My name is Dr. Vikram Nayar. I'm a neurosurgeon at MedStar Georgetown University Hospital. I have
specialized in the treatment of several conditions that affect the brain and the spine. Some of the more
common conditions that I treat are brain tumors and meningioma, brain aneurysms, and herniated
disks in the cervical spine and lumbar spine. I also treat certain conditions that are more
rare including moyamoya disease, carotid artery stenosis, arteriovenous malformations, trigeminal
neuralgia, and hemifacial spasm. I have special expertise in microsurgical techniques. Most of
the operations that I perform on the brain and on the spine are with microsurgical techniques.
These specialized techniques allow us to maintain the highest level of safety and achieve the best
possible outcomes for patients. I also perform minimally invasive endoscopic surgery and
CyberKnife which is an effective non-invasive treatment that's appropriate for some patients.
I'm committed to helping every patient overcome his or her condition and return to normal life.
There are several ways that we can ensure that a patient has the best outcome. When I meet a
patient, I take the time to carefully evaluate his or her condition and to help the patient
fully understand the different options available for treatment. For many patients, surgery is not
needed, When surgery is the best option, I carefully plan the operation. I pay meticulous attention to
detail during every step of the surgery. I meet people who have conditions that are
life-threatening or that significantly affect their quality of life. I love my job because
I have the unique privilege of caring for those patients and helping them overcome those problems.
Microsurgery is a set of techniques that has revolutionized brain surgery and spine
surgery. There are several aspects involved in microsurgery. One aspect
is the use of the operating microscope, a technology that allows the neurosurgeon
to visualize delicate structures deep in the nervous system through small openings.
Another aspect is the use of advanced microsurgical techniques with specialized
instruments. These specific techniques allow the neurosurgeon to effectively
correct the problem without disturbing normal structures in the nervous system.
Microsurgery is an extremely valuable treatment that I can offer to most patients who need a brain or
spine operation. It allows me to separate a brain tumor or skull base tumor from delicate nerves,
blood vessels, and other critical structures. It allows me to approach and clip an aneurysm
without disturbing the brain at all. I use microsurgery in minimally invasive spine operations
to gently remove a disc herniation and relieve pressure on a nerve. And microsurgery allows
me to connect small arteries in the brain with sutures that are thinner than a human
hair for conditions like moyamoya disease. We're fortunate to be able to offer the most advanced
microsurgical techniques at MedStar Georgetown because with these techniques we can maintain
the highest level of safety and achieve the best possible outcomes for our patients.
A brain aneurysm is a balloon-like bulge of a brain artery that is caused by a weakening
of the blood vessels wall. As blood flows through the artery, it fills the aneurysm.
Aneurysms usually form underneath the brain or between the brains lobes in a space around
the brain called the subarachnoid space. If the aneurysm ruptures or breaks open,
then blood fills the subarachnoid space. That condition is known as subarachnoid
hemorrhage. Subarachnoid hemorrhage can cause devastating brain damage, and it's often fatal.
A ruptured brain aneurysm is one that has caused bleeding and requires urgent
treatment. The patient would typically have a very severe headache that starts suddenly. If
someone survives the initial hemorrhage, then the act of bleeding has stopped because a blood clot
has formed around the aneurysm. The patient should be rushed to the emergency room. Often,
patients are then transferred to a center that is specialized in brain aneurysm treatments like
MedStar Georgetown. If you've been diagnosed with an unruptured brain aneurysm, you should
be carefully evaluated by a neurosurgeon who specializes in this condition. Over the past
several years, I've had the privilege of caring for most of the patients who are diagnosed with
brain aneurysms at MedStar Georgetown. In some cases, I'll determine that the aneurysm
has no significant risk of causing problems, and the patient will not need to have any
procedure for treatment. I may arrange a plan for follow-up imaging studies. In other cases,
the aneurysm may be life-threatening if it's left untreated. I then evaluate several factors
often in consultation with other specialists to determine which treatment is safest for
the patient. It's very important to consider both short-term safety and long-term safety.
