The Advanced Aneurysm Treatment Unit at Nanavati Max Super Speciality Hospital offers comprehensive care for the treatment of aneurysms. A cerebral aneurysm is a medical condition that occurs due to weakness in the wall of an artery in the brain, which results in a balloon-like sac outpouching. An aneurysm may be detected following a haemorrhage presenting as severe headache or incidental. Our multidisciplinary team of neuro-intensivists, vascular neurologists, endovascular neurosurgeons, and vascular neurosurgeons takes a joint consultation with neuro-radiologists for providing optimal treatment solutions tailored particularly for an aneurysm. We strive to offer the most appropriate care in the shortest time possible and are available 24X7 for emergencies. The unit follows a multidisciplinary approach in treating most of the complex and rare cases related to a brain aneurysm using advanced minimally invasive technology and services, in order to ensure quality care and successful recovery. We are at the forefront to provide the highest quality evidence-based care to individuals who have been affected by a brain aneurysm and to help them improve their quality of life. We offer treatment for cerebral aneurysms using the most complex and precise neurosurgeries also called Neurointerventions or Neuroendovascular surgeries that are performed using the endovascular route without opening the skull.

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About 80% of adults in India experience back pain at some point in their lifetime. It can be due to many reasons such as poor posture, sedentary lifestyle, injuries, acquired conditions and diseases, infections, tumours, etc. The Back Pain Management Unit Nanavati Max Super Speciality Hospital offers comprehensive services to manage back pain varying from simple lower back pain, caused by a range of sprains and strains to acute and chronic back pain that may last for a few weeks or months. We specialize in treating back pain even after an initial injury or uprooting the underlying cause of low back pain.

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Spine is one of the strongest parts of the human body. It balances the entire body weight and our workload. Spine suffers a lot of wear and tear continuously throughout life. Before the age of 30, we can jump/run and endure long hours of work and play. This is because the spine and muscles are strong. All we feel is a tired ache or cramp due to overactivity which is relieved with proper rest. After the age of 30, your spine starts getting weaker and stiffer thereby losing its performance endurance and strength. Hence, to support the spine better, our muscles need to gear up. The Centre of Spine Surgery at Nanavati Max Super Specialty Hospital offers a wide range of services to diagnose and treat acute and chronic spinal disorders. From non-surgical treatments to surgical options, we develop patient-centric treatment plans intending to help our patients return to a normal and active lifestyle. The centre is known for providing comprehensive care to each patient using a multidisciplinary approach, leading-edge technology, state-of-the-art infrastructure, and managing all kinds of spinal surgeries such as:- 

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The Centre for Neurosciences at Nanavati Max Super Speciality Hospital offers Cranioplasty Surgery treatment for patients requiring surgical treatment for complex problems of the skull. Cranioplasty is a surgical repair procedure that is performed to repair a bone defect in the skull which could be a result of injury or left behind after a previous operation. Our team of craniofacial, neuro-plastic, and microvascular surgeon follow a multidisciplinary approach to achieve the best possible results for patients requiring surgical repair of skull fractures or deformities. We treat both simple and complex deformities by using cranial modelling technology to provide patients with positive outcomes, both medically and cosmetically. The Centre for Neurosciences at Nanavati Max Hospital performs Cranioplasty Surgery for a variety of medical conditions such as head trauma or a surgical procedure that has left a noticeable change in the contours of your skull or face. We understand the patient’s unique needs and offer a surgical approach that combines the skill and precision of both neurosurgery and craniofacial plastic surgery. The overarching goals of cranioplasty include restoring natural function, as well as enhancing aesthetics. In order to correct the defect a doctor perform Cranioplasty using a prosthetic or other synthetic surgical material or material from patients own body, such as: A piece of bone from the patient’s rib or pelvis A piece of bone from the patient’s skull (that is removed and replaced) Acrylic Mesh or plate titanium Synthetic bone-like material We are committed to offering the latest surgical techniques for Cranioplasty Surgery, with an emphasis on Minimally Invasive Surgery. As a patient, you can expect to receive most personalised surgical plans that will address your specific condition and provide access to the care you need and deserve

