Patient with tumour treated using minimally invasive technique at city hospital

The neurosurgeons at Velammal Specialty Hospital here have performed a highly complex endoscopic skull-base surgery on a woman patient.

Speaking to media persons on Thursday, the doctors at the hospital said they had to remove a giant calcified brain tumour (meningioma), measuring 5.2 cm, located deep in the central part of the brain. The procedure was performed through the nose without opening the skull — a remarkable feat achieved only in a few centres worldwide.

The patient, a 50-year-old woman schoolteacher, arrived with severe headaches and vomiting for two months. MRI scans revealed a large calcified tumour situated close to critical brain structures, including optic nerves, cerebral vessels and hypothalamus. Traditional surgery using craniotomy posed significant risks.

Bagath Singh Karuppanan, senior neurosurgeon, noted that although his team had performed many endoscopic skull-base surgeries, this case stood out because of the tumour’s size, calcification, and proximity to vital blood vessels.

Using CT-PNS and MRI angiography–based navigation, the team accessed the tumour through a narrow endonasal corridor. High-definition endoscopes, skull-base micro-instruments and laryngeal coblators were used to remove the calcified mass with minimal retraction of brain tissue.

The dura and parts of the hypertrophied bone were carefully drilled and removed. After full excision, a vascularised nasoseptal flap was used to close the skull-base defect, preventing cerebrospinal fluid leakage.

The surgery lasted seven hours with a blood loss of just 250 ml. The patient recovered well and was discharged without complications. Follow-up CT and MRI scans after four weeks confirmed complete tumour removal with no residual calcification. At two years of follow-up, the patient remained symptom-free with no recurrence.

He said this case had been presented at multiple national neurosurgical and skull-base conferences and was recognised as a significant milestone in the field of advanced endoscopic neurosurgery.

To promote such advanced techniques, Velammal Specialty Hospital organised a Neuroendoscopic Cadaveric Dissection Workshop at Velammal Medical College recently as part of “Velammal AnatoCon 25”.

Around 15 senior skull-base neurosurgeons trained 25 young neurosurgeons, emphasising the importance of anatomical mastery for safe endoscopic skull-base tumour removal.

It was a medical breakthrough in Madurai and a proud moment for Indian neuro-endoscopy, Velammal Group chairman M.V. Muthuramalingam said, and appreciated the surgeons for the commendable work.