Leading Neurosurgical Expertise in Singapore: Awake Craniotomy, Brain Surgery, Trauma Care and more.
Brain Aneurysm Surgery
Brain aneurysm surgery aims to treat a weakened area in the wall of a blood vessel in the brain that causes an abnormal bulging or ballooning.
There are two primary treatment approaches to treat brain aneurysms: surgical clipping or endovascular treatment. The choice depends on various factors such as the location, size, and shape of the aneurysm and the patientโs overall health.
Surgical Clipping: A traditional surgical technique that involves creating a small window in the skull, known as a craniotomy, to access the aneurysm. The neurosurgeon first places a small metal clip across the neck of the aneurysm, isolating it from the main artery and preventing it from rupturing or causing further damage. After the clip is placed, the craniotomy site is closed with surgical materials. Recovery time for this procedure varies depending on the patientโs overall health and the specific details of the surgery.
Endovascular Treatment: This is a less invasive procedure compared to clipping. It includes coiling or stenting, and involves inserting a catheter through an artery in the groin, which is then guided through the blood vessels to the site of the aneurysm in the brain. Using the catheter, the surgeon inserts small platinum coils into the aneurysm. These coils initiate a clotting response, effectively sealing off the aneurysm from the main artery reducing the risk of rupture. This procedure does not require opening the skull, which often leads to a quicker recovery than clipping surgery. However, it may not be suitable for all types of aneurysms.
Brain Aneurysm Surgery
Brain aneurysm surgery aims to treat a weakened area in the wall of a blood vessel in the brain that causes an abnormal bulging or ballooning.
There are two primary treatment approaches to treat brain aneurysms: surgical clipping or endovascular treatment. The choice depends on various factors such as the location, size, and shape of the aneurysm and the patientโs overall health.
Surgical Clipping: A traditional surgical technique that involves creating a small window in the skull, known as a craniotomy, to access the aneurysm. The neurosurgeon first places a small metal clip across the neck of the aneurysm, isolating it from the main artery and preventing it from rupturing or causing further damage. After the clip is placed, the craniotomy site is closed with surgical materials. Recovery time for this procedure varies depending on the patientโs overall health and the specific details of the surgery.
Endovascular Treatment: This is a less invasive procedure compared to clipping. It includes coiling or stenting, and involves inserting a catheter through an artery in the groin, which is then guided through the blood vessels to the site of the aneurysm in the brain. Using the catheter, the surgeon inserts small platinum coils into the aneurysm. These coils initiate a clotting response, effectively sealing off the aneurysm from the main artery reducing the risk of rupture. This procedure does not require opening the skull, which often leads to a quicker recovery than clipping surgery. However, it may not be suitable for all types of aneurysms.
Brain Tumour Surgery
Brain tumour surgery is a specialised procedure performed to remove abnormal growths within the brain. The neurosurgeon will eliminate as much of the tumour as possible during the surgery while preserving brain function.
Craniotomy involves creating an opening in the skull to access the tumour. The neurosurgeon carefully removes the tumour or as much of it as possible without causing damage to healthy or eloquent brain tissue. In some cases, advanced imaging, such as neuronavigation, is used to precisely locate and remove the tumour. During the surgery, a biopsy is performed to obtain a small tumour sample to analyse the tumour type and guide further treatment options.
In cases where brain tumours are located in accessible areas, minimally invasive endoscopic surgery may be suitable. It involves inserting a thin, flexible tube with a camera and surgical instruments through small openings to visualise and remove the tumour. Such surgery technique reduces trauma to the surrounding brain tissues, leading to a potentially faster recovery, shorter hospital stays, and fewer complications.
Brain Tumour Surgery
Brain tumour surgery is a specialised procedure performed to remove abnormal growths within the brain. The neurosurgeon will eliminate as much of the tumour as possible during the surgery while preserving brain function.
Craniotomy involves creating an opening in the skull to access the tumour. The neurosurgeon carefully removes the tumour or as much of it as possible without causing damage to healthy or eloquent brain tissue. In some cases, advanced imaging, such as neuronavigation, is used to precisely locate and remove the tumour. During the surgery, a biopsy is performed to obtain a small tumour sample to analyse the tumour type and guide further treatment options.
In cases where brain tumours are located in accessible areas, minimally invasive endoscopic surgery may be suitable. It involves inserting a thin, flexible tube with a camera and surgical instruments through small openings to visualise and remove the tumour. Such surgery technique reduces trauma to the surrounding brain tissues, leading to a potentially faster recovery, shorter hospital stays, and fewer complications.
