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NI FEATURE: CITADELS SCULPTING FUTURE - COMMENTARY
Year : 2017  |  Volume : 65  |  Issue : 2  |  Page : 348-359

Government Medical College Trivandrum – Fifty years of Neurosurgery in Kerala state


Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India

Date of Web Publication10-Mar-2017

Correspondence Address:
Anil Kumar Peethambaran
Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.201847

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 » Abstract 

The Department of Neurosurgery founded in the Trivandrum Medical College, Kerala, the first teaching hospital in Kerala state, is celebrating its 50th anniversary. The history of Neurosurgery in this Institute is synonymous with the history of Neurosurgery in the state as this was the first medical college to start a Neurosurgery department within the state.The students after undergoing their rigorous training in the department, went on to establish advanced neurosurgical centres throughout Kerala and in several other parts of the country. This article traces the illustrious history of the Department of Neurosurgery, Trivandrum Medical College and also of the eminent faculty members and residents, who helped in advancing the standards of Neurosurgery in the region as well as the rest of India.
The Department of Neurosurgery was founded in the Trivandrum Medical College, Kerala, the first teaching hospital in Kerala state, in the year 1951, and is celebrating its 50th anniversary. The history of Neurosurgery in this Institute is synonymous with the history of Neurosurgery in the state as this was the first medical college to start a Neurosurgery department within the state.The students after undergoing their rigorous training in the department, went on to establish advanced neurosurgical centres throughout Kerala and in several other parts of the country. This article traces the illustrious history of the Department of Neurosurgery, Trivandrum Medical College and also of the eminent faculty members and residents, who helped in advancing the standards of Neurosurgery in the region as well as the rest of India.


Keywords: Government Medical College, Trivandrum, Thiiruvananthapuram, Kerala, history of Neurosurgery
Key Messages:
The illustrious history and seminal achievements of the Department of Neurosurgery, Trivandrum Medical College, Kerala, are presented. The valuable contributions of its faculty members and residents that helped in the establishment of modern Neurosurgery, not only in the state of Kerala, but also in rest of the country are recounted


How to cite this article:
Peethambaran AK, Chandran RS. Government Medical College Trivandrum – Fifty years of Neurosurgery in Kerala state. Neurol India 2017;65:348-59

How to cite this URL:
Peethambaran AK, Chandran RS. Government Medical College Trivandrum – Fifty years of Neurosurgery in Kerala state. Neurol India [serial online] 2017 [cited 2017 Mar 26];65:348-59. Available from: http://www.neurologyindia.com/text.asp?2017/65/2/348/201847


Soon after the famous institutes like Christian Medical College (CMC), Vellore and Madras Medical College, Chennai developed their neurosciences wing, the department of Neurosurgery was founded in the Trivandrum Medical College in Kerala. This was the first teaching hospital in Kerala state. This medical college was inaugurated by Shri Jawaharlal Nehru, the Prime Minister of India, in the year 1951.

Thiruvananthapuram is the capital city of one of the most literate states of India, Kerala. The history of Neurosurgery in this Institute is synonymous with the history of Neurosurgery in the state as this was the first medical college to start a Neurosurgery department within the state. Even though head trauma was being handled way back from 1930 in the state by general surgeons like Dr. AE John and Dr. Poduval with exploratory trephination, no proper department was organised for regular neurosurgical procedures. These doctors even performed laminectomies and removed spinal tumours based of clinical localization and skiagrams. Dr. V. Kumarapillai, a physician who practiced Neurology, concocted “Mistura Diabolica” from magnesium sulphate and magnesium carbonate, which helped to reduce intracranial pressure in patients by catharsis. In those days, tertiary neurosyphilis was a common entity and pyrrotherapy was often performed to kill the organisms by raising the body temperature using 3 minims of the typhoid-paratyphoid A and B vaccine. Colonel Dr. Sabesan, the professor of Surgery and Dr. KI George, the senior consultant of Orthopaedics used to operate on spinal tumours after diagnosing and localising them with myodil myelograms. As early as in 1957, Dr. Mahadevan Pillai, a neuroradiologist, performed carotid angiograms here. Later, Dr. Sambasivan, who was a medical student, learned the technique of carotid angiography and started performing it under supervision of the then professor of Radiology, Dr. MP Joseph and his assistant, Dr. CP Mathai. He managed to diagnose a parasellar meningioma by carotid angiogram that was later operated by Dr. Kesavan Nair. Dr. M Sambasivan also had the opportunity to work under Dr. Sivarajan, professor of Surgery, who did brain surgeries for brain abscesses and head trauma. Later in 1961, Dr Mathew Varghese trained under Dr. Earl Walker at Baltimore and joined the Trivandrum Medical College as a general surgeon. He performed craniotomies at the medical college and Dr Sambasivan had the opportunity to assist him. In 1961, Dr. RM Varma, while visiting Trivandrum Medical College, operated on a pituitary adenoma with Dr. Sivarajan and the patient's vision improved dramatically. At the same time, Dr. Raman Nair and Dr. VJ Nair, both paediatric surgeons, started operating on patients with congenital hydrocephalus. Dr. Samabasivan had the opportunity to perform ventriculograms in these patients and later assisted the two surgeons during shunt surgeries, in which cerebrospinal fluid diversion was performed using an infant feeding tube. In 1964, Dr. Sambasivan, who had by this time developed considerable interest in Neurosurgery, on finding that there were no properly trained neurosurgeons in the state at that time, decided to go to CMC Vellore to get trained under the father of neurosurgery in India, Dr Jacob Chandy. During this period, Dr Bahuleyan from Madras Medical College joined Trivandrum as an assistant professor after his FRCS from Glasgow and started doing neurosurgical procedures regularly. Soon he joined the army and later on went to USA for further training. Dr Bahuleyan was the founder of Brain and Spine Institute in Vaikkom, Ernakulom.

