Soon after famous institutes like Christian Medical College (CMC), Vellore, and Madras Medical College, Chennai, developed their neurosciences wing, the department of neurosurgery was founded in the Trivandrum Medical College in Kerala. This was the first structured teaching hospital in the state.
The medical college, which was inaugurated by the then Prime Mini-ster Jawaharlal Nehru in 1951, was the first one to start a neurosurgery department in the state. Though head trauma was being handled way back from 1930 in the state by general surgeons like Dr A.E. John and Dr Poduval with exploratory trephination, no proper department was organised for regular neurosurgical procedures. Dr V. Kumarapillai, a physician who practised neurology, concocted ‘Mistu-ra Diabolica’ from magnesium sulphate and magnesium carbonate, which helped to reduce intracranial pressure in patients by catharsis. In those days, tertiary neurosyphilis was a common entity and pyrrotherapy was often performed to kill the organisms by raising the body temperature using 3 minims of the typhoid-paratyphoid A and B vaccine. Colonel Dr Sabesan, professor of surgery, and Dr K.I. George, the senior consultant of orthopaedics, used to operate on spinal tumours after diagnosing and localising them with myodil myelograms.
As early as in 1957, Dr Mahadevan Pillai, a visiting neuroradiologist, performed carotid angio-grams here. Later, Dr Sambasivan, who was a medical student, learnt the technique of carotid angiography and started performing it under supe-rvision of the then professor of radiology, Dr M.P. Joseph and his assistant, Dr C.P. Mathai. He managed to diagnose a parasellar meningioma by carotid angiogram that was later operated by Dr Kesavan Nair. Dr Sambasivan also had the opportunity to work under Dr Sivarajan, professor of surgery, who did brain surgeries then.
Later in 1961, Dr Mathew Varghese who trained under Dr Earl Walker at Baltimore and joined the Trivandrum Medical College (TMC) as a general surgeon performed craniotomies here and Dr Sambasivan had the opportunity to assist him. In 1961, Dr R.M. Varma of NIHMANS while visiting TMC, operated on a pituitary adenoma with Dr Sivarajan and the patient’s vision improved dramatically. At the same time, Dr Raman Nair and Dr V.J. Nair, both paediatric surgeons, started operating on patients with congenital hydrocephalus.
Dr Samabasivan performed ventriculograms in these patients and later assisted the two surgeons during shunt surgeries, in which cerebrospinal fluid diversion was performed using an infant feeding tube.
In 1964, Dr M. Sambasivan, who had by this time developed considerable interest in neurosurgery, on finding that there were no properly trained neurosurgeons in the state at that time, decided to go to CMC Vellore to get trained under the father of neurosurgery in India, Dr Jacob Chandy. During this period, Dr Bahuleyan from Madras Medical College joined Trivand-rum as an assistant professor after his FRCS from Glasgow and started doing neurosurgical procedures regularly.
Dr Sambasivan hailed from a family of Sanskrit scholars who were adept at studying and reciting Vedas and Upanishads. His father performed rites at temples. Being a ‘tantri’ himself, he wanted his son to be a Sanskrit scholar, too.
Dr Sambasivan developed a flair for the healing art and wanted to study medicine. He promised his father that he would pursue both the disciplines, and indeed, he succeeded in striking a balance between the two. Dr Sambasivan thus became a Sanskrit scholar who also got admission in TMC to obtain his MBBS degree. He used to perform rites at the temple regularly and at the same time became an excellent clinician. He sought a scientific basis for many of the legends in the ancient scriptures like the birth of ‘Kauravas’ from a single piece of tissue, which got transformed into 100 children. He thought that this medical miracle in the scriptures could be due to cloning, a technique which probably had already been discovered and practised by the scientific community of ancient India.
Dr Sambasivan realised that patients with traumatic brain injury and brain tumours fared poorly in the medical college then and read about the advances in neurosurgery in Europe and USA. Around this time, the principal of the Government Medical College, Trivandrum, Dr Thankavelu happened to meet Dr Jacob Chandy on a train journey, who had just returned from Montreal Institute of Neurology, Canada. He requested Dr Chandy to train someone from TMC in neurosurgery. Dr Jacob Chandy agreed to train a person from Trivandrum on the request of Dr Thankavelu and Dr Sambasivan got selected for the post.
Dr Sambasivan was an ardent student in the subject and became the favourite student of Dr Jacob Chandy. In 1966, Dr Sambasivan, who had already graduated from CMC Vellore, returned to Kerala to start the first department of neurosurgery at the Trivandrum Medical College.
Dr Jacob Chandy had been trained under Dr. Wilder Penfield, and later, Dr Theodore Rasmussen in Montreal. Therefore, the quality of neurosurgical procedures done at the medical college even during those times was of high standards. The protocols that were observed in Montreal Neurological Institute were being followed at the medical college. Thus began the era of Dr Sambasivan, who became the ‘last word’ for brain surgery within the state. He worked with just two beds under him exclusively earmarked for neurosurgery patients in the general surgery wards. Soon after forming the department, he operated on his first neurosurgical patient, Mr Pillai, who was suffering from post-traumatic acute subdural haema-toma, that was diagnosed by a carotid angiogram on admission. In those days, saving a head injured patient from death by performing a neurosurgical procedure was considered a miracle. It was a revolutionary surgery and the patient survived after the procedure to live long. In those days, in the pre-CT era, ev
ery time a patient suffering from head trauma came to the casualty, Dr Sambasivan was informed. He would rush the patient to the X-ray room and would perform an angiogram to localise the area of bleed.
Following this, the patient was operated promptly. Often these patients were severely brain-damaged. He still remembers that in those days, performing an angiogram to locate the lesion in patients was difficult and sometimes fatal. People used to call it as ‘antiogram’ which meant ‘last rites’ in the local language.
