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 »  Abstract
 »  About Tirumala, ...
 »  The Tirumala Tir...
 » SVIMS: Inception
 »  Department of Ne...
 »  Department of Ne...
 »  Conferences/CME/...
 » Unique Traditions
 »  References
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Table of Contents    
NI FEATURE: CITADELS SCULPTING FUTURE - COMMENTARY
Year : 2019  |  Volume : 67  |  Issue : 1  |  Page : 207-217

History of Neurosurgery at Sri Venkateswara Institute of Medical Sciences, Tirupati


Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Date of Web Publication7-Mar-2019

Correspondence Address:
Dr. Ramesh Chandra Vemula
Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupati - 517 507, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.253574

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 » Abstract 


The history of the Department of Neurosurgery, at Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, a leading tertiary care center in Andhra Pradesh, is presented. The inception of this department and its growth to its present stature is documented. The Department of Neurosurgery was started in 1993, and the residency program in 2003. It caters to a huge population from Andhra Pradesh, Tamil Nadu, and parts of Karnataka. The Tirumala Tirupati Devasthanams (TTD), the caretaker of the Tirumala Venkateswara Swamy temple is a major stakeholder in SVIMS. The hospital provides quality health care without resulting in any financial burden to the patient.


Keywords: History, neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupati
Key Message: The history of the Department of Neurosurgery at SVIMS, Tirupati, a leading tertiary care center in Andhra Pradesh, from its inception to its present stature is documented.


How to cite this article:
Vemula RC, Hanu G. History of Neurosurgery at Sri Venkateswara Institute of Medical Sciences, Tirupati. Neurol India 2019;67:207-17

How to cite this URL:
Vemula RC, Hanu G. History of Neurosurgery at Sri Venkateswara Institute of Medical Sciences, Tirupati. Neurol India [serial online] 2019 [cited 2019 May 27];67:207-17. Available from: http://www.neurologyindia.com/text.asp?2019/67/1/207/253574




The history of the Department of Neurosurgery, at Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati a leading tertiary care center in Andhra Pradesh, is presented. The article will give an overview of the location, the inception of the hospital, and the establishment of the Department of Neurosurgery. It will throw some light on the patient care, academics, achievements, and future plans of the department.


 » About Tirumala, Tirupati Top


”. Venkatadri Samam Sthaanam Brahmande Naasti Kinchanaa…

Venkatesa Samo Devo Na Bhootho Na Bhavishyati.”

(Neither in the past nor in the future would there be a sacred place in this universe that can equal the sanctity of the Venkatadri hills nor would there be a God who can equal the Holy Lord Sri Venkateswara).[1]

Tirumala also called as “kaliyuga vaikunta” is located in Tirupati. It is a hill town where Tirumala Venkateswara Swamy temple is located, which is the abode of Lord Venkateswara [Figure 1]c. It is located 3200 feet above the sea level. Surrounding the hills are seven peaks of the Seshachalam range, Eastern ghats, namely Seshadri, Neeladri, Garudadri, Anjanadri, Vrushabadri, Narayanadri, and Venkatadri [2] [Figure 1]a. Hence, the temple is also known as “Temple of seven hills.”
Figure 1: (a) The seven hills, (b) Logo of TTD, (c) Tirumala Sri Venkateswara Swami Vari temple

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Tirupati the “Spiritual capital of Andhra Pradesh “is a city in Chittoor district of Indian state Andhra Pradesh. It is the third fastest growing city in Andhra Pradesh. It is one among the hundred cities selected as a smart city under the smart cities mission by Government of India.[3] It is ranked fourth in the top 10 most livable cities in the country according to the ease of living index.[4]


 » The Tirumala Tirupati Devasthanams and Sri Venkateswara Pranadanam Trust Top


Tirumala Tirupati Devasthanams, abbreviated as TTD [5] [Figure 1]b, is an independent trust which manages the Sri Venkateswara Swami Temple at Tirumala, Andhra Pradesh. The trust oversees the operations and finances of the second richest and the most visited religious center in the world. It is also involved in various social, religious, literary, and educational activities. Alleviating human suffering has been a part of dedicated services of TTD to mankind. To provide the most advanced medical technology to the needy, the TTD launched a monument, a blessing from the Lord by opening SVIMS, a sophisticated super specialty hospital at Tirupati.