Dr. Sambasivan hailed from a family of Sanskrit scholars who were adept at studying and reciting Vedas and Upanishads. His father performed rites at temples. Being a 'tantri' himself, he wanted his son to be a Sanskrit scholar, too. Dr. Sambasivan developed a flair for the healing art and wanted to study medicine. He promised his father that he would pursue both the disciplines, and indeed, he succeeded in striking a balance between the two. Dr. Sambasivan, thus, became a Sanskrit scholar who also got admission at the Trivandrum Medical College to obtain his MBBS degree. He used to perform worship at the temple and at the same time became an excellent clinician. He sought a scientific basis for many of the legends in the ancient scriptures like the birth of 'Kauravas' from a single piece of tissue, which got transformed into 100 children. He thought that this medical miracle in the scriptures could be due to cloning, a technique which probably had already been discovered and practiced by the scientific community of ancient India.

It was during this time that he developed a passion for surgery and assisted many famous surgeons who got trained in the UK in those days. He realised that patients with traumatic brain injury and brain tumours fared poorly and read about the advances in Neurosurgery in Europe and USA. Around this time, the Principal of the Government Medical College, Trivandrum, Dr. Thankavelu happened to meet Dr. Jacob Chandy, who had just returned from Montreal Institute of Neurology, Canada. He requested Dr Chandy to train someone from Trivandrum Medical College in Neurosurgery. Dr. Jacob Chandy agreed to train a person from Trivandrum on the request of Dr. Thankavelu and Dr. Sambasivan got selected for the post. Dr. Sambasivan was an ardent student in the subject and became the favourite student of Dr. Jacob Chandy. According to him, Dr. Chandy was a 'live wire' and maintained strict discipline, like that of a military camp, in his department. On the first day, he told Dr. Sambasivan that the only books in Neurosurgery that could be found there were on the beds in the wards-referring to the need to closely examine and observe patients admitted to the wards. Dr. Chandy insisted that Dr. Sambasivan study the ailments of his patients thoroughly as he would have to not only localize and prove the disease by a thorough clinical examination but also by opening the skull and showing the exact location of the lesion in the brain as well. Dr. Sambasivan used to forgo his sleep and finish all the case records on the first day of admission itself so that Dr. Chandy was not displeased the next morning. Dr. Chandy was amazed at Dr Sambasivan's meticulous surgical skills and used to entrust Dr. Sambasivan with managing haemostasis after he had removed the brain tumours. At the time of the final examination of Dr. Sambasivan, Dr. Jacob Chandy told the examiners that they could ask him anything they wanted regarding Neurosurgery, and if he did not answer the questions to their satisfaction, they had every right to fail him. If, however, he was able to answer the questions, he should be given a 'D.' By this time, Dr. Sambasivan had already acquired considerable skill and knowledge in Neurosurgery and had no trouble in passing the examination with distinction.

