Prof. Shailesh B Gaikwad

Chief N.S. Centre

The Neurosciences Centre consists of the Departments of :-

Prof. P.N. Tandon

Prof. P.N. Tandon (1965-1990) presently Emeritus Professor Neurosurgery

“The Departments of Neurology and Neurosurgery at the All India Institute of Medical Sciences were initiated in March 1965 with the appointment of Prof. Baldev Singh and myself as the first Professors. A neurology service in the Department of Medicine started by Dr. Jim Austin from the USA and later under care of Dr. Vimla Virmani was already in existence at that time. Significantly enough the Institute was, from its very inception, an important centre of neuroscience research. The first two Professors in Department of Physiology (Prof. B.K. Anand and Prof. A.S. Paintal) were undisputable leaders of neurophysiology in the country. Dr. Paintal had, however, already moved to Patel Chest Institute a year earlier, the remaining faculty members of the department were all pursuing neurophysiology research. Prof. Keswani, the Chief of Anatomy, was primarily interested in neuroanatomy. Prof. G. P. Talwar, at that stage, was enthusiastically involved in researches in neurochemistry This was of course before his shift to immunology. Acknowledging these strengths International Brain Research Organization (IBRO) had already held one of its earlier workshops in the Institute. Dr. Sriramachari, Deputy Director of Indian Council of Medical Research, though not on the faculty of the Institute freely provided his services for all neuropathological work till several years later when Dr. Subimal Roy took over the responsibility fully. While clinical neurology and neurosurgery departments existed at several centers in the country much earlier; even the oldest such centers at Vellore, Madras, Bombay and Calcutta, did not have such broad base of neuroscience as we were fortunate to have at the Institute. Given the overall milieu of rapid growth and development in the institute at that time, the clinical departments also expanded rapidly. It will be hard for the current staff and students of the Institute to visualize how close interaction existed among all these departments and units in the earlier years. This was in no small measure due to the all pervading influence of Prof. Baldev Singh real father figure for all of us.

The idea of establishing a "Brain Research Centre" at the Institute had already been envisaged by Prof. B.K. Anand even before the clinical departments came into existence. No doubt this was primarily thought of as a basic research centre. Thus on 1st December 1964, Dr. Anand vide his letter No. Phy/64/1235 requested the Director for initiating steps for developing a Brain Research Centre" with the existing ICMR Neurophysiology unit as its nucleus. Unfortunately no action was taken on his request.

In 1968, when the Institute was to formulate its development plans for the Fourth Five Year plan of the Government, Prof. Anand, Prof. Baldev Singh and I had several informal discussions to once again revive the proposal for a Brain Research Centre. It may be mentioned that, not surprisingly, this proposal was heavily loaded in favour of creating research laboratories including a couple for neurology and neurosurgery. While we were heavily constrained in our clinical work due to limited diagnostic and operative facilities at this time we went along with Prof. Anand in supporting this proposal hoping to strengthen the patient care services through the development plan for the Institute hospital which was to be commissioned

The Development Committee approved the proposal in principle, but owing to financial constraints no concrete steps were taken. The Institute Body ultimately agreed to create a few staff positions so that "Centre can make a start as early as the Financial Year 1970/71. In practical terms it amounted to absorbing some of the staff of the Indian Council of Medical Research Neurophysiology Unit and nothing more.

When we finally shifted to the new hospital the Neurosurgery Department had 22 beds allotted to it. We had one operation theatre, but no specialized neurosurgical operation table and no intensive care unit. The neuroradiology set up consisted of a skull table without automatic changer for angiography, no facilities for tomography nor a dedicated unit for myelography. Isotope encephalometry then a routine diagnostic investigation abroad was nonexistent. We had an EEG machine but no facilities for EMG or nerve conduction. Nonetheless we were facing increasing demands for patient care from all over the country and also our neighboring countries. Waiting lists for admission and surgery were a constant source of worry for us and frustration for the suffering patients. We had already started the M. Ch. course.

Similar problems were being faced by the Cardiology and Cardiothoracic Surgery Departments. One day in 1971 when Prof. Gopinath and I were scrubbing for surgery in the common scrub room between our two theatres, he informed me that they have submitted a proposal for a Cardiothoracic Centre "Why don't you also do so, otherwise we will never progress". I, therefore, once again took up this matter with Prof. Anand who was now also the Dean and sounded the Director, Prof. V. Ramalingaswami. On receiving a favorable response, it was decided that, unlike in the past, our proposal this time should be a comprehensive one, including parallel development of basic neurosciences and clinical disciplines. Dr. Manchanda along with Prof. Anand formulated the proposal in respect to basic neurosciences. I, in consultation with Prof. Sumedha Pathak, the then Professor and Head of Department of Neurology and on the advice of Prof. Baldev Singh and Dr. Banerji prepared the plan for the clinical centre. A draft proposal was thus submitted on 16`" July 1971 to the Dean with the comments "in view of the present extent of development at the Institute to start with emphasis will be on neurophysiology, neurology and neurosurgery. Nucleus for the following will be established with a view to development of these into fully fledged specialties, as integral part of the centre, as personnel and fiscal resources were available". These included neuroanatomy, neurochemistry, neuropathology. This proposal was discussed by Prof. Baldev Singh (who was now an Emeritus Professor) with Prof. B.K. Anand who agreed with it fully and desired to "go ahead and fill up all the details regarding space, equipment, personnel etc. working out the cost" etc. We agreed to change the name from Brain Research Centre to Neurosciences Centre. We had a detailed and somewhat ambitious plan formulated. Though the plans were ready there was no obvious source for funding it. Was it going to be another document for the archives? This thought remained a constant worry, Prof. Ramalingaswami was fully in agreement but was finding it difficult to find funds for it.

