Dr. R. Ramnarayan,

Consultant Neurosurgeon and Functional Neurosurgeon

Dr R Ramnarayan is a leading Neurosurgeon who has set his foot prints across the globe. Specialised in Restorative Neurosurgery, Dr Ramnarayan has over 500 plus successful specialised restorative neurosurgeries under his credentials.

With almost no specialised surgeons to provide a complete normal life to the patients, Dr Ramnarayan focuses only on these specialised restorative neurosurgeries and so is able to generate good results repeatedly.

Dr Ramnarayan uses his expertise and experience to treat and restore a lot of neurological and other problems where nervous system may be the cause. This way he restores the function of these structures. So his specialty id also called ‘RESTORATIVE NEUROSURGERY’. As these are all neurosurgical procedures, a detailed preoperative assessment is done for each patient including trial procedures in most cases to confirm whether the patient will benefit from the surgery and will have no major adverse effects. The most important indication for any of these surgeries is that the patient should have tried complete and comprehensive medical management but either there was no effect or patient could not tolerate the treatment due to side effects. Given below is a list of the diseases treated surgically by Dr Ramnarayan.

      1) Movement disorders like Parkinson’s disease, dystonia, essential tremor.
     2) Some types of autism especially those with severe aggressive behaviour.

      3) Some psychiatric problems like depression, OCD, Tourette’s syndrome.
     4) Intractable addiction/ alcoholism
     5) Intractable epilepsy
     6) Intractable obesity
     7) Chronic pain especially the central post stroke pain      
     8) Selected cases of schizophrenia.                                   

      9) Cases of patients in coma (persistent vegetative state)
     10) Cancer pains
    11) Failed back surgery syndromes (Post laminectomy syndrome).
     13) Other types of noxious pain like osteoporotic pain, rheumatoid arthritis.
     14) All types of spasticity (stiffness of hands and legs) as in
                               1. Cerebral palsy
                               2. Hypoxic encephalopathy (such as drowning, smoke inhalation)
                               3. Multiple Sclerosis
                               4. Severe head injury
                               5. Spinal cord injury
                               6. Stroke
                               7. Some Neurodegenerative illness
      15) Patients in persistent vegetative state.
      16) Cases of spino-cerebellar degeneration 
      17) Patients with cerebellar involvement in Multiple sclerosis 

       18) Refractory .angina/ Intractable heart Failure (Class 3 and 4)
      19) Patients with failed back surgery syndrome
      20) Patients with severe painful diabetic neuropathy.
      21) Patients with brachial plexus injury pain
      22) Patients with severe peripheral vascular disease (limb saving) 

        23) Some cases of persistent vegetative state

        24) Urinary incontinence due to nervous diseases
       25) Urinary retention (non-Obstructive) due to nervous diseases
       26) Faecal incontinence due to nervous diseases
       27) constipation due to nervous diseases
       28) some cases of irritable bowel syndrome
       29) Pelvic pain in women

        30) uncontrolled epilepsy

        31) Uncontrolled depression including suicidal tendency

 

Deep Brain Stimulation (DBS) is the surgery where electrodes are inserted through small holes in the skull into various parts of the body for various diseases. The electrodes are the connected through wires under the skin to a battery placed under skin below the collar bone. This battery (also called IPG) stimulates the electrodes and causes improvement in the symptoms of the patients. The common conditions where Deep brain stimulation has been found to be effective include:
  1) Movement disorders like Parkinson’s disease, dystonia’s, essential tremor.
     2) Some types of autism (aggressive types with self harm).

      3) Some psychiatric problems like depression, OCD, Tourette’s syndrome.
     4) Intractable addiction/ alcoholism
     5) Intractable epilepsy
     6) Intractable obesity
     7) Chronic pain especially the central post stroke pain       only few cases; has
     8) Selected cases of schizophrenia.                                    still not become routine

      9) Cases of patients in coma (persistent vegetative state)

  • Movement disorders like Parkinson’s disease, essential tremor and dystonia interfere with the free movements of the body. The diagnosis is by clinical features which include tremor of the hands and legs and uncontrolled abnormal movements of the hands, legs and even the whole body. The treatment of these is initially with medications but later the medicines start becoming ineffective. So surgery is another option. The surgery that is offered is called Deep Brain stimulation (DBS) where pacemakers are introduced into various parts of the brain. The results of DBS in the properly selected patients are very good.