In 1966, Dr. Sambasivan, who had already graduated from CMC Vellore, returned to Kerala to start the first Department of Neurosurgery at the Trivandrum Medical College. Dr. Jacob Chandy, as we all know, had been trained under Dr. Wilder Penfield, and later, Dr. Theodore Rasmussen in Montreal. Therefore, the quality of neurosurgical procedures done at the medical college even during those times was of high standards. The protocols that were observed in Montreal Neurological Institute were being followed at the medical college. Thus, began the era of Dr. Sambasivan, who became the 'last word' for brain surgery within the state. He worked with just two beds under him exclusively earmarked for Neurosurgery patients in the General Surgery wards. Soon after forming the department, he operated on his first neurosurgical patient, named Mr. Pillai, who was suffering from post-traumatic acute subdural haematoma, that was diagnosed by a carotid angiogram on admission. Probably at that time, the saving of a severe head trauma patient from certain death by performing a neurosurgical procedure was considered a miracle. It was considered as a revolutionary surgery and the patient lived for a long time after the procedure. In those days, in the pre-computed tomographic era, every time a patient suffering from trauma came to the casualty, Dr. Sambasivan was informed. He would rush the patient to the X ray room and would perform an angiogram as well as a ventriculogram to localize the area of bleed. Following this, the patient was operated promptly. He still remembers that in those days, performing an angiogram to locate the lesion in patients who had suffered from head trauma was difficult and sometimes fatal. People used to call it as 'antiogram' which meant 'last rites' in the local language. The procedure often left Dr. Sambasivan in severe depression, especially when the patient did not make it. But in elective cases, he found it as a good tool to localize brain tumours. The patients, following the angiogram done for elective cases, had a relatively better prognosis. In 1967, Dr. Sambasivan, who had become a good neuroradiologist also, while performing carotid angiograms by himself on patients with suspected spontaneous intracerebral bleed and subarachnoid haemorrhage (SAH), found that they harboured aneurysms. It was his landmark paper from India which proved that cerebral aneurysms were not uncommon in Indian, a finding that was contrary to the general belief prevalent at that time that intracranial aneurysms frequently occurred the Caucasian population and their prevalence rate was low in Indian patients. He managed to diagnose about 18 cases of aneurysms by this technique initially and presented his seminal findings in international conferences. He then became skilled at performing ventriculograms using Myodil as a contrast medium and diagnosed a posterior third ventricular region tumour. This was operated successfully by him through the trans-tentorial approach. In fact, he had developed an extraventricular lateral transtentorial approach to the posterior third ventricle in the sitting position to tackle pineal region lesions. Till then, all pineal tumours were sent for radiation in India as none of the neurosurgeons dared to operate upon them due to the increased mortality rates associated with the various approaches to the posterior third ventricular region. Dr. Sambasivan was the sole qualified neurosurgeon in the department until 1968. Soon, Dr. S K Ramachandran Nair who did his training in Neurosurgery from CMC Vellore, joined the department. He was followed by Dr. Sanal Kumar in 1969. Soon the department got separated from the department of General Surgery to become an independent department with just three of them as faculty members. Thus, it became the fifth department in India exclusively dedicated to Neurosurgery, while in most other centres, Neurosurgery was a part of General Surgery. With these three hard working neurosurgeons contributing actively in the department, neurosurgical procedures became a regular feature. Thus, Trivandrum Medical College was already a well-known neurosurgical centre in the early seventies. Thousands of cases were diagnosed clinically, with their lesions localized using angiograms and ventriculograms, and operated successfully. Pineal region tumours and posterior fossa tumours were operated using the Gardner's chair in sitting position in the times when intraoperative monitoring facility was not available. Dr. Sambasivan and his team used the animal lab and anatomy department to acquire the surgical skills required for performing new procedures and novel approaches to various parts of the brain. His interest in vascular surgery increased as more and more aneurysms were diagnosed following performance of angiograms for suspected spontaneous/hypertensive bleeds. Even Dr. Charles Drake and Dr. Gazi Yasargil became fascinated by the number of aneurysms he had been able to pick up from the state and decided to help him in establishing a centre of excellence in vascular neurosurgery.

Dr. Sambasivan decided to go for vascular neurosurgical training and worked with the famous neurovascular surgeon, Dr. Charles Drake in London in 1972, and later with Dr. Gazi Yasargil in Zurich. Dr. Yasargil was fascinated by his enthusiasm and knowledge in handling neurovascular cases and considered him as a colleague rather than his student. His mentor, Dr. Drake was amazed at his surgical skills and advised him to set up a section of neurovascular surgery in Trivandrum. In the early seventies, Dr. Sambasivan managed to successfully dissect and clip an anterior communicating artery aneurysm with the very silver clip donated by Dr. Drake. Acknowledging the vast number of aneurysms, he had diagnosed and operated upon, many international neurosurgeons like Dr. Drake, Dr. Eskeil and Dr. Carbicke constantly encouraged him as well as donated aneurysm clips and applicators to him, whenever he met them. He also purchased these clips and applicators, whenever he had a chance to go abroad. Soon, impressed by his vascular work, Dr. Charles Drake visited him in Trivandrum in his department and helped him procure aneurysm clips and applicators for the department. This made this centre famous for vascular work even in the early seventies itself. Many foreign neurosurgeons visited India to observe Dr. Sambasivan operate on aneurysms, which were being tackled only at a few centres around the world. Dr. Sambasivan was not only skilled in conducting vascular neurosurgery procedures but had also operated on a considerable number of vestibular schwannomas and pineal region tumours, making him world famous. He was also well known in the world conferences as 'a Sanskrit scholar who also had considerable neurosurgical skills.' He had published ample papers in these areas, which included rare vascular cases like the intra- petrous and cavernous carotid aneurysms. Thus, the Department of Neurosurgery, Trivandrum Medical College, became prominent on the world map of neurovascular surgery, right from the early seventies itself. It became one of the few centres in India where aneurysms were being successfully treated. At that time, it was the fifth centre in India to manage all types of complicated neurosurgical cases. Many papers were published in international journals regarding rare and difficult cases tackled here and references of patients came from all over India to Trivandrum.

