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|Year : 2022 | Volume
| Issue : 2 | Page : 478-484
Prof. B. Ramamurthi – A Glimpse into his Contributions to Neuroscience
K Sridhar1, K Santosh Mohan Rao2
1 Department of Neurosurgery, MGM Healthcare, Chennai, Tamil Nadu, India
2 Department of Neurosurgery, Rainbow Children's Hospital, Chennai, Tamil Nadu, India
|Date of Submission||19-Apr-2022|
|Date of Decision||19-Apr-2022|
|Date of Acceptance||19-Apr-2022|
|Date of Web Publication||3-May-2022|
Dr. K Sridhar
Director, Neurosciences and Spine, MGM Healthcare, Chennai, 2/154, MGR Street, Eden Garden, Uthandi, ECR, Chennai - 600 119, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Prof B Ramamurthi was a pioneer of Indian neurosurgery and a major force in the development of Indian neuroscience. Founding the Madras Institute of Neurology and later the A Lakshmipathi Neurosurgical Centre (ALNC), both at Madras (or Chennai as it is now called), he developed centres of excellence in his career that spanned over five decades. During this period of time he made Madras, a destination for neurosurgery and neuroscience. Along with his colleagues a large number of publications were produced which influenced the world. Notable among his contributions were those in Stereotaxy for movement disorders, epilepsy, pain and psychiatric illness. He also had notable contributions in brain tumours especially acoustic neurinomas and pituitary tumours. His papers on the low incidence of aneurysms is still quoted widely. Head injuries formed a major part of the neurosurgical work and major contributions were made in that field too. As a developing country with socio-economic issues, infections of the nervous system were seen commonly. His publications on tuberculomas of the brain are noteworthy. He was intrigued by the neurophysiological basis of consciousness. He writings on the subject reflect his attempt to bring together ancient eastern thoughts and concepts of consciousness and life and western science. In the later part of his career he spoke on ethics in and the changing milieu of neurosurgery. While contributions to spinal surgery were not seen in the first half of his career, he along with his colleagues from ALNC published original articles on spinal surgery especially tumours and OPLL. Prof B Ramamurthi, has not only influenced, taught and mentored, during his lifetime, a great many neuroscientists, but he also continues to do so through his publications which continue to be relevant in todays world. A glimpse into his contributions show us how without the technology of today a lot was achieved - and we need to see that, to inspire us to achieve more and to strive for greater heights.
Keywords: Acoustic neurinomas, B Ramamurthi, counsciousness, head injuries, neuroscience, neurosurgery, stereotaxy, tuberculomas
Key Message: This article highlights the significant contributions of Prof B Ramamurthi to the field of Neurosciences.
|How to cite this article:|
Sridhar K, Mohan Rao K S. Prof. B. Ramamurthi – A Glimpse into his Contributions to Neuroscience. Neurol India 2022;70:478-84
Prof. B. Ramamurthi, or BRM as he was called, was a major force in Indian neurosurgery [Figure 1]. Not only was he one of the pioneer neurosurgeons of the country and a founder of the Neurological Society of India, but also he was the face of Indian neurosurgery worldwide. He was born in an illustrious family as the second child to his parents, on January 30, 1922 at a small town in southern India called Sirgazhi, where his father, Capt. Dr. T. S. Balasubramaniam, worked as a physician. A product of the famed ER High school in Tiruchirapalli, he graduated from the Madras Medical College in 1943, receiving the Johnstone Gold Medal as the best outgoing student. He procured his Masters in General Surgery in 1947 and then his FRCS Edinburgh in a record 6 weeks. He was steered onto the path of neurosurgery by his surgical chief Dr. Narasimha Iyer, and in 1949, he reached Newcastle upon Tyne to start his neurosurgical training with Prof. Rowbotham. Spending time with Prof. Geoffrey Jefferson at Manchester, he visited various centers in Europe, including those of Prof. Krayenbuhl at Zurich, Dr. Edward Busch at Copenhagen, and Prof. Olivecrona at Stockholm. In 1950, Dr. Ramamurthi proceeded to the Montreal Neurological Institute and spent 4 months with Prof. Wilder Penfield. On completing his training, he returned to Madras, bringing back with him the traditions of the British, American, Canadian, and European schools of neurosurgery. On October 24, 1950, which was an auspicious day (Vijayadasami) in the Hindu calendar, he joined the Department of Surgery as an assistant surgeon in neurosurgery. Thus started the organized neurosciences department at the Madras Medical College and General Hospital, the second in the country. This humble beginning grew to become the Institute of Neurology, fashioned after the Montreal Neurological Institute, which by the 1970s became a world recognized center for its work in various aspects of neurosciences. After his retirement from government service, Prof. Ramamurthi continued his clinical and academic work at the Dr. A. Lakshmipathi Neurosurgical Center (ALNC), Voluntary Health Services, Chennai (Madras). This center too grew to be a center of excellence under his guidance.
