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Target
localisation deep seated Third Ventricle Tumour |
Brain tumour is a major disease of central nervous system which requires prompt and precise treatment. Patients who suffer from brain tumour generally present with head ache, vomiting, fits, visual disturbance and weakness of limbs. The basic investigations done to diagnose, are CT scan and MRI Scan.
The treatment of brain cancer primarily consists of tumour biopsy, removal to the maximum, radiotherapy (radiation) and chemotherapy (medicine).Brain tumour biopsy is essential for further management. This requires a method by which the tumour tissue can be taken up for lab test. (Histopathology)
Conventionally for the biopsy procedure, major brain operations (craniotomy opening for the skull ) are in practice. However with recent advancement such big operations are not necessary. The recent development is to obtain the brain tissue through a small hole in the skull. This is performed with a advanced Stereotactic system. (CRW- Stereotactic System)
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| Stereotactic
Neuro Surgery |
What
is the Stereotactic Surgery?
Stereotactic Neuro Surgery is a method for locating points
within the brain using an external, 3-dimentional frame
of reference. It is a minimally invasive procedure.
What are the common indications
for Stereotactic Neuro Surgery?
a) brain tumour (for biopsy & treatment)
b) brain hematoma, abscess(evacuation & catheterization)
c) stereotactic guided micro neuro surgery |
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Biopsy
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Target Entry |
What are the
advantages of Stereotactic Neuro Surgery?
a) minimally invasive – performed through small
entry point, minimal operative scar
b) can be done under local anesthesia.
c) Less time consuming(avoids long duration operation
time)
d) Cost-effective
e) Less hospital stay(patient can be discharged next day)
f) Less neurological complication
g) Can be performed in high risk patients
h) Can be performed for deep seated lesions (target) which
are not approachable by conventional surgery.
Where else Stereotaxy is applied?
a) Functional neuro surgery e.g., movement disorder/ epilepsy/
pain
b) Stereotactic radiotherapy
c) brachytherapy
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How Stereotactic
biopsy of a brain tumour is performed?
The stereotactic frame is attached to the patient’s
head and the CT scan is performed to locate the brain
tumour in relation to the frame. The brain tumour is now
pin point located on the CT scan using co-ordinates in
three directions. These calculations are transferred to
an arc system which guides the neuro surgeon to pass a
needle to the brain tumour and take a bit of tumour tissue
for laboratory test (biopsy- Histopathology).
This avoids a major operation and big opening of the skull.
The procedure is lees time consuming with less morbidity
and mortality. Hospital stay is reduced to one or two
days in comparison to open surgery. |
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Stereotaxy
guided microsurgery |
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| Brain Surgery |
| Tumour Surgery: |
1.
Pituitary Tumors - endocrine tumour
Surgery offered – Transphenoidal Pituitary Surgery
This Technique is done through the nose
to reach the brain tumour. This is a simple and safe, cosmetic
since it does not involve cranial exposure. Teams of doctors
involved in this tumour management are endocrinologist,
pathologist and neurologist.
Different types of pituitary tumors are
• Prolactinoma – causing lactation and amennonrhea
(cessation of menstruation)
• GH secreting adenoma – causing gigantism acromegaly
• ACTH adenoma causing Cushing’s syndrome etc.,
Tumors less than 1 cm size are called micro adenoma and
tumours more than 1 cm size are called macro adenomas.
MRI
showing pituitary Tumour
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Tumour approached through nasal cavity
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2. Surface Tumors
Meningiomas excised by microsurgical technique.
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Before
Operation
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After Operation
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Pre-Operative
CT scan showing a big tumor on the surface of the brain
compressing the brain significantly
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Post Operative
CT Scan showing successful removal of the tumour using
microsurgical technique
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3.Cerebellopontine angle tumors
Acoustic tumours
Arise from the VIII Neive causing hard of hearing, facial
weakness, numbness, incoordination and difficulty in
walking. This tumour is closely related to cerebellum.
Pre-Operative
Scan of the tumor Note the tumor Compressing
the brain stem
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Total removal
of the tumor by microsurgical technique
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Pre-operative
scan (cp angle)
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Total removal
by microsurgical technique
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4. Forman Magnum
Tumors
Clivus tumors like meningiomas are rare and are situated
at the base of the skull compressing the brain stem. These
tumours are operated by skull base approaches. These tumours
can cause weakness of all four limbs, difficulty in swallowing,
thinning of tongue & respiratory difficulty.