It was in 1972 that another famous neurosurgeon, Dr. A. Marthanda Pillai, joined the department as a lecturer. With three skilled neurosurgeons working under Dr. Sambasivan, the department improved considerably. Both Dr. S.K Ramachandran Nair and Dr. Marthanda Pillai were trained in Neurosurgery from CMC Vellore like Prof Sambasivan and had ample neurosurgical skills. The department of Neurosurgery, Trivandrum Medical College organized the national conference of Neurological Society of India in the year 1978 under the guidance of Dr. Sambasivan. It was a memorable event as many eminent neurosurgeons and neurologists from India and abroad attended the program and appreciated Dr. Sambasivan's efforts and hospitality. An array of dignitaries from all over the world like Dr. Teasdale, Dr. Drake, Dr. Lister, Dr. Stauffer, Dr. Lindsey Symon, Dr. Eskeil, Dr. Carbicke, and Dr. Yalow; and, famous neurosurgeons from India like Dr. Jacob Chandy, Dr. PN Tandon, Dr. B Ramamurthy, Dr. RM Varma, Dr. BS Das, Dr. AK Banerjee, Dr. S. Kalyanaraman, Dr. Jacob Abraham, Dr. Balparameshwara Rao and Dr.SN Bhagwati had visited the department and appreciated the excellent work being done there [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5],[Figure 6],[Figure 7],[Figure 8],[Figure 9],[Figure 10],[Figure 11],[Figure 12],[Figure 13],[Figure 14],[Figure 15],[Figure 16],[Figure 17],[Figure 18],[Figure 19],[Figure 20].
Figure 1: Dr. Charles Drake during his visit to the department

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Figure 2: Dr. Drake sharing his experiences with the department

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Figure 3: Dr. Lister, paediatric surgeon from Liverpool during his visit to the department in 1977

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Figure 4: Dr. Earl Walker with the faculty and residents

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Figure 5: Dr. Sambasivan with Dr. David Cavicke and Dr. MRS Menon. In the background are photos of cerebral angiograms displayed in the department that had been personally done by Dr. Sambasivan

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Figure 6: Official emblem of Neurological Society of India national conference Trivandrum in 1978

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Figure 7: Operative photograph following total excision of a craniopharyngioma in the early '70s

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Figure 8: NSI 1978, Mrs Jyothi Venkitachalam the honourable governer, Drs. Vimala Virmani, Baldev Singh, Ramamurthi and Sambasivan

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Figure 9: Dr. Rossalyn Yalow, the nobel laureate during her visit to the department in 1978

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Figure 10: Dr. Earl Walker with Dr. Sambasivan and other faculty members

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Figure 11: Dr. CKP Menon, Dr. Ramamurthi, Dr. Balsalam and Dr. Sambasivan

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Figure 12: Dr. Sambasivan with Mrs. and Dr. Drake

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Figure 13: Dr. Sambasivan showing the enormous collection of cerebral angiograms done by him to Dr. Stauffer from Zurich in the early '70s

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Figure 14: Dr. Sambasivan, Dr. Majid Samii and Dr. K V Mathai

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Figure 15: During the 1998 NSI conference Trivandrum, padmashri Dr. Marthanda Pillai, Dr. Jacob Chandy, Dr. Sambasivan and Dr. Madhusoodanan

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Figure 16: Dr. Jacob Chandy inaugurating the NSI National Conference at Trivandrum in 1998

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Figure 17: NSI national conference Trivandrum in 1998

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Figure 18: Dr. Sambasivan, Dr. Jacob Chandy, Dr. Banerjee, Dr. Ramamurthi

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Figure 19: Dr Marthanda Pillai, Dr. Ramamurthi and Dr. Samii in 1998

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Figure 20: NSI 1998 team. Dr. Suresh, Dr. Thomas, Dr. Utham, Dr. Anil P, Dr. M.Pillai

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In 1979, the first neurosurgical training programme in the state was started in Trivandrum Medical College. Dr. Sanal Kumar was the first MCh Neurosurgery student who passed out from this department. He held the fort day and night as a single resident for two years gaining considerable skills in Neurosurgery. After his graduation, he was promoted to the post of assistant professor and was sent to other medical colleges in the state to perform neurosurgical procedures. Dr Sanal Kumar later became the Head of Neurosurgery in Medical College, Kozhikode. After his appointment, all the neurosurgical cases from northern Kerala, which were being referred to Trivandrum earlier on, could be managed in Kozhikode itself. Soon, another resident trained in Trivandrum Medical college, Dr. Premraj Mohan joined Dr. Sanal Kumar in Kozhikode Medical College, and this newly established department of Neurosurgery became very popular in North Kerala. Dr. Sanal Kumar also had the enterprise to start an MCh training program at the Kozhikode Medical College as well. During this period, other students of Dr. Sambasivan from Trivandrum, Dr. Ekbal and Dr. Jayakumar joined Dr. Rajan in Medical College Kottayam, to handle the neurosurgical cases in that district. Dr Bhavadasan, trained in Trivandrum Medical College, headed the department of Neurosurgery in Medical College, Alapuzha. Dr Divakar Rao went to Mangalore to serve the people there, as there were no neurosurgeons in that city prior to their arrival. Dr. Mahadevan and his wife, Dr Pushkala, both trained under Dr. Sambasivan, joined Dr. Ekbal to develop the department of Neurosurgery at Kottayam. Dr. Zulfiquer stayed with the Trivandrum team while Dr Gnanadas was sent to Malapuram, which was a rural area then, to start Neurosurgery. The latter joined the Moulana Hospital in Perunthalmanna. Dr. Thajuddin, Dr. Devadas and Dr. Jacob Alapat went abroad for further training and work. Thus, the scarcity of neurosurgeons in Kerala was being slowly resolved by a gradual distribution of highly skilled neurosurgeons from the Trivandrum Medical college throughout the state of Kerala. This tremendously reduced the mortality from head injury in the state and neurosurgical cases could be managed by reaching any hospital within an hour's drive from the place at which the patient resided, in any part of Kerala. This achievement was only possible due to the great vision of Dr. Sambasivan, who started the first training centre in the state and spread his students all over the state to provide service to every nook and corner of Kerala.