Several months passed. One day while casually discussing our mounting frustrations with lack of any progress with my elder brother, who was then a Jt. Secretary in the Prime Minister's office, I initially got a cautious reply, "Prakash, officially I do not wish to get involved in any thing that may be considered as a favour to my brother. The only thing I can do is to arrange a meeting for you with the PS to the Hon'ble Minister of Health Shri Uma Shanker Dixit. Even before that, first take the permission from your Director to do so". It was easy to obtain Director's permission and shortly afterwards a meeting was held with Shri Rajgopal, who was more than sympathetic to our request for establishing the Neurosciences Centre. At the end of the meeting he told me that it was not possible to get such a major scheme funded in the middle of a plan period but "may be we could get advanced action initiated which can then be formalized in the next plan". He promised to discuss this with Dixitji at an appropriate time. The meeting ended with encouraging but cautious note, "I promise nothing but I am convinced it is a genuine need. You are asking nothing for yourself? you are willing to provide more and better service to those knocking at your door".

Not expecting any prompt action I was pleasantly surprised to receive a call from the Director later that evening, "Health Secretary Shri K.K. Dass wants us to include the matter related to the establishment of the Neurosciences Centre in the agenda for the next meeting of the Institute Body due shortly. He wants a copy of the proposal sent to him in advance". On 2nd August 1972, a copy of the formal proposal was duly sent to the Shri K.K. Dass by the Director. At the Institute Body meeting held on 12'" September 1972, the Institute decided, "The Institute considered that it was fortunate that expertise in several fields of Neurosciences exists at the institute both in basic and clinical areas. The Institute considered the scheme put up for its consideration as possible, desirable and in the larger interests of the country. Recognizing the strengths already built in the various departments in respect of the neurosciences, the Institute approved the proposal in principle to set up a Centre for Neurological Sciences at the AIIMS and decided that not only it be included in the proposals for the Fifth Five year Plan of the AIIMS but, the possibility of advance action in the Fourth Five Year Plan itself, should also be seriously explored. It was accordingly decided that the matter be considered by the Finance Committee in greater detail". We felt happy but not jubilant, fully conscious of the harder battles ahead

The Proposal was duly put up to the Finance Committee meetings held on 4th January 1973, 8th February 1973 and 5th April 1973 and as feared owing to "financial constraints" no funds could be made available. The real reason was no doubt that Shri K.K. Dass had retired by now and his successor Shri Ramachandran had his own antipathies against the Institute as future events confirmed.

However, without waiting for a formal decision of the Finance Committee, Prof. Ramalingaswami forwarded the proposal to Dr. Banwari Lall, Chief, Health Division, Planning Commission for his consideration. Dr. Lail was a close friend of Prof. Anand who arranged a meeting with him in the Planning Commission after Dr. Lall had opportunity to scrutinize the proposal. With high hopes Prof. Anand and I attended the meeting. To our surprise Dr. Lall, after a brief discussion, said, "Bal (B.K. Anand), I am sorry this proposal as it stands is unlikely to be approved owing to severe financial constraints. The only component that may be favorably looked at is the patient care part". He also made several suggestions for curtailing the budgetary demands even for the clinical component. It was with a sense of disappointment that we walked out of his office. I was, in addition assailed with the fear of losing Prof. Anand's interest and support for the project. Probably sensing my thoughts, on our way to the exit he suddenly stopped said, "Prakash, it is too bad to have things take a turn this way, but let us be practical. We should take whatever we can get and keep trying for the rest. You will have my full support". Few in his place could have been so generous and even more so the enthusiastic support we continued to get from him later on provided enough proof of the genuineness of these sentiments. For all this he no doubt, got the flak of his colleagues in the Physiology Department.

In pursuance of the decision of the Institute Body and the informal advice received from Dr. Lall we carried out another detailed exercise to draft a formal EFC (Expenditure Finance Committee) memo. In the meanwhile Prof. Gopinath had carried out a similar exercise for the Cardio-thoracic Centre. As a matter of fact, these exercises were mostly done with the constant consultations with each other. Combined these two proposals required considerable financial support. Dr. Ramalingaswami advised us that we should seek the views of the new Health Minister Shri Khadilkar. After a patient hearing of our individual proposals, he pointed out the difficult financial situation and advised that we should try and economize by establishing some common facilities and sharing whatever can be shared thus bringing down the total cost of two proposals. He promised to get the demands included in the Fifth Five Year Plan proposals of the Institute. Thus Prof. Gopinath and I carried out another exercise maintaining the basic character of two independent centers, yet having some common areas and support laboratories. On 2nd August 1973, a new draft proposal was forwarded to the Director with a note, "In view of the difficult economics situation, we (Profs. Anand, Gopinath and Tandon) have also reviewed the projects with an idea to prune these without undue detriment to the utility of the projects". And further, "Following this review, if we could get a total of Rs. 350 lakhs (Rs. 200 lakhs for Cardiothoracic and Rs. 150 lacs for Neurosciences Centre), we could still make a worthwhile contribution".

The Planning Commission, discussed the proposals of the Health Ministry (which included those of AIIMS) on 31^st August 1973. The bias of the Health Secretary, Shri Ramachandran against the institute was too obvious. He had proposed a total of Rs. 150 lakhs for the whole Institute. As a matter of fact it was specially emphasized that the Ministry "did not favor that all the specialties should be concentrated in one place in the country". Following strong pleadings by the Director, one of the members of the Planning Commission, Member (M), pointed out that "the Ministry had proposed Rs. 1.50 crores for the AlIMS as against the Fourth Plan provision of Rs. 3.33 crores, and since this was a premier Institute in the country, the Ministry may explore the possibility of providing some additional funds for the Fifth Five Year Plan. With regards to the proposals for the two centers, the Planning Commission ultimately decided to allocate separate funds for "the development of super-specialties: a total of 236 lakhs, without specifically mentioning our proposals. This was a typical bureaucratic stroke by the Health Secretary to scuttle our proposal. Before implementing the program, the Ministry of Health decided to enquire from all medical institutions in the country to submit their proposals for "development of super-specialties", notwithstanding the fact that the Central Government is supposed to directly fund only the national institutes. As expected proposals were received from several places and interestingly even Orthopaedics was considered a super-specialty. The Health Ministry, obviously under the instructions from its Secretary put the whole matter in the cold storage with the usual excuse, "the matter is under consideration": even though the Fifth Plan had already begun from April 1974.

