Fourth ventricular epidermoid

Thought I'd post a few images of what we operate here. This 65 year old was bed ridden because of severe cerebellar ataxia for last six months. Due to lack of support from family she didnt undergo treatment despite a CTscan diagnosis 3 months back.

Surgery- midline suboccipital craniotomy and subtotal excision. [actually intraop impression was gross total excision, but some tumor stuck to the obex and that exiting beyond the foramina of Lushka were left behind to avoid unacceptable deficits.] *surgeons:I and Hari.

intraoperative events and problems encountered: Blood pressure rose to 200/160 as the tumor was decompressed although no significant maniulation of the floor of the fourth ventricle occurred. Controlled with propofol infusion. Bp remined high in immediate postop period. [NTG patch now].

operating microscope [the chinese make borrowed from plastic surgery] malfunctioned and surgery was done without it!

outcome: no new deficits except mild gag tolerence. however she experienced near aspiration on attempted feeding. Indirect laryngoscopy showed fixed left vocal cord. So she was maintained on ryles tube feeds until the right cord started compensating. Relatives refused the option of gastrostomy.

We did start the fire…

We did start the fire…

This is just a beginning. Everything starts small. Even the giant sequoia.

I’d say this is a log on how we went about constructing this department. Just to remind ourselves the possibilities that keeps shining through.

June 2006 – Dr Roopesh VR and I get appointed as Asst Profs in Neurosurgery. We are however under administrative control of Dept of Surgery since Aps cannot be given administrative control of a dept.

June 2006 – first neurosurgery – L4-5 disc prolapse with cauda equine syndrome. Many thanks to the director Prof KSVK Subbarao , Prof AK Das [MS], Prof Karoon Agarwal [plastic surgery hod] , Prof Jagdish [Hod Surgery] for their support.

July 2006 – 2 beds in CTVS ICU and two more in ward 44.

OT days are Fridays and alternate Tuesdays. That’s too few. Buts that’s life!

OP days - Mondays and Wednesdays [10 am , 83 A, 2nd floor]

Feb 2007 after months and months of toiling on “specifications” on excel files, the first instruments have landed. Our tenure almost got over before that happened! [Just as Dr Ananthakrishnan had warned]

March 2007 – Surgical diathermy, instruments, Leyla retractor system, pneumatic drill are in the purchase pipeline. [a very long one that ]