What Everyone Is Saying About Moyamoya Disease

Moyamoya Disease

It is caused by blocked arteries at base of brain. The word "moyamoya"  implies "smoke puff". It describes appearance of tiny vessels narrow and become blocked, which can result in stroke.

Blood supply of brain

The cartiod artery is large whose pulse can be felt on both sides of neck. It starts at aorta and divides near larynx into external and internal carotid arteries. The external artery supply blood to face and scalp. Internal arteries supplies blood to front and side of brain.

What is moyamoya disease?

It is a chronic and progressive narrowing of internal carotid arteries at base of brain which divides in middle and anterior cerebral arteries. The walls of arteries become thick, which narrows the inside diameter of vessel. The narrowing result in complete block and stroke.

To reduce the narrow arteries, the brain create a collateral blood vessels in attempt to deliver rich-oxygen blood to the deprived areas of brain. These small vessels, when seen in angiogram looks hazy. In this condition,  the blood vessels are more weaker than normal blood vessels. The small collaterals can break and bleed, which can cause brain hemorrhage. The disease can affect front and side areas of brain.

The progression of the disease follow typical course and are as follows:

·       Stage 1- Internal carotid arteries get narrowed.

·       Stage 2- Development of any moyamoya vessels at the base of brain.

·       Stage 3-Internal cartoid artery narrowing and moyamoya vessels gets intensified.

·       Stage 4- Increased collateral vessels from scalp and minimizing moyamoya vessels.

·       Stage 5- Narrowing of internal carotid artery and reductionof moyamoya vessels.

·       Stage 6- The disappearance of moyamoya vessels, internal carotid artery is completely blocked.

Once the process of blockage begins, it continues. There is no medicine to reverse the effect. If had a major stoke or bleeding occurred, the patient will have permanent loss of function.

Symptoms

The symptoms include:

·       Mini stroke.

·       Ischemic stroke.

Causes

The real cause of moyamoya disease is not known. The inheritance can be a cause of the disease.

Diagnosis

If you are having symptoms like stroke, then you will be referred to neurosurgeon. The surgeon will check about the possibility of some symptoms, any medical problems, current medications ,family history. Physical exam, diagnostic tests like mri, ct scan, angiogram, etc. will also be performed. To confirm the diagnosis of moyamoya disease, an angiogram is required.

Surgery

The surgery is recommended for moyamoya patient with progressive TIAS or stroke. There are various kinds of surgeries available.

Cerebral bypass procedure: It is a method of revascularization. It involves connecting a blood vessel from the outside of brain to  inside vessel of brain, so that the reroute of blood flow around an artery which is blocked, damaged or narrowed. Most common bypass procedure is STA-

MCA(Superficial Temporal Artery to Middle Cerebral Artery),this may help in instant improvement in the blood flow. If suppose, the superficial temporal artery is not available then another artery can be used. 

EDAS(Encephalo Duro Arterio Synangiosis) procedure: It is a process of revascularization in which the superficial temporal artery is kept in contact with the surface of brain. A hole is made in skulljust below the artery. The artery is then stitched to the surface of brain and the bone replaced. After sometime, small arterial vessels form to the brain.

EMS(Encephalo Myo Synangiosis) procedure: It is a process in which the temporal muscle which is on side of the head is dissected, through an opening of skull and is placed onto the surface of brain. Then new vessels form between blood muscles and brain.

EDAMS (Encephalo Duro Arterio Myo Synangiosis) procedure: It is a combination of the technique of EDAS and EMS.

A Guide To rotator cuff repair At Any Age

Rotator Cuff Repair

The rotator cuff is a combination of muscles and tendon which link upper arm bone, humerus to your shoulder blades. The rotator cuff holds the upper arm bone in right place in shoulder socket. There are four muscles in rotator cuff which are supraspinatus, infraspinatus, teres minor and subscapularis. Each muscle is connected to the arm bone by tendons. The rotator cuff surgery is used to repair any tear in any of these tendons.

