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| NI FEATURE: CITADELS SCULPTING FUTURE - COMMENTARY |
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| Year : 2017 | Volume
: 65
| Issue : 6 | Page : 1366-1377 |
The Department of Neurosurgery, G. B. Pant Hospital, New Delhi
Anita Jagetia, Daljit Singh, Arvind K Srivastava, AK Singh
Department of Neurosurgery, G. B. Pant Hospital, New Delhi, India
| Date of Web Publication | 10-Nov-2017 |
Correspondence Address:
Dr. Anita Jagetia
Department of Neurosurgery, G.B. Pant Hospital, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.217980
The history of the prestigious Department of Neurosurgery, Gobind Ballabh Pant Institute of Medical Education Institute and Research, New Delhi, a leading tertiary care centre, is presented. Its eminent faculty and outstanding patient care attracts patients and students from all over the country.The patients opt for this institution to get a standard of care that may be comparable with the highest standards prevalent; and, the students achieve their goal of getting excellent education in Neurosurgery at par with the best institutes of the world. The department has, therefore, over the years, established its place in the country as a premier training facility and an epitome of medical excellence.
Keywords: G.B Pant Hospital, Gobind Ballabh Pant Institute of Medical Education Institute and Research, history, Maulana Azad Medical College, New Delhi, Neurosurgery
Key Message:
The article traces the history of the prestigious Department of Neurosurgery, Gobind Ballabh Pant Institute of Medical Education and Research, New Delhi, as well as the invaluable contributions of its eminent faculty and alumini.
How to cite this article:
Jagetia A, Singh D, Srivastava AK, Singh A K. The Department of Neurosurgery, G. B. Pant Hospital, New Delhi. Neurol India 2017;65:1366-77 |
Gobind Ballabh Pant Hospital, popularly known as G.B. Pant Hospital (GBPH) is a tertiary care center associated with Maulana Azad Medical College (MAMC), University of Delhi. Four hospitals namely Lok Nayak (LN) Hospital (Irwin Hospital), GB Pant Institute of Postgraduate Medical Education and Research (formerly G.B. Pant Hospital), Guru Nanak Eye Centre, and Maulana Azad Institute of Dental Sciences are affiliated with the Maulana Azad Medical College. The college, with its eminent faculty, high standards of education, research and patient care, attracts students from all over the country, who opt for this institution to achieve their goal of getting an excellent education in health sciences at par with the best institutes of the world. The college made a very humble beginning in the year 1958 with the starting of Irwin Hospital (now the Lok Nayak Hospital). The Maulana Azad Medical College, University of Delhi, is named after the great patriot, freedom fighter, educationist and the first education minister of India, Mr. Maulana Abdul Kalam Azad and has established its place in the country over the years as a premier institute of the country and an epitome of medical excellence.
The GBPH is named after the freedom fighter, Pandit Gobind Ballabh Pant. Its foundation stone was laid on 31st October 1961. The hospital was formally inaugurated by the erstwhile Prime Minister of the country, Pandit Jawahar Lal Nehru on 30th April, 1964 [Figure 1]. The hospital celebrated its golden jubilee in the year 2014 when a postage stamp was also issued to commemorate the occasion by the President of India [Figure 2]. With time, this institution has grown and has been providing affordable tertiary and quaternary health-care to citizens of Delhi, nearby states, and nations across the world, meeting international standards. This institution is today a leading super-specialty tertiary care center having incorporated the latest scientific and technological advances in health care, teaching and research activities. | Figure 1: Left: Clip from an article published in a national daily dated 29th April 1964 regarding the inauguration of the GB Pant Hospital. Right: Pandit Jawahar Lal Nehru at the inauguration of GB Pant Hospital with Dr. Sushila Nayyar, the Union Health Minister on 30th April 1964
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 | Figure 2: Left: The senior faculty members of GB Pant Institute of Medical Education and Research with the Vice-President of India, Dr. Hamid Ansari and the Lieutenant Governor of Delhi, Mr. Najeeb Jung as guests of honor, at the commemoration ceremony of 50 years of excellence in health care of the institute. Right: A postage stamp being released at a function organized in a hall at the Indian President's Estate related to the golden jubilee celebrations of GB Pant hospital.