 

  • Autism is a problem of communication and has a worldwide incidence. The symptoms vary from very mild to very severe. That is why it is also called autism spectrum disorder. Other than communication issues the other problem parents face in atleast 40% of patients is very aggressive behaviour. This becomes worse as the patients grow up. By DBS those aggressive behaviour can be controlled. During this process the patient also has improvement in the autism features also.

 

  • Psychiatric illnesses take a huge toll of our population. Among these Depression and Obsessive compulsive disorders (OCD) are well known. Depression affects a lot of people and many end up in suicide. Medical management is very effective in many of these patients but a significant percentage does not benefit or develop side effects. Surgery is helpful in these patients. For OCD again DBS surgery is very effective. For depression DBS surgery is offered in severe cases and vagal nerve stimulation is offered in moderately severe cases. Two other conditions where DBS surgery is done are in Tourette’s syndrome and in Tardive dyskinesia. Stimulation of the vagal nerve in the neck is also done with good results. It is approved by the USFDA for depression.

  • Addiction is a huge problem all over the world. There are excellent deaddiction regimens but the relapse rates are very high. The relapse is blamed on an area of the brain called nucleus accumbens. This nucleus causes the craving. In those patients who relapse surgery could be an option. DBS of the nucleus accumbens helps these patients to get out of the addiction. The same surgery is very beneficial to people who have obesity or have failed bariatric surgery.

  • Epilepsy is both a medical and a social problem. A good majority of the epileptics do respond to drugs but not all. For these patients with uncontrolled epilepsy either DBS surgery or Vagal nerve stimulation is very effective.These surgeries control and in a few cases could abolish the seizures totally. In DBS the area of the brain called anterior nucleus of the thalamus is stimulated. In vagal nerve stimulation, the vagus nerve in the neck is stimulated.

  • Obesity and other metabolic diseases are a big problem all over the world. Bariatric surgery in the abdomen especially laparoscopically has been done in thousands of individuals but unfortunately relapse of the condition is very common. In this scenario DBS surgery has been offered and has been effective in the few cases that have been operated. More studies are being done and the ideal targets will emerge soon.

  • Chronic pain especially of central origin like after thalamic stroke is very miserable and usually resistant to medicines. In such cases DBS of the thalamus have been given with good results in some patients. Similarly the results of DBS in Schizophrenia also are promising but these are very early days.

  • DBS surgery has been tried in patients who are in a coma for sometime. There has been tremendous success in some situations but it needs a lot of refining and fine tuning before it is applied universally.

 

Cerebrospinal fluid (CSF) is a clear, colourless body fluid found surrounding the brain and spinal cord. It is secreted in the middle portion of the brain and then travels down the brain stem and spinal cord upto the lower end and then comes back to the sides of the brain and gets absorbed there. This is therefore a local circulation of the brain and spinal cord. The advantage of this circulation is that drugs put at the lower back level will find its way into the brain without having to touch the brain. The space where the CSF is found is called intrathecal space.

 

This principle is used in Intrathecal drug delivery systems. The two drugs used are intrathecal morphine and intrathecal baclofen. Intrathecal morphine is very effective in many types of severe pain especially in severe cancer pain. Here morphine is filled in a pump which is placed just under the skin of the lower abdomen. This then delivers the drug directly into the CSF and reaches all parts of the brain and spinal cord to give good pain relief. The same drug is used in many other conditions like Failed back surgery syndrome, rheumatoid arthritis, osteoporotic pain etc. The other drug used in this way is baclofen. Baclofen is a muscle relaxant and is very good in spasticity. Spasticity is the stiffness of the hands and legs that happen in conditions like Cerebral palsy, hypoxic encephalopathy (drowning), Multiple Sclerosis, severe head injury and spinal cord injury, Stroke and in some neurodegenerative illness. Putting the baclofen directly into the CSF helps by having reduced dosage and so much less adverse effects, 24/7 action and ability to control the dose from outside using wireless technology. A trial procedure is always done as an OPD to see whether the patient will benefit from the pump surgery. Many studies have shown the effectiveness of both morphine and baclofen pump and both are approved by the USFDA.