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Pre Operative
Scan of the tumor note the tumor compressing
the brain Stem
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Total removal
of the tumor by microsurgical technique
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5. Cerebro Vascular Surgery
Aneurysm clipping
Aneurysms are abnormal dilatations of cerebral blood vessels
which can rupture suddenly and cause bleeding in the brain
(subarachroid hemorrhage). These Aneurysms can be treated
by microsurgical technique called clipping of aneurysm. In
this procedure the neck of the aneurysm is closed in order
to prevent further bleeding and to provide free blood circulation
to the brain. This disorder is often critical in nature.
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Pre-operation
scan
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Pre-operation
scan
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| 6.Neuro Cosmetic Surgery
A) Carnioplasty – closure of skull defects
Cranioplasty for a large skull bone defect can
be a challenging surgical problem. A variety of
materials have been used for cranioplasty. Due
to the advances in Bioengineering, custom templates
and prosthesis are now available for Cranioplasty
using Rapid Prototyping (RP) technology. Rapid
prototyping technology was originally developed
to rapidly build a prototype of a new product,
especially in automobile industry. Now the same
technology is used in the medical field in the
production of anatomical models and templates,
which facilitate Surgeons to optimize preoperative
surgical planning, interactive surgical simulation,
while reducing operative time and complications.
TIFAC CORE (Technology Information, Forecasting
and Assessment Council -Center of Relevance and
Excellence), PSG College of Technology, Coimbatore
provided the first custom template for cranioplasty
in our patient. Under the broad umbrella of technology
vision-202O, TIFAC has set up a center of Relevance
and Excellence in Product design, optimization
and collaborative Product.
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Patient.
with skull defect after head injury |
A frontotemporal
craniotomy defect in a head injury
victim was closed with a prosthesis
made up of a biocompatible substance
polymethyl metha acrylate (Figure
1).
This prosthesis
was a replica of the custom template
produced by Rapid Prototyping Technology,
using the data of 3D-CT scan images
and 2 mm CT cuts submitted to TIFAC
CORE (Figure 2) |
Post
Operation picture
of the patient
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Rapid prototyping (RP) is a term that has been
used to describe the production of solid models
from 3D computer data by a group of relatively
new technologies. Using an additive approach to
building shapes, RP systems join liquids, powder
or sheet materials to form physical objects layer
by layer. Rapid prototyping is now widely applied
in the medical field. Some of the classical fields
for medical applications of RP models are surgical
planning and simulation, surgical rehearsal, training
of student surgeons and radiologists, communication
between medical staff and patients, and design
of individual implant and prostheses. Some of
tile common additive Rapid prototyping technologies
in medicine are Selective Laser Sintering (SLS),
Fused Deposition Modeling (FDM), Stereolithography
and recently, the most advanced Multi-jet Modeling.
Rapid prototyping technology has shown significant
benefit in Maxillo facial reconstruction, cranio
synostosis, skull and maxillo facial tumor surgery,
skull plasties, orthodontic surgery, deformities
of long bone joints and knee surgery, pelvic fractures,
hip dysplasia, spinal trauma, congenital and,
degenerative spinal diseases, foot and hand malformations,
and in models of soft tissue structures such as
the cardiovascular system. The most exciting case
in which RP technology was used in the recent
past was in planning the successful separation
of conjoined twins (Siamese twins) by using the
RP model of the twins' brain and their venous
structure.
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Defect closed
with biocompatible Custom implant using rapid prototyping
technology |
Patients Own bone
rib graft |
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B) Craniosynostosis
It is a condition where the skull is deformed due to premature
closure of sutures. The skull is deformed and can lead to
mental retardation. This requires reconstruction of the skull.
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Patient
(baby) with deformed skull |
After
surgery note well formed rounded forehead
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CT
Scan showing absence of suture on the right side
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Deformed
frontal bone is removed
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Reconstructed
for round shape
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This
procedure is done with prototype model
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7.Trigeminal Neuralgia
– Facial pain
Trigeminal neuralgia causes shock like severe facial pain.
This can be cured by a simple injection around the nerve
bundle (ganglion) using glycerol. This procedure can be
done under local anesthesia
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Injection is done
under image guidance |
Injection of glycerol
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