Dr. Sambasivan became a full Professor in 1975 and was later appointed as consultant neurosurgeon in the Armed Forces Medical services in 1987. He was also appointed as the neurosurgeon to the President of India in the same year. In the year 1990, Dr. Sambasivan was conferred an Honorary FRCS (Glasgow) based on his achievements in the field of Neurosurgery within the country and abroad.

He organized the 9th International Congress of Neurological Sciences in New Delhi in 1989 as well as many other international and national level conferences. He was appointed the Secretary of Neurological Society of India from 1984 to 1990 and the President of the World Federation of Neurosurgical Society later on. In 1972, on the 60th birthday of His Royal Highness, Sree Chitra Tirunal Maharajah of Travancore, Dr. Sambasivan was called and asked what could be done to commemorate the 60th birthday of the king. Dr. Sambasivan suggested that a full-fledged super-specialty hospital, dedicated to curing the diseases of the brain and heart, would be ideal. He was allotted Rs. 8 lakhs and also given a piece of land within the Trivandrum Medical College campus for starting the work related to the development of the institute. Thus, he was instrumental in initiating the work related to the development of Sree Chitra Tirunal Institute of Medical Science and Technology (SCTIMST) within the campus with the recommendation from the Royal family and also financed by the Department of Science and Technology, Government of India. Dr. Sambasivan was well known for his work in neurovascular neurosurgery as well as on approaches to the cavernous sinus and posterior third ventricular regions, in the seventies itself, when these areas were thought of as being difficult-to-approach regions.

He has always been an excellent teacher and had successfully trained many neurosurgeons in this department until his retirement in the year 1991. He managed to procure many advanced instruments like the operating microscope, Gardner's operating chair, bipolar forceps, ultrasonic suction aspirator, craniotome, ultrasound, diapulse, vascular clips, sterotactic frame, surgical instruments and even endoscopes for his department. He has been an author in many neurosurgical textbooks and international journals and has more than 130 publications to his credit. His landmark paper on using powdered 'chitosan' as a haemostatic agent derived from the shell of crustaceans acquired much acclaim as an original molecule being developed in the area of haemostasis.[1] He developed this study with the help of Dr. Radhakrishnan, the neuropathologist in SCTIMST. Later, the Hoechst company from Germany took the rights for developing this chemical. His Indian Council of Medical Research (ICMR) report on the epidemiological study of subarachnoid haemorrhage in India changed the scenario of spontaneous aneurysmal subarachnoid haemorrhage, which were until then, being managed conservatively, with the patients often succumbing following re-rupture of the aneurysm.[2],[3]

A few of his remarkable papers are:

  1. Epidemiological study of subarachnoid hemorrage (SAH) in India, an ICMR 1987 study
  2. Surgery of intracranial aneurysms, Neurology India (NI) 1987, volume 35
  3. Case of corpus callosum lipoma, NI 1988, volume 36
  4. Middle cerebral artery aneurysm presenting as chronic subdural haematoma1986, NI volume 34
  5. Analysis of 1000 cases of SAH and experience with intracranial aneurysms in India, NI, volume 32, 1984
  6. Analysis of internal carotid artery division anomalies from 1000 carotid angiograms, NI volume 31,1983
  7. A survey of the problems with head Injury in India, NI, 1977
  8. Epidermoid cyst of the pineal region, Journal of Neurology Neurosurgery and Psychiatry, Volume 37,1974
  9. Surgical experience with 80 cases of acoustic schwannomas, NI 1966
  10. Analysis of vertebral venous system, Indian Journal of Surgery, 1963.


During his tenure he had operated on about 4000 cases of head trauma, 2256 cases of chronic subdural haematoma, 827 cases of gliomas, 256 cases of meningiomas, 189 cases of vestibular neurinomas, 62 cases of pituitary adenomas, 110 cases of craniopharyngiomas, 67 cases of medulloblastomas and 37 cases of pineal region tumours according to the available records. He has often operated on many difficult cases, which were considered inoperable at many major centres. To quote an example, a patient harbouring a craniophayngioma, whom he had operated 30 years ago, came to him recently. The patient was still without any deficits. To show his gratitude, the patient, who is a renowned sculptor, presented him with a wooden mural of 'Navarasas,' which Dr. Sambasivan ardently cherishes. The mural is displayed in his living room. In this situation, a patient with a craniopharyngioma, having been operated without a microscope, surviving without deficits for more than 30 years, and now being able to sculpt a piece of art with meticulous skill, clearly exhibits his good visual acuity and motor dexterity- nothing short of a miracle. Dr. Sambasivan was asked what gave him the courage to operate on the brain in those days, when opening and closing the skull itself was a formidable task and one was never sure if the patient would survive. His reply was that everything related to the brain was a challenge in those days, there were no proper instruments, no technology backing for patient safety-related issues, no ventilators, no bipolar forceps, and no good antibiotics available; still, by ensuring strict aseptic precautions and exercising extreme care and skill, good results could be achieved. He has also been a world renowned Sanskrit scholar, recites verses from the Vedas and interprets them to his students. He is a tantri in a famous temple in the city and spends his spare time in doing worship there.