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The GB Pant Institute of Postgraduate Medical Education and Research (GIPMER) is an ambitious project of the Delhi government, which strives for excellence and quality care rendered to all sections of society, especially the marginalized and poor sections of the society. The institute ensures that each citizen has access to good health care at either no or minimal cost with a humane approach. The appointments of the faculty members and the paramedical staff are conducted by the Central or Delhi government, and funds for running of the institution are provided by the government. The functioning of this hospital, therefore, is unlike other autonomous institutions, which have liberal funds and the liberty to equip themselves frequently from time-to-time. The institute offers super-specialty treatment to approximately 300,000 patients in the outpatient department (OPD) and 15000 indoor patients every year and the number is increasing exponentially.
| » The Voyage of the Department of Neurosurgery at the MAMC Campus | |  |
Before the existence of GBPH, neurosurgical services were provided at Irwin Hospital, one of the largest hospitals in Asia during the year 1936. Dr. Victor Rao, a neurosurgeon trained from Christian Medical College, Vellore, the first neurosurgeon in the city of Delhi, was performing neurosurgical operations at the Irwin Hospital (presently known as Lok Nayak Jai Prakash Hospital). He served in this hospital from 1960 to 1966. In 1964, the Department of Neurosurgery came into existence at the G. B. Pant hospital with the joining of Dr. A. D. Sehgal as an Associate Professor. He was the first formally qualified neurosurgeon joining G. B. Pant Hospital after acquiring his Diplomate Neurosurgery Certification from the American Board of Neurological Surgery at Cleveland Clinic Hospital, USA. He worked until 1967 and then continued working, thereafter, until 1968 as a senior honorary neurosurgeon at the G.B. Pant – Irwin Hospital complex. He was the first neurosurgeon who initiated the concept of establishing a private neurosurgical facility in the capital city of India, Delhi, and at the same time, started the concept of public-private partnership for the benefit of patients in the medical field. In 1968, Dr. R. M. Varma joined the department as an Associate Professor and Head of the Department and provided services until 1970 before he left the institution to join the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, as the Head of the newly established Department of Neurosurgery there. Dr. D. S. Mehta also contributed his services from 1970 to 1972 and helped in the growth of the department, before moving to Amritsar. His outstanding contribution towards the department was in maintaining meticulous patient records. Dr. Jawahar Dhar, who completed his M. Ch. Neurosurgery from the All India Institute of Medical Sciences (AIIMS), New Delhi, joined the department as the Lecturer and Head of the Department in 1972 and worked until 1974, when he left the country. Dr. D. N. Pal, from Calcutta, had joined the department in 1972 as a General Duty Medical Officer. He went on to do his M. Ch. (Neurosurgery) training from the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh in 1976. For the period from 1974-76, Dr. Pal headed the neurosurgical service at GBPH. Dr. A. K. Reddy, who completed his M. Ch. Neurosurgery from AIIMS, New Delhi, joined the department as Lecturer and Head of the Department in 1976. He was also keen on starting stereotactic neurosurgery and had ordered stereotaxy apparatus which, unfortunately was delivered after he had already left GBPH. He stayed on until 1978, following which he joined NIMHANS, Bangalore. Dr. D. N. Pal rejoined the department as a Lecturer in 1979 after completing his training. He served in the department until 1996 before retiring as Director- Professor. Dr. Sushil Kumar, after completing his M. Ch. Neurosurgery from PGIMER, Chandigarh in 1974, and having worked for a short while at Safdarjung Hospital, New Delhi, joined the Department in 1979 as an Assistant Professor and acting Head of the Department. Dr. Brahm Prakash, a visionary and an internationally renowned neurosurgeon, the first alumnus of AIIMS, Neurosurgery, New Delhi, who completed his neurosurgical training in 1968, joined this hospital in September 1980 as Professor and Head and worked until 1993, following which he took voluntary retirement. Thereafter, he started an independent neurosurgical centre at Lion's Hospital, Friend's Colony, Delhi, while at the same time working with Apollo Indraprastha Hospital as a Senior Consultant. He passed away in the year 2005 after suffering from carcinoma of the lung. Dr Sushil Kumar, who had also served for 3 years in the Indian Army before completing his MS (General Surgery) in 1983, initially joined the Rohtak Medical College as Professor and Head of Neurosurgery. Around 5 months after that, he re-joined G. B. Pant Hospital and continued to provide his valuable services to this department. Dr. Sushil Kumar took over charge as the Head of the Department of Neurosurgery in 1993 after Dr Brahm Prakash's retirement. He also worked as the Dean, Maulana Azad Medical College, New Delhi, from 31st August 2001 until his superannuation from Government services on 31st October 2002, after providing a long and meritorious service. Thereafter, he joined as the Head of Neurosurgery at Saint Stephen's Hospital, Delhi. His modesty and integrity made him an immensely popular personality in the campus. Dr. A. K. Singh, after completing his M. Ch. training from King George Medical College, Lucknow in December 1978 under the outstanding training