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NI FEATURE: TIMELESS REVERBERATIONS - COMMENTARY
Year : 2015  |  Volume : 63  |  Issue : 2  |  Page : 128-129

My serendipitous move to neurosurgery


Emeritus Professor of Neurosurgery, Consultant Emeritus Newcastle Health NHS Trust, UK. Founder Chairman, National Neuroscience Centre, Kolkata, and Founder Chairman, Institute of Neurosciences, Kolkata, West Bengal, India

Date of Web Publication5-May-2015

Correspondence Address:
Ram Prasad Sengupta
Emeritus Professor of Neurosurgery, Consultant Emeritus Newcastle Health NHS Trust, UK. Founder Chairman, National Neuroscience Centre, Kolkata, and Founder Chairman, Institute of Neurosciences, Kolkata, West Bengal, India

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.156269

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How to cite this article:
Sengupta RP. My serendipitous move to neurosurgery. Neurol India 2015;63:128-9

How to cite this URL:
Sengupta RP. My serendipitous move to neurosurgery. Neurol India [serial online] 2015 [cited 2019 Oct 22];63:128-9. Available from: http://www.neurologyindia.com/text.asp?2015/63/2/128/156269











To be a surgeon was my childhood dream. My concept of neurosurgery from the days in the medical college in Calcutta was confined to the knowledge that the overall results of surgery were poor. This, of course, was in mid-fifties when Dr. Jacob Chandy and Dr. B. Ramamurthy were struggling to establish neurosurgery as a distinct entity in our country. Their mission and influence had yet to reach far afield. Hence, very few students would think of becoming a neurosurgeon.

Fate, however, brought me to the throes of neurosurgery in Newcastle. A very kind hospital manager found me a locum doctor's job in neurosurgery. Since there was no response to my applications for other jobs, I got stuck with neurosurgery.

My interest in neurosurgery began when I realized how closely life and death, or recovery and disability were linked, and were influenced by the skills of neurosurgeons based on their dedication and perseverance. Aneurysm surgery became my focus of attention when I started appreciating the effects of various methods of management on patients with aneurysmal subarachnoid hemorrhage (SAH). Prof. Hankinson, having trained with Prof. McKissock, saw the disasters of direct surgery and became convinced that proximal ligation was the only method of preventing further bleeds; while Mr. Lassman believed in conservative treatment that included lowering the blood pressure and enforcing strict rest for weeks. On the other hand, I saw Mr. Jack Small operating on patients by clipping the aneurysmal neck in an acute stage with temporary arrest of circulation. The patients operated by him in this manner went home fully recovered. Thus, began my long journey to explore the mysteries of an aneurysm, its effects on the brain when it bleeds, and the ways to make surgery safe once the aneurysm is exposed.

I became convinced that direct surgery was far superior to proximal ligation. Heroic surgery with hypothermia and circulatory arrest, however, was far too drastic. Dr. Yasargil and the microsurgical techniques propagated by him were not yet on the scene. After searching the literature, I came to know that there were surgeons who were reporting good results with direct surgery. It occurred to me that those reports would only be meaningful if I could personally observe these surgeons in their actual practice. Thus began my journey to various cities of Europe, USA, Canada, and Japan. I saw Dr. Norlen in Copenhagen delaying surgery for 3 weeks after the bleed and taking note of the anomalies of the circle of Willis. Dr. Thor Sundt in Mayo Clinic demonstrated skills of his hands in dissection. From my visit to Dr. Drake in London, Ontario, I learnt more of the courage to deal with basilar aneurysms than any particular skill. My meeting with Dr. William Sweet at the Harvard Medical Centre resulted in my being impressed with him as an individual much more than I was impressed with the aneurysm surgery there. Similarly, the meeting with Prof. Penfield in Montreal was of great historical interest. Dr. Suzuki in Sendai showed an excellent outcome with temporary proximal occlusion using the Sendai cocktail, a mixture of steroid, mannitol, and vitamin E. He reported his results after performing surgery on 1000 cases. From the first-hand experience of direct aneurysm surgery that I gained, it appeared to me that 3 weeks after the bleed, the rent in the aneurysm was almost well-repaired; whereas in the early days, the rent was still weak and located at the apex. Furthermore, premature rupture was one of the most common causes of a poor outcome. It was significant that Dr. Norlen, who believed in virtues of a late operation and the value of understanding the anatomy of the Circle of Willis, denied the existence of vasospasm.

From all these visits, I learned that the factors that mattered most in aneurysm surgery were the duration from ictus to surgery, the condition of the patient, the knowledge of anatomy of the aneurysm and the surrounding vessels, careful dissection to avoid a premature rupture, approaching from the base, minimum temporary occlusion, and the support of the anesthesiologist. When I got a free hand to operate on aneurysms as a senior registrar, I used to spend hours looking at the various projections of the angiograms to have a good knowledge of the anatomy of the aneurysm. With the introduction of the computed tomographic scanner, the actual manifestations within the brain after an SAH became evident, thus permitting a more accurate management. Dr. Whitby, a dedicated neuro-anesthetist used to watch over my operations like an anxious mother. When I first reported my own series of ophthalmic aneurysms with direct surgery, Prof. Hankinson doubted my results. On another occasion, as I was reporting my series of 32 anterior communicating aneurysms without mortality, another British neurosurgeon, Henry Gossman termed it as "Black Magic." Soon, most of the patients with aneurysmal SAH started being referred to my boss, Mr. Lassman so that I could operate upon them.

By 1971, I started getting information regarding Prof. Gazi Yasargil's work and took his course in microsurgery that included performing dissections on rats. It took me a while before I could master microsurgery. On my second visit to Zurich, I had an interesting encounter with Prof. Yasargil. Before he would start his surgery for the day, there would be an assembly of some international students like me. As soon as he asked my name and place of work, he became angry and asked me to draw the Circle of Willis and the site of origin of the posterior communicating artery aneurysm. Feeling completely numb with this outburst, I tried to draw but was not very accurate with the drawing. He shouted at me saying how dare I come to learn from him and yet preach against his ideas. It appeared that one American student who had visited Newcastle earlier, questioned his work and the benefits of microsurgery advocated by him, quoting my results of aneurysm surgery (that was performed without the use of a microscope). Later on, we became the best of friends and in the late 80's, we also spent a month together in India visiting various centers. Success in aneurysm surgery allowed me to give lectures, perform surgery and represent Britain at many international gatherings. When the wife of one of the Presidents of India suffered from a SAH, Prof. Ramamurthy suggested my name, and she came to Newcastle for surgery. My book on SAH would not have seen the light of the day without the insistence and contribution of Dr. Sastry Kolluri.

What is the relevance of the story of my life for younger neurosurgeons of today? Firstly, gathering the requisite expertise needed to dissect an aneurysm also allows one to improve his or her performance in any other difficult brain or spinal cord surgery. Secondly, aneurysm surgery will never be overtaken by endovascular surgery for many reasons. Finally, I believe that to excel in any area, one needs dedication, determination and diligence, and the ability to make the best use of the situations one is placed in, rather than waiting to seek an ideal one.




 

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