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What is Epilepsy? Epilepsy is a neurological disorder causing recurrent seizures due to abnormal neural activity in the brain cortex. Seizures are sudden and erratic electrical impulses that disturb the normal activity of the brain. A person is said to be suffering from epilepsy if they have two or more seizures without any trigger. Associated Anatomy Brain Types of Epilepsy Epilepsy is divided into four, depending on the type of seizures: Generalized seizures: affects both sides of the brain which may or may not involve muscle movements. When muscles are involved, they are called motor seizures and cause jerky movements that lead to muscle rigidity and weakness. If there are no muscles involved, then they are termed non-motor seizures and cause brief twitching, blinking or staring, and a confused look. Some other types of generalized seizures are Petit Mal or absence seizures Myoclonic seizures tonic and atonic seizures grand mal or tonic-clonic seizures Focal seizures: affect only one part of the brain and spread to other parts causing symptoms that range from mild to severe. They are the most common seizures that begin with a typical sensation called Aura, a feeling of blankness or an unpleasant sensation in the stomach. Generalized and focal seizures: involves the features of both generalized and focal seizures Unknown seizures: when there is no clear-cut distinction between the type of seizures, and even medical professionals do not have information about its origin. Causes of Epilepsy Most seizures have an unknown origin. However, genetics and some acquired factors are known to cause epileptic seizures. People having a family history of epilepsy in parents, siblings and immediate relatives, have a higher chance of developing this condition in the future Congenital conditions A serious brain injury during childbirth Metabolic diseases like Phenylketonuria Brain tumors Infections like meningitis, encephalitis, neurocysticercosis and cerebral malaria A brain stroke Accidents causing injury to the brain Chronic alcohol and drug use Epilepsy Symptoms The most typical feature of epilepsy is recurrent seizures which may or may not be accompanied by erratic muscular movements. Different types of seizures have different symptoms: Symptoms of simple or focal seizures A feeling of uneasiness in the stomach A feeling of having a deja vu Tingling sensation in hands and legs Sudden twitching movements of hands and arms A person doesn't lose consciousness in focal seizures and it is always accompanied by an Aura, a premonition sign that something is about to happen. Symptoms of complex focal seizures Accompanied by the smacking of lips, swallowing, and chewing Random movements of arms Tonic-clonic seizures (Grand mal seizures) A typical epileptic fit occurs in two stages, lasting for a few minutes. Stage 1 or Tonic stage: Unconsciousness, stiffness in the body, and chances of falling down Stage 2 or Clonic stage: Jerky limb movements with chances of injury to the tongue, lips, and cheeks. Absence or Petit Mal seizures Loss of consciousness of the surroundings Gazing blankly into space Fluttering of eyes Jerking movements of the body Myoclonic seizures Resembles a person having an electric shock Lasts for a few seconds and generally occurs after waking up from sleep Status epilepticus A severe form of seizure and requires immediate medical attention lasts for a long time loss of consciousness Risk factors of Epilepsy Trauma during birth that may have caused injury to the brain Premature birth Brain tumors Injury in any part of the brain that damaged blood flow Stroke Brain infections like meningitis and encephalitis Fever in childhood that lasted for a long time, affecting the brain Family history of epilepsy Alcohol and drug abuse Cerebral palsy Complications of Epilepsy Epilepsy alters the quality of life of an individual, if not treated. Possible complications that may arise are: Permanent brain damage Difficulty in learning and thought Prone to grievous injuries like accidents, drowning, etc. Choking on saliva or food during seizures Epilepsy Treatment Medications Anticonvulsants or antiepileptic drugs like valproic acid, zonisamide, phenytoin, and oxcarbazepine are prescribed. They work by altering the chemicals in the brain and hence control the onset of seizures. Surgery Laser interstitial thermal therapy (LITT): a minimally invasive procedure that targets the defective lesion that is causing seizures Focal resection: removes the defective part of the brain through a procedure called Craniotomy. Vagus nerve stimulation: a device is inserted inside the brain to stop the distorted electrical impulses. Hemispherectomy: This procedure removes the entire defective hemisphere of the brain. Usually done in case of severe seizures. Epilepsy Prevention Primary Prevention Epilepsy can be triggered by numerous factors. The only way to prevent an epileptic attack in vulnerable people is to avoid certain triggers Different people may have different triggers. So the first step is to identify those potential triggers and avoid them. Strong flashing lights, emotional outbursts, loud noise, and visual stimulation are a few common triggers. Avoid stress and anxiety Adopt a proper sleeping schedule Avoid alcohol and other brain-altering substances like drugs Secondary Prevention Ketogenic diet: A diet low in carbohydrates and high in fats helps in controlling seizures. However, this should be carefully monitored, especially in people who are obese or suffering from other cardiovascular conditions Alternative therapy for emotional management. Epilepsy Diagnosis If someone reports two or more seizures, a detailed medical history will be taken. After that, some specific tests are done to evaluate the cause and severity of the epileptic seizures: Neuroimaging: CT scans, MRI Cerebrospinal fluid tests to look for brain infections Typical test Required for Epilepsy An electroencephalogram (EEG) is the most common test for diagnosing epilepsy. It records the electrical activity of the brain. Small electrodes are attached to various places on the head, and the activity of the brain is monitored. Any abnormal activity is reflected on the screen and a diagnosis is made accordingly. Other tests that are needed: Positron emission tomography (PET) scan Single-photon emission computerized tomography (SPECT) Magnetoencephalography (MEG) Neuropsychological tests for the assessment of other secondary symptoms like speech, memory, etc. Differential Epilepsy Diagnosis Epileptic seizures take a long time to get diagnosed and are commonly misdiagnosed due to the presence of other diseases that may share similar symptoms, such as: Hypoglycemia Syncope Panic attacks Paroxysmal movement disorders Migraine attacks