Prof. Ramamurthi believed that one needed to show others what work one does, what problems one faces, and what triumphs one celebrates. His large volume of publications on varied subjects is a testament to this fact. His commitment to publication was seen in that, even in his last few months, when he was not well, he would continue to edit and write chapters for the Textbook of Operative Neurosurgery. On the occasion of his birth centenary, it is an honor for us to present a review of his publications, which is definitely not a complete bibliography of his works, but which will give the reader a glimpse of his thoughts, his surgical acumen, and the milieu in which he worked achieving the great heights that he did.
| » The Madras School of Stereotaxy|| |
No essay on Prof. BRM will ever be complete without mentioning the famed “Madras School of Stereotaxy.” The 1960s and 70s might have been famous for the Spin Quartet in Indian Cricket, but in the annals of Indian stereotactic neurosurgery, it was the era of the “Madras Stereotactic Quartet” of Profs Ramamurthi, V. Balasubramaniam (VBS), G. Arjundas, and K. Jagannathan, who were pioneers, later joined by Profs T. S. Kanaka and S. Kalyanaraman. To develop stereotaxy in a neurosurgery department in a third-world country in the 1960s was almost unheard of. His achievements here made the world take notice of Indian neurosurgery and even brought international stalwarts to visit Madras, thereby putting the city on the world neurosurgical map. The origins of the Madras School of Stereotaxy date back to 1960 when Prof. BRM was able to procure with tremendous difficulty a Leksell stereotactic apparatus for the neurosurgical department, followed by a Schaltenbrand Stereotactic Atlas More Details. The visit of the neurosurgeon Prof. Lawrence “Ticky” Walsh and neurologist Denis Williams from the Atkinson Morley Hospital, South London, to the Madras Medical College heralded the birth of a proper stereotactic neurosurgery program in the Department of Neurosurgery, Madras Medical College., The contributions of Prof. BRM and his team in the field of stereotactic and functional neurosurgery are truly remarkable; but what makes this even more wondrous is that they achieved this despite having severe restrictions in technology and resources.
One should remember this was the pre-CT era, and imaging was confined to pneumoencephalograms and ventriculograms. He even made his own material for lesioning stereotactic targets made from myodil and wax. Prof. A. K. Banerji, a neurosurgeon, jocularly summed up the situation prevailing then in verse form in “The Undrained Brains” as follows:
“We the willing, led by the unknowing,
And doing the impossible for the ungrateful.
We have done so much with so little, for so long.
We are now qualified with nothing to do anything.”
Sheer toil and perseverance underlie all these achievements. Prof. BRM was not only a pioneer, but under his tutelage and guidance, his colleagues too did groundbreaking work in the fields of functional and movement disorder surgery.
A synopsis of Prof. BRM's contributions to stereotactic and functional neurosurgery is given below.
