Treatments offered at Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield

Cardiac Catheterization

Cardiac catheterization is a common diagnostic test performed to evaluate the condition of heart muscle, valves, and vessels.

  • During this procedure, special long, flexible tubes, called angiography catheters, will be inserted into your heart and coronary arteries.
  • Contrast media (also called dye) is injected through the angiography catheter while x-ray images are taken.
  • The dye causes areas where blood flows, including vessels and heart chambers, to temporarily become darker than the surrounding tissue. This enables the physician to see how effectively your heart is pumping, and to determine if there are any narrowed blood vessels
  • Blood pressure measurements are also taken at this time.

Unlike cardiac surgery, most of the cardiology procedures have common steps with the changes being in the selection of “the interventional triad”: the Guiding Catheter, the Guide Wire and the Balloon (depending on the procedure). The basic process of cardiac catheterization remains the same.

Diagnostics and procedures in Cardiology may be divided into two broad categories, arrhythmia related procedures and anatomy related procedures.

Anatomy related diagnosis and treatment

Percutaneous Transluminal Mitral Commissurotomy (PTMC)
PTMC is a procedure where a balloon is used to dilate a stenosed mitral valve by threading it onto a catheter that is maneuvered into the mitral valve site. The most beneficial and effective technique was developed by Inoue in 1982.
PDA coil closure
A steel or MRI compatible metal coil is placed across the PDA to help In thrombotic closure – Thrombus (Clot) formation occurs on the metal coil and the PDA is sealed.
Pulmonary Valve Balloon Dilatation PVBD
This is done for Pulmonary valvular stenosis. A balloon catheter is maneuvered into the pulmonary valve through a right heart catheterization procedure and is inflated (valve is dilated) in a single stage.
Aortic Valve Balloon Dilatation AVBD
This is done for Aortic valvular Stenosis. A balloon catheter is maneuvered into the pulmonary valve through a left heart catheterization procedure and is inflated (valve is dilated) in a single stage.
Coarctation of Aorta Dilatation
When there is a block in the Aorta after the arch (thoracic or abdominal segments) obstructing the flow to the lower limbs of the body, a balloon is placed across this obstruction and inflated clearing the way for the blood to flow.
Peripheral Angiogram
The standard angiogram procedure is performed for other vascular structures of the body under investigation for obstructions/anomalies.

Anatomy related diagnosis and treatment

Pericardial Effusion Tapping (PE Tapping)
A catheter is inserted through the intercostal spaces (between the ribs) into the pericardial sac and pre-calculated (excess) pericardial fluid is aspirated (removed) using a syringe. The position of catheter confirmed using fluoroscopy and the liquid level is assessed using echocardiography.
Percutaneous Transluminal Angioplasty (PTA)
This is a generic name given to the interventional procedure that follows the angiogram. Angioplasty attempts to bring the vasculature back to normal through different means (stent, removal of plaque…). This procedure can be done anywhere in the body and the name changes according to the location such as: Coronary, Renal, Abdominal, Sub-Clavian, Carotid, Iliac, Brachial, Femoral, etc.
SAM Dilatation
More of a palliative procedure. A Sub Aortic Membrane, which is absent in a normal heart, causes obstruction to blood flow out of the Left Ventricle into the aorta. A balloon is inflated in the membrane area to suppress the growth so as to improve blood flow. It is generally considered not very effective. Surgery is the final option.
Tricuspid Valve Balloon Dilatation (TVBD)
Procedure similar to PTMC but the tricuspid valve is involved.
Balloon Atrial Septostomy (BAS)
This is a unique procedure to enable the mixing of pure and impure blood which enhances survival of the patient. This is normally done within one week to three months of birth generally for DTGA situations.

