- rays and other radiological tests, Dobutamine stress echocardiogram for cardiac fitness and like. Other specialist may also see you on as and when required basis. Blood grouping and typing will be done so as to be ready for blood transfusion if you so need. Blood will not be routinely required to be reserved for this surgery exception being rare blood groups. Once fit for procedure, a fasting period of 6 hours will be required for anesthesia. Surgery will be done under general anesthesia.
Informed consent will need to be signed so as to permit the surgeon and anesthetist to undertake procedure in good faith. Consent form enumerates the disease process, reasons for undergoing surgery, benefits to expect, risks involved, alternative procedures if any, identifies operating surgeon and needs your informed consent along with a witness signature.
Once in operation theatre, general anesthesia will be introduced by asking you to breath through a mask. Procedure involves a skin crease cut across the side of neck, access to the spine between the carotid artery (artery supplying blood to brain) and the trachea (wind pipe) and the esophagus (food pipe). An X-ray will be taken to confirm the correct level of surgery.
Intervertebral disc will be incised and microscopically removed decompressing the spinal cord and/ or nerve roots. Occasionally an additional incision is made over the anterior aspect of hip to remove small bone piece (7- 8 mm) for use in fusion of adjacent vertebra, alternatively metal case with or without plate is used for fusion. Artificial disc replacement is an alternative to fusion. The wound is closed with or without drainage tube in front of vertebra, which is subsequently removed next morning. Anesthesia will be reversed in operation theatre and you will come out wide awake.
Breathing exercises and anti- embolic stockings help in healthy recovery. Subsequently with a cervical collar and physiotherapist mobilization will be done. After overnight stay under observation in ICU transit to ward will happen. Discharge from hospital will happen by twothree days after surgery. Physiotherapist will assist and teach you maneuvers which are to be continued even after discharge. Stitches may either be self dissolving, subcuticular (buried) or may require to be removed six days after surgery.
Cervical collar needs to be worn for a period of three months, whenever sitting or ambulant. Check X-Rays will be done on follow –up there after to confirm bony healing.
Cervical disc prolapse
Although surgery is relatively safe, it dose carries certain associated risks. The incidence of risks this surgery in our hospital are low and are comparable to any other advanced neurosurgical centre.
Surgical complications include but are not restricted to:
1.1) Injury to larynx (vocal box) and/or nerves to larynx leading to hoarseness of voice which is mostly transient.
1.2) Movement of graft or loosening of instrumentation leading to difficulty in swallowing
1.3) Injury to spinal cord/ nerve root resulting in weakness of arm or legs (&lt; 1%)
1.4) Injury to coverings of spinal cord/ nerves(dura) leading to cerebro- spinal fluid leak predisposing to meningitis and poor wound healing
1.5) Abnormal sensations or numbness in limbs
1.6) Blood clot at operative site leading to breathing difficulties
1.7) Pain in the hip wound (only if graft is taken)
1.8) Infection of wound causing redness and/ or pain with increased incidence in diabetics.
1.9) Injury to the esophagus(food pipe) causing difficulty in swallowing and throat irritation
1.10)Increased risk of chest infection and breathing difficulty especially in obese and smokers.
1.11)Bedridden and those with decreased movements of limbs are at maximum risk of complications.
 After discharge from hospital, for further assistance please contact at following phone numbers: 26825558 / 26925858 or 5801 on ext. no. 2001 and 2012.

FAQ's on Aneurysm Surgery

Q- What is Aneurysm Surgery?

Ans- Aneurysm Surgery

Aims of the surgery include clipping the neck of the aneurysm to prevent re bleeding, to remove the clots – which decreases the severity of vasospasm and to do third ventriculostomy [alternative opening for CSF pathway] to decrease the chances of hydrocephalus

Neuroanesthesia specialist and internal medicine consultants will pay visit to you and assess fitness with test including blood tests, X- rays and other radiological tests, Dobutamine stress echocardiogram for cardiac fitness, cerebral angiogram to access the anatomy of aneurysm and like. Other specialist may also see you on as and when required basis. Blood grouping and typing will be done so as to be ready for blood transfusion if you so need. Blood may be required to be reserved but transfusion will depend upon the intraoperative blood loss.

Once fit for procedure, a fasting period of 6 hours will be required for anesthesia.

Surgery will be done under general anesthesia. Informed consent will need to be signed so as to permit the surgeon and anesthetist to undertake procedure in good faith. Consent form enumerates the disease process, reasons for undergoing surgery, benefits to expect, risks involved, alternative procedures if any, identifies operating surgeon and needs your informed consent along with a witness signature.

Once in operation theatre, general anesthesia will be introduced by asking you to breathe through a mask. Procedure involves a skin incision on the part of head corresponding to the aneurysm, creating a window through the skull bone, localizing the aneurysm and safe clipping of aneurysm.

Bone flap will be replaced and fixed. The wound is closed with or without drainage tube which is subsequently removed next morning. Anesthesia may be reversed in operation theatre or continued in the I.C.U. for brain protection.

Breathing exercises and anti- embolic stockings help in healthy recovery. Subsequently with a physiotherapist mobilization will be done. After a day or two stay under observation in ICU transit to ward will happen. Discharge from hospital will happen by four- five days after surgery. Physiotherapist will assist and teach you manoeuvres which are to be continued even after discharge. Stitches may either be self-dissolving, subcuticular (buried) or may require to be removed six to eight days after surgery. Check CT scan will be done in post-operative period to confirm post operative status.

Although surgery is relatively safe, it dose carries certain associated risks. The incidence of risks this surgery in our hospital are low and are comparable to any other advanced neurosurgical centre.

Surgical complications include but are not restricted to:

 1.1) Operative site bleeding – can produce haematoma and may require further surgery for removal if patient shows worsening in consciousness level or if the clot is significant.

1.2) Post-operative seizures – prevented by adequate anti-convulsants drugs.

1.3) Infection – meningitis– which may require injectable antibiotics for few weeks and prolong the hospital stay.

1.4) Developing fresh neurological defects – may not be related to surgery but more due to vasospasm. It is prevented post-clipping by maintaining adequate blood pressure to increase the blood supply to the brain. Inspite of all the efforts the chances of postoperative deficits is seen in nearly one-third patients which usually recovers over time in significant number of patients.

1.5) Chest infections  – particularly in elderly or patients who are bed ridden for long time.

1.6) Secondary complications due to bed ridden state.

1.7) Local wound infections – rare require antibiotics and local dressings.

1.8) Hydrocephalus – which may require a CSF diversion procedure like VP shunt.

1.9) Prolonged ICU may be required as delayed neurological complications may occur because of spasm of the blood vessels of the brain or hydrocephalus.

Generally life risk for patients undergoing surgery without any previous medical illness is 2 - 5 % and risk of complications is 10 to 15 % depending upon location of aneurysm and severity of bleed. The risk to life and complications increase depending upon the above factors or if patient is in poor neurological status before surgery.