“The Brain is a highly active organ. It doesn’t sleep. It is responsible for our internal needs, external demands, and social interactions. So, if we keep this one organ healthy, it knows how to keep the rest of the body in order”. In this brief interaction, Dr Venkataramana N K, Founder and Chief Neurosurgeon of Bengaluru Regenerative Advanced Institute of Neurosciences (Brains) explains to Y Maheswara Reddy how important it is to keep the brain healthy.
How would you describe what you do?
The Brain is a very active organ. It doesn’t sleep. Day or night, it keeps a watch on the rest of the body. It is the boss. It knows what is happening minute to minute inside the body and knows how to respond, how to protect us. No computer can match its intricacy, its agility and its response. Many people are working on Artificial Intelligence capabilities but have yet to come close to the capability of the Brain.
With the advent of state of the art technology, we have new noninvasive diagnostic tools which have aided the imaging and understanding of the brain’s structure and functioning. Despite this however, we know very little about the brain, its ability or its disorders, of which there are numerous possibilities.
Also the public continues to be clueless in this regard for two reasons. The first one is lack of awareness. The second reason is lot of myths about neurological disorders. People have formed opinions based on traditional knowledge, the internet and word of mouth about many neurological disorders like epilepsy, paralysis and other disorders. Similar is the case with strokes. Modern research does not get translated into action.
Conventional treatment is not necessarily the answer. We need to have special treatment facilities for the right treatment at the right time. The brain is unique among organs in the body. Every part of the brain has a distinctive function that regulates the body. If there is a delay in availing appropriate treatment, the brain can undergo damage, and there will be some amount of permanent disability.
Brains in Brains Hospital is an acronym that stands for Bengaluru Regenerative Advanced Institute of Neurosciences. At Brains we want to create affordable accessibility to awareness, knowledge, investigation, early diagnosis, emergency management, elective treatment, chronic care, rehabilitation and regeneration of the brain.
What is the difference between a neurosurgeon and a neurologist?
A Neurosurgeon is one who surgically intervenes to correct brain disorders. A Neurologist on the other hand treats disorders of the brain with medicines only. There are certain diseases that do not require surgery. For example, initial epilepsy, infections, some degenerative diseases are treated by neurologist. Brain tumor, injuries, brain stroke, advanced epilepsies and spinal cord problems are treated surgically by a neurosurgeon.
What is most challenging about what you do? and what is most rewarding?
Brain surgery is very challenging. Every single cell of the brain is valuable. We cannot afford to create any damage. The Brain is a big mesh of network. You cannot put your fingers in and search like it may be done in abdominal surgery. We have to precisely go to the point where we need to correct. We have to do that in such a way that we don’t damage the brain cells in any way. This is now possible with advanced imaging technology!
When would you advise me to see a neurosurgeon (What Symptoms should I look for)?
It is better to see a neurosurgeon for any issue related to nerves. They can decide whether there is a need for a surgery. They will refer to a neurologist or other specialists for medical therapy if there is no need for a surgery. Neurosurgeons are well versed in identifying neuro problems quickly. As I said the brain is a very sensitive organ. Nerves undergo continuous damage if they are not treated at the right time. So time is crucial to bring the patient to normal.
Should I see a neurologist before I come to neurosurgeon?
Ideally neurologists and neurosurgeons should work together for effective care. It depends. Sometimes for minor things like a headache, a neurosurgeon will be able to look at the surgical possibility first. Surgery requirements need to be identified and eliminated before we put the patient on medical therapy. There is no compulsion that a patient should go through a neurosurgeon or neurologist. Either way is okay because these specialists are so rare. It is better to see whoever is available as early as possible.
What are the most common neurological issues you have had to deal with in your career? Do all of them require surgery?
A good majority of them require surgery. Starting from day one, a baby which is born with spinal cord deformity or abnormal spinal cord development or abnormal brain development or water collection in the brain and brain tumors. As age advances, we have numerous problems like brain tumor, brain stroke, blood supply problems, brain hemorrhage, brain injury etc. Epilepsy is a major problem; back pain is a major problem. In advanced age, we have many conditions like Parkinson disease, Alzheimer disease and autoimmune disease etc. In our country, we have a variety of infections, bacterial, viral, fungal and tuberculosis. In situations like stroke, brain hemorrhage, epilepsy, Parkinson’s disease etc. some of them require surgery.
At Brains, we have created a team of neurologists, a team of neurosurgeons, a team of critical care specialists, a team of neuro emergency doctors because the neuro emergencies have to be done as quickly as possible. We talk about Golden Hour. Within one hour, we need to sort out the problems, make sure the patient is protected. Similarly, neuro critical care is very important. The role of neuro critical care is to see that brain functions are monitored well and brain is protected and the recovery is promoted without fail. If we don’t do that, we might save a patient but the quality of the life gets affected severely.
