Latest Techniques

Latest Techniques are used by Prof Shahzad Shams to remove brain tumours which are as following:
 1. Endoscopic minimally invasive keyhole brain surgery
2. Endoscopic minimally invasive keyhole removal of brain tumours through nose.
3. Neuronavigation used to precisely target the lesion and for complete removal.
4. Stereotactic neurosurgery a minimally invasive keyhole surgery technique for deep seated lesions with 1mm accuracy
5. High Powered Microscopes are used to magnify the tumour for safe removal .
6. Telescopes attached to camera with images on monitor are used to treat Hydrocephalus.
7. Per operative neurophysiological monitoring is done to protect important nerves and areas of Brain.
8. Safest and best technique performed by only one Team of Prof Shahzad Shams in Pakistan called Translabyrinthine minimally invasive keyhole surgery and approach for Acoustic Neuroma surgery.
All these methods help in safe and complete removal of tumors giving excellent results.
 

Brain Tumor Surgery

MALIGNANT BRAIN TUMORS

Malignant  brain tumors also called Gliomas and most aggressive in nature.

They need to be dealt as soon as possible basis as their growth rate which  is rapid and their local spread in the brain causes damaging effects.

Prof shahzad Shams has operated on more than 5000 Gliomas.

First step for him is diagnosis by MRI with contrast. Then planning about surgery and decision about safe approach to tumor and clean and safe removal so that no deficits are given so that patient has a good quality of life. Surgery is performed by using the Latest techniques and gadets like Endoscopes, microscopes, Stereotactic surgery and best microsurgical techniques. After surgery biopsy report reveals the grading of tumor which helps to make decision about Radiotherapy and chemotherapy. Biopsy also gives information about prognosis.

BENIGN BRAIN TUMORS

Meningiomas, Schwanomas, Neurofibromas, Tuberculomas and Fungal granulomas are few examples.

First step for him is diagnosis by MRI with contrast. Then planning about surgery and decision about safe approach to tumor and clean and safe removal so that no deficits are given so that patient has a good quality of life. Surgery is performed by using the Latest techniques and gadets like Endoscopes, microscopes, Stereotactic surgery and best microsurgical techniques. After surgery biopsy report reveals the type of tumor which helps to make decision about further treatment. Biopsy also gives information about prognosis.

Acoustic Neuroma

Acoustic neuroma is a benign tumor which lies in the region of brain where many important nerves and brain structures are present.

Acoustic neuroma surgery is one of the complicated surgeries and should be attempted by an experienced and trained neurosurgeon.

Prof Shahzad has operated on more than 2000 cases of Acoustic neuroma also called cerebellopontine schwanoma.

He suggests following options according to size and involvement of  adjacent structures:-

1. Gamma Radiosurgery

2. Sub occipital craniotomy

3. Translabyrinthine approach

He is one of the best neurosurgeon who has given excellent results and many patients operated for acoustic neuroma are livivng a normal life since decades.

Stereotactic Brain tumor biopsy

STEREOTACTIC BRAIN TUMOR BIOPSY (MINIMALLY INVASIVE KEYHOLE SURGERY)

Prof Shahzad Shams is the first Neurosurgeon in Pakistan to start Stereotactic brain tumor biopsy in Pakistan and Stereotactic Brain tumor biopsy in Lahore in the Private sector which involves mapping the brain in a three dimensional coordinate system. With the help of MRI and CT scans and 3D computer workstations, he is able to accurately target any area of the brain in stereotactic space (3D coordinate system). He uses RM frame system and Inomed IPS Planning software for this purpose. Stereotactic brain biopsy is a minimally invasive procedure that uses this most advanced and cutting edge technology to obtain samples of brain tissue for diagnostic purposes and for aspiration of cystic lesions.

INDICATIONS

This procedure is used to obtain tissue samples of areas within the brain that are suspicious for tumors or infections. The main indications for stereotactic biopsy are :-

  • Deep-seated lesions like brain tumors in Pakistan
  • Lesions in Eloquent areas of brain like Thalamus and Brain Stem.
  • Multiple lesions like Metastatic lesions
  • Diffuse Infiltrative lesions like Encephalitis and Diffuse Glioma
  • Lesions in patients who cannot tolerate anesthesia like old aged
  • For Aspiration of Brain abscess and cystic lesions
  • For Aspiration of hematomas

TECHNIQUE

On the afternoon of surgery a head ring is placed on the patient. This involves giving local anaesthesia to the skin in four areas and placing the ring on the head with four pins. A CT scan is then performed.