Arrhythmia related diagnosis and treatment

Electro-Physiological Study (E-P Study):
The normal heart beats according to the electrical impulses from the sinoartial node to the atrioventricular node. Sometimes additional abnormal path ways form and cause dangerous changes to the normal rhythm of the heart (arrhythmias) EP study is a diagnostic procedure done to find out extra pathways that cause these arrhythmias.
Radio Frequency Ablation (RF Ablation):
This is a remedial procedure for arrhythmias. A special catheter is maneuvered into the position identified by the EP study to be the anomalous pathway and the tip of the catheter is heated through application of Radio Frequency and burn the extra pathways preventing further arrhythmias (ablated).
Temporary Pacemaker Implantation (TPI):
A normal heart beats at a “pace” that causes the heart to eject blood into the aorta at the required pressure to circulate to the whole body. Due to various reasons the heart begins to slowdown leading to a condition called Bradycardia. Consequently the blood flow to the systemic circulation reduces (low cardiac output) leading to other complications. Temporary Pacemaker Implantation is a procedure wherein a catheter is positioned into the heart muscle and electrical impulses sent from an external pacemaker at the required pace to enable the heart to pump out its normal volume. This can be done under situations ranging from emergency interventions (accidents, organ failures, etc.) to procedural requirements in the Cath lab. In an emergency situation the TPI may itself suffice till the necessary action is taken and the heart returns to normal. Cath procedures requiring TPI include the process of Permanent Pacemaker Implantation (PPI), TPI is done to keep the heart beating normally till the PPI is completed.
Permanent Pacemaker Implantation (PPI):
When a TPI fails or the heart muscle is beyond salvage and cannot regain its original pace a PPI is performed. This is a semi surgical procedure done in the Cath lab itself. Pacemaker is a little device implanted in the chest to regulate the heart rate and rhythm. Through a simple procedure the implantation is often done in the operation theatre or cardiac catheterization lab, and usually takes an hour or two.
Pacemakers usually are implanted under local anesthesia, one will be relaxed, but awake, during surgery. Usually, pacemakers are implanted just under the skin in the upper chest. Typical complications for pacemaker implants are not life threatening, but may require a repeat operation or a longer than normal hospital stay. Common complications include bleeding, infection, lead dislodgment, and lead or pacemaker problems following surgery. Complications occur less than 1% of the time.
Intra Cardiac Defibrillator Implantation:
When the ventricles of the heart especially the left one beats on its own at a fast rate eg: 200bpm as against the normal 120bpm, it is called Ventricular Tachycardia. When this arrhythmia cannot be cured by ablation, the only other solution is to apply an electrical shock to bring it back to normal rhythm. Patients are implanted with a defibrillator that is programmed to sense this VT and “shock” it back to normal. The procedure for implantation is similar to that of the pacemaker but the instrument is a defibrillator instead of pacemaker.
Biventricular Pacemaker Implantation:
The left and right ventricles of a healthy heart pump out blood in a synchronized beat /rhythm. Some hearts do not have this synchronization, which leads to cardiac dysfunction and heart failure. To help such conditions, a special variety of pacemaker is implanted to bring the two ventricles back into sync and consequently improving the functioning of the heart.

Coronary related diagnosis and treatment:
Coronary Angiogram
Angiography (also called cardiac catheterization or a heart cath) is a common diagnostic test performed to evaluate the condition of heart muscle, valves, and vessels. This procedure is most commonly performed to determine a patient’s cardiac condition and what form of treatment is required, including: medical management, angioplasty (PTCA, stenting or balloon widening of a vessel), or surgery.
Percutaneous Transluminal Coronary Angioplasty PTCA
This is a procedure in which a balloon is used to dilate blocked coronary arteries. This procedure has its advantages in that it postpones or avoids CABG surgery, but is limited to the extent of blockage. The process of Atherosclerosis may be far to advanced in certain cases for the procedure to successfully restore blood flow. In such cases CABG /OPCAB are the available surgical options.
Percutaneous Transluminal Angioplasty (PTA)
This is a generic name given to the interventional procedure that follows the angiogram. Angioplasty attempts to bring the vasculature back to normal through different means (stent, removal of plaque…). This procedure can be done anywhere in the body and the name changes according to the location such as: Coronary, Renal, Abdominal, Sub-Clavian, Carotid, Iliac, Brachial, Femoral, etc.
Percutaneous Trans-Septal Myocardial Ablation (PTSMA)
Each chamber of the heart has an optimal filling volume, which is in exact proportion to the other chamber volumes. When the Left Ventricular Volume is reduced, the carrying capacity/pumping volume also reduces, consequently the patient suffers secondary complications. This reduction in volume is sometimes due to Septal thickening. PTMA involves injecting an alcohol into the vessel supplying the thickened vessel dies part becomes thin. LV volume increases.

