Conditions We Treat Inclide, but are not Limited to the Following:
Acoustic neuromas are benign tumors that originate from the nerves that serve hearing and balance. These benign tumors can often present with hearing loss and ringing in the ear. Occasionally, they can present with more serious symptoms such as hydrocephalus, which is an impairment in the circulation of the flow of fluid in the brain. Dr. Ghosh had the privilege of doing specialized training in the surgical management of acoustic neuromas with Dr. William Hitselberger. Dr. Hitselberger is a pioneering neurosurgeon with the greatest experience in the operative management of acoustic neuromas in the history of man with over 6,000 acoustic neuromas performed by him during his tenure at the House Ear Clinic. Dr. Ghosh had the privilege of scrubbing on over 100 cases with both Dr. Hitselberger and Dr. John Diaz Day during his time at the House Ear Clinic. Dr. Ghosh brought that experience to the skull base team of Senta Clinic in San Diego. The current tools to manage include microsurgical resection, stereotactic radiosurgery with CyberKnife or Gamma Knife, and simple observation as a certain percentage of acoustic neuromas do not grow in a patient’s lifetime. Dr. Ghosh has considerable expertise and experience in every facet of the management of acoustic neuroma. He is trained and experienced in the three different types of surgical approaches including the retrosigmoid craniotomy, the translabyrinthine craniotomy, and the middle fossa craniotomy. He is one of the few neurosurgeons in the country that has experience and training in all three approaches and he can tailor the surgical approach to the individual patient’s need.
In addition, Dr. Ghosh is trained in the two key modalities of radiosurgery for acoustic neuroma including Gamma Knife radiosurgery and CyberKnife radiosurgery. He is able to utilize both of these techniques when it is in the best interest of the patient. A recent trend in the management of acoustic neuromas includes the planned subtotal resection of giant acoustic neuromas, which is done in the interest of decompression of the critical brainstem and neurovascular structures while focusing on avoidance of injury to the facial nerve. In this situation, the tumor is substantially debulked and then the remaining tumor is treated with radiosurgery in a planned manner sometime after the primary surgery. This combined technique has been used with great success with several patients in the past as can be seen in the video of Dr. Greaves. Dr. Ghosh is one of a small handful of neurosurgeons in the country who can provide a full armamentarium of treatment options for patients with this brain condition.
Dr. Ghosh possesses substantial experience in the management of brain trauma. He spent seven years as a neurosurgical resident and on clinical faculty at the University of Southern California, Los Angeles County General Hospital Medical Center. At L.A. County General Hospital, Dr. Ghosh had the opportunity to actively participate in one of the busiest trauma centers in the country, if not the world. He spent seven years actively managing a vast array of head injuries including head injuries from gunshot wounds, blunt trauma, motor vehicle accidents, sports-related injuries, and assaults of various types.
After beginning private practice in San Diego in 2002, Dr. Ghosh was approached by the faculty of Scripps Memorial Hospital in La Jolla. He was asked to work with another neurosurgeon, Dr. Frank Coufal, to initiate a subspecialty neurotrauma program at Scripps Memorial Hospital in La Jolla. Working closely with Dr. Coufal, Dr. Ghosh initiated state-of-the-art protocols in the management of head injury. He acted as the assistant director of neurotrauma at Scripps Memorial Hospital in La Jolla from 2004 to the present. The neurotrauma program created by Dr. Ghosh and Dr. Coufal has gained special commendation from the American College of Surgeons during their review of Scripps Memorial Hospital’s overall trauma review. Dr. Ghosh also provides neurosurgical consultation to the University of San Diego’s athletic department for student-athletes who have suffered head injuries and concussion. Furthermore, Dr. Ghosh provides neurosurgical consultation services for patients who have suffered a head injury in industrial and automobile accidents. Dr. Ghosh is certified and trained in the state-of-the-art management of head injury including surgical techniques of craniotomy and decompressive craniectomy and the use of a ventriculostomy. In addition, Dr. Ghosh employs state-of-the-art techniques for intracranial pressure monitoring including Camino ICP monitoring and Licox cerebral oxygen monitoring.
Dr. Ghosh provides salient care in the management of brain tumors of all types. The current state-of-the-art management of brain tumors includes the use of microneurosurgery with the operating microscope image guidance with the neurosurgery equivalent of global positioning system, endoscopy, radiosurgery with the use of a robotic device to deliver precision radiation, Gamma Knife radiosurgery, and cranial base surgery for accessing deep-seeded brain tumors. Dr. Ghosh has extensive training, background, and experience in all of the aforementioned techniques and methods for managing and treating brain tumors of all kinds.
Dr. Ghosh has substantial expertise and experience in the surgical management of cerebral aneurysms. Dr. Ghosh did subspecialty training in the arena of skull base surgery, which involves dismantling of the eye socket and base of the skull to provide access to cerebral aneurysms. Furthermore, he spent a substantial amount of time under the tutelage of world famous neurosurgeon Dr. Steven Giannotta while at the University of Southern California. Dr. Ghosh currently practices cerebrovascular surgery as a member of the neurosurgery staff and Comprehensive Stroke Center at Scripps Memorial Hospital in La Jolla. He engages in collaboration with the endovascular service at Scripps Memorial Hospital in La Jolla and provides neurosurgical support in operative and nonoperative treatments of patients with cerebral aneurysm rupture.