In the operating room, the patient receives light sedation. An incision only a few millimeters long is made in the scalp and a small hole is drilled into the skull. A thin biopsy needle is inserted into the brain using the coordinates obtained by the computer workstation. The specimen is then sent to the pathologist for evaluation. Patients are monitored for several hours following the procedure and usually go home the same day.

Accuracy of the RM frame and IPS Planning system is of sub millimeter level and is considered to be the best system in the world giving 100% results to reach diagnosis.

Brain Tumor

Brain Tumours

 

Prof. Shahzad Shams presently works as Head and Professor of Neurosurgery Department at Lahore General Hospital, LGH, Lahore.

 

 

BRAIN TUMORS OPERATED BY PROF. SHAHZAD SHAMS BY ENDOSCOPIC MINIMALLY INVASIVE KEY HOLE BRAIN SURGERY :-

 MENINGIOMAS , MALIGNANT Brain Tumour(Glioma, Astrocytoma, Metastatic)Cerebellopontine angle tumoursAcoustic Neuroma Schwannoma Tumor, Pituitary tumor, Prolactinoma, Colloid cysts, Craniopharyngioma, Rathke’s Cleft Cyst, Sellar and Parasellar tumors and Brain Tuberculomas.

 

Brain tumours are responsible for approximately 2% of all cancer deaths. Central nervous system tumours comprise the most common group of solid tumours in young patients, accounting for 20% of all paediatric neoplasms. The overall incidence of brain tumours in 4-5/10,0000 population per year.

A study by the United States Department of Health in 1966 showed the incidence to be 2/100000 per year at two years old and 1/100000 during the teenage years. The incidence increases after the 4th decade of life to reach a maximum of 13/100000 per year in the 7th decade.

 The surgery of various intracranial tumours is obviously one of the main areas of a neurosurgeon’s work. There is a large number of different tumours that can occur in the brain, arising from a variety of different tissues. These include tumours of the nerve cells and their supporting structures, tumours of the lining membranes of the brain (meninges), various tumours associated with the pituitary gland, and tumours occurring on some of the cranial nerves (acoustic neuromas).
The brain can also be the site of tumour seedlings (metastases) from disease in other organs of the body.

Symptoms and Signs

Tumours can cause symptoms either by taking up space within the skull, leading to an increase in pressure within the head, or by interfering with the function of the adjacent brain or cranial nerves. Common symptoms therefore include headache, nausea and vomiting, epileptic fits or seizures or epilepsy and weakness or sensory loss in the face, arm or leg.

Imaging

Brain tumours can be imaged using CT or magnetic resonance imaging (MRI). Some types of tumour may then need surgical treatment, such as diagnostic biopsy or, where possible, complete surgical removal. Adjuvant treatments such as radio and chemo therapy may also be needed.

RESULTS

The results of  Brain tumor surgery are excellent specially after the Introduction of Endoscopes and endoscopy in brain surgery. Now it  has become less invasive and hospital stay is less than 24 hours without any complications.

 

 

 

 

Trigeminal Neuralgia Surgery

TRIGEMINAL NEURALGIA

This is a condition which may be treated by GP’s, Neurologists, Psychiatrists, Neurophysicians and Neurosurgeons. It is characterized by a severe spasmodic and lancinating pain which affects one side of the face. The pain is excruciating, severe and is triggered by actions like chewing, swallowing, drinking hot or cold liquids, brushing the teeth, or being exposed to cold wind. 

The cause of the symptoms is the pain which usually affects one branch of the trigeminal nerve which supplies sensation to the side of the face. In many cases symptoms seem to be related to a loop of a blood vessel within the brain itself pressing on the trigeminal nerve.

Prof. Shahzad Shams worked as Head and Professor of Neurosurgery Department at Lahore General Hospital, LGH,  and presently works as Chairman Department of Neurosurgery King Edward Medical University and Mayo Hospital, Lahore, Pakistan

TREATMENT

MVD SURGERY

ENDOSCOPIC MICROVASCULAR DECOMPRESSION 

Endoscopic Microvasular decompression is a procedure in which a 2cm opening is made behind the ear and through this opening a endoscope of  4mm size is inserted to find the vessel which is offending oe pressing the trigeminal nerve which is then separated from the nerve using micosurgical instruments and a small teflon graft is placed in between the vessel and nerve. Patient is immediately relieved of the severe  pain on the face and is disharged within 24 hours from the hospital.

