The Department of Neurosurgery, Grant Medical College and Sir J.J Group of Hospitals, Mumbai
Keywords: Grant medical college, Mumbai, Maharashtra, history of neurosurgery
The rich history and the immense contributions of faculty members and residents of the Department of Neurosurgery, Grant Medical College and Sir J.J. Hospital, Mumbai are documented in this article. Since its inception in 1958, the department has fostered its efforts for providing services to the lesser privileged section of the community [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d. The department renders its super specialized services to the needy people from all over India. This includes patients from Maharashtra, Goa, Karnataka, Andhra Pradesh, Uttar Pradesh, Bihar, and Madhya Pradesh.
Our department has continued with its uninterrupted services to the community including the successful treatment of the most complicated and challenging cases referred for tertiary care to our department. The department has the latest and sophisticated biotechnological armamentarium, which includes intra-operative ultrasonography [GE electronics], neuronavigation system for spine and brain [Medtronic], radiofrequency generator, Leica OH5 and Zeiss OPMI Pentero microscopes, neuroendoscope [Karl Storz], and neuromonitoring. Our efforts for providing better services to patients have further been strengthened by the presence of a monoplace hyperbaric chamber in our department. Our department is a well-equipped super-speciality unit.
The department has continued to perform complex cranial and spinal surgeries with excellent results as the flow of patients continued unabated from all over the country. The Rajeev Gandhi Jeevandayee Arogya Yojana [RGJAY]/Mahatma Jyotiba Phule Jeevandayee Arogya Yojana [MJPJAY] which enables the poor and the middle-class patients of the community to avail free Neurosurgery treatment through the government insurance policy was further expanded to involve all districts of Maharashtra state.
In the year 2017, the department acquired a new Leica microscope OH-5 with indocyanine green and immuno-fluorescent technology for brain tumor and aneurysm surgery. The department acquired ethical committees' permission for a path breaking research project on a novel procedure to avoid shunt surgery in patients with hydrocephalus. The department continues to conduct Cadaveric Workshops every year so as to train young neurosurgeons from all over India. 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.
Dr. Gajendra Sinh, a prodigy of Grant Medical College started the Department of Neurosurgery at the J.J. Hospital in the Yellappa Balaram Pavilion in the Sir David Sassoon Building in 1958. He underwent training in Neurosurgery between 1955 and 1957 at Christian Medical College Vellore, along with Dr. Jacob Chandy.,
On his return, he was allotted four beds in the surgical wards of Yellappa Balaram Pavilion in David Sassoon building. The Radiology Department was in the adjacent out-patient's building and taking patients to-and-fro for ventriculography and angiography was time-consuming and nerve-wracking. Neurosurgical operations were conducted in General Surgery operation theater after the completion of their list.
Neurosurgery department was allotted 45 beds on the 4th floor of the new JJ hospital building in 1961, which included Ward 24 (for women and children) and Ward 25 (for men) on the fourth floor of the “new” J.J. Hospital building. The neurology wards (Ward 23 for men and Ward 24 for women and children) were also on the fourth floor. Sister Biwalkar was in charge of the male neurosurgery ward. Strict with resident doctors, nurses, and other staff, she was greatly concerned about the welfare of patients under her care. She kept herself well informed about the condition of each of her patients and would often guide neurosurgery residents regarding their treatment. The operation theaters designed by Dr. Gajendra Sinh had Sister Gaikwad in charge and were on the fifth floor.
Neurology with Dr. N.H. Wadia as its head was also given 30 beds in ward 23 for male patients and 15 beds in ward 24 for female patients on the same floor adjacent to neurosurgery wards. Thus, the 4th floor north wing of the new J.J. building was dedicated to Neurology and Neurosurgery. There was a seminar room for clinics, and meetings office rooms for staff to sit and discuss and rooms for electroencephalography (EEG) and electromyography (EMG). The neuropathology unit of Indian Council of Medical Reaserch (ICMR) under Dr. Darab Dastur was shifted from Tata Hospital to the Sir J.J. Hospital campus in the Postgraduate Laboratory building. This was the first fully dedicated neuropathology unit in the country. Dr. Dastur would conduct weekly brain cutting sessions and the residents of the concerned unit would present the case history, which was correlated with the brain section. After the death of a patient, it was compulsory for the resident doctor to attend the post mortem study and see to it that the brain was sent to the neuropathology unit for fixation. Dr. Dastur would personally conduct these sessions which were very informative and interesting.
The Department of Neurosurgery had the support of neurology, neuropathology, neuroradiology, and neuro electrophysiology services. Late Dr. V. L. Buch and Dr. Gangal (from Nepal) were Dr. Gagendra Sinh's early registrars. In 1962, Dr. S.N. Bhagwati and Dr. Vijay S. Dave were appointed as honorary assistant neurosurgeons after their training in London and Canada, respectively.