The Pranadanam scheme was established in November 2001 with a trial of 50 patients admitted to SVIMS for free treatment.[6] Seeing not only the immediate but the long-lasting benefit provided by the Pranadanam Trust, a base fund was established by TTD, raising funds from donors for sustaining the program in perpetuity. The outpatient/inpatient treatments including surgeries, medications, and meals are provided for free. This scheme along with the state government Vaidya Seva scheme helped our department to deliver highly sophisticated and costly treatment (including deformity surgery and deep brain stimulation) to the patients without any financial constraints.


 » SVIMS: Inception Top


SVIMS was conceived in the year 1986 and the foundation stone was laid on 18th April 1986 by late Sri. N.T. Rama Rao, the Hon'ble Chief Minister of Andhra Pradesh (A.P.) [Figure 2]. It was established with a view to providing super-specialty facilities with nominal cost to the poor. The hospital started functioning from 26th February 1993 by an Act of A.P. State Legislature.[7] [Figure 3]a. In 1995, SVIMS became a University. In 2006, SVIMS was upgraded to a status at par with AIIMS, New Delhi, under the Pradhan Mantri Swasthya Suraksha Yojana scheme of Government of India.[8] SVIMS is recognized by Medical Council of India, for starting various MD/DM/MCh medical courses since 2003. Sri Padmavathi Medical College for Women and associated hospital [Figure 3]b and c] were established in the year 2014 with an annual intake of 150 students for the MBBS course. It is the second government medical college in India exclusively for women students. In 2018, SVIMS was ranked among the top 100 Higher Education Institutions in India (National Institutional Ranking Framework [NIRF] rank 62 among Universities).[9]
Figure 2: SVIMS foundation stone laid by late chief minister Sri NT Rama Rao

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Figure 3: (a) SVIMS main building panoramic view, (b and c) Sri Padmavati Medical College and Hospital.

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 » Department of Neurosurgery: the Beginning Top


The Department of Neurosurgery at Sri Venkateswara Institute of Medical Sciences was started in September 1993 by Dr C.V. Ravi Kumar, an alumnus of NIMHANS Bangalore.

The primary mission of this department is to deliver high-quality neurosurgical care to the needy. As the workload increased, the faculty has been strengthened by neurosurgeons trained in some of the premier centers in India. The department caters to the people of Rayalaseema in particular and also gets referrals from the entire Andhra Pradesh, and the neighboring states of Tamil Nadu and Karnataka. Subsequently, the following faculty members joined the department (in order of joining): Dr. Arun K Singh, Dr Ravikanth Palur, Dr. B Ravi Mohan Rao, Dr S Satish, Dr. GR Chandrasekhar, Dr Satyendra Kumar, Dr D Radhakrishna Reddy, Dr K Ganesh Murthy, Dr P Pandurangan, Dr. G Prakash Rao, Dr Suresh Naik, Dr B Kishore Swain, Dr JV Bhusan, Dr Ravi Suman, Dr K Chandra Sekhar, and Dr A Anil Kumar [Figure 4].
Figure 4: Past Faculty, From top left to right; Dr C V Ravi Kumar, Dr Ravikanth Palur, Dr B Ravimohan Rao, Dr S Satish, Dr G R Chandrasekhar, Dr Sathyendra Kumar, Dr Radha Krishna Reddy, Dr Ganesh Murthy, Dr G Prakash Rao, Dr Suresh Naik, Dr B Kishore Swain, Dr J V Bushan, Dr Ravi Suman, Dr K Chandrasekhar, Dr A Anil Kumar, Dr T Suresh, Dr K S Kiran, Dr G Vara Prasad, Dr D Jagadeeswara Reddy, Dr V Ravikanth, Dr A Sidda Reddy

