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Neurosurgery - About the Department

The Department of Neurosurgery at Jaslok Hospital is one of the oldest Department of Neurosurgery in Mumbai, in the private sector; but has ensured that it keeps pace with the latest developments in the neurosciences. Neurosurgery is a highly specialised area of medicine and requires intense training as it deals primarily with brain and nervous system. These are the only areas of the body which are unforgiving, i.e. if you make a mistake you cause permanent damage and there is no way to correct any error.

The Neurosurgical Department offers treatment for brain tumours, vascular pathology, spinal cord dysfunction, Paediatric Neurosurgical Disorders, endoscopic surgery. The only department in our city with capabilities to offer all the above with a high level of expertise under one roof. Add to this, the Best Deep Brain Stimulation program for Parkinson’s in India, plus a functional Neurosurgery Department dedicated entirely to Functional Neurosurgical domain involving movement disorder surgeries, epilepsy surgeries, surgery for chronic pain and spasticity.

The Neurosurgery Department is supported by high end technology and equipment like navigation system, microscope, micro electrode recording machine, radiofrequency lesion generator etc. which are mostly not available in any other institutes across the city. The aim and mission of the Neurosurgical Department is to offer highest level of patient care with safety and compassion.

Neurovascular surgery encompasses both microsurgical excision/obliteration of a vascular lesion or percutaneous endovascular approach to coil or stent without surgery by an advanced DSA machine along with embolization of a vascular lesion.

Minimally invasive techniques like use of endoscopes for excision of tumors through nose or small incisions in brain bring minimum or scarless surgery.

Minimally invasive techniques for spine, disc herniation, trauma, excision of tumor or instrumental fixation of spinal instability under neuromonitoring provides added safety.

A dedicated team of neuro-anesthetist and intensivists provide round the clock perioperative care yielding optimum benefit to our patients.

o Brain Tumour Surgery: Adult and Paediatric Brain Tumours

o Vascular Neurosurgery: Aneurysms, Arteriovenous Malformations, Carotid Endarterectomy, Skull Base Tumour Surgery

o Functional Neurosurgery: Stereotactic Biopsy of Intracranial Lesions, Surgery for Movement Disorders, Epilepsy, Pain, Spasticity and Psychiatric Disorders

o Spinal Surgery: Instrumentation for Degenerative Spine Diseases, Surgery for Spinal Tumours

Centre for Brain Tumour Surgery

Incidence of brain tumours in India is 4 per 100,000 population. Brain tumours can be primary or secondary. Gliomas form the most common type of primary brain tumours (50.4%), followed by meningioma (20.8%) and other types. The secondary brain tumours are metastatic from other cancerous sites, such as lungs, breast etc. We provide a comprehensive treatment of brain tumours which include a combination of surgery, radiotherapy and chemotherapy under one single roof. The usual stay is for 7 days. The latest 3-tesla (3T) MRI scan, along with functional imaging and diffusion tensor imaging (DTI), provides the most accurate diagnosis and details of these brain tumours. Surgery is made safe using the latest technology to prevent injury to the normal brain structures. Superficial tumours such as gliomas and meningiomas are operated using navigation; deep-seated tumours are biopsied by stereotactic techniques; skull base tumours such as acoustic schwannomas and meningiomas are operated using neurophysiological monitoring.

Vascular Surgery

Our centre runs programmes to evaluate, diagnose and treat complex cerebrovascular diseases including arteriovenous malformations (AVMs), aneurysms, carotid artery disease, Moyamoya disease, cavernous malformations and vascular diseases of the spine.

Aneurysm is a bulging that occurs in the blood vessel due to weakness in the wall of an artery. Incidence of aneurysm in India is 1%.

AVMs are leash of blood vessels without intervening capillaries, constituting high-pressure circuit liable to bleed. They manifest either as haemorrhage or with intractable epilepsy.

Carotid Artery Disease

Atherosclerosis causes plaque to form in the carotid arteries at the junction of the external and internal carotid arteries. These plaques can release emboli or accumulate to cause stenosis. This can manifest as syncope, transient ischaemic attack (TIA) or stroke. The incidence of stroke—including fatal stroke—is 1% to 2% per year.

There are two treatment options in order to prevent stroke: First, carotid endarterectomy is done for patients with moderate to severe stenosis (50% to 99% blockage) using intraoperative electroencephalogram (EEG) monitoring. Second, carotid stenting is done for cases having high risk for surgery.

Movement Disorder Surgery

Parkinson's disease (PD), tremors and dystonia are some of the common movement disorders. Surgery is now an established treatment option for moderate to advanced PD. We offer a comprehensive PD care programme—from consultations by a movement disorder specialist to deep brain stimulation (DBS) surgery. Over 350 DBS procedures have been performed by us since 1998. Patients who cannot afford DBS can be offered lesioning surgery. The rate of complication involved in these surgeries is amongst the lowest in the world.