One day Dr. Karan Singh, who was now the Minister of Health, desired to see me for some unconnected reason. At the end of our meeting, I enquired about our proposals for the centers. Only then the cat came out of the bag. He frankly informed me that the Secretary was sitting on the file on the excuse of collecting information mentioned above. Dr. Karan Singh recognized the futility of the exercise. Since in the limited funds allocated for super specialities it would be impossible to meet the needs of even a few. He promptly took the initiative and in August 1974 appointed a committee under the Chairmanship of Dr. Srivastava, the Director General Health Services, to assess the existing potentials and future possibilities of strengthening superspecialities in the centrally funded institutions only. The Committee included experts in the concerned disciplines from all over the country. It collected the necessary information from various institutions and finally paid site-visits to each of these before recommending our two proposals alongwith some allocations to a couple of others. Thus from a total of Rs. 236 lacs allocation for super specialities the two Centres at the AIIMS, was provided Rs. 188.37 lacs.

On March 26, 1975, even before we received a formal approval of the Government to establish the Centre, a letter addressed to the Director, AlIMS received from Dr. Sharad Kumar, DDG(M), indicating that, "Under the Purely Central Scheme of "Development of Superspecialities', the Government of India has sanctioned a provision of Rs. 10 lakhs for the development of the Departments of (1) Neurosurgery and Neurology; and (2) Cardiology and Cardiothoracic Surgery...............”

This communication, though not mentioning anything about the Centers, was the first indication that the Government had selected AIIMS; for development of these super-specialties. Two weeks later on 11^th April 1975, the recommendations of the "Expert Committee on Establishment of Cardiothoracic and Neurosciences Centre at the Institute", were ultimately received, setting at rest all uncertainties about the two proposals. It would be worth reproducing the extracts of this communication with respect to Neurosciences Centre (see Dr. Sharad Kumar's letter dated 11th April 1975). Shortly afterwards on 22"d July 1975 a formal letter from the Ministry of Health and F.W. No. V. 16020/54/ME (PG), communicated to the Institute an allocation of Rs. 188.37 lacs for the super-specialties (including both centers) for the 5^th Five Year Plan. It needs to be recorded that the fullest understanding between Prof. Gopinath and myself and the cooperation of the rest of the faculty of the concerned departments made it possible for us to keep on revising and redrafting the proposals as per the bureaucratic needs of the Government, without sacrificing the basic objectives. No hidden rivalries, personal egos or unjustified interests of individuals ever cast any shadow as we pursued the planning and implementation of the projects through various administrative channels. For me it was a rare experience of trust and camaraderie not so common in our institutions.

As expected it was not smooth sailing from now onwards. We had to wait till March 1976 for the first release of funds, a paltry sum of Rs. 3 lacs. At one stage the Financial Advisor to Ministry of Health, whose main grudge against the Institute happened to be "misuse of funds for erecting black marble columns in the foyer" without any justification reduced the total allocation for the Fifth Plan by nearly Rs. 40 lacs, probably worrying that we would waste it on black marble columns. When no explanation and assurances from Dr. Gopinath and myself failed to convince him, we had to approach the office of the Finance Minister (Shri C. Subrramanayam) and the Planning Commission Deputy Chairman Shri P.N. Haksar, two of the most progressive policy makers of the country has known. Let me hasten to add that Prof. Gopinath and I approached them with the approval of our Director.

In July 1976, the Estate Committee formally appointed M/s. Pradhan Ghosh and Associates as the architects. However, between 1976 and 1978 repeated revisions of the building plan were required due to pruning of the budget allocations and rising cost of the building. At last on 14^th April 1978, the President of India Shri Neelam Sanjiva Reddy laid the foundation stone of the twin centers. In his welcome address Dr. Ramalingaswami stated, "Our vision of the Centers is that they will be Centers both of public service and of higher learning at the same time". Their philosophy is that in which the patients and their needs come first, everything else is subordinate and subservient to this: He pointed out that, "The greatest and deepest need of a Centre is to be needed by Society". Quoting the famous economist Francis Delaisi, he said that. "the purpose of an Institution is to supply stability needed for long term operations. At the same time, Institutions must be able to adjust to change. It is our hope that stability, adjustability and continuity will mix in the centers in appropriate balance". Rashtrapatiji in his address expressed his happiness on the establishment of these Centers. While emphasizing that, "Our most urgent need is Primary Health Care" which should be pursued with all energy and resources at our command." He pointed out that, "we cannot altogether neglect the setting up and improvement of more advanced levels of health care at District, State and national levels. We need to have a few Centers of excellence in a large country like ours where the most advanced levels of care can be provided; specialists and researchers can be trained and the most complex problems may be referred for appropriate management" For him, "It is not a question of this or that" but a "proper balance in the developments of these various levels of health care". He was equally concerned about the scientific community which must be able to discover, adopt and innovate suitable methods not only in dealing with our current problems but also in coping with changing trends and changing needs of the future". I have quoted these excerpts from the speeches because I believe that as long as we pursue these ideals the Centre would continue to justify the generous resources provided by the government and enjoy the trust of the people.

Five years later, in March 1983, out patient clinics for Neurology, Neurosurgery (as also Cardiology and Cardiothoracic Surgery) moved to the new building, while the work continued to complete the rest. Progressively as the work progressed we continued to occupy the areas already completed. By July 1984, the built up area included basement, OPD, receiving station, noninvasive laboratories, radiology wing, 8 operation theatres (Neuro 3, Cardiac 4, Common 1) along with ICUs and postoperative wards. It was only in 1988-89 that the Centres became fully functional in their new abode. At this time Neurosciences centre had a total of 180 beds, 3 fully equipped operation theatres, 30 bedded ICUs, Intermediate care wards, fully fledged departments of Neuroradiology, Neuroanaesthesia, within this complex. The offices of the faculty and supportive staff, Neurochemistry laboratories continued to remain in the old building and by mutual agreement the Neuropathology still continues to be in parent Department of Pathology. This may be compared to the facilities available to us before we moved to the Centre. The combined strength of beds for Neurology and Neurosurgery including a half baked ICU was only 72, scattered in different parts of the old hospital.

