Advanced Treatment Techniques

Craniotomy is the most commonly performed procedure in neurosurgery, in which a portion of the skull is temporarily removed to provide direct access to the brain. This technique is used in a wide range of conditions including traumatic brain injury, intracranial haematoma, haemorrhagic stroke, brain tumours, and raised intracranial pressure.

Timely and precise craniotomy is critical in trauma cases, significantly improving prognosis. This surgical intervention reduces intracranial pressure by evacuating haematomas or removing contused tissue. Ultimately, this protects viable brain parenchyma, minimizes long-term brain injury, and maximizes recovery potential.

Some pituitary adenomas respond well to medical management, whilst others are better treated surgically. At FV Hospital, through close collaboration between experienced neurosurgeons and ENT specialists, many pituitary adenomas can be treated using an endoscopic endonasal trans-sphenoidal approach, allowing direct access to the pituitary gland without the need for craniotomy.

Through this natural anatomical corridor, surgeons can remove the tumour with a high degree of precision whilst minimising disruption to the brain and surrounding structures. This minimally invasive technique reduces post-operative pain, lowers the risk of infection, shortens the hospital stay, and enables faster recovery.

In many cases, surgery also results in restoration or improvement of endocrine function, a reduction in long-term medication dependence, and a meaningful improvement in quality of life.

Hydrocephalus is a condition in which the cerebral ventricles (the fluid-filled cavities deep within the brain) contain an excessive volume of cerebrospinal fluid (CSF), or in which the CSF pressure within those cavities is abnormally elevated. Hydrocephalus occurs most commonly in children and may be caused by congenital conditions in which the brain develops abnormally and the CSF drainage pathways are malformed, leading to fluid accumulation. It may also develop as a consequence of brain tumours, intracranial haemorrhage, or acquired disease.

The most widely used treatment is ventriculo-peritoneal (VP) shunt insertion. The surgeon places a system of slender tubing within the cerebral ventricle to divert the excess CSF to the peritoneal cavity of the abdomen, where it can be reabsorbed by the body. The system incorporates a pressure-regulating valve, which is calibrated to control the rate of drainage appropriate to each patient’s individual condition.

By maintaining stable intracranial pressure, the VP shunt helps relieve symptoms, protect brain function, and support long-term neurodevelopmental progress and quality of life.

When a tumour is situated in or near the eloquent cortex, the areas of the brain that govern speech or motor function, performing surgery purely under general anaesthesia may prevent the surgical team from monitoring functional integrity in real time.

An awake craniotomy addresses this difficulty head-on: the patient remains conscious and comfortable during the critical stage of the operation, carrying out straightforward tasks such as talking or moving a hand whilst the surgeon operates. Should any alteration in neurological function be picked up, the team can immediately modify their approach. The benefit is a more complete tumour resection with a substantially lower risk of post-operative neurological deficit.

Spine conditions affecting the neck and back are among the most common medical ailments. Approximately 80% of people will experience backache at some point in their lives. Pain arises when the complex structures of the spine — comprising the vertebral bodies, intervertebral discs, spinal cord, nerve roots, and paraspinal musculature — become disrupted or degenerate. Everyday movements such as twisting, bending forward, prolonged standing, and lifting can become acutely painful and mechanically restricted.

Meningocele is a congenital spinal defect in which the meninges and cerebrospinal fluid herniate through a gap in the vertebral column, forming a visible sac on the surface of the back. In the majority of cases, the sac does not contain neural tissue, yet surgical repair is still required to protect the nervous system and prevent complications.

The surgical objective is to close the defect and reconstruct the protective covering of the spinal cord. The specific technique chosen depends on the anatomical level of the lesion.

With modern surgical techniques, treatment can reliably protect neurological function, reduce the risk of infection, and support improved long-term mobility and development.