Symptoms

The rotator cuff injury can happen to anyone. You can hurt your rotator cuff through wear and tear or poor movement over time. As you get aged, the rotator cuff gets irritated by calcium deposits in shoulder area or bone spurs due to arthritis. The symptoms of rotator cuff include:

·       Shoulder Weakness.

·       Pain in shoulder when you lift or pull.

·       Decrease in range of motion in shoulder joint.

Diagnosis Of Rotator Cuff Injury

A physical exam and medical history is very important for the proper diagnosis of the injury. A complete medical history is needed. Doctor will perform physical exam. The doctor will give some tests to be performed to confirm the diagnosis.

After getting the results, doctor will decide whether the surgery is required or not. If the surgery is required, the surgeon will examine the shoulder using an arthroscope. It is not always required. During an arthroscopy, a small camera is inserted to check the shoulder. During the procedure, anesthesia is given at first. The doctor will make a cut and insert camera linked to video monitor. The doctor will use the camera to take a look on tendons, ligaments, and cartilage to check whether the surgery will solve the problem or not.

Deciding On Rotator Cuff Repair Surgery

Surgery is not the first recommended treatment for shoulder injuries. Doctors recommend rest, ice packs, and some exercise. If the injury is not so severe, these treatment approach will be enough. If the tendon is torn, then surgery is required.

          You can go for the shoulder surgery if:

·       You have shoulder pain for more than 6 months.

·       You have shoulder weakness.

The rotator cuff surgery will work best on any recent injury rather than any chronic condition.

Preparing For Rotator Cuff Surgery Repair

Rest and cold packs are best to ease the shoulder pain while waiting for surgery. The doctor will recommend some exercise to help with pain. Some over-the-counter drugs such as aspirin, ibuprofen and naproxen are given. Some pain killers are also given.

Rotator cuff Repair Procedure

First you will receive a general anesthesia. After that it is done with either an arthroscope, open or small incision. If the doctor want to do the surgery with arthroscope, they will put a small camera in one hole and will make one to three small cuts for instruments. The surgeon will use these instruments to reattach tendon to bone. Once the tendon is at the right place, surgeon will attach it with sutures. Surgeon will often use small rivets called as suture anchors. These rivets can be metal or material which will dissolve eventually. The sutures attach to the rivet, reattaches the tendon from where it was torn.

If the rotator cuff tear is large, then you will need a open incision instead of arthroscopic approach. The cut can be 2.5 to 4 inches long for regular open repair or 1.25 to 2 inches for mini-open repair.

Mini-open surgery is required if the doctor wants to remove calcium deposits or bone spur. Bone spur can also develop as people grow old. When the cuts are stitched, then a clean dressing is applied.

Risks

Every surgery carries some risk which include nerve damage, infection, and excessive bleeding. In some cases, the patient may be allergic to anesthesia or suffer from breathing problems during procedure.

Recovery

After surgery, doctor can instruct you to keep arm in sling for 4-6 weeks. You may need to wear shoulder immobilizer. This will help shoulder to hold at 1 place. Some pain medications and exercises are also recommended. Recovery may take 3-6 months depending on nature of shoulder injury.

Craniotomy: Do You Really Need It?

Craniotomy is the surgical process to remove a part of bone from skull to expose to brain. Special tools are used to remove the section of bone called as bone flap. The bone flap is removed temporarily, and then replaced after the surgery is performed.

For some procedures, computer and imaging are used to reach the exact location in brain which is to be treated. The technique require the use of frame placed onto skull using superficially placed markers on scalp. When any of the imaging process is used with craniotomy procedure, called as stereotactic craniotomy.

Endoscopic craniotomy is another type of craniotomy which involve the insertion of lighted scope with camera in brain through a small cut in skull.

Aneurysm clipping is a surgical process which may require craniotomy. The cerebral aneurysm is bulging weakened area in wall of artery in brain, which results in abnormal widening. Due to the weakened area in wall, there is a risk of rupture of aneurysm. A metal clip is placed across the neck of aneurysm, which isolates it from rest of circulatory system by blocking blood flow, and preventing the rupture.