There was only one dedicated operation theatre for neurosurgery and we shared another one with Cardiothoracic Department three days a week. There were four members on the faculty of Neurosurgery. I have been informed that there will be separate write-up's about the development of Neurology, Neuroradiology, Neuroanaesthesia, Neuropathology, Neurochemistry etc. hence I shall restrict myself in the remaining part of this review on Neurosurgery only. Nonetheless it should be mentioned that once the scheme for creating the Centre was approved, in the interval before its complete occupation we were permitted to augment the overall facilities and staff strength in a progressive manner with a view to improve the quality and maximise output of all our activities-patient care service and education in particular. Funds for research had, as even now, to be obtained on competitive basis from the grant giving agencies. During this interval we were able to obtain a munificent grant from the Swedish International Development Agency (SIDA) which modernized our diagnostic and clinical facilities including those for operation theatres and ICU. The first CT Scan in the country was installed under this grant. It was not just a coincidence that this was inaugurated by the President of India on the same day as the foundation of the Centre(s) was laid.

Coming back to the growth of neurosurgical services, in the first full year of our work i.e. 1966 we admitted 140 patients, attended to 540 in the OPD and performed 111 major and 89 minor surgical procedures. It may be mentioned that at that time many of our patients were admitted, operated upon and discharged from the emergency ward. Five years later in 1971 these numbers were 422 admitted, 1044 attended in OPD and 535 (303 major and 232 minor operations performed. In 1976, the year when the first token grant was received for the Centre we admitted 1094 patients, attended to 3784 (1960 new and 1824 old) patients in the OPD, and performed 520 major and 785 minor surgical operations. It may be recalled that at that time neuroradiological investigations pneumoencephalography ventriculography, angiography and myelography were performed by. the clinical team and hence were included as minor operations. In 1986, prior to shifting to the Centre 1898 patients were admitted, 11.225 (3406 new and 7918 old) patients seen in the OPD and 735 and 257 major or minor operations were performed. Starting with only two faculty members in 1965 - Dr. Banerji and myself, it was only in 1971 that we added one more lecturer. Dr B. Prakash. The next person to join was Dr R. Bhatia as Lecturer in 1974 The first faculty position in the Department of Neurosurgery after the Centre came into existence, was 1979 with Dr. Banerji taking over as a Professor. A little known episode in this connection needs mention to illustrate the prevailing team spirit at that time. When we got the first position of a Professor sanctioned for the Centre, I had in my mind wanted it for Dr. Banerji. The day the matter was to be finalized in the Academic Committee I was indisposed and requested Dr. Banerji to attend the meeting and briefed him about my plan. His immediate response was that it should be alloted to Neuropathology, "Dr. Subimal Roy should be given a chance before me". Dr. V.S. Mehta then joined as a Lecturer in 1981 followed by Dr. A.K. Mahapatra in 1983. In the meanwhile Dr. B. Prakash left for G.B. Pant Hospital in 1980. Thus even after fully commissioning the Centre in 1988, the Department had a total strength of 5 faculty members; who continued to share the ever increasing service load as indicated by the figures provided above.

Education

Besides the full fledged in-service M.Ch. course (3 years for post MS (surgery) and a direct 5+1 year after MBBS), the department has been participating in undergraduate education as well as collaborating with basic science department for Ph.D. program. From 1968 when our first trainee obtained his M.Ch. degree, till 1988, twenty eight persons obtained their postgraduate degrees. Since 1988 up to date an additional 31 have qualified. Most of these are serving the country. Several of them became chiefs of their departments at Delhi, Varanasi, Srinagar, Bangalore, Cuttack and Hyderabad, thus fulfilling an important objective for which the Centre was created. From its inception the Department has been actively engaged in CME programs both intramural and extramural. Short-term training programs are organized regularly on recent advances like CT scanning, Microsurgery, Neural Transplantation, Vascular Surgery, Skull base surgery etc. An yearly course on Neurobiology for Clinicians was organized (4 at the AIIMS and 1 at NIMHANS, Bangalore). National level Hands-on Workshops were organized from time to time with the help of international faculty as for example on microneurosurgery, skull-base surgery, neural transplantation etc. A microneurosurgical laboratory, the first of its kind in the country, was established for training in microsurgical techniques, not only for neurosurgeons but for others specialities also from all over the country. The first National Neural Transplantation Facility was established in collaboration with the Department of Anatomy. The first Text Book of Neurosurgery in the country was the result of a joint effort between Madras Neurological Institute and AlIMS in 1980. This has been completely revised and updated in 1996. Four monographs "Lectures in neurobiology" were brought out in collaboration with the Department of Anatomy, AIIMS. The faculty has made contributions to several national and international text books including Tropical Neurology, Handbook of Neurology and Techniques in Neurosurgery.

Research

AlIMS provided a unique milieu for advancing frontiers of knowledge. The Neurosurgery Department fully participated in this effort The major areas of research contributions of the Department involved collaboration of other departments in the Institute and outside included;