Pain Procedures

Our centre has performed 400 radiofrequency thermocoagulation (RFTC) procedures for trigeminal neuralgia, with a success rate of 95% and recurrence of less than 15%. Intractable migraine not responding to conventional treatment can be treated by occipital nerve stimulation (OCN). This was introduced in India for the first time at our centre.

Spasticity

Spasticity is among the common sequelae of stroke, cerebral palsy, trauma, multiple sclerosis and other neurological diseases. Depending on the distribution and disability due to spasticity, several neurosurgical procedures such as intrathecal Baclofen pump, neurotomy and dorsal root entry zone rhizotomy can be performed.

Psychiatric Disorder Surgery

Depression and obsessive compulsive disorder (OCD)—the two most common psychiatric disorders—can now be treated through surgery. The common surgical procedures include cingulotomy, capsulotomy or deep brain stimulation (DBS). We are the only centre that has set up the psychiatric surgery programme as per the international guidelines—of which Dr. Doshi is one of the authors.

The first case of capsulotomy in India was performed at our hospital in 2010. The first DBS for depression in Asian and Australian continent was also performed by Dr. Doshi at our hospital in 2013.

Epilepsy Surgery

Intractable epilepsy can be cured by surgery. The lifetime prevalence of epilepsy is 20/1000. Of this, 30% cases are intractable and will benefit from surgical treatment. For certain forms of epilepsy, such as temporal lobe epilepsy, surgery is the preferred line of treatment.

Centre of Excellence Endocrine Surgery

What is Endocrine Surgery?

Endocrine surgery is surgery that is done on the endocrine glands of body. These are the thyroid, parathyroid and adrenal glands.

A condition called familial Endocrine Neoplasia is also treated by experts in endocrine surgery.

With advances in minimally invasive surgery, laparoscopic and robotic surgery, as well as advances in nuclear medicine and diagnostic technologies, management of conditions of the endocrine glands has become more safe.

What are parathyroid glands? What is hyperparathyroidism?

We have 4 parathyroid glands, secreting parathyroid hormone, or PTH. PTH helps to control blood calcium levels.

An overactive parathyroid gland is called hyperparathyroidism. The most common cause of hyperparathyroidism is a parathyroid adenoma in a single gland. Hyper-functioning of parathyroid gland may also be caused by kidney diseases, vitamin D deficiency, or genetic conditions. The diagnosis of hyperparathyroidism is made based on blood levels of calcium and PTH. Vitamin D levels are also important when the diagnosis of hyperparathyroidism is considered and will affect its management.

What are the types of Parathyroid Surgery?

Focused or mini-invasive parathyroidectomy

Minimally invasive parathyroid surgery is performed through very small neck crease incisions (1 to 1½ inches). The incision is almost invisible when closed by a sutureless technique.

Before the diagnosis is made it is important to localize the hyper-functioning parathyroid gland by nuclear medicine scans and ultrasonography. Excision of the gland is confirmed measuring the PTH levels intraoperatively.

Bilateral Neck Exploration

In case localization facilities are not available in a hospital or in cases with multi-glandular parathyroid diseases, all four parathyroid glands are explored to remove the diseased gland. Typically performed through a neck incision, 5 to 6 inches long, all four glands are explored during surgery.

What are the symptoms of hyperparathyroidism?

As medical students are taught, symptoms of hyperparathyroidism should be remembered with the mnemonic of stones, bone and groans. Calcium stone in the kidney, bone pain due to bone loss or osteoporosis and abdominal cramps, peptic ulcer and altered bowel habits. Physicians should have a high level of suspicion and consider the presence of hyperparathyroidism when these symptoms are present. Patients reporting with such symptoms should have a serum calcium level with PTH ordered.

What is an adrenal gland? What hormones does it produce?

There are two adrenal glands as part of our endocrine system, located just above each kidney. They are very small glands but several important lifesaving hormones are produced by them.

Medical mnemonic sugar, salt and sex, defines cortex of adrenal gland, As one moves layers into the adrenal cortex, compounds that control salt, mineralocorticoids, aldosterone, control sugar, glucocorticoids, cortisol, and sex hormone, androgens are produced. Adrenal medulla is source of Catecholamine, such as: epinephrine (adrenaline), norepiniphrine, and dopamine - affect heart rate and blood pressure.

Aldosterone - regulates salt balance and blood pressure, Cortisol - controls immune system, metabolism, salt balance and response to other hormones, Small amounts of androgens & estrogens are Sex hormones.

What is a Pheochromocytoma?

A pheochromocytoma is an adrenal tumour that secretes catecholamines (i.e. adrenaline & Nor-adrenaline). When bursts of catecholamines are secreted, patients often have symptomatic spells of High blood pressure, Palpitations, headache, panic attacks, Flushing, sweating and finally Fatigue, that lasts up to an hour.

What is Cushing's Syndrome?

