10 May,2011 08:43 AM IST | | Astha Saxena
26-year-old Iraqi national gets tumour removed from next to his spine through a rare surgery at a Gurgaon hospital. Only eight other people in the world have benefited from this technique
Ali Aid Abdulhamla, a 26-year-old man from Iraq thought that he would not be able to walk again. For the past four months he has been wheelchair bound and unable to even stand. Suffering from a rare genetic disorder called Neurofibro-matosis Type 1, Ali had difficulty in breathing too.
Fit and fine: Ali Aid Abdulhamla after the operation. Pic/Imtiyaz Khan
"For the last four months I was scared even while going to sleep as I used to think that I might not wake up again. With breathing problems along with difficulty in walking, I was getting into a state of depression. I was unable to do anything on my own; one of my family members would have to be with me at all times. I had become completely dependent on others," said Ali.
Hindrance: A scan shows the tumour pressing against the spinal cord.
All in the family?
Neurofibromatosis Type 1 occurs due to abnormality in a gene for a protein called Neurofibromin. If either of the parents has NF-1, each of the children have a 50% chance of having the disease.u00a0 Surprisingly, neither Ali's mother nor his father have ever suffered from this complication. Doctors say this is a rare condition in a patient who has no family history of the disease.
"He was having multiple injuries in the spinal cord. He had cafe au lait spots and subcutaneous nodules since birth which were not bothering him. But for the past four months he noticed progressive pain and weakness in arms and legs," said Dr Sudhir Dubey, Head, Minimal Invasive Neurosurg-ery, Medanta, The Medicity, in Gurgaon.
Root of the problem
After initial examination doctors found tumours along most of his nerves, with a large one near the spine at the junction between head and neck. "The tumour was pressing the spinal cord and displacing the lower part of brain stem. He required excision of this tumour as it involved his respiratory centre, sensory and motor pathways of brain. The case had major challenges as any normal approach would have caused some collateral damage," added Dr Dubey.
The doctors then removed the tumour with an innovative spinal technique called Travelloscopic Spine Surgery. In the process, a travelling endoscope is used at various lengths during operating upon the patient. The endoscope travels outside to inside through a port to enable removal of the tumours from the nerves. "The port ensures minimal or no normal tissue disruption. This enabled us to reach the tumour directly without any bony disruption and while working through the travelloscope, we were able to remove tumour from outside as well as inside without even touching the spinal cord," said Dr Dubey.
Apparently, this is the ninth surgery in the world to have been conducted using this unique technique. Doctors feel that this is just another step towards robotic surgery. "Robotic Surgery is Neurosurgery has not been introduced in India. As the travelloscopic surgery is gaining popularity, soon we will see robots performing the surgery," said Dr Dubey.
Ali was discharged in third day from the hospital and was able to walk on his own, the very next day. "After the surgery, there was no numbness in my body and I was able to walk. It was an emotional moment for me. I am extremely happy that I will be able to walk again," said a happy Ali."Watching him walking on his legs was like a miracle for us. Looking at his previous condition, I used to feel so bad and helpless that I can't do anything for my brother. But now, I am thankful to god for helping my brother," said Mohammed Aid, Ali's brother.
All in the genes
Neurofibromatosis (commonly abbreviated NF; neurofibromatosis type 1 is also known as von Recklinghausen disease) is a genetically-inherited disorder in which the nerve tissue grows tumours (i.e., neurofibromas) that may be benign or may cause serious damage by compressing nerves and other tissues. The disorder affects all neural crest cells (Schwann cells, melanocytesu00a0 and endoneurial fibroblasts). Cellular elements from these cell types proliferate excessively throughout the body, forming tumours; melanocytes also function abnormally in this disease, resulting in disordered skin pigmentation and "caf ufffd au lait" spots. The tumours may cause bumps under the skin, coloured spots, skeletal problems, pressure on spinal nerve roots, and other neurological problems.