- Stereotaxy for Parkinson's disease:,,, Prof. BRM was schooled by Prof. Walsh. He, therefore, believed that the best site for lesioning in Parkinson's disease was the posterior part of the VL nucleus of the thalamus, which included the VOA with a small encroachment onto the VOP of Hassler and with a slight extension into the STN (where it encroaches on the zona incerta and Forel's field). He was daring enough to attempt bilateral lesions in the same sitting. He presented a series of VL thalamic lesions, wherein 90% of the patients had relief from tremors.
- Stereotaxy for spasticity and other movement disorders: He also did a lot of work in the management of choreoathetosis, where he employed lesions in the GP and STN. The role of dentatothalamotomy (dentate +Vim) for infantile hemiplegia with athetosis and stereotactic dentatectomy for refractory tremors was pioneered by his department. Much of the work in stereotactic surgery for spasticity was done by Prof. Kanaka under his guidance.,,, He published a large series of centrum medianum (CM) nucleus lesioning for spasticity, wherein he described (with Prof. VBS) a unique “capsular delineation method” to help identify the CM nucleus.
- Stereotaxy for behavioral disorders (psychosurgery): Psychosurgery is a field where Prof. BRM's work was outstanding, but is often forgotten. New methodologies and targets for various diseases were described., He had commenced open orbital undercutting operations while in UK in 1949 and had seen the benefits it could bring about with careful case selection and meticulous technique. He described a novel cingulotomy technique which he employed for drug addiction and depression in a case series of 154 patients, with 67% reporting improvement, which was higher than most other series for that era. He also developed a new technique of stereotactic amygdalotomy.,, In fact, his series of amygdalotomy (both unilateral and bilateral) numbering 603 cases has been acknowledged as the largest series in literature and this has been recognized in the modern era too. What added value to this series was the long follow-up data he had over several decades for these patients. He also described (with Prof. VBS) a new technique of hypothalamotomy. He reported a series of 42 cases of basifrontal (subcaudate) tractotomy for severe depression, where he gave a recovery rate of 72%.
Psychosurgery earned for itself a bad reputation the world over as people misconstrued it as “mind control,” thanks to its misrepresentation in popular culture, and it fell into disuse. Simultaneously, better medical treatment methods were being discovered. But there were always cases refractory to medicines and for them, surgery would have helped. The onset of deep brain stimulation, RF coagulation, and gamma knife lesioning techniques has renewed the interest in these procedures. The vast volume of work that Prof. BRM and his team have done in this field is being rediscovered in the 21st century. However, few are aware that someone has already tread the path before them.
- Stereotaxy for epilepsy: Prof. Ramamurthi was specially interested in epilepsy. He described stereotactic ablation of irritable foci in the treatment of TLE., Early on, he realized the value of sphenoidal electrodes. He advocated stereotactic amygdalohippocampectomy as a first stage in the treatment of TLE., Stereotactic capsulotomy for epilepsy, wherein lesions were made in the internal capsule, was described years later as a very bold move by Balasubramaniam. Prof. BRM et al. had deciphered that the motor fibers, contrary to traditional teaching, pass medial to the internal capsule and not through it. This shows the depth of knowledge and also his confidence in executing this procedure. He developed his own technique of stereotactic amygdalotomy for temporal lobe epilepsy and had success in 24 of 43 cases, with better results reported in patients who had seizures with olfactory auras and hallucinations. He also described combined stereotactic lesioning for the treatment of myoclonic epilepsy.
- Stereotaxy for pain: Prof. Ramamurthi described lesions made in the posteroventromedial (pVM) nucleus of the thalamus (lesions in the quintothalamic tract) for intractable pain in facial and pharyngeal malignancies with success. He reported pain relief without sensory deficit.
