Where there is will there is a woman. A brave Sikkimese woman from a village near Ravangla in South Sikkim and her will to survive has reiterated this. At 69 years, all that this elderly woman (a mother of six) wanted was a good harvest this year. However, life was not easy and her toughest hurdle was a small, painless tumour on the left side of her neck that had been silently growing.
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. The headaches eventually became continuous and she had to contend 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 in Gangtok 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 essentially a channel in the venous outflow of the brain and contains a huge amount of blood. Now 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 compressing the brain. The brain adjusts when the tumour is small but when it grows beyond limits it gets decompensated and intra cranial pressure rises sharply. This explained her symptoms and could have even lead to death.
The brain adjusts when the tumour is small but when it grows beyond limits it gets decompensated and intra cranial pressure rises sharply.Timely visit to a health care facility is key in terms of obtaining favourable outcomes. In this elderly lady's case too the odds worked in her favour due to her timely arrival at the right healthcare facility. The neurosurgery team at CRH with Dr. Pranav Rai and his colleague Dr. Simranjeet Singh, thoroughly examined the case and judiciously planned the procedure at every step. Despite their proficiency and experience in handling complex neurosurgeries, the doctors did not underestimate the case and took complete precautions to prevent known complications.
The plan was to remove as much of the tumour as possible while inflicting minimal damage to the brain (the latter was inevitable because of the location of the tumour). Meningiomas are actually non malignant tumours arising from the meninges that cover the brain.
Their benign (non-cancerous) character however does not make them any less dangerous. Most grow rapidly to large sizes before they cause symptoms. Significant brain compressions 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 and she was taken up for surgery on 22nd October 2020. A skilled nursing team led by staff nurses Dinesh, Alina and Chukit had 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 the patient but had also blessed her with 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 some weeks, she was finally discharged in a stable and healthy condition. 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.