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Acoustic Neuroma Surgery and Treatment in India

Symptoms of Acoustic Neuroma:

Early symptoms are easily overlooked, thus making diagnosis a challenge. There usually are symptoms, however, indicating the possibility of an acoustic neuroma. The first symptom in 90% of those with a tumor is a reduction in hearing in one ear, often accompanied by ringing in the ear or tinnitus. The loss of hearing is usually subtle and worsens slowly, although occasionally a sudden loss of hearing is noted. There may be a feeling of fullness in the affected ear. These early symptoms are sometimes mistaken for normal changes of aging, or attributed to noise exposure earlier in life and therefore the diagnosis is often delayed.

Other Less common symptoms include:

� Difficulty understanding speech � Dizziness � Headache � Loss of balance � Numbness in the face or one ear � Pain in the face or one ear � Sleepiness � Vision problems � Weakness of the face

Types of Acoustic Neuroma:

There are two types of acoustic neuromas:

Unilateral Acoustic Neuromas - Unilateral acoustic neuroma affects only one ear. This type accounts for approximately 8 percent of all tumors inside the skull. One out of every 100,000 individuals per year develops an acoustic neuroma. Symptoms may develop at any age, but usually appear between the ages of 30 and 60. This is not a hereditary condition.

Bilateral Acoustic Neuromas - Bilateral acoustic neuromas affect both ears and are hereditary, caused by a genetic disorder called neurofibromatosis-2 (NF2). This tumor develops in the teens or early adulthood. In addition, patients with NF2 usually develop multiple brain and spinal cord related tumors.

Overview:

Acoustic neuroma (vestibular schwannoma or Cerebellopontine angle tumor or

Angle tumor) is a noncancerous (benign tumor) that develops on the main nerve

leading from inner ear to brain. The cells that form an acoustic neuroma are called

Schwann cells and make up the lining of the eighth cranial nerve as it passes

through a tiny canal, which connects the inner ear to the brain. Acoustic neuroma

typically grows slowly or not at all, but in a few cases it may grow rapidly and

become large enough to press against the brain and interfere with the vital

functions. Because branches of this nerve directly influence your balance and

hearing, pressure from an acoustic neuroma can cause hearing loss, ringing in your

ear and unsteadiness.

Preparation for Acoustic Neuroma Surgery:

� Surgery for acoustic neuroma is performed on an inpatient basis, which means you will stay in the hospital after the procedure. In some cases, you may also need to stay overnight before the procedure.

� You will be given specific instructions as to where and when to arrive at the medical facility, how to prepare for your surgery, and what to expect the day of and the days following your procedure. In addition, you will be asked not to eat or drink anything for at least eight hours beforehand.

� Because you will not be able to drive for some time after acoustic neuroma surgery, be sure to arrange for someone to drive you home on the day you leave the hospital.

Acoustic Neuroma Surgery:

The options open to Acoustic Neuroma patients are basically:

� Surgery � Radiation � Watch & Wait (no treatment)

Surgery - An operation to remove an acoustic neuroma is a specialized procedure, as it involves surgery inside the inner ear, and sometimes inside the skull, depending on the exact location of the tumour. Once the tumour has reached a size where symptoms are becoming problematic, surgery may be the only choice available. The actual surgery involves microsurgery and neurosurgery, as well as a general anaesthetic. Surgery may be performed via three routes

� Retrosigmoid � Translabrynthine � Middle Fossa

Causes of Acoustic Neuroma:

The cause is unknown. Acoustic neuromas can be sporadic or caused by an

inherited condition called neurofibromatosis type 2 (NF-2) (also known as von

Recklinghausen's disease). Acoustic neuromas have a 5 percent association

with von Recklinghausens's disease (NF-2), a rare disease characterized by

multiple tumors in various sites, especially the skin, which can cause bilateral

acoustic tumors.

Diagnosis of Acoustic Neuroma:

If your doctor suspects acoustic neuroma, he may recommend several tests to

diagnose acoustic neuroma. These tests are:

� Hearing test (audiogram)

� Computerized tomography (CT) scans, enhanced with intravenous

dye (contrast)

� Magnetic resonance imaging (MRI), enhanced with intravenous dye

(contrast).