program initiated by Dr. V. S Dave and Dr. D. K. Chhabra in Lucknow, joined the department in 1981 and worked until 2004, except for a short stint of 3 months at Sanjay Gandhi Postgraduate Institute of Medical Sciences, (SGPGIMS), Lucknow, in 1991 (when he had joined as Additional Professor). He was very keen to stay back in Lucknow but fate deemed otherwise. On the advice of his teacher, Dr. Dave, he joined the department headed by Dr. Brahm Prakash. The latter who was an ardent advocate of microsurgical techniques, was very keen to build up a department that included excellent surgeons. Dr. A. K. Singh took over as Head of the Department of Neurosurgery in September 2001 and was promoted to the post of Director Professor in 2003. He took premature retirement in 2004 to join a corporate hospital. Dr. Ajay Sharma joined the department in December 1985. He had completed his M. Ch. training from Christian Medical College, Vellore, in December 1982 and had joined Sree Chitra Tirunal Institute of Medical Science and Technology, Trivandrum, as Lecturer and continued in this position for over three years before making a northward move to G.B. Pant Hospital in 1985. He joined as Assistant Professor and rose through the ranks to later become Director Professor and Head of Neurosurgery after Dr A.K. Singh took voluntary retirement in 2004. He remained at the post of Head of the department until 2013. Dr Raj Kumar, an alumnus of this department, served in this department as Assistant Professor from 1990 to 1991when he left the department to continue his private practice in Neurosurgery. Dr. Sanjiv Sinha, after completing his M. Ch. from G. B. Pant Hospital in 1989, and after a short stay as Senior Research Associate, joined the Department of Neurosurgery G. B. Pant Hospital, as Associate Professor in 1995. Before joining GBPH, he was working in Ram Manohar Lohia (RML) Hospital, New Delhi, as Specialist Neurosurgeon until 1991. He was promoted as Professor and Director- Professor over the years. He took charge as Head of the Department in the year 2013.
After Dr Brahm Prakash superannuated, only 3 faculty members remained to conduct the activities of the Department, as appointments had to be made through the Union Public Sevice Comission; however, this scarcity of faculty positions was compensated by several faculty members who initially joined as Senior Research Associates through the Council of Scientific and Industrial Research, a temporary post in which a neurosurgeon could continue to be affiliated with the department for a maximum duration of 3 years. This gap in the increasing amount of clinical work at the G.B. Pant Hospital and the lack of sufficient number of faculty members was bridged by the joining of Dr. Daljit Singh as Associate Professor in the year 1999 after continuing as Senior research Associate in the same department. He has been a MAMC student all through his medical education including MBBS, MS (General Surgery) and (M. Ch. Neurosurgery). Further expansion of the department took place by the joining of Dr. Arvind K. Srivastava, as Associate Professor in the year 2002. He was an alumini of the GBPH 1991 batch. He worked as Senior Research Associate at GBPH following his M. Ch. and then joined RML Hospital as Specialist Neurosurgeon, before joining GBPH as a faculty member. In year 2006, three faculty members also started contributing their services to the department, working on a contractual basis, including Dr Anita Jagetia, Dr PN Pandey and Dr Pankaj Upadhaya. In the year 2007, through the Union Public Service Commission interviews, three more faculty members were added that included Dr. Anita Jagetia (who now became a permanent faculty member), Dr Rahul Gupta and Dr Hukum Singh. Dr. Rahul Gupta had undertaken his training in M. Ch. Neurosurgery from PGIMER Chandigarh while the other two faculty members had undertaken their training at GBPH itself. Dr Rahul Gupta resigned to join private practice after attaining the post of Associate Professor while Dr. Anita Jagetia and Dr. Hukum Singh have continued to work in the Department. There was a long gap of 10 years before any further addition to the faculty strength took place in the Department. During this decade, the department witnessed the sad demise of Dr. Sanjiv Sinha in year 2015, immediately following his appointment as Professor and Head of the Department; and, the superannuation of Dr. Ajay Sharma in year 2016. In 2016-17, four more Assistant Professors were recruited through the Union Public Service Commission including Dr. Wazid Nazir, Dr. Ghanshyam Das Singhal, Dr. Vikas Kumar and Dr. Shaam Bodeliwala. The present faculty strength consists of 8 faculty members, out of which 6 are alumni of the same institution [Table 1] and [Table 2]. A harmonious and cohesive working atmosphere exists in the department that has encouraged several young doctors to join here as faculty members as well as senior residents. The department is continuing on its path of advancement under the leadership of Dr. Daljit Singh, its Director-Professor and Head since 2015 [Figure 3], [Figure 4], [Figure 5]. | Table 1: The faculty members who have rendered their invaluable services over the years of existence of the department
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 | Table 2: The present set of faculty members of the Department of Neurosurgery, GIPMER
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 | Figure 3: Torch bearers and visionaries of the department: a. Dr. A. D. Sehgal, the first formally qualified neurosurgeon of the department (tenure: 1964-1967); b. Dr. Jawahar Dhar (tenure: 1972-1974); c. Dr. D.N. Pal (tenure: 1978-1996); and, d. Dr. Sushil Kumar (tenure:1980-1993).