Craniectomy is similar process in which a part of skull which is permanently removed or replaced later during second surgery after the swelling goes down.

Types of Craniotomy

Extended Bifrontal Craniotomy

          It is a traditional skull base approach used to target difficult tumors toward front of brain. It involve making a cut in scalp behind hairline and removing the bone which form the contour of orbits and forehead. The bone is replaced at the end of surgery.

Minimally Invasive Supra-Orbital "Eyebrow" Craniotomy

          It is sometimes called as eyebrow craniotomy. It is a procedure which is used to remove brain tumors. In this procedure, neurosurgeon will make a small cut within eyebrow to access pituitary tumor. Since it is minimally invasive procedure, the eyebrow craniotomy can offer:

          1. Minimum scar.

          2. Less pain.

          3. Faster recovery.

Retro-Sigmoid "Keyhole" Craniotomy

          It is sometimes called as keyhole craniotomy. It is a minimally-invasive surgical procedure done to remove the brain tumors. The process allow the removal of skull base tumors by a small cut behind ear, which provides the access to cerebellum and brainstem.

          This can be performed on following types of brain tumors-

          1. Meningiomas.

          2. Spine tumors.

          3. Acoustic neuromas.

          4. Skull base tumors.

Orbitozygomatic Craniotomy

          It is a traditional skull base approach which is used for difficult tumors and aneurysms. It is used for those lesions which are too complex to remove by minimally invasive approach. It involves making a cut in scalp behind hairline and removing the bone which forms the contour of orbit and cheek. The bone is replaced at end of surgery. The temporary removal of bone helps surgeon to reach the difficult areas of brain and minimizing the damage to brain.

Translabyrinthine Craniotomy

          It is a procedure which involve making a cut in scalp behind ear, and then remove the mastoid bone and some inner ear bone. The surgeon will find and remove tumor.

Reason for surgery

A craniotomy may be done for various reasons, including

·        Removing blood or blood clots from leaking blood vessels.

·        Repairing skull fracture.

·        Repairing or clipping of an aneurysm.

·        Relieving pressure within brain by removing swollen areas of brain which is caused by stroke.

·        Draining brain abscess.

Risks

Risks include:

·        Infection.

·        Blood clots.

·        Bleeding.

·        Blood pressure.

·        Swelling in brain.

·        Seizures.

·        Coma.

·        Paralysis.

·        Memory problem.

Surgery

          A craniotomy require three to seven days stay in hospital. The procedure vary depending on the patient's condition. An intravenous line will be inserted in arm or hand..To drain urine, a urinary catheter will be inserted. Head will be shaved and skin over surgical site will be cleaned with antiseptic solution. Cut will be made according to the affected area of brain. If the cut is small, then an endoscope is used. The scalp will be clipped and pulled up to control bleeding while accessing the brain. A medical drill can be used to make burr hole in skull. Bone flap will be removed and saved. The excess fluid will be flown out of brain, if needed. Microsurgical instruments helps surgeon to see better view of brain structure and differentiate between healthy and unhealthy tissues. A special type of monitor is placed to check the pressure inside skull. After the surgery is complete, surgeon will sew the tissues layers together. Bone flap will be reattached using plates or wires. If tumor is found in bone, flap will not be replaced. The scalp will be closed with sutures. A sterile bandage will be applied over the cut. The patient will be under observation for some time, and  then discharged.     

-SurgeryXchange is an online platform for medical second opinions and advisory services for hospital admission.

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A Guide To Mastectomy Surgery At Any Age

MASTECTOMY

Mastectomy is a surgery to remove all breast tissue from breast, a way to treat/prevent breast cancer. In early stage of breast cancer, lumpectomy is used to remove the tumor from breast. Mastectomy can be a secondary option.  

Mastectomy and lumpectomy are difficult. Both procedures are effective to prevent the recurrence of breast cancer. Lumpectomy is not for everyone with breast cancer, others prefer to go mastectomy. The breast reconstruction is done to restore the shape of breast. It can be done at same time during mastectomy or in second operation.