� These acoustic neuroma tests are critical in the early detection of an

acoustic neuroma and are helpful in determining the location and size

of a tumor and in planning its removal.

The choice of approach is largely dependent on the surgeons' choice followed by the presence of useful hearing and the size

and position of the tumour.

Radiation - Focused beam radiation (e.g. the Gamma knife) has been greatly advocated as a new technology for benign brain

tumors, especially the acoustic neuroma. The goal of the treatment is to kill or inactivate the tumor cells so they no longer

duplicate. Since acoustic neuroma is a very benign type of tumor, it need not be completely destroyed. Instead, the aim is to

stop further growth. An acoustic tumor that does not grow will not jeopardize the patient's health in the future.

Observations “Wait n Watch” - Some tumours are very small and because we know they are slow growing, there is an option to

"watch" the tumour. This is done through serial MRIs. If and when growth is observed, option 1 and 2 and re explored.

Types of Acoustic Neuroma Surgery:

The exact type of operation done depends on many factors. The most significant are the size of the tumor and the level of

hearing in the affected ear. If the tumor is very small, hearing may be saved and accompanying symptoms may improve. As the

tumor grows larger, surgical removal is more complicated and hearing and balance may be lost. The facial nerve accompanies

the nerves of hearing and balance along their course from the brain through the ear and this is a very important nerve to

protect during microsurgery. The preservation of the facial nerve is of utmost importance, and is more of a priority than the

patients hearing. The three approaches to remove an acoustic neuroma are:.

Retrosigmoid Approach: The surgeon opens the skull about three inches behind the ear. The cerebellum, the part of the brain

surrounding the acoustic neuroma, is gently retracted to expose the tumor. The advantage of this approach is that hearing can

sometimes be preserved. This is also called the sub-occipital approach.

Middle Fossa Approach: An opening is created above the ear, and the surgeon drills toward the tumor while staying outside the

dura covering of the brain. Bone is removed over the internal auditory canal to expose the tumor. This approach most often

used when preservation of hearing is a primary goal.

Translabyrinthine Approach: This approach may be used when the patient has no remaining hearing in the ear, or when other

approaches are not feasible. The surgeon drills immediately behind the outer ear and removes bone with the goal of exposing

the tumor as completely as possible. The advantage of this method is that no part of the brain need be retracted, and the facial

nerve can easily be seen.

Follow-Up Care Post Acoustic Neuroma Surgery:

Follow-up care after the surgery for acoustic neuroma is important. During the follow-up period after acoustic neuroma surgery,

the doctor will monitor your recovery and check for a recurrence of your symptoms. Checkups help ensure that any changes in

your health are noted and treated if needed. Between scheduled visits, you should contact the doctor if you have any health

problems.

Benefits of Acoustic Neuroma Surgery:

With the advancement of medical technology, dedicated physicians can now offer hope and help patients by offering the most

effective, least invasive treatments for acoustic neuroma surgery.

Observation or watchful waiting can help avoiding surgery and exposure to radiation. If the patient and his family members stay vigilant and keep an eye on the status of the disease, there may not arise any need for surgery or radiation therapy. But with advanced stage of Acoustic Neuroma surgery can be a source of great relief for the patients. Through surgery tumour can be completely removed with remote risk of recurrence. After surgery only one follow up MRI would be needed. There are minimal long-term side-effects. Radiation therapy for Acoustic Neuroma helps controlling small tumours and the control rate is approximately 80-90% with less than 5- 6 years of follow up. Radiation therapy also helps in quick recovery and the stay in the hospital is usually short. Surgery and treatment of Acoustic Neuroma can help patients to resume their normal daily living depending on the size of the tumour.

Complications:

There are various possible complications after Acoustic Neuroma surgery like Balance Problems, weakness of the face, numbness, headaches, taste and swallowing Problems, dry eyes, etc.

Acoustic Neuroma Surgery in India:

Indian medical professionals are trained in nervous system conditions, brain surgery, hearing and balanced disorders. These experts attract over a million people in India every year. They have huge experience in diagnosing and treating brain and nervous system conditions. There are internationally trained neuro-oncologists for tumour treatment, otolaryngologists for ear, nose and throat conditions, audiologists for hearing conditions, radiologists for imaging and other doctors and surgeons. All these facilities make India a desirable destination for Acoustic Neuroma Surgery.

