SKULL BASE NEUROSURGERY INDIA ,PUNJAB, CHANDIGARH, MOHALI

Dr Vineet Saggar M.B.B.S, Ms, Mch( Neurosurgey)

Consultant Department of Neurological and Spinal Surgery

IVY Superspeciality Hospital Sec-71, Mohali. Punjab

Dr Vineet Saggar is an alumnus of D.A.V college Chandigarh sec-10.After his MBBS from Maulana Azad Medical College (M.A.M.C) New Delhi in 2002 , he did his Post Graduation in General Surgery from Safdarjung Hospital(2002-2005). He went for his training in MCh Neuro Surgery at S.M.S Medical College Jaipur. At Jaipur he got the privilege of working with one of the pillars of Spinal Surgery -Prof. R.S. Mittal under whom he trained for almost 2yrs. After completing his MCh in July 2009, he trained under Prof. S.R. Dharker one of the pioneers of Micro- Vascular Neurosurgery in Rajasthan and India. Before joining Ivy Hospital as consultant Neuro Spinal Surgeon, he headed Department of Neurosurgery at Adesh Medical College Bathinda for some time. He has special interest in Spinal Surgery and Skull-Based Micro Neurosurgery. Apart from many national and international publications, he also has research publications on Head Injury to his credit.

Publications:

1. Abnormal Migration of shunt in Pitutary fossa. The internet Jounral Of Neurosurgery;Vol 5 No. 2.

2. Hemostatic Abnormalities in Patients with Closed Head Injuries and Their Role in Predicting Early Mortality. J Neurotrauma.2009 Vol 26(1-4)

3. Bilateral pupil-sparing oculomotor nerve paralysis with multiple cranial nerve palsies and hormonal imbalance following head trauma. Report of a rare case with clinicopathologic correlation. Indian Jounral of Neurotrauma. VOLUME 6 | NUMBER 1 | JUNE 2009

4. Penetrating injury to cervical spine from a nail gun.Indian Jounral Of Neurotrauma.VOLUME 6 | NUMBER 2 | JUNE 2009

5. . Isolated cysticercosis Of Inferior rectus Muscle. Under Publication( Indian Jounral Of Medical Practitioners).

Department of Neuro Spinal Oncology(Brain and spinal Cancer surgery) IVY Hospital

Department of Neurospinal surgical oncology made its beginning under the able guidance of Dr Vineet Sagger in August 2010 and has touched new heights ever since. We in or department are now performing complex cranial and spinal tumour surgeries such as posterior fossa tumours , skull base neuro surgery, spinal tumours apart from complex Corpectomies and cervical laminectomies for OPLL(ossification of posterior longitudinal ligament) apart from cervical and lumbar spinal fixations. Most of these patients of Cervical and Lumbar PIVD are being discharged next day following the surgery and we at Ivy Hospital plan to make it a Day care surgery very soon.

Case 1:

A 45 Yrs old Lady presented with complaints of bilateral radiating pain in legs and faecal incontinence. MRI of spine had revealed large tumour extending from D-12 vertebral body to L-5 level measuring approx 12 cms in size. Patient was operated by Dr Vineet Saggar on Monday and complete tumour removal was done and patient was discharged on Wednesday without any neurological deficit. This patient was refused surgery at many centers across Punjab .However such spinal tumour surgeries are being routinely done at IVY hospital by Dr Vineet Saggar

Postop Pic of The Tumour Intra operative Picture Of The tumou

MRI Showing Large Tumour From D-12 To L-5 Level Patient Just Before Discharge

Case 2

A 50 year old man present with paraplegia and severe pain in back for past one day following trivial trauma MRI revealed D-9 vertebral collapse with cord compression secondary to metastatic involvement. Patient underwent laminectomy tumour biopsy and pedicle screw fixation and was discharged the next day

MRI showing vertebral collapse and cord compression Xray post operative showing pedicle

screws and Rod Fixation of spine

Case 3

A 50 year old female presented with severe pain upper back radiating to bilateral upper limbs. MRI revealed Tumour at D-1 level .Patient was successfully operated and discharged the next day.

MRI of patient showing large tumour at D1 level

Case 4

A 45 year female present in OPD with complaints of giddiness and frequent falls associated with headache and vomitings . MRI brain revealed large tumour in posterior fossa. Patient was operated by us and after six hours of surgery highly vascular tumour was removed and patient made complete recovery postoperatively.

MRI showing large tumour in cerebellum Tumour after removal Patient just before

Discharge

Case 2.

A 60 yr old man from Kurali presented with History of mild trauma followed by weakness all four limbs which was progressing and he came to us in quadriparetic state and was bed ridden from past 1 month. CT and MRI cervical spine revealed segmental OPLL behind 4^th cervical vertebra. Patient underwent C 4 Corpectomy and C3 To C5 Fusion using bone graft and implant. Next day patient was discharged in walking condition.

MRI showing Cord. CT Cervical spine showing calcification behind C 4 Patient first post operative day compression at C4 Level body and causing canal compromise

Figure 4. X ray post op. showing cervical implant at C4 level

Spinal surgeries being Done at IVY hospital:

1.Cervical spine Fixations

2.Cervical Discectomiues

3.Spinal tumours

4. Lumbar Discectomies (Microdiscectomies)

5. Pedicle screw Fixations

6. Lateral Mass fixations( Cervical)

Microvascular Neurosurgery At IVY Hospital

Microvascular Neurosurgery at IVY Hospital also made its beginning under Dr Vineet Saggar in Aug2010 when a case of ruptured MCA aneurysm was operated in Emergency. A 24 yr young male presented in emergency with sudden loss of consciousness of 6 hrs duration C T head revealed Massive frontoparietal ICH with intraventricular extension. A large 2.5 cms giant MCA bifurcation aneurysm was found and clipped During surgery .Since then microvascular aneurysm clipping is being regularly performed at IVY hospital by Dr Vineet Saggar.

Fig 1&2 Pre Op CT scan images showing ICH with Intraventricular Extension

FIG 3&4 Post Op Scan showing removal of clot and Aneurysm Clips in situ

Patient just before discharge

Department of Neuro interventional surgery

p-Com aneurysm

Post coiling

Acom aneurysm coiled

Post coiling basilar top aneurysm

Core Neurosurgical Procedures being done at IVY Hospital by Dr Vineet Saggar

1 Head injuries- EDH, SDH, Depressed Fractures , CSF Rhinorrhoea

2 Tumour Surgeries

3.VP Shunt Surgeries For Hydrocephalus

4.Decompressive Craniotomies For Stroke

5.Thrombolysis For stroke

6.Skull Base Neurosurgery

7. Orbital Tumours

A 24year male presented to us in emergency with sudden onset loss of consciousness followed by seizures. Patient was intubated and CT head was done which revealed SDH right FTP region, and temporal haematoma and SAH. CT angio revealed aneurysm distal to ICA bifurcation and proximal to MCA BIFURCATION. Patient was operated via right Forto-temporoparital craniotomy with clipping of aneurysm which was arising from junction of large lenticulostriate branch of right MCA just proximal to bifurcation. Patient was discharged after one month after surgery without GCS of E4VtM6 with left hemiparesis and is still recovering.

Fig 1-4.CT ANGIOGRAPHY SHOWING aneurysm distal to ICA bifurcation and proximal to MCA BIFURCATION. Lenticulostriate artery aneurysm.

Fig5 plain CT images showing temporal haematoma with SAHIL AND SDH.

FIG 6 CT ANGIOGRAPHY SHOWING LENTICOSRIATE ARTERY MCA JUNCTION ANEURYSM.

FIG 6 and 7. POST operative scans.