Why its required?

A mastectomy is performed to remove the breast tissues, if breast cancer is in developing stage.

Mastectomy may be the treatment option for many types breast cancer-

·        Early stage of breast cancer.

·        Stage 3 breast cancer.

·        Recurrent breast cancer.

Surgery

Mastectomy is the removal of breast completely. There are different types of mastectomy. They are listed below-

·        Total Mastectomy-

          The surgeon will completely remove the breast. Surgeon will not perform lymph node dissection. Sometimes lymph nodes are removed, since they are located within the breast tissue take during surgery. Muscles are not removed from beneath the breast. It is for women who are having multiple or large area of ductal carcinoma in situ(DCIS).

·        Modified Radical Mastectomy-

          It involves removal of breast tissue and lymp nodes. Surgeon removes the complete breast. Auxillary lymp node dissection is done during which level 1 and 2 of underarm lymph nodes are removed. Beneath the breast no muscles are removed. People with invasive breast cancer who wants to go for mastectomy will get modified radical mastectomy, so that  lymph node can be examined.

·        Radical Mastectomy-   

          The surgeon will remove the complete breast . Level 1,2 and 3 of underarm lymph nodes will also be removed. The chest wall muscles will be also removed. It is recommended when cancer spread to chest muscles under breast.

During the procedure:

The procedure is performed under general anesthesia. The surgeon will make an elliptical cut around breast. The breast tissue is removed and depending on procedure, other part of breast can also be removed.

The breast tissue and lymph node are removed and sent to lab for analysis.

If breast reconstruction is to be performed during mastectomy, a plastic surgeon will accompany the breast surgeon.

People who will go for radiation therapy after surgery, a temporary tissue expander is placed in chest to hold breast skin in place.

After the surgery is completed, the cut is closed with stitches which will dissolve after sometime. You may also have one or two plastic tube placed where breast was removed. The tubes will help in draining any fluids that comes out after surgery. Tubes are sewed in place and ends are attached to small drainage bag.

Risks

·        Infection.

·        Bleeding.

·        Pain.

·        Swelling in arm.

·        Shoulder pain.

-SurgeryXchange is an online platform for medical second opinions and advisory services for hospital admission.

  To know more click here. 

What Everyone Must Know About Club Foot

Clubfoot

The Clubfoot occurs when the foot and ankle are twisted permanently. In clubfoot, the ligament and tendons which holds the muscles to bones very tight. It is a congenital deformity.

Clubfoot is classified in two groups:

·        Isolated clubfoot: It is very common form of deformity and occur to children who have no medical issues.

·        Non-isolated clubfoot: It occurs in combination with various health condition.

The cause of clubfoot is not clear, it may be the combination of genes and environment.

Symptoms

·        Affected leg may be shorter.

·        Calf muscles in affected leg is under developed.

·        Top of foot is twisted downward and inward.

Treatment

          An orthopedic surgeon is recommended for the surgical treatment to correct bone structure of foot. There are non-surgical and surgical treatment for clubfoot.

Non-surgical Treatment-

Ponseti Method:  It is a widely used technique throughout the world. In this method a gentle stretching and casting is done to correct the deformity.

The elements of ponseti method includes:

1. Manipulation and casting- The baby's foot is stretched and manipulated to correct position and held in place with long legged cast. Every week the process of stretching, re-position, and casting is repeated till the foot is improved. The improvement takes about 6 to 8 weeks.  

2. Achilles tenotomy-  After going through manipulation and casting, 90 percent of babies need minor procedure to release tightness. For this a quick procedure is performed, doctor will take a thin instrument to cut tendon. The cut is very small and will not require stitches. New cast will be applied to protect the tendon during healing process. It takes about 3 weeks to heal. By the time cast is removed, the achilles tendon regrow to proper length and clubfoot is cured.