Also India offers some of the best hospitals and medical centers of the world which has high-class infrastructure, hi-tech apparatus, a team of specialists, health professionals and nurses known for their compassion and dedication towards the service of their patients. Accommodation has never been a problem in India. As medical tourism is booming in India and has become an industry, the overall infrastructure has also developed and improved remarkably. There are several state-of-the-art hotels, resorts and lodges all around India.

Cities in India that offers Acoustic Neuroma Surgery at some of the best hospitals are as follows;

Mumbai Hyderabad Kerala

Delhi Pune Goa

Bangalore Nagpur Jaipur

Chennai Gurgaon Chandigarh

Cost of Acoustic Neuroma Surgery in India:

India is widely popular for the low cost treatment it offers for various medical and health related problems. The cost of Acoustic Neuroma surgery in some of the best hospitals in India is barely half the amount charged by hospitals of US, UK, and other developed countries. People usually travel from developed countries to India to avail such affordable treatment options, which is an impossible dream in their own country. Even travel and accommodation is very reasonable with world-class hotels and travel services. Low-cost does not affect the quality of service offered by hospitals and medical professionals. There is no compromise on quality care. This has satisfied many medical care- seekers from all around the globe.

Some of the common countries from which patients travel to India for surgery are:

USA UK Canada

Australia New Zealand Nigeria

Kenya Ethiopia Uganda

Tanzania Zambia Congo

Sri Lanka Bangladesh Pakistan

Afghanistan Nepal Uzbekhistan

ABOUT INDIA

Located in South Asia, bordered by Pakistan, Nepal, China and Bangladesh, India is South Asia's largest, sovereign, democratic republic. India has an edge over other countries when it comes to offering comprehensive, cost-effective and timely medical care: it also offers an exotic, adventure-filled or cultural -if you wish array of destinations to discover and revel in for the travelers. Indian cities like Mumbai, Hyderabad, Goa, Bangalore, Nagpur, Kerala, Delhi, Pune, Jaipur, Chennai, Gurgaon, and Chandigarh offers best medical tourism service.

Mumbai - Formerly known as Bombay, is the commercial & financial capital city of India. Mumbai is famous for many things, including its thriving Bollywood film industry, teeming bazaars, colonial-style buildings, Art Deco structures and a superb choice of restaurants, often being rated as the dining capital of India. The tourist district of Colaba in Mumbai is a great place to start exploring this great city.

Hyderabad – Hyderabad city is a great place to visit in the state of Andhra Pradesh. The place has witnessed a continuous growth for last many years. Hyderabad has become a tourist hotspot following ever increasing number of tourists during past few years. Hyderabad has a well-founded reputation as one of the safest cities in the world.

Goa - The country's smallest state and famed for its colonial Portuguese and Catholic past, most tourists visit Goa for its endless selection of sandy beaches and coastal attractions. Standing proudly next to the Arabian Sea, Goa is a particularly compact state and often feels like a large town, being easy to travel. Around Goa, tourists will soon realize that the state has much more to offer than simply stunning beaches, fishing, water scooters, windsurfing and scuba diving.

Bangalore - Beauty lies in the eyes of beholder and if you want to see one of the most beautiful places in India then Bangalore is the word for it. Bangalore has earned sobriquets like 'Silicon Valley of India', 'Pub Capital of India', and 'City of Gardens'. Pleasant climate with colorful gardens with lakes and glittering nightlife, Bangalore has made its own attraction for travelers as one of the most charming cities in India,

Nagpur - Nagpur is the largest city in central India, but with its friendly atmosphere and dependable transportation, you’ll instantly feel at home. The city of Nagpur has a well-built infrastructure, is a clean and affluent city which makes a good jumping-off point for a series of trips into the far eastern corner of Maharashtra.

Kerala - Natural beauty, clean air and primordial greenery amidst the vast expanse of water and sky, typifies the state of Kerala – better known as God's own country. Kerala is famous for its alternative medical therapies such as Ayurveda, which help to rejuvenate and revitalize the body. The region is also home to India’s only virgin tropical rain forest – the Silent Valley National Park, supporting an overwhelming range of life forms, many of which are highly endangered, and endemic to this part of the planet.