1. Head Injury: epidemiology, intracranial hematomas and temporal lobe lesions, brainstem injuries, growing skull factures, outcome of severe head injury. Those studies included a collaborative investigation with Institute of Neurology, Madras and another with University of Charllotesville, Virginia, USA. With in the Institute departments of ENT, Ophthalmology, Pathology, Radiology and Medical Jurisprudence were parts of the investigations at various stages.
2. CNS Tuberculosis experimental studies on pathogenesis, clinical manifestations, etiology and management of post meningitic sequelae, neuroimaging. evaluation of therapeutic modalities (These studies were carried out in collaboration with the Departments of Microbiology, Pathology and Radiology and Nuclear Medicine).
3. Brain Abscesses: Etiopathology, clinical manifestations, brain abscess in cyanotic heart disease, subdural abscesses, management strategies.
4. Cysticercosis: its clinical manifestations, diagnostic dilemmas, CT imaging, role of surgery.
5. Brachial Plexus injuries: a series of investigations as one of the largest in the world, included problems of diagnosis, evaluation of surgical procedures. These studies have been carried out in collaboration with Department of Neurology.
6. Optic nerve injuries are a subject of prospective investigations for more than a decade. Clinical manifestations, visual evoked potentials, role of surgery have been evaluated in collaboration with the department of ENT and as a part of an international multicentric study.
7. Subarachnoid hemorrhage and Intracranial aneurysms specially epidemiological, etiopathological investigations and studies to evaluate various management strategies. The initiation of these studies was done as a part of a multicentric national study which proved the fallacy of the prevailing view of rarity of intracranial aneurysms in India
8. Pituitary Tumours: Immunohistochemical classification, correlation of clinical-pathological and hormonal profile, tissue culture studies (These studies were carried out in collaboration with the Departments of Endocrinology and Neuropathology). Most of these studies were initiated after Trans sphenoid surgery had been established, for the first time in India, in collaboration with ENT department.
9. Gliomas: were a subject of a series of investigations on pathology, classification, evaluation of growth potentials, prognostic factors etc. Surgery for gliomas of the dominant hemisphere constituted a major thrust. A large number of investigations including EM, immunohistochemistry, in-vivo and in in-vitro labeling index studies, tissue culture and molecular markers have been carried out by the neuropathology department.
10. Experimental studies on intracranial hypertension elaborated the patho-physiological mechanisms based on a biomechanical model. These studies were carried out in collaboration with the Department of Physiology at AlIMS and Biomedical Engineering at Indian Institute of Technology, Delhi. In another series of investigations with the Department of Pharmacology the pathogenetic mechanism of pulmonary oedema in raised ICP was elaborated.
11. Experimental neural Transplantation: A national fetal Neural Transplantation Unit (supported by Department of Science and technology) was established in collaboration with the Department of Anatomy. A number of original contributions were made through a series of papers.

The above account will testify that much has been accomplished, no doubt a lot more needs to be. For me personally it has been a rewarding experience and source of great satisfaction, not just the physical growth of the Centre but the years of affection and friendship of the team who really made this happen. The only regret that continues to haunt me is our failure to see a parallel growth of the basic neurosciences as an integral part of the Neurosciences Centre. Individually these disciplines in the Institute have made very outstanding contributions. It has been stated that an institution is the lengthened shadow of an individual. If there is one example to disprove this adage, the Neurosciences Centre is one. It was born in the dreams of several, nurtured with the selfless, dedicated services of many who submerged their egoes for a cause greater than themselves, working as a team the parallel of which could hardly be found any where. In the true spirit of Gita, their sole concern was duty and not the reward. No sacrifice was great enough for establishing a centre of excellence. Posterity will judge whether they succeeded on not but no one would deny that they attempted. Unlike many other such centres in our country, even after the departure of those who initiated it, the Centre continues its journey to greater heights as will be obvious from the story told by those who succeeded. I hope and pray that the Centre will continue to live up to the foundation stone. "In the ultimate analysis, it is not the budget, nor the number of staff positions that makes a truly great centre of public service and higher learning. It is the presence of thoughtful, imaginative, humanistic, loyal and devoted faculty and students that is vital". The Centre continues to be endowed with them and I can only wish them greater heights in years ahead.

Recommendations of The Committee on Establishment of Neurology and Neurosurgery Centre at the AIIMS and Safdarjang Complex

This Centre has been chosen for the following reasons :

1. The excellent staff that are in position and the very good record of patient care, teaching and research, particularly at the AlIMS.
2. The existence of the supporting departments of basic sciences which are fully equipped and which can provide initially the nucleus for each ancillary department of the proposed Neurosciences Centre.
3. The proximity of the department of Neurology at the Safdarjang Hospital which can serve as a trauma and emergency unit for this proposed centre.

The needs of this proposed Neuro-centre are indicated in Appendix I and may be seen to be economical and the minimum required.

This recommendation to make the neurology complex of the AlIMS and Safdarjang Hospital into a Neuro Centre is based on the following requirements.

1. Enthusiastic cooperation from the Departments of Anatomy, Physiology, Biochemistry, Pathology, Microbiology, Endocrinology, Genetics, Immunology and Experimental Medicine and Surgery of the AlIMS and their capacity to provide the necessary staff and equipment to develop these special aspects like neuro-anatomy, neuro-physiology, neuro-pathology, neuro-chemistry etc. that is, a pooling of the resources already available. As this Neuro-centre develops and the national resources improve, each one of these sub-specialities may develop its section in a new building to be constructed.
2. Expansion of the bed strength facilities will need space not available in the present building. A piece of land has already been earmarked to build a Neurocentre which has to be taken up on a priority basis.
3. Till such times as the building is ready, the rest of the recommendations may be given effect to immediately.

Neurology and Neurosurgery Centre cont.

The Committee has further observed that

1. Minimum arrangements have to be made to coordinate the emergency and head injury service of the Safdarjung Hospital with the Neuro-centre by:
   1. according mutual and appropriate designations for the staff of each institution in the other; and
   2. arranging full clinical coverage of these beds by the combined staff of the Neuro-Centre and delineating mutual responsibilities.
2. The Neuro-radiological facilities already available in the Safdarjung Hospital, including one Mimer X-ray machine, must be made available for this Neuro-Centre immediately, alongwith early sanction of the recommended neuro radiology staff.
3. Experienced Neuro-pathologists being very few in the country, the Committee strongly recommends the immediate appointment of Dr. S. Sriramachari, Director, Registry of Pathology, New Delhi, as the Hony. Professor of Neuro pathology in this Neuro-centre
4. The various sub-sections collaborating from the parent departments in the AlIMS should. in course of time, become full-fledged departments of the sub-speciality - e.g. neuro-pathology, neuro-radiology, neuro-physiology, neuro-chemistry, neuro-psychology etc.”

Prof. A K Banerji

(1965-1995) presently Emeritus Professor Neurosurgery

“It was May 1965 that I came to Delhi from Vellore where I was a lecturer, to appear for a Union Public Service Commission interview for the job of Reader at G. B. Pant hospital, Delhi and All India Institute of Mental Health, Bangalore (later to become NIMHANS). I was the only candidate and was asked at the end as to which place would I prefer. I chose Bangalore. Just before leaving for the interview, I had gone to see Dr. Baldev Singh and Dr P. N. Tandon (PNT) at AIIMS to pay a courtesy call. They were sharing an office and I suspect eagerly waiting like spiders, to catch a victim in neurosurgery, who could stick on at AIIMS, which at that time had actually nothing no space, equipment or staff. After a little talking about general things, suddenly, Dr. Baldev Singh asked me to think whether I at all wanted to go for the interview, as AIIMS could possibly offer me a job, I of course declined the proposal as a bird in hand was better than two in the bush. Then Dr. Tandon asked me to come home for tea that evening. I left for the Union Public Service Commission office. Today when I see large number of candidates for a job interview my own experience seems miraculous.

