Massive cricket ball sized brain tumour successfully removed in Central Referral Hospital

Gangtok, 07 Nov: Where there is will there is a woman. A story of a brave Sikkimese woman from a village near Ravangla in South Sikkim and her will to survive. At 69 years, all the mother of six wanted was a good harvest this year so she could walk into her next decade, but life wasn't going to make it easier. Her toughest hurdle was right in front of her. A small, painless tumour on the left side of her neck had been growing and being a tough simpleton, she chose to ignore it initially. Overtime, it grew to such an extent that it started compressing her trachea (windpipe). She consulted the ENT department in STNM hospital where she was told that surgery could not be avoided. A major surgery was performed in May this year and the ENT Oncosurgeons managed to remove the tumour completely. Weeks later she recovered and went home thinking she would live a safe and happy life. However, life on the other hand had another surprise for her.

A few months later, after her thyroid surgery she started having severe bouts of headaches which became progressively worse over time. It eventually became continuous and was presented along with nausea, vomiting and giddiness. One unfortunate day, she had a fall and lost consciousness and since then never recovered fully.

The worried relatives brought her back to STNM hospital and the emergency team got a CT scan of the brain. There seemed to be a huge mass compressing the brain on the left side. She was hurriedly referred to Central Referral Hospital (CRH) for an emergency Neurosurgery consultation.

Amidst the chaos and fear caused by the Covid-19 pandemic she was admitted. An MRI scan of the brain confirmed the diagnosis. There was a Meningioma (a type of brain tumour) approximately the size of a cricket ball. It was growing from the wall of the superior sagittal sinus which is a channel in the venous outflow of the brain and contains a huge amount of blood. It wouldn't sound all that big but when put in a rigid structure like the skull with no space for expansion, the extra mass volume has to be accommodated at the cost of compensation by compressing the brain. The brain adjusts when the tumour is small but when it grows beyond limit it gets decompensated and intra cranial pressure rises sharply. This explained her symptoms and could have even lead to death.

Timely visit to a health care facility is key to tipping healthcare intervention towards favourable outcomes. Odds worked in her favour due to her timely arrival to the right healthcare facility. The Neurosurgery Team at CRH with MCH Neurosurgery, Dr Pranav Rai and his colleague MCH Neurosurgery, Dr Simranjeet Singh thoroughly examined and judiciously planned the procedure every step of way. Each patient is an individual and despite past surgeries of similar surgeries before, and their over1- 2 year experience in Neurosurgery at CRH and outside, they did not underestimate the case and took complete precautions to prevent known complications. The plan was to remove as much of the tumour, doing as little damage to the brain. Meningiomas are non-malignant tumours arising from the meninges that cover the brain. Their benign (non-cancerous) character however doesn't make them any less dangerous. Most grow rapidly to large sizes before they cause symptoms. Significant brain compression caused by large tumours are often lethal. Removing them is always difficult and if not completely removed they grow back again. Delicate veins, vital brain tissues and the Sinus wall where the tumour was growing from, were all to be preserved in order to achieve good or acceptable results.

The planning team involved the Residents of the Neurosurgery department, Dr Zigmee Ongchuk Bhutia, Dr Karma Bhutia and Dr Indrajit, and Anaesthetists Dr Sophia and Dr Swaroopa. The brave woman and her family agreed and consented for the procedure despite its risks was taken up for surgery on 22 Oct, 2020. Skilled nursing team led by staff nurses Dinesh, Alina and Chukit assisted in the case. The complex and technically challenging surgery lasted 7 long hours.

Aggressive and detailed monitoring and post-operative period care ensured a remarkable recovery. The six decades of village life must have been hard on her but had also blessed her with the extraordinary positivity and strength. Although she had some changes in her personality due to the damage caused by the tumour in the brain, she was up and smiling a few days later, already planning to raise poultry at home. The dedicated physiotherapy team worked with her daily until she was walking on her own. After about two weeks, she was finally discharged in a stable condition, ambulatory and healthy.

With hope, determination and the love from her family, she headed home and now looks towards happily turning 70, leaving behind an inspiring story for all.