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 | Figure 4: Torch bearers and visionaries of the department: a. Dr. Brahm Prakash (tenure: 1980-1993); b: Dr. A.K. Singh (tenure: 1978-2004); c: Dr. Ajay Sharma (tenure: 1985-2013); d: Dr. Sanjiv Sinha (tenure: 1989-2015).
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 | Figure 5: Dr. Daljit Singh, Head of the Department of Neurosurgery since 2015 and the Medical Superintendent of Neurosciences.
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Evolution of Neurosurgery at MAMC
The Department of Neurosurgery, GBPH has always been providing emergency services to the state of Delhi, including the management of patients suffering from traumatic brain injuries. The Neurosurgery services at LNH were delivered under the Department of General surgery until 1995, when Dr. Chetan Sharma, an alumini of GBPH joined as Specialist and Head, Department of Neurosurgery at LN hospital. Before that, the residents undergoing Neurosurgery training used to go to LN Hospital to perform neurosurgical operations with a set of autoclaved instruments. They used to perform direct carotid puncture cerebral angiography to locate the lesion and craniotomy based on the findings of angiogram using X-ray machine in the Radiology department. Dr. Victor Rao used to perform stereotactic biopsy and functional neurosurgery in the form of thalamotomy, using an old cumbersome stereotactic frame and was very skilled in the art of ventriculography in the early 1960's. Dr. D.N. Pal, even when he was alone, was managing trauma services for the entire state of Delhi. He was provided with an ambulance in which he used to carry his craniotomy set to various hospitals. This service to the society was remarkable and is unimaginable in the present day era.
The M. Ch. program in Neurosurgery was started in 1983 once Dr Brahm Prakash joined as Professor and Head, with 2 candidates inducted per year in the beginning. He worked as the inspiring force, which resulted in the department retaining the shape it has today. Due to his efforts, the department attained stability and acquired the visage of an academic and research center of national and international repute. Dr. Brahm Prakash was a very disciplined and punctual person and a meticulous record keeper. He used to start his ward round at 8.30 AM and everybody would try to join it on time. This used to be followed by the morning meeting every day at 9 am sharp. This meeting consisted of enquiries about all the new admissions as well as the operations done during the last day and the emergency calls attended. Attendance was also taken to ensure the presence of all members of the department. He would give instructions on what was needed to be done for the patients during the day. This strictness was resented by some faculty members but he paid no heed to their objections. The same practice has been followed thereafter and is still accepted today in a modern and a more polished way.
A very dedicated post-MS senior resident, Dr Lodha worked here for 2 years. Dr. B. S. Sharma, who later on became the Professor and Head of AIIMS, New Delhi, and Dr. R. C. Mishra who, later on, established the Department of Neurosurgery at SN Medical College, Agra, joined as senior residents in 1982. Dr. B.S. Sharma left the department to join the MCh Neurosurgery course in PGIMER Chandigarh after spending 6 months in the department. Dr. R.C. Mishra and Dr Subodh Hiran joined the GBPH as the first MCh students in 1983. The anaethesia team at that time consisted of Dr. Budhiraja and Dr. B K Rao as senior residents (Dr. Rao joined Sir Ganga Ram hospital in 1982 and eventually became the Chairman of that hospital's administrative board).
The start of the M. Ch program made a world of difference in the patient outcomes. Prior to the joining of senior residents in the M. Ch program, the infection rate hovered around 60% and the mortality around 40%. The high morbidity and mortality statistics were investigated closely by all members of the department working in unison. Processes such as operation theatre (OT) cleaning, OT sharing (as the OTs were shared between the Departments of Neurosurgery, Plastic Surgery and General Surgery), and instrument sterilization procedures were streamlined. Dr. Brahm Prakash succeeded in convincing the administration to allow the Department of Neurosurgery to exclusively start using the OTs, and the Departments of Plastic Surgery and General Surgery were shifted to the Irwin Hospital. Dr. Brahm Prakash had an able ally in Dr. Mehta, the renowned microbiologist, and together they discovered the pathogenic organisms that were infecting the OTs, identified and modified unhealthy practices and installed laminar flow systems in the OTs – the GBPH was the first hospital in the country to do so! Dr. A.K. Singh spent a lot of time with the nurses to change the instrument sterilization protocols and to ensure less visitors inside the OT. The arrival of M. Ch senior residents ensured a close surveillance of the operated and serious patients by informed and interested residents. They started recognizing the early warning signs and acting on those on an emergent basis. These measures helped to bring the infection and mortality rates down to acceptable levels. Dr. Brahm Prakash in Central/North India, and Dr. Sambasivan (at the Government Medical College, Thiruvanthapuram) in South India, were the two pioneering cerebrovascular surgeons in the country of that era. Besides his focus on vascular neurosurgery, his work on thalamic tumors and the approaches required to resect them were published in the journals of international repute. In the campus, all the arriving patients with subarachnoid hemorrhage were given preference and were operated on an emergency basis, as this was the only government institution providing surgical management