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Bhagwan Mahaveer Jain Hospital Conducts Yet Another Successful Live Brain Surgery

Bangalore doctors are set to mark another milestone in the world of Brain Surgery. The last time, it was Abhishek Prasad, a 37-year-old Guitarist who underwent a Live Brain Surgery. Ever Since he has been strumming away to Glory. This time, it was for VIRUPAKSHA, 28 Years, son of a Poor farmer from rural north Karnataka, suffering from a disabling and generalized, complex movement disorder called Cervical Dystonia (Retrocollis), to restore his confidence and regain his life!

Virupaksha noticed the abnormal movements of the neck at the age of 19 years. It was initially intermittent and predominantly bending of the neck backward which evolved slowly.  But for the past three years, it became so severe that he was not able to even sit, stand or walk without someone physically supporting his head so as to prevent the excessive backward bending of the neck. He also had severe dystonia of the upper limbs and needed support for all his day to day activities, including bathing, feeding, dressing, etc. This meant that one family member (usually his mother) had to be with him all the time. This has caused severe trauma to his family members. The constant shaking of his head & neck even while he is lying down had caused ‘hair loss’ on the back of his head. He was diagnosed to be having a complex movement disorder, predominantly axial and truncal dystonia.

He eventually underwent Deep Brain Stimulation (DBS) surgery (putting a specialized brain pacemaker) about three years back in one of the major hospitals in south India, costing nearly Rs. 9 lakhs. Coming from a BPL family from rural north Karnataka, this poor family had to borrow this big sum as a loan with the hope of some benefit. However, even after 9 to 12 months of surgery, he did not show much improvement and within one and a half years, the pacemaker battery went dead. He was recommended battery replacement, but he was not able to afford this due to financial reasons.

He was referred and brought to the Jain Institute Of Movement Disorders & Stereotactic Neurosurgery (JIOMSN), at the Bhagwan Mahaveer Jain Hospital, Vasanthnagar, Bengaluru, where he was evaluated by Dr. Sanjiv C.C, Movement Disorders Neurologist and Dr. Sharan Srinivasan, Stereotactic & Functional Neurosurgeon. “For the past 3 months before our evaluation, his symptoms had further deteriorated with severe symptoms of backward bending of the neck, inability to stand, walk and to carry out daily activities without significant support. After a detailed evaluation and discussions with the patient, his father, and uncle, we decided to remove the brain pacemaker (as it was dead and they could not afford the replacement) and instead do a specialised brain circuit surgery – Lesioning v3.0 (Lesionectomy – Small burning of Brain Circuit)” said Dr. Sanjiv and Dr. Sharan

The Patient underwent a simultaneous bilateral pallidotomy (Lesioning of both sides of inner part of the brain – Globus Pallidus) – which can be claimed as a first of its kind effort in India since Lesioning is done on one side and the other side in all probability is supposed to be done after a gap of 1 year or so based on how the patient responds to the surgery done on one side. This case was so severe that we had to take the risk of mapping both the sides and operating simultaneously.

Dr. Sanjiv CC, senior Neurologist and Movement disorders specialist, a senior consultant practicing in Bangalore for more than 23 years says, “It was a very big challenge for us as DBS had failed. We had to remove the DBS which is like a pacemaker inserted in the chest with a wire connected to the deep part of the brain and do the burning of circuits. Lesioning is a very effective method and a good option for people with medical resistant Dystonia who cannot afford high costs DBS Surgery.

Speaking about the Surgery, Dr. Sharan Srinivasan Said, “Lesioning surgery involves ‘burning’ certain ‘misbehaving’ brain circuits deep inside the brain. This is not very commonly performed in India due to its complexity and is usually done to one side of the brain only, or one side at one sitting.  However, in Virupaksha’s case, since the symptoms were very severe and involving both sides of the body, we took a calculated risk and decided to perform a SIMULTANEOUS BILATERAL PALLIDOTOMY (Lesioning of both sides of the inner part of the brain – Globus Pallidus). Such surgeries have been very rarely performed in India. This was done on 14th October 2017.

The surgery had many challenges and complexities.

  • Since his head, neck and trunk were severely shaking, even the act of fixing the special ‘stereotactic frame’ to his head as well as the MRI of his brain needed to be done under GA (General Anesthesia).
  • However, in such Lesioning surgeries, the patient NEEDS TO BE AWAKE all through the critical parts of the surgery – so as to give a constant and ‘real time’ feedback to the neurologist and neurosurgeon in the OT that they are burning the ‘right circuits’ as well as ensuring that they are also ‘not burning’ the ‘wrong & critical circuits’! To keep such a patient (who was under GA) awake and co-operative continuously for over 3 hours without any complications is very difficult and challenging and this was very well executed by our team of anesthetists headed by Sudhakar Koppad.
  • Performing Lesioning on both sides of the brain, especially simultaneously – has a very high risk of DYSPHAGIA (difficulty in swallowing) and DYSARTHRIA (difficulty in speaking). Hence we followed a surgical strategy fine-tuned & mastered by us.

Within a couple of days after surgery, he started noticing improvements in his preoperative symptoms, and his head & neck pulling came down by over 60%. Advanced and customized neurorehabilitation (physiotherapy, occupational therapy, speech and swallow therapy) was done by Team NewRo headed by Dr. Prathiba Sharan for 4 months. The entire treatment so far (including 4 months of neurorehabilitation) has cost only Rs. 4 lakhs. However, in view of his BPL status and the huge amounts that they had already spent on the past treatment, they couldn’t afford even this and BMJH as well as the doctors, along with NewRo have raised an amount of Rs. 2.3 lakhs to fund a major part of this treatment.

Now, he is able to stand and walk, perform his routine activities like bathing, dressing, eating food, drinking water, etc independently and also able to walk without much difficulty. Currently, he is stable and managing himself more or less independently said Dr. Sanjiv and Dr. Sharan who are basking in the success of yet another complicated Brain Surgery.

 

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