Cardiac Surgical procedures
Cardiac surgery consists of basically two types of procedures, Open heart and Closed heart, the former being done with the help of a heart lung machine and the latter, without the need for a heart lung machine.
• The commonest open heart procedures, include coronary artery bypass CAB (the commonest surgical procedure in the world today), valve replacements, aneurysm repairs and correction of congenital heart defects.
• In SSSIHMS, a majority of Coronary artery bypass procedures are done without the help of a heart lung machine, (Off pump Coronary Artery Bypass – OPCAB) but with a fully assembled pump available, if needed.
• Majority of the valve procedures are replacements, with repairs accomplished when feasible.
• Aortic aneurysms depending on their location, are treated appropriately, with valve conduits or grafts as indicated.
• Total correction procedures form a major part of the pediatric surgical procedures, with palliative closed procedures when indicated.
• Examples of closed heart surgery include PDA ligation, Bi-Directional Glenn, Blalock-Taussig shunt, Coarctation of Aorta repair, and so on.
Following are the most common procedures done in the department of CTVS at SSSIHMS Wfd.
1. ALCAPA repair: Anomalous Left Coronary Artery Arising from Pulmonary Artery. This is a rare congenital anomaly where the Left Coronary Artery instead of arising from the aorta arises from the Pulmonary Artery. The surgical procedure involves re-implanting the left coronary artery back to the ascending aorta where it should have been arising, to start with.
2. Aortic Root Replacement: A surgical procedure where both the aortic valve and the ascending aorta are replaced with artificial valve and graft and re-implantations of the coronary buttons into the prosthetic graft.
3. AP Window closure: Aorto Pulmonary Window closure – a communication between ascending aorta and the pulmonary artery. Repair involves closure of this communication using a prosthetic or pericardial patch.
4. ASD closure: Atrial Septal Defect –Surgical closure of a defect in the septum/partition between the left and right atria, usually with a pericardial patch.
5. AV canal repair: Atrio-Ventricular canal repair. This is a complex defect where not only are the valves incompletely formed, but the atrial and/or ventricular septae / partitions are also deficient. Repair consists of not only repairing the two valves but also reconstituting the septae.
6. AVR: Aortic Valve Replacement, a procedure where the Aortic valve is replaced with a prosthetic (mechanical) /bio-prosthetic (tissue) valve.
7. BD Glenn: Bidirectional Glenn – It is an initial procedure that improves the blood flow to lungs, by connecting the Superior vena cava to the right pulmonary artery, as a prelude to connecting the inferior vena cava to the main pulmonary / left pulmonary artery.
8. Modified BT Shunt: Modified Blalock Taussig Shunt – A palliative procedure for many cyanotics with decreased pulmonary blood flow, Tetralogy of Fallot being the most common, where the subclavian artery is connected to the corresponding pulmonary artery using an an appropriate sized artificial tube graft.
9. CABG: Coronary Artery Bypass Graft: This is a procedure whereby blocked coronary arteries are bypassed using conduits from another part of the body (Left/Right Internal Mammary Artery from the chest wall, radial artery from the forearm and / or veins from the legs). The surgery is usually done with out the help of a Heart lung machine using myocardial tissue stabilizers, called as OPCAB and in selective case using cardio pulmonary bypass.
10. CoA Repair:This is a condition where there is a narrowing (Coarctation) of the aorta usually occurring in the proximal thoracic aorta section. The surgery involves removing the narrowed segment and connecting the two ends of the aorta directly whenever possible, or by placing a prosthetic graft between the two aortic segments.
11. Cor Triatriatum repair: An abnormal membrane in the Left Atrium that divides the LA into two chambers. The membrane is surgically removed during this procedure.
12. DCRV repair: Double Chambered right ventricle – abnormal obstructing muscle bundles inside the Right ventricle that are surgically removed.
13. DORV repair: Double Outlet Right ventricle generally occurs with both the great arteries arising from the right ventricle. The repair consists of closing the ventricular septal defect such that the left ventricle pumps blood into the aorta and the right ventricle into the main pulmonary artery.
14. Fontan: A procedure for congenital heart diseases with a functionally single ventricle where the systemic venous return is directly sent to the pulmonary circulation by detaching the SVC and the IVC and connecting them to the Pulmonary arteries. It is most often done without the use of heart lung machine, by using SVC-RA and IVC- RA shunts.
15. Lung resection: A procedure for removal of tumors and cysts in the lungs.
16. MV Repair: Mitral Valve Repair, where the mitral valve is surgically repaired.
17. MVR: Mitral Valve Replacement, where the Mitral valve is surgically replaced with a prosthetic (artificial) / bio-prosthetic (tissue) valve. This is done only when the valve is beyond salvage and cannot be repaired.
18. Myxoma excision: a surgical procedure where a myxoma – a connective tissue tumor usually found in the heart chambers, is excised (cut and removed). Commonly occurs in atria.
19. PAPVC repair: Partial Anomalous Pulmonary Venous Connection repair. One are more of pulmonary veins drain into RA. Surgical correction involves closure of the associated ASD, routing the pulmonary vein/s to LA.
20. PDA Ligation / Division: Patent Ductus Arteriosus Ligation /Division, a procedure in which the Patent Ductus Arteriosus, a connection between the pulmonary artery and the aorta is ligated (tied) or divided (cut).
21. Pericardiectomy: A surgical procedure for the condition of Pericarditis (infection of the pericardium) involves removal of the adhered pericardium.
22. RSOV repair: Ruptured Sinus Of Valsalva repair – a condition where one of the cusps of aorta in the sinus of Valsalva ruptures (tears / opens up) into one of the right sided chambers of the heart. Repair involves closure of the rupture.
23. SAM Excision: Sub Aortic Membrane excision, a surgical procedure on the aorta where a membrane below the aortic valve is obstructing the outflow of blood into the aorta.
24. Supra Valvular Aortic Stenosis: Surgical repair of severe narrowing supra valvular portion of the ascending aorta.
25. TAPVC repair: Total Anomalous Pulmonary Venous Connection repair – condition in which all the pulmonary veins drain into RA instead of LA. Surgical correction involves routing them to LA.
26. TGA: Transposition of great arteries is a serious congenital condition where the aorta arises from the right ventricle and the pulmonary artery from the left ventricle leading to parallel systemic and pulmonary circulation. Senning’s, Mustard are procedures at the atrial level, while Jatene’s is an arterial switch operation with coronary transfer. These procedures are named after their founders.
27. Thymectomy: A surgical treatment for the condition of Myasthenia Gravis which involves excision of the thymus gland. This is also done for tumors of the Thymus.
28. T.O.F Repair: A surgical procedure performed for the Tetralogy of Fallot (TOF) condition (Ventricular Septal Defect, Pulmonary Stenosis, Right Ventricular Hypertrophy, Overriding Aorta,), the VSD is closed and the Right Ventricular Outflow Tract (RVOT) is reconstructed / augmented.
29. VSD closure: Ventricular Septal Defect – Surgical closure of an abnormal opening in the septum/partition between the left and right ventricles. There are various types of VSD depending upon the position of the opening in the septum.

