In India, a surgical challenge

Patient’s brain tumor was so big that it “sat like a head on top of another head.”

For the last several years, Santlal Pal had been watching a tumor emerge from his skull.

Doctors in India say Pal’s brain tumor grew so big that it weighed nearly 4 pounds and measured nearly 8-by-12-by-12 inches, according to local news reports.

It may have been the largest tumor in the world.

But now it is gone: Doctors successfully removed the mass during an intensive, six-hour operation on Valentine’s Day.

Trimurti Nadkarni, head of the neurosurgery department at Nair Hospital in Mumbai, told the Indian Express that the tumor “sat like a head on top of another head.”

Surgeons “had to cut through the bone,” Nadkarni said. “The sheer size of the tumor was a challenge, and we had to ensure blood pressure was maintained while surgery was on.”

More than a week after the surgery, Nadkarni told BBC News that Pal, a 31-year-old shopkeeper in the state of Uttar Pradesh, is “out of danger. Now it’s a matter of recovery.”

The Hindu news site reported Pal’s tumor had been growing for years — most rapidly in the last year. The mass was clinging to the back of Pal’s head; his skull and hair grew over the top of it. The mass appeared as large or larger than Santlal Pal’s head.

“In a month, it grew over an inch,” his brother Akhilesh Pal told the Indian Express. Following treatment, including chemotherapy, the mass continued to grow, Akhilesh Pal said.

“He would feel a heaviness in his head, which ached constantly, and his vision was blurred,” he told the newspaper.

Pal’s wife, Manju, told the Hindu that the couple consulted several doctors in Uttar Pradesh but were told that the tumor was inoperable. Doctors said 10 percent of the tumor was growing within Pal’s skull, putting pressure on his brain and causing him to lose his eyesight. If not treated successfully, it could have caused neurological damage or paralysis.

Surgeons at Nair Hospital took it on.

“We had to cut open the scalp and remove the tumor,” Nadkarni, the neurosurgeon, told the Hindu. “The part of the tumor within the skull was removed by making an opening in the skull.”

Nadkarni said Pal received 11 units of blood during the operation and that, for three days following the procedure, he had to be on a ventilator to breathe. “Such cases are critical,” the surgeon told the BBC.

Doctors are waiting to see whether Pal will regain his eyesight.

Srikant Balasubramaniam, with the neurosurgery department at Nair Hospital, told the Indian Express that the center treats about 500 brain tumors per year, half of which are in advanced stages.

“The tumor in Pal’s head grew so much because his surgery was delayed,” he said.