Clinical Services

Our institute faculty includes 10 full time academic clinicians each with highly developed clinical subspecialisation geared toward providing care for patients in various major neurosurgical subspecialties.

Neurotrauma

Neurointensive care is a subspecialty discipline within neurosurgery that deals with application of critical care principles to patients with critical neurologic illness. Principles of basic ventilator and airway management as it applies to neurologic patients, critical care of neuromuscular disease, invasive monitoring in the intensive care unit, types of and uses of neurophysiologic monitoring, and applications of cerebral blood flow monitoring are employed daily. Timely management of critical events and close attention to brain function and the interaction of the brain and rest of the body are important aspects of neurocritical care which we employ to manage our patients.

For patients with post-traumatic cognitive and behavioral deficits, long-term care is coordinated with the traumatic brain injury rehabilitation services.

Neuro-oncology

The neuro-oncology team is made up of highly trained neurosurgeons, physicians, nurses, and personnel dedicated to the compassionate, multi-disclipinary treatment of patients with brain tumors. As a regional referral center our neurosurgeons have expertise in the treatment of various types of brain tumor. The latest technology is used in order to perform the safest most effective surgery possible. With the upcoming set up of the intraoperative MRI ,our neurosurgeons will be able to obtain high-resolution MRI scans during the course of an operation. For brain tumor surgery, this can potentially increase the extent of resection of such tumours.

We are also able to use the complementary information obtained from PET imaging, functional MRI brain mapping and spectroscopic MRI imaging of brain tumors and these images can then be fused for use with our advanced neuronavigational systems in the operating room.

Neurovascular

We provide the highest level of care for patients with aneurysms and arteriovenous malformations (AVMs) as well as other neurovascular problems of the brain and spinal cord. Our highly experienced staff includes physicians specialising in neurosurgery, neurology and interventional neuroradiology. Utilizing advanced neurologic technology, this multidisciplinary team works together to prevent or minimise the neurologic impact of an aneurysm or AVM and maximize the patient's recovery.

Recent advances in MRI, CTA, and angiography allow more precise anatomic localization of the aneurysm or AVM and greatly aid treatment planning. Superselective injection of intracranial vessels can better define the relationship of the aneurysm neck or identify feeding vessels to the AVM. After careful analysis of the vascular studies and factors such as the patient’s age, clinical presentation and natural history, the multidisciplinary team develops a treatment plan. The goal of treatment is complete obliteration of the aneurysm or AVM.

For stroke therapy, a variety of new techniques are now available. Surgery for carotid endarterectomy provides protection front stroke if carotid artery narrowing is found in an, asymptomatic or symptomatic patient. In addition, if a stroke has occurred, new endovascular techniques of thrombolysis (clot disruption) are now available.

Skull base

Skull base surgery is one of the most challenging and technically demanding subspecialities in the field of neurosurgery. Our experienced skull base surgeons together with multidiscplinary surgical specialities from plastic surgery, head and neck surgery, ear/nose/throat surgery and opthalmology are able to deal with complex aspects of skull base tumour resection and reconstructive surgery.

Disorders of the cranial base which our center has vast experience and is prepared to treat include:

Anterior and Middle Cranial Base

Neoplasms of the nasal and sinus cavities and nasopharynx
Meningiomas involving the orbit, frontal fossa, sphenoid wings and cavernous sinus
Other tumors of the orbit and cavernous sinus
Bone tumors including chordoma, chondrosarcoma and fibrous dysplasia
Pituitary and other tumors of the sella
Craniofacial vascular malformations
Traumatic or neoplastic compression of the optic nerve

Posterior and Lateral Cranial Base

Acoustic neuromas
Other tumors of the cerebellopontine anglc and jugular foramen including meningiomas, schwannomas and glomus tumors
Lesions of the petrous apex including cholesterol granulomas and cholesteatomas
Cranial nerve neoplasms
Osteoradionecrosis
Developmental and congenital abnormalities including basilar impression, Chiari malformation.

Entire Cranial Base

Vascular lesions including aneurysms, angiomas and artcriovenous malformations
Cerebrospinal fluid leak
Post-traumatic reconstruction

Functional Neurosurgery

Functional neurosurgery is directed to correct poor function of the central or peripheral neurosystem. The interventions are planned in advance to disconnect and stimulate pathways and, most recently, transplantation of tissue and engineered cells are under study. These surgical procedures correct movement disorders such as Parkinson's Disease, tremor, dystonias, spasmodic torticollis, spasticity, rigidity related to cerebral palsy and spasticity related to spinal cord injury. Functional neurosurgical procedures are also applied for treatment of severe intractable chronic pain secondary to nervous tissue compression or damage by trauma, surgery, or cancer, (i.e. trigeminal neuralgia).

Movement Disorders and Parkinson’s Disease

As Singapore's population continues to age, the number of people with Parkinson's Disease and Movement Disorders, such as essential tremor, dystonia, chorea and myoclonus will rise. As with many other medical conditions, these diseases currently do not have a cure. However, there are effective treatments available to control symptoms and improve daily function. Minimally invasive surgery is also available to treat patients with advanced disease.

The Parkinson's Disease and Movement Disorders Programme emphasises the provision of excellent comprehensive clinical services coupled with strong research initiatives. A multi-disciplinary neurologists, neurosurgeons and therapists work together to provide the care that is currently accepted widely as most effective care.

Spine Surgery

Spinal disorders include abnormalities of the spinal column, intervertebral discs, nerve roots, spinal cord and the adjacent structures. They represent the most common problems encountered in general neurosurgery and are often related to degenerative disc disease and nerve compression that require specialized diagnosis and treatment. Less common disorders of the spine include vascular, neoplastic and congenital anomalies and syringomyelia that require a highly specialized approach with precise diagnosis and treatment for optimal outcome.

Our experienced spine surgeons specialise in cervical, thoracic, lumbar, and lumbosacral intervertebral disc removal, treatment of spine fractures and other spine injuries, spinal synovial or ganglion cysts, spinal cord herniation syndromes, Arnold Chiari-Malformation, syringomyelia, vertebral hemangiomas, schwannomas (neuromas), neurofibromas, gliomas (including astrocytoma, olgiodendroglioma, ependymoma, and ganglioglioma) chordomas, spinal chondrosarcomas, other spine tumors, and surgery for spinal stenosis.

Our unit comprises a comprehensive multidiscplinary spine service and provide complete care for all aspects of spinal disorders – imaging studies, nerve conduction studies, full neurological consultations, operations by experienced spinal neurosurgeons, intra-operative microscope and intra-operative spinal monitoring.

Nurse clinicians, rehabilitation physicials, physiotherapists and occupational therapists are available to facilitate all areas of pre and post operative care.

Peripheral Nerve Surgery

The Peripheral Nerve Program is available to provide and coordinate a full range of services for the evaluation and surgical care of individuals suffering from peripheral nerve pathology. Diagnostic services such as evaluation by EMG and nerve conduction studies are supplemented by the use of specialized Magnetic Resonance Neurography imaging techniques that are applicable to suspected peripheral nerve tumors, traumatic injury, post-irradiation neuritis, chronic compression, and pain syndromes where an anatomic lesion is suspected. Lesions involving any part of the peripheral nervous system can be dealth with by our experienced neurosurgeons. These include the surgical therapy of nerve entrapment such as carpal tunnel syndrome.