Cushing's syndrome is excessive amounts of cortisol secretion by adrenal glands. The symptoms are High blood pressure, Weight gain, Fatigue, Acne or facial hair, truncal obesity, i.e. rounding of the face and Buffalo hump (fat pad at back of neck), Straie (purplish stretch marks on the skin), Elevated blood sugars.

There are many potential causes of excessive cortisol, and extensive testing is needed for diagnosis. There is considerable variation in steroid production throughout the day. Adrenalectomy may be performed to remove one or both adrenal glands, depending on the cause of cortisol excess. After surgery most patients require additional steroids that are tapered over several months.

What are advances in Surgery of adrenal gland?

Laparoscopic adrenalectomy has almost replaced open operation with large 8 to 10 inches for adrenal. Laparoscopic adrenalectomy involves making 3 or 4 very small incisions of 1 to 1½ inches and removing the adrenal gland using a telescope, laparoscopic instruments and advanced energy devices. There is drastic reduction in pain and morbidity due to laparoscopic procedure with early recovery. Patients after laparoscopic procedure could be discharged within 48 hours of admission. Jaslok hospital is equipped with surgeons and instrumentations to offer laparoscopic adrenalectomy to almost all patients.

What is Multiple Endocrine Neoplasia (MEN) Syndromes & their treatment?

Multiple endocrine neoplasia syndromes are endocrine disorders related to genetic mutation, manifested as tumours of various endocrine glands in combination.

Types, MEN 1, MEN 2, FMTC

MEN 1 frequently involve tumours of the parathyroid glands, the pituitary gland, and the pancreas. Tumours in these glands can lead to the overproduction of hormones. The most common presentation of MEN 1 is hyperparathyroidism.

MEN 2 A is associated with a form of thyroid cancer called medullary thyroid carcinoma. Some people with this disorder also develop a pheochromocytoma, which is an adrenal gland tumour that can cause dangerously high blood pressure and hyperparathyroidism

MEN 2B is also associated with medullary carcinoma thyroid, pheochromocytoma and mucosal neuromas.

FMTC, familial medullary thyroid carcinoma

The treatment of these conditions is by multidisciplinary approach involving various specialities. Jaslok hospital is well equipped to offer comprehensive treatment for such conditions.

What is Thyroid Goitre or enlargement?

Enlargement of the thyroid is called goitre and lumps within it are called thyroid nodules. They may be obvious to the naked eye or can be found incidentally by imaging studies of the neck, such as a sonography of neck. Most goitres and thyroid nodules will not interfere with a person's health.

When thyroid goitre needs surgical attention?

Goitres and thyroid nodules needs surgical attention if they cause symptoms or cosmetically unacceptable for the patient.

1. Large goitres could become uncomfortable and cause breathing, swallowing difficulties, airways, esophagus constriction or blood vessels obstruction.

2. Thyroid nodules that have an indeterminate diagnosis or suspicious for cancer need surgical attention.

3. Nodular goitre causing hyperthyroidism

What is a Thyroid Nodule?

A thyroid nodule is simply a lump or mass in the thyroid gland. Thyroid nodules are relatively common; that can be felt on examination or sonographic imaging. Thyroid nodules are evaluated by sonography, aspiration cytology, thyroid function tests and treated accordingly.

What are the causes of Thyroid Goitre?

Physical and physiological strain on body metabolism, iodine deficiency, certain drugs such as lithium carbonate, genetic mutation for the proteins that permit the thyroid gland to make thyroid hormone, typically develop a thyroid goitre.

Inflammation of the thyroid gland (thyroiditis) can produce gland swelling, such as autoimmune thyroiditis and painless postpartum thyroiditis. Autoimmune thyroiditis (Hashimoto thyroiditis) occurs when a person's immune system turns against their own thyroid gland, causing thyroid inflammation. Progression of these conditions leaves thyroid permanently under active.

What are symptoms of Hyperthyroid?

Loss of weight, heat intolerance, tremors in hands, palpitations, insomnia, anxiety, increased frequency of bowel movements or diarrhoea.

What are symptoms of Hypothyroid?

Weight gain, cold intolerance, constipation, very dry skin, slowed thinking, depressed mood,

Risk factors for thyroid cancer

What are advances in Thyroid surgery?

Convention surgery, video-scopic surgeries, minimally invasive surgeries and robotic surgeries, there are tremendous advances in thyroid surgeries. Highly precise energy sources, magnified viewing loops, ultrasonic devices have made thyroid surgery safer and effective.

Collar incision in neck is till date cosmetically the best incision offered in thyroid surgery. With sub-cuticular stitching and post operatively wound care this neck incision is almost not detectable after surgery.

Videoscopy in thyroid has very limited scope for unilateral small thyroid lesions; minimally invasive thyroid surgery reduces neck incision length. Robotic surgery through axillary incision is still evolving.

What is post-operative care in thyroid surgery?

