African lady with severe, suicidal pain gets a new lease of life at Pune

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Pune 27th June, 2023 – A 54-year-old eastern African female patient got a new lease of life at Sahyadri Super Speciality Hospital, Deccan Gymkhana recently. This patient had an extremely rare and complex case involving a combination of Trigeminal and Glossopharyngeal Neuralgia along with large high flow Arterio-Venous-Malformation (AVM) of Cerebellum (a tangle of blood vessels that connects arteries and veins in the brain). Dr. Jaydev Panchawagh, an eminent brain and spine surgeon, treated her by a combination therapy of Angiography led Embolization followed by a brain surgery to remove the malformation completely and to relieve her of severe double neuralgia. The patient is now recovering well and enjoys a painless life at her hometown in Africa.

While sharing the case details, Dr. Panchawagh explained that Trigeminal Neuralgia, also known as ‘Suicide disease’ is the disorder with the infamous tag of “the worst pain that could be experienced by man” and Glossopharyngeal Neuralgia is another such severe pain syndrome. Thus, the case of this patient suffering with double neuralgia is a very rare and uncommon case the city has come across. This patient from Malavi was in severe pain of Trigeminal and Glossopharyngeal neuralgia since 4 years and she was on high doses of brain numbing medications and antidepressants. In addition, there was another challenge added to this case which was an Arterio-Venous Malformation (AVM) inside the brain (Cerebellum).

He added that AVMs are abnormal clusters of blood vessels that are tightly packed together in the affected area. These vessels lack the usual muscular layer and capillary structure, causing a fast and direct flow of arterial blood into veins, leading to abnormal flow rates. Removing AVMs through surgery in the brain is especially difficult as they often occur in critical areas and the brain’s blood flow regulation is very unique.

The procedure was done at Sahyadri Super Speciality Hospital, Deccan Gymkhana under the planning and guidance of Dr. Panchawagh and Interventional Neurologist Dr. Anand Alurkar. The team of medical experts devised a comprehensive plan to address both the debilitating pain and the underlying Cerebellar AVM located in close proximity to the affected nerves. In this multi-stage procedure, the team first performed Angiography-guided embolization to partially occlude the AVM. This technique involved the insertion of a thin catheter into the blood vessels supplying the AVM, followed by the injection of medical glue to occlude the vessels. Once the embolization was safely completed, the team proceeded with the removal of the AVM to eliminate the risk of continued bleeding.

In this case, the AVM was still receiving blood supply from multiple arteries within the cerebellum. Therefore, during the surgery, utmost care was taken to separate and preserve vital ‘transiting vessels’ that passed near the AVM. After an intense and intricate eight-hour surgery, the most crucial aspect remained—the separation of the blood vessels compressing the Trigeminal and Glossopharyngeal nerves, effectively treating the patient’s double neuralgia.

Dr Sunil Rao, COO, Sahyadri Hospitals, “The success of this procedure underscores the importance of meticulous planning, skilled execution, advanced neurosurgical techniques with medical expertise and unwavering commitment exhibited by the medical team. Our utmost priority continues to be delivering the highest standard of care to our patients.”

This complex Neurosurgery marks a significant milestone in the MVD surgery centre at Pune, offering hope for patients facing similar complex cases involving AVMs and neuralgia. The MVD surgery centre at Pune was spearheaded by Dr Jaydev Panchawagh and his team 18 years back is perhaps the only focused MVD surgery centre in India with experience of more than 2000 surgeries. The center is dedicated to excellence, innovation and research, teaching and patient education in the field of Trigeminal Neuralgia, Hemifacial Spasms, Glossopharyngeal Neuralgia, Intractable Tinnitus and Vertigo, collectively known as Neurovascular conflict syndromes.