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Minimally access brain surgery technique uses specialised endoscopes with high resolution video cameras to perform surgery of the brain. This technique can be used to diagnose and treat neurological conditions such as brain tumours, hydrocephalus (fluid build-up in the brain) and movement disorders such as Parkinson’s disease. Traditional brain surgery requires removing a part of the skull to allow access to the brain, in minimal access brain surgery, it usually involves making tiny incisions, which allow sutureless procedures to be performed. Says Dr Sunil Kutty (Consultant, Neurosurgeon, Apollo Hospitals, Navi Mumbai), “Minimal access brain surgery is not more or less risky than traditional surgery when performed with the purpose of making the patient’s life easier and secure. As long as the goal of the procedure is not compromised, it will always offer something extra than open surgery, such as a better quality of life through faster recovery and less scarring. Plus, the prospect of undergoing a surgery, which involves only a small opening or no obvious opening, is mentally more acceptable to patients who are already traumatised and scared of an impending brain surgery.” In some cases, minimally access neurosurgery brings an entirely new facet of treatment to the force, for example, in the treatment of hydrocephalus. Hydrocephalus is a condition frequently encountered in clinical practice, in which there is an abnormal amount of cerebrospinal fluid (CSF) accumulation in the cranium. Traditionally, the treatment of hydrocephalus has been through correcting the overproduction of CSF or diverting the build-up away from the head by surgically placing tubes called shunts inside the brain ventricles and draining it into body cavities. Though effective, shunts are occasionally associated with serious complications, including infection, over-drainage or malfunction. Now using video guidance and no hardware, a surgeon can insert an endoscope through a small hole in the skull into the third ventricle of the brain. There a perforation is made in a membrane to restore normal flow of CSF. Though not all hydrocephalus patients are eligible for approach, approximately 70 to 80 per cent of properly selected patients are successfully treated this way. “Minimally invasive neurosurgery is a young field of just a few decades old the world over. In India, its advent started perhaps in the last two decades and neurosurgeons here have whole-heartedly embraced this new technology and are exploring the numerous possibilities it throws up. We perform endoscopic third ventriculostomy (like in the case of hydrocephalus), endoscopic removal of pituitary tumours and other skullbase tumors, endoscopic treatment of intra-ventricular tumours, intraparenchymal and ventricular bleeds etc. Endoscopic neurosurgery continues to evolve with technical contributions from neurosurgeons around the world. With accessibility to real time imaging and advanced image guided navigation system, neurosurgeons are able to monitor a patient’s progress and perform more complicated surgeries with accuracy and improved clinical outcomes,” ends Dr Kutty. Call: 022 3350 3350. Mumbai.apollo hospitals.com www.askapollo.com(*Procedures given are based on the expert’s understanding of the said field) Times of India - Dated : 1st December 2017 - Page 12 on Bombay Times

Op To Avoid Secondary Brain Injury Thirty-two year old Belapur housewife Priyadarshini Vichare was a victim of irresponsible driving in Navi Mumbai -she was hit by a speeding auto driver during an early morning walk. She fell and hit her head against the divider resulting in injuries to her skull. Her husband took her to a nearby hospital, where he was asked to consult Dr Sunil Kutty , consultant neurosurgeon at Fortis Hospital in Vashi. Priyadarshini was unconscious and dependent on AMBU (Artificial Manual Breathing Unit) ventilation, at the time of admission. The CT scan revealed a blood clot, severe swelling in her brain and a left temporal bone fracture in her head. “We decided to perform a decompressive cranieotomy , a procedure in which a part of the skull (bone flap) is removed to allow space for the traumatised and swollen brain to expand without being squeezed. This is done to avoid secondary brain injury to that part of brain not injured by trauma but is affected by the swelling,“ said Dr Kutty . This kind of surgery is usually performed on victims of traumatic brain injury or stroke. Its aim is to reduce intracranial pres sure (ICP) and studies have shown that larger the bone flap, the more ICP is reduced. Post surgery , Priyadarshini was on a ventilator for 10 days and her recovery was gradual. By the third week, she was responding to verbal commands and by the 20th day she was functional with some support. “Her age and the fact that she suffered from no other ailment helped her case. On an average, we do 2-3 skull surgeries a month,“ added Dr Kutty . Priyadarshini said that as her condition improved, she was discharged to recover at home. “But I returned to the hospital last week to get another surgery done. The bone flap had to be placed back as the brain swelling had reduced,“ she added. Dr Kutty added that both the surgeries had gone well and the patient's recovery has been good. “She can now lead a healthy life following her treatment,“ he said. Apr 04 2014 : The Times of India (NaviMumbai) Brain surgery helps accident victim recover Indira Rodericks TNN