Delhi - "Welcome to The Capital City of India - New Delhi" Delhi is famous as Capital city of India is located in North India. Delhi is truly a symbol of the old and the new; a blend of ancient well preserved monuments and temples along with jam-packed burger joints and up market shopping malls. Delhi has state of the art Hospitals and the best qualified doctors.

Pune - Once referred to as the Oxford of the east, Pune continues to be a stronghold for academics and culture. An array of factors like availability of efficient and experienced doctors, comparatively low treatment costs, hospital facilities of international standards and many more have made Pune one of the top destinations for medical tourism.

Jaipur - Jaipur is one of the most popular destinations on a tourist's itinerary. The magnificent forts, beautiful havelis and colourful bazaars make Jaipur a popular tourist destination among tourists. Jaipur has pioneered health and medical tourism in India.

Chennai - Chennai is one of the most developed urban centers in the Indian subcontinent. The city forms the capital of Tamil Nadu state and is the fourth largest metropolitan city in India. They have some of the very best hospitals and treatment centers in the world. Each hospital is equipped with state of the art facilities. The technology brought into practice is the very latest, including robotic surgery.

Gurgaon – It is one of the four important satellite cities of the National Capital Region and is often referred to as the 'Millennium City.' Gurgaon has recently emerged as the latest hub for Medical Tourism. Apart from being IT hub and a favorite haunt for MNC offices, the city has a number of world class hospitals that not only treat Indian citizens but also people from outside.

Chandigarh - Chandigarh is a rare epitome of modernization co-existing with nature's preservation. It is here that the trees and plants are as much a part of the construction plans as the buildings and the roads. India’s first planned city, Chandigarh is a rich, prosperous, spic and span, green city rightly called “THE CITY BEAUTIFUL”.

Knee Replacement Surgery in India

Knee replacement surgery also known as knee arthroplasty is procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. The procedure has been proven to help individuals return back to moderately challenging activities such as golf, bicycling, and swimming. Total knees are not designed for jogging, or sports like tennis and skiing (although there certainly are people with total knee replacements that participate in such sports). Knee replacement is a routine surgery performed on over 600,000 people worldwide each year. Over 90% of people who have had Total Knee Replacement experience an improvement in knee pain and function.

Knee Replacement Surgery Candidates A person would be considered a candidate for knee replacement if there is:

• Daily pain • The pain is severe enough to restrict work, recreation and ordinary activities of daily living

• Significant stiffness in the knee

• Significant instability (constant giving way) of the knee • Significant deformity (knock-knees or bow-legs) that hinders normal function of the knee

• Damage from arthritic conditions, such as osteoarthritis, rheumatoid arthritis or post-traumatic arthritis

Success Rate of Knee Replacement Surgery: Knee replacement surgery is recognized as a miracle of modern surgery. Most orthopedic experts consider replacement to be the best method of handling arthritis in the knee. Knee replacements have literally put hundreds of thousands of Americans back on their feet and allowed them to enjoy their golden years.

Knee Replacement Surgery Preparations:

• If you smoke, cut down or quit. Smoking changes blood flow patterns, delays healing and slows recovery.

• If you drink, don't have any alcohol for at least 48 hours before surgery.

• Ask your doctor for pre-surgical exercises. If you are having hip or knee replacement surgery, doing exercises to strengthen your upper body will help you cope with crutches or a walker after surgery.

• Your primary care physician or an internist will conduct a general medical evaluation several weeks before surgery. This examination will assess your health and your risk for anesthesia. The results of this examination should be forwarded to your orthopaedic surgeon, along with a surgical clearance.

• Shortly before your scheduled surgery, you will probably have an orthopedic examination to review the procedure and answer any last-minute questions.

• You may need to take several types of tests, including blood tests, a cardiogram, a urine sample and a chest X-ray.

• Advice your surgeon of any medical conditions you have and of all the medications you are taking. You may need to stop taking certain medications or your surgeon may recommend substitute medications until your surgery. Medications such as corticosteroids, insulin or anti-coagulants will need to be managed before and after surgery.