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THE PITUITARY GLAND AND TUMOURS
Called the ‘master gland’, the pituitary gland produces hormones that regulate various organs and glands, making it critical to the functioning of the body. Pituitary tumors are among the most common intracranial tumours occuring in a variety of sizes. More than 90% of these are benign, about 5 to 10% are a little more aggressive and less than 1%  are malignant.

Nearly 20% of people have pituitary tumours but many go through their whole lives without having them diagnosed. Those which do grow however can have serious effects considering the critical nature of the pituitary’s functions and require surgery without delay.

Considering the location of the pituitary gland and its vital importance to the functioning of the body, surgery to extract these tumours is complex and challenging and demands the highest level of neurosurgical skill.

At Sita Bhateja Speciality Hospital we have a highly skilled team of surgeons who have had a high level of success treating pituitary tumours. In fact, the pituitary and skull base surgical programme is among our most highly regarded programmes.

Read more about our Pituitary and Skull Base Tumour Programme here.

Trigeminal Neuralgia
Sometimes referred to as ‘tic douloureux’, trigeminal neuralgia is among the most excruciating forms of pain known to man. Pain is centred around the lower part of the face and jaw and occasionally the nose and the area above the eye. The pain, often described as an intense, shock-like pain (resembling an electric shock) is a result of irritation of the trigeminal nerve which branches out to the forehead, cheek and lower jaw. Pain is usually only on one side of the face.

Treatment
Unfortunately trigeminal neuralgia cannot always be cured. However, the good news is that there are a variety of treatments to manage the pain. First choice for most patients are anticonvulsive medications. If patients develop a resistance to medication, surgery can be an effective option too.

The surgery with the best results and least adverse effects is microvascular decompression. This is a microsurgical procedure in which a compressing artery is gently separated from the trigeminal nerve and an insulating pledget of teflon is placed between the two. This immediately relieves the patient of pain and liberates them from
the need for constant medication.

(LINK TO VIDEO)

Arteriovenous Malformations
An AVM is a tangle of abnormal arteries and veins which has a propensity to bleed. While it can occur anywhere, brain and spinal AVMs are the ones which can put a patient at substantial risk.

Due to the brain and its blood vessels being formed together during embryological development, abnormal blood vessel formation tends to be associated with abnormal brain tissue. Thus, AVMs tend to be associated with abnormal tissue thereby allowing their removal without damaging healthy brain tissue.

Dural AVMs are found in the dura (covering) of the brain. These are ‘acquired’ which means they are triggered by trauma. AVMs may develop after a head or spine trauma, and these are referred to as AV fistulas.

Carotid Stenosis
The carotid arteries lie on each side of the neck, extending from the aorta in the chest to the base of the skull. They perform a critical function as they are the main blood vessels to the brain. Sometimes due to the build-up of cholesterol and fat, plaque is formed, thereby narrowing the carotid arteries and reducing blood flow. This condition
is known as carotid stenosis and it can lead to a stroke.

Treatment: Carotid stenosis is treated by a fairly common surgical procedure called a ‘carotid endarterectomy’ which can effectively prevent a stroke.

Cavernous Malformations
Also referred to as cavernomas, cavernous angiomas, cavernous hemangiomas or intracranial vascular  malformations, these are clusters of small, abnormal, blood vessels and large, thin-walled blood vessels filled with blood. Typically found in the brain, they do also occur in the spinal cord, the dura (the covering of the brain) and the
nerves in the skull. They cover a broad range of sizes from as little as a quarter of an inch to 3 to 4 inches.

Treatment: Cavernomas can potentially haemorrhage, putting the patient at huge risk. So, they require surgical excision via a craniotomy.

Click here to read more about our patient Moumita’s case study

Cerebral Aneurysm
A cerebral (brain or intracranial) aneurysm occurs when a blood vessel in the brain weakens. This results in a bulge or balloon developing in the wall of the blood vessel. Typically an aneurysm tends to develop at a ‘fork’ in a blood vessel since that is where it is structurally vulnerable. They can be the result of congenital defects or a variety of
conditions like atherosclerosis, high BP and occasionally trauma to the head or even infection.

Aneurysms may present as catastrophic rupture leading to sub-arachnoid haemorrhage – a potentially life-threatening fatal condition.

Treatment: Once ruptured then the patient requires immediate admission to an ICU and evaluation regarding the presence and location of the aneurysm. Based on this evaluation and the patient’s clinical condition, a decision is taken regarding treatment.

The primary goal of treatment is exclusion of the aneurysm from the circulation. This can be done by one of two methods – surgical (clipping of the aneurysm) or endovascular (via coils).

Cerebrovascular Disease
The word cerebrovascular is made up of two parts – ‘cerebro’ which refers to the large part of the brain, and “vascular” which refers to arteries and veins.

Cerebrovascular disease refers to any and all disorders wherein a part of the brain is affected (whether temporary or permanent) by bleeding or ischemia with cerebral blood vessels being involved. It may include carotid, vertebral and intracranial stenosis, aneurysms, strokes and vascular malformations.

Restrictions in blood flow may occur from vessel narrowing (stenosis), clot formation (thrombosis), blockage (embolism), or blood vessel rupture (hemorrhage). Lack of sufficient blood flow (ischemia) affects brain tissue and may cause a stroke.

Treatment: Treatment is cerebral revascularization using a STA-MCA bypass or a highflow bypass in selected cases.

Stroke
Stroke is an abrupt interruption of constant blood flow to the brain causing a loss of neurological function. This may be due to blockage or bleeding. The former causes the more common ischemic stroke which causes about 87% of all strokes. The latter causes the haemorrhagic stroke which, although rarer, is considered infinitely more dangerous.

Often there is very little warning of an impending stroke but the effects of it can be debilitating to fatal. Starved of blood flow, brain cells which require constant oxygen and nutrients can be damaged or even die within minutes. Once dead, brain cells typically don’t regenerate and this can result in mental and even physical disabilities. Thus, it is of vital importance that oxygen and blood flow be restored as quickly as possible.






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