Bengaluru, India – A 34-year, gentleman named Mr. Adan (name changed), hailing from Ghana, South Africa adhering to Jehovah’s beliefs, presented with symptoms of left-sided weakness persisting for a year and headaches worsening over the pasts eight months ago. The weakness affected his left upper and lower limbs progressively, leading to difficulty grasping objects with his left hand and walking difficulty. He had a seizure episode two months ago which worsened his headache and neurological deficits.
Mr. Adan was subsequently admitted to Sakra World Hospital in Bengaluru, where Dr. Arjun Srivatsa, Director & HOD – Institute of Neurosciences, Dr. Shylesh M P, Associate Consultant – Neurosurgery and their team, conducted a thorough examination followed by a panel of imaging and blood tests. The MRI Brain Contrast revealed a large 10x 9 cm tumor abutting the right side of the brain.
Dr. Arjun, Director & HOD – Institute of Neurosciences , Sakra World Hospital, explained, “A meningioma is a tumor that grows from the membranes that surround the brain and spinal cord, called the meninges. A meningioma is not a brain cancer, but it may press on the adjacent brain, nerves and vessels and can cause trouble. Meningioma is one of the most common type of tumor that arises in the brain. Most meningiomas grow very slowly, however certain tumours can grow at a rapid rate and behave aggressively. They can grow over many years without causing symptoms. But sometimes, their effects on nearby brain tissue, nerves or vessels may cause serious disability. Meningiomas occur more often in women. They’re often found at older ages. But they can happen at any age and either sexes. Because most meningiomas grow slowly, often without symptoms, they do not always need treatment right away, instead, they may be watched over time. However large meningiomas causing compression of the brain require immediate attention”
Following the diagnosis of right parietal convexity meningioma, the patient underwent a successful craniotomy for tumor excision. Dr. Arjun stated “Since Mr. Adan being a follower of Jehovah’s sect and clearly against transfusion of blood or any forms of blood products like platelets, plasma etc., it is a challenging situation for the surgeons and the anesthetic team to handle the intraoperative blood loss. Meningiomas being highly vascular tumours tend to bleed profusely during the surgery hence a meticulous surgical technique and hemostasis has to be achieved during the surgery to minimize the amount of blood loss. This patient had a significant amount of bleeding during the surgery inspite of all the necessary precautions to minimize blood loss and had a significant dip in his hemoglobin levels. It was quite as task for us to remove the entire tumour amidst significant bleeding encountered during surgery. Yet, with best of our efforts the entire tumour was resected without much complications. Patient recovered well without any neurological deficits, however his hemoglobin level were well below the expected levels. Despite encountering significant post-operative anemia, we were able to manage without any blood transfusion. “
He further added, “Significant advancements in anesthesia and surgical techniques have enabled the minimization of blood loss and the avoidance of blood transfusions during procedures which is specifically benificient in such patient’s who are followers of the Jehovah sect”
The patient improved and was weaned off the ventilator, though he had generalized weakness, dizziness and was severely pale because of low hemoglobin levels. We started him on Human recombinant Erythropoietin which is a medicine used to boost up the hemoglobin levels. Patient began to show signs of improvement, started eating normally, and was initiated on neurorehabilitation and physiotherapy. At the time of discharge patient was back on his feet, with no neurological deficits, feeding well and returned back to his country with a smile on his face”
Dr. Arjun stressed, “Blood loss is a known thing in huge complex meningiomas. Operating on Jehovah’s witness patients demands sensitivity to their beliefs. Timely diagnosis and prompt intervention are keys for a good functional post-operative outcome.
“After surgery,” said Mr. Adan, “I felt relieved as my headaches decreased and I regained strength and mobility. I’m grateful for the successful outcome and the team’s understanding of my decision to avoid a blood transfusion.”
