"The tools used by the surgeons must be adapted to the task and where the human brain is concerned they cannot be too refined."
by Lars Leksell

History
Neurosurgery has undergone a sea change since the days of Harvey Cushing. The development of bipolar cautery, the use of the surgical microscope, the availability of the ultrasonic surgical aspirator have all contributed to decreasing morbidity and mortality. Advances in neuroanaesthesia, neurosurgical intensive care and neuro-imaging technology have played a significant role. We are now in the age of Minimally Invasive Neurosurgery. The goal and the aims of treatment have shifted. It is no longer enough to save life but preserving of all functions, cosmesis and reducing pain, shorter hospital stay, avoiding discomfort are equally important. To fulfill these aims of excellence in neurological health care, the Apollo Institute of Neurosciences has been set up as a part of Dr. Reddy's vision of World Class Health Care facilities in India.

The Apollo Institute of Neurosciences is equipped with facilities at par with the best in the world. The most modern technology and equipment is provided to cover the entire range of neurological diseases. About 1000 major neurosurgical operations are being carried out every year. Transsphenoidal surgery for pituitary tumor, spinal fusions for congenital and traumatic (CT scan & MRI for locating the target for functional neurosurgery) and intra-operative monitoring for different kinds of surgery are all being done on a routine basis.

The highlights of the facilities available are :

1. Dedicated Neurosurgical and Neuro Anaesthesia Team
The department consists of five full time, one part time and several visiting Senior Consultant Neurosurgeons, each with their own associate consultants. There are four dedicated neuroanaesthesiologists to run the anaesthesia services. Two operating theatres with nursing staff and eleven bedded dedicated neurosurgical intensive care unit. Intra-operative electro physiological monitoring for spinal surgery, functional surgery and posterior fossa surgery is being carried out by an expert specially trained for intra-operative monitoring.

2. Diagnostics
The Diagnostics department is fully complete with facilities for Computerised Tomography (CT), Magnetic Resonance Imaging (MRI) and Angiography. All routine X-rays and ultrasound investigations are carried out here. The department of Radiology consists of thirteen Senior consultants, Associate consultants, Junior Consultants, Registrars and Sonologists.

3. Operating Rooms
The two neurosurgical theatres are ultra modern and equipped for all types of neurosurgical operations. Both theatres have a laminar air flow system and are equipped with the latest ceiling mounted microscope with in-built still photography and video recording facilities. One of them also is capable with the optical tracking system (OTS). OTS allows the monitoring of the progress of surgery in real time. Residual tumors, haemorrhage etc. can all be visulised.

4. The Intensive Care Unit
The modern eleven bedded facility is equipped with the latest Modular invasive monitoring system (HP) and advanced life support equipment capable of managing complicated neurosurgical and neurological patients effectively. The nursing ratio is one to one. All associated specialists like respiratory physicians, nephrologists and endocrinologists are available round the clock.

5. Specialised Equipments

a. Dedicated X-Knife
An exclusive department in the hospital houses this machine which is the first dedicated X-Knife outside the United States. X-knife has the added advantage of being used for fractioned treatment (stereotactic Radiotherapy-SRT) for benign and malignant tumors not suitable for SRS.

b. Computer Assisted Neurosurgery
The Apollo Hospital has now taken the first step in this part of the world with the availability of this new technology. This was the first centre in North East Asia to have this equipment. Surgeons at the Apollo Institute of Neurosciences are now using an operating computer with an accuracy of 1mm in which images of the patient's brain can be directly transferred from the MRI or CT Scan to the Operating Theatres at the Operating Table. The surgeon can join the probe to different parts of the brain and retrieve the images previously taken. This is of great help not only in locating difficult tumors, but also in avoiding critical structures and ensuring completeness of excision. Surgery for abnormal movements, epilepsy and small deep malformation is being done.

c. Frame Based Stereotaxy
The Radionics CRW System in this hospital is complete with full range of accessories to include the ability to carry out Frame Based Stereotactic Surgery including Craniotomies. Equipment is also available to generate RF lesions and has been used successfully for functional neurosurgery procedures like pallidotomy and thalamotomy for treatment of movement disorders and parkinsons disease. Image guided Frameless stereotaxy allows safe surgery in eloquent areas. This Apollo Institute of Neurosciences is one of the first hospital to have this kind of complete technology in this part of the world.

d. Interventional Neuro Radiology
A separate Department and a separate machine is available for this crucial area. The development of such a centre was a priority with this hospital. This machine has biplane rotational angio facilities and is being utilized for embolization of arteriovenous malformation, treatment of giant aneurysms by proximal occlusion and endovascular packing using GDC system. Thrombolysis by injection of Urokinase directly into thrombus in the specific artery in the treatment of brain attack is being done. Angioplasty and stenting is being done to prevent stroke. Vascular lesions such as dural AV malformations, carotid-cavernous fistula hemangiomas of the head and neck, vascular tumors are all being treated. More than 150 therapeutic procedures and more than 300 diagnostic procedures are being done annually.

e. Microsurgical Instrumentation
Two complete sets of Microsurgical Instruments are available for all surgeons to carry out full range of microsurgery for cranial as well as spinal surgery.

f. Neuroendoscopy
Equipment for minimally invasive endoscopic removal of certain tumors (eg. intraventricular and pituitary tumors), third ventriculostomy in the treatment of hydrocephalus, drainage of brain abscesses and cysts is used routinely.

g. Spinal Instrumentation
A complete range of spinal instrumentation is available for stablising the spine using metal implants. These are used in cases of spinal instability from spinal injuries, Tuberculosis & tumors. This allows early ambulation, facilitates rehabilitation and early discharge from hospital.