RESULTS

The results for ENDOSCOPIC Microvascular decompression (MVD) are excellent and the procedure once done the patient is relieved of the pain forever and permanently. Hospital stay is only for 24 hours.

 

 

 

 

 

 

Pituitary Tumour

Prof. Shahzad Shams presently works as Head and Professor of Neurosurgery Department at Lahore General Hospital, LGH, Lahore.

PITUITARY TUMOURS/

SELLAR & PARASELLAR TUMORS

Professor Shahzad Shams is known world over for providing Quality care to Pakistani and patients from abroad for Nasal technique of removal of brain tumours like Pituitary adenoma, Prolactinoma, Craniopharyngioma, Rathke’s cleft cyst, Sellar and Parasellar tumors using Transnasal Transsphenoidal endoscopic pituitary surgery technique of removal of tumour through the nose also known as Transnasal endoscopic surgery of Pituitary tumours also called Transphenoidal surgery.  Patients come from countries like US United states of America USA , United Kingdom UK Britain England, Canada, Italy, Greece, Germany, Spain, Australia, Saudi Arabia, United Arab Emirates UAE, Dubai, Kuwait, Qatar, Bahrain and Afghanistan requiring Neuro, Neurological surgery or Neurosurgery management.

Brain Tuberculomas

 

Prof. Shahzad Shams presently works as Head and Professor of Neurosurgery Department at Lahore General Hospital, LGH, Lahore.

Intracranial Tuberculomas

Best treatment of Brain Tuberculoma is Stereotactic biopsy which is Minimally invasive keyhole surgery which is safest surgery and done while patient is awake and stay in Hospital is only for 24 hours. On positive biopsy report of tuberculoma treatment with Anti tuberculous therapy completely cures the patient.

 

 

An intracranial tuberculoma originates by haematogenous spread from tuberculous lesions in other parts of the body, especially the lung. Tuberculomas are frequently multiple and are predominantly located in the posterior fossa in children and young adults, but may occur throughout the cerebral hemispheres.

The clinical presentation is similar to an intracranial tumour, with features of raised intracranial pressure, focal neurological signs and epileptic seizures, systemic symptoms of tumberculosis, such as fever, excessive perspiration and lethargy, occur in less than 50% of cases.

The MRI and CT scan appearance of a tuberculous granuloma is an area of low attenuation with a contrast-enhancing capsule. There is usually surrounding oedema and the lesions may be multiple. The tuborculoma is occasionally calcified.

LATEST ADVANCED TREATMENT OF INTRACRANIAL TUBERCULOMAS

 

Best treatment of Brain Tuberculoma is Stereotactic biopsy which is minimally invasive keyhole safest surgery and done while patient is awake and stay in Hospital is only for 24 hours. On positive biopsy report of tuberculoma treatment with Anti tuberculous therapy completely cures the patient.

Life saving Emergency Surgery for Head Injured Patients

Prof. Shahzad Shams presently works as Head and Professor of Neurosurgery Department at Lahore General Hospital, LGH, Lahore.

Life Saving Emergency Surgery for Head Injured Patients

Neurosurgeons are involved in the management of all kinds of head injury, both minor and major. Surgical involvement is usually directed more towards the major head injuries.

Major Head Injuries

A major head injury can result in a variety of insults to the brain and skull. These include various types of skull fracture, large blood clots (haematomata) which may press on the underlying brain and damage it, contusions and lacerations to the brain itself, and diffuse bruising (swelling) of the entire brain. These major injuries are often managed by emergency referral to a neurosurgical unit where life saving surgery may be needed to remove an intracranial blood clot (subdural or extradual haematoma), or to elevate and repair major skull fractures. Patients with major head injuries may require time on intensive care and may also have their intracranial pressure monitored with a surgically implanted probe.

Minor Head Injuries

Neurosurgical involvement often consists of careful observation and/or CT scanning in order to exclude any of the more major injuries outlined above, and to be in a position to respond rapidly should any of these occur.

RESULTS
The results of Minor and moderate  head injury are excellent.