Advanced neurosurgery techniques, great mental solace
The first reported case of neurosurgery was in the CMJ of 1889, a
compound fracture in the frontal region of the skull, operated by E. E.
Modder, a colonial surgeon at the Kegalle hospital, and the significant
factor in the case was the removal of a lipo meningioma from the left
rolandic area by J. H. F. Jayasuriya 1936.
The patient was pregnant at that time and surgery had been done under
local anaesthesia. Again the same surgeon had removed osteoclastoma from
the lamina of the dorsal spine in 1934. Finally Dr. Shelton Cabraal laid
the foundation for modern and organised Neurosurgery in Sri Lanka.
President of Neurosurgeons Association Dr. Abeysuriya made the
following comments to the Sunday Observer.
Dr. Shelton Cabraal was a Founder Member of the Department of
Neurosurgery in Sri Lanka. The first Neurosurgery Unit was set up in
1956 at the then General Hospital Colombo, with 12 beds which in later
years became the centre for undergraduate and postgraduate trainees.
The first trainee under Dr. Cabraal was Daival Weinman and with the
completion of his post graduation in 1962, he became the second
Neurosurgeon in the country. Further expansion of this unit was done in
1959 and as a result the entire 4th floor of the five storey building at
the General Hospital which is adjacent to the present Neurology Ward
unit was allocated for Neurosurgery in 1959.
The major step towards development was the establishment of a
Neurosurgery unit by Dr. Subramaniam at the Jaffna Hospital in 1960 and
it marked the first step towards this decentralisation of Neurosurgery
in Sri Lanka.
On completion of my general surgical training I joined the
neurosurgery unit in 1962, as a Registrar and later with my
post-graduate degree in England I assumed duties as a Neurosurgeon at
Neurosurgery unit at the National Hospital, Colombo.
For a short spell I performed surgeries in the Colombo unit, and with
the need of further expansion of Neurosurgery facility to other areas, I
volunteered to move on to the Teaching Hospital, Kandy. With the help of
hospital staff and the Ministry of Health I was able to establish a
neurosurgery unit at the Teaching Hospital Kandy, in 1972.
The second unit at the National Hospital "The Institution of
Neurology" was an outright purchase by the public through the Buddhist
Congress with Dr. J. B. Peries who was instrumental in getting this
However further development of neurosurgery in Sri Lanka faced a
severe setback from 1990 to 1993, during this short period four
Neurosurgeons left the unit due to some internal disputes. As a result
Dr. Lal Gunasekara, Dr. Selladorai and Dr. Gunanandan left the country.
In addition to these woes Dr. Subramaniam passed away. These chain of
events hindered the further development of neurosurgery. At that time we
generally used angiography for detection of brain disorders.
The first CT scanner was set up at the National Hospital in 1988,
followed by MRI scanner with financial assistance from Presidents' Fund
and public donations. The MRI scanner was set up under the supervision
of Dr. Colvin Samarasinghe.
However with in a short span of time two more MRI scanners were set
up one at Karapitiya and the other one at Kandy. The CT scanners are now
widely available in most of the teaching hospitals in the country, Dr.
The Secretary to the Ministry of Health, Dr. Athula Kahandaliyanage
said, "We all must thank Minister Nimal Siripala de Silva for his
initiative in the rapid expansion of neurosurgery in the country. It was
under his leadership that we were able to set up new Units at the Galle,
General Hospital Badulla, Ratnapura, Kurunegala and Batticaloa and a
second unit at TH Kandy.
Since the Ministry had no funds of its own to purchase the needed
equipments for these units but the Minister raised funds from donor
countries to provide these units with CT scanners, MRI scanners, ultra
sonic aspirators and theatre equipments.
I must also express my thanks for the hard work led by Dr. Sunil
Perera, Dr. Himashi Kularatna, Dr. Wadanmbi, Dr. Prassana Gunasena and
Ranjith Wickremasinghe, by creating new units at Galle, Badulla,
Anuradhapura and Kandy.
In the process of the development of Neurosurgery units in the above
hospitals, that the Director General Bio-Medical Muditha Jayatillaka and
Anura Maitipe both made an immense contribution to the successful
implementation of these units.
The Ministry has a clear cut policy to develop neurosurgery units in
the country and our next target is to develop units at TH Jaffna and
General hospital Vavunia.
At present there are three neurosurgeons at the National Hospital
Colombo, two in Kandy, one in Galle, one in Anuradhapura and one in
Batticaloa. The Units at TH Kurunegala, TH Ratnapura and Batticaloa are
still in the early stages of development. Dr. Himashi Kularatna who
based his comment on the subject said, "There was no neurosurgery
facility in the Southern Province until 1997.
The Minister of Health Nimal Siripala de Silva appointed me to TH
Karapitiya as a Neurosurgeon in 1997 soon after I returned from the UK
on completion of my post-graduation. A section of the normal ward at TH
Karapitiya was allocated then for neurosurgery. There were no beds,
theatre facilities or fine instruments needed for surgery.
An American ship enroute via Sri Lanka to the US after the Gulf war
in 1991 had donated few beds and other equipments to the Ministry of
Health. The items were dumped in the stores. And I was able to find some
beds, mattresses, blood pressure apparatus, ophthalmoscopes, head lamps
and some minor surgical instruments out of these donated items.
And I must thank Minister Nimal Siripala de Silva for his efforts in
this task who helped me to get the needed sophisticated equipments to
set up a well equiped Neurosurgery Unit at TH Karapitiya along with an
intensive care unit and a new theatre.
I must also thank Director General Bio Medical Mudith Jayatillaka and
Anura Maitipe who were instrumental in getting these major neuro
surgical instruments to fulfil this task.
