MBBS · MCh Neurosurgery · IFAANS. Consultant neurovascular and endovascular neurosurgeon, Jaslok Hospital & Research Centre and Lilavati Hospital & Research Centre, Mumbai.
Most surgeons who treat cerebrovascular disease are trained either to operate on the brain or to work inside its arteries through a catheter. Dr. Ambekar completed fellowships in both — skull base and open microsurgery at Louisiana State University in Shreveport, endovascular neurosurgery at the University of Miami — and returned to Mumbai in 2015 to practise them together.
That matters mainly for one reason: the recommendation you receive is not shaped by the only technique available. An aneurysm can be coiled, flow-diverted or clipped; an arteriovenous malformation can be embolised, removed or irradiated. The choice is made on the anatomy in front of us.
He carries each case through personally, from the diagnostic angiogram to the embolisation or operation, and works across aneurysms, arteriovenous malformations and fistulas, chronic subdural haematoma, paediatric vascular disease and acute stroke.
Much of the practice is second opinions — patients told they have an aneurysm and left frightened, or people whose pulsing ear noise or slowly failing legs have been investigated in the wrong direction for years. A useful proportion of those consultations end with the advice to do nothing and watch, which is a legitimate result rather than a wasted visit.
Maharashtra Medical Council 2017083828
A fine tube is passed from an artery at the wrist or groin and steered up to the brain under X-ray guidance. There is no cut on the head and no shaving of hair. Depending on the case it is done under sedation or general anaesthesia, and most patients are walking the next day and home within two.
Some lesions are better treated directly, through a small opening in the skull using an operating microscope. Hospital stay runs to several days and recovery is slower, and the reasons for choosing this route will be explained with your own scans on the screen in front of you.
That is usually the right question, and often the answer is no. Send the scans and you will get a straight opinion — including when the safest course is to do nothing and watch.