Prof. Suresh Nair Narayanan NairIndia
SCTIMST
| 06/2022 to present | Visiting Professor PD Hinduja Hospital Mumbai |
| 09/2023 to present | President International Meningioma Society |
| 07/1986 - 02/1999 | Asst/ Assoc/ Additional Professor of Neurosurgery, SCTIMST, Trivandrum |
| 03/1999 - 06/2006 | Professor of Neurosurgery, SCTIMST, Trivandrum |
| 07/2006 - 06/2017 | Professor & Chairman of Neurosurgery, SCTIMST |
| 01/2013 - 12/2015 | Dean, SCTIMST, Trivandrum |
| 11/2018 - 01/2020 | Professor of Neurosurgery, AIIMS, Bhopal |
Surgery for Vestibular Schwannoma, Trigeminal Schwannoma, Petroclival meningioma, Spinal Intramedullary tumors
Prof Suresh Nair had a distinguished career as a faculty for 31 years at the Department of Neurosurgery at Sree Chitra Tirunal Institute for Medical Science and Technology (SCTIMST) at Trivandrum, India which is an institute of national importance under the Ministry of Science & Technology, Government of India. He became Professor in March 1999 and headed the department from July 2006 till his superannuation in June 2017. He was also Dean of the institute for three years (2013-15). During his tenure at SCTIMST, he trained 101 residents who are all accomplished surgeons all over India and abroad. He also served as Professor (Consultant) in the Department of Neurosurgery at the All India Institute of Medical Sciences (AIIMS), Bhopal in November 2018 and worked there for fifteen months and during that time he could start residency program in neurosurgery there. He was the President of Neurological Society of India (NSI) in 2018 and the President of the Skull Base Surgery Society of India in 2015. He is currently a visiting professor to PD Hinduja Hospital, Mumbai.
He has been made President of International Meningioma Society at International Meningioma Congress in Sept 2023. He was the Secretary of the World Federation of Skull Base Societies ( 2016 – March 2022). He had served as a member of the nominating committee of World Federation of Neurosurgical Societies (WFNS) (2019-2021) and had also served as a member of WFNS Cerebrovascular Committee for two terms. He was also a member of the WFNS Skull Base Surgery Committee (two terms) and Complications Committee. He is an executive member of Asian Oceanian International Skull Base Surgery (AOISBS) committee. He is one of the two Indians who is a member of the International Editorial Review Board of the prestigious journal “Neurosurgery”. He is also on the Editorial Board of Neurology India, International Journal of Evidence Based Medicine besides being a reviewer for World Neurosurgery, Asian Journal of Neurosurgery, Childs Nervous System to name a few. He has been recently made a founding member of Yasargil Microsurgical Academy.
He has been a visiting Professor to Fujita Health University in Toyokae (2006-07) and visiting faculty to various Universities in Japan, USA & India. During his career he has delivered 14 orations which includes the prestigious B Ramamurthi centenary oration, Prof. RM Varma oration, Prof Dave oration and Mr Sengupta oration to name a few. He has the coveted honor of conducting two invited CPC meetings at the All India Institute of Medical Sciences, New Delhi. He is an examiner in Neurosurgery to various Indian Universities and to the National Board besides being a resource person for Nurological Society of India’s educational ventures. Prof Nair has published 170 peer-reviewed articles, and has presented more than 400 scientific presentatios in international meetings. He has 3340 citations with an h index of 25, and i 10 index of 51. He has authored 37 chapters in text books. He is an accomplished surgeon in posterior fossa surgery and has operated upon more than 1000 CP angle surgeries which includes 835 vestibular schwannomas. His areas of interest are cerebellopontine angle tumors, petro-clival meningiomas, trigeminal schwannomas, clival chordomas and spinal intramedullary tumors. For his outstanding contributions to neurosurgical training and education, he was awarded Prof RM Varma distinguished neurosurgery teacher award by Sree Chitra Tirunal Institute for Medical Sciences and Technology
Demystifying myths about arachnoid in relation to 7th nerve in surgery fir large vestibular schwannoma: Based on personal experience of 835 cases
1108 08:20-08:30
Skull Base/304A
Objectives: An understanding of the mechanism of formation of arachnoid fold around vestibular schwannoma is crucial in preserving the anatomical integrity of 7th nerve.
Methods: The author, who has an operative experience of more than 1000 cerebello-pontine angle surgeries which include 835 cases of large and giant vestibular schwannomas over a period of 19 years, describes the technical pearls for preservation of facial nerve. As these tumors are presently presumed to be subarachnoid in origin inside the internal auditory canal, the mechanism of formation of the double fold of arachnoid over the posterior tumor surface in the cisternal part is different from the old epiarachnoid concept described by Yassargil. As these tumors grow they get adhered to the arachnoid and dura at the porus and with further increase in size, this arachnoid adhesion moves towards the angle resulting in an overlap of arachnoid membrane. The essential initial step is peeling of the double layer of arachnoid from the posterior tumor surface and as this double layer doesn’t cover the entire posterior surface, a stage reaches when surgeon has to work in the subarachnoid space of the acoustico-facial cistern by doing intracapsular circumferential tumor decompression, maintaining intact arachnoid over both the trigeminal and lower cranial nerves which are essentially in other cisternal spaces. After reduction of the tumor volume, seventh nerve is identified in the canal and traced to its location over the already decompressed tumor capsule which is essentially the attenuated perineurium of the vestibular nerve from which tumour has arisen. The key element in successful vestibular schwannoma is understanding that flattened facial and cochlear nerves do not have a arachnoid separating them from the tumor capsule. Total resection may not be feasible in some cases and if the tumor cannot be dissected from 7th and auditory nerve, a sub-perineural dissection is advised.
Result: The essential understanding needed to successfully execute surgery on a vestibular schwannoma is to realize that the perinureum of the vestibular nerve forms the capsule of the schwannoma and the cochlear and facial nerves lie directly over this capsule without any intervening arachnoid layer. Operative videos of few large tumors showing seventh nerve preservation will be shown.
Conclusion: Surgeons operating on large and giant vestibular schwannoma should strive to keep anatomical integrity of 7th nerve even in large and giant tumors.
Complication avoidance in Spinal Intramedullary tumors
1109 15:25-15:35
Spine/304A
Intramedullary spinal cord tumors at times may cause significant difficulties in differentiating between inflammatory and vascular lesions. Neurosurgeons are often asked to evaluate patients for spinal cord biopsies when pre-surgical neuroimaging demonstrate inconclusive findings. Sometimes both non neoplastic and neoplastic intramedullary pathology may have similar clinical presentation and even CSF findings which also compound the issue Although cord enlargement is the hall mark of tumors, this can also occur in acute inflammatory setting. Inflammatory lesions most often demonstrate patchy and peripherally situated enhancements and these are less common for neoplasms. A ring enhancement is not seen for tumors, while presence of intratumoral and peritumoral cysts are common for neoplasms. The importance brain imaging, visual and fundus examination and CSF studies in situations of diagnostic dilemmas with operative videos of clinical cases will be presented. If neurosurgeon is unsure a longer observation of the clinical course with empirical treatment and follow-up MR would be a more prudent approach if patient is not rapidly deteriorating. Author will show video presentations