Rare tumour extracted from the 36-year-old patient at Manipal Hospitals Bangalore

Manipal Hospitals Bangalore achieved yet another medical marvel by successfully removing a rare tumor 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 specialized doctors from different streams got together to perform this complex surgery: 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.

Jagadeesh Ratha was on medication for hypertension for many years. He was facing recurrent lower backache for the past one year with radiating right lower limb pain for eight months. He also reported having lost weight over the past six months. Thorough investigation revealed that he was suffering from a spinal paraganglioma, with excess secretion of Catecholamine hormone leading to hypertension.

"According to a recent study, these kinds of tumors are found in two out of every million people each year and are the cause of high blood pressure in less than 0.2 per cent of people. Though in this case, it was a benign tumor, but the excess release of Catecholamine from the tumor in uncontrolled bursts could cause serious health problems like stroke, heart attacks and even death to the patient. Therefore, he required multi-disciplinary attention", said Dr Karthik Prabhakar, Consultant, Diabetes & Endocrinology, Manipal Hospitals Bangalore.

"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 ten hours of complex surgery with constant monitoring of his vital signs", said Dr Praveen M Ganigi, Consultant, Neurosurgery, Manipal Hospitals Bangalore.

"Since the urinary metanephrines' value was on the higher side, we had to initiate adrenergic receptor blockers, along with appropriate antihypertensive medications for preoperative BP management. During surgery, hormones in the tumor 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", said Dr GS Nagaraja Prabhakar, Consultant, Anesthesiology, Manipal Hospitals Bangalore.

"For these kinds of rare cases 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 tumor", added Dr Shabber Zaveri, Consultant, Cancer Care, Manipal Hospitals Bangalore.

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 tumor.

"Post-surgery and upon review he was evaluated and was symptomatically better, mobilizing independently and healing well with no fresh deficits. The patient underwent regular physiotherapy and was mobilized with thoraces-lumbar brace post the surgery as per the physical rehabilitation team and was discharged in a stable condition", said Dr Bopanna KM, Consultant, Neurosurgery, Manipal Hospital Bangalore.

"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 teamwork. All the doctors were extremely supportive throughout the procedure and gave me the confidence to recover. I appreciate the efforts and commitment of the doctors", expressed Jagadeesh Ratha.

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