Santlal Pal with his wife Manju after the surgery. (Express) Santlal Pal with his wife Manju after the surgery. (Express)

A dailywage labourer with a head tumour measuring 30 cm x 30 cm x 20 cm — so large it seemed “like a head on top of another head” — was operated upon in Mumbai’s BYL Nair Hospital on February 14. Santlal Pal (31) underwent the surgery in the civic-run hospital after treatment in three facilities in Uttar Pradesh and Madhya Pradesh and after some waiting in the queue at Tata Memorial Hospital in Mumbai.

Pal was operated upon for six hours to remove the 1.87-kg tumour. In such surgeries, the patient faces the risk of massive blood loss. Pal required 11 bottles of blood. The biopsy report on the tumour is awaited. Pal is expected to be released later this week. He was in the ICU for three days after the surgery.

Dr Trimurti Nadkarni, head of the neurosurgery department at Nair Hospital, said the tumour “sat like a head on top of another head…. We had to cut through the bone. The sheer size of the tumour was a challenge and we

had to ensure blood pressure was maintained while surgery was on.”

According to some doctors in Nair Hospital, the tumour could be the largest to be removed from a brain in medical literature globally. The case is yet to be cited in any medical journal. The last two similar cases to be recorded in India were in KEM Hospital in 2002 when a tumour weighing 1.4 kg was removed from the brain, and in 2008 at Sir Gangaram Hospital, New Delhi, when a tumour measuring 16 cm x10 cm x 8 cm, and weighing less than a kg, was removed from a woman’s brain.

Pal, who is from Allahabad, felt a bump at the back of his head nine months ago. “In a month, it grew over an inch,” his brother Akhilesh Pal said. The family visited Kamla Nehru Memorial Hospital in Allahabad where Pal had previously been operated upon to remove a tumour in his left leg which was benign.

However, suspecting that the tumour may be malignant, Pal was put through a session of chemotherapy. The bump subsided, then grew again within a month. The family travelled to Rewa, Madhya Pradesh, where Pal tried Ayurveda. By then, he had already undergone two chemotherapy cycles. “He earns only Rs 9,000 a month. We could not spend a lot,” his wife Manju said.

When Ayurveda did not help, Pal returned to Uttar Pradesh. It was after a CT scan in Swaroop Rani Nehru Hospital, Allahabad, that doctors realised the tumour was by now too big and advised Pal to come to Tata Memorial Hospital in Mumbai. But here, the waiting list was too long, so Pal went to Nair Hospital on February 1.

A series of CT angiography, CT scan and MRI showed that the blood vessels in Pal’s brain had grown into the tumour, providing fresh blood supply to tumour cells. The tumour had also entered a part of his brain and started growing outside the skull bone.

“He would feel a heaviness in his head which ached constantly and his vision was blurred,” Akhilesh said.

Pal is also anaemic. Doctors at at Nair Hospital said if allowed to grow, the tumour could have led to vascular steal, a condition when blood flow gets diverted from one region to another, in his case from the brain to the tumour. The condition could be fatal.

“We get about 500 cases of brain tumour every year. Of these, at least 50 per cent patients come at an advanced stage. The tumour in Pal’s head grew so much because his surgery was delayed,” said Dr Srikant Balasubramaniam, who is with Nair Hospital’s neurosurgery department. Akhilesh said the family was hopeful Pal’s vision would

return.

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