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 » Department of Neurosurgery: the Era of Dr BCM Prasad Top


The evolution of the Department of Neurosurgery at SVIMS can be divided into two periods, the era before and after the advent of Dr BCM Prasad [Figure 5]. Dr BCM Prasad is an alumnus of Andhra Medical College and NIMHANS Bangalore. He was appointed as Professor and Head of the Department at SVIMS in 2007 and was entrusted the task of developing the residency program.
Figure 5: Dr BCM Prasad

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Dr BCM Prasad with the help of an efficient team of assistants, Dr T Suresh, Dr KS Kiran, Dr G Vara Prasad, Dr E Srinivasa Rao, Dr P Maheswar Reddy, Dr VV Ramesh Chandra, Dr A Sasidhar, Dr V Ravikanth, Dr D Jagdeeswara Reddy, Dr Kiran, Dr Jayachandra, Dr Jagadeesh, Dr Sanjeev, Dr Sidda Reddy, Dr Krishnamohan, Dr V. Niranjan, Dr K Venkat, Dr Sudarshan, Dr Sasank, and Dr Srikanth catapulted the department to a new high.

Dr Ramesh Chandra, an alumnus of JIPMER Pondicherry and PGIMER Chandigarh joined the department as Assistant Professor in 2009. Dr BCM Prasad constantly supported, encouraged, and nurtured his career, gave him an opportunity to partake the responsibility of developing the department into its present form. The mentor–mentee relationship and the mutual understanding between them did wonders for the development of the department [Figure 6].
Figure 6: Tell me and I forget. Teach me and I remember. Involve me and I learn, Dr Ramesh Chandra with Prof. BCM Prasad

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The other members of the present faculty include Dr Niranjan, an alumnus of Osmania University, Dr Venkat, an alumnus of AIIMS Delhi, and Dr Srikant, an alumnus of SVIMS Tirupati [Figure 7]. The department has made great strides forward since then, in rendering modern neurosurgical services to patients. With the acquisition of state-of-the-art equipment, it has evolved into a full-fledged, neurosurgical center in the state of Andhra Pradesh.
Figure 7: Present team. From top left to right -Faculty: Dr B C M Prasad, Dr V V Ramesh Chandra, Dr V Niranjan, Dr K Venkat, Dr T Srikanth. Residents: Dr Viveksharma, Dr Rukmaji Jagtap Pratap, Dr P Rajesh, Dr Kunal Kumar, Dr Nitin M Barde, Dr T Goutham Hanu, Dr N Mohana Murali Krishna, Dr G Sree Ram, Dr B Hanuma Naik

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Patient care

The department runs regular outpatient clinics on Monday, Wednesday, and Friday. The total bed strength is 50. The department has two well-equipped operation theaters [Table 1] functioning all around the year, with 100–150 surgeries being performed per month.
Table 1: Major equipment

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The clinical services under Dr BCM Prasad were streamlined and the concept of subspecialization was introduced. With the implementation of various health insurance schemes like Rajiv Aarogyasri/NTR Vaidyaseva and Pranadanam, the patients attending the outpatient department and the surgeries performed increased threefolds [Figure 8]. The quantity and quality of the neurosurgical work done at SVIMS were recognized by the Andhra Pradesh government and it was awarded the “Best Neurosurgery Department” state award for 2018 [Figure 9]b.
Figure 8: Year-wise statistics of outpatients and surgeries performed (Arrowhead marks the induction of Dr BCM Prasad into the department)

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Figure 9: (a) BMJ Awards 2017 Finalist “surgical team of the year” (b) AP state government award for best neurosurgery department in the state (2018)

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The department caters to a huge population and comprises several clinical programs that encompass the entire spectrum of neurosurgical practice. The programs unique to SVIMS which are available at very few neurosurgical centers are the minimally invasive spine (MIS), spinal deformity and deep brain stimulation (DBS) programs.

