Kharel, 37, looks normal and talks in a way to give an impression that the January 31 surgery-- he remembers the date of surgery with much effort-- was routine. But his was not a normal case. His surgery was the first of its kind in Nepal and probably in South Asia, according to senior neurosurgeon Dr Basanta Panta. [break]
Kharel had a decent job with Canara Bank in Delhi, India where he worked for seven years before falling for an agent´s trap and landing in Dubai in October. Typical to his nature, he accepted his fate and everything was going normally until he fell ill last month. He was diagnosed with brain tumor in a Dubai hospital.
“My employers said it was life-threatening and would require a lot of money for treatment in Dubai. They advised me to return home and seek treatment here,” Kharel said.
Ground-breaking surgery
Kharel landed in Kathmandu on January 20 and reached Annapurna Hospital and Rehab Center, Maitighar on Jan 26. Dr Panta examined him and an MRI (magnetic resonance imaging) revealed he had a mass tumor at temporal lobe of his brain which was confirmed by EEG (electroencephalography).
“The fact that the tumor was in temporal lobe, which controls speech, vision and memory, made it a complex operation and he could have lost those functions in the process of surgery even if his life was saved,” Dr Panta said. Kharel also had complex partial seizure, a type of epilepsy.
Dr Panta and his team, including anesthesia team, decided to try a new type of surgery on Kharel with his consent. The anesthesia team -- Dr BB Singh, Dr Pravesh Rajbhandari, Dr MB Chand, Dr Ravi Shrestha, Dr Pradeep Vaidya and Dr Medha Koirala -- devised a sleep-awake-sleep technique for Kharel.
He was brought into consciousness after his brain was exposed. The doctors then did cortical mapping of speech and language and started to stimulate the parts of temporal lobe. The doctors started talking with Kharel even as his brain was stimulated -- the rationale being that he would not be able to talk if the part that controlled speech and language was stimulated.
Simultaneously, the doctors also stimulated hippocampus -- the part that stores memory--and started to ask him about his personal details. “He would tell that he had two daughters and a son and also tell their names along with his wife Dilsara´s,” a doctor, who was involved in the surgery, recalls.
The doctors thus mapped the area around the tumor and removed the entire seven centimeter tumor after again making him unconscious ensuring that the parts controlling speech and memory were not removed. Kharel is now out of danger and plans to return to Dubai to continue his job.
“It is a ground-breaking surgery and measures up to the highest standard across the globe,” Dr Panta claimed and said his team can now separate conjoined twins here in Nepal.
Functional surgeries by Dr Panta
Dr Panta called Kharel´s case a functional surgery incorporated into life-saving surgery and said functional surgery is not done elsewhere in Nepal. “Functional surgery is done to restore some specific functions of a person and doctors usually don´t want to risk life just for the sake of restoring a function,” Dr Panta argued.
Dr Panta referred to the case of 12-year-old girl Shaba Ali Bano, whose right hand remained closed for three years following an accident, to explain numerous functional surgeries he has done.
“I was playing hide-and-seek at a friend´s birthday and fell when a friend pushed me,” Bano said, pressing a kind of gripper (device for improving hand strength) with her right hand that has been surgically mended a few weeks ago.
The doctors cut her hand from wrist to elbow and separated her ulnar nerve into filaments. They then stimulated each filament and cut the ones that were hypersensitive while leaving others. “She could hold a pen the next day after the operation,” Dr Panta said.
Bano was in the second grade in Neptune Boarding School at the time of accident and didn´t go to school in the intervening period as she had to remain in Intensive Care Unit for nearly a month and also had problems with her right leg.
“I taught her at home and now the school has agreed to take her in the fifth class after this surgery,” an elated Neesha Ali, Bano´s mother, said.
premdhakal@myrepublica.com
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