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The Functional Neurosurgery Unit at Nanavati Max Super Speciality Hospital offers comprehensive surgical care for patients with brain, spinal cord, and peripheral nerve diseases. Functional neurosurgery is an advanced field that involves the restoration of neurological conditions and functions. We treat various chronic neurological disorders using a variety of advanced techniques such as highly focused neuromodulation and deep brain stimulation. Our highly specialised multi-disciplined team includes doctors and surgeons from a broad range of specialties such as neurology, neurosurgery, neuropsychology, neurogenetics, neuropsychiatry neurophysiology, speech and language therapists and specialist nurses. We are thus capable of diagnosing and evaluating various neurological conditions and diseases in our patients more effectively and accurately. The department is fully equipped with state-of-the-art facilities like modern imaging methods and advanced diagnostic techniques such as: MRI CT scan Positron emission tomography (PET) or PET-CT scan Electroencephalography (EEG) Electromyography (EMG) Functional tests (to check for normal reflexes, balance issues, and physical movements) Using a full spectrum of latest diagnostic and therapeutic techniques, a comprehensive assessment is obtained to accurately diagnose neurological conditions and offer comprehensive treatment plan as these diseases can affect the patient’s condition, behaviour, and quality of life. Our treatments are based on electrical stimulation of various parts of the nervous system. We implant electrical stimulators resembling a heart pacemaker in patient’s body that act on the nervous system to treat a wide range of neurological conditions. This electrical stimulator delivers small pulses of electricity to the target area, which helps in relieving symptoms of the disease. Some of the common neurosurgical techniques include that uses electricity to alter the neurological functions include:  Deep Brain Stimulation: Change the function of the brain. Spinal Cord Stimulation: Alter the function of the spinal cord. Occipital Nerve Stimulation: Change the functioning of the occipital nerve.  

