• Mr Babiker Hassabelgawi Ahmed’s small nodule turned into a malignant tumour on forehead
• Forehead tumour was of 6cmx8cm outer part and 18cmx12cm deep inside the brain
• The tumour damaged the skull of the forehead and the inner linings of the brain

Mr Babiker Hassabelgawi Ahmed, a 57year old man, resident of Sudan, who underwent a tumour removal surgery 15 years back, did not have any problems till 2018. Life took a devastating turn for Mr Ahmed, when he was diagnosed with his first tumour in left side of his head at the age of 42, got it surgically removed in Sudan. 2 years back he started having a few episodes of seizure for which treatment was provided in Sudan, later on he noticed a small nodule over his forehead a year back, which exponentially increased in size within 7 – 8 months of duration and by the time patient realised that it is a big problem, the skin around the tumour mass eroded, his health deteriorated, and he started getting frequent seizures, which was poorly controlled with medicines.

His health was not getting any better and while he was dealing with his condition through medication. He was advised for an MRI by experts at Sudan, which he conveniently neglected and within a short span of time it grew breaking the skull of the forehead making the shape of a horse-shoe.

Mr Ahmed, came to Aakash Healthcare on 17^th July 2019, in a bad shape from Sudan and after getting lot of opinions from various hospitals – that his surgery could be dangerous and he may not come out alive or may develop severe neuro deficit – looking at the condition of the tumour on his forehead.

The size of his forehead tumour was of 6cmx8cm long outside and 18cmx12cm deep inside, the brain. It turned into malignant tumour due to sheer negligence. He was immediately attendant by Dr Amit Srivastava, Director and Sr. Consultant Neuro Surgery and his team, patient was advised for MRI and CT Scan of the head. Reports showed large, extra axial mass eroding galea and skull spreading inside the bone in the frontal sinuses (in the between the eyebrows), fixed to the underlying bone, firm, non-compressive, non-pulsatile, non-expansile, and non-translucent. It was immediately decided to do surgery of the head to remove the tumour and reconstruct the skull and lining of the brain.

Speaking about this complex case, Dr. Amit Srivastava, Director and Sr. Consultant Neuro Surgery, Aakash Healthcare Super Speciality Hospital, Dwarka said, “Seeing Mr Ahmed’s case, we planned to do surgical removal through bicoronal flap mobilization, strip craniotomy and excision of the complete bone tumour, exteriorisation of frontal sinus and duroplasty by artificial dura, and cranioplasty by titanium mesh and flap tailoring to close the galea. The condition which he was suffering from is called invasive anaplastic meningioma WHO Grade III arising from frontal convexity dura and falx. We created a flab on the forehead skin, since skin was involved, we had to remove the upper lining and bones in the brain along with the tumour, as it was hugely spread across the forehead skull and skin. The area above the nose and the middle of the forehead which was affected due to the tumour was removed and thigh fascia and fat was used to re-graft that area.”

The surgery was very challenging and complex, as it involves a human being’s most important functional area, brain and any wrong cut can leave scar in the brain which will lead to post-surgical complications. The surgery was done successfully and it went for almost 11-12 hours and a team of 3 doctors. Dr. Nagesh Chandra another neuro surgeon, and Dr Pallav Kumar, Neuro-anaesthetist were involved. These kind of tumours are usually due to some genetic disorders.

Celebrating his successful surgery, Mr Ahmed, said, “I lost all my hopes when the tumour hit my life for the second time. My wife and my kids were under immense mental and emotional stress when they saw my condition, my family supported me throughout and it gave me courage and zeal to fight with the disease. Aakash Healthcare extended all possible support to us and the entire team of doctors were very comforting and helpful. Our case was treated on priority and I, was given a second chance to life. My entire family will always be thankful to Dr Amit Srivastava, Dr. Nagesh Chandra and Dr. Pallav Kumar, his team for the unconditional support and for helping us through this tough phase.”

The patient was discharged on the 7^th day post-surgery and is doing fine now, his urinary incontinence, blurry visions have been managed now and will be on medication for few months. He is now advised to visit oncologist for further treatment in form of chemo and radiotherapy to avoid any recurrence of such type of tumour. This case spreads awareness and hope to many such other patients that if timely intervention provided by right medical expertise, at the right time and place can help from dreadful consequences.