For some aneurysms, the appropriate treatment is endovascular involving a catheter that's
passed from an artery in the groin up to the arteries of the brain. Metal coils that can
then be packed into the aneurysm preventing blood from entering it. For other aneurysms, the safest
treatment is microsurgical clipping. This involves gently approaching the aneurysm underneath the
brain or between the lobes of the brain and obliterating the aneurysm with a small clip.
At MedStar Georgetown, we use the most advanced microsurgical techniques that
allow us to obliterate the aneurysm without disturbing the brain. We use state-of-the-art
technology like ICG video angiography to visualize and preserve blood flow through
tiny but important brain arteries. And, we have neurologists who are dedicated to monitoring
the electrophysiology of patients while they're under anesthesia. They can provide
real-time feedback on how the nervous system is functioning during surgery. All of these
techniques allow us to achieve the very best results when we treat a patient with a brain
aneurysm which is considered one of the most serious and complex conditions in
neurosurgery. After microsurgical clipping of an unruptured aneurysm, most of our patients
can go home after 2 to 3 days and can expect to return to normal life without limitations.
Brain tumors can be classified into two types, those that are within the brain and those that arise
outside of the brain substance but within the skull. Tumors that arise within the brain may form
from cancerous brain cells. They are generally called gliomas with various names for specific
subtypes. Cancers that arise in other parts of the body can also spread to the brain. In this
case, the tumor is called a metastasis. There are several types of tumors that arise inside the
skull but outside the brain substance. Meningiomas arise from a covering of the brain called the
meninges. Pituitary adenomas arise from the pituitary gland which is a structure at the
base of a brain. And schwannomas, such as acoustic neuromas, arise from nerves at the skull base.
We're able to provide the most advanced treatments for brain tumors and skull
base tumors. For some patients, surgical resection is the best treatment. I use
specialized microsurgical techniques to safely and effectively remove tumors. In
appropriate cases, I use minimally invasive endoscopic techniques. For other patients, a
noninvasive treatment called CyberKnife is appropriate. CyberKnife is stereotactic
radiosurgery, a treatment that directs radiation to the tumor. I work with a radiation oncologist
deliver this treatment. At MedStar Georgetown, we have a multidisciplinary team dedicated to
caring for patients of brain tumors. It includes neurosurgeons like myself, neurooncologists,
radiation oncologists, otolaryngologists, neuroradiologists, and neuropathologists.
A herniated disc in the cervical spine or lumbar spine can cause severe pain and
sometimes neurologic dysfunction. I'll describe two types of minimally invasive spine surgery
that have excellent patient satisfaction rates. The lumbar micro discectomy and the ACDF or anterior
cervical discectomy and infusion. For a lumbar disc herniation, a micro discectomy is often
the procedure of choice. It involves making a small 2 centimeter incision in the low back. I use the
operating microscope to work in a small window in the spine and gently remove the herniated disc and
decompress the nerve. Patients usually experience immediate improvement in symptoms and can go home
the same day. For a cervical disc herniation, an ACDF or anterior cervical discectomy infusion
is often the procedure of choice. It involves making an incision in the front part of the
neck and approaching the cervical spine through natural planes in the neck. I use the operating
microscope to gently remove the herniated disc and decompress the nerves in the spinal cord. I
then place a bone graft in the disc space and secure it in place with a plate and screws to
stabilize that segment of the spine. Most patients can go home the following morning.
There are surgical conditions are conditions that affect the brain and the spine. And in
some cases, they are life-threatening. They can be you know terrifying for a patient to
be diagnosed with. In other cases, they severely affect someone's quality of life either because
they cause significant pain that prevents them from doing the things they like to do or because
it actually causes a neurologic deficit which means a lack of function of some part of their
body, a disability. And so, it's our goal as best as we can as neurosurgeons to help fix that
problem, hopefully to reverse the condition or at least prevent it from getting worse.