of aneurysms at that time by clipping them. The first use of laser in Neurosurgery in India took place at the GBPH under his leadership and a workshop was also organized to recount its uses. Many students and faculty were benefitted by a foundation called Indo-Europa, which was formed with the help of Dr. Ashok K. Chauhan, a founder President of the Amity Group of Education in India. Dr. Sushil Kumar, a true academician, and a well composed, hardworking neurosurgeon, was well trained in percutaneous radiofrequency thermocoagulation treatment for trigeminal neuralgia and propagated this treatment modality. All kinds of surgery were being performed at GBPH such as oncological, cerebrovascular, posterior fossa and cerebellopontine angle surgery as well as surgery related to traumatic injury. However, spinal surgery was still in its infancy, which became established after Dr. A.K. Singh, an energetic and dynamic personality joined the department. He took the initiative to start different operative procedures and designed several new instruments in the department that the newer generation of doctors are still using. GBPH was given generous funds and equipment when Delhi had hosted the Asiad games in 1982 as GBPH was made the designated center for providing emergency cover. During those times, the corridors outside the store would be full of imported equipment waiting to be utilized. Dr A.K. Singh was the junior-most member of the team, and therefore, at that time, had the least amount of clinical work. He could, therefore, spend many useful hours browsing through the store and picking up all varieties of drills, plates, and other instruments. It made the surgical operations much easier for the department. He could perform the first transoral odontoidectomy in 1983 using a dental drill with a speed of 14000 revolutions per minute (the modern drill sytems work at a speed of 100,000 revolutions per minute). The handles and drill bits of the drill system were purchased from a dental equipment supplier, who would often not charge for them. Dr. A.K. Singh also performed the first median corpectomy using the same drill. Around 1987, the store officer provided 3 full sets of Anspach drills, all in 3 month's time. GBPH perhaps became the first Indian hospital to acquire this high-speed drill system, which became a boon for the neurosurgeons working in the department.
In 1981, the principal modes of investigation were the angiography, ventriculography, pneumoencephalography and myelography. The congregation of a combination of faculty members from different places in India served as an excellent impetus for the growth of Neuroradiology in this institution, and perhaps for this reason, this department became the center of excellence for neuro-interventional procedures as well as training. Radiology was headed by Dr. S. R. Sharma, Associate Professor, who was a recognized figure in the emerging field of Neuroradiology in India. Dr. S. Gupta and Dr. U. C. Pandey were the other faculty members who also contributed immensely to this field. All the neurosurgeons followed the practice of assembling in Dr. Sharma's room to discuss the previous day's radiology.
In 1984 – 85, the department got the first laser equipment and the ultrasonic surgical aspirators. GBPH was the first department in India where they were installed, and naturally, the department became the object of envy for all. Dr. Brahm Prakash conducted many international conferences on surgical management of neurosurgical patients utilizing ultrasonic suction aspirator and laser equipment. He was recognized as one of the pioneers and leading experts on the use of ultrasonic suction aspirator in India and abroad. Around the same time, the department had also obtained 2 operating microscopes and was among the first departments in India to get a video recording device that included a video recorder and a television to play the recorded operative movie. This equipment was indeed a novelty in those days.
Stroke surgery was routinely performed in the department, which included the procedure of carotid endarterectomy. Dr. D. S. Mehta, in the 1970's, performed the first carotid endarterectomy in GBPH, and perhaps in the whole city and state of Delhi.
This department was initially incomplete due to the non-availability of neuro-otologists, neuro-ophthalmologists and neuro-endocrinologists for the multi-disciplinary management of patients. However, this did not deter the faculty members of this department from performing procedures requiring an initial help from these sub-specialties. Dr. Arun Agarwal, Professor of the Department of Otorhinolarngology, LNH and the ex-Dean, used to come to the Neurosurgery OT to perform endoscopic repair for cerebrospinal fluid rhinorrhoea as well as the sublabial approach to the sphenoid sinus and the sella for excision of sellar masses. Neurosurgeons here got trained in these two approaches from him. Orbital masses were approached both cranially and through the minimally invasive approaches with the help of the Ophthalmology faculty members from Guru Nanak Eye Institute. Microvascular decompression for trigeminal neuralgia and hemifacial spasm were routine surgeries being performed in the 1990's. Skull base surgery for cerebellopontine angle region was being performed in all the three positions, namely sitting, supine and lateral. Majority of patients requiring surgery for irreducible atlantoaxial dislocation underwent a one-stage transoral excision followed by posterior fixation using implants that intially included a stainless steel wire; later on, the posterior fusion procedures graduated to the use of the titanium wires, contoured rods, and titanium rods and plates. An intra-operative ultrasound and transcranial Doppler was installed in the 1990s and lot of research work was carried out related to this field.
