Question 1

Can DBS help patients with epilepsy, chronic pain, or psychiatric disorders?

Dr. Anil Kumar Kansal · Accepted Answer

For intractable epilepsy, we prefer other surgical methods first — removing an identified lesion (medial temporal lobectomy, or hemispherectomy in appropriate cases). If no focus is identifiable and epilepsy remains uncontrolled, electrodes can be placed in the anterior thalamus, with roughly 70 to 80% success; vagal nerve stimulation is the alternative. For psychiatric disorders we have done some frontal DBS placements, but results are variable, the procedures are not curative, and patients still need to continue medication.

Question 2

What are the long-term drawbacks of DBS — what happens after 10 or 15 years?

Dr. Anil Kumar Kansal · Accepted Answer

The main issues over time are battery depletion (non-rechargeable batteries need changing every 5 to 7 years, rechargeable systems last around 15 years), electrode disconnection or failure from trauma or mechanical wear, and the need for settings adjustments as the disease progresses. Patients need periodic visits for reprogramming, though newer devices allow remote setting changes via mobile. Battery change is the most common long-term issue.

Question 3

When does DBS come in the sequence of Parkinson's treatment, and what does it cost?

Dr. Anil Kumar Kansal · Accepted Answer

We always start with medication at a lower dose, increasing gradually to control symptoms. The ideal time to move to DBS is around 4 to 5 years after diagnosis, when the required dose is becoming too high, side effects are a problem, or the medication effect is fading — DBS at that stage can abolish or significantly reduce the drug requirement and restore quality of life. At our hospital, the total package including surgery, anaesthesia, device, medicines, testing and hospital stay runs approximately USD 30,000 to 35,000, with the variation depending on rechargeable versus non-rechargeable devices.

Question 4

There is a lot of public fear around spine and brain surgery. Can you share the actual complication rates so we can counsel patients accurately?

Dr. Anil Kumar Kansal · Accepted Answer

For spine surgery, major complications run around 2%, life-threatening complications around 0.5%, and neurological deficit around 1 to 1.5% — 98% of patients do well, 90% do very well, at a centre doing 400 to 500 spine surgeries a year. Patients should understand that surgery corrects the structural problem but can't always undo pre-existing nerve damage, so some residual tingling or numbness may persist even in a good outcome. For brain surgery, mortality is around 1 to 2% and total risk of neurological deficit is 5 to 7% at expert centres, with 93% of patients doing very well after tumour removal — the main caveat is that malignant tumours can recur despite surgery, since resection alone isn't curative and radiotherapy and chemotherapy are also required.

Question 5

How close are we to restoring function in patients with complete spinal cord injuries?

Dr. Anil Kumar Kansal · Accepted Answer

Complete spinal cord injuries will not result in complete neurological recovery, and some patients recover only minimally. What we can address is the secondary symptoms: pain and spasticity, managed with baclofen or morphine pumps, and dorsal cord stimulators, which can improve sensation and reduce spasticity, with some incomplete-injury patients regaining a degree of leg power combined with physiotherapy. If hand function is preserved, we train patients to manage daily life with their upper limbs and a wheelchair. But for complete injuries specifically, meaningful motor recovery is not something we can promise.

Question 6

What is the role of stem cells in spinal cord injury management?

Dr. Anil Kumar Kansal · Accepted Answer

I conducted a study on this myself — we took stem cells from the iliac bone and implanted them at the injury site in around 20 patients. One patient showed some improvement, but it couldn't be separated from natural recovery under medication, and statistically we found no significant benefit. We discontinued the trial. Stem cell therapy for complete spinal cord injury is still not recommended anywhere in the world; for partial injuries there may be some benefit, but meaningful recovery from stem cells in complete injuries has not been demonstrated.

Question 7

What are the current limitations of awake craniotomy and how are they being addressed?

Dr. Anil Kumar Kansal · Accepted Answer

Awake craniotomy, used for tumours near the motor cortex or speech areas, requires full patient cooperation throughout — some patients become agitated under partial sedation and we've had to convert to general anaesthesia. For international patients, a translator has to be present in the operating room the entire time, which adds another layer of difficulty. Personally I'm not very keen on it given how demanding it is for the patient; we now prefer using preoperative functional MRI to map eloquent areas and then operate under general anaesthesia while avoiding those mapped regions, which reduces the need for awake craniotomy in many cases.

Question 8

I have a case of a hemangioma found on MRI in the cervical vertebral region. At what point does the patient benefit from surgery?

Dr. Anil Kumar Kansal · Accepted Answer

Small vertebral hemangiomas are benign and don't require treatment unless they cause problems. If it's a large hemangioma involving the pedicle, causing vertebral body destruction, or resulting in a fracture or neural compression, then decompression and spinal fixation are required. Share the MRI report with the Jivo team and we can assess based on size and extent.

Question 9

As a leading neurosurgeon who has treated many international patients, what's your perspective on how direct doctor-to-doctor communication with African colleagues improves patient care?

Dr. Anil Kumar Kansal · Accepted Answer

Communication is key. I'd suggest two things: topic-oriented sessions on one specific subject at a time — lumbar spine surgery, or brain tumours — where everyone shares experience and problems and we learn from each other, since doctors from Africa and India face similar socioeconomic challenges. And continuous feedback after a patient returns home: the local doctor monitors recovery and communicates with us on repeat imaging and medication adjustments. That collaboration, by WhatsApp or email at any time, directly improves outcomes.

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