Two important structures, recurrent laryngeal nerve and parathyroid glands are in close proximity to thyroid, and special precautions are taken to prevent injuries to these structures. Post operatively patients are monitored for such complications and treated accordingly. Major complications are negligible and correctable by proper post-operative care.

What about thyroid supplement after surgery?

Not all patients need thyroid supplement; small amount of thyroid gland is enough to take care of body’s requirement. Those patients, who need Thyroid hormone or thyroxin supplement, find no change in their routine lifestyle.

What about scar after surgery

Neck scar is almost not visible and is hidden in neck crease. Stitches in thyroid surgery are absorbable and placed subcuticular, not visible on skin. They dissolve by themselves in body in course of 2 to 4 weeks. Postoperatively avoidance to sun exposure and operative placement of scar in neck crease and technique of wound closure leaves behind no scar after surgery.

ENDOSCOPIC SKULL BASE SURGE

For certain conditions in the brain that are located at the base of the skull such as a pituitary tumor or tumors located towards the front of the brain, surgery may be possible endoscopically.

The treatment for these conditions is provided by a multidisciplinary team of neurosurgeon, ENT surgeon, ophthalmic surgeon and endocrinologist.

The treatment involves a type of surgery that is carried out through the sphenoid sinus, which is located directly behind the nose. Using this method, the doctor does not enter the brain cavity itself. This approach is called the Endoscopic Endonasal Approach.

Under anaesthesia, your surgeon will place an endoscope which has a very small diameter through one nostril. The endoscope has a powerful camera at the end of it which allows the surgeon to view the area directly. With the help of micro-instruments inserted through either nostril, the surgeon will carefully remove your tumor after which the floor of the skull base is repaired and the endoscope is removed. The endoscope allows the surgeon to see the areas around the tumor as well.

The Endoscopic Endonasal Approach allows surgeons to treat many hard-to-reach tumors, even those once considered "inoperable," without disturbing the face or skull.

Being less invasive than traditional open surgical techniques it results in faster recovery and less pain.

At Jaslok Hospital, these surgeries are performed by a team of experts in dedicated and state-of-the-art operation theatres that incorporate sophisticated imaging technology.

The concept of team surgery has allowed our centre to expand the role of the Endoscopic Endonasal Approach (EEA) to include all pituitary tumors, regardless of size or invasiveness, and to access tumors of the skull base from the sphenoid sinus all the way down to the upper cervical spine and out to the cavernous sinus, Meckel’s cave, jugular foramen and beyond.

In addition, our center has experience with these techniques for pediatric patients as well as for challenging lesions such as aneurysms and angiofibromas.

These are some of the growths and conditions that may be treated by skull base surgery:

Cysts that develop from birth.
Growths caused by infections.
Pituitary tumors. The pituitary gland sits behind the nose and eyes.
Meningiomas. These tumors are often benign and grow from the meninges, the tissue that covers the brain and lies between the brain and skull.
Chordomas. This is a slow-growing bone tumor most often found at the base of the skull.
Trigeminal neuralgia, an intense pain on one side of the face.
Craniopharyngiomas, growths that occur near the pituitary gland.
Craniosynostosis, a condition in which the bones of the skull of an infant close too early, causing problems with brain growth and the shape of the skull.
Cerebrospinal fluid fistulas.
Cerebral aneurysm, a weak, often bulging area in a blood vessel in the brain.
Arteriovenous malformations. These are arteries and veins that are abnormally connected to one another.

Symptoms

You may have many possible symptoms arising from a growth or abnormality in the skull base area. Symptoms will depend on the size, type, and location of the growth or abnormality, and may include:

Facial pain
Headache
Dizziness
Visual problems
Numbness
Weakness of the face
Hearing loss or ringing in the ears
Nasal congestion or frequent sinus infections

Diagnosis

The diagnosis of growths or abnormalities that may require skull base surgery is based on your symptoms and a physical exam. Because this area cannot be seen directly, these exams and imaging studies are important parts of the diagnosis:

Brain imaging studies: Special tests such as MRI, MRA (magnetic resonance angiogram), PET (positron emission tomography)and CTscans create pictures of the skull to help your medical team see a growth or abnormality.

Managing after skull base surgery

After skull base surgery, you will be closely cared for by your medical team. Some people need continued therapy, and many will need repeated testing to make sure that a growth is not coming back over time.

Dr.Paresh Doshi, Director of Neurosurgery.
MBBS: 1985 (First rank), N H L Municipal medical college, Ahmedabad. M.S.(General Surgery): 1989 (Gold Medal), V S Hospital, Ahmedabad. M.Ch: (Neurosurgery) 1992 (First rank), Nair Hospital, Mumbai. Fellowship in Functional Neurosurgery, UK

He has several firsts to his credit, from the first deep brain stimulation (DBS) surgery in India, to operating the youngest and oldest Parkinson's disease patients in the world. He was the first neurosurgeon to perform surgery for Depression in Asian-Australian subcontinents. Jaslok hospital has the largest series of DBS procedures in South Asia. The functional neurosurgical unit has recently published the first series (in the world) of DBS in patients of Progressive Supranuclear Palsy (PSP). Today, the functional neurosurgery department has performed more than 450 DBS procedures and the largest spectrum of functional neurosurgical procedures with excellent results.