The minimally invasive approach to spinal canal stenosis and intervertebral disc disease uses percutaneous tubular retractors to perform the entire procedure through small skin incisions, avoiding the extensive muscle dissection required in open surgery. MIS spinal fusion techniques are particularly applicable to patients requiring stabilisation due to trauma, advanced degenerative disc disease, or facet joint arthropathy.

Compared with open spinal surgery, this approach offers smaller incisions, significantly less post-operative pain, reduced risk of surgical site infection, faster recovery, and minimal disruption to the healthy musculature surrounding the spine, maximising both the efficacy and efficiency of the procedure.

Patients presenting with advanced degenerative spinal disease, scoliosis, spondylolisthesis, or other forms of spinal deformity may require complex multi-level spinal fusion procedures. These operations utilise titanium pedicle screw-and-rod constructs to immobilise the affected spinal segments, the segments causing pain due to arthritic degeneration or abnormal alignment. In both scenarios, the vertebral joints exhibit pathological movement, which generates pain upon movement.

The goal of surgery is to eliminate movement-related pain by achieving solid bony fusion across the instrumented levels, locking the unstable joints into correct alignment. Fusion is considered successful once the instrumented segment has consolidated into mature bone. The titanium implants provide structural support and maintain spinal alignment throughout the fusion process.

These are minimally invasive procedures used in the treatment of vertebral compression fractures caused by osteoporosis or trauma. An untreated vertebral compression fracture causes significant pain and can progress to kyphotic deformity.

In vertebroplasty, the surgeon introduces a needle into the collapsed vertebral body and injects polymethylmethacrylate (PMMA) bone cement directly to stabilise the fractured bone, providing rapid pain relief and improved functional mobility.

In kyphoplasty, a small balloon catheter is first inflated within the collapsed vertebral body to restore vertebral height before the cement is injected. This technique achieves partial restoration of vertebral height and helps prevent further kyphotic deformity.

Conditions such as trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia are typically caused by neurovascular compression, which is abnormal contact between a blood vessel and a cranial nerve. This contact then triggers severe episodes of pain or involuntary muscle contraction that profoundly affect daily life. Minimally invasive options include percutaneous rhizotomy, in which a needle is used to selectively ablate the pain-generating fibres of the trigeminal nerve.

Where open surgical intervention is required, microvascular decompression (MVD) is performed through a small retromastoid craniotomy. This procedure identifies and separates the offending vessel from the compressed nerve and interposes a protective implant, providing durable, long-term relief of symptoms.

Chronic pain management at FV is delivered through a multimodal approach that integrates minimally invasive interventional techniques with advanced surgical procedures. Methods such as analgesic injections and spinal nerve blocks not only provide symptom control but also assist in precisely identifying the anatomical source of cervical or lumbar pain.

For patients with persistent or treatment-refractory pain, advanced neuromodulation techniques, including spinal cord stimulation (SCS) and deep brain stimulation (DBS), may be indicated to modulate aberrant pain signalling. Microvascular decompression and rhizotomy are available for specific neuropathic pain conditions such as trigeminal neuralgia.

For patients with chronic post-surgical spinal pain, implantable devices such as intrathecal drug delivery systems or spinal cord stimulators can provide superior long-term pain control, restore functional capacity, and significantly improve quality of life.

For patients whose epilepsy is refractory to antiepileptic medication, surgery can offer the potential for meaningful seizure reduction or complete seizure freedom. One of the most well-established procedures is selective amygdalohippocampectomy, in which the surgeon excises a precisely delineated area of tissue deep within the temporal lobe, the region most commonly responsible for generating drug-resistant focal seizures.

At FV Hospital, the procedure is carried out with the support of the intraoperative neuronavigation system and continuous intraoperative neurophysiological monitoring (IOM), ensuring accurate localisation of the epileptogenic zone whilst minimising any impact on critical functions such as memory and language. Consequently, many patients achieve a substantial reduction in seizure frequency or complete cessation of seizures, with sustained improvement in their quality of life.