The MIS program was developed to be at par with any international center. The program boasts of performing all the minimally invasive spine (MIS) procedures described in the literature [Figure 10]. The center has been identified as a visiting surgeon program center for MIS and it trains surgeons interested in these procedures.
Figure 10: Minimally invasive spine (MIS) surgery (a) MIS transforaminal lumbar interbody fusion [TLIF], (b) MIS TLIF with bone cement augmentation, (c) Balloon kyphoplasty, (d) Oblique lateral interbody fusion (OLIF), (e) MAST MIDLIF, (f) MIS Longitudinal fusion, (g) OLIF with PIVOX

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The Department started the spinal deformity program [Figure 11] in 2013 with the help of Dr HS Chhabra from Indian Spinal Injury Centre; Delhi [Figure 12]. The department has treated independently around 120 patients [Figure 13] with various deformities under this program. This is the only center in Andhra Pradesh with a dedicated spinal deformity program offering treatment to a large number of patients regularly. The work done on spinal deformity was presented as “Development of the surgical program for spinal deformity at a tertiary center – challenges and outcomes” at the British Medical Journal South Asia Awards 2017 and was selected as a finalist under the category “Surgical team of the year” [Figure 9]a.
Figure 11: Spinal deformity correction pre- and postoperative clinical and radiology images

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Figure 12: Proctors for spinal deformity program: Dr HS Chhabra and Dr Ankur Nanda for the first case of spinal deformity

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Figure 13: The department with the initial patients of spinal deformity and the Director, Dr TS Ravikumar

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The departments of neurosurgery and neurology started the movement disorder program [Figure 14] in July 2017. Dr Anandh Balasubramanian and Dr Kiran Khanapure were the proctors for the initial cases to transfer the technical know-how for deep brain stimulation (DBS) [Figure 15]. The department has independently and successfully treated 25 patients with DBS till now. This is the only center in Andhra Pradesh offering DBS and conducted the first-ever “Live DBS workshop for Parkinson's disease” in India. Around 150 neurologists and neurosurgeons participated from all over the country and made it a huge success [Figure 16].
Figure 14: Deep brain stimulation of bilteral subthalamic nucleus for Parkinson's disease

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Figure 15: Dr Ramesh Chandra with the proctors for DBS program, Dr Kiran Khanapure and Dr Anandh Balasubramanian

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Figure 16: The first live DBS workshop in India

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The movement disorder and the spinal deformity programs are good examples wherein the quality healthcare reaches the financially weaker section of people without any financial burden to them. The huge success of these programs received extensive media coverage and reached out to a lot of poor patients [Figure 17].
Figure 17: Media coverage about the work done at SVIMS

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Academics

The residency program (MCh Neurosurgery) was properly structured and the intake of residents increased from one student per year to three per year. Till now, a total of 19 residents have been awarded MCh degrees [Figure 18]. The academic activities were streamlined and the proper protocol was followed in line with that of the best institutes in the country. Interactive teaching sessions including neuroradiology sessions, seminars, journal clubs, preoperative discussions, morbidity-mortality meets, and case presentations are regularly conducted for the MCh Residents. The neurosurgical work done at SVIMS has been accepted and presented at various international (ACNS, Global spine congress, Worldspine, SMISS, etc) and national (NSICON, SPINE, ASSICON etc) conferences. The faculty [Figure 19] and the residents [Figure 20] bagged some prestigious fellowships to enhance their exposure to various subspecialties.
Figure 18: Residents awarded MCh from SVIMS. From top left to right; Dr Suneel, Dr E Srinivas Rao, Dr P Maheswara Reddy, Dr A Sasidhar, Dr M L Ananth, Dr V A Kiran Kumar, Dr V Jayachandar, Dr M A Jagadish Kumar, Dr I Kaushal, Dr A Sanjeev Kumar, Dr M A Ameen, Dr K Pundarikakshaiah, Dr C Krishna Mohan, Dr Siva Subramanyam, Dr V Bala Balaji, Dr B V Ravi Kumar, Dr A Sudarsan, Dr D M Sasank, Dr T Srikanth