The department of neurosurgery also runs the DNB Neurosurgery program, under him. This program trains one neurosurgeon every year. He also runs a fellowship program in functional neurosurgery, to train neurosurgeons from India and abroad.
• President of The Neuromodulation society of India
• Director, World society for Stereotactic and Functional Neurosurgery
• Director, Asian-Australian society for Stereotactic and Functional Neurosurgery
• Past President of the Indian Society for Stereotactic and Functional neurosurgery

Dr. Paresh Doshi CV:
https://neurologicalsurgery.in/wp-content/uploads/2017/09/Curriculum-Vitae.pdf

http://neurologicalsurgery.in/

Dr. Doshi has been the Director of the Department of Neurosurgery since 2011. Under his supervision a multi-subspecialty neurosurgical program has evolved at the Jaslok hospital.He has over 20 years of experience in treating brain tumors and disorders of the brain. His work has been highly appreciated in Media, by the patients and caretakers He has been a pioneer in functional neurosurgery in India. He is also the Director of Stereotactic and Functional Neurosurgery program at Jaslok Hospital established since 1998. This is the only dedicated and comprehensive Stereotactic and Functional Neurosurgical program in India. Dr. Doshi has been extensively trained in the field of Stereotaxy and Functional Neurosurgery at the most premiere centers in England for a period of four years. These includes the National hospital for neurology and neurosurgery, Queen square London, Maudsley and King’s college hospital, London and Newcastle General hospital. He had further exposure and experience for specific Movement Disorder surgeries in USA Netherlands, Sweden, France and Austria.

• He was the recipient of Indo-American young achiever’s award
• He has been awarded the Medscape India award for excellence in Neurosciences.
• He has conducted several scientific research projects at the Jaslok hospital, including research on stem cells.

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His area of expertise and interest is in Endoscopic and Skull Base Surgery, Management of Pituitary Adenoma and Sellar Pathology, Neuro-oncology and Minimally-invasive Brain Surgery, Vascular Neurosurgery and Minimally Invasive Spine Surgery and instrumentation.

Prof. Deepu Banerji has 34 years of experience in Neurosurgery after completing his training from GB Pant, New Delhi. He has been a faculty at NIMHANS, Bengaluru and
SGPGIMS, Lucknow with experience of over 8000 neurosurgery operations of Brain & Spine.
SGPGIMS, Lucknow has named an Operation Theatre in his honour.
He has been a Sugita Fellow at University of Nagoya, Japan in 1994 and visiting Prof, to Shinshu University, Japan.
He did observer-ship at Mt. Sinai Hospital, NY and Michigan University, Ann Arbor.
He has been President of Neurological Society of India (2017), Skull Base Surgery Society of India (2012) and Bombay Neuroscience Association (2017-18).
He is Member Editorial board Of Surgical Neurology International.
He has been conferred Honorary Member of Society of Neurosurgeons of South Africa.
Earlier he had been Director Neurosurgery at Fortis Hospital, Mumbai and Narayana Super-speciality Hospital, Gurugram.

He has 70 publications in International & National journals. 20 chapters in books, been the editor of "Progress in Clinical Neurosciences" Vol.24, 25, 26.
He has given multiple orations, guest lectures & conducted many symposiums and workshops in India & abroad.
President Neurological Society of India 2017
Chairman Scientific Committee of NSI 2016
President Bombay Neurosciences Association 2017-18
President Skull Base Surgery Society of India 2012
Former Convenor CME, Neurology Society of India
Former Treasurer Neurology Society of India
Former Hon. Sec. SBSSI
Former EC Member Indian Society of Neuro-oncology
International Member Editorial Board: Surgical Neurology International
Honorary Member: Society of Neurosurgeons of South Africa

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His area of special interest is Cerebrovascular Disorders which includes Haemorrgic and Ischaemic strokes that can be managed by open surgery and percutaneously with Endovascular Techniques.

He has developed expertise in the management of following Neurosurgical problems,

Cerebrovascular disease (clipping of aneurysms, excision of AVMs, carotid endarterectomy)

Cervical &lumbar degenerarative disease (Cervical and Lumbar PID)

Spinal Instrumentation (for tuberculosis, AAD, fractures and dislocations)

Skullbase surgery (Acoustic neurinoma, Pituitory tumor, craniopharyngioma, microvascular decompression for trigeminal neuralgia)

Endovascular surgery (coiling of aneurysm, embolization of AVM, thrombolysis, carotid angioplasty and steting) Endoscopic surgery (Pituitory tumors, craniopharyngioma, third ventriculostomy, diskectomy, tumor biopsy, CSF leak repair) Stereotactic surgery

Dr.Batuk Diyora is Professor (Additional) at Department of Neurosurgery at LTM Medical Collage and Sion Hospital, Mumbai and visiting consultant at Jaslok Hospital and Research center.

