Dr. Ravi A. IchalakaranjiMBBS · MS (General Surgery) · MCh (Neuro Surgery)
Combining precision, compassion, and the latest surgical techniques to deliver exceptional neurological and spinal care to patients across India and beyond.
17+Years Experience
1000+Surgeries
MCI Verified
Accepting Patients
Neuron Brain Spine
Belagavi · Karnataka
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17+
Years of Surgical Experience
2+
Years as Specialist
1,000+
Surgeries Performed
Verified
MCI Registration · Active
The Physician
A philosophy of care, grounded in precision.
A surgeon's hands are guided by a lifetime of training — but the outcome is shaped by the principles behind them.
Super-Specialist Training
MCh Neurosurgery from KLE Jawaharlal Nehru Medical College — one of India's premier neurosurgical training programmes.
17+ Years of Experience
More than a thousand neurosurgical and spinal procedures performed — from emergency trauma to elective micro-spine surgery.
Full-Spectrum Neurosurgery
Brain tumors, spine disorders, cerebrovascular, peripheral nerve, and trauma — a complete scope under one trusted pair of hands.
Minimally Invasive Techniques
Microdiscectomy, keyhole craniotomy, endoscopic and image-guided approaches — smaller incisions, faster recovery, same outcomes.
Patient-First Approach
Detailed consultations, clear explanations, and continuity of care — from first visit through post-op recovery and rehabilitation.
Evidence-Based Practice
Guided by current international guidelines, peer-reviewed literature, and continuous learning — never by pressure or presumption.
A curated, visual guide to the conditions most commonly seen in a neurosurgical practice — their anatomy, warning signs, diagnostic workup, and the modern surgical techniques used to treat them.
Brain Tumors · Hydrocephalus · Epilepsy
Spine Disc Herniation · Myelopathy
Peripheral Nerve Neuralgia · Compression
Vascular Aneurysm · Stroke
Trauma Head Injury · Spinal Trauma
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Condition Guides
0+
Years of Practice
0+
Surgeries Performed
0%
Success Rate
Conditions & Treatments
Common Problems We Treat
Tap any card to explore its anatomy, warning signs, diagnostic workup, and step-by-step surgical approach. Use the filters or the anatomy map above to narrow by region.
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A brain tumor is a mass of abnormally dividing cells inside the skull. Tumors may be primary (originating in brain tissue) or metastatic (spread from another organ). Even benign tumors can cause harm by compressing adjacent structures.
~120
Tumor Types
30%
Metastatic
4-6 hrs
Avg. Surgery
Severity
At A Glance
1.Accounts for ~2% of all cancers, but a leading cause of neurological morbidity.
2.Meningiomas (benign) are the most common — slow growing, often curable.
3.Modern neuronavigation and awake craniotomy enable safe resection near eloquent cortex.
Cross-section showing a right parietal mass with mass effect
Severe headaches (worse mornings)
Seizures (new-onset)
Vision or hearing changes
Personality / cognitive changes
Weakness on one side
Balance, coordination loss
Nausea, vomiting
Speech difficulty
MRI Brain with Contrast
Gold standard — identifies tumor size, location, edema, enhancement pattern, and relation to eloquent cortex.
CT Scan
Rapid first-line imaging in emergencies; detects calcification, haemorrhage, and bone involvement.
Functional MRI / DTI
Maps speech, motor pathways — guides safe surgical corridors.
Stereotactic Biopsy
Minimally invasive needle biopsy for histopathological diagnosis when resection is not immediately feasible.
Conservative
Watchful Observation
Small, asymptomatic meningiomas are monitored with serial MRIs every 6–12 months.
Medical
Steroids & Anti-Epileptics
Dexamethasone reduces peritumoral edema; anti-seizure medications control symptoms.
Surgical
Craniotomy & Tumor Resection
Image-guided microsurgical removal — the definitive treatment for accessible tumors.
Adjuvant
Radiotherapy / Stereotactic Radiosurgery
Gamma Knife or CyberKnife for residual disease or deep-seated inoperable tumors.
Adjuvant
Chemotherapy
Temozolomide for high-grade gliomas — often combined with radiation.
1
Anaesthesia & Positioning
General anaesthesia with head fixation using a Mayfield clamp for absolute stability.