Brain Mapping/Awake Surgery
Awake brain surgery (also known as awake craniotomy) refers to the resection of brain tumours in eloquent brain areas. It is now a standard practice in most neurosurgical departments. This procedure aims to remove as much tumour as possible and to improve the patientโs quality of life, including symptoms and seizure control.
During the surgery, while removing the tumour, the neurosurgeon will test the patientโs speech, language and movement functions through real-time feedback, providing insights into the brainโs functional areas. This enables the neurosurgeon to safely remove the tumour whilst preserving the patientโs functions.
Furthermore, brain mapping techniques also help identify specific brain regions responsible for critical functions like motor skills, emotions, executive functions, speech and sensory processing. This information enables the surgical team to avoid damaging these essential areas during the procedure. This technique serves several crucial purposes:
- Assessing Language Function: During awake brain surgery, language mapping is critical. Techniques such as direct cortical stimulation or functional imaging can help the surgical team identify language areas in the brain. Surgeons can precisely locate and preserve essential language centres by stimulating specific brain regions and observing the patientโs response.
- Monitoring Motor Function: Brain mapping also helps monitor motor function during awake brain surgery. By stimulating various brain areas and observing the patientโs motor responses, surgeons can avoid damaging motor areas critical for movement and coordination.
- Adjusting Surgical Strategy: Real-time brain mapping data obtained during the surgery allows the surgical team to adjust their approach as needed. Suppose the mapped function is found to be near the affected area. In that case, the surgical team can modify their technique to minimise the risk of causing functional deficits.
- Maximising Tumour Resection: With brain mapping techniques, surgeons can achieve maximal tumour resection while avoiding damage to healthy brain tissue and critical functional areas. This approach aims to improve patient outcomes and reduce the risk of post-operative neurological deficits.
Many studies have shown improvements in epilepsy (seizures/ fits) control and post-operative neurocognitive (brain functioning) scores. In addition, it is relatively painless (as the brain itself cannot feel any pain) and patients can tolerate the procedure well.
Brain Mapping/Awake Surgery
Awake brain surgery (also known as awake craniotomy) refers to the resection of brain tumours in eloquent brain areas. It is now a standard practice in most neurosurgical departments. This procedure aims to remove as much tumour as possible and to improve the patientโs quality of life, including symptoms and seizure control.
During the surgery, while removing the tumour, the neurosurgeon will test the patientโs speech, language and movement functions through real-time feedback, providing insights into the brainโs functional areas. This enables the neurosurgeon to safely remove the tumour whilst preserving the patientโs functions.
Furthermore, brain mapping techniques also help identify specific brain regions responsible for critical functions like motor skills, emotions, executive functions, speech and sensory processing. This information enables the surgical team to avoid damaging these essential areas during the procedure. This technique serves several crucial purposes:
- Assessing Language Function: During awake brain surgery, language mapping is critical. Techniques such as direct cortical stimulation or functional imaging can help the surgical team identify language areas in the brain. Surgeons can precisely locate and preserve essential language centres by stimulating specific brain regions and observing the patientโs response.
- Monitoring Motor Function: Brain mapping also helps monitor motor function during awake brain surgery. By stimulating various brain areas and observing the patientโs motor responses, surgeons can avoid damaging motor areas critical for movement and coordination.
- Adjusting Surgical Strategy: Real-time brain mapping data obtained during the surgery allows the surgical team to adjust their approach as needed. Suppose the mapped function is found to be near the affected area. In that case, the surgical team can modify their technique to minimise the risk of causing functional deficits.
- Maximising Tumour Resection: With brain mapping techniques, surgeons can achieve maximal tumour resection while avoiding damage to healthy brain tissue and critical functional areas. This approach aims to improve patient outcomes and reduce the risk of post-operative neurological deficits.
Many studies have shown improvements in epilepsy (seizures/ fits) control and post-operative neurocognitive (brain functioning) scores. In addition, it is relatively painless (as the brain itself cannot feel any pain) and patients can tolerate the procedure well.
Brain Trauma Surgery
Brain trauma surgery focuses on treating traumatic brain injuries (TBIs) as a result of various causes such as accidents, falls, assaults, or sports-related injuries. It aims to stabilise the patient, prevent further damage to the brain and reduce the risk of complications. Several surgical procedures may be employed depending on the severity and type of brain injury:
> Craniotomy: In cases of severe traumatic brain injury, a craniotomy may be performed to remove blood clots, repair skull fractures or relieve pressure caused by swelling in the brain. This procedure involves temporarily removing a part of the skull to access the brain and address the underlying damage.