Neurological conditions evaluated and treated routinely at SSSIHMS include the following:
1. Face head and neck pain
2. Epilepsy and related conditions
3. Cerebrovascular diseases
4. Infections of the CNS
5. Multiple Sclerosis (MS) and other demyelinating disorders
6. Dementia
7. Parkinson’s Disease and movement and ataxic disorders
8. ALS and Other Motor Neuron Diseases
9. Trigeminal Neuralgia, Bell’s Palsy, and Other Cranial Nerve Disorders
10. Spinal Cord Diseases
11. Peripheral Neuropathies including Guillain-Barre´ Syndrome
12. Neuromuscular diseases
13. Tumors of the Nervous System
14. Psychiatric disorders and Mental health problems
Face, Head and Neck pain: These patients are generally managed on OPD basis.
1. Atypical Facial Pain
2. Cervical Spondylosis
3. Migraine, other headaches and variants
4. Muscle Contraction Tension Headache
5. Chronic Back Pain
6. Post-herpetic Neuralgia
7. Trigeminal Neuralgia
Epilepsy and related conditions: These patients are investigated as required and treatment instituted. Some patients depending upon their condition are admitted as part of their management.
1. 1. Fits, black outs, jerks and faints
2. 2. non – epileptic attacks
3. 3. Sleep disorders
Cerebrovascular diseases : Acute cases are admitted and managed with anti-coagulants and physiotherapy. Chronic cases are evaluated as required.
1. Acute Stroke Management
2. Cerebral Venous Thrombosis
3. TIA Transient Ischemic Attack
Infections of the CNS.: These patients are managed following diagnosis of the infections based on Lumbar puncture and other investigations with admission and institution of appropriate anti-microbial therapy.
1. Meningitis-acute and chronic-bacterial/viral/protozoal/fungal
2. Encephalitis
3. Brain abscess
Multiple Sclerosis (MS) and other demyelinating disorders:
1. Optic Neuritis
2. Transverse Myelitis
3. Other demyelinating disorders
Dementia: These patients are investigated.
1. Alzheimer’s disease
2. Vascular dementia / Multi-infarct dementia
3. Reversible dementias
4. Prion (Creutzfeldt-Jakoband Gerstmann-Straussler-Scheinker disease)
Parkinson’s Disease and movement and ataxic disorders : These patients are seen on an OPD basis and treatment is instituted and optimized as required.
1. Dystonia
2. Tremors
3. Parkinson Disease and related disorders
4. Spinocerebellar ataxias
ALS and Other Motor Neuron Diseases : ENMG and conduction studies are used to reach a definitive diagnosis in these patients.
1. Amyotropic lateral sclerosis / MND
2. Spinal muscular atrophy
Trigeminal Neuralgia, Bell’s Palsy, and Other Cranial Nerve Disorders: Are investigated and treated appropriately.
Spinal Cord Diseases: When surgical intervention is required then the patients are reffered to the sister dept of neurosurgery.
1. Myelopathy
2. Spinal cord tumors
3. Cervical spondylosis
4. Prolapsed disc
5. Transverse myelitis
Peripheral Neuropathies including Guillain-Barre´ Syndrome: ENMG, NCV and Nerve biopsies are conducted for diagnosis.
1. Polyneuropathies eg.diasetic
2. Acuteneuropathies eg GB Syndrome
Neuromuscular diseases: These are investigated by ENMG and Muscle biopsy.
1. Dermatomyositis/Polymyositis
2. Inclusion Body Myositis
3. Limb-Girdle Muscular Dystrophy
4. Metabolic Myopathies
5. Periodic Paralyses
Tumors of the Nervous System: These once diagnosed are dealt by the Neurosurgery department. Psychiatric disorders and Mental health problems: Psychiatric problems when secondary to neurological disorders if diagnosed are treated in-house by a Consultant Psychiatrist.