When Dr. Sambasivan retired in 1991, Dr. SK Ramachandran Nair became the head of the department with Dr. Marthanda Pillai, Dr. Zulfiquer, Dr. Gnanadas and Dr. Jacob Alapat as assistants [Figure 21]. Dr. SKR Nair, who had also undergone training at CMC Vellore, had earlier joined Trivandrum Medical college to assist Dr. Sambasivan. He assisted and learned from his professor to become an excellent teacher and a skilled neurosurgeon. He was interested in the suprasellar region, skull base meningiomas and anterior cervical discectomy procedures. It was his efforts that helped in acquiring a new building for the department. His ability to maintain a cordial relationship with his colleagues and his administrative skills earned him the coveted post of the medical superintendent of the Trivandrum Medical College. In 1992, Dr Anil KumarP and Dr Raymond Morris joined as lecturers, and the next year, Dr Suresh Kumar KL also joined the department as a lecturer. Dr.SKR Nair headed the department for about five years when he was promoted as the Principal in 1996 and joined the Alleppey Medical College in Kerala.
Figure 21: Dr. S K Ramachandran Nair, the second head of the department

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Dr. A Marthanda Pillai succeeded Dr. SKR Nair as Head of the Department. His team consisted of Dr. Raymond Morris, Dr. Anil KumarP and, Dr. Suresh Kumar KL. Like his predecessors, he, too, had undergone his Neurosurgery training at CMC Vellore. Dr Pillai got his membership of the National Academy of Medical Sciences in 1979 and later became the Fellow of the Royal College of Surgeons (FRCS) while he was undergoing training in microneurosurgery and neuroradiology in the U.K. from 1980 to 1983. His tenure always reminds us of his meticulous techniques during the performance of neurosurgical procedures including the pre-operative preparation, intra-operative handling of instruments and respect for tissue as well as the postoperative care of the neurosurgical patients, which significantly reduced the infection rates. He insisted on limiting antibiotics to a mere three doses, a single preoperative dose and two postoperative doses at 6 hourly intervals. His bold actions inspired confidence in the fact that by maintaining meticulous sterility and discipline in the Neurosurgery theatre, it was posible to considerably reduce the risk of infection. The technological advancements that were notable in the department during his tenure as head of the department were the acquisition of a state-of-the-art operating microscope, high speed pneumatic drills and craniotomes, automated neurosurgical operating tables, neurosurgical bipolar forceps, a neuroendoscopic system with cameras, an X ray image intensifier machine, multiple patient parameter recording monitors and state-of-the- art ventilators. The operating theatre and the intensive care unit were suitability modified to meet the highest standards. The quality of treatment and outcomes improved considerably within no time. The procedure of transoral odontoidectomy with anterior fusion of atlantoaxial joint had been started in the department during his time. Before the advent of modern high speed drills, he used dental drills and rongeurs to achieve this feat. Median corpectomy without fusion for cervical spondylosis – a modified technique developed by him, proved to be very effective in his patients, without the occurrence of any complications in them. This technique was presented at the 49th Annual Conference of the Neurological Society of India held at Chennai in 2000. Dr. Marthanda Pillai carried out a lot of pioneering work in the development of nuances of craniofacial and upper cervical spine surgery in Kerala since 1983, which resulted in his authoring chapters concerning these developments in the book 'Progress in Clinical Neurosciences' brought out on the occasion of Annual Conference of Neurological Society of India. Not only has he published 84 scientific articles in various national and international journals and contributed chapters in 8 text books, but has also made a notable contribution in the publication of the 'Drug Formulary,' which is a ready reference book on rational drug prescriptions. He has presented 161 scientific papers in the state, national and international conferences. He has also edited two very popular books, 'Medical Records Documentation' and 'Consent and Recent Advances in Medicine.' He has 10 research projects to his credit, of which 4 have been sponsored by the Department of Science and Technology, Government of Kerala. The most important among them are the study of incidence of post-traumatic ischaemia in head injured patients, a drug trial to treat post-traumatic ischemia, cryoimmunology of glial tumours of the brain, and scanning electron microscopic study as a prognostic index of malignancy in meningiomas. The 6-bedded neuro- intensive care unit (ICU) was upgraded to a 22-bedded ICU with all modern facilities. A new physiotherapist's post was created for maintaining the neuro-rehabilitation services. A dedicated Neurosurgery operation theatre that had been planned for elective surgery during Dr. SKR Nair's time, was commissioned during Dr. Marthanda Pillai's time. Following the commissioning of the operating theatres for elective neurosurgery, operations started being conducted on all six days of a week, a practice that has been continuing since then. In 1998, Dr. Marthanda Pillai and his team hosted the Annual Conference of the Neurological Society of India (NSI) in Trivandrum, which was a memorable event for all the members of NSI. Many dignitaries from the country and abroad came to Trivandrum to attend the meeting. Dr. Tetsuo Kano, Dr. Yoko Kato and their Japanese team, Dr. Robin Sengupta, Dr. Arnold Menezes, Dr. Graham Teasdale, Dr. Setti S. Rengachary, Dr. Laligam Sekhar, Dr. Chandranath Sen from abroad; and, Dr. Jacob Chandy, Dr. KV Mathai, Dr. B Ramamurthy, Dr. AK Banerjee, Dr. PN Tandon, Dr. BS Das, Dr. Varma, Dr. Bhagavati, Dr. B. Rao, Dr. Jacob Abraham, Dr. Mathew Chandy, Dr. Rajshekar, Dr. VK Kak, Dr. Khosla, Dr. Turel and other famous neurosurgeons from India attended the meeting. Dr. Marthanda Pillai was awarded the 'best doctor of the state' award in the year 1998. During this period, Dr. Bhavadasan joined the department and a second unit was started. Dr. Rajmohan BP, Dr. Ramesh Babu and Dr. Anil Varma joined as senior lecturers in the department. Additional posts were created to improve the faculty strength and Dr. Sharmad, Dr. Sunil and Dr. Ajith joined as lecturers. The latter two later went to UK for higher training. In 2001, Prof Pillai retired and went on to establish the Ananthapuri Hospitals and Research Institute, which is now the biggest Neurosurgical centre in the private sector in the city. He was awarded Padmashri for his achievements in 2011 and later became the National President of the Indian Medical Association in 2015.

