Surgeons remove fist-sized ball of brain matter hanging from boy’s nose

The 13-year-old son of plantation workers, leading an isolated life, underwent 11-hour surgery at Amrita Institute of Medical Sciences that involved reconstruction of a part of the skull, repositioning of the eye sockets, and re-modelling of the nose


Kochi: A 13-year-old tribal boy Manikandan, son of plantation workers in Parambikulam, Palakkad, was the butt of ridicule since birth because of a rare medical condition called encephlocele in which brain matter oozes out of a gap in the skull into a sac-like structure, giving the patient’s head a grotesque appearance.

A fist-sized ball of brain matter used to hang from Manikandan’s nose as a pendulum. It obstructed his vision and deformed his nose and face. His life changed radically for the better a few days ago when a 10-member team of surgeons at Amrita Institute of Medical Sciences removed the external deformity in a surgery that lasted 11 hours. The cost of the procedure was borne by Kerala Government agencies, as Manikandan’s parents – Selvan and Ramata – are from a poor socio-economic background.

Said Dr Subramania Iyer, Head, Plastic & Reconstructive Surgery, Amrita Institute of Medical Sciences (Amrita Hospital): “It was a complex surgery. Manikandan’s encephlocele was very large which had pushed the bone of his right eye outwards. For surgery, his skull was opened and the normal brain isolated from the sac of non-functioning brain matter hanging from his face. The removal of the deformity left a defect in the skull, a portion of which had to be reconstructed. The patient’s eye sockets were repositioned to remove the deformity in the right eye, and the nose was also remodeled. All these were huge surgical challenges. Manikandan has recovered fully from the surgery and is ready for discharge. He will now be able to attend school and participate in all social activities like any other child of his age. The surgery was carried out by the combined efforts of the paediatric craniofacial department consisting of more than 12 surgeons and anesthetists.”

The surgical team that operated on Manikandan consisted of paediatric neurosurgeons, craniomaxillofacial surgeons and plastic surgeons, assisted by neuro anaesthetists and a paediatric neuro ICU nursing team. It was led by Dr Suhas Udaykumar, Dr Pramod Subhash and Dr Subramania Iyer, helped by the anesthetic team led by Dr Gokuldas and Dr Mathew.

Manikandan, the patientA fist-sized ball of brain matter used to hang from Manikandan’s nose as a pendulum (left side).

Said Selvan, Manikandan’s father: “We belong to the Marasar tribe and work in a plantation. I have five children, who are all normal and healthy, except Manikandan who was born with a swelling on the nose which kept growing. Because of the huge deformity on his face, he never went to school or mingled with other children, as people used to make fun of his appearance. After surgery, he is eager to go back home, start school and make friends. I thank the doctors of Amrita Hospital from the bottom of my heart for enabling my son to lead a normal life.”

The district administration of Palakkad and the tribal welfare department stepped in to fund Manikandan’s surgery. Mr. Suresh, District Tribal Welfare Officer, Palakkad, brought the plight of the boy to the attention of Dr. P Pugazhenthi (IFS), Director, Scheduled Tribes Development Department, Kerala. He, in turn, escalated the issue to Mr AK Balan, Hon. Minister for Welfare of Scheduled Castes, Scheduled Tribes and Backward Classes, Govt. of Kerala. The Minister took keen interest in the matter and sanctioned funds for Manikandan’s surgery. Ms P Marykutty (IAS), District Collector, Palakkad, provided logistical support to liaison between the various Government departments and visited Manikandan at Amrita Hospital to monitor his progress.

Encephalocele is a rare congenital disorder – found in 1 in 5,000 births – in which bones of a baby’s skull do not close completely in the mother’s uterus. This creates an opening through which brain tissue and cerebro-spinal fluid protrude out of the head in a sac-like structure. The condition can be fatal if the encephalocele hampers brain development. Once past infancy, patients usually live an isolated life, ashamed to show their face in public.