Man Undergoes Rare Brain surgery - The Procedure, Called Awake Craniotomy, was performed by Dr. Sunil Kutty - Neurosurgeon Kalyan: a brave 24-year old resident of Kalyan, Jayaram Shinde chose to fight a tumour in the speech area of his brain with a revolutionary brain surgery, wherein he could communicate with the doctors during the operation. The operation known as :Awake Craniotomy" was conducted at the Fortis Hospital in Kalyan. Awake Craniotomy is performed like a conventional craniotomy, the difference being that the patient is kept awake during the procedure. This is a preferred technique for operations to remove tumors close to , or involving, functionally important regions of the brain, like the areas responsible for speech or limb movement. This allows surgeons to test or verify regions of the brain before they are removed and the patient's functions can continuously be monitored, minimizing the risks of such operations. "When I visited my family doctor post convulsions, he suspected something wrong and recommended an MRI scan, The MRI scan revealed a large tumor located around the speech area on the left side of the brain. The tumor was also close to the motor area of the brain, responsible for movement of the right side of the body. We took a second opinion and the results were the same, "Shinde said. The doctors recommended Jayaram a surgery to remove the tumor. "I realized that if the operation was done in the conventional manner, there was a high possibility that Jayaram would lose control over his speech. So we decided to go ahead with a unique method of Awake Craniotomy," said Dr. Sunil Kutty, Neurosurgeon at Fortis Hospital. Jayaram and his family were explained the whole procedure. "I feel that i have got a new life. The operation was lengthy and critical, but I had faith in my doctors and survived it," said Shinde. Written By: Megha Pol megha.pol@hindustantimes.com

Don’t ignore that persistent neck ache, as it could be an indication of a serious cervical ailment. Ever felt a pinching, dull pain between your shoulder blades or the nape of your neck? This could be a precursor to suscle spasms, spondylosis and prolapsed inter-vertebral discs which are on the rise. This is due to excessive usage of computers, laptops and increased time spent driving through bustling traffic. Blame it on the lifestyle change, but people spend most of their indoors without any exercise and sunlight exposure. Lack of exercise makes the neck muscles weaker and insufficient exposure to sunlight caused vitamin d deficiency. The bones consequently become weaker and can cause pain. Constant neglect of the neck sudden trauma or other condition affection the bones and muscles can alter the delicate balance of the structures constituting and contained in the cervical spine. When the space between two adjacent vertebrae narrows, there is out-growth of bony spurs which can cause compression of a nerve root emerging from the spinal cord. This may cause radiculopathy (sensory and motor disturbances, such as severe pain in the neck, shoulder arm, back and / or leg, accompanied by muscle weakness). Less commonly, direct pressure on the spinal cord may result in myelopathy characterized by weakness, loss of balance and loss of bowel and / or bladder control. The patient may experience a shock-like sensation (paresthesia) in hands and legs because of nerve compression and restricted blood flow. Though the incidence rate is alarmingly high, there are easy ways to prevent them from happening. Spending outdoors, regular exercise and eating healthy food helps prevent this painful condition. If your job involves sitting in one position for long, a two minute long break to exercise you neck muscles can do wonders to keep neck pain at bay. People with severe pain or associated neurological deficits (Limb weakness, abnormal or loss of sensation, loss of urinary and bowel control) have to consult a doctor. Surgery of the spine has now become safer thanks to the use of microscopes and endoscopes. They allow better visualization of the vital structures. In simple terms the surgery for degenerative diseases of spine involves decompression of the involved neutral structures and fusion of the bone to prevent movement at the involved level. The newer disc implants available also allow normal mobility of the neck. The further one delays in getting treatment, the more damage there is to the cervical area. Ensure you consult a good orthopedic on the onset of pain, discomfort and related symptoms. Author: Dr. Sunil Kutty – Neurosurgeon Fortis Hospital, Mumbai

