Neurosciences at the Bombay Hospital - Its Continuing Progress
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Review Articles Neurosciences at The Bombay Hospital - Its Continuing Progress SN Bhagwati, G Parulekar, S Shah, M Chaudhary, N Mehta he Bombay Hospital was established in from the beginning, the work continued to T 1949 essentially to help the patients of increase, more beds were commissioned as the middle class who did not want to go to necessary and more theatre time utilized. By general hospitals and who could not afford early sixties, the department of neurosurgery high charges of a private hospital. It was was recognized as one of the best in the city. Sadar Vallabhbhai Patel who inaugurated this Further expansion occurred when hospital. Several physicians and surgeons of Dr. Bhagwati joined as a neurosurgeon and eminence had joined the hospital. Dr. Singhal as a neurophysician, specially for It was in 1953-54 that Dr. R.G. Ginde development of EEG in 1962. This is how joined the Bombay Hospital as an Hon. Dr. Ginde widened the field of neurosciences Neurosurgeon. Dr. Ginde had been a pioneer by having electrophysiology also as a part of neurosurgeon in Western India and with his it. Now a new field of neurosurgery was attachment, Bombay Hospital started having started with the performance of stereotactic neurosurgical patients from all over the surgery for Parkinson’s Disease and country. Initially the department was started behavioural disorders. Bombay Hospital was with four beds in the general ward and 3 half the only institution practicing stereotactic operation days in the general operation surgery for a long time. Over 300 stereotactic theatre per week. This much theatre time pallidotomies and thalamotomies were was found to be inadequate as the work kept performed over next decade. People were on increasing. All type of cranial and spinal referred from all over the country for surgical work was done and the need for expansion of treatment till the advent of L-Dopa when the services was felt. Soon the services of surgical treatment for Parkinson’s disease neurophysicians were added, so also of neuro became less prevalent. Neuropathological radiologist. Dr. Dadhich was sent to examination of tumour tissues was performed Scandinavia for a year’s training. After by Dr. Iyer and Dr. Darab Dastur, researchers returning from Oslo, a special table for from cancer institute till Dr. Darab Dastur performance of myelography and a started his department at J.J Group of schonander table for performing air study was Hospitals. purchased. In 1972 the Medical Research Centre wing Dr. Vijay Dave and Dr. Vijay Daftary was built. The management of the hospital joined the team and along with was extremely pleased with the work that Dr. Premchandani who was with Dr. Ginde the department of Neurosciences, Neurosurgery in particular was doing and sanctioned a new operation theatre wing with Department of Neurosurgery, Bombay Hospital and Medical Research Centre, Mumbai 400 020. one large well equipped theatre and one 328 Bombay Hospital Journal, Vol. 51, No. 3, 2009 smaller theatre. In the same wing, 5 cubicles By 1986-87 Dr. Geeta Parulekar joined the with 4 beds each were sanctioned as general hospital. In 1988 Dr. Turel joined as ward beds and one cubicle as recovery room. Consultant surgeon. The staff thus kept on Thanks to the management one now had a increasing in number. Dr. Deopujari joined well established department of Neurosurgery. as Asst Hon. Neurosurgeon around the same Dr. Wagh who initially was our house surgeon time. By 1984 with a good surgical microscope had had further training in U.K. and joined that had been installed, transsphenoidal as a junior consultant. By now the need for hypophysectomy for pituitary tumours was expansion of neurophysiology department was started. In 1991 the first GE MRI was visualized. An EMG machine was brought in installed. This further facilitated the diagnosis with Dr. Shobha Pandya in charge. This was of brain tumours, vascular pathologies and a very useful adjunct in the study of nerve intervertebral discs and neoplasms of the muscle disease. The department of neuro spinal cord. It was most useful in knowing radiology had also improved and good the damage to the spinal cord in trauma. With arteriographic studies became available. This the better diagnostic technology that had was again a philip to the study and treatment become available and the availability of good of vascular diseases of the brain, aneurysms surgical microscope, the scope of surgery and AVMs in particular. Also a study of widened and we started doing more extensive ischaemic stroke could be started. and larger number of surgeries. Obviously With this all round development of the need for further expansion arose. Neurosciences, Bombay Hospital started In 1992 the new wing was constructed. The occupying a pride of place in the city. The management immediately sanctioned management also became more