Prof. BRM and VBS, in their research on hypothalamotomy for aggressive behavior, began studying the effect of the procedure on gastric acid secretion. They finally gathered enough data and had zeroed in on a suitable hypothalamic target to decrease gastrin secretion in early 1971, which was safe and effective. This, they thought, would be a solution to acid peptic disease. If this had been published, then it would have indeed been revolutionary. However, the onset of war delayed publication. They were able to present their findings only in 1975. By then, the H2 blocker “cimetidine” was discovered by James Black and had been approved for trials in 1975. The significance of this research of theirs was lost by the delay in publication.
Prof. BRM maintained meticulous records of all his functional neurosurgical cases till the very end. The psychosurgery cases he did were followed and their long-term outcomes were recorded even 30 years after the procedure., He always embraced new technology, but believed that “technology should always be subservient to the transcending values of human worth and dignity.” His paper on ethics in functional neurosurgery reflects this.
| » Acoustic Schwannomas and Intracranial Tumors|| |
Prof Ramamurthi had a large experience with surgery for acoustic schwannomas.,,,,, Writing on his experience with more than 500 patients spread over four decades, he mentioned that computed tomography (CT) scans were available only for the last 196 cases between 1980 and 1993 and small tumors formed only 1% of the total number. He wrote, “Forty-three years of experience, one would have thought, would take away the anxiety and nervousness associated with a common clinical situation, but acoustic neurinomas have proved an exception to this rule.” However, he also commented, “I have participated in this exciting and wonderful saga of neurosurgical advances which have lowered mortality from 33 to 2% and less, and which enables us to discharge a patient with an acoustic tumour an the fourth or fifth day with most functions preserved.” He changed from a skilled neurosurgeon operating without magnification and with lighted handheld retractors to a surgeon par excellence who operated acoustic neurinomas under the microscope. He pushed his younger colleagues to procure results that bettered his own saying “now you can see and preserve the neurovascular structures of the CP angle!”
Gupta and Tripathi, in their commentary on BRM's paper of 1970, stated that the paper was a seminal article that had far-reaching implications relevant even in the modern era. They touched upon the difficulties that BRM and his colleagues faced operating on these lesions, as well as the “candid confessions” seen in the article. The article highlighted the need for early diagnosis, the management of raised intracranial pressure and hydrocephalus, positioning of the patient and the various incisions used, the use of cerebellar lobectomy, prevention of air embolism, size of tumor and direction of growth, as well as preservation of the lower cranial nerves and facial function. According to the authors, “the experience shared in this article guided several generations of neurosurgeons and boosted their confidence while performing the complex surgical procedure of VS excision.”
He had a great interest in pituitary tumors and other sellar and parasellar lesions.,,,,, A number of papers were published on a variety of brain tumors, including some rare ones.,,, He felt that creating an awareness about brain tumors was important, as this would lead to early diagnosis, and therefore better outcomes. This interest in tumors did not end with his retirement from the Institute of Neurology, but continued with greater vigor at the next department at the VHS hospital. He encouraged his younger colleagues to publish and put pen to paper.,
| » Aneurysms|| |
Dr. Ramamurthi was specifically concerned about the low incidence of aneurysms and subarachnoid hemorrhage seen and diagnosed in India. Reporting an incidence of 75 aneurysms and 49 arteriovenous malformations seen out of a total of 10,141 patients admitted between 1951 and 1967, he also reported a low incidence of incidental aneurysms seen in angiograms done for other reasons. He also reported a similar low incidence from other centers across India and felt that the most likely cause was that they were not being diagnosed. He writes, “Thus although allowance can be made for missing some cases in overcrowded general hospitals, still the low incidence of subarachnoid haemorrhage and aneurysms seen in all centers seems significant. This problem has been raised periodically in neurological conferences in India and the East.” He also published articles in general medical journals in order to raise awareness regarding neurovascular pathologies.,,
| » Other Publications|| |
Head injuries formed a major part of the neurosurgical work at the Madras Institute of Neurology, and it holds the distinction of creating the first exclusive head injury ward in the country. As a result, there were many papers published on the topic.,,,,,,, He also published work on language and recovery of speech in patients with brain injury. The authors felt that rather than the mother tongue, what mattered was the language of thought, prayer, and mental calculations in the recovery of speech following a brain injury.