Dr. Bhavadasan, who was a student of Dr. Sambasivan, had the opportunity to head the department from 2001 onwards [Figure 22], and Dr. Raymond Morris, who returned from his training at the Montreal Institute of Neurology, headed the second unit. Most developments in neurovascular, neuroendoscopic and spinal instrumentation surgery took place during this period. Most of the contemporary neurosurgeons of the state heading various departments in other neurosurgical centres like Dr. Raymond Morris (Head of the Department (HOD), Pushpagiri medical College), Dr. Anil KumarP (HOD, medical College Trivandrum), Dr. Suresh Kumar KL (HOD, Anathapuri Hospital), Dr. Rajmohan BP (Chief of Unit I, Trivandrum medical college), Dr. Ajith R Nair (HOD, SUT hospital), Dr. Biju Krishnan (HOD, Thrissur medical college), Dr. Biju Bhadran (HOD, Alappuzha medical college), Dr. Sharmad (Medical Superintendent, Trivandrum medical college), Dr. Sunil Kumar, Dr. Noushad and Dr. Jyotish worked under the HOD, Dr. Bhavadas simultaneously, to uplift the standards of this department significantly [Figure 22],[Figure 23],[Figure 24],[Figure 25],[Figure 26],[Figure 27].
Figure 22: Dr. Bhavadasan who succeeded Dr. Pillai as head of the department in 2002college),

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Figure 23: Dr. Sanal Kumar, Dr. Rout and Dr. Sambasivan in 1998

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Figure 24: The Neuro-oncology seminar in 1991

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Figure 25: Dr. Lister in Trivandrum

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Figure 26: Dr. Gerrard Moore, Dr. Suresh Nair and Dr. Raymond Morris in 1998

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Figure 27: Dr. Sambasivan with Dr. Kalyanaraman

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After Dr. Bhavadasan retired in 2004, Dr. Raymond Morris became the head with Dr. Suresh Kumar, as the chief of unit II. Dr Raymond was instrumental in enhancing the teaching programme by inviting international faculty from other countries. He was popular in improving the standard of vascular and transsphenoidal surgery in the department after his training in Montreal. Dr Raymond Morris retired in 2010 from the Medical college to head the department of Neurosurgery in Pushpagiri medical college, Thiruvella. Dr. Suresh Kumar KL became the head of the department. Dr Pushkala joined as second unit chief for a brief period and returned to Medical College Kottayam as head. Dr Anil Kumar P became the unit II chief and during this period. The study on novel techniques for decompressive craniotomy using 'four quadrant osteoplastic bone flap' was started and later published in Neurology India, which eliminated the need for a second surgery like a revision cranioplasty.[4] Soon the new super-specialty block was created with the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) fund. It has a multi-storey building dedicated solely to super-specialty departments and was equivalent to any corporate hospital in the state. There is a centrally air conditioned outpatient department, a modern ICU with all facilities like full functional ventilators, monitors, pneumatic compression devices for prevention of deep vein thrombosis, infusion pumps, modular theatres, anaesthesia workstations, state-of-the-art equipment like operating microscopes, ultrasonic suction aspirators, high speed drills, neurophysiological monitoring, intraoperative ultrasound, and plasma sterilizing system.