and more creation of a new theatre complex with 2 large responsive to the needs that modern 20 x 20 operation theatres and a recovery technology demanded. In 1984 Bombay room ICU of 10 beds with all monitory Hospital was the first institution to install equipments. We also had a new Zeiss Surgical whole body CT scanner. This was again a microscope along with a ceiling mounted landmark in the development of Leica microscope. New equipments like high neurosciences. This enabled one to have a speed drills, new bipolar diathermy units, non invasive study of various brain disorders. ventilators, monitors, etc were brought and The use of arteriographies for tumours we could perform more extensive surgeries became less frequent and that of with greater facilities. The management very ventriculography almost extinct. The enthusiastically instituted Ginde Oration in detection of brain tumour became much 1992 in the memory of Dr. Ginde who had easier as they could be seen in a CT scan. started the department in 1953-54. Even a negative scan in a suspected patient Internationally renowned Prof. Madjid Samii proved to be of great relief ! Soon the hospital was invited to be the first Ginde Orator when management extended the benefit of CT scan over 100 neurosurgeons from all over the to indoor patients of government medical country attended it. Since then every year college by doing their scans at the same an internationally well known neurosurgeon concessional rates as its own general ward is invited as Ginde Orator who gives an patients. Not only did they generate a oration and performs live surgery. The tremendous amount of goodwill, it also helped oration is totally sponsored and supported by quite a few economically disabled patients. the hospital management. Last year Prof. Bombay Hospital Journal, Vol. 51, No. 3, 2009 329 Yasargil who is declared as Neurosurgeon of Last year 1600 operation procedures were the century was invited as the orator when performed. It is by far the largest number of over 350 neurosurgeons from all over the operative procedures carried out in any of the country attended it. The oration has become private trust hospitals. A fair number of these an event of great educational value. operations are performed totally free when The volume of work again kept on the patients are admitted to the general ward. increasing. By 1999-2000 further expansion This is the only institution with 340 general of the operation theatre complex was carried ward beds. Department of neurosurgery out. Besides the extra 2 large theatres, 2 having 20 dedicated general ward beds for more operation theatres were constructed, economically weaker sections of the society. the theatre complex now having 4 operation The hospital has a linear accelerator with theatres totally dedicated to neurosurgery. X-knife with which one can give stereotaxic Each theatre had a surgical microscope, radiotherapy (SRT) or stereotaxic overhead lights, Macquet operation table, radiosurgery (SRT for deeper tumours and high speed drills, anaesthesia machines with A.V. malformations). X knife is similar to monitors, CUSA, bipolar diathermy machines. Gamma knife and works on same principles. Sugita frames as well as May field clamps and The linear accelerator is used to give microsurgical instruments. We now have a radiotherapy to other lesions like bigger portable C arm of Philips on which even DSA tumours, etc. This treatment is again offered can be performed in the operation theatre. at a very concessional rate to economically For last few years we also have an endoscope disabled patients. to perform endonasal transphenoidal excision As far as neurology is considered, the of pituitary tumours and third department is manned by extremely well ventriculostomies for hydrocephalus. The known neurologists like Dr. B.S. Singhal and recovery room patients are looked after with Dr. N.E. Bharucha. They are ably aided by 4 channel monitors, ventilators, etc., the ratio Drs. A.B. Shah, Dr. Jimmy Lalkaka and of nurses being one nurse between 2 patients. Dr. Khadilkar. Advanced therapies for With the increasing availability of demyelinating disease, myaesthenia Gravis, operation time, Dr. Suneel Shah, movement disorders, epilepsy with video EEG, Dr Deopujari and Dr. Rajan Shah were paediatric neurology, etc are carried out. appointed as consultant surgeons. With Radio imaging department manned by Dr. Dr. Mahesh Choudhari and Dr. Uday Andar Talwar and Dr. Sunila Jaggi are looking after who had been appointed earlier, we now have 64 slice CT Scanner and a new 1.5 Tessla MRI 8 neurosurgeons and 2 assistant machine, doing over 20 MRIs and 30 CT Scan neurosurgeons. We now have a new daily. navigation equipment which enables us to do Thus one finds that neurosciences at the navigation guided biopsies and craniotomies. Bombay Hospital have made a tremendous Till now we used to do either CT guided or progress since its inception in 1953 and has MR guided stereotactic biopsies.