Tribhuvan University Department of Neurosurgery (TUTH)

T.U. is a large nearly 500 bed hospital that offers all surgical and general medical services.  There are quite a number of other hospitals in Kathmandu, and T.U. is the main teaching hospital.  There are neurosurgeons in private practice who work at all the other hospitals.  T.U.'s Department of Neurosurgery has three faculty: Sushil, Mohan, and Gopal.  Sushil is a fully trained general surgeon and did his neurosurgery trainingin Phoenix.  Mohan did three years of neurosurgery in Seattle under Dick Winn and Rich Ellenbogen.  Gopal was trained in Asia.  All three are extremely intelligent and very kind, gentle people.  Sushil is our host and has been wonderful to myself, my wife, and our youngest son.  In general, one can safely say that Nepali's are warm-hearted, gentle souls.  The first day at work stated with a presentation by the residents about the cases on the wards, in the ICU, and those just admitted from the E.R.  The room was full of the attendings sitting on one side wall, the residents sitting on the opposite side wall, and the medical students sitting in the middle.  The presentations were to the point and complete with all pertinent details including films.  The cases included several complex brain tumors and aneurysms, trauma, pediatric cases, hypertensive hemorrhages, TB, encephalitis, discitis, and a potpouri of others.  Very busy neurosurgery service. There was the usual questions and teaching by the attendings, reminding me of my residency. 

Then we did ward and ICU rounds where we saw a lot of these cases at the bedside.  This is where I was able to teach the residents and discuss surgical options for new cases and post-op care for the already operated cases. Two cases were presented in detail for my benefit and for surgery tomorrow: one case with a two month history of C4-5 locked facets, neurologically intact, with significant kyphosis.  We had a long discussion about surgical options and i will be helping the residents do this case tomorrow.  The other was a C1-2 that requires posterior decompression plus C1-2 transarticular screw fixation which we will also operate on soon.  Tomorrow, we will also perform a craniotomy for p-comm aneurysm and a couple of other cases.  This is all on Sushil's day in surgery.  Mohan has Mondays and Gopal another day.  

I saw a case of Japanese encephalitis with a ventriculostomy in place, an MVA case with a hemorrhage that looked more like an aneurysmal hemorrhage so we will be getting an angiogram done today.  

I unpacked all of the donated and loaned implants, instruments, and drill with Sushil and Gopal.  They are most appreciative.  We discussed how it there is a shortage of fluoroscopy available in the O.R.'s (total of 8) since the other surgical services all need fluoro even more than the neurosurgeons.  We should be able to reserve the fluoro for any instrumented spine cases however.  T.U. does have an CT, MRI, and two operating microscopes. 

On an non-clinical note, Kathmandu's streets are by and large all being widened, so there are incredible muddy, rocky ruts, huge holes, all made more complex to get around due to massive traffic.   It's an adventure just walking down the street or moreso, driving anywhere with Sushil and Mohan.  They are experts at "off-roading" on the main roads!  

Richard Wohns