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Figure 19: Fellowships (Dr Ramesh Chandra) (a) Indo-Japan young neurosurgeon fellowship Nagoya University under Dr. T Wakabayashi (b) With Dr Muneesh Gupta Indo-American Spine Alliance (IASA) Fellowship Washington University St. Louis, USA (c) With Dr Phillipe Bancel, International Group for Advancement in Spinal Science (IGASS) Fellowship Paris

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Figure 20: Fellowships (residents) (a) Dr Siva Subramanyam, Fellowship in interventional neuroradiology with Dr Shinichi Yoshimura, Nishinomiya, Japan. (b) Dr DM Sasank, Fellowship in interventional neuroradiology with Dr Vikas Gupta, Manipal Hospitals, Delhi. (c) Dr Bala Balaji, Fellowship in cerebrovascular surgery with Dr Yoko Kato, Fujita University, Japan

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Research

Apart from the many projects done on conventional neurosurgical topics,[10],[11],[12],[13] the department has ventured into research into basic neurosciences. In vitro differentiation of cultured human CD 34+ cells into astrocytes was done.[14] We identified novel NF1 gene mutations in three different neurofibromatosis type 1 Indian families,[15] novel mutations were identified in sequence analysis of NF2 and TRAF 7 genes in meningiomas. All the sequence variants identified herein have been deposited in the GenBank (http://www.ncbi.nlm.nih.gov/Sequin/).[16]


 » Conferences/CME/Orations Top


The department conducted the annual state conference of the Andhra Pradesh Neuroscientists Association (APNSA) in 1996, 2003, and 2014 [Figure 21]. Two orations [Table 2] are conducted every year, the Cherukuri Narasimham and Subhadra Devi oration (March) and the Srinivasa neurosurgery endowment oration (October) [Figure 22]. The department holds a CME (How I do it video presentations) every year focusing on a specific subspecialty and related cadaveric demonstration [Figure 23].
Figure 21: Annual state conference of APNSA 2014

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Table 2: Orations at SVIMS

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Figure 22: Annual Orations. (a) The first Cherukuri Narasimham and Subhadra Devi Oration, Dr BS Das. (b) The first Srinivasa Neurosurgery Endowment Oration. Dr VK Khosla

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Figure 23: Srinivasa Neurosurgery Endowment Oration (Dr SK Gupta) and CME on Skull Base Surgery (Faculty: Dr Sanjay Behari, Dr Manas Panigrahi, Dr Ashish Suri, Dr Sandeep Mohindra, Dr Manjul Tripathi)

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Other academic activities

The concept of a local neurosciences club was thought and was materialized as Tirupati Neuro club where the local neurosurgeons, neurologists meet and share their experiences [Figure 24]. In view of the demand from our outgoing residents who wanted some surgical videos depicting the critical steps of a surgery, we started an online video library on YouTube (Neurosurgery@SVIMS https://www.youtube.com/user/SVIMSneurosurgery/videos?view_as = subscriber) [Figure 25]. This was very well appreciated by the younger neurosurgical community.
Figure 24: First Meet of Tirupati Neuro Club (Dr BCM Prasad, Dr B Vengamma, Dr Satya Rao)

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Figure 25: Neurosurgery@SVIMS YouTube channel

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Relationship with the administration and other departments

The department shares a very cordial relationship with the supporting departments especially the department of neurology. The department of neurology was started and is headed by Dr B Vengamma, an alumnus of SVMC Tirupati and NIMHANS Bangalore. The coordination between the departments of neurosurgery and neurology is one of the best among the neurosciences centers in the country and is exemplified by the good results obtained in the management of stroke and movement disorders.

