5-year-old becomes world’s youngest patient to undergo ‘awake brain surgery’ at AIIMS; Read on to know all about this unique case In a first, doctors at AIIMS, Delhi successfully performed a brain tumour surgery on a five-year-old girl while keeping her awake during the operation. The hospital claims that she was the youngest patient in the world to undergo such a procedure. The procedure termed as ‘awake craniotomy’ or conscious sedation technique surgery for a left perisylvian intraaxial brain tumour was performed on January 4, AIIMS said in a statement. The tumour was removed successfully by a team of neurosurgeons and she remained conscious throughout the procedure. “Technological adjuncts viz preoperative functional MRI brain, intraoperative ultrasonography, neuronavigation were used to localise tumour precisely during resection while mapping of functional areas was being carried out under awake conditions. Ice cold saline was used for the brain surface to prevent any seizures during the procedure,” the statement said. “The child is doing well and will be sent home on Monday,” it said. The girl was shown common objects, and common animals and given some tasks for language and sensorimotor assessments before surgery and suprising these tasks were repeated during the surgical procedure also. She is a first-standard student and was quick in identifying the picture of Prime Minister Narendra Modi during the surgery, the statement said. The doctors explained that awake surgeries for brain tumours are done for maximising tumour removals and minimising neurological deficits. According to the doctors, during awake craniotomy, patients should feel a minimum level of pain while being completely able to cooperate in neurological tests. “Although this method is called an awake craniotomy, this method requires even more collaboration in perfect harmony of the surgical and anaesthesia teams than other operations under general anaesthesia said,” Dr Deepak Gupta, Professor of Neurosurgery who performed this operation with his team with neuroanesthesia team led by Dr Mihir Pandia and Dr Gyanendra Pal Singh. Dr. Gupta also revealed that this girl happens to be the youngest child in the world to undergo successful brain tumour surgery under awake conditions at this age at AIIMS, Delhi. According to Mayo Clinic, awake brain surgery is used to treat some brain (neurological) conditions, including some brain tumours or epileptic seizures. “If your tumor or the area of your brain where your seizures occur (epileptic focus) is near the parts of your brain that control vision, movement or speech, you may need to be awake during surgery, it stated. This procedure allows the surgeon to know exactly which areas of your brain control those functions and avoid them. According to Mayo Clinic, some of the risks of awake brain surgery include:
The Japanese pharma major is also filing a plea before the Delhi HC seeking appointment of forensic auditors to analyse transactions involving IHH, Fortis Healthcare and RHT, Singapore, as directed by the HC on October 18.
The development is likely to create legal hurdles and delay the proposed open offer as IHH had recently told FE that it could only go ahead if Sebi agreed with its legal interpretation that the SC’s September 22 order has lifted all such restraints.
IHH managing director and CEO Kelvin Loh told FE on November 9 that the company would like to go ahead with the open offer “as soon as possible” as there has already been a delay of four years. Ravi Rajagopal, chairman of Fortis Healthcare, had added that their legal counsel has advised that the company can go ahead with the open offer as the SC order has disposed of various appeals, including the suo motu contempt. “We have represented to the Sebi and the matter is with them,” Rajagopal had said.
However, legal observers told FE that the matter is not that straightforward and simple as the Delhi HC has to take the final call on the matter of open offer as well as whether a forensic audit has to be done in the share sale which was executed in 2018.
Also Read: IHH to float open offer for Fortis if Sebi concurs with our legal view: MD & CEO
Loh and Rajagopal had said the possibility that the matter may take a different turn when it comes up in Delhi HC cannot be ruled out.
IHH had in July 2018 acquired a 31% stake in Fortis Healthcare for Rs 4,000 crore through the bidding route. It had also earmarked Rs 3,000 crore to make an open offer for an additional 26% to the public shareholders as required under the law.
Daiichi has written to Sebi that the SC in its September 22 order had asked the HC to consider ordering a forensic audit into the dilution of FHL shareholding, repeated violation of undertakings and assurance by former FHL promoters — Malvinder and Shivinder Singh — and the transaction between FHL, IHH and the clandestine transfer of Rs 4,666 crore to RHT Singapore.
Daiichi is “severely prejudiced” with IHH’s clandestine attempt to subvert the status quo order directed by the SC on December 14, 2018, and September 22 with respect to the conduct of forensic audit and the pending proceedings before the HC by purportedly consulting regulatory authorities, including Sebi, on the proposed FHL-IHH transaction. It has reiterated that the FHL-IHH transaction was currently sub-judice before the HC where FHL is also a party, its solicitors, P&A Law Offices, have said in the letter.
“We further state that any such attempt by FHL and/or IHH to proceed with the FHH-IHH transaction would be in direct contravention of the HC and SC orders,” the letter sent by the law firm has stated. Daiichi Sankyo is pursuing the enforcement of Rs 3,500-crore arbitration award against the Singh brothers pronounced by a Singapore tribunal for concealing information when they sold Ranbaxy Laboratories to it for $4.6 billion in 2008. The apex court had in 2018 put on hold the sale of Fortis Healthcare to IHH on a contempt plea filed by the Japanese drugmaker against the Singh brothers.