He joined LTM Medical College and Sion Hospital, Mumbai in year 2001. He obtained his DNB Degree in Neurosurgery from Mumbai University in year 2004. After completing his basic Neurosurgery training, he visited Fujita Health University, Japan for Advanced Training in Neurosurgery under guidance of Prof. Tetsuo Kanno, and Prof. Yoko Kato.

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Area of expertise

He has special interest in Skull base surgery. He is trained in operating complex Cranio-vertebral abnormalities and skull base tumors like acoustic shwannoma, pituitary adenomas and skull base meningiomas.

Introduction

Dr. Ramdasi is currently a Consultant in Neurological Surgery at the Jaslok Hospital and Research Centre since 1 year. He has completed his neurosurgical training from Seth G.S. Medical Collage and KEM hospital one of the best institutes in India.

Awards/Fellowship

"2nd Rank in the university in Mch exam 2013

Got Best paper awards at various national and international conferences.

Has published over 25 peer reviewed journal articles in international journals.

Has renowned research in complex Cranio-vertebral junction abnormalities and rare brain tumors. "

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Area of expertise

"acoustic neurinoma/schwannoma, Arnold Chiari Malformation, Metastases, Cavernous Malformations, Cerebral Ischemia / Cerebrovascular Surgery, Cranial Neurological Surgery, Gliomas, Hemifacial Spasm, Meningioma Surgery, Neuro-Oncology, Pituitary Tumors, Skull Base Surgery, Trigeminal Neuralgia, Trigeminal Neuralgia. "

Introduction

"Dr. Ambekar is currently a Consultant in Neurological Surgery at the Jaslok Hospital and Research Centre. Previously, he graduated cum laude with a M.B.B.S. from JIPMER, Pondicherry, which is one of the primer institutes in India. He completed a 5-year neurosurgical residency at NIMHANS, which is the best University for training in Neurosurgery in India, followed by a 1- year skullbase surgery fellowship and a 2-year endovascular fellowship at the LSUHSC, Shreveport, LA and the University of Miami Department of Neurological Surgery, United States. Dr. Ambekar specializes in the treatment of brain aneurysms and AVMs (arteriovenous malformations).

He is one of the few dual-trained neurosurgeons in the country able to offer both surgical and minimally invasive endovascular solutions to complex cerebrovascular disease. The minimally invasive endovascular techniques allows for patients to be treated through a 1mm incision in the leg with no incisions in the head. Because of his dual training, he unbiased with regards to the treatment chosen. While most lesions can be treated endovascularly, there are some cases are safer with surgery. Dr. Ambekar is able to perform every procedure from the initial angiogram to the final embolization or surgery. He is also a specialist in pediatric vascular disease such as aneurysms and tumors, and treating children with surgical and endovascular techniques.

Dr. Ambekar also is specifically involved in mechanical thrombectomy for acute ischemic stroke, intracranial stenting for atherosclerotic disease, carotid endarterectomy/stenting and treatment of intracranial dural arteriovenous fistulae "

Awards/Fellowship

"Best Outgoing Resident in Neurosurgery (2011)

Has published over 75 peer reviewed journal articles and 5 book chapters

Research in the role of Computational Fluid Hemodynamics in characterizing the growth and rupture of intracranial aneurysms "

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Dr Manish Baldia completed his MBBS from Narayana Medical College, Nellore in 2008. He mastered his Neurosurgical and Neurocritical care skills over 12 years from the prestigious Christian Medical College, Vellore. He did his fellowship in Functional Neurosurgery, at Jaslok Hospital & Research Centre, Mumbai and Neuromodulation course from Queen Mary University, London.

He received Young Neurosurgeon Award in 2018 and owns many original research publications, patents and innovations like stem cell therapy for disc prolapse, automated bio-medical device for CSF drainage, low-cost 3D printed patient specific cranial implants and transcranial electrical stimulator etc. He had many interdisciplinary national and international university collaborations for clinical and biomedical research. He received many grants for his research work.

He has wide experience in managing all the complicated neurosurgical cases and has operated more than 1500 cases till date. His is one of the rarest ambidextrous skilled Neurosurgeons. His areas of expertise are Brain tumor surgery, Stereotactic biopsy, Stereotactic radiosurgery, Parkinson surgery, Spasticity surgery, Epilepsy surgery, Writer’s cramp, Trigeminal Neuralgia, Pituitary surgery, Spinal dysraphism, Spine tumors, Spondylosis and Cranioplasty.