2
Neuronavigation Registration
MRI data fused with real-time position tracking — millimetre-accurate surgical planning.
3
Craniotomy
A bone flap is raised over the target. The dura mater is opened carefully to expose the cortex.
Cortical mapping preserves motor & speech function; awake craniotomy when adjacent to eloquent areas.
6
Closure & Recovery
Dura repaired, bone flap secured with titanium plates. ICU observation for 24–48 hours.
Recovery: Most patients are mobile within 48 hours. Full return to routine activity in 4–6 weeks. Histopathology guides any adjuvant therapy.
The brain normally produces ~500 ml of CSF daily, which circulates through the ventricles. When drainage is blocked or absorption fails, fluid accumulates — enlarging the ventricles and compressing brain tissue.
1:500
Newborns
500 ml
CSF / day
2 hrs
Avg. Surgery
Severity
Types
A.Obstructive — CSF flow is blocked (aqueductal stenosis).
B.Communicating — absorption failure post-meningitis or haemorrhage.
C.Normal Pressure (NPH) — the classic triad in the elderly: gait, cognition, incontinence.
CSF accumulation dilates the ventricular system
Headache, worse in mornings
Nausea, projectile vomiting
Blurred or double vision
Shuffling, magnetic gait
Memory problems (NPH)
Urinary incontinence
Infant: bulging fontanelle
Increasing head circumference (infants)
Cranial MRI / CT
Shows ventriculomegaly, periventricular edema, and identifies the site of obstruction.
CSF Tap Test
In NPH — 30 ml of CSF removed; gait improvement over 24 hours predicts shunt response.
ICP Monitoring
Invasive pressure tracing when diagnosis is uncertain; differentiates true hydrocephalus from atrophy.
Temporary
External Ventricular Drain
Emergency CSF diversion in acute presentations — stabilises the patient.
Surgical
Ventriculoperitoneal (VP) Shunt
A programmable valve diverts CSF from the ventricles into the abdominal cavity for absorption.
Surgical
Endoscopic Third Ventriculostomy
Minimally invasive — creates a new CSF pathway, avoids permanent hardware.
Surgical
Shunt Revision
Malfunction or infection may require replacement — valves programmed externally via magnet.
1
Positioning
Supine, head turned; scalp and abdomen prepared simultaneously.
2
Burr Hole
A small opening made at Kocher's point to access the frontal horn of the lateral ventricle.
3
Ventricular Catheter
Proximal catheter passed into the ventricle under neuronavigation guidance.
4
Tunneling
The distal catheter tunneled subcutaneously from scalp to abdomen; programmable valve sits behind the ear.
5
Peritoneal Placement
A small abdominal incision; distal catheter placed within the peritoneal cavity for CSF absorption.
6
Closure
Valve pressure set post-op via external magnetic adjustment based on clinical response.
Outcome: Dramatic symptom relief is often seen within days. Lifelong surveillance is needed to detect shunt malfunction early.
Each intervertebral disc has a tough outer ring (annulus) and a gel centre (nucleus pulposus). When the annulus tears, the nucleus herniates — most often at L4-L5 or L5-S1 — compressing the exiting nerve root and producing the classic burning pain down the leg.
~80%
Resolve Non-Op
L4-S1
Most Levels
60 min
Microdiscectomy
Severity
Key Points
✓Most common spine problem in adults 30–50 years.
✓Cauda equina syndrome (saddle anaesthesia, bladder loss) is a surgical emergency.
✓Conservative care succeeds in 8/10 patients within 6 weeks.
Herniated disc compressing the exiting nerve root
Sharp, burning leg pain
Numbness, tingling in foot
Low back pain with flexion
Weak dorsiflexion (foot drop)
Pain worse with coughing/sneezing
Positive straight-leg raise test
Saddle numbness (emergency)
Bladder dysfunction (emergency)
Clinical Exam
Dermatome-specific sensory loss, myotome weakness, and reflex changes localise the involved nerve root.
MRI Lumbar Spine
Gold standard — shows the exact level, laterality, and degree of nerve compression.
X-Ray (Flexion/Extension)
Assesses spinal alignment and instability when fusion is being considered.
EMG / Nerve Conduction
Distinguishes a disc herniation from peripheral neuropathy when imaging is equivocal.
