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“Doctor, you have to operate on my friend Ashwini,” requested a visitor in my OPD. Then he said, “You don’t recognize me, do you? You operated on me ten years back.” I recognized him then and felt happy and surprised to see him.
This person had come to me ten years back. At that time he was a young boy lying in a stretcher, not able to walk, sit or stand, not able to swallow food, not able to speak clearly, and breathing with difficulty. His MRI showed a tumor in the junction of the brain and spinal cord. I removed the tumour by operation and he started improving from day one after surgery. By the time he was discharged from the hospital on the seventh day after operation, he had started sitting up and even eating some food. Now here he was, running a business, and doing well in life.
There is a misconception in the minds of many people and even doctors that if an operation is done on the brain or the spinal cord, the patient will develop some mental problem or lose his memory or become unable to speak or get paralysed etc. Many people even give examples of their relatives who had undergone operations and become disabled in some way. However, they do not tell the disease for which an operation was done. Let me tell you that many times brain operation is done as a last-ditch effort to save the life of a very severely injured brain and such patients may be saved but they may not become normal. Same is true for spinal cord injury patients. This does not mean that the operation should be blamed. It is the state in which the patient comes to the surgeon that decides the outcome of the operation.
Symptoms of Neurological Problems
Headache with vomiting, weakness of limbs i.e. paralysis, decreased vision, difficulty in walking, difficulty in memory, difficulty in speaking, decreased hearing in one ear are some symptoms which indicate involvement of nervous system. These symptoms by themselves are not a disease. Whenever somebody comes with these symptoms and a disease affecting the nervous system is suspected then the doctor needs to investigate the patient to know the cause of the symptoms and arrive at a diagnosis of the disease.
There are some diseases of the nervous system that are neither treatable nor curable. These are degenerative diseases, demyelinating diseases, muscle diseases (myopathy) and some neuropathies. For them, the only treatment is supportive treatment in form of physiotherapy and symptomatic medication.
But there are a large number of diseases that are curable by medication or surgery. We have seen tremendous improvement in science and technology for performing operations on brain and spine during the last four decades in the world and in India. One should know that now every advancement in the world is available in India. Therefore, a large no of foreign patients are coming to India where they get world-class treatment at very affordable rate.
Today we can cure a large number of brain tumors by removing them by surgery. These patients usually present with headache which may be associated with vomitting and/or decreased or blurred vision at the peak of headache. They may have progressive weakness (paralysis) of one side of the body, may have difficulty in naming things or in speaking proper words or sentences, may have difficulty in understanding what other people are saying, may have loss of memory, may have recent onset of difficulty in wearing clothes or finding the way to their own house. Some may have so much imbalance in walking that an onlooker would think that the person was drunk. Some may have difficulty in swallowing or difficulty in hearing from one ear or progressive loss of vision.
There is a condition called trigeminal neuralgia in which a person suffers severe pain in his face. This pain occurs in episodes and is precipitated by eating, drinking and touching the face. Some patients are not able to eat food because of the pain and become very weak. We can cure trigeminal neuralgia by doing surgery.
We can also cure hemifacial spasm by surgery. It is episodic severe spasm of face in which the person winks repeatedly involuntarily. This is very embarrassing for the unfortunate individual.
We can cure paralysis caused by lumbar or cervical spondylosis, spinal cord tumors by doing surgery. These patients generally come with progressive weakness/numbness in lower limbs and/or upper limbs to the extent that they are not able to walk or and feed themselves. Other people have to help them for their day-to-day activities. In the late stage of the disease they can lose control over urine and passing of stool. The results of surgery in these patients are very gratifying and most of them improve completely. However, if surgery is delayed for a very long time then the recovery may not be complete or may take a very long time.
We can do surgery to treat epilepsy in selected cases. These are the patients who are refractory to treatment with medicines and the tests reveal a focus of spark causing the epileptic fits. This focus is removed by surgery to treat the patient.
Results of Neurosurgical Operations
The results of treatment of head injury and spinal injury are way better than what was the case thirty years back. When I joined neurosurgery training in 1977, all my friends questioned my decision as in those days neurosurgeons mainly did surgery for head injuries and only about 2 % of the patients having severe head injury could be saved. The best cases to operate were those who had chronic subdural hematoma as those could be completely cured by simple surgery. We did not have CT Scans and MRI Scans that we now have. These scans show anatomy in minute detail. We also did not have the operating microscope that we now have and which shows us all the minute vessels and nerves while doing surgery. All these sophisticated instruments make surgery very safe these days.
Don’t be afraid!
Finally, I would like to say that one should not be afraid of getting an operation done for brain or spine surgery nowadays. Investigations have improved to such an extent that they can show exactly where the problem is located and what it is. They can guide a surgeon to plan a safe surgery. We have three-dimensional technologies available for this. We have equipment which guide us during surgery warning us about the function of the nerves. Our microscopes help us see the nerves very clearly by enlarging their size.
Anaesthesia facilities are also very advanced these days and we have high quality of intensive care units available to deal with the most difficult situations.
In short, the facilities available in India are no less than anywhere in the world.