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We at the Microscopic / Endoscopic Disc Surgery Unit at the Centre for Neurosciences believe in offering super-speciality tertiary care to patients suffering from a condition of the herniated or degenerative disc in the lower spine. Our team of experts at the unit is committed to providing state-of-the-art treatment and exceptionally compassionate care to patients, using minimally invasive techniques when doing surgery for the removal of a herniated disc. The process is known as Discectomy. A herniated disc refers to a problem with one of the rubbery cushions (discs) between the individual bones (vertebrae) that stack up to make your spine.  In most cases, a herniated disc occurs in your lower back (lumbar spine) and a patient might experience symptoms such as arm or leg pain, numbness or tingling, weakness, etc. Disc herniation is most often the result of gradual, ageing-related wear and tear called disc degeneration. With age, your spine disc starts losing some of its water content thereby making it less flexible and more prone to rupturing even with a minor twist. Our surgeons hold surgical excellence and innovative abilities in performing both Microscopic Disc Surgery & Endoscopic Disc Surgery at the unit by following a minimally invasive approach. Our unit is equipped with the latest techniques and technology to improve care for people with herniated or degenerative discs.  We perform discectomy on patients who are experiencing severe leg pain (for at least over six weeks) and have failed conservative treatments such as oral steroids, NSAIDs (non-steroidal anti-inflammatory drugs), and physical therapy.

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The Neuro Electrophysiology Unit is a part of the Centre for Neurosciences at Nanavati Max Super Speciality. It is one of the most comprehensive centres in Mumbai with well-equipped latest technology machinery and Senior experienced staff to carry out the diagnostic procedures and for interpretation of the Recorded data. Services Provided: The Neurophysiology Department offers variable tests to diagnose the neurological problems EMG -NCS (Electromyography and Nerve Conduction Study) Electromyography and Nerve Conduction Study Facial Nerve Study Sympathetic Skin Response (For testing autonomic function ) Pediatric Electromyography and Nerve Conduction Study EMG guided Botulinum toxin injections Evaluation of Birth /Adult brachial plexus injuries Specialized tests for Neuromuscular Junction Disorders(Decrement Study and Single Fiber EMG study) Evoked Potentials: Visual Evoked Response(VER) / BrainStem Auditory Evoked Response(BAER) / Somato Sensory Evoked Response(SSEP) Intraoperative Neuromonitoring (IONM) EEG lab (Electroencephalography) Routine EEGs and Video EEG (2 hours, 4 hours) Portable Bedside EEGs in ICUs. Sleep Deprivation EEG Neonatal EEGs Introduction: EMG/NCS is a combination of diagnostic procedures that is indicated for any neuromuscular disorder and helps the referring doctor to narrow the differential diagnosis by Localising the lesion Quantifying the problem (Mild /Moderate/Severe ) Identifying the pathophysiology (Axonal, Demyelinating or Mixed) Any associated or underlying neuromuscular problem Assess prognosis especially in cases of nerve injuries Why the test is done: The referring doctor may recommend these tests to the patient if he/she shows signs or symptoms that may indicate a nerve or muscle disorder. These symptoms may include: Tingling in hands or feet Numbness Muscle weakness Muscle pain or cramps Traumatic Injuries The clinical conditions where the test is mostly indicated: Peripheral Neuropathies Muscle diseases: Myopathies Diseases of Nerve and Muscle junction-Myasthenia Gravis Diseases of Motor neurons of the brain and spinal cord-Motor neuron disease Screening nerves in Diabetic patients of more than 5 years of history of Diabetes Nerve conduction study (NCS) is always required along with Needle EMG Nerve Conduction Study- (NCS) Do not apply lotion or cream over the skin and preferably wear loose clothes. Can be done very safely even in the newborn & pregnant women. The test would be contraindicated in patients with Pacemakers and in patients who are oral Anticoagulants (Warfarin) Procedure: Some sticky pads will be placed on parts of your limbs will record the responses from your nerves. We stimulate nerves locally by giving bearable shocks in Milliamperes and may even cause slight movement of the muscle being stimulated. Needle EMG examination It is done by inserting fine disposable NEEDLE Electrodes into the muscles for a few seconds. Procedure: The muscle activity is picked up by the needle electrodes and displayed on the monitor and over a loudspeaker and diagnosis is made on-line. Repetitive Nerve Stimulation (Decrement Study) Certain diseases where pathology at the nerve and muscle junction (the neuromuscular Junction) is suspected Special tests can evaluate these diseases. Repetitive Nerve Stimulation (Decrement Study or RNS test ) Single Fiber EMG (SFEMG) Procedure: For RNS test please stop medication (if already started for Myasthenia Gravis) 24 hours prior with your referring doctor’s consent. During this test, continuous current stimuli (6-7 taps) are given to a nerve to be tested. Kindly carry the medication along so that it can be taken as soon as the test is completed. Evoked Potentials: These are specialized tests, which involve three major tests that measure responses to Visual, Auditory and Electrical stimuli. Visual evoked Responses (VEP): Tests the Optic pathway Brainstem Auditory Evoked Potentials (BAEP): Tests the Auditory pathway. Somatosensory evoked potential (SSEP): Tests the Spinal cord function Children will require sedation for the above test. Intraoperative Neuromonitoring (IONM) This is a highly specialized technique offered at our centre. The nervous system can be monitored during the surgery. It is used for complex spinal surgeries and certain brain surgeries. Electroencephalogram (EEG) An EEG records the electrical activity that arises from the brain. Indication for An EEG test : Epilepsy or other seizure disorder Brain tumour Head injury Brain dysfunction that may have a variety of causes (encephalopathy) Encephalitis Stroke Dementia List of tests offered in EEG lab is EEG – Both Sleep-deprived or routine Video EEG-( short and long term monitoring) Neonatal sleep EEG Dedicated Portable video EEG for ICU bedridden patients Procedure: Several external electrodes are placed on your scalp. These records the electrical impulses generated from different centres or areas of your brain that are picked up by the electrodes and seen on the screen of the EEG machine. It is a painless and noninvasive test and can be done on children and adults safely. Video EEG Video EEG is an EEG performed along with a live Video recording. A Video picks up seizure activity when the patient is clinical experiencing a seizure and can add immense value to localization of a seizure. A Video EEG is typically done for long hours. Performed as an out-patient in our hospital The Neuroelectrophysiology department has well-trained staff Full time dedicated Neurophysiologists Neurologist attached to the hospital is involved in diagnosing EEG abnormalities 3 full times well experienced Senior Neurotechnologists.