> Decompressive Craniectomy: In situations where there is significant swelling and increased pressure inside the skull, a decompressive craniectomy may be performed. This procedure involves removing a larger part of the skull to allow the brain to expand, reducing the risk of further damage due to increased intracranial pressure.
> Intracranial Pressure Monitoring: In some cases, surgeons may place intracranial pressure monitoring devices to continuously monitor the pressure inside the skull. This helps guide the management of intracranial pressure and can be crucial in preventing secondary brain damage.
> Repair of Skull Fractures: Surgery may be necessary to repair severe skull fractures that could potentially damage the brain or its surrounding structures. The repair is performed to stabilise the skull and protect the brain from further harm. After surgery, patients usually receive thorough observation, rehabilitation, and ongoing care aimed at aiding their recovery and maximising functional restoration.
Brain Trauma Surgery
Brain trauma surgery focuses on treating traumatic brain injuries (TBIs) as a result of various causes such as accidents, falls, assaults, or sports-related injuries. It aims to stabilise the patient, prevent further damage to the brain and reduce the risk of complications. Several surgical procedures may be employed depending on the severity and type of brain injury:
> Craniotomy: In cases of severe traumatic brain injury, a craniotomy may be performed to remove blood clots, repair skull fractures or relieve pressure caused by swelling in the brain. This procedure involves temporarily removing a part of the skull to access the brain and address the underlying damage.
> Decompressive Craniectomy: In situations where there is significant swelling and increased pressure inside the skull, a decompressive craniectomy may be performed. This procedure involves removing a larger part of the skull to allow the brain to expand, reducing the risk of further damage due to increased intracranial pressure.
> Intracranial Pressure Monitoring: In some cases, surgeons may place intracranial pressure monitoring devices to continuously monitor the pressure inside the skull. This helps guide the management of intracranial pressure and can be crucial in preventing secondary brain damage.
> Repair of Skull Fractures: Surgery may be necessary to repair severe skull fractures that could potentially damage the brain or its surrounding structures. The repair is performed to stabilise the skull and protect the brain from further harm. After surgery, patients usually receive thorough observation, rehabilitation, and ongoing care aimed at aiding their recovery and maximising functional restoration.
Cranioplasty
Cranioplasty is a surgery that repairs defects or deformities in the skull. It involves reconstructing or repairing a section of the skull that has been removed or damaged due to trauma, infection, tumour removal, or other neurological conditions. Cranioplasty helps restore the skullโs integrity and offer some form of protection to the brain, improve oneโs overall appearance, and in certain circumstances, may improve a patientโs overall neurology.
There are various options for Cranioplasty such as autograft, allograft and custom implants.
> Autograft: The surgeon uses the patientโs own bone, often previously stored in the patientโs abdomen, to reconstruct the skull defect. Autografts are often preferred as they reduce the risk of rejection and infection.
> Allograft: Uses bone from a donor, which is sterilised and processed before implanting into the patientโs skull. While allografts provide an alternative when autografts are not feasible, there is a risk of immune rejection and infection.
> Custom Implants: Advances in technology have led to the development of custom-made implants (patient-specific implant) using materials such as titanium or acrylic or other biocompatible materials like PEEK. These implants are designed based on the patientโs specific skull measurements, ensuring a precise fit and improved aesthetic outcome.
Cranioplasty
Cranioplasty is a surgery that repairs defects or deformities in the skull. It involves reconstructing or repairing a section of the skull that has been removed or damaged due to trauma, infection, tumour removal, or other neurological conditions. Cranioplasty helps restore the skullโs integrity and offer some form of protection to the brain, improve oneโs overall appearance, and in certain circumstances, may improve a patientโs overall neurology.
There are various options for Cranioplasty such as autograft, allograft and custom implants.
> Autograft: The surgeon uses the patientโs own bone, often previously stored in the patientโs abdomen, to reconstruct the skull defect. Autografts are often preferred as they reduce the risk of rejection and infection.
> Allograft: Uses bone from a donor, which is sterilised and processed before implanting into the patientโs skull. While allografts provide an alternative when autografts are not feasible, there is a risk of immune rejection and infection.