Expertise

Neurosurgery-Cranial cases - Glioma, Meningioma, Craniopharyngioma, Pituitary, Head injuries, Cranioplasties, ACF repair, Chiari malformation, Shunt surgeries, Encephaloceles, Moya moya disease, Craniosynostosis, Hemangioblastoma, AVM, Aneurysm clipping, Spinal cases – Cervical spondylosis, Lumbar disc prolapse, Lumbar canal stenosis, Spondylolisthesis, Spine trauma, Spine tumours, Spinal dysraphism, Spine instrumentation.

Functional Neurosurgery: Deep Brain Stimulation, Thalamotomy, RFTC, Motor cortex stimulation, Spinal cord stimulation, Stereotactic biopsies, Stereotactic radiosurgery for tumors and AVM’S.

Neurocritical Care: Management of Neurotrauma, elective neurosurgical postoperative, and Neurology patients

Work experience in the field of Neurosurgery - 13 years

Jan 2009 - Oct 2009
Medical officer in Neurosurgery Department, Narayana Medical College, Nellore, Andhra Pradesh, India

Nov 2009 - Jul 2011
ICU Registrar (Non-PG post) in Neuro ICU at Christian Medical College, Vellore, India (management of head injury, postoperative and neuromedicine patients)

Aug 2011- July 2017
M. Ch (Neurosurgery, 6 years) at Christian Medical College, Vellore, India.

Sep 2017 – Jan 2020
Assistant Professor of Neurosurgery, Christian Medical College, Vellore, India

Feb 2020 – Mar 2021
Associate Professor of Neurosurgery, Christian Medical College, Vellore, India

Mar 2021- Feb 2022
Fellowship in Functional Neurosurgery with Dr Paresh Doshi at Jaslok Hospital and Research Centre, Mumbai

Feb 2022 – till date
Consultant - Functional Neurosurgery and Comprehensive Neurosurgery at Jaslok hospital and Research Centre, Mumbai

Prizes and Awards:

1. 3-Minute thesis presentation award at Christian Medical College 2017- Regeneration of intervertebral disc using mesenchymal stem cells in a mouse disc degenerated model.

2. Annual Research Day award -2017. First prize at Christian Medical College, Vellore,

3. Young Neurosurgeon Award, India – 2018 by Baidya Nath Charitable trust, Mumbai.

4. Annual Research Day award – 2018. Second prize at Christian Medical College, Vellore.

5. Travel grant award ISNO-2019 for platform presentation of “Case selection for single sitting sequential transsphenoidal and cranial surgery for giant pituitary adenomas”.

6. Special prize in Helmet awareness Movie making competition at CMC, Vellore 2010 titled “Grey and grey”

7. Special prize in poster competition – “Escape from escape by a simple hand wash” in Hospital infection control week 2014 held at CMC, Vellore.

8. Second prize in poster competition “Design your ideal helmet” conducted by Mary Verghese institute of rehabilitation, CMC, Vellore- Feb 2016.

Publications:

1: Baldia M, Joseph M, Sharma S, Kumar D, Retnam A, Koshy S, Karuppusami R. Customized cost-effective polymethylmethacrylate cranioplasty: a cosmetic comparison with other low-cost methods of cranioplasty. Acta Neurochir (Wien). 2022 Feb 2. doi: 10.1007/s00701-022-05121-0. PMID:35107617.

2: Baldia M, Mani S, Walter N, Kumar S, Srivastava A, Prabhu K. Bone Marrow- Derived Mesenchymal Stem Cells Augment Regeneration of Intervertebral Disc in a Reproducible and Validated Mouse Intervertebral Disc Degeneration Model. Neurol India. 2021 Nov-Dec;69(6):1565-1570. doi: 10.4103/0028-3886.333531. PMID: 34979644.

3: COVIDSurg Collaborative; GlobalSurg Collaborative. SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study. Anaesthesia. 2022 Jan;77(1):28-39. doi: 10.1111/anae.15563. Epub 2021 Aug 24. PMID: 34428858; PMCID: PMC8652887.

4: COVIDSurg Collaborative; GlobalSurg Collaborative. Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study. Anaesthesia. 2021 Nov;76(11):1454-1464. doi: 10.1111/anae.15560. Epub 2021 Aug 9. PMID: 34371522.

5: Baldia M, Rajshekhar V. Corona Reset 2020: Yet to Find the Key. Neurol India. 2021 May-Jun;69(3):782-783. doi: 10.4103/0028-3886.294826. PMID: 34169899.

6: Baldia M, Gandham E, Prabhu K. Clinico-Surgical Outcomes of Giant Intracranial Epidermoids: Gross Total Resection vs Subtotal Resection Which is Better? Turk Neurosurg. 2021;31(4):574-581. doi: 10.5137/1019-5149.JTN.32228-20.1. PMID: 33978215.

7: COVIDSurg Collaborative, GlobalSurg Collaborative. SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study. Br J Surg. 2021 Sep 27;108(9):1056-1063. doi: 10.1093/bjs/znab101. PMID: 33761533; PMCID: PMC7995808.