Conservative
Activity Modification & NSAIDs
First-line for 4–6 weeks; most patients improve without intervention.
Image-guided local steroid delivery for persistent radicular pain.
Surgical
Microdiscectomy
Minimally invasive removal of the herniated fragment via a 2 cm incision.
Surgical
Endoscopic Discectomy
Single-port endoscope; same-day discharge in most patients.
1
Prone Positioning
Patient positioned prone on a Wilson frame; abdomen free to reduce venous pressure.
2
Fluoroscopic Level Localization
C-arm imaging confirms the target disc level before incision.
3
Micro Incision
A 2–3 cm midline incision; muscle retracted without cutting.
4
Laminotomy
Small window in the lamina exposes the nerve root under the microscope.
5
Disc Fragment Removal
The nerve is gently retracted and the free fragment extracted, relieving pressure.
6
Closure & Mobilisation
Skin closed with subcuticular sutures; patient walks within 4 hours.
Recovery: Walking same day, discharge in 24 hours. Return to desk work in 2 weeks, heavy lifting in 6 weeks. 90%+ report immediate leg pain relief.
Over decades, discs dehydrate, osteophytes form, and ligaments thicken. The spinal canal in the neck narrows, pressing on the delicate spinal cord. Left untreated, myelopathy progresses — leading to permanent disability.
#1
Cord dysfunction cause > 55
C5-C6
Common Level
3 hrs
ACDF Surgery
Severity
Red Flags
!Clumsiness with buttons, coins, chopsticks — hallmark sign.
!Unsteady, wide-based gait; frequent stumbles.
!Once symptoms begin, early surgery outperforms conservative care.
Cervical canal stenosis compressing the spinal cord at C5-C6
Clumsy hands, dropping objects
Difficulty buttoning shirts
Unsteady, broad-based gait
Electric shocks down spine (Lhermitte)
Neck stiffness & pain
Arm/hand numbness
Bladder urgency
Brisk reflexes, Hoffman's sign
MRI Cervical Spine
Identifies canal diameter, cord signal change (myelomalacia), and the specific levels of compression.
Dynamic X-Rays
Flexion-extension views reveal subluxation or instability.
SSEP / MEP
Electrophysiology confirms functional cord dysfunction when MRI is ambiguous.
CT Myelogram
Alternative when MRI is contraindicated (pacemaker, severe claustrophobia).
Mild only
Physiotherapy & Soft Collar
Only appropriate for mild, non-progressive disease under close observation.
Gold Standard
ACDF (Anterior Cervical Discectomy & Fusion)
Front-of-neck approach — disc removed, cord decompressed, levels fused with a cage/plate.
Motion preserving
Cervical Disc Arthroplasty
Replaces the diseased disc with an artificial implant; preserves neck motion.
Multi-level
Posterior Laminoplasty
Reshapes the posterior bony canal — ideal for 3+ level stenosis.
1
Anterior Approach
Horizontal neck-crease incision; natural plane between carotid and oesophagus.
2
Discectomy
Diseased disc and osteophytes removed under the operating microscope.
3
Cord Decompression
Posterior longitudinal ligament resected to fully free the spinal cord.
4
Cage Placement
PEEK or titanium cage filled with bone graft restores disc height.
5
Anterior Plating
Titanium plate and screws stabilise the segment until fusion completes (~3 months).
6
Closure
Platysma and skin closed; soft collar for 2–4 weeks.
Outcome: Arrests disease progression; hand function and gait often improve. Driving in 2 weeks, desk work in 3–4 weeks.
The trigeminal (5th cranial) nerve carries sensation from the face. A looping artery — most often the superior cerebellar — compresses the nerve at its entry to the brainstem, stripping its myelin sheath and causing misfiring.
V2/V3
Commonest branches
>95%
MVD Success
3 hrs
MVD Surgery
Pain severity
Triggers
•Light touch — shaving, washing the face, a breeze.
•Chewing, talking, brushing teeth.
•Cold drinks; temperature changes.
