New Delhi, Aug 9 (PTI) A 12-year-old girl from a remote village in Kerala, who suffered debilitating epileptic seizures for nearly a decade after a stroke in infancy, has been living a seizure-free life for the past two years and has resumed her normal day-to-day activities following a series of highly specialised minimally invasive procedures at the AIIMS, Delhi.
The child, who had one to two seizures every day despite multiple anti-epileptic drugs, underwent an innovative robotic brain procedure followed by a minimally invasive endovascular treatment for a rare complication, helping her avoid two major brain surgeries.
Doctors at AIIMS described the case as an example of how multidisciplinary care and advanced surgical innovations can transform outcomes even in children considered too high-risk for conventional brain surgery.
The girl’s mother, a single parent, had spent years travelling across hospitals in Kerala in search of treatment after her daughter developed epilepsy following a major stroke at the age of nine months.
Financial assistance through the Kerala Chief Minister’s Relief Fund enabled the family to travel to AIIMS in Delhi in March 2024.
The child was born with a congenital heart disease and dilated cardiomyopathy, Dr Manjari Tripathi, head of Department of Neurology at AIIMS, Delhi said.
“The stroke left the right half of her brain permanently damaged, and by the age of two she began suffering frequent seizures that severely affected her quality of life,” she said.
Following a detailed evaluation, the AIIMS epilepsy team concluded that surgery offered the best chance of controlling the seizures.
Tripathi said the child had drug-resistant epilepsy and continued to experience disabling seizures despite prolonged medical therapy.
“She had been living with daily seizures for years, affecting every aspect of her childhood. After comprehensive evaluation, we found that surgery was her only realistic option. Seeing her seizure-free and returning to normal daily activities has been immensely satisfying for the entire team,” she said.
Ordinarily, such patients undergo an open hemispherotomy involving a large craniotomy, Dr P Sarat Chandra, Head of the Department of Neurosurgery and Gamma Knife at AIIMS, Delhi said.
However, because of the girl’s severe heart disease, he said the risks of conventional surgery were extremely high.
The neurosurgery team instead opted for Robotic Thermocoagulative Hemispherotomy (ROTCH), an ultra-minimally invasive procedure developed by Chandra at AIIMS, Delhi.
The procedure allows surgeons to disconnect the diseased half of the brain through tiny keyhole pathways with minimal blood loss.
“Her cardiac condition made conventional surgery extremely risky. ROTCH enabled us to perform the procedure through a minimally invasive approach while avoiding a large craniotomy. It represents an important advance for carefully selected patients who may not tolerate open surgery,” Chandra said.
During the operation carried out by Chandra and Dr Ramesh Doddamani, the child suffered a cardiac arrest and required prolonged resuscitation before being stabilised by the multidisciplinary team.
Doddamani, professor in the Department of Neurosurgery, said the surgery highlighted the importance of coordinated care across specialities.
“Managing the neurological problem was only one part of the challenge. The successful outcome was possible because neurology, neurosurgery, anaesthesia, critical care and cardiology teams worked together at every stage. Despite the intraoperative setback, she recovered remarkably well,” he said.
During a follow-up examination three months later, doctors detected a large chronic subdural haematoma, a condition that traditionally requires another brain operation.
Given the girl’s fragile cardiac condition, the team again avoided open surgery.
Dr Ajay Garg, professor of the Department of Neuroradiology, performed a middle meningeal artery embolization, a minimally invasive endovascular procedure that successfully treated the condition.
“Instead of subjecting her to another high-risk brain surgery, we used an endovascular technique to treat the haematoma. The procedure was completed safely, and she recovered well without the need for another craniotomy,” Garg said.
Head of the Department of Neurology Tripathi said the child is now free from disabling seizures even 2 years after surgery and is able to carry out routine daily activities, offering a new lease of life to both her and her family.
She added that the case also demonstrates how innovations developed in India are finding acceptance internationally and expanding treatment options for children with complex forms of drug-resistant epilepsy. PTI PLB SKY SKY
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