3. Bracing- After successful correction, the clubfoot can recur. To ensure, foot is completely corrected, baby will have to wear braces for few years. The brace will keep the foot at correct angle to maintain correction.

4. Considering Ponseti Method- The ponseti method is extremely effective for most of the children . It require high commitment from family to apply the braces properly every day.

Surgical Treatment

          The child's foot is partially corrected with stretching and casting, then to fully correct the clubfoot, following kind of surgery-

          1. Less extensive surgery- It will target those tendon and joints which are helping in deformity. This include releasing of tendon at back to inside of mid foot.

          2. Major reconstructive surgery- It involve extensive release of multiple soft tissue structure of foot. Once the correction is made, joints of foot are stabilized with pins and long-leg cast while the soft tissue heals. After 4-6 weeks doctor will remove pins and cast. A short leg cast is applied, which has to be worn by the child for 4 weeks. When the cast is removed, there is still chance of club foot to return, s special shoes are used for a year after surgery.    

 

Risks

·        Genes.

·        If mother smokes during pregnancy.

·        If you have spina bifida or other spinal injuries.

-SurgeryXchange is an online platform for medical second opinions and advisory services for hospital admission.

  To know more click here.

Breast Cancer

Cancer happens once changes referred to as mutations ensue in genes that regulate cell growth. The mutations let the cells divide and multiply in an uncontrolled approach.

Breastcancer is cancer that develops in breast cells. Typically, the cancer forms in either the lobules or the ducts of the breast. Lobules area unit the glands that turn out milk, and ducts area unit the pathways that bring the milk from the glands to the pap. Cancer may occur within the adipose tissue or the fibrous animal tissue among your breast.

The uncontrolled cancer cells usually invade alternative healthy breast tissue and might travel the humour nodes beneath the arms. The humour nodes area unit a primary pathway that facilitate the cancer cells move to alternative components of the body.

For more details, click here.

Knee Surgery

Knee Surgery

Knee replacement is also called as knee arthroplasty. It is a surgical process to resurface a damaged knee by arthritis. Plastic or metal parts are used to cap end of bones which forms the knee joint. This surgery is for those who have serious injury in knee.

There are various types of arthritis which affect the knee joint.

·       Osteoarthritis- It is a degenerative joint disease, which affect the middle aged  and older adults. It causes the breakdown of joint cartilage and adjacent bone in knee.

·       Rheumatoid- It causes which causes inflammation of the synovial membrane and results in excessive synovial fluid, can lead to pain and stiffness.

·       Traumatic- It is due to injury in knee.

Risks

·       Infection.

·       Blood clot in legs.

·       Pain.

·       Bleeding.

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Varicose Veins

VARICOSE VEINS

Varicose veins are swollen and twisted veins which appears blue or dark purple. It happens when the blood flow in veins do not flow properly. The treatment is needed when there is pain in leg.

Treatment

Surgery

The surgery is only needed when the veins are large. It is performed under general anesthesia and patients can go home on the same day.

Laser Treatment

Catheter is inserted in patient's veins. Laser is threaded through catheter and positioned at top of targeted vein, a short energy bursts which heat up the veins, sealing in shut.

To know more about the surgery and its cost, click here.  

Thyroid

Thyroidectomy is the process to remove thyroid gland. Thyroid gland is butterfly shaped gland which is at the base of neck. Thyroidectomy is used to treat thyroid disorders such as cancer, goiter, etc.

Why it is required?

The thyroidectomy is required for following conditions:

·        Thyroid cancer.

·        Goiter.

·        Hyperthyroidism.

Risks

It include:

·        Infection.

·        Bleeding.

To know more about the surgery and cost, click here.

CABG

Coronary Artery Bypass Grafting

Coronary Artery Bypass Grafting(CABG)  is a process to improve poor  blood flow to heart. It is needed when the artery supply of blood to heart tissue are blocked. It is used in an emergency, like in heart attack.

CABG is recommended-

·        If you need an open-heart surgery for any other reason.

·        If you have diabetes.

To know more about the CABG surgery and its cost, click here