The Department of Neurosurgery trains many of the practising neurosurgeons in Singapore, and it remains today the largest in Singapore in terms of number of neurosurgeons, patient load and number of surgical procedures performed. In Singapore, our well equipped and state-of-the-art hospitals, have enhanced the quality of care for our patients and changed the art and practice of neurosurgery. Rapid advances in computed imaging of brain and spinal cord have provided our neurosurgeons invaluable knowledge about the normal and diseased central nervous system. Neurosurgeons now have a better understanding, not only on the pathology of the problem, but also its relation to and effect on adjacent brain and skull structures. This permits pre-operative planning, allowing neurosurgeons to choose the best approach that will cause minimal trauma to neural structures during surgery. Technological advances have also made possible surgical navigation systems. These are based on frameless stereotactic systems coupled to pre-operative computed imaging. 'Surgical navigation' is like a 'road directory' that allows the surgeon to see his position inside the patient's head at every point during surgery, thus increasing the safety, effectiveness and speed of operation. Microsurgery, on the other hand, facilitates the preservation of vital structures and ensures satisfactory tumour removal. The operation microscope makes this possible as it provides the needed lighting and magnification of fine structures. All operating theatres in the hospitals of NNI Campuses are equipped with operating microscopes. Also available are high-speed drills to remove bone for better lesion exposure, and ultrasonic aspirators made small enough for intracranial use. This allows the neurosurgeon to remove tumours that are too hard to cut using conventional means. Taking advantage of the cutting edge technology and facility, our team of neurosurgeons have developed neurosurgical subspecialties and programmes for the various diseases encountered in the local population.

Neuro-Oncology

Neuro-Oncology refers to brain tumours. These tumours may be either primary tumours of the central nervous system or result from neurological complications of systemic cancers. For benign tumours, total removal is curative and carried out by our surgical oncology team. For malignant tumours, surgery has to be followed by radiation therapy or chemotherapy. In the case of radiation therapy, this is carried out either at the National Cancer Centre, Singapore Gamma Knife Centre or The Cancer Institute. Chemotherapy treatment of brain cancers is managed through the Neuro-Oncology Clinics at the NNI campuses. In the case of radiation therapy, this is carried out managed at the National Cancer Centre, Singapore Gamma Knife Centre or The Cancer Institute. Chemotherapy treatment of brain cancer is carried out at the Neuro-Oncology Clinics at the NNI campuses in Tan Tock Seng Hospital and Singapore General Hospital. The Neuro-Oncology Clinics provide patients with a one-stop treatment centre for radiotherapy, chemotherapy and surgery as they are looked after by the unit’s team of medical neuro-oncologists, neurosurgeons, neuroradiologists and case manager. Together, they keep close track of the patient’s overall treatment, progress and well-being. There have also been new approaches developed in the removal of lesions previously deemed inaccessible. Often referred to as skull base surgery, this is carried out by our neurosurgeons together with surgeons from Otolaryngology and Plastic & Reconstructive Surgery. For selected tumours, radiosurgery using the Gamma Knife machine located at the Singapore Gamma Knife Centre is another treatment option. Radiosurgery is the use of a single large dose of focussed radiation to treat lesions within the unopened skull. It is the treatment of choice for some conditions e.g. small acoustic schwannomas, brain metastases from cancers elsewhere in the body, and also for small arteriovenous malformations (AVMs). All conditions are treated on an outpatient procedure basis, except for AVMs, where a night's stay in hospital is required.

Head Injury

Head injury is the most common condition treated in the Department. The Department's Head Injury Programme offers treatment not only to patients from Tan Tock Seng Hospital, but also Singapore General Hospital, Changi General Hospital and KK Hospital. Severely injured patients are closely monitored for raised intracranial pressure and early signs of neurological deterioration in the Neuro-Intensive Care Unit. Once stable, the patient is sent for intensive rehabilitation and therapy, which may include physiotherapy and speech therapy.

Vascular (Stroke) Surgery

This subspecialty treats all patients with spontaneous intracranial bleeding. The underlying cause may be hypertension, ruptured aneurysms or arteriovenous malformations (AVM). With surgical intervention necessary for the latter two, and sometimes for hypertensive bleeds, the Department of Neurosurgery works very closely with the Department of Neuroradiology, both in diagnosis and also in its management. Every patient with a suspected aneurysm or AVM undergoes 4-vessel cerebral angiography. For certain aneurysms like basilar artery bifurcation aneurysms or aneurysms in very ill patients, endovascular obliteration instead of open surgery is carried out by our neuroradiologists.

Spine Surgery

A very common disorder of the spine is the degenerative condition called cervical and lumbar spondylosis, whereby the discs, bony protrusions and hypertrophied ligaments press on the spinal nerves and spinal cord to cause pain, numbness, weakness and at times, difficulty in walking and passing urine. The majority of such patients seen under our Spine Programme are treated with medications and physical therapy. Those with spinal cord compression and neurological deficits usually will require surgery. Less common are spinal tumours, which can be benign or cancerous. These tumours are usually removed so that they do not cause further paralysis. The NNI Spine Programme also works in collaboration with the TTSH Spine Programme in many aspects including a reconditioning centre for strengthening the back. Together, the two programmes, bringing together surgeons, therapists, nurses and rehabilitation physicians, also manage patients with acute spinal injury.

Functional Neurosurgery

For some 20 - 30 % of epilepsy patients whose condition cannot be controlled by medication, epilepsy surgery becomes a treatment option. Epilepsy video monitoring and MRI are used to assess their suitability for surgery. For patients with advanced Parkinson's disease or other movement disorders like dystonia and intractable limb tremors, minimally invasive surgery such as stereotactic surgery is available here at the NNI. These procedures are carried out by specially trained neurosurgeons under local anaesthesia, with brain mapping to target the relevant areas. Some of the other surgical techniques carried out include pallidotomy, thalamotomy and deep brain stimulation of the sub thalamic nucleus. Patients with facial pain caused by trigeminal neuralgia are always initially treated by medications, usually with good results. For those with intractable trigeminal neuralgia or who are unable to tolerate medications, neurosurgery is an alternative treatment option. At the NNI, this ranges from percutaneous trigeminal gangliotomy to micro-vascular decompression of the trigeminal nerve root.

Paediatric Neurosurgery

Children also suffer from neurological illnesses that may require surgical intervention. As such, the Department has a specifically trained paediatric neurosurgeon. The Paediatric Neurosurgery Programme is sited at the KK Women's and Children's Hospital, and the service is headed by staff of the Department. For more information about services of Neurosurgery Department, please click here Department of Neurosurgery NNI @ TTSH Campus