- Epilepsy Surgery
- Pain Relief Surgery
- Trigeminal Neuralgia Surgery
In some cases of epilepsy, surgery is performed to control the seizures that are not manageable with medications. Although various anti-epileptic drugs are available but sometimes all the drugs remain ineffective in controlling the seizures. Also, sometimes the cause of epilepsy can only be treated by surgery. So in all these cases, surgery becomes inevitable to provide quality and fear free life to the patient. There are many types of epilepsy surgery and the choice depends upon type, severity and originating point of epilepsy. The main forms of surgery are:
- Intra-operative Monitoring: In this technique, a small incision is created in the scalp to remove a piece of bone along with dura. Now catheter and other specialised instruments are inserted into it. During pre-operative evaluation, the actual size, location and type of seizure are analysed. This greatly helps to completely remove the damaged part during surgery. After the completion of surgery, the bone and dura are again fixed into their place and stitches are applied to the scalp.
- Amygdalohippocampactomy: This is one of the most successful and relatively easier procedures that are performed to treat Mesial Temporal Sclerosis with consistent results.
- Multiple subpial transections: This technique is employed in situations where it seems to be impossible to remove the damaged part causing seizures. A series of cuts are made around the damaged part in an attempt to separate the seizure causing part from the surrounding area. Thus the movement of seizure across the brain is stopped.
- Corpus callosotomy: This method aims at dividing the corpus callosum into two parts i.e., hemisphere. The part containing the seizures is separated from the other part. This helps in controlling the spread of seizure into other part of the brain and thus reduces the severity of the seizure.
- Hemispherectomy: It is a major surgery that involves the removal of cortex (outer covering) of one of the hemisphere to limit the spread of seizures. This is done in conditions where one-half of the brain is damaged
Pain Relief Surgery
Surgery is often considered as a last option to get immediate relief from pain. There are a variety of pain relieving surgeries that may give temporary or permanent relief to the patient. They include:
- Cordotomy: It is the most common method of treatment of pain. It separates the spinal cord nerve fibers from travelling towards the brain. It may be done through a laminectomy or percutaneously. The fibers may be on one or both side of spinal cord. The sense of pain and temperature are affected by cordotomy.
- Mesencephalotomy: This method involves using any structure in the midbrain, especially spinothalamic tract or Quinto-thalamic tract to relief pain. It is a useful method for treating unbearable pain. It is also helpful in reducing harmful head and neck pain.
- Sympathectomy: The sympathectomy is a useful method for reducing long-term pain. In this procedure, the nerves in the sympathetic nervous system are surgically removed. This increases the flow of blood and reduces pressure. This technique is also useful in treating the heavy sweat produced in the palms or underarms or face.
- Myelotomy: The surgical process which involves the separation of midline transverse fibers of the spinal cord is known as myelotomy. This reduces the pressure in the spinal cord. Hence the unbearable pain is almost reduced.
- Cingulotomy: It is a useful method to reduce pain in severe psychiatric patients. The nerve fibers related to emotions and motivations are destroyed. The surgery reduces or eliminates the suffering of the patient. It does not affect the mental abilities of the patient.
Trigeminal Neuralgia Surgery (Microvascular Decompression)
Initially, treatment for trigeminal neuralgia includes medications (anti-seizure drugs such as Carbamazepine or gabapentin or muscle-relaxing agents such as baclofen etc. or complementary approaches (like meditation, yoga, acupuncture, low impact exercise etc.). But as it is a progressive disorder, medications soon become ineffective or may start showing side effects. In such cases, neurosurgical procedures like Microvascular Decompression should be considered that relieve the nerve pressure.
Microvascular decompression is a highly effective surgical method that mainly addresses the source of neuralgia by treating neurovascular disabilities associated with spasm and facial pain.
Method of Microvascular Decompression
The surgery is performed under general or local anaesthesia and involves relocating or removing blood vessels that are in contact with the trigeminal root. Through an incision behind the ear on the side of pain, surgeon enters the endoscope through a small hole in the skull. Any artery that is in contact with the trigeminal nerve is moved away from the nerve, and a pad is placed between the nerve and the arteries. In case, a vein is compressing the nerve, it may be removed as well. In some rare cases, a part of the trigeminal nerve (neurectomy) may be cut during this procedure if arteries aren’t pressing on the nerve. This provides relief to the patient from the symptoms of neuralgia. A follow-up after 2-3 months is usually required after surgery
Advantages of Microvascular Decompression
- Successfully eliminates or reduces pain in most of the cases
- Provides rapid & long-term relief from pain
- Is a safe and flexible technique
- Low risk of recurrence
Risks of Microvascular Decompression
The procedure does have some risks that may include any of the following:
- Decreased hearing
- Facial weakness
- Facial numbness
- Nerve damage
- Stroke etc.
Microvascular decompression can successfully eliminate or reduce pain in most of the cases, but pain can recur in some people. Most people who have this procedure have no facial numbness afterward.Authored By : DR. Manish Vaish
Dr Manish Vaish - Neurosurgeon
Neurosurgeon NCR, Delhi
Dr. Yashpal Bundela MS Mch
Dr.Girish Rajpal MS Mch FINR
Dr. Shiwani Jain MD FNB
PDFC (Neuro-anaesthesia and Critical care)
Dr Hrishikesh Chakrabartty
Dr.Praveen Kumar MS Mch
Dr. Manish Marda MD DM