Artery looping against the trigeminal nerve root
Lightning-bolt facial pain
Unilateral (one side of face)
Attacks lasting seconds–minutes
Fear of eating, bathing
Triggered by light touch
Pain-free intervals
Normal neurological exam
Weight loss from fear of chewing
Clinical Diagnosis
Paroxysmal, unilateral, shock-like pain in a trigeminal distribution — diagnosis is primarily clinical.
3D FIESTA MRI
High-resolution sequences demonstrate the offending vessel contacting the nerve — crucial for MVD planning.
Exclude MS
In young patients or atypical cases, MRI screens for demyelinating plaques in the pons.
First-line
Carbamazepine / Oxcarbazepine
Controls pain in 80% initially; efficacy often declines over years.
Adjunct
Baclofen / Gabapentin
Added when monotherapy fails or side-effects limit dosing.
Curative
Microvascular Decompression (MVD)
Gold-standard surgery — teflon pad separates the artery from the nerve. Durable cure in >95%.
Percutaneous
Balloon Compression / RFA
For elderly or unfit patients — selective nerve ablation via a cheek needle.
Non-invasive
Gamma Knife Radiosurgery
Focused radiation to the nerve root — pain relief over 4–6 weeks.
1
Lateral Positioning
Patient on their side, head fixed; incision planned behind the ear.
2
Retromastoid Craniotomy
A 3 cm bone opening gives access to the cerebellopontine angle.
3
Microsurgical Exposure
The cerebellum is gently retracted to visualise the trigeminal nerve at the brainstem.
4
Identify Offending Vessel
The compressing artery — usually superior cerebellar — is mobilised off the nerve.
5
Teflon Pledget Placement
A small shredded-teflon sponge permanently cushions the artery away from the nerve.
6
Closure
Dura and bone flap replaced; most patients wake pain-free.
Outcome: Immediate, durable cure in most. Discharge by day 3, full recovery in 3 weeks. Preserves facial sensation.
Aneurysms form at arterial bifurcations where flow stresses the wall. Most are silent until they rupture — producing a "thunderclap" headache. Rupture carries 30-40% mortality; survivors often face significant neurological deficits.
~3%
Adults Affected
1%/yr
Rupture Risk
4 hrs
Clipping Surgery
Severity
Risk Factors
•Uncontrolled hypertension.
•Smoking — doubles rupture risk.
•Family history, polycystic kidney disease.
A berry aneurysm ballooning from a cerebral artery
"Worst headache of my life"
Sudden loss of consciousness
Stiff neck (meningismus)
Photophobia, vomiting
Dilated pupil (CN III palsy)
Sentinel headache (days before)
Seizure at onset
Hemiparesis
Non-contrast CT
Detects subarachnoid blood in the first 24 hours with 95% sensitivity.
CT Angiography
Rapid, non-invasive mapping of the cerebral vasculature — defines aneurysm neck and morphology.
Digital Subtraction Angiography
Gold standard — dynamic imaging of blood flow; also the access route for coiling.
Lumbar Puncture
Xanthochromia confirms SAH when CT is negative but suspicion is high.
ICU
Blood Pressure Control
Strict BP control with nimodipine prevents vasospasm and rebleeding.
Open Surgery
Microsurgical Clipping
Titanium clip placed across the neck — permanent exclusion from circulation.
Endovascular
Coil Embolisation
Platinum coils packed into the aneurysm sac through a groin catheter.
Endovascular
Flow Diverter Stent
For wide-neck aneurysms — redirects flow away from the sac.
1
Supine Positioning
Head fixed and rotated; anaesthetist maintains tight BP control.
2
Pterional Craniotomy
Behind-the-hairline bone flap opens access to the Sylvian fissure.
3
Sylvian Fissure Split
The frontal and temporal lobes gently separated to reveal the Circle of Willis.
4
Proximal Control
A temporary clip placed on the parent artery before tackling the aneurysm itself.
5
Permanent Clipping
Titanium clip reconstructs the neck while preserving parent and perforator flow.
6
Flow Verification
Intraoperative ICG video-angiography confirms exclusion and vessel patency.
Outcome: Clipping provides permanent cure. ICU stay 2–7 days depending on grade; many unruptured patients discharge within a week.
A clot travels to the brain — usually from the heart or a carotid plaque — blocking an artery. The tissue downstream begins dying within minutes. Rapid restoration of flow is the only effective treatment.