Hailing from a princely family, Dr. Gajendra Sinh had royal tastes, a need for perfection and impatience with bureaucracy and officialdom. Dr. Dave was down-to-earth, patient, gentle and modest. Their mutual respect was obvious. Dr. Gajendra Sinh had his British training in thoracic surgery and his training in neurosurgery under Dr. Jacob Chandy. Dr. Dave brought to the department all that he had learnt from Drs. Wilder Penfield, William Cone, Theodore Rasmussen, Arthur Elvidge, Herbert Jasper, and others at the Montreal Neurological Institute.
Dr. Gajendra Sinh created a library in the department office in Ward 25 where he placed all his books on neurosurgery, issues of the Journal of Neurosurgery and other relevant publications for his residents to use.
Since the hospital did not have instruments needed for neurosurgery, Dr. Gajendra Sinh had purchased, from personal funds, sets needed for procedures such as drilling burr holes, performing a laminectomy, and performing a craniotomy. These sets were deposited in the operation theaters for use by any member of his staff. He also purchased and kept his Asahi Pentax Spotmatic camera in the department so that his residents could use it for photographing interesting patients, specimens, and make slides for teaching. He also kept his Olivetti portable typewriter in the department office to help his residents prepare summaries on each patient for the departmental records. One copy of each record was sent to the Medical Records Department headed by Dr. Freny Marker.
Dr. Sinh was strict about a number of matters: the care of patients, maintenance of records, discipline, courtesy to everyone in the department, and respect towards the nurses. The suggestions of Sister Biwalkar and Sister Gaikwad were always gravely acknowledged and their suggestions for the improvement of the department implemented as soon as possible. He kept in touch with Sister Biwalkar after she retired and soon inducted her into Jaslok Hospital as the Matron. He later continued to provide help to both these admirable nurses right up to their deaths.
He replaced the lumpy cotton mattresses on all our beds in Wards 24 and 25 by foam rubber mattresses, using his own funds and those donated by well-wishers. This step greatly reduced the incidence of pressure ulcers in bed-ridden patients. He set up a three-bed neurosurgery intensive care room near the entrance to Ward 25.
After Dr. Noshir Wadia (Head of Neurology) demonstrated the high incidence of cranio-vertebral anomalies in patients attending J.J. Hospital, Dr. Gajendra Sinh developed surgical operations for their treatment. Along with Dr. Wadia and Darab Dastur, he also worked on tuberculosis of the central nervous system.
Drs. Noshir Wadia and Gajendra Sinh at J.J. Hospital, Drs. E.P. Bharucha, Homi Dastur and Anil Desai at K.E.M. Hospital and Dr. Vijay Daftary at Nair Hospital intiated clinical neurology meetings, starting at 2 pm on the second Saturday of each month. They were held in rotation at each of these three hospitals. Dr. Jimmy Sidhva and Darab Dastur were enthusiastic participants once they joined the hospital staff. These meetings continue to this date and serve as a source of considerable enlightenment, especially to the resident doctors in the various neuroscience departments.
In 1963, Dr. Sunil Pandya joined the Department of Neurosurgery as registrar under Dr. Gajendra Sinh. Later in 1967, Dr. Pandya joined the KEM Hospital as assistant neurosurgeon under Dr. Homi Dastur and subsequently became Head of Neurosurgery department.
In 1964, Dr. Ram G. Ginde was appointed as Professor of Neurosurgery and was made head of second unit of Department of Neurosurgery at J.J. Hospital. There were now two units in neurosurgery. He worked here till he retired at the age of 58 years in 1970.
Dr. S.N. Bhagwati, who had returned after training in neurosurgery with Mr. Wylie McKissock at Atkinson Morley's Hospital in London, was appointed assistant to the Director. Soon thereafter, Dr. Vijay Dave was transferred to Dr. Ginde's unit and Dr. Bhagwati made assistant to Dr. Gajendra Sinh. In 1967, Dr. Dave left for Lucknow, where he had been appointed Head of the Department of Neurosurgery at King George Medical College and Hospital. He continued in this post till his retirement in 1989. In 1970, Dr. S.B. Yodh who was trained at Toronto and then in Boston at Harvard Medical School under Dr. William Sweet was appointed as Honorary Assistant Neurosurgeon. Dr. Gajendra Sinh retired from his alma mater in 1977.