SURGERY VS SEMI: PATIENTS PICK BIG GAME OVER KNIFE By Lata Mishra | Updated: Mar 28, 2011, 03.44 AM IST They are, in fact, happily accepting requests from their patients to postpone their surgeries which were scheduled for that day. Such is the hype around the match, that some patients don't mind paying through their nose for deluxe rooms which come with attached televisions- in case the surgery cannot be rescheduled. At Hiranandani hospital in Powai, doctors said that so far 15 surgeries slated for Wednesday have been postponed on the request of patients. Of these, six are hip and knee-replacement surgeries. (Akhilesh Chaturvedi has requested for a rescheduling of his spine surgery as he is not willing to miss the Indo-Pak match) Dr Pradeep Bhosle of the Powai hospital said that requests for rescheduling these surgeries are being accepted because these come under the category of planned surgeries and are not emergency ones. A typical cricket fanatic, 35-year-old sales executive Akhilesh Chaturvedi has requested his doctors at Kalyan's Fortis hospital to operate on his spine on Monday. Chaturvedi, who has already been admitted to the hospital for preliminary investigations, has made it clear that in case he has to stay in the hospital on Wednesday, his room should be fitted with a television. ""I didn't think India and Pakistan would clash in this World Cup. I'm not going to miss this match for anything. I believe Sachin will make his 100th international century and India will beat Pakistan,"" said a confident Chaturvedi. Chaturvedi's doctor Sunil Kutty said that he has received three other similar requests. As the craze around the do-or-die Mohali match reaches a fevered pitch, patients are happily sacrificing hard-won appointments with their busy surgeons. Renowned gynaecological surgeon Dr Nandita Palshetkar, who practices in Lilavati, has patients waiting for almost two months for a surgery appointment. But several of them have requested for a fresh schedule.""It started off with one patient and when I agreed to the request, I got four others. Even the staff was keen to watch the match so I thought it's better that we allow the rescheduling,"" said Dr Palshetkar. Dr Arvind Kulkarni, among the city's busiest spine surgeons, told Mumbai Mirror that he already has requests from five patients while others have requested for an upgrade to the deluxe rooms at almost Rs 20,000 per day in case they were doomed to spend Wednesday in the confines of a hospital ward. According to Bombay Hospital sources, these demands for upgrading may put pressure on the 15 deluxe rooms next week. In the case of a 47-year-old lady from Juhu however, the request for a rescheduling of her surgery has less to do with her love for the game and more to do with her family, especially her husband. It was her husband who asked doctors at Juhu's Sujay hospital if his wife's surgery to remove her uterus could be performed on some other day.Dr Udhav Raj from the hospital said that he is grappling with five other requests for a change in surgery dates.

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Skinny jeans can cause nerve disorder They may make you look slim, but at what cost? Experts now say super-tight trousers cause a condition called Meralgia Paresthetica Skinny jeans have been a fashion staple for a long time. However, if you prefer good health over a garment that makes you look slim, read on. A recent article posted by an international website reported that too-tight skinny jeans could cause health problems. Another New York-based daily scripted an advice on the same topic by Dr Robert Rhee, chief of vascular surgery at a Brooklyn hospital, who said, "Switch to a larger size. The numbness is a sign your body is not getting enough blood." What is the health risk? Skinny jeans worn too tight can cause a nerve disorder called Meralgia Paresthetica, and was brought to the spotlight by Dr Karen Boyle from the Greater Baltimore Medical Center in the US. The website stated her as saying, "It's a disorder that occurs when one of the nerves that runs in the outer part of a thigh gets compressed." This nerve disorder has been noted in medical papers. In 2003, Malvinder S Parmar reported three cases in the Canadian Medical Association Journal stating that patients who suffered from Meralgia Paresthetica were all overweight women who had worn tight, low-rise trousers over the previous six to eight months. How does it occur? Explains neurosurgeon Dr Sunil Kutty, "Meralgia Paresthetica is a nerve condition where the lateral cutinous nerve (sensory) of the thigh, which exits around the waist to supply the lateral part of the skin of the thigh, can be damaged. When someone puts on weight (most commonly a paunch) or wears a tight belt, this nerve could get compressed. When such a compression happens, the function of the nerve may alter and even a slight touch can be perceived as pain." Before you develop a denim scare and swear off skinny jeans again, here are a few things to remember. "Wearing skinny jeans might cause this condition only if it's worn tight around the hip area. This can be treated but there's no easy cure. We recommend removal of the stimulant, i.e. not wearing a tight belt or jeans that are tight around that area. To cure it, we either decompress the nerve or cut it off completely," says Dr Kutty. Neurophysician Dr PP Ashok confirms, "Obese people tend to get this nerve pinched, as the nerve is very delicate. It's not a blanket rule that this is bound to happen to people wearing tight clothes, but it's advisable not to. People prone to pressure-sensitive numbness and diabetes are more likely to suffer from this disorder. One may have numbness and a burning sensation on the outer thigh." Another detail flagged up was about wearing high heels with skinny jeans, worsening the situation because tilting the pelvis increases pressure on the sensitive area. Dr Ashok says, "When one wears high heels, the weight of the body comes on the toes and this can effect the tender nerves. All these contribute to this problem." Skinny jeans have raised health concerns in the past as well when an article stated that doctors advise men trying for a baby to avoid these as they may cause the testicles to overheat, lowering their sperm count. Wearing skinny jeans can also increase the chances of developing thrush. Reporter - Times of India Simi Kuriakose | TNN | Jul 24, 2012, 12.00 AM IST

Traffic cops learn about trauma management Fortis hiranandani Hospital , Vashi, Organised a workshop on world trauma day. On world trauma day on October 17, 2012 Fortis Hiranandani Hospital, Vashi organised a workshop for navi mumbai traffice police on how to handle cases of road trauma. Dr. Sunil Kutty - Neurosurgoen Supervised the event. He spoke about Trauma Management and emergency Procedures