What are the latest advances in Neurosurgery and do we have all those facilities here? How do you keep yourself updated in this regard?
Yes, technology has advanced neurosurgery levels to an unprecedented level. The advanced technology has helped us to identify the abnormal and three-dimensional orientation of the brain and has made surgery very safe. Now, during surgery, starting from opening of the skull, we have high-speed drills, we have neuro monitoring, we have an operating microscope to magnify the nerves and show us invisible nerves very nicely. We have endoscopes and all the latest equipment is available at Brains. We keep ourselves updated because we attend international conferences. We also invite many international speakers. Last month, we conducted a workshop and symposium here. I am a member of many international scientific communities. That is how we update and imbibe a lot of things from around the world.
Generally, what is the prognosis post-surgery? How quickly can I expect to recover from surgery?
When I was in training, neurosurgery was growing by stages. People used to be scared about any treatment let alone surgery related to the brain or spinal cord. So, those days whatever surgery we did, there used to be significant amount of problems. Now, it has become easy for neurosurgeons to operate on the brain because of latest technology and equipment. But it depends on at what stage the patient comes to the doctor. If the patient comes to the doctor at an advanced stage, no matter the facilities at our command, we can’t do much. If they come at the right time, neurosurgery is better than any other surgery. The patients can recover very fast. Some of them however, require a lot of rehabilitation to improve their functional ability.
Parkinson’s, Alzeimhers and Dementia – all related to brain degeneration – any hope for such patients?
Yes, right now a lot of medicines are available. A lot of research is going on for newer medicines. There is a surgical treatment for Parkinson’s disease. Deep brain stimulation has become the gold standard now. It helps patients to improve their quality of life phenomenally. The future is going to be regeneration of the brain. A lot of molecular biology and genetics are understood now. We are now looking at how to manipulate those genes. Chemotherapy is coming in a big way. When I was a student, we were told that brain cannot be regenerated. Today, we are confident that the brain can be regenerated. Not only that we can also maintain the quality and ability of the brain as long as possible. Because of this research, stem cells are going to provide a great future because we can not only regenerate the brain but also repair the brain which was not possible all these years. With that, I think that we can find solutions for many diseases that were considered impossible to cure.
How affordable is brain surgery in India?
Brain surgery is very much affordable because it is one of the aims. However unfortunately all advanced equipment required for neurosurgery is very expensive and we need to import them. This is where I think lot of research and indigenization should happen. So that cost of the equipment can be brought down. I am not going to refuse any surgery for want of money.
Why Brains Hospital? What is unique about this hospital?
The unique thing about this institution is that it is established with passion, backed by experience, skills, infrastructure and advanced technology. One of our aims, as I said earlier, is to bring to the public one of the best available facilities in the world as far as neurosciences is concerned. There are many hospitals but treating the patient the right way is most important. All the facilities here are accessible to the common man.
What education or skills are needed to become a skilled neurosurgeon?
It is a real sadhana. It is a six-year training after MBBS just to qualify for it. Now, neurosurgery has grown up. There are so many sub specialties in neurosurgery. One has to develop a passion and interest towards some of these sub specialties. Neurosurgeons need to get trained again and again to hone up their skills. After that, every day is a relentless learning effort to upgrade skills and keep abreast in the interest of the patient. It is a tough job to be a good neurosurgeon.
What advice would you offer someone considering this career?
I love anyone who aspires to be a neurosurgeon. It is a challenging specialty, a fascinating journey. Day and night, whatever it is, every surgery is completely different. You don’t know what you are in for when you start the surgery. If you plan something and it doesn’t work, you need to be very quick in introducing alternative treatment plans and making treatment decisions – the right decisions at the right time. You have to keep yourself alert all the time. Secondly, it is a highly skilled job. It provides the surgeon complete satisfaction right from diagnosis, planning and operating to post-operative care and recovery.
How much time off do you get/take? And how do you balance family life with your profession?
Please don’t ask my wife this question. She always says that our home is a hostel for me. I come, sleep and get out. Anyway, I am thankful to her. She has been an ardent critic but a silent supporter. So, it is a tough thing, not today but right from the beginning. My daughter also complains because I always tell them that I will come at a particular time but I am never able to go home at that particular because our surgeries are very long. It needs lot of thinking and planning.
Many a times I am non-communicative at home and everyone at home wonder what has happened to me. In reality I am deep in thought about how I am going to deal with a surgery on the morrow – what problems am I likely to encounter?. Balancing professional and personal life is really a tough thing but I am fortunate that I am able to do that and that my family members are very understanding.