In 1966, Prof. Ramamurthi coauthored a paper with Prof. VBS, where it is interesting to see the varied surgical procedures carried out for the management of hydrocephalus in children. Even more interesting is the identification of hypovitaminosis A in breastfed neonates with hydrocephalus and their management with observation and administration of vitamins. The effective use of a third ventriculostomy procedure without the endoscope is also worth noting. There were also publications on the issue of neural tube defects and craniovertebral junction anomalies in children.,
Considering the social and economic state of the country in the 1950s until the 1980s, Prof. Ramamurthi and his colleagues treated a large number of patients with infections of the nervous system.,,,,,,,,,,,,,,,, In a government hospital setting in a developing country, as one can imagine, the problem of tuberculous meningitis and its sequelae as well as tuberculomas was enormous.,,, Tuberculomas continued to be of interest to him even after his practice moved from the government sector.,,,, In 1993, he wrote that though CT scans helped in the early detection of lesions thought to be tuberculomas, there were some which did not respond to antituberculous therapy, and these perhaps would need surgery. He was the coauthor of the article published posthumously on the rare cystic form of tuberculomas.
Some very rare cases were reported, including the first case in literature of a circumscribed intramedullary cryptococcic granuloma of the spinal cord that was successfully removed.
Due to the workload in head injuries and stereotaxy, Prof. Ramamurthi did not publish any major articles on spine. Interest in spine surgery started only when spinal surgery was started in earnest in the 1990s at the ALNC and a series of articles were published, including some original work on cervical OPLL, unilateral approach to spinal tumors, and the like.,,,
He also coauthored many neurology papers.,,, One interesting paper showcased a nonfatal variant form of maple syrup urine disease in siblings. He was very interested in the concept of nonvolitional biofeedback and felt that this could be an effective treatment method for certain disorders.
| » Consciousness, Yoga, and Ethics|| |
Prof. Ramamurthi had a keen interest in the ancient thoughts of consciousness and sought to explain the neurophysiological basis of the same., He felt that “The complicated structure of the brain, the extravagant abundance of neural and glial elements in the brain, the infinite possibilities of synaptic junctions and synaptic transmission, and the multitude of neurotransmitters and neuromodulators; all these point to the definite possibility of a much greater level of performance and achievement for the human brain than has been apparent so far.”
He felt that Yoga presents the culmination of efforts made by mankind till now to control the mind and behavior. He wrote, “Yoga is living science, practiced in an elementary fashion by many in India and that the difficulty is in giving scientific proof to these speculations.” Bagchi and Wengar undertook this difficult task in India in 1960 with some success.
He also propounded the ancient Indian and eastern concepts of consciousness and the benefits of Yoga to transcend the everyday “consciousness” that the human brain works at. He appealed that “… international scientific bodies might take interest in this science of Yoga and test its hypothesis by controlled studies on volunteers. While the East may have the knowledge and the background, the West has the sophisticated technology to test these postulates ….”
In an article that was published just after he passed away, he had spoken on appropriate technology in neurosurgery. A compelling article, he wrote on how it was important, especially in developing countries, for young neurosurgeons to be trained in all the modern technologies available in the world, but not make it an excuse, when not having all of the technical gadgets, for not treating the patient competently. He pointed out that it was important that youngsters do not feel a sense of inferiority just because they do not have the technology that a more developed country has or a hospital with deeper pockets has. He emphasized that it was the duty of the governments, public, neurosurgical teachers, societies, and journals to ensure that the neurosurgeon working at a peripheral hospital be provided with the essential neurosurgical equipment (what he called appropriate technology) as well as good compensation.