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The Centre for Neurosciences has a dedicated Neuro-endoscopy Surgery Unit, which provides the most comprehensive quality care for patients suffering from a variety of neurological conditions such as brain injury or diseases, brain haemorrhage, head injury, brain tumours, hydrocephalus, nerve injuries and various congenital malformations like atlantoaxial dislocation, etc. Neuro-endoscopy is an advanced surgical approach that allows the surgeon to look into the skull, base, and spine through a small incision and with minimal trauma. Our team of highly experienced neurologists, neuro-surgeons, neuro-physicians, neuro-anaesthetists, intensivists and rehabilitation specialists performs the full range of minimally invasive neuro-endoscopic surgeries on both adult and paediatric patients. The unit is well equipped with state-of-the-art diagnostic and therapeutic procedures to treat complex neurology diseases and conditions without the need for other implants or fixations. Some of the diagnostic techniques we use to evaluate the patient’s current medical condition involved: MRI CT scan Genetic Molecular testing of the tumour Electroencephalography (EEG)/ Video EEG Electromyogram (EMG) Test & Nerve Conduction Study (NCS) Visual evoked potential (VEP) Brainstem Auditory Evoked Potential (BAEP) With an aim to improve the quality of life of the patient, we offer patient-centric treatment plan that helps in shortening their recovery time and enable them to quickly restore their daily functioning. Some of the disorders we treat using Neuro-endoscopy, include: Hydrocephalus Aqueductoplasty Compartmentalized Hydrocephalus Multi-Compartment Hydrocephalus Septum Pallidotomy Third Ventriculostomy Ventricular catheter placement Arachnoid cyst fenestration Colloid cyst removal Hyperhidrosis Neurocysticercosis Thoracic and lumbar disc removal Upper limb sympathetic mediated pain. Endoscope-assisted surgery Acoustic neuromas Cerebral aneurysms Microvascular decompression Pituitary tumour resection Skull base tumour biopsy

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Movement disorders is an umbrella term for a group of neurological conditions that trigger abnormally increased voluntary and involuntary movement as well as reduce the pace of the former. These can be a result of many factors like genetics, infections, a side-effect of certain medications, damage or injury to the brain and spinal cords, metabolic disorders and cardiovascular diseases like stroke. While some movement disorders can be easily treated by medicinal, therapeutic and surgical means, others need to be managed lifelong so as to improve the quality of the patient’s life.