Cranial Surgery Procedures

Excision of Cranial and Spinal Arterio-Venous Malformation (AVMs)
These are complex surgeries aimed at removing malformed conglomeration of blood vessels that parasitize the brain’s blood supply. The operation involves meticulous dissection around the tumour like growth of abnormal blood vessels and removal in toto. Similar AVMs in the spinal cord require greater expertise. However the procedure involved in similar to the one described above.

Clipping of aneurysms
Intracranial aneurysms are out -pouchings of blood vessels, similar to a balloon. These may burst causing life threatening sub-arachnoid haemmorage. We are equipped with the facilities to perform ‘clipping’ of these aneurysms in any location in the brain after performing a digital subtraction angiogram (DSA). Clipping means, that the aneurysm is removed from the circulation by application of a clip at its base.

Surgery for giant aneurysms under CPB
For certain aneurysms which are located in exquisite areas or are giant in size, clipping as described above may not be feasible. In such cases, the help of the Cardiac surgery team is sought to perform a Cardio Pulmonary Bypass and temporarily block the blood flow to the site of the aneurysm. This is done by cooling the patient to profound hypothermia conditions and initiating Total Circulatory Arrest. The window of opportunity is around 30 minutes within which the clipping has to be accomplished. This expertise is available in a only a handful of centers around the world.

Dural AV fistula (DAVF)
DAVFs are rare anomalies which may be managed with either open surgery or interventional procedures. At SSSIHMS a variety of operative strategies are employed in an attempt to disconnect the abnormal communication between an artery and a vein.