> Custom Implants: Advances in technology have led to the development of custom-made implants (patient-specific implant) using materials such as titanium or acrylic or other biocompatible materials like PEEK. These implants are designed based on the patientโs specific skull measurements, ensuring a precise fit and improved aesthetic outcome.
EC-IC Bypass Surgery
Extracranial-intracranial (EC-IC) bypass surgery shares similarities with cardiac bypass surgery, as it diverts the blood flow from the blocked brain arteries to enhance the brainโs oxygen and nutrient supply, much like how cardiac bypass surgery redirects blood around clogged heart arteries to improve blood and oxygen flow to the heart.
During the surgery, an alternate pathway is created for blood to bypass the narrowed or blocked arteries, ensuring an adequate supply of oxygen and nutrients to the brain.
The most common EC-IC bypass procedure involves:
Superficial Temporal Artery to Middle Cerebral Artery Bypass: The superficial temporal artery is a branch arising from the external carotid artery. This technique connects the superficial temporal artery to the middle cerebral artery, allowing blood to flow directly into the brain, bypassing occluded or stenosed arteries.
EC-IC Bypass Surgery
Extracranial-intracranial (EC-IC) bypass surgery shares similarities with cardiac bypass surgery, as it diverts the blood flow from the blocked brain arteries to enhance the brainโs oxygen and nutrient supply, much like how cardiac bypass surgery redirects blood around clogged heart arteries to improve blood and oxygen flow to the heart.
During the surgery, an alternate pathway is created for blood to bypass the narrowed or blocked arteries, ensuring an adequate supply of oxygen and nutrients to the brain.
The most common EC-IC bypass procedure involves:
Superficial Temporal Artery to Middle Cerebral Artery Bypass: The superficial temporal artery is a branch arising from the external carotid artery. This technique connects the superficial temporal artery to the middle cerebral artery, allowing blood to flow directly into the brain, bypassing occluded or stenosed arteries.
Endoscopic Endonasal Pituitary Surgery
Endoscopic endonasal pituitary surgery is a minimally invasive surgical procedure that treats various pituitary gland disorders. This technique involves accessing the pituitary gland through the nasal passages, eliminating the need for external incisions on the face or skull. The procedure uses an endoscope โ a thin tube with a camera and light at its tip, allowing the surgical team to visualise and access the surgical site.
During the surgery, the endoscope will be inserted through the nostrils and navigated to the sphenoid sinus, a hollow space behind the nasal passages. Using a specialised surgical instrument, it removes tumours, cysts, or other abnormalities affecting the pituitary gland. This approach provides direct access to the pituitary gland and surrounding structures, allowing for precise and targeted removal of lesions while minimising damage to healthy tissues.
Endoscopic Endonasal Pituitary Surgery
Endoscopic endonasal pituitary surgery is a minimally invasive surgical procedure that treats various pituitary gland disorders. This technique involves accessing the pituitary gland through the nasal passages, eliminating the need for external incisions on the face or skull. The procedure uses an endoscope โ a thin tube with a camera and light at its tip, allowing the surgical team to visualise and access the surgical site.
During the surgery, the endoscope will be inserted through the nostrils and navigated to the sphenoid sinus, a hollow space behind the nasal passages. Using a specialised surgical instrument, it removes tumours, cysts, or other abnormalities affecting the pituitary gland. This approach provides direct access to the pituitary gland and surrounding structures, allowing for precise and targeted removal of lesions while minimising damage to healthy tissues.
Gamma Knife Radiography
Gamma Knife Radiosurgery is a non-invasive neurosurgical procedure that uses highly focused gamma radiation to treat various conditions within the brain, including tumours, vascular malformations and functional disorders. Despite its name, it does not involve any incisions or the use of an actual knife. Instead, it utilises multiple beams of gamma radiation to target specific areas in the brain with precision, delivering a high dose of radiation to the targeted site while minimising exposure to the surrounding healthy tissue.
During the procedure, the patientโs head is secured in a frame to ensure precise positioning. Advanced imaging techniques, such as MRI or CT scans, are used to create a detailed, three-dimensional map of the target area. Based on this map, the Gamma Knife system delivers highly focused radiation beams to the specific target, resulting in the destruction of the targeted tissue over time.