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The Spine Fusion Surgery Unit at Nanavati Max Super Speciality Hospital offers comprehensive services to treat a variety of spine conditions such as scoliosis, kyphosis, spine fracture, unstable spine, etc. We at the unit are committed to providing each patient under our care with the safest, highest-quality, patient-centric care and improved patient outcomes. Spine fusion surgery is the comprehensive surgical procedure that fuses (joins) two vertebrae (spinal bones) together to stabilise and align the spine and restore normal disc space between the bones, thereby preventing further damage to spinal nerves and cord.  Our team of neurosurgeons, neurologists, neuro-anaesthetists, intensivists at the unit combines experience, expertise, and innovation to offer the most appropriate diagnosis and treatment of diseases and injuries related to spine. The diagnostic services offered by the unit include: Physical examination: Muscle strength Possibility of tender regions in the back Range of motion Reflexes Sensitivity to touch Walking ability X-ray MRI (magnetic resonance imaging) CT (computed tomography) scan Electromyogram (EMG) Nerve Conduction Studies (NCS) The fusion of the spine in the human body is the result of the joining of vertebral bones of the spine thereby eliminating the motion between vertebrae. Surgeons opt for spine surgery only when the non-operative treatments fail to control the pain and possibly neurological symptoms. The procedure Our surgeons follow a minimally invasive surgical approach for performing spine fusion surgery. A small incision is made in the middle of the back or at the side and muscles are moved aside using various small instruments to gain access to the spine. A surgeon then implants the bone grafts between the vertebrae and hold it in place with metal implants -- rods, screws, hooks, or wires until the vertebrae fuse. Bone grafts are either taken from the patient’s own body (pelvic bone or rib) or a bone bank. Spine fusion surgery procedure usually takes 3 to 4 hours. Most patients have to stay for a few nights in the hospital. After four to nine months following the procedure, a patient’s body starts producing living bone to replace the bone graft, which will fuse the vertebrae and create a single bone. 

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The Stroke Unit based at Nanavati Max Super Speciality Hospital (one of the best brain specialist hospitals in Mumbai, India) is an acute neurological section providing specialist services to people who recently have a new suspected stroke, affecting the areas of the brain. The specially designated unit is committed to providing state-of-the-art emergency care to stroke cases in order to preserve brain cells, save lives and improve recovery. Our stroke unit also provides high-end therapy, education, and support to patients to help them regain functionality and quality of life. According to the studies, stroke is considered the fourth leading cause of death, after diseases of the heart, lungs, and all forms of cancer. We have a multidisciplinary team of expert stroke neurologists, emergency physicians, intensivists, neurosurgeons, neuroradiologists, and physiotherapists, who focus on providing acute care and rehabilitation to stroke patients. Our unit is well equipped with advanced facilities to help the doctor to identify the type of stroke the patient has had, and possible reasons for the stroke. We also have a dedicated neuro ICU. The Unit follows a comprehensive patient-centric approach to developing a comprehensive brain stroke treatment plan with the goal of significantly improving the chances of a patient to prevent or recover optimally, from a stroke. Our tertiary care centre handles most complex cases of stroke and other emergencies under one roof. We have an emergency response code- “Code White,” that is announced to handle the emergency for Patients with Stroke. The code is activated in Accident and Emergency (A & E) Department, MRI Department & Critical Care Unit (CCU) with the objective of treating the patient within the Golden hour for best clinical outcomes. In this Code white the patient with Stroke symptoms are assessed immediately by clinicians, patient transferred to MRI section for investigations & transferred to CCU for Thrombolysis CCU / Cath lab for Mechanical Thrombectomy

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