Coming back after the interview I recounted what happened to Gopal and his wife Radha (Dr. G.K. Vishwakarma was then Asst. Professor Orthopaedics and later became D.G.H.S. of Government of India) Insidious pressure started from them to come to AIIMS and forget about Bangalore. Incidentally Bangalore had a working, full fledged department with Prof. RM. Verma and he tried hard to get me there even after I joined AIIMS.

That evening I spent at Tandons. Dr. P. N. Tandon had been my Anatomy demonstrator in 1952 while Mrs. Leela Tandon was my lecturer in Obstetrics and Gynaecology at Medical College, Lucknow. I had met Dr. P.N. Tandon in 1963 at the annual Neurological Society of India meeting in Calcutta. For both of us it was the very first meeting that we had attended of NSI. Dr. P. N. Tandon had established the department of neurosurgery at AlIMS 2 months before in March 65. He had been promised equipment but nothing had arrived in the two months. He was eager that I should join but was frank to say he did not know how things would eventually develop. After returning to Gopal's house, Radha and Gopal took me to see 'My Fair Lady' at Sheila Theatre which then was the best in Delhi, if not India. After returning well past midnight we slept on the roof and went on talking about what I should do. I think it was near the break of dawn that I finally succumbed to pressures from Gopal and Radha and said OK I'll come to Delhi if the job was offered. Next morning before I left Delhi Dr. Baldev Singh took me to meet Prof. K. L. Wig then Director AIIMS. Our liking for each other was instantaneous and the bond carried throughout.

I joined as adhoc Assistant Professor in June'65. There was one office of Dr. Baldev Singh in which in addition to Dr. P. N. Tandon another chair and a small table was put for me. The process of starting a department began really from scratch. Space was allotted on the first floor by the side of anatomy lecture theatre. I and Dr. V. Virmani (my opposite number in Neurology) sat down to draw maps and carve out rooms in the large halls. At that moment, our vibes were bristly to say the least. Dr. Virmani was considerably senior in age plus she had known Dr. Baldev Singh since Amritsar days and she also held the trump card of being Punjabi speaking which was then the lingua franca of AIIMS. Over the years our relationship mellowed and we did develop mutual admiration and respect for each other. I hit upon the strategy in our dealings at that time of building the departments, of saying exactly opposite of what I wanted. Dr. Virmani would of course, reverse my suggestions much to my advantage. Today when I look back it all appears so childish. But then it was great fun. Slowly collecting items like pins, chairs, tables, almirahs and make real offices was a new challenge for which I was not trained. Anyway we built the office cubicles, laboratories and got the OPD on the 4th floor in ship shape. It was so gratifying after two years of joining that we had a place of our own.

We started with surgical instruments which actually were of World War II vintage which included an operation table. Burr holes had to be made by a brace in 4 stages and both Dr. Tandon and I developed the art to perfection. To begin with we had no beds. Both for Neurology and Neurosurgery, Prof. K.L. Wig and the Pediatricians generously allowed us use of their beds in what is now the nurses hostel. There was so little clinical work that it was terribly frustrating in the beginning. I started taking clinics for the MD students of medicine, pediatrics and radiology. I slowly became quite popular to the extent that one day Dr. Wig called me to see one of his patients in his office. I must have impressed him no end as after that on several occasions he would ask for my opinion on patients. This was a small matter for him but a great boost for my confidence for which my gratitude goes to him.

By 1968 we were having a ward in the OPD block (ward IX) and we were well settled. The operation theaters were in the College of Nursing Block. Radiology to begin with was in the nurses hostel, and only in 1968 shifted to its present location. That was the time when we had Dr. S. K. Ghosh in radiology from 1965 to 1968 and he was a great help. Very often we started the day at 7.30 A.M. with ward rounds, dressings and stitch removals, followed by neuroradiology  (ventriculograms angiograms etc) and then this was followed by surgery which would invariably end by 7 or 8 P.M., particularly if it was a posterior fossa tumour. At night one of us i.e. PNT or myself would sleep in the doctors room adjacent to the main O.T. block. From 1966 onwards Dr. B.B. Sawhney and Dr. M. Gourie Devi, now Director and Vice Chancellor NIMHANS who were residents in neurology would help us out by doing night duties and also assist in surgery as we did not have regular residents of our own. The role played by Col. G.C. Tandon, the Professor of Anaesthesia, was unforgettable. Dr. Hattangdi's lectures in anaesthesia helped us enormously and he also shared our burden in looking after patients, sometimes relieving us of our daily chores. The two films I saw with Anjali, my wife, during the time was courtesy of Hattangadi. Before I proceed I must tell of my first day in the operation theatre block (MOT) in the consultants changing room, where I went on my own apprehensively, to discover its ambience. The only person there in OT dress was reading an Agatha Christie paperback with great seriousness. On entering he asked me as to who I was and then got up with great cordiality and shook me by the hands. That was Dr. Satish Nayyar, Assistant Professor in Surgery well known as he was a Hallet medalist in the primary FRCS examination. Dr. Satish Nayyar gave me a cup of tea and then said that I must cultivate some hobby (his was reading mystery novels) as Assistant Professors had nothing to do as the Professor usurped all the work which was worthwhile, while all the minor work was done by the Registrars (later called residents). I went into depression from which it took me a long time to come out. Within a week I took courage in my hands and went to talk it over with PNT. We decided that alternate cases would be operated by us while the other would assist. Matters went on well but I was perturbed over the fact that if he assisted, he would go out and talk to the patients attendants before I could come out. Again I went to him in 1968 and PNT graciously agreed he wouldn't do so. This was a remarkable thing at AIIMS. My struggle for identity of Assistant Professors went on to the faculty over such oligarchy and it was ultimately in 1970 that I was able to change the nomenclature of hospital units which hitherto were identified with the head, to that of the departments. Thus Prof. P.N.T's unit changed to Neurosurgery unit-a practice which continues today. I have always felt that to obtain the best from colleagues a measure of democracy and participation should be the prime substance PNT's contribution towards this was immense which allowed me to put my heart and soul in developing the department and later the Neurosciences Centre. I guess the role of wives is also very great. Our families (Tandon and Banerji) were close to each other and even today no major decision in the Banerji family takes place without Tandons consultation. I guess this meeting was lucky for both of us.

