Strides in neurosurgery were never a topic of interest for Nilomani Deb, whose only goal after retirement from the directorate of plant protection was to relax in his hometown of Shillong. Two years into retired bliss, he, however, became one of the first few patients to experience the ease of a variant of minimal access neurosurgery. Only a tiny incision on his eyebrow is a reminder that he had actually undergone a brain tumour surgery nine months back.

It was during a holiday in Guwahati that Deb suffered convulsions late in the night along with a fainting spell. Quick tests in the Assamese capital revealed a brain tumour located in the anterior region of his skull. "As I was told to get operated at the earliest, both me and my son started an extensive search on the internet for a doctor before zeroing down on Dr Dipu Banerji at Fortis Hospital in Mumbai, " he says.

Traditionally, a patient such as Deb would have a quarter of his skull cut, with a long and deep scar to show for it. "Moreover, there could be some damage to the brain while handling or lifting it, " says Banerji. The advent of endoscopic techniques has, however, changed the hitherto grim world of neurosurgery that is associated with high morbidity.

"Removal of brain tumours through smaller and less invasive techniques has now become possible. Newer 'keyhole' approaches can now be used to remove a majority of benign and malignant brain tumours, including those that arise from the brain itself, coverings of the brain and skull base, pituitary gland or from metastatic brain tumours arising from cancers elsewhere in the body, " Banerji adds. Six years back, neurosurgeons in India started tackling tumours in certain parts of the brain through the nose. This trans-nasal surgery is most often done in collaboration with ENT surgeons.

In Deb's operation in January, only a 2cm-long incision was made along his left eyebrow to access the skull bone, a small portion of which was cut to access the anterior portion of the brain with specialised instruments that permit angular access. The only grey cloud was the fact that Deb's tumour was close to the nerve responsible for the sense of smell. "Luckily, it wasn't affected. "