Excision of Cavernomas
Carvernomas are mulberry shaped overgrowth of intracranial small blood vessels, which may bleed. They may be located in almost any part of the brain or spinal cord. Great care has to be exercised in removal of these lesions which may be small and may be located in eloquent regions of the brain or at great depth. Sophisticated surgical aids like a neuro-navigation system are often employed to reach the lesion and remove it without damaging the surrounding brain tissue.

Trigeminal Neuralgia
This is a painful condition involving the face where the patient presents with unbearable, episodic, shooting pain in a particular portion of his/her face. The offending structure is usually a loop of an intracranial blood vessel which irritates the nerve conducting sensation from that portion of the face. Surgery is very gratifying and involves separating these two structures under the operating microscope.

Intracranial gliomas
These are brain tumours which may range from benign to malignant high grade tumors(Grade I to grade IV). Depending on its location, size and patient condition, the surgical strategy is planned for tackling each tumor.

Acoustic tumors( Vestibular schwannoma)
These are common tumors arising from the nerve responsible for conducting the sound from the ear. Unfortunately even in this day and age, the patients seen at SSSIHMS present at a late stage with some even losing vision and almost all tumors being extremely large in size.

Meningiomas
Meningiomas are benign tumors arising from the covering of the brain and spinal cord. Depending on its location, the surgical approach is planned.

Complex cranial base tumors
Cranial base surgery is a sub specialty in neurosurgery which is oriented towards the approach of lesions located at areas in the brain where routine surgical approach may not be successful.

Pituitary tumors
The pituitary gland which has been described as the master gland in the human body may be home to a variety of tumors some of which may present with mass effect (visual deterioration, neurological symptoms) and others with endocrinological symptoms. Trans-nasal, trans-sphenoidal approach is used commonly to operate these tumors. i.e the surgeon operates on the pituitary gland through the nose. Other larger tumors may require an intracranial approach.

Skull tumors
A variety of primary and secondary skull tumors are seen. Surgery involves removal of the tumor and reconstructing the bone defect.

Intracranial metastasis
The brain is a common site for the lodging of cancer deposits from primary malignancies elsewhere in the body. Sometimes the location of the primary may elude detection.

Intraventricular tumors
The ventricles of the brain are cavities filled with the cerebrospinal fluid. A whole range of tumors from, the most innocuous to the most malignant may be harbored within the ventricles. By virtue of its location, the approach has to be planned in great detail before embarking on surgery.

 Pediatric Neurosurgery:

  1. Pediatric Tumors
  • Posterior Fossa tumors:
    These are the commonest location for tumors in children. Medulloblastomas and ependymomas are the commonest pathologies noted.
  • Optochiasmatic / hypothalamic tumors:
    These tumors arise from the optic pathway and hypothalamus. Therefore apart from vision, they may present with hypothalamic disturbance.
  • Craniopharyngiomas:
    They are common childhood tumors located in the portion of the brain above the pituitary gland. Of uncertain etiology, they may prove to be a surgical challenge to remove in toto.
  • Pineal tumors:
    The pineal gland is located in the geometrical centre of the cranial cavity. This innocuous structure has unknown and mysterious functions.

2.Neuro – Developmental disorders:

  • Chiari malformation:
    The hind brain may protrude downwards causing symptoms. Treatment involves removing a portion of the skull, creating greater space and shrinking the cerebellar tonsils in an effort to alleviate symptoms.
  • Encephalocoele:
    These are out-pouchings of portions of the covering of the brain in areas deficient of bone. Some may have significant amount of brain tissue contained within them.
  • Hydrocephalus:
    This refers to a collection of excess fluid within the ventricular system. Treatment involves placing an alternative conduit for draining this fluid. This is achieved by inserting a shunt one end of which is within the ventricular cavity, and the other end is in the abdominal cavity. An alternative procedure is to endoscopically open the floor of the third ventricle to internally drain the fluid.
  • Spinal Dysraphism repair:
    These are abnormalities in the development of the spine and spinal cord. Surgery involves appropriate planning to achieve the most optimal results.
  • CVJ (Craniovertebral junction) anomalies:
    These are complex clinical conditions involving the transitional region between the brain and spinal cord. Surgery may involve, two procedures one, performed through the mouth and another in the back to place an implant.