In 1969 Dr. S.K. Ghosh left for Goa on promotion as Professor and Neuroradiology was taken over by Dr. R.K. Goulatia for whom a separate post was created in neuroradiology. In mid 70's Dr. S.S. Saini was persuaded to join Neuroanaesthesia and this started the nucleus of a comprehensive clinical setup. Fortunately we were able to persuade (Mrs. D. Saini to join as our OT sister incharge and thus there was a feeling of family and belonging, so important in the development phases of any new venture. Dr. Subimal Roy was spending considerable time in Neuropathology to complete the picture. I had a vision of Neurosciences Centre akin to PNT, however I knew that basic neurosciences can never develop on its own because of economic compulsions. My emphasis was on developing clinical neurosciences and bring in basic neurosciences within its umbrella.

By mid 70's both neurosurgery and neurology had relocated itself on the main hospitals 4th floor and we were lucky to have separate independent wards. Mrs. M. Bindra joined us as sister I/C of neurosurgery ward and her dedication eventually made our ward the talking point of nursing care in the Institute. She eventually rose to become the Nursing Superintendent of the Neurosciences Centre.

In 1966 one day, walked into my office Dr. Brahm Prakash, who had resigned his Short Service Commission in the army and had married recently. He was at loose ends, asking my advise as to what he should do. He had earlier worked as my junior resident in general surgery at Medical College, Lucknow and the association was about 10 yrs. old. I persuaded him to join neurosurgery.  We were able to rustle up the required formalities for starting MCh course with bare facilities but boundless enthusiasm. He was the first trainee and later joined our faculty and went on to become the Director Professor at G.B. Pant Hospital and started his own MCh programme. The AlIMS MCh course went from strength to strength and eventually we were having both the 5 yr and 3 yr streams. Neurology D.M. had started already in 1965. Now AlIMS trainees are spread all over India. Several headed departments e.g? Dr. Gourie Devi became Director Vice Chancellor of NIMHANS, Dr. B. Prakash at G.B. Pant Hospital Delhi, Dr. B.S. Das at NIMHANS, Dr. S. Mohanty at IMS, BHU Varanasi, Dr. A. K. Reddy at NIMS Hyderabad, and Dr. M.A. Wani at SKIMS Srinagar. Many hold important positions in teaching as well as private sector. We i.e. PNT and I are inordinately proud of all who trained themselves with us and wish them all the best in their future endeavors. Our wish is that they better us in their achievements. A major breakthrough in our clinical services occurred in 1976 with the coming of Prof. H.W. Pia who did a course in laboratory microsurgery. In the next few years we started a microsurgery laboratory and operative microsurgery was initiated. In the Indian scenario we stole the lead. In late 60's with the help of our ENT surgeon Dr. S.K. Kacker we started trans-sphenoidal pituitary surgery which consolidated in the 70's and became a routine procedure.

The process of development of the Neurosciences Centre in collaboration with the Cardiothoracic Sciences Centre started in real earnest in early 70's. Dr. N. Gopinath of Cardiothoracic Surgery and PNT were the architects. Land allocation was done by Prof. V. Ramalingaswami, the then Director AIIMS. Ghosh and Pradhan Associates were appointed architects and their started the planning for the basement, ground floor and the operation theatre block of our centre. Hours and hours of meetings with the architects-designing and tearing plans, it went on and on. I heard my wife say that I started talking of planning even in my sleep. We were about ready to have the foundation stone laying. This was 1977 and Mrs. Indira Gandhi's infamous emergency was coming to an end. One afternoon, in PNT's office, Dr. N. Gopinath suddenly said it would be nice to have Mrs. Gandhi lay the foundation stone. I had recently treated Mr. Dhawan's (then the personal secretary to Mrs. Indira Gandhi) nephew and I said shall I try. I rang him up on the phone from PNTs office. Mr. Dhawan immediately said yes and wanted probable days and times so that it could be confirmed taking into account Mrs. Gandhi's tour programmes. Elections were round the corner and Dr. Ramalingaswami wisely asked us to go slow. Mrs. Gandhi lost the elections and it is possible that the Janata Government which followed may have taken offence and delayed the start of the Centre had we got Mrs.lndira Gandhi to lay our foundation stone. Eventually, President Mr.Neelam Sanjeeva Reddy lay the foundation stone in 1978. When the building started many problems surfaced e.g. we suddenly discovered that there were very few toilets while most of the patients of cardiology were on diuretics and required use of toilets frequently. Again to the drawing boardbreaking of walls, laying of new sewer lines and so new toilets came into being. I know the OPD and of course the toilets have today become too inadequate with increasing number of patients coming to the Centre.

The brief period of Janata regime from 1977 and 1979 saw the irrepressible Mr. Raj Narain come as the Health Minister. All work in the Ministry came to a halt as also our Centre which bore the backlash of erratic ways of Mr. Raj Narain. The only thing I remember was meeting him near the present Community Medicine Department late in the evening,  Mr. Raj Narain was coming to inaugurate, if I remember correctly, the Centre of Community Medicine. As usual he was hours late and the then Director Dr. L.P. Agarwal was standing with 3to4 faculty members. I tried slinking away but Dr. L.P. Agarwal called me and more or less forced me to stay on awaiting Mr. Raj Narain. He eventually came when the numbers of people waiting was not more than half a dozen. Before going to cut the ribbon he was introduced to all of us. He was highly intrigued with me and asked what would I find if I did have an opportunity to see the inside of the head of Mrs. Indira Gandhi. I made some polite comments though I was sure Mrs. Gandhi had a better quality brain than Mr. Raj Narain. Anyway he went on to narrate it with great gusto during a special convocation to award an Honorary D. Litt to Dr. Sewoosagar Ramgoolam of Mauritius. It was in such bad taste that Morarji Desai who was chairing frowned and all of us in the auditorium hung our head with embarrassment.