Pediatric Neurosurgery was started by Dr. Ajay Sharma who got trained in the UK. He has been a pioneer of Pediatric Neurosurgery in India and has performed surgery and maintained records of a large series of cases of spinal dysraphism and encephalocoele. Skull base approaches such as basifrontal and interhemispheric trans-lamina terminalis approaches for supra-sellar and intraventricular tumours as well as both infratentorial supracerebellar and posterior interhemispheric transtentorial approaches for pineal tumours were all well-established here by the 1990s.
When a C-arm intensifier with digital subtraction angiogram facility was approved for the GBPH in the year 1998, Dr. AK Singh ensured that the equipment be installed in the Neurosurgery OT [Figure 6]. He had the vision to envisage that this would be the future advancement in the field of cerebrovascular surgery. This vision is bearing fruits in the modern era of Neurosurgery. GBPH is among the very few centers in India where neurosurgeons are performing both open vascular and endovascular procedures. Initially, Dr. Anil Karapurkar, Dr. Shakir Hussain and Dr. Harsh Rastogi were kind enough to perform cases here as their patients were often not able to afford costlier endovascular treatment at private hospitals. This helped the young faculty and senior residents in learning the basics of the diagnostic and therapeutic endovascular procedures. Further boost to endovascular surgery was provided by Dr. Daljit Singh assisted by Dr. Anita Jagetia. Neurosurgeons and trainees interested in this field come here to get exposure and more than 20 neurosurgeons have started performing endovascular procedures after getting trained here. With the improvement in techniques, carotid endarterectomy has been replaced by carotid stenting. Majority of the anterior circulation aneurysms, however, are still clipped. | Figure 6: Left: Neuroendovascular laboratory inauguration in 2002. Dr. A.K. Singh, Dr. Sushil Kumar with the Health Minister, Dr. A. K. Walia; Right: Inauguration of “Cushing's ward” by the Health Minister, Dr. A. K. Walia on 30th April 2003.
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Endoscopic third ventriculostomy (ETV) was started in the late 1990's. The procedure of ETV in post-meningitic hydrocephalus was first supported by Dr. Daljit Singh (who also published his experience regarding this indication in the literature). He was initially very much criticized for advocating the use of ETV for post-meningitis hydrocephalus but later got the support of several of his colleagues in Neurosurgery. The number of patients undergoing aneurysm surgery has increased tremendously over the last one decade. This has led to several neurosurgeons developing a keen interest in this field as they have learnt to clip even difficult aneurysms in the initial years of their career. They have the liberty to decide which procedure, either open or endovascular, is beneficial for the patient.
There was further advancement in the field of spine surgery when Dr Sanjiv Sinha completed the Sugita Fellowship from Japan. Expansile laminoplasty, minimally invasive spine surgery, endoscopic spine surgery, rigid cranioverebral junction instrumentation were the procedures that were established in this field. Since this hospital has been dealing with many patients of the lower socio-economic strata, many cases with central nervous system infection, such as postmeningitic sequele or Pott's spine are often encountered. The department has published a large series on tuberculosis of the craniovertebral junction and on extra-cavitatory approaches to the spine.
Leksell's stereotactic frame was procured by the department and Dr. Arvind K. Srivastava underwent training in this field from Amsterdem Medical University. His keen personal interest in this field led to the resurgence of stereotactic surgery. During the same period, a team of neurologists, Dr. Vinod Puri and Dr. Neera Choudhary; neurosurgeon, Dr. Daljit Singh; and, neuro-anesthetist, Dr Pragati Ganjoo, along with sister Beena Malhotra, got trained in epilepsy surgery at the Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvanthapuram. Over 100 cases suffering from intractable epilepsy have been operated since then. The utilization of indocyanine green microscopy, intraoperative microvascular Doppler, 5-aminolevulinic acid assisted excision of brain tumor and endoscopic skull base surgery have been added to the armamentarium of Neurosurgery.
GBPH has always had the good fortune of having a vibrant Neurology department, which was initially headed by Dr. Janaki. The department has been conducting the DM Neurology program for quite some time. Dr. Meena Gupta completed her D.M. in Neurology in 1981 as the third batch resident and joined the department. Dr. Vinod Puri, along with Dr. Vinod Arora, were in the next batch, and Dr. M M Mehndiratta and Dr. L K Malhotra were in the subsequent batches. Dr. Meena Gupta became the Head of the Department in 1985 (after all her seniors left service!). Dr. Ravi Nehru joined the department in 1985. Being a formally trained psychiatrist and a self-trained neuro-linguist, and the philosopher of the group, he has remained a friend and guide for many budding neurologists.