8: COVIDSurg Collaborative; GlobalSurg Collaborative. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study. Anaesthesia. 2021 Jun;76(6):748-758. doi: 10.1111/anae.15458. Epub 2021 Mar 9. PMID: 33690889; PMCID: PMC8206995.

9: Baldia M, Mani S, Walter N, Kumar S, Srivastava A, Prabhu K. Development of a Unique Mouse Intervertebral Disc Degeneration Model Using a Simple Novel Tool. Asian Spine J. 2021 Aug;15(4):415-423. doi: 10.31616/asj.2020.0366. Epub 2020 Dec 28. PMID: 33355845; PMCID: PMC8377218.

10: Baldia M, Rajshekhar V. In Reply to the Letter to the Editor Regarding "Minimizing CSF Leak and Wound Complications in Tethered Cord Surgery with Prone Positioning: Outcomes in 350 Patients". World Neurosurg. 2020 Oct;142:571. doi: 10.1016/j.wneu.2020.07.181. PMID: 32987607.

11. Baldia M, Rajaratnam S, Rajshekhar V. Postoperative Hormonal Outcomes in Patients with Large and Giant Non-functioning Pituitary Adenomas. Neurol India. 2020 May-Jun;68(Supplement):S106-S112. doi: 10.4103/0028-3886.287670. PMID: 32611900.

12: Baldia M, Rajshekhar V. Minimizing CSF Leak and Wound Complications in Tethered Cord Surgery with Prone Positioning: Outcomes in 350 Patients. World Neurosurg. 2020 May;137:e610-e617. doi: 10.1016/j.wneu.2020.02.073. Epub 2020 Feb 20. PMID: 32088374.

13: Baldia M, Sharma SA, Prabhu K, Koshy S. Cost effective, technically simpler, and aesthetically promising cranioplasty in developing countries. Neurol India. 2017 -Jun;65(3):660-663. doi: 10.4103/neuroindia.NI_210_16. PMID: 28488649.

14. Bharath RV, Premlal KV, Baldia M, Samson SK. Brain abscess: Trouble by tip of a top in a child. Journal of Pediatric Neurosciences. 2011 Jan;6(1):96. PMID: 21977108, PMCID: PMC3173935

15: Baldia M, Premlal K, Menon B, Samson SK. Marcus Gunn phenomenon with abducens palsy: As pseudo-false localizing signs. J Neurosci Rural Pract. 2011 Jan;2(1):101-2. doi: 10.4103/0976-3147.80086. PMID: 21716868; PMCID: PMC3122987.

16: Samson SK, Nair PR, Baldia M, Joseph M. Television tip-over head injuries in children. Neurol India. 2010 Sep-Oct;58(5):752-5. doi: 10.4103/0028-3886.72171. PMID: 21045503.

17. Archana R, Baldia M, Jeeva JB, Joseph M. Strength analysis of Cranioplasty PMMA flap material. Materials Today: Proceedings. 2019 Jan 1;15:167-72.

18. Peer reviewed 35 manuscripts for international neurosurgery journals (World Neurosurgery and Spine Journal

Patent:

1. CSF drainage remote monitoring device with smart technology (Patent no – IPOTEMP/E1/43280/2019CHE). Currently in the stage of manufacturing the product with an industrial partner.

2. “A process for reconstruction of cranial implant” patent applied to government of India (IPOTEMP/E1/22324/2022CHE). Currently in the process of collaboration with a marketing company.

Innovations:

1. Manish Baldia (PI) - Development of a stereotactic tool to create a mouse disc injury – 2014, at CMC Vellore

2. Manish Baldia (PI) - Development of a Unique Mouse Intervertebral Disc Degeneration Model Using a Simple Novel Tool. – 2016, at CMC, Vellore

3. Manish Baldia (PI) - Cost effective, technically simpler, and aesthetically promising cranioplasty in developing countries using bone impression technique – 2017, at CMC, Vellore

4. Dr Manish Baldia (PI), Dr Vedantam Rajshekhar, Dr Suresh Devasahayam Title: “CSF drainage remote monitoring device with smart technology”. - 2018

5. Dr Manish Baldia (PI), Suresh Devasahayam, Srinivasa Babu, Mathew Joseph. Title: “Development of transcranial stimulator for early detection of spinal cord injury in trauma patients”. A DBT funded BIRAC/PACE government project. - 2019

6. Dr Manish Baldia (PI), Dr Mathew Joseph, Dr Deva Kumar Dr Santhosh. Title: “Development of software algorithm and low-cost Vellore 3D cranioplasty technique”. (A collaboration with Vellore Institute of technology, VIT Vellore) - 2020

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Dinesh Patel

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Benjamin Ward

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Hospitalization of Mr.Mehroze Dadrewalla in Jaslok Hospital under Dr. Pettarusp wadia
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