 Spinal surgery procedures:

Degenerative Spinal Conditions

  1. Lumbar Spondylosis
  • Micro lumbar discectomy
  • laminectomy

Lumbar disc disease is one of the most common conditions encountered in the clinic. If non operative measures fail, surgery is offered. Surgery is done with the help of an operating microscope or with the endoscope. The surgery involves removal of the disc material and decompressing the compressed nerve roots.

  1. Lumbar Spondylolisthesis
  • Pedicle screw fixation
  • PLIF Posterior lumbar instrumentation and fusion
  • ALIF Anterior lumbar instrumentation and fusion

Lumbar spondylolisthesis means, a slip of one vertebra over another. Correction involves, realignment with the help of titanium alloy screws and rods and bony fusion.

  1. Cervical Spondylosis
  • Anterior cervical discectomy
  • Laminectomy
  • Laminoplasty
  • Corpectomy and instrumentation
  • Lateral mass plate or screw fixation
  1. Cervical Spondylolisthesis
  • Anterior and posterior fusion

Similar to the lumbar disc disease the cervical or uppermost portion of the vertebral column may also degenerate. One or two levels of disc protrusion and cord compression are treated by removing the offending disc and fusing that level by interposing a bone chip in the space. For two or more level involvement, the disc spaces concerned and the intervening vertebral body is removed and a large bone graft placed and this is reinforced by placing a plate and screws (Corpectomy). A larger level of involvement requires either removal of the back portion of the vertebrae (laminectomy) which may be aided by placing screws through the lateral masses. Sometimes laminectomy may be inappropriate and here the back portion of the vertebrae may be opened out (laminoplasty)

  1. Thoracic Disc Disease
  • Laminectomy
  • Discectomy

Similar to cervical and lumbar degenerative disc disease, the thoracic vertebrae may also degenerate though less frequently. However, the approach for these locations is more complex because of the lungs and heart located in front of them.

  1. Spinal Tumors
  • Intramedullary – (Glioma, Ependyomoma)
  • IDEM (Intra-dural extramedullary Tumour)

Spinal tumors require gentler handling and precision. They may range from benign IDEM which originate from either the nerve roots or from the coverings to tumors arising from the neural tissue itself.

  • Vertebral Bony Lesions
  1. Spinal Infection
  • Tuberculosis

Tuberculosis infection of the spine may require surgery because of the compression of the neural structures by the pus or destroyed bony elements. Surgery is followed by antituberculosis chaemotherapy for a course of one and a half years.

  • Pyogenic spinal infections

Other procedures:

Stereotactic procedures:

  • Biopsy
  • Drainage of abscess / cyst
  • Placement of reservoirs

Stereotaxy is a technique which uses the Cartesian coordinates to precisely localize any portion within the cranial cavity. This is helpful in performing surgeries for conditions located deep within the brain.

Intracranial Infections:

  • Cardiogenic Intracranial Abscesses
  • Otogenic Abscesses

Intracranial abscesses are decreasing in occurrence because of better medical facilities. However at SSSIHMS because of a large cardiac department, brain abscesses secondary to congenital heart disease is seen very often. Emergency surgery is done to remove the pus. Apart from heart conditions, infections anywhere in the body like ear, tooth etc, may spread to the brain.

Peripheral nerve surgery:

  • Carpal Tunnel Syndrome
  • Ulnar nerve release

Peripheral nerve surgery involves operating on the nerves which come out of the spinal cord. One of the commonest procedures it involves, decompressing the median nerve at the wrist by opening out, the carpal tunnel through which it passes.

 

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Sri Sathya Sai Institute of Higher Medical Sciences
EPIP Area, Whitefield,
Bangalore 560 066,
Karnataka, INDIA.

Telephone: +91-80-28004600/28411500
Fax: +91-80-28411503

For Patient Queries: adminblr@sssihms.org.in

Hospital

Sri Sathya Sai Institute of Higher Medical Sciences

EPIP Area, Whitefield,

Bangalore 560066

Phone: +91-80-28004600

Patient Enquiry : adminblr@ssihms.org.in

 

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