A joint panel of neurosurgeons and plastic surgeons recently performed a rare and complicated operation at the Manipal Institute of Neurological Disorders (MIND) to save the life of a 29-year-old woman from Kolkata. The patient has now been discharged from the hospital.

The operation was done to remove a tumor in the base of the skull, an area which a majority of surgeons are reluctant to enter, because of the delicate anatomical structures placed in close proximity to each other. Among the team leaders were Dr. Sujay Rao, neurosurgeon, MIND and Dr. Y N Anantheshwar, micro-surgeon, Plastic Surgery department, Manipal Hospital.

"The efforts by a skilled team of neuro-plastic-micro surgeons and a neuro anesthetist along with the availability of world class equipment at the Manipal Hospital provides hope to 20-25 percent of Craniofacial tumor patients in the country that there is both treatment and relief for such cases available in India," Dr. Sujay Rao said.

Although the team at Manipal Hospital has performed 1200 Craniofacial procedures in the last 6-7 months, yet this skull tumour happens to one of the rare types affecting one in 10,000 of the population in India, Dr. Rao said at a press conclave. The patient's skull-based tumour began to grow out through the root of the nose under the skin and its removal is considered to be one of the most challenging and complicated surgeries for neuroplastica team any where in the world.

A detailed slide-presentation of the surgical procedure was made by Dr. Rao, which showed that the skull incision on the top of the head extended from one ear to another ear. The main arteries feeding the tumor were identified in the neck and clipped to reduce the hemorrhage from the tumor during the surgery.

The bone of the forehead was widely opened and the tumor was found to have grown completely in the skull, brain and into the space between the eyes. The brain was exposed and the tumor was micro-surgically removed from the cups that contains the eyeballs by Dr. Anantheshwar with an incision along the sides of the nose and lip.

The reconstructive micro surgery was done with a piece of bone harvested from the skull and placed in nose as there was a large vacuum with the removal of tumor (which caused death and seizures in patients in the past) and then fitted with titanium screws to complete the surgery.

The patient had already undergone a dangerous biopsy through the nose elsewhere, which could have resulted in catastrophic hemorrhage, apart from several other diagnostic procedures that escalated the medical expenses.

A typical cranio-facial surgery costs Rs. 2 lakh or more in India. At Manipal Hospital the charges for the entire procedure including hospitalization amounted to Rs.1 lakh despite the use of expensive titanium screws, instead of the cheaper stainless steel screws. The latter are not preferred because they might rust and lead to infection or other problems.

The two surgeons waived their professional fees and hospital took on several expenses, stated R Basil, CEO Manipal Hospital who hoped that many more patients in the country would be able to access the facility for such procedures that can be carried out successfully by neuroplastica surgery experts.