Gamma Knife Radiography
Gamma Knife Radiosurgery is a non-invasive neurosurgical procedure that uses highly focused gamma radiation to treat various conditions within the brain, including tumours, vascular malformations and functional disorders. Despite its name, it does not involve any incisions or the use of an actual knife. Instead, it utilises multiple beams of gamma radiation to target specific areas in the brain with precision, delivering a high dose of radiation to the targeted site while minimising exposure to the surrounding healthy tissue.
During the procedure, the patientโs head is secured in a frame to ensure precise positioning. Advanced imaging techniques, such as MRI or CT scans, are used to create a detailed, three-dimensional map of the target area. Based on this map, the Gamma Knife system delivers highly focused radiation beams to the specific target, resulting in the destruction of the targeted tissue over time.
Skull Base Surgery
Skull Base Surgery treats various conditions affecting the intricate structures at the skullโs base and the top of the neck. This complex area houses critical nerves and blood vessels responsible for crucial functions such as vision, hearing, balance, and facial movement. Conditions that may require skull base surgery include tumours, vascular abnormalities, trauma, and specific congenital abnormalities.
Skull Base Surgery can be performed via open surgical techniques, minimally invasive endoscopic procedures or a combination, depending on the specific condition and location. It removes tumours, repair abnormalities, relieve pressure on the brain or nerves, and preserve neurological function and overall quality of life. Advanced imaging such as MRI, CT scans, and angiography, are used to precisely map the area and identify the extent of the pathology before the surgery.
In addition, skull base surgery has significantly evolved with the advancements in surgical techniques and technologies, allowing for improved outcomes, reduced morbidity, and enhanced quality of life for patients with complex skull base conditions.
Skull Base Surgery
Skull Base Surgery treats various conditions affecting the intricate structures at the skullโs base and the top of the neck. This complex area houses critical nerves and blood vessels responsible for crucial functions such as vision, hearing, balance, and facial movement. Conditions that may require skull base surgery include tumours, vascular abnormalities, trauma, and specific congenital abnormalities.
Skull Base Surgery can be performed via open surgical techniques, minimally invasive endoscopic procedures or a combination, depending on the specific condition and location. It removes tumours, repair abnormalities, relieve pressure on the brain or nerves, and preserve neurological function and overall quality of life. Advanced imaging such as MRI, CT scans, and angiography, are used to precisely map the area and identify the extent of the pathology before the surgery.
In addition, skull base surgery has significantly evolved with the advancements in surgical techniques and technologies, allowing for improved outcomes, reduced morbidity, and enhanced quality of life for patients with complex skull base conditions.
Ventriculo Peritoneal (VP) Shunts
Ventriculoperitoneal (VP) shunts are medical devices used to treat hydrocephalus, a condition characterised by the accumulation of Cerebrospinal Fluid (CSF) within the brainโs ventricles, leading to increased pressure and potential brain damage.
The VP shunt works by diverting excess CSF from the brainโs ventricles to the abdominal cavity, where the body can absorb it. The shunt system consists of several components, including a catheter placed within the brainโs ventricles, a valve regulating CSF flow and another catheter extending to the peritoneal cavity in the abdomen.
The VP shunt placement procedure involves creating a small hole in the skull to insert the catheter into the ventricles. The other end of the catheter is passed under the skin, usually behind the ear, down the neck, and into the peritoneal cavity. The valve helps regulate the flow of CSF, ensuring that the pressure within the brain remains at an appropriate level. This may help alleviate the symptoms associated with hydrocephalus, such as headaches, nausea, gait instability and cognitive difficulties, by reducing the excessive buildup of CSF.
Ventriculo Peritoneal (VP) Shunts
Ventriculoperitoneal (VP) shunts are medical devices used to treat hydrocephalus, a condition characterised by the accumulation of Cerebrospinal Fluid (CSF) within the brainโs ventricles, leading to increased pressure and potential brain damage.
The VP shunt works by diverting excess CSF from the brainโs ventricles to the abdominal cavity, where the body can absorb it. The shunt system consists of several components, including a catheter placed within the brainโs ventricles, a valve regulating CSF flow and another catheter extending to the peritoneal cavity in the abdomen.
The VP shunt placement procedure involves creating a small hole in the skull to insert the catheter into the ventricles. The other end of the catheter is passed under the skin, usually behind the ear, down the neck, and into the peritoneal cavity. The valve helps regulate the flow of CSF, ensuring that the pressure within the brain remains at an appropriate level. This may help alleviate the symptoms associated with hydrocephalus, such as headaches, nausea, gait instability and cognitive difficulties, by reducing the excessive buildup of CSF.