4.5 hr
tPA Window
24 hr
Thrombectomy Window
2M
Neurons / min
Urgency
BE-FAST
BBalance — sudden loss of coordination.
EEyes — sudden vision change.
FASTFace, Arm, Speech, Time — call emergency.
MCA occlusion with downstream ischemic territory
Sudden facial droop
Arm weakness / drift
Slurred or garbled speech
Sudden vision loss
Severe dizziness, vertigo
Sudden severe headache
Confusion, disorientation
Loss of balance / fall
Non-contrast CT
Rules out haemorrhage within minutes — mandatory before thrombolysis.
CT Angiogram + Perfusion
Localises the occluded vessel and quantifies salvageable penumbra.
Diffusion MRI
Shows the infarct core within 30 minutes — most sensitive modality.
Cardiac Workup
ECG, echo, telemetry search for atrial fibrillation and cardio-embolic sources.
Emergency
IV Thrombolysis (tPA)
Given within 4.5 hours of onset; dissolves the clot chemically.
Endovascular
Mechanical Thrombectomy
Stent retriever pulls the clot out through a groin catheter — up to 24 hours.
Surgical
Decompressive Craniectomy
Life-saving removal of a bone flap for malignant cerebral oedema.
Secondary Prevention
Antiplatelets / Anticoagulation
Lifelong based on aetiology (aspirin, clopidogrel, DOACs).
1
Arterial Access
Femoral or radial puncture under local anaesthesia.
2
Guide Catheter
Advanced through the aorta into the affected carotid or vertebral artery.
3
Cross the Clot
A microcatheter is gently navigated past the occlusion.
4
Deploy Stent Retriever
Self-expanding stent engages the thrombus like a corkscrew.
5
Aspiration & Retrieval
Stent and clot withdrawn under continuous suction.
Outcome: Functional independence at 90 days is 2-3× higher with thrombectomy than medical therapy alone. Every 15 minutes saved improves outcome.
TBI is classified by the Glasgow Coma Scale (GCS) into mild (13-15), moderate (9-12), and severe (≤8). Primary injury happens at impact; secondary injury — from swelling, hypoxia, and raised ICP — is what neurosurgeons work to prevent.
Epidural haematoma following impact — a surgical emergency
Loss of consciousness
Severe progressive headache
Vomiting, seizures
Unequal pupils
Clear fluid from nose/ear (CSF leak)
Battle sign / raccoon eyes
Confusion, amnesia
Slurred speech, weakness
Glasgow Coma Scale
Rapid bedside assessment of eye, verbal, motor response — drives the urgency of intervention.
Non-contrast CT Head
First-line; detects bleeds, skull fractures, midline shift, and herniation.
C-Spine Imaging
Every major head injury must clear the cervical spine — fractures coexist in 10%.
ICP Monitoring
Bolt or ventricular catheter for GCS ≤8 — guides escalation of therapy.
ABC
Airway, Breathing, Circulation
Intubate for GCS ≤8; maintain SBP >100 and SpO₂ >94%.
Medical
Osmotic Therapy
Hypertonic saline or mannitol rapidly reduces cerebral oedema.
Emergency
Craniotomy & Clot Evacuation
Epidural and subdural haematomas with midline shift require urgent evacuation.
Life-saving
Decompressive Craniectomy
A large bone flap is removed to accommodate brain swelling; stored for later replacement.
Rehab
Neurorehabilitation
Physiotherapy, speech therapy, and cognitive rehab — recovery continues for 12–24 months.
1
Rapid Transfer to OT
For expanding haematomas — every minute counts.
2
Large Question-Mark Flap
A generous craniotomy/craniectomy over the clot, often frontotemporal.
3
Bone Flap Removal
Flap lifted; in decompressive cases, stored in the abdomen or frozen for 6–12 weeks.
4
Clot Evacuation
Blood gently irrigated and aspirated; bleeding source coagulated.
5
Duraplasty
Dura expanded with a patch to allow the brain room to swell safely.
6
Closure & ICU
Scalp closed; multimodal monitoring (ICP, brain oxygen) continues in neuro-ICU.
Recovery: Highly variable — from full recovery in concussion to prolonged rehabilitation in severe TBI. Cranioplasty (bone flap return) performed at 8–12 weeks.
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