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Professor Balasubramaniam Ramamurthi

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Professor Balasubramaniam Ramamurthi Gupta and Tripathi: Vestibular schwannomas: Footprints in the sands of time (acoustic neuromas): Surgical management and results with an radiosurgery to minimize morbidity without compromising tumor emphasis on complications and how to avoid them. Neurosurgery control. Int J Radiat Oncol Biol Phys 2012;84:278‑9. 1997;40:11‑21. 38. Piccirillo E, Hiraumi H, Hamada M, Russo A, De Stefano A, 35. Mandpe AH, Mikulec A, Jackler RK, Pitts LH, Yingling CD. Sanna M. Intraoperative cochlear nerve monitoring in vestibular Comparison of response amplitude versus stimulation threshold in schwannoma surgery—does it really affect hearing outcome? Audiol predicting early postoperative facial nerve function after acoustic Neurootol 2008;13:58‑64. neuroma resection. Am J Otol 1998;19:112‑7. 39. Thakur JD, Banerjee AD, Khan IS, Sonig A, Shorter CD, 36. Talfer S, Dutertre G, Conessa C, Desgeorges M, Poncet JL. Surgical Gardner GL, et al. An update on unilateral sporadic small vestibular management of large vestibular schwannomas (stages III and IV). schwannoma. Neurosurg Focus 2012;33:1. Eur Ann Otorhinolaryngol Head Neck Dis 2010;127:63‑9. 40. Gabert K, Régis J, Delsanti C, Roche PH, Facon F, Tamura M, et al. 37. Barani IJ, Parsa AT. Adaptive hybrid surgery: Feasibility of Preserving hearing function after gamma knife radiosurgery for planned subtotal resection of benign skull base tumors followed by unilateral vestibular schwannoma. Neurochirurgie 2004;50:350‑7. APPENDIX Professor Balasubramaniam Ramamurthi (This photograph has been kindly provided by Dr. B. Dibbala Rao) “ If I have seen further than others, it is by standing upon the shoulders of giants” ‑Isaac Newton Prof. Balasubramaniam Ramamurthi (fondly called ‘BRM’ and ‘Chief’), the doyen of Indian Neurosciences started his neurosurgical career in 1950 after his training under Mr. GS Rowbotham and Prof. Geoffrey Jefferson in Great Britain. A very well read and travelled person, BRM attended several schools of excellence during his training abroad under Prof. Krayenbuhl at Zurich, Dr. Edward Busch at Copenhagen, Prof. Olivercrona at Stockholm, and Prof. Wilder Penfield at Montreal. BRM was born in an illustrious family of scholars. He passed out of the Madras Medical College in 1943, secured his Master of Surgery (M.S.) in 1947, and then his Fellowship at the Royal College of Edinburgh. On his return from the West, at a young age of 28 years, he joined the Madras Medical College and General Hospital as an assistant surgeon in Neurosurgery on 24th October 1950. Prof. B. Ramamurthi, a great visionary and an incomparable intellectual, took upon himself the task of establishing Neurosurgery on a firm footing in India, 3 years after independence when the odds were very high and resources were severely limited. There was no looking back from that point and with his unfathomable energy, untiring efforts, enthusiasm, commitment, and complete disregard towards his personal comforts, he went on to establish Neurosurgery in India in its present form. Neurology India | Volume 66 | Issue 1 | January‑February 2018 15 Gupta and Tripathi: Vestibular schwannomas: Footprints in the sands of time In association with other giants in the field like Dr. Jacob Chandy, Dr. ST Narasimhan, and Dr Baldev Singh, Prof. B. Ramamurthi established the Neurosurgical Society of India (NSI) at Madras (now Chennai) in 1951. He was the founder‑editor of the journal ‘Neurology India’. He published extensively on spinal extradural granulomas, brain abscess, ventriculographic diagnosis of cysticercosis, pituitary apoplexy, central nervous system tuberculosis, and head injury. He meticulously maintained the records of his patients in an era when no computers and softwares were available. He was one of the pioneers who helped in establishing and promoting Stereotactic Neurosurgery in India. Madras Institute of Neurology became an institution of international repute under his able guidance for the management of functional disorders and psychosurgery. He has a distinct honour of establishing and heading two centers of excellence during his lifetime, ‘Institute of Neurology’ at Government General Hospital and ‘Dr. Achanta Lakshmipathi Neurosurgical Centre’ at Voluntary Health Services Hospital in Chennai (1978). He emphasized on a curriculum based Neurosurgery training in India as he stressed upon better teaching facilities for this sub‑specialization of surgery. He openly criticized governmental policies on the poor infrastructure that existed for Neurosurgery training in India while commenting on the news of an Indian actor’s mother being operated upon on the wrong side. He was the main guiding force behind the formation and development of the National Board of Examinations. He played a key role in establishing the “National Brain Research Centre” at Manesar, New Delhi, an apex center for neuroscience research. Looking at the plight of head injured patients, he established ‘Accident Victims Association’. A keen observer, a constant learner, and a teacher par excellence, his contributions to the field of Neurosurgery were innumerable. He received many awards for his professional excellence including the Johnstone Gold Medal award for the best outgoing student from Madras Medical College (1943), and the Honorary Brigadier title by the Indian Army. He also became the Honorary President of World Federation of Neurological Surgeons (WFNS) and the President of ‘International Stereotactic Society.’ For his efforts, the Government of India honoured him with the prestigious ‘Padma Bhushan’ and ‘Dhanvantri Award’. He, along with Prof PN Tandon, published the first edition of ‘Textbook of Neurosurgery’ in 1980. With his untiring efforts, high professional standards, passion for teaching, and empathy towards his patients, he established the presence of Indian Neurosurgery around the world. He is often recognized as the “Father of Neurosurgery in India”. A great son of India, whose contributions have immortalized him and have constantly served as a beacon of inspiration for younger generation of Neurosurgeons. His autobiography “Uphill All The Way” is a continuous source of inspiration. He was a true leader who not only walked on that path but also guided the younger generations of neurosurgeons to achieve excellence in their professional and personal lives. He was a 'living legend' in the true sense. ROM THE TREASURE TROVE OF NEUROLOGY INDIA Acoustic Neurinoma B. Ramamurthi, V. Balasubramaniam and S. Kalyanaraman Neurology India 1970;18: 176‑80 INTRODUCTION Acoustic neurinomas have always been a challenge to the skill of the neurosurgeons ever since the days of Cushing. In India, they are the most difficult neurosurgical problems to tackle, straining ones surgical skill as well as postoperative nursing resources. Almost all cases come late for treatment with severe papilloedema, enlarged ventricles, multiple cranial nerve paralysis and large tumours, over and above there is poor general condition of the patient. Hence, the aims and objects of surgical therapy and the type of treatment to be given to make the patient fit seem to be different from that followed in other parts of the world, where patients seek treatment earlier. This paper summarises our experience in the treatment of acoustic neurinomas over the past 18 years. MATERIAL AND METHODS In last 18 years, 122 cases of acoustic neurinomas were diagnosed, either clinically and/or radiologically, of which 84 were operated. 38 were not operated either because the patient refused surgery or they died in the hospital while waiting for surgery as the facilities for urgent and emergency surgery were lacking in the first few years of the development of the department. Clinical features Clinical analysis revealed that 40% of the cases referred in the first 9 years were blind, whereas in the later period only 16% of the patients were seen with total loss of vision. This is not to say that now we do not get severely advanced cases, but the tendency is towards earlier recognition. It is interesting to note that none of these cases were referred by the Ear, Nose and Throat (ENT) surgeons or diagnosed initially by them. In all the patients, the diagnosis of acoustic neurinoma was suspected from neurological symptoms, which was later confirmed by audiological investigations. The age incidence was as shown in Table I. Compared to the figures from western countries it was seen that the maximum incidence, in the present series of acoustic neurinoama, was a decade earlier. This is also true for many other intracranial tumours in India. Our youngest patient was 14 years old. Of 122 tumours, 59 were on the right and 55 on the left; 8 patients had bilateral tumours, 3 of them had associated von 16 Neurology India | Volume 66 | Issue 1 | January‑February 2018 Gupta and Tripathi: Vestibular schwannomas: Footprints in the sands of time channels in the occipital region. Their presence should be looked for in all cases. Recklinghausen’s disease. Of the 144 unilateral tumours, 3 were associated with neurofibromatosis. Of the 8 bilateral tumours, It is essential to coagulate and wax these enlarged vessels 4 were operated on one side and 2 expired. The 2 who were quickly to prevent an air embolism, especially if the operation alive are being followed up. Association with other tumours is being done in the sitting posture. was noted in 2 cases; 1 had a convexity meningioma and the other had a glioma of the frontal region. So far, the need for cisternography has not arisen as all the patients presented with unmistakable signs. Hence, we have Symptoms and signs are not discussed in detail. Attention is no experience of it in the early diagnosis of acoustic neurinoma. drawn to a few features. In the authors’ experience an early sign of facial nerve involvement is the slight lag of one eyelid Myodil ventriculgram is done routinely in all patients with while blinking. Close observation of the patient’s face during cerebello‑pontine angle tumours to obtain preoperative conversation will reveal this. A sensory loss over cornea was knowledge of the tumours' extent despite the unequivocal observed more frequently than the weakness of the facial nerve clinical diagnosis of an acoustic neurinoma.
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