Conferences and society
In 1986, the department hosted the annual conference of the Neurological Society of India in MAMC. This was a well-attended conference where for the first time, the video recording of the entire conference was conducted. The first conference of the Skull Base Surgery Society of India was conducted in the year 1998 and was organized at Vigyan Bhawan, New Delhi, by the department. A series of international courses in the field of Neurosurgery were also initiated to teach the recent advances to the young neurosurgeons. Many renowned faculty from India participated in those conferences. Later, Instructional Courses in Neurosurgery (ICINS) were started by Dr. A.K. Singh and numerous other conferences were also organized by the department to promote educational activity [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]. | Figure 7: Inaugural conference of Skull Base Surgery Society of India at Vigyan Bhawan in 1997.
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 | Figure 8: The First International Clinic of Neurosurgery 2000 (the Indo-Canadian Symposium) at G.B. Pant Hospital. Mrs. Sheila Dixit, the Chief Minister of Delhi, Dr. A.K. Walia, the Health Minister, Dr. S.P. Agarwal, Director General of Health Services, with Dr. Mandal and Dr. Sushil Kumar.
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 | Figure 9: Memories of ICINS. G.B. Pant Institute of Medical Sciences organizes a conference once in two years that focuses on various topics of neurosurgery with eminent faculty from India participating. a. The First ICINS held in 2012 with Dr. Atul Goel as the chief faculty. b. Hands-on workshop on the usage of high-speed drills. c. Dr. Sanjay Behari from SGPGIMS, Lucknow; and, d. Dr Shashank S. Kale from AIIMs, New Delhi, interacting with the delegates.
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 | Figure 10: Left: Delegates at the Third ICINS; Right: Dr. Anil Karapurkar was the chief faculty in this workshop that focused on neuroendovascular procedures in Neurosurgery.
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 | Figure 11: The Brain Tumor Awareness Week was organized in November 2010.
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The credit for the registration of the Delhi Neurological Society (DNA) goes to Dr. A.K. Singh. After several brain storming sessions and initially facing resistance, Delhi Neurological Association (DNA) was formed in the year 1998, and Dr. A. K. Singh was appointed the first secretary of this body. The current logo of the DNA was sketched and designed by Dr. Daljit Singh. Dr Sanjiv Sinha and Dr. Daljit Singh have been Secretaries of DNA, Dr A.K. Singh and Dr Ajay Sharma have been its Presidents, and Dr. Daljit Singh is the current President for the year 2017. Dr Hukum Singh had been an executive member of the same society [Figure 13]. More than 50 national and international conferences have been organized by the department [Figure 13] and [Figure 14]. | Figure 13: The First Delhi Neurological Association meeting being held at GBPH conducted by Dr. A.K. Singh with Dr. Rashid Jooma, Director General Health Services, Pakistan (sitting in the left corner) in March 2011
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 | Figure 14: Dr. Veena Chaudhary, the Director of the Institute at the inauguration of the modular operation theatres and intensive care unit in January 2008
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Infra-structure and Training Program
The faculty, under the dynamic leadership of Dr. Brahm Prakash, and the other leaders who followed in succession, expanded the scope of activities of the department. M. Ch. in Neurosurgery was started at G. B. Pant Hospital in 1983 with enrolment of two candidates per year and remained a two-year course until 1998. Thereafter, it became a 3-year course with an increase in the number of candidates to four, and in the year 2010, the number of candidates was increased to six. The M. Ch. (Neurosurgery) program was affiliated to University of Delhi. One hundred and seven students have completed their M. Ch training from this institution until 2017.
Until the mid-1990's, the outpatient department (OPD) used to be conducted 2 days a week in the old building, which changed to every working day thereafter, due to an increasing number of patients and the political pressure. Outdoor patient attendance increased year after year as the popularity of GBPH increased. In the year 2010, a new OPD complex was inaugurated under the leadership of the eminent, and dynamic director, Dr. Veena Chaudhary (who was also the Director- Professor of Radiology, MAMC) [Figure 14].
Two major OTs and one minor OT were activated at the inception of the department, which increased to six in number in the year 2007 [Figure 15], [Figure 16], [Figure 17], [Figure 18]; however, all 6 OTs were never functional due to shortage of staff in the Department of Anesthesia as well as the shortage of nursing and technical staff members. The operation theatres are functional 24 hours a day, in which routine and emergency operations and angiography and endovascular interventions, are regularly conducted. Running of the OT on a 24-hour basis is possible only due to the dedicated efforts of the hardworking staff of the department. A few of the many hard working people include Sister Washington, Sister Panjy, Sister Beena Malhotra, Sister Jyotsana; and, the OT technicians, Mr. Tiwari, Mr. Raghupati, Mr. Shri-Bhagwan and Mr Nand Lal [Figure 19] and [Figure 20]. | Figure 15: Inauguration of the old operation theatre complex by Smt. Shiela Dixit, the Chief Minister of Delhi
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 | Figure 16: Equipment used during the initial period of development of Neurosurgery.