It has been shown for the last many decades that stimulating the spinal cord help in many conditions especially in chronic pain. From this arose the concept of dorsal spinal cord stimulation where a stimulator is placed in the dorsal extradural space (outside the covering of the spinal cord called dura) and connected to a battery in the front of the chest. This is useful in a variety of neuropathic (nerve related) chronic pain like failed back surgery syndrome, diabetic neuropathy pain, patients with refractory angina or failed cardiac bypass surgery, patients with brachial plexus injury pain, and also in some conditions like peripheral vascular disease especially in diabetes. Just like the previous note here also atrial procedure is done under local anaesthesia to see whether patient benefits from the treatment. Recently this procedure has been tried in some patients in a vegetative state with good results. So the conditions where spinal cord has been found to be effective are

              a) Refractory .angina/ Intractable heart Failure (Class 3 and 4)
             b) Patients with failed back surgery syndrome
             c) Patients with severe painful diabetic neuropathy.
             d) Patients with brachial plexus injury pain
             e) Patients with severe peripheral vascular disease (limb saving) 

             f) Some cases of persistent vegetative state.

 

The sacral nerves are the nerves arising from the lower end of the spinal cord and supplying the organs of the pelvic region. There are five sacral nerves S1, S2, S, S4, S5 out of which S2, S3, S4 play a role in controlling the bowel and bladder. In many neurological conditions like Parkinsonism, spinal cord injury, multiple sclerosis, stroke, old meningomyelocoel etc. In patients with these problems and having difficulty in controlling their bladder and bowel, they will benefit from sacral nerve stimulation. Sacral nerve stimulation involves introducing electrodes into the lower back so as to stimulate the S3 nerve with a battery placed under the skin of the lower abdomen or buttocks. A trial procedure is always done to see whether the patient will benefit from the surgery. The usual indications are  

             a) Urinary incontinence
           b) Urinary retention (non-Obstructive)
            c) Faecal incontinence
             d) Severe constipation
            e) some cases of irritable bowel syndrome
            f) Pelvic pain in women

Vagal nerve also called the tenth cranial nerve is the nerve which arises from the brain and goes into the body to control the heart, intestines and other abdominal organs. It is seen very prominently in the neck. There are two conditions where stimulating the vagal nerve produces very good results. One is in uncontrolled seizures and second is in severe treatment resistant depression. The surgery is done in the neck and usually takes less than two hours. It is approved by the USFDA.

 

Dr Ramnarayan provides his expertise in providing international standard care to the patients to help them lead a normal life for the patients suffering from the above health issues

 

Dr Ramnarayan with his expertise of over 25 years across various countries has touched the life of various individuals who had been left bedridden for their life to rehabilitate and lead a normal life pursuing their dreams.

 

Dr Ramnarayan provides in-depth counselling to the patients before and after the treatment to ensure that they are completely aware of their do’s and don’ts while leading their normal course of life.  While most of the surgeries require only a couple of day’s hospitalisation, with periodical check-ups, a few cases would require a longer hospitalisation for complete recovery.  It’s a passion and vision for Dr Ramnarayan to provide his expertise for the patients to help them come out of their chronic disabling  disorders Pain and to lead a normal life, which in most of the cases, the patients are deprived of due to lack of awareness of such treatments in our country.

 

Recently Dr Ramnarayan has been coopting Ayurveda treatment also for some of the chronic neurological disorders. These patients are given ayurvedic treatment and aloopathic physiotherapy and occupational therapy. This has proved to be very good wherein more than 90% of the patients have seen highly effective and quick recovery while compared to the allopathic way of treatment alone.

Surgery is not always the operative part alone but includes the post operative and long term care. It is an ethical and moral commitment of Dr Ramnarayan who has been associated with various leading brand of Hospitals across the globe, to ensure that there is proper study done on the patient’s ailment history and strictly only the cases, which would require a surgery are advised surgical options.

 

Dr Ramnarayan is a medical professional who believes that every individual gets an opportunity to lead a normal and healthy life, which is also affordable to them commercially.  Dr Ramnarayan strongly believes that high quality treatment can be provided at nominal costs without much overhead to ensure that the facilities are available to even the common man.

If you are going through severe chronic problems of the body and mind, or have been told by other medical practitioners that, your rest of the life will be on medicines or in bed, please do have a consultation with Dr Ramnarayan, who has helped several such people to regain and lead a healthy normal life.

We recommend you to have a personal clinical consultation with Dr Ramnarayan to understand how he could help you with your present medical issues, as cases could vary from person to person.