The procedure often left Dr Sambasivan in severe depression, especially when the patient did not make it. But in elective cases, he found it as a good tool to localise brain tumours. The patients, following the angiogram done for elective cases, had a relatively better prognosis.
In 1967, Dr Sambasivan, while performing carotid angiograms on patients with suspected subarachnoid haemorrhage (SAH), found that they harboured brain aneurysms — a condition where out pouchings of blood vessels due to thinning of its wall occurs. He presented it in the world congress and it was a landmark paper from India which proved that cerebral aneurysms were not uncommon in India, a finding that was contrary to the general belief prevalent at that time that intracranial aneu-rysms frequently occurred in the Caucasian population only.
Dr Sambasivan was the sole qualified neurosurgeon in the department until 1968. Soon, Dr S.K. Ramachandran Nair who did his training in neurosurgery from CMC Vellore, joined the department. He was followed by Dr Sanal Kumar in 1969. Soon, the department got separated from the department of general surgery to become an independent department with just three of them as faculty members.
Thus, it became the fifth independent department in India exclusively dedicated to neurosurgery, while in most other centres, neurosurgery was a part of general surgery. With these three hard working neurosurgeons contributing actively in the department, neurosurgical procedures became a regular feature. Thus, Trivandrum Medical College became a well-known neurosurgical centre in the country then.
Dr Sambasivan decided to go for vascular neurosurgical training and worked with the famous neurovascular surgeon, Dr Charles Drake and later with Dr Gazi Yasargil, who is considered as the father of modern neurosurgery. His mentor, Dr Drake was amazed at his surgical skills and advised him to set up a section of neurovascular surgery in Trivandrum. Acknowledging the vast number of aneurysms he operated upon, many international neurosurgeons like Dr Drake, Dr Eskeil and Dr Carbicke constantly encouraged him as well as donated aneurysm clips and applicators to him. Dr Charles Drake visited him in Trivandrum in his department to watch him operate. This highlighted Trivandrum on the world map of neurovascular surgery. He had published ample papers in these areas and thus, the department of neurosurgery became prominent on the world map of neurovascular surgery, right from the early seventies itself. Dr Sambasivan also operated on rare and difficult cases here and references of patients came from all over India to
Trivandrum.
It was in 1972 that another famous neurosurgeon, Dr A. Marthanda Pillai, joined the department as a lecturer. With three skilled neurosurgeons trained from CMC Vellore, the department improved considerably. The department of Neurosurgery, TMC, organised the international conference of Neurological Society of India in 1978 under the guidance of Dr Sambasivan. An array of dignitaries from all over the world like Dr Teasdale, Dr Drake, Dr Lister, Dr Stauffer, Dr Lindsey Symon, Dr Eskeil, Dr Carbicke, and Dr Yalow and famous neurosurgeons from India like Dr Jacob Chandy, Dr P.N. Tandon, Dr B. Ramamurthy, Dr R.M. Varma, Dr B.S. Das, Dr A.K. Banerjee, Dr S. Kalyanaraman, Dr Balparameshwara Rao and Dr S.N. Bhagwati had visited the department and appreciated the excellent work being done there.
Dr Sambasivan was appointed as the neurosurgeon to the President of India in 1987. In 1990, Dr Sambasivan was conferred an Honorary FRCS (Glasgow) based on his achievements in the field of neurosurgery within the country and abroad. He was appointed the secretary of Neurological Society of India from 1984 to 1990 and the president of the World Federation of Neurosurgical Society later on.
In 1972, on the 60th birthday of Sree Chitra Tirunal Maharajah of Travancore, Dr Sambasivan was called and asked what could be done to commemorate the birthday. Dr Sambasivan suggested that a full-fledged super-specialty hospital, dedicated to curing the diseases of the brain and heart, would be ideal.
Thus, he was instrumental in initiating the work related to the development of Sree Chitra Tirunal Institute of Medical Science and Technology (SCTIMST) within the campus with the recommendation from the royal family and also financed by the department of science and technology, Gover-nment of India.
In 1979, the first neurosurgical training programme in the state was started in Trivandrum Medical College. Dr Sanal Kumar was the first MCH neurosurgery student who passed out from this department. Dr Sanal Kumar later became the head of neurosurgery in Medical College, Kozh-ikode.
Later, other students of Dr Sambasivan, Dr Premraj Mohan, Dr Ekbal, Dr Jayakumar, Dr Bhavadasan, Dr Moh-anlal, Dr Mahadevan, Dr Pushkala, Dr Zulfiquer, Dr Gnanadas, Dr Alapat, Dr Dominic and Dr Raymond trained in TMC managed neurosurgery cases in various other medical colleges of Kerala. Dr Divakar Rao went to Mangalore to serve the people there, as there were no neurosurgeons in that city prior to their arrival. Thus, the scarcity of neurosurgeons in Kerala was being slowly resolved by a gradual distribution of highly skilled neurosurgeons from the TMC to other parts of Kerala. This achievement was only possible due to the great vision of Dr Sambasivan, who started the first training centre in the state.
After Dr Sambasivan retired, the following doctors headed the department:
1. Dr S.K. Ramachndran Nair
2.Dr A.Marthanda Pillai
3. Dr Bhavadasan
4. Dr Raymond Morris
5. Dr K.L. Suresh Kumar
6. Dr Anil Kumar Peethambaran
Now, the department has 11 consultants and 18 residents making it one of the biggest neurosurgery departments in India with state-of-the-art equipment and commendable training. The department is headed by Dr Anil Peetambaran NSI chief, and the NSII unit chief Dr B.P. Rajmohan.
(Compiled by Dr Anil Peethambaran, ,MCh, head of neurosurgery Government Medical College, Trivandrum)