Dr. S.N. Bhagwati took over from Dr. Gajendra Sinh after his retirement in 1977 [Figure 2]a, [Figure 2]b, [Figure 2]c. During his tenure, Dr. S.N. Bhagwati procured a Carl Zeis OPMI microscope, Codman bipolar cautery and fiber optic head lamps in early 80s. He worked on central nervous system (CNS) tuberculosis that was very prevalent in those days. Hydrocephlaus in tuberculous (TB) meningitis used to be diagnosed by ventriculography. This research was published in the Journal of Neurosurgery in 1967. At that time, ventriculo-atrial shunts were done which were gradually replaced by ventriculo-peritoneal shunts. Many continuing educational programs (CME) were organized by him to update the knowledge of post graduate students. Invited guest faculty members for these CME were Dr. Pia, Dr. Gaab in 1980, Dr. Samii, Dr. Jules Hardy, Dr. Sengupta, and Dr. Bates in 1982 [Figure 3]a, [Figure 3]b, [Figure 3]c, [Figure 3]d, [Figure 3]e. Dr. S.N. Bhagwati became the member of International Society for Pediatric Neurosurgery (ISPN) in 1974 and presented path-breaking papers on congenital atlantoaxial dislocation (AAD), shunts and its complications, intracranial tuberculomas, optic pathway gliomas, and brainstem gliomas. He started the Indian Society for Pediatric Neurosurgery in 1989 and became the president of Neurological Society of India in 1989.
Dr. Manoj Virani became the Head of Department in 1986 after the retirement of Dr. S.N. Bhagwati. Dr. Virani was the aluminus of Grant Medical College and also had worked as a registrar under Dr. Gajendra Sinh. He was later appointed as an Honorary Assistant Professor of Neurosurgery in 1973. He became an Honorary Professor of Neurosurgery in 1977 and was the Head of the Department from 1986 till September 1994.
Dr Virani had done fellowship at the Cleveland Clinic International Center, USA, in 1979, and had worked with Dr. Peter Janetta, being trained in microvascular decompression (MVD) in the management of trigeminal neuralgia. On his return to India, he started the procedure of MVD for trigeminal neuralgia at Sir J.J. Hospital Mumbai. The first case series on the role of microvascular decompression in trigeminal neuralgia was published in the journal, Neurology India, in 1985 (Retromastoid microsurgical exploration for tic douloureax Vol. 33, No. 2, Pgs 97-107 by Virani and Palande June, 1985). He also wrote a chapter on microvascular decompression in the revised edition of Textbook of Neurosurgery, edited by Prof B. Ramamurthi and Prof P.N. Tandon in 1993. He also started the trans-sphenoidal approach to the pituitary tumors at J.J. Hospital. He was the first person to start video-endoscopy in Neurosurgery in a case of intraventricular arachnoid cyst, which was operated on October 4th, 1990. He also started the transoral surgery for AAD and presented video presentations of these procedures at the XI Annual Conference of Neurological Society of India at Manipal in 1991. Videoendoscopic neurosurgery (A prospective study of 55 patients) was published in Neurology India, Volume 46, No. 1, March 1998. Under the guidance of Dr. Virani, Dr. Palande procured video endoscopes from Storz, ultrasonic surgical aspirator, Maquet operation tables, monitors, bipolar cautery machines, ventilators, high speed drills, C arm X-ray image intensifiers (Shimadzu), operation theatre lights, a computed tomographic scan, and upgraded the Neurosurgery operation theatre at J.J. Hospital. Dr. Virani took retirement in September 1994 and handed over the baton to Dr. D.A. Palande who was working as a full time Associate Professor under him.
Dr. Deepak A. Palande became the Head of the Department in September 1994. He had joined the department as Lecturer in 1979 and was appointed Associate Professor in 1988. He was the first full time Head of the Department, as all the previous professors were Honorary Consultants to the department. Dr. D.A. Palande was the chairman of the purchase committee for the equipment under Rajiv Gandhi scheme. He was instrumental in getting ultrasonic surgical aspirator, microinstruments, C arm image intensifiers, ventilators, a stereotactic frame, suction machines, bipolar cautery machines, a CT scan, OT lights, and maquet OT tables under the scheme. Video endoscopic neurosurgery equipment were also purchased from Storz. Thus, our Department of Neurosurgery became one of the most sophisticated neurosurgical set ups of the country. Procedures like microdiscectomy, video endoscopy, and stereotactic surgeries were being performed. Anesthesia equipment and monitors were upgraded. Dr. D.A. Palande started performing microvascular decompressions, transoral, transthoracic, cervical/lumbar microdiscectomies, and trans-sphenoidal surgeries.