After Dr. Suresh Kumar was transferred to Medical College, Alapuzha, as head of the department there, Dr. Anil Kumar Peethambaran became the head of the department in Trivandrum in 2012 [Table 1]. Dr. Rajmohan BP joined as the chief of unit II. The department conducted an international cadaveric workshop on neuroendoscopy with Dr. Paul Gardner and Dr. Carl Snyderman from Pittsburg university collaborating under the aeges of the Endoscopic Base of Skull Society (EBOSS) in 2015. The number of cases related to skull base and vascular neurosurgery went up significantly. Two dedicated neurosurgical theatres running simultaneously on all working days handled the increased work load. Original papers are being published in indexed journals. High quality instruments, bipolar cautery machines, Doppler ultrasound for vascular procedures and pituitary tumors, full array of aneurysm clips and applicators, endoscopic spine system, state-of-the-art spinal instrumentation of quality are being used regularly. Antibiotic impregnated shunt systems for post-meningitic hydrocephalus were procured at reasonable rates and utilised for the patients to prevent shunt infections. Insurance services and Karunya fund are being used to help the poor people and the treatment is being offered completely free of cost for the poor patients. An academic environment has flourished and the department has six Medical Council of India recognized MCh Neurosurgery seats, which are coveted all over India. The centre has also been selected by the National Board of Examinations for conducting the regular DNB Neurosurgery practical. Our residents have consistently fared well in the National Neurosurgery Quiz due to the high quality of teaching in the department. Apart from the in-house faculty, often retired guest faculty like Dr. Madhusoodhanan, a renowned Neurology teacher, have been invited to train our residents in clinical Neurology. The residents are sent to NIMHANS Bangalore, CMC Vellore, NIMS Hyderabad and SCTIMST, Thiruvananthapuram for training in neurointerventional procedures and in other aspects of Neurosurgery for a month. The residents are well trained in both trauma and elective neurosurgical procedures due to the high volume of cases that the department caters to. All adult patients with brain and spinal ailments are operated at our hospital and all paediatric cases are operated in the S.A.T. Hospital for Mother and Child, within the campus. We operate upon over 1300 to 1500 cases every year of which a major chunk is brain and spine trauma. The residents are well-trained to handle trauma surgery independently. At present, the teaching faculty consists of Dr. Anil Kumar Peethambaran as the head, Dr. Rajmohan B.P as the unit two chief, Dr. Sunil Kumar, Dr. Sharmad (also the medical superintendent), Dr. Jyotish and Dr. Raj S Chandran as associate professors, and, Dr. Rajah Kutty and Dr Prashant Asher, as assistant professors [Table 2] and [Table 3], [Figure 28]. In the year 2016, the department of Neurosurgery in Trivandrum Medical College celebrated its 50th year of existence, since it was formed in 1966 by Dr. Sambasivan [Table 3]. I am sure that he is extremely proud to note that the department he established is now one of the largest departments in south India, producing high quality work that is being recognised in the country and abroad. The department will always remember Dr. Sambasivan as the founder of the first Neurosurgery department in the state and will be grateful to him for this venture. May God bless the stalwarts of the department of Neurosurgery, Trivandrum Medical College, who strived hard in the initial stages to uphold the high standards of the department despite all the difficulties they initially encountered. In a recent interview, Dr Sambasivan was asked to give a message for the younger generation of neurosurgeons. He said, 'Always be truthful to your patients, your teachers and the subjects. Do the best you can to help the suffering patient.' The department strives to uphold these sacred values of its founder.
Table 1: The successive Heads of the Department of Neurosurgery, Trivandrum Medical College, Thiruvananthapuram

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Table 2: The current teaching faculty

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Table 3: MCh trainees who passed out from the Department of Neurosurgery, Trivandrum Medical College

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Figure 28: Present faculty- - Sitting from the left: Drs. Sunil Kumar BS, Rajmohan B P, Anilkumar P, Sharmad MS, Jyothish LS). Standing behind from the left: Drs. Raja K Kutti, Prasanth Asher, Raj S Chandran

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Financial support and sponsorship

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Conflicts of interest

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 » References Top

1.
Sambasivan CN, Cho SD, Zink KA, Differding JA, Schreiber MA. A highly porous silica and chitosan-based hemostatic dressing is superior in controlling hemorrhage in a severe groin injury model in swine. Am J Surg 2009;197:576-80.  Back to cited text no. 1
    
2.
Sambasivan M. SAH in India. An epidemiological study. ICMR Bulletin 1988;18:4.  Back to cited text no. 2
    
3.
Sambasivan M, Nair SKR, Sanal Kumar. Analysis of 1000 cases of subarachnoid haemorrhage and experience with intracranial aneurysms. 1984; 32: 17-25.  Back to cited text no. 3
    
4.
Peethambaran AK, Gopal VV, Valsalamony J. Four-quadrant osteoplastic decompressive craniotomy: A novel technique for refractory intracranial hypertension-A pilot study. Neurol India 2015;63:895-902.  Back to cited text no. 4
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17], [Figure 18], [Figure 19], [Figure 20], [Figure 21], [Figure 22], [Figure 23], [Figure 24], [Figure 25], [Figure 26], [Figure 27], [Figure 28]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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