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 | Figure 17: The Neurosurgery operation theatre and intensive care unit before 2007. The patients are being cared for on trollies.
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 | Figure 18: After the year 2007, the upgraded OT complex consisting of 6 modular OTs dedicated to Neurosurgery with a 22-bedded intensive care unit were established.
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 | Figure 20: Sister Washington with team. Photo courtesy Sister Pancy Chauhan
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Six modular OTs and a 21-bedded intensive care unit are providing a comprehensive subspecialty care to the patients in several neurosurgical subspecialities including pediatric, vascular, endovascular, spine, minimally invasive, endoscopy, skull base, stereotactic surgery, neuro-oncology, functional and epilepsy surgery, and surgery for brachial plexus injury.
The students who passed out from this center occupy positions of authority all over India and abroad. This includes six faculty members in this department itself. Dr. R.C. Mishra (Professor and ex- Head of SN Medical College and Hospital, Agra), the first-batch alumnus, and Dr. Deepu Banerjee, the second batch alumnus of the institution, have held the post of President of Neurological Society of India, one of the most prestigious and oldest medical societies of India. The Delhi University has awarded the degree of M. Ch. Neurosurgery to two women neurosurgeons, namely Dr Zehra Hussain and Dr Anita Jagetia, in a men-dominated field.
The Neuro-anesthesia team has been very efficient from the time of Dr. Brahm Prakash. Dr. Joseph used to give anesthesia for the patients of Dr. Victor Rao, who used to perform mainly ventriculoperitoneal and ventriculoatrial shunts. Dr Budhiraja, and Dr Mary Abraham were the pioneering faculty members responsible for establishing the guidelines for neuro-anesthesia; later Dr. Rajiv Chawla (the present Director-Professor in the Department of Anesthesia), Dr Pragati Ganjoo and Dr Monica Tandon have made significant advances in the field of neuro-anesthesia despite the limited resources available. At the same time, they have trained several residents in neuro-anesthesia. These students have proceeded to excel in their field after completing their residency at GBPH and are posted in reputed institutions. The efficient Neuropathology department initially included Dr Medha Tatke, who was later on joined by Dr. RK Saran and Dr. Vinita. Dr. Medha has been a very meticulous, polite and a diligent pathologist, who took voluntary retirement after providing excellent services for a number of years.
At present, the Department of Neurosurgery has a faculty strength of eight members [Figure 21] with an intake of six registered M. Ch. students per year for a three-year course. On an average, 1800 neurosurgical operations are being performed annually. The department extends their services to the Sushutra Trauma Center under the Delhi government, and has been providing services to the LN hospital as well as other hospitals of Delhi [Figure 22], [Figure 23], [Figure 24]. | Figure 22: The trends of in-patient admission of patients over the years.
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 | Figure 23: The trends of the neurosurgical procedures performed in the department over the years
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 | Figure 24: The trends of increasing out-patient department attendance of patients over the years
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Faculty achievements
The faculty of the department have been organizing various social activities such as the brain tumor awareness week and meeting for paying tribute to soldiers who have sacrificed their lives in various wars [Figure 25]. The faculty has been decorated with various achievements such as the Commonwealth Fellowship, the International Fellowship on Pediatric Neurosurgery, the Indo-German Fellowship, the World Health Organization Fellowship, the Sugita Fellowship, the Stereotactic and Functional Neurosurgery Fellowship, the Epilepsy Fellowship, the Endovascular Fellowship, the Dr. Sano Cerebrovascular Fellowship, the Fellowship of Fujita University, Dr. BC Roy award [Figure 26] as well as an entry into the Limca Book of Records [Figure 27]. | Figure 25: Among the social activities conducted by the department, Dr. Sanjiv Sinha is with families of army personnel at a function organized in memory of army soldiers who paid the supreme sacrifice in the proxy war in Kashmir
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 | Figure 26: Dr. Daljit Singh (middle row standing, fourth person from the right) being awarded the Dr. B.C Roy award by the President of India, Shri Pranab Mukherjee
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 | Figure 27: The doctors of the Department of Neurosurgery, GBPH remove a large brain tumor to have their feat recorded in the the Limca book of records
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Acknowledgement
We are thankful to Dr Sushil Kumar (Retired Professor and Head of Neurosurgery), Dr Rajkumar (Ex-Assistant Professor), Dr Pragati Ganjoo (Professor of Anesthesia) and Dr. Vikrant Sethia (Senior Resident in the Department of Neurosurgery) for their advice and support in collating the facts for this manuscript.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17], [Figure 18], [Figure 19], [Figure 20], [Figure 21], [Figure 22], [Figure 23], [Figure 24], [Figure 25], [Figure 26], [Figure 27]
[Table 1], [Table 2]
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