Furthermore, equipment like Aesculap cautery, pneumatic drill, OT light (Merilux), Mizuho OT table, high pressure sterilizer, C-arm system, and defibrillator were procured under Japanese International Cooperation Agency (JICA) project in 2004–2005. Dr. D.A. Palande retired in the year 2007 and continued to work as Professor and Head of Unit II on a contract basis till 2014 on the request of the Dean. Under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), he was instrumental in purchasing many equipment in 2007. During this period of 7 years, he has shared his valuable experience with Dr. Vernon Velho who is now the Head of Department.
Dr. Vernon Velho had joined the department in 2000 as Lecturer after getting selected through the Maharashtra Public Service Commission selection procedure. He had done his M. Ch training at the Lokmanya Tilak Municipal Medical college and Hospital (LTMMCH) at Sion, Mumbai where he had more exposure to neurotrauma cases. His training on the neurosurgical microscope was infantile. Here at J.J. Hospital, the Department of Neurosurgery was bigger, with more bed strength, a separate floor for operation theaters, wards, and all other neurological facilities like conducting an electromyogram (EMG) and an electroencephalogram, unlike at LTMMC Sion. The wards here were filled with patients of various neurological diseases. He could also learn and perform various endoscopic neurosurgical procedures under the guidance of Professor D.A. Palande. These surgeries, unlike those of spine and trauma, lasted for longer hours, under the care of the full-time and qualified neuro-anesthetist, Professor Bharati Kondwilkar.
He was promoted as Associate Professor in 2005 and administrative responsibilities increased by many folds as he took over as Head of the Department in November 2007 after the retirement of Professor D.A. Palande. The shortage of full-time staff members resulted in an increased workload and surgeries per day with only few basic equipment available at that time.
The department started to grow as he continued the ideals and methodologies of his mentor Dr. Palande. He focused on patient care, resident training programs, and projection of the work done by the department through paper presentations and publications. He was monumental in buying instruments like ultrasonic instrument cleaner, stereotactic frame, intraoperative ultrasound, image guidance system for brain/spinal cord lesions, radiofrequency generator, operation table (Trident) under the PMSSY in 2009. Further in 2010, he also procured the Zeiss OPMI PENTERO Surgical microscope, neuro- endoscope (Storz), plasma sterilizer, Sonastar ultrasonic aspirator, and KLS Martin LEDT OT double dome light in 2015–2016. The deep brain stimulation (DBS) system was also added in year 2015 from the funds of the Mumbai Metropolitan Region Development Authority (MMRDA). A neurosurgical operating microscope (LEICA OH5) was added into the vast armemantarium of our neurosurgical equipment in 2017. The installation of the biplanar digital subtraction angiography (DSA) unit under the Radiology Department has increased the number of vascular cases being treated in the department. With all these equipment, the quality of service to the patients has increased manifold.
Under his leadership, there has been a continuous growing trend of increased admissions, surgeries, paper presentations, and publications every year. The department has organized two alumni meets in 2008 [Figure 4]a, [Figure 4]b, [Figure 4]c, [Figure 4]d, [Figure 4]e, [Figure 4]f, [Figure 4]g and 2018 [Figure 5]a, [Figure 5]b, [Figure 5]c, [Figure 5]d wherein alumni from various batches from all over the India participated and shared their experiences and memories associated with the hospital [Figure 5]e, [Figure 5]f, [Figure 5]g, [Figure 5]h and [Table 1], [Table 2].
The present faculty in the department is shown in [Figure 6]. The subspecialties of the department include:
Equipment in the department till date [Figure 7]a and [Figure 7]b:
Heads of the Department till date.
Prof. Gajendra Sinh (1958–1977) [Figure 8]a.
Prof. S.N. Bhagwati (1977–1986) [Figure 8]b.
Prof. M.J. Virani (1986–1994) [Figure 8]c.
Prof. D.A. Palande (1994–2007) [Figure 8]d.
Prof. Vernon. L. Velho (2007–till date) [Figure 8]e.
From 2007 to 2017, the department has performed 8833 surgeries, presented 150 papers in various conferences and published 85 articles in national and international journals [Graph 1], [Graph 2], [Graph 3], [Graph 4], [Graph 5]. [Figure 9] showing J.J alumni working in various parts of India. The department has organized 12 cadaveric workshops till date. We have already performed 1500 surgeries in the present academic year of 2018 [Figure 10]a, [Figure 10]b, [Figure 10]c.
We would like to continuously update and review our performance to give the best possible tertiary neurosurgical care to our patients, thus abiding by the tradition of our department. The department plans to acquire intraoperative CT, MRI, DSA machines and to construct 6 modular operating theaters in the proposed Super-specialty building.
Financial support and sponsorship
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]
[Table 1], [Table 2]