Another thought-provoking article was published in 1998, but is still relevant. Speaking of the cultural influences on ethics, Prof. Ramamurthi compared the eastern and western philosophies, which he then says are mostly comparable. But what has changed, he felt, is the scientific advancement in medicine and its commercialization to a great extent, along with the changing fabric of society. With neurosurgical patients posing multiple ethical dilemmas to the treating physician, there cannot be a uniform rule of ethical practice, but one that is guided by the cultural and social norms of time and place, while at the same time maintaining the basics of “Do no Harm!”
More than his scientific papers, what have perhaps been the most impactful contributions are the two editions of the Textbook of Neurosurgery that he brought out along with Prof. P. N. Tandon., They were comprehensive books written mainly by Indian authors for neurosurgeons of the subcontinent, looking at the topical issues and situations there.
When one thinks of Prof. BRM, we are reminded of these lines penned by the poet Henry Wadsworth Longfellow in “The Psalm of Life”
“Lives of great men, all remind us,
That we can make our lives sublime,
And departing leave behind us,
Footprints on the sands of time.”
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Kalyanaraman S, Ramamoorthy K, Ramamurthi B. Analysis of two thousand cases of head injury. Neurology (Bombay) 1970;18:30-3.
Kalyanaraman S, Ramamurthi B, Ramamoorthi K. Chronic subdural hematoma. Neurol India 1970;18(Suppl 10):25-9.
Kalyanaraman S, Ramamurthi B, Kanaka TS, Ramamoorthi K. Traumatic intracerebral hematoma. Neurol India 1970;18(Suppl 1):30-3.
Ramamurthi B, Kalyanaraman S. Rationale for surgery in growing fractures of the skull. J Neurosurg 1970;32:427-30.
Ramamurthi B, Chari P. Aphasia in bilinguals. Acta Neurochir Suppl (Wien) 1993;56:59-66.
Balasubramaniam V, Ramamurthi B. Experiences with hydrocephalus. Neurochirurgia (Stuttg) 1966;9:202-4.
Ramamurthi B. Problems of Spina bifida in developing countries. J Ind Med Assoc 1990;88:151-2.
Srinivasan K, Balasubramaniam V, Ramamurthi B. Craniovertebral anomalies. Neurol India 1967;15:42.
Ramamurthi B, Varadarajan MG. Diagnosis of tuberculomas of the brain. Clinical and radiological correlation. J Neurosurg 1961;18:1-7.
Natarajan M, Vedachalam SP, Ramamurthi B. Intramedullary tuberculoma of the spinal cord. Ind J Surgery 1962;24:727-9.
Ramamurthi B. Dense calcification in conservatively treated tuberculoma. Proc Inst Neurol 1973;3:61-4.
Ramamurthi B. Experience with tuberculomas of the brain. Ind J Surg 1978;49:104-8.
Ramamurthi B, Vasudevan MC, Thamburaj VA. Tuberculous brain abscess. Neurol India 1981;19:35-7.
Ramamurthi B. Tuberculoma and Syphilitic gumma. In: Youmans JR, editor. Neurological Surgery. 3rd
ed. WB Saunders Philadelphia; 1990. p. 3752-8.
Ramamurthi B. Management of tuberculomas of the craniovertebral junction. Br J Neurosurg 2000;14:600.
Ramamurthi B, Ramamurthi R, Vasudevan MC, Sridhar K. The changing face of tuberculomas. Ann Acad Med Singapore 1993;22:852-5.
Sridhar K, Ramamurthi B, Vasudevan MC. Cystic tuberculomas of the brain--Two case reports. Neurol Med Chir (Tokyo) 2004;44:438-41.
Ramamurthi B, Anguli VC. Intramedullary cryptococci granuloma of the spinal cord. J Neurosurg 1954;11:622-4.
Raman TK, Ramamurthi B, David CV. Cysticercosis. Indian Physician 1950;9:207-22.
