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If an aneurysm in the brain ruptures, it is a medical emergency often requiring surgery. Endovascular repair is more often used when this happens.

The diagnosis of brain aneurysm begins with an acute onset of the headache, associated with a stiff neck and an ill-appearing patient on physical examination. This typically leads the doctor to order a CT (computerized tomography) scan of the head. This will show a haemorrhage in more than 90% of cases of leaking aneurysm.

Indication of Surgery:

Aneurysm repair is a surgical procedure to correct an aneurysm, a weak area in a blood vessel wall that causes the blood vessel to bulge or balloon out and sometimes burst (rupture). It may cause:

Technique:

Surgical intervention is the only option to remove the aneurysms.

The best method to repair each aneurysm depends upon several factors, including the location and shape of the aneurysm as well as the overall health of the patient.

Depending upon the location of the aneurysm, either there is complete removal of the aneurysm or cutting the wall of the weakened artery to open it.

Treatment for a symptomatic aneurysm is to repair the blood vessels. Clipping and coiling are two treatment options.

Disc Prolapse Surgery:

A prolapsed (herniated) disc occurs when the outer fibres of the intervertebral disc are injured, and the soft material known as the nucleus pulposus, ruptures out of its enclosed space.

The prolapsed disc or ruptured disc material can enter the spinal canal, squashing the spinal cord, but more frequently the spinal nerves.

Herniated discs rarely occur in children, and are most common in young and middle-aged adults. A herniation may develop suddenly, or gradually over weeks or months.

Causes:

  • Falling from a significant height and landing on your buttocks. This can transmit significant force across the spine. If the force is strong enough, either a vertebra (bone) can fracture, or an intervertebral disc can rupture.
  • Bending forwards places substantial stress on the intervertebral discs. If you bend and attempt to lift an object which is too heavy, this force may cause a disc to A definite diagnosis is made by radiological investigations. CT scans will usually reveal significant disc prolapses, however these are often not the most reliable tests.

An MRI scan is the most accurate test, however small prolapses may be missed, particularly as most of these investigations are performed while you are lying flat – this places less pressure on the disc and may show less bulging than when you are sitting.

Other investigations that your neurosurgeon or spinal surgeon may organise include a CT myelogram (where dye is injected into the spinal canal and a CT performed), and a nerve sheath injection with local anaesthetic (this may confirm exactly which nerve is generating your symptoms.

Treatment of Surgery:

At least 80 or 90% of disc prolapses settle by themselves and their symptoms almost disappear. Typically this process takes 6-8 weeks, but may take longer.

Unless there is evidence of significant spinal cord or nerve root compression or impaired function, acute disc prolapses are almost always treated conservatively in the first instance.

If the symptoms do not settle with reasonable conservative treatment, intervention may be recommended. This may include a nerve sheath injection with local anaesthetic (steroids have not been shown to provide additional benefit), or surgery. Surgery has been shown to speed recovery following disc prolapse.

Cervical or Lumbar Spinal Stenosis Treatment

Spinal stenosis is a narrowing of the spinal canal, which places pressure on the spinal cord. If the stenosis is located on the lower part of the spinal cord it is lumbar spinal stenosis. Stenosis in the upper part of the spinal cord is cervical spinal stenosis.

Spinal stenosis can occur in each section of the spine: cervical, thoracic and lumbar. It is most commonly found in the lumbar spine.

While spinal stenosis can be found in any part of the spine, the lumbar and cervical areas are the most commonly affected. Sometimes such stenosis could be a birth defect. Most often spinal stenosis is seen in patients over 50 years of age. In these patients, stenosis is the gradual result of aging and “wear and tear” on the spine during everyday activities. As people age, the ligaments of the spine thicken and harden (called calcification).

Indication of Surgery:

Patients with lumbar spinal stenosis may feel pain, weakness, or numbness in the legs, calves or buttocks specially while walking. Cervical spinal stenosis cause similar symptoms in the shoulders, arms, and legs leading to hand clumsiness and gait and balance disturbances.

Spinal stenosis can be treated non –surgically with medications, injections or rest/ restricted activity exercise etc., and surgically with spinal stenosis operation.

Laminectomy Surgery

Lamina is part of the bone that makes up a vertebra in the spine. Laminectomy is surgery to remove the lamina. Laminectomy is also performed to remove bone spurs in the spine.

Patients also experience problems in emptying or controlling bladder and bowel. Symptoms worsen while standing or walking leading to poor quality of life and disability in patients

Indications of Surgery:

The procedure helps to reduce the pressure off the spinal nerves or spinal cord. Laminar spurs exerts pressure on the spinal nerves leading to painful legs, weakness or heaviness in buttocks and legs etc. leading to difficulty in mobility and movements in the patients.

The main reason for this operation is the intolerable pain. For severe pain and disability surgery is the treatment option. However, advanced age is one of the deterrents for this procedure.

Steps taken:

  • In laminectomy lamina (part of the bone that forms the vertebral arch in the spine) is removed which is putting pressure on the spinal cord leading to back pain, numbness in legs, difficulty in walking etc.
  • This is the result of spinal stenosis and the surgical inventions are towards removing the stenosis of the spine to relieve the pain.
  • A laminectomy is performed under anesthesia. Patient is administered either a general anesthesia or spinal anesthesia. An anesthesiologist continuously monitors the patient you throughout the surgery.
  • The incision is either through back or neck. The part of lamina bone is reached with the help of radio-imaging techniques with minimal incision. .
  • The removal is either in parts or the entire lamina bone is removed depending upon the need of the surgery for the patients. The incisions are sutured and closed with sterile bandages for preventing infection and healing.

The success rate of a lumbar laminectomy to alleviate pain from spinal stenosis is generally favourable. Following a laminectomy, approximately 70% to 80% of patients will have significant improvement in their function (ability to perform normal daily activities)

Laminectomy surgeries have good outcomes with most patients getting pain relief of their leg pain and are able to perform daily activities.

Laminectomy patients can usually be out of bed several hours after the operation. The majority of patients go home 48 to 72hours after surgery. In few instances patients can be discharged after 24 hours.