The administration has always been supportive of the department. Dr G Subramanyam, the former Director [Figure 26]a implemented the Arogyasri and Pranadanam schemes thus paving the way to an increased patient load. Dr B Vengamma, the former Director [Figure 26]b procured the latest equipment for the department and enhanced the surgical armamentarium to be at par with any well developed neurosurgical center in the country. Dr TS Ravikumar, the present Director [Figure 26]c started the DBS program for movement disorders, streamlined the emergency/trauma care, and introduced the concept of quality control in health care.
Figure 26: With Directors (a) Dr G Subramanyam (b) Dr B Vengamma (c) Dr TS Ravikumar

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 » Unique Traditions Top


Dr BCM Prasad introduced a lot of unique traditions in the department to increase bonding among the faculty and residents. All birthdays, teacher's day, any month with the number of surgeries crossing a hundred, anybody returning from hometown after a vacation warranted celebrations/treat [Figure 27]a. Every day, we have a common lunch at the hospital. Get-togethers and Tirumala temple darshans are planned regularly [Figure 27]b and [Figure 27]c. The get-togethers include all the faculty, residents, and supporting staff [Figure 28].
Figure 27: (a) Celebrations (b) Darshans (c) Get-togethers

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Figure 28: Get together at Mamandur with the whole team

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Future plans

Developing a state-of-the-art cadaver lab to provide the best learning environment possible for the residents is the first priority for the future. Introducing the subspecialty of endovascular neurosurgery to make the vascular neurosurgery program complete is another plan for the future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 » References Top

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Gopalacharyaswamy, Sri Venkatachala Mahatyam part-II, Sri Sri Tridandi Srimannaryana Jeeyar Swamy; 1972. p. 460.  Back to cited text no. 1
    
2.
Ramesan N. The Tirumala Temple. Tirumala: Tirumala Tirupati Devasthanams; 1981.  Back to cited text no. 2
    
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5.
The Andhra Pradesh Charitable and Hindu Religious Institutions and Endowments Act, 1987, AP Gazette first published on 23-5-1987, TTD, p. 97.  Back to cited text no. 5
    
6.
[Internet]. Tirumala.org. 2018 [cited 13 November 2018]. Available from: http://www.tirumala.org/SriVenkateswaraPranadanaTrust.aspx. [Last accessed on 2018 Oct 20].  Back to cited text no. 6
    
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Ramesh Chandra VV, Prasad BC, Mohan K, Kalawat TC, Satyanarayana V, Lakshmi AY. An algorithmic approach for clinical management of low back pain. Neurol India 2016;64:950-7.  Back to cited text no. 10
    
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Prasad BCM, Ramesh Chandra VV, Devi BV, Chivukula SS, Pundarikakshaiah K. Clinical-radiological and functional evaluation of surgical treatment in degenerative lumbar canal stenosis. Neurol India 2016;64:677-83.  Back to cited text no. 11
[PUBMED]  [Full text]  
12.
Ramesh Chandra V V, Prasad BC, Jagadish MA, Jayachandar V, Kumar SA, Kumar R. Segmental polymethylmethacrylate augmented fenestrated pedicle screw fixation for lumbar spondylolisthesis in patients with osteoporosis-A case series and review of the literature. Neurol India 2017;65:89-95.  Back to cited text no. 12
    
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Chandra Vemula VR, Prasad BC, Jagadeesh MA, Vuttarkar J, Akula SK. Minimally invasive transforaminal lumbar interbody fusion using bone cement-augmented pedicle screws for lumbar spondylolisthesis in patients with osteoporosis. Case series and review of the literature. Neurol India 2018;66:118-25.  Back to cited text no. 13
    
14.
Venkatesh K, Srikanth L, Vengamma B, Chandrasekar C, Sanjeev Kumar A, Mouleshwara Prasad BC, et al. In vitro differentiation of cultured human CD 34+ cells into astrocytes. Neurol India 2013,61:383-8.  Back to cited text no. 14
[PUBMED]  [Full text]  
15.
Prasad BCM, Chandra VV, Sudarsan A, Kumar PS, Sarma PV. Clinical characteristics and NF1 gene mutation analysis of three successive generations in three different Indian families with neurofibromatosis type 1 and peripheral nerve sheath tumours. J Clin Neurosci 2018;53:62-8.  Back to cited text no. 15
    
16.
[Internet] retrieved from: https://www.ncbi.nlm.nih.gov/nuccore/MF116142. [Last accessed on 2018 Oct 20].  Back to cited text no. 16
    


    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]



 

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