I also must thank sister Wijetillaka who extended her fullest
cooperation to establish this unit by providing necessary staff.
As I was the one of the and the only Neurosurgeon at Karapitiya
Hospital I had to work day and night throughout the year to treat
patients. I am happy that our unit had rendered great service to the
patients at the time and after tsunami disaster. All the patients with
head injury were treated at this unit and we handled the situation in a
very successful manner.
The fifty years of development of neurosurgery in Sri Lanka
With the commemoration of the fiftieth anniversary of introducing
Neurosurgery in Sri Lanka the Sunday Observer interviewed Dr. Abeysuriya
the President of the Neurosurgical Association of Sri Lanka and Dr.
Athula Kahandaliyanage, Secretary to the Ministry of Health.
Dr. Abeysuriya stated the most important milestones in the history of
Neurosurgery and Dr. Athula Kahandaliyanage stressed upon the most
recent developments in the field.
1956 - Dr. S. A. Cabraal was the founder of Neurosurgery in Sri
Lanka. The first Neurosurgical unit in the country was established by
him in 1956 at the National Hospital in Colombo.
At the beginning of this Unit it had only 12 beds. The first trainee
of Dr. Cabraal was Dr. Darrel who completed his post graduation 2, 1962
and he became the second Neurosurgeon in Sri Lanka.
1959 - The fourth floor of the Bandaranaike building was allocated to
Neurosurgery by Dr. Cabraal which comprised three wards, male, female
and paediatric along with a theatre, ICU and a physiotherapy unit.
1960 - Dr. Subramanian established Neurosurgical unit in Jaffna
Hospital 1972 - Dr. S. C. Abeysuriya established Neuro Surgical Unit at
1984 - The Neurology Institute was constructed with public donation
under the guidance of Dr. J. B. Peries.
The second unit was established in the second floor of this building
with theatre facilities. Dr. Lal Gunasekera in the late 1980s converted
to a fully-pledged neurosurgical unit and started performing the latest
Neurosurgical procedures. Dr. Sunil Perera took over this unit in 1966
and improved the infrastructure further. Currently it is served by two
neurosurgeons Dr. H. Kularathne and Dr. Rajakaruna.
1989-1990 - Neurosurgical unit located on the fourth floor of
Bandaranaike building fully furnished by the Finish Project to the
current status. This unit is functional up-to-date with the same
facilities and with the same bed strength.
1988 - The first CT scanner at the General Hospital Colombo was
installed on the fourth floor of the Bandaranaike building, a donation
of German Government.
1994 - The MRI scanner of the NHSL was installed in the ground floor
of the Bandaranaike building. Two thirds of the funds for the scanner
was from the President's Fund. Mr. Chandra Wickramasinghe played the
main role in providing these funds. The balance one third was raised by
the Neurosurgery Trust Fund mainly through public donations, headed by
Dr. Colvin Samarasinghe.
1989-1994 Neurosurgery unit was closed because of the lack of a
neurosurgeon. In 1994 Dr. Sunil Perera after returning from training in
the United Kingdom re-established this unit.
Dr. D. Jayawickrama took over this unit after Dr. Sunil Perera was
transferred to Colombo. Dr. Ranjith Wickramasinghe established the
Neurosurgical unit in Kandy during this time. Currently there are two
Neurosurgical units in Kandy by Dr. Ranjith Wickramasinghe and Dr. J.
1996 - Dr. Sunil Perera was appointed as the Neurosurgeon to NHSL. He
continued his duties in the Neurosurgical unit located at the Institute
of Neurology. He pioneered certain advanced techniques of spinal and
He also pioneered Epilepsy Surgery and Deep Brain Stimulation for
Parkinson's disease which are technologically most advanced forms of
surgeries in the world.
He was instrumental in soliciting funds for the Neuro Trauma Unit
amounting to US$ 13 million from Saudi Fund. This building which is
currently under construction is scheduled to be completed towards the
end of this year. When it is operational it has the potential to become
the best Neuro Trauma Unit in the world.
Minister of Health Nimal Siripala de Silva fully supported to get
this project off the ground.
To keep your mind working, keep your feet moving.
Elderly people who walk the most have the best mental function,
according to two new studies in the Journal of the American Medical
University of Virginia researcher Robert D. Abbott, PhD, and
colleagues looked at elderly men ranging in age from 71 to 93. Those who
walked more than 2 miles a day were nearly half as likely to get
dementia as men who walked less than one-quarter mile a day.
Harvard researcher Jennifer Weuve, ScD, and colleagues looked at
elderly women aged 70 to 81. Women who walked at an easy pace for at
least 90 minutes a week had better mental function than those who walked
less than 40 minutes a week.
"Physically capable elderly men who walk more regularly are less
likely to develop dementia," Abbott and colleagues write. "Promoting
active lifestyles may have important effects on late-life [mental]
function." Exercise: the Fountain of Youth? The Abbott study looked at
2,260 men who live in Hawaii. The effects of walking in this group of
men were also shown to reduce the risk of death, heart disease, and
However, walking did not overcome the bad health effects of
smoking.Among smokers, walking did not cut dementia risk. But smoking
itself was linked to a higher risk of dementia.
The Weuve study looked at nearly 19,000 women enrolled in the Nurses'
"Higher levels of long-term regular physical activity were strongly
associated with higher levels of [mental] function and less [mental]
decline," Weuve and colleagues write.
If there's a fountain of youth, it may be physical activity. Weuve's
team found that the most active women seemed years younger.
"The apparent [mental] benefits of greater physical activity were
similar in extent to being about three years younger in age and were
associated with a 20 per cent lower risk of [mental] impairment.