The 66 year old woman was referred to Dr. Amitabh Goel as a case of progressive worsening of all four Limbs. On investigations it was found that she was suffering from severe compression off the cervical spinal cord which is accountable for most of the body movements below the neck including both arms and both legs. Due to this compression she was powerless to mover arms or legs for the last 1 and half month and had been bedridden. She also did not have any control over her bladder and bowel function and use to soil her clothes from time to time.
On MRI test it was found that she is having a main spinal tumor in the uppermost parts of her dangerous area of the neck which is compressing the main nerve exiting from the brain and displacing the critical structures backwards. The family was counseled and explained in full fact the need for removal of this seriously located tumor. Since the main nerve had been displaced backwards it was of Paramount importance that no damage to the nerve happens during surgery has the nerve was already severely compromised. 2 days and she was put on medication and pre anaesthesia check up and full detail was carried out by the senior and anesthetist.
This preanesthesia checkup is of critical importance because it helps in risk assessment of the surgery and also provides an opportunity to the person who is going to administer anaesthesia to talk to the patient before landing on the operating table. This PAC as it is called is a matter of routine at Metro Hospital Noida, as it prevents any surprises springing up at the last moment just before surgery.
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Adequate arrangement of blood products was made and only then was the patient shifted for surgical removal this is spinal tumor. It was also clearly mention to the family that in case complete removal of the tumor was not possible Hindi first operation she would need another procedure after a few weeks as it is critically important that no damage is done to the spinal cord which is a structure which has to be handled with utmost care, has any damage to the apus cervical spinal cord would not only cause permanent weakness of all the four Limbs loss of urine and stool control but also would significantly compromise her respiratory effort or in other words she may not be able to breathe at all because the muscles of breathing also supplied by the same Main nerve.
Explaining this to the family is never easy nevertheless has to be done so that one is aware of the criticality of the operation and what could go wrong in case the nerve gets damaged. However the family was forthcoming specially because they could see that she was getting worse by the day and would eventually have all those complications which are weakness of all four Limbs and difficulty in breathing if surgery is not done.
Having the full confidence of the family and support of senior anesthetists the procedure was carried out from the back of the neck after creating space to reach the tumor. As expected the tumor was almost completely covered by the spinal cord and the tumor had to be removed in bits and pieces so that the small space available by the side of the spinal cord was utilised to full effect. During these tense moments of surgery the anesthetist captive very close watch on the vital parameters of the patient because any injury this would have caused sudden drop and blood pressure and heart rate even without losing any blood.
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As the tumor was progressively removed it was found that it was arising from the anterior most part of the spinal canal. Its attachment or origin was also taken care of so that the tumor does not come back later. She recovered very well from anaesthesia and was able to communicate with Dr. Amitabh Goel she was given something to eat by the same evening. This gritty lady was able to move her arms and legs more effectively from the very next day and was walking which support after 2 days. She is likely to continue to make Rapid progress and her slim power and should be soon on her own as independent as she once was. Complicated neurosurgery has always been a team work, which Metro hospital Noida has even having for a very long time.
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