My two stints as Chief of Neurosciences Centre were significant in the development of the Centre. The first was a 2 year term as acting Chief of Centre while Dr. PNT was on Nehru Fellowship between 1984-86. This was the time when after the first phase of building (OPD, radiology wing, basement and OT block) we had reached a dead end as far as expansion of the Centre was concerned. Prof. M. L. Bhatia was the Chief of Cardiothoracie Sciences Centre. Our formal requests for funds were stiffly rebuffed by the then Joint Secretary Finance Adviser (JSFA) of Health Ministry. Ms. Sarla Grewal, widely nick named 'hunterwali' by her unkind colleagues, was the Secretary. We were advised not to try and influence her which could cause an unpredictable antagonism to our proposal. Anyway we went to meet her, placed before her, the developments till date, including our mounting clinical load, increasing public expectations, and the blockades experienced by us for expanding our Centres to what was originally planned. Ms. Grewal quietly listened to us, occasionally interjecting for a clarification. After we completed she asked for the JSFA who was the main stumbling block, to come and join the meeting. The moment he saw us his hackles were raised. On being asked by Ms.Grewal as to what were the problems in giving us the grant he started off with a long list of financial mismanagement by AlIMS in which our Centres had no role to play. (Most of the problems recounted were exaggerated to say the least). Ms. Grewal asked as to why our Centres were being penalised for what AlIMS had done. To this the JSFA said that this is a part of financial management for which he was responsible. Then we saw the legendary Ms. Sarla Grewal come into her elements. In chaste Punjabi she asked the JSFA as to who was the Secretary of the Ministry and how dare he speak to her like that. The poor JSFA spluttered and stuttered and tried to put in a word edgeways. Ms. Grewal asked him to leave the office and we knew that our battle was half won. However after leaving her office both Prof. M.L. Bhatia and I, as a matter of diplomacy, went to the JSFA's office. He was in the dumps. We nursed his hurt ego by asking for his help as we knew that he was quite capable of going to the Finance (Expenditure) Secretary and derail our proposals. I think the strategy worked as he did become a supporter. Of course things were helped as a few close relations of the JSFA fell conveniently ill at the same time requiring cardiac and neurosurgery. Funds eventually came though it took another year and in 1986 the remainder of the present Centre's building was started. Prof. P. Venugopal was a constant source of support in our endeavours. In the same period the next Union Health Secretary was Mr. Srinivasan, who was unenthusiastic about our Centres. His general impression was that we were overstaffed, our equipment underutilized and our clinical output low compared to other hospitals e.g. G. B. Pant Hospital Delhi, Christian Medical College Vellore, and certainly Apollo Hospital Madras which to him was the ultimate in financial management and output. Incidentally he was involved with the starting of Escorts Heart Institute which he clearly told us is a 'better bet than us'. Prof. Bhatia, Venugopal and I went through our records as well as what we could gather from the other institutions which Mr. Srinivasan thought had better quality and quantity of work. He had a meeting separately with our Neurosciences group to take stock. I had taken Dr. Baldev Singh and Dr. P.N. Tandon for the presentation made by me. By the end Mr. Srinivasan was convinced of the genuineness of our proposals. My plea at that time was to get financial grant equal to G.B. Pant Hospital whose output was half of ours. It was a landmark victory as our grants immediately increased, a trend which continued in the future.

My next stint as Chief of Centre was between 1988-95. Finances were forthcoming in good measure We had a CT scan and state of art angiography equipment. Our ICU was the best in the country. What we lacked was a MRI Scanner. I must pay special thanks to Mr. R.L. Mishra who was the Union Health Secretary in the latter part of my assignment. We had an excellent relationship and he was always positive in his approach. It is through his help that we got the NMR department setup at AIIMS, which was far more than merely obtaining MRI equipment. Incidentally even today the NMR Department has the only 2 Tesla machine capable of MR Scan and also MR Spectroscopy. The NMR department also has chemical NMR and the only experimental NMR in India today. It was an unique experience to create a whole department with the help of the then director Dr. S. K. Kacker who was always supportive.

It is during my tenure that proposals were sent to the Government for making the Centre the best equipped not only in India but in the Asian region. The Gamma Knife has started after I retired and I am sure PET scan and other newer equipment would come in due course.

I am often asked as to whether I have any regrets. My special regret is our offices being removed from the main Institute. It was originally envisaged that offices would remain where they were located i.e., adjacent to Anatomy dissection hall. The translocation has severed the umbilical cord to the other specialties in the Institute. This isolation does not augur well for the future of our Centre, as any branch of medicine to flourish requires interaction with sister disciplines. My other regret is the inability to have nonclinical neurosciences to come and establish themselves in our Centers new building. I had tried, even to the extent of keeping a floor vacant for one year under various pretexts.

My greatest gains were the colleagues I had - friends for life. I know I left alive vibrant active Centre which will only grow from strength to strength. Even today for anything I always say Neurosciences Centre, AIIMS is the best and with every breath only wish it the very best in its future endeavors.”

Neurosurgery operation rate list

1. Burr hole, tracheostomy, E.V.D., Ommaya. I C P monitoring, ICA ligation: Rs-2000/
2. VP Shunt, DBS, Endoscopy, Brain Biopsy: Rs - 5000/
3. Simple spine(No instrumentation), Extramedullary tumor, Peripheral nerve surgery, Carotid endartrectomy:Rs- 10000/
4. Complex spine ( including CVJ instrumentation), Intramedullary tumors, Laminoplasty:Rs- 15000/
5. Simple craniotomy ( including head injury, Supratentorial and infratentorial tumors), Transphenoidal surgery:Rs- 15000/
6. Complex Craniotomy ( including craniotomy for aneurysm, AVM, Epilepsy surgery, CP angle tumor, skull base tumors): Rs- 20000/
7. For every single titanium aneurysm clip used Rs 5000 will be charged