Ependymomas are benign tumors that arise within the fluid-filled space of the brain. They may occur in the brain and in the spinal canal. Through state-of-the-art techniques including endoscope-assisted techniques, Dr. Ghosh is skilled in removing ependymomas.
Gamma Knife surgery is a technique of precision radiation treatment of benign and malignant tumors of the brain. This technique allows for the treatment of tumors within the brain while avoiding the risks of open surgery. Dr. Ghosh has training and certification in Gamma Knife surgery and is familiar with the limitations of this type of technique. He is able to present to his patients the option of Gamma Knife radiosurgery when it is in their best interests.
Dr. Ghosh has considerable expertise and experience in the management of gliomas of all types. He uses the current state-of-the-art technique in the management of glioma resection including microsurgical technique and use of image guidance. For tumors that cannot be removed safely or completely with open surgery, Dr. Ghosh utilizes stereotactic radiosurgery using the CyberKnife system or the Gamma Knife system when indicated. In addition, Dr. Ghosh performs minimally-invasive stereotactic biopsies of these tumors when the need arises.
Hemifacial spasm is a rare disorder that presents with uncontrolled twitching of the facial musculature on one side or the other. This condition is due to irritation of the facial nerve at the brainstem from a blood vessel. Hemifacial spasm can be temporarily treated with botulinum toxin injections. However, a more permanent cure involves microsurgical decompression of the offending blood vessel off of the facial nerve. Dr. Ghosh uses meticulous microsurgical technique to identify the facial nerve. He uses special facial nerve monitoring to avoid injury to the facial nerve. He also uses special auditory monitoring to avoid injury to the hearing apparatus and is able to effectively decompress the facial nerve and treat hemifacial spasm.
Dr. Ghosh has substantial expertise and experience in the management of meningiomas. Dr. Ghosh uses state-of-the-art techniques including microsurgical removal using the operating microscope and neuro-navigation systems. In addition, Dr. Ghosh utilizes robotic radiosurgery and Gamma Knife radiosurgery when a complete removal of the tumor poses too great of a risk for the patient. Furthermore, Dr. Ghosh has substantial experience and expertise in the management of cranial base surgery to access deep-seeded meningiomas. These meningiomas are otherwise inaccessible with standard neurosurgical techniques. Dr. Ghosh is featured in the Discovery Health Channel Show: Medical and Incredible where he was the lead surgeon in removal of the largest meningioma on record in the Scripps Health system.
Pituitary adenomas are common tumors that originate from the base of the skull. These tumors can secrete hormones and cause acromegaly from excessive growth hormone or Cushing’s syndrome in the case of excessive cortisol secretion. In addition, tumors may cause symptoms related to excessive prolactin production. Tumors that do not secrete hormone may grow to the point of causing compression of the optic nerve and cause vision loss. Current management of pituitary adenomas includes hormone therapies, microsurgical resection, and radiosurgery with the CyberKnife or the Gamma Knife system. Furthermore, some pituitary adenomas do not grow in a patient’s lifetime and simply require observation with serial MRI imaging.
Dr. Ghosh has considerable training and expertise in every facet of the management of pituitary adenomas. He is certified to perform both CyberKnife radiosurgery and Gamma Knife radiosurgery when each is necessary. Furthermore, he has expertise in all of the different approaches to surgical management of a pituitary adenoma including endoscope endonasal approach, sublabial microscopic approach, and transcranial approach. Because of his breadth of skill and expertise in the management of pituitary adenomas, Dr. Ghosh can tailor the treatment to the individual needs of the patient. He has every weapon in the arsenal in the treatment of pituitary adenomas at his disposal.
Robotic radiosurgery is a current state-of-the-art technique involving the CyberKnife radiosurgery system to deliver precise radiation to treat benign and malignant tumors. Dr. Ghosh is instrumental in the arrival of the first CyberKnife system in San Diego County. Dr. Ghosh is certified and trained in the use of CyberKnife for the management of brain and spine tumors. CyberKnife treatment has some limitations and several great benefits. Dr. Ghosh is able to present this as an option to his patients with brain and spine tumors of all types.
Dr. Ghosh possesses substantial training and experience in the management of trigeminal neuralgia. Trigeminal neuralgia is a brain condition that results in severe, disabling, lancing, or electric shock-type pain in a portion of the face. Classic trigeminal neuralgia is generally managed with medication as the first line of defense and patients that do not have success with medication can then be treated with surgical or radiosurgical options. Dr. Ghosh is trained and certified in both the surgical and radiosurgical management of trigeminal neuralgia. Surgical management involves microsurgical approach to the brainstem and the trigeminal nerve and decompressing any offending artery that may be compressing and irritating the trigeminal nerve. Dr. Ghosh uses microsurgical technique and endoscope-assisted technique for the surgical management of trigeminal neuralgia. In addition, radiosurgery using the Gamma Knife system or robotic radiosurgery using the CyberKnife are also effective modalities. Both open surgery and radiation have their benefits and their limitations. Dr. Ghosh is facile with both treatment modalities and can present his patients with a balanced, tailored view for treatment to best serve individuals' needs.
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