Surgeons at Manipal Hospitals Bangalore have successfully removed a rare tumour of the nerve cells, ‘Paraganglioma’ which was secreting excess hormone and was present at the lower back, near the spine of 36-year-old patient, Jagadeesh Ratha.
A multidisciplinary team with specialised doctors from different streams got together to perform this complex surgery are Dr Praveen M Ganigi, Consultant, Neurosurgery, Dr Bopanna KM, Consultant, Neurosurgery, Dr Shabber Zaveri, Consultant, Cancer Care and Dr Karthik Prabhakar, Consultant, Diabetes & Endocrinology, Dr G S Nagaraja Prabhakar, Consultant, Anesthesiology.
Ratha, was on medication for hypertension since many years. He was facing recurrent lower back ache for the past one year and he had lower limb pain that was radiating for the past 8 months. He also reported to have lost weight over the past 6 months. Thorough investigation revealed that he was suffering from a spinal paraganglioma, with excess secretion of catecholamine hormone leading to hypertension.
Dr Karthik Prabhakar said, “According to a recent study, these kind of tumours are found in 2 out of every million people each year and are the cause of high blood pressure in less than 0.2% of people. Though in this case, it was a benign tumour, but excess release of catecholamine from the tumour in uncontrolled bursts could cause serious health problems like stroke, heart attacks and even death to the patient. Therefore, he required a multi-disciplinary attention.”
Speaking about the case, Dr. Praveen M Ganigi said, “Spinal paraganglioma is rare, with approximately 90 cases reported in the literature and can affect people between the ages of 30 and 50. The surgery was conducted in two steps, one from the front and another one from the back of the spine, taking a total of around 10 hours of complex surgery with constant monitoring of his vital sings”.
Dr G S Nagaraja Prabhakar said, “Since the urinary metanephrines’ value was on the higher side, we had to initiate adrenergic receptor blockers, along with appropriate antihypertensive medications for preoperative Blood pressure management. During surgery, hormones in the tumour could be released and could cause serious problems such as elevated blood pressure and pulse. We had to be alert and maintain his body stable at the time of the surgery”.
“For these kind of rare case of paraganglioma, complete removal of tumour by surgical resection is the first choice of treatment with or without radiotherapy. However, since paragangliomas are highly vascular lesions and in view of anticipated large volume blood loss, Jagadeesh underwent pre-operative endovascular embolization to cut off blood supply to the tumour” added Dr Shabber Zaveri.
As it was a spinal paraganglioma, it could also change the shape of the spinal cord, which could have been disastrous. Therefore, the doctors had to reconstruct the spine as well, post removing the tumour.
Dr Bopanna KM said, “Post surgery and upon review he was evaluated and was symptomatically better, mobilising independently and healing well with no fresh deficits. The patient underwent regular physiotherapy and was mobilised with thoraces-lumbar brace post the surgery as per the physical rehabilitation team and was discharged in a stable condition”
Expressing his happiness on the treatment, Ratha said, “I have recovered completely and now leading a happy and normal life all thanks to the team of doctors’ at Manipal Hospitals. This was a true example of success achieved via team work. All the doctors were extremely supportive throughout the procedure and gave me confidence to recover. I appreciate the efforts and commitment of the doctors.”