Ramamurthi B, Balasubramaniam V. Experience with cerebral cysticercosis. Neurol Bombay 1970;18:89-91
Balasubramaniam V, Ramanujam PB, Ramamurthi B. Hydatid disease of the nervous system. Neurol India 1970;18(Suppl 1):92-5.
Balasubramaniam V, Kanaka TS, Ramamurthi B. Fungal granulomata. J Indian Med Assoc 1971;57:348-50.
Ramamurthi B. Spinal arachnoiditis. Indian J Med Sci 1961;15:776-81.
Ramamurthi B, Govindan R, Kanaka TS. Spinal extradural cyst. J Indian Med Assoc 1970;55:417-8.
Sridhar K, Ramamurthi B. Granulomatous, fungal and parasitic infections of the spine. In: Menezes AH, Sonntag VKH, editors. Principles of Spinal Surgery. McGraw Hill Book Co.; 1996. p. 1467-95.
Sridhar K, Ramamurthi R, Vasudevan MC, Ramamurthi B. Limited unilateral approach for extramedullary spinal tumours. Br J Neurosurg 1998;12:430-3.
Sridhar K, Ramamurthi R, Vasudevan MC, Ramamurthi B. Giant invasive spinal schwannomas: Definition and surgical management. J Neurosurg 2001;94:210-5.
Sridhar K, Ramamurthi R, Vasudevan MC, Ramamurthi B. Surgery for ossification of the posterior longitudinal ligament of the cervical spine. Neurol India 2001;49:116-23.
Sridhar K, Vasudevan MC, Ramamurthi B. Posttraumatic total dislocation of the upper thoracic spine. Surg Neurol 2004;61:343-6.
Kanaka TS, Balasubramainam V, Ramamurthi B. Mental changes in epilepsy. Neurol Bombay 1967;15:116.
Arjundas G, Ramamurthi B. Incidence of convulsions in 184 verified supratentorial lesions. Neurol Bombay 1968;16:111-6.
Ramamurthi B, Gurunathan SK. Epilepsy in Ayurveda. Neurol Bombay 1969;17:91-3.
Dharmapal N, Ramamurthi B. Epilepsy in twins. Inst Neurol Madras Proc 1973;3:97-102.
Kalyanaraman K, Chamukuttan S, Arjundas G, Gajanan N, Ramamurthi B. Maple syrup urine disease (branched-chain keto-aciduria) variant type manifesting as hyperkinetic behaviour and mental retardation. Report of two cases. J Neurol Sci 1972;15:209-17.
Ramamurthi B, Vasudevan MC. Non-volitional biofeedback therapy in nervous disorders. J Indian Med Assoc 1985;83:191-5.
Ramamurthi B. Concepts of consciousness. Acta Neurochir (Wien) 1990;105:65-8.
Ramamurthi B. The fourth state of consciousness: The Thuriya Avastha. Psychiatry Clin Neurosci 1995;49:107-10.
Ramamurthi B. Yoga--An explanation and probable neurophysiology. J Indian Med Assoc 1967;48:167-70.
Ramamurthi B. Some thoughts on neurophysiological basis of yoga. Anc Sci Life 1981;1:20-4.
Bagchi BK, Wenger MA. Electrophysiological correlates of some yogic exercises. The Fourth International Congress of Electroencephalogram and Clinical Neurophysiology. 'Excerpta Medica' Netherland; 1957. p. 25.
Ramamurthi B. Appropriate technology for neurosurgery. Surg Neurol 2004;61:109-12; discussion 112-6.
Ramamurthi B. Ethics in Neurosurgery: Cultural influences on ethics in medicine. Surg Neurol 1998;50:104–9.
Ramamurthi B, Tandon PN. Textbook of Neurosurgery I Edition. BI Publications; 1985.
Ramamurthi B. Tandon PN. Textbook of Neurosurgery, II edition. In: Ramamurthi B, Tandon PN, Ravi Ramamurthi, Sridhar K, editors. London: B I Churchill Livingstone; 1996.