Wockhardt Hospitals Blog

For three years, a host of doctors were unable to diagnose Manju Talwar’s medical problem. The 24 year old school teacher complained of abnormal lactation, irregular menstrual cycles and was unable to conceive.

All symptoms suggested a possible gynaecological problem but despite heavy medication, Talwar’s condition did not improve. However, early this year, a MRI scan revealed a tumour in her pituitary gland.

The pea-sized gland situated at the base of the brain controls growth, metabolism and reproductive functions among others. In Talwar’s case, the tumour was pressing her optic nerve, which could lead to blindness. She was advised immediate surgery.

Talwar’s was not an easy surgery as while removing the tumour we had to ensure that the gland is preserved as she is in the child bearing age,” said Dr. Deepu Banerji, a neurosurgeon at Wockhardt Hospital,Mulund,Mumbai.

The Pituitary gland which is located at the center of the brain manufactures and secretes hormone that regulate growth ,sexual development and fluid balance in the body.

Pituitary adenomas(tumors) are abnormal growth on the pituitary glands which account for about 10% of intracranial neoplasms. They often remain undiagnosed, and small pituitary tumors have an estimated prevalence of 16.7% (14.4% in autopsy studies and 22.5% in radiologic studies). Tumor removal is usually done through transspheoidal approach. Endoscopic surgery is the new approach allowing a surgeon to gain maximum access within the narrow confines of the region avoiding extensive dissection.

Surgery is a common treatment for pituitary tumors. Trans-sphenoidal adenectomy surgery can often remove the tumor without affecting other parts of the brain. Endoscopic surgery has become common recently.

Dr Deepu Banerji, who operated on Talwar over three months, opted for a relatively new endoscopic trans-nasal technique for the delicate operation. This involved insertion of an endoscope through nasal cavity.

Banerji claimed that so far in Mumbai most doctors have been using microscopic transeptal technique, which involves a microscope inserted through the nasal cavity. This, he claimed has led to post-operative complications like numbness around nose and lips, nasal deformity or pain and incomplete removal of tumor.

In the new technique, an endoscope provides good view of the tumor to the doctor. Also, it makes it easier to differentiate between the tumor and the gland – leading to greater chances of complete tumour removal and preserving hormonal functions.

Talwar said she has so far not complained of any post-operative complications.For inquiries please contact us at enquiries@wockhardthospitals.net

Wockhardt Hospitals, Kalyan successfully performed a revolutionary minimally invasive spine surgery - Percutaneous Endoscopic Lumbar Discectomy (PELD) on a 49-year-old man suffering from severe backache.

Truly a minimally invasive spinal surgery, the procedure known as PELD was performed with a single 0.6 cm incision using a technically evolved Yeung endoscopic spine system (YESS) method under local anaesthesia. The PELD Technique is known to be an innovative spine procedure that can help appropriately screened patients recover faster without scars or stitches and more importantly, helps patients walk immediately after the procedure without any pain.

The patient, Sunil Ghag, was suffering from acute back pain as a result of prolapsed inter-vertebral disc, more commonly known as slipped disc. With the severity of the pain only increasing with time, conservative treatment with non-steroidal anti-inflammatory drugs (NSAID) and intermittent pelvic tractions was of little help, forcing him to seek surgical intervention.

An MRI confirmed the prolapsed disc, revealing disc degeneration. "The patient had two options," recalls Dr Vikas Gupte, consultant spine surgeon, Wockhardt Hospitals. "He could either opt for the conventional open discectomy, or the minimally invasive PELD under local anaesthesia." The patient was convinced about going for it as the chances of root injuries were minimal with PELD, promising immediate normalcy and discharge from the hospital.

As Dr Gupte explains, "In the PELD procedure, the patient is made to lie prone on a special operation table and the exact entry point is mapped on the patient's body using image intensifier x-ray system. A long spinal needle is then passed from the side of the back which goes into the disc directly by-passing other bone and ligaments. Through this needle, a guide wire is passed and after making a 6mm incision under local anaesthesia, a dilator and working cannula are passed through the incision. The camera and the monitor are attached to an endoscope that is passed through the incision and the prolapsed part of disc is removed under vision. Advanced instruments like radio-frequency and laser machine are used for such surgery. The surgery lasted for 40 minutes and the wound was closed with a single stitch."

Dr Deepu Banerjee, Neurosurgeon, Wockhardt Hospitals points out that the instrumentation using YESS technique consists of a 6 mm scope that facilitates direct view of the disc fragments in the spine thus minimizing muscle, ligament and tissue damage, while alleviating chances of nerve root injury. "Even the nerve roots are clearly visible through the powerful camera of the Yeung endoscope," he added.

Post-op, the patient was able to walk without any pain and was discharged after 24 hours. According to experts, PELD with YESS technique is the ultimate form of minimal invasive spine surgery in appropriately screened patients.