What is Neurosurgery

About Neurosurgery
– By Dr. Jaydev Panchawagh, Neurosurgeon, Pune, India
Our nervous system is made up of millions of cells, supportive tissue and coverings (members) to protect the brain & spinal cord. It is one of the most delicate of all body organ-systems; the brain that gives man his ‘human nature’ and the spine that makes him’ stand by’! It therefore follows that diseases of such an intricate system must also be crucial. In fact, diseases of the brain & spinal cord were thought to be difficult to diagnose & treat till the previous century.
The last 50 years, and especially the last 20 years have seen the advent of various types of diagnostic tests and techniques to treat brain pathologies. For example, some brain tumours which were thought to be impossible or too dangerous to remove are now being excised using computerized techniques. These techniques help immensely during surgery. Even complex spine surgeries have become easier because of modern tools.
Surgeries which were being done with long incisions are now being done with either much smaller incisions or done endoscopically. (Yes, even in the brain and spine!).
Simultaneously, the anatomy & function of structures within the brain and spinal cord are better understood. In the past, we did not even know where man’s thoughts, emotions or intelligence originated from! Even today one hears ‘that man has no heart’- what they mean to say is that ‘he is unemotional or unsympathetic’. That we think emotions came from the heart becomes obvious from this statement!
Until recently, it was not known that all centers for originating messages to be sent out to various organs in the body are present in the brain. The brain not only stimulates other organs to perform their respective functions, but also co-ordinates all organ-systems, so that they should all work harmoniously to keep the body healthy & fit.
The past 50 years has also seen an increasing knowledge of centers in the brain which control thought, emotion, mathematics, foresight, various forms of art etc. unfortunately though, the public has become more knowledgeable about heart disease, cancer etc. but not about disease related to Brain & Spinal cord.
During my practice as a neurosurgeon, I have experienced various types of reactions from patient’s relatives lay public and doctors as well. People who diagnose, advice investigations and treat neurological diseases are not necessarily experts in this field. They could be relatives, neighbour, colleagues, or just well-wishes. The confidence with which lay people diagnose others diseases, and give advice never ceases to amaze me. Each one of us has an opinion about many things, but they need not necessarily be the best advice for a patient.
Then why do patients listen to non-expert advices? The answer lies in the fact neurologic diseases make them so vulnerable & helpless, that they are likely to try any form of treatment. That life is dear to each one of us has been highlighted by the wise Birbal.
One tends to get disturbed by even small diseases that affect our body.
And when either the Brain or spinal cord is affected, it is not surprising that we tend to lose our confidence.
What helps us to face our enemy better is knowledge. Fear of the disease is based on an ignorance of it.
For example, if a patient is told by his doctor that he has a ‘Slipped Disc’, what would his reaction likely to be?
  1. I need to meet an expert immediately. Let me ask my neighbour who I should go to: he had a similar problem”.
  2. Oh! My God. If I go to a Doctor, he would definitely advise surgery. It would probably be better to visit an ‘Alternative Medicine Doctor’ who might give me relief by other means”.
  3. “Let me see if there’s any information available in any of the medical books for the public, or on the internet. Then let me visit the appropriate specialist Doctor”.
Of all these possible reactions, the third one occurs least in India, even among the ‘Socially advanced’ class.
Also, books written for the public in a simple language that they can understand is lacking.
This book aims at educating the public about common diseases of the nervous system, various diagnostic investigations that may be done, Medical treatment, surgeries, newer techniques etc.
This is not a comprehensive encyclopedia of neurosurgery. Similarly, while reading, the book people may either think that the surgeries are either very simple or too complex.
The reader is requested to just utilize this information and discuss further with their doctors.
Faith-healing has been a sort of tradition in Indian culture. The belief and trust that patients have in sadhus/sadhvis/ saints is sometimes taken to the extreme-one just has to tell them the problems, & they will take care of the rest!
And even on modern medical Indian practice, we often find that patients expect the doctor ‘to do the needful’. While this is very hearting, people must understand that doctors cannot play God.
Patients must have faith in their doctors, but with eyes wide open. The patients and their relatives should be aware of the pros & cons of medicine, and that diseases have their own natural cause, despite interventions. Faith in their treating doctors should be based on a scientific knowledge & out look. The patients need to be involved in decision-making, after gaining the required information about the disease and various treatment options.
What are the main features of diseases of the brain & spinal cord?
If one notices the primary symptoms or signs, what does one need to do?
The objective of this book thus is that the public should have answers to such questions, and that they should approach the disease in the right perspective. This should help them choose their doctors and consult them at the right time.
I have tried to relate in a story form, certain typical events or symptoms & signs that are associated with each type of neurologic disorder. These are all true stories albeit with the names changed.
While reading these stories, some symptoms & signs are easily identifiable. And at the end, some information is presented about surgical approaches to each disease.
From the questions asked by many of my patients, I realized that the basic knowledge of the disease they have is very poor. And I also felt that had they known more, they could have picked up their symptoms or signs earlier, and approached the relevant doctors earlier, when the surgical results could have been better.
As far as the spine is concerned, our society as a whole has many beliefs. These misbelieves are based on ignorance, and there are many people willing to take advantage of it. ‘It will make you better by making you walk in water’, I will treat you with laser’. ‘My massages will treat you’ etc. are the many false promises that I have heard of (there are more!). Some doctors project their ethics by saying “Surgery is not necessary” or “surgery is all humbug”.
On the other hand, there are others who would operate on even un-indicated patient. What is the patient to do, and how should he recognize his options?
The optimal solution would be ‘not to operate when not indicated, and to go ahead with surgery, when it is necessary to do so’.
This is the outlook I name attempted to present in this story-series.
This is perhaps the right time to mention that all said & done, and having tried to treat the patient with the best available options, one could still have unforeseen complications, or failures.
Society either places the neurosurgeons and other doctors either in the role of God or the devil incarnate!
If they learn to recognize that Doctors are also human beings who are striving to get the patient better, and not otherwise, it would help everyone all around.
If, after reading this, even a few patients reach the hospital in time before it is too late, or approach the right doctor for treatment, then I would think that my job has been done.
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