Kerala surgeons remove fist-sized ball of brain matter hanging from the nose of a 13-yr-old tribal boy

Encephalocele is a rare congenital disorder – found in 1 in 5,000 births – in which bones of a baby’s skull do not close completely in the mother’s uterus.

In an 11-hour-long surgery, doctors at a Kerala hospital removed a fist-sized ball of brain matter that hung from a 13-year-old tribal boy’s nose like a pendulum.

Manikandan, son of plantation workers in Parambikulam, Palakkad, was ridiculed because of a rare medical condition called encephlocele in which brain matter oozes out of a gap in the skull into a sac-like structure, giving the patient’s head a grotesque appearance.

The condition obstructed his vision and deformed his nose and face.

A 10-member team of surgeons led by Dr Subrahmania Iyer, Dr Suhas Udayanarayanan and Dr Pramod Subhash at Kochi’s Amrita Institute of Medical Sciences removed the external deformity in a highly complex surgery that lasted more than 10 hours.

“Manikandan’s encephlocele was very large that had pushed the bone of his right eye outwards. For surgery, his skull was opened and the normal brain isolated from the sac of non-functioning brain matter hanging from his face,” said Dr Iyer, head, plastic & reconstructive surgery at the hospital.

The removal of the deformity left a defect in the skull, a portion of which had to be reconstructed.

“The patient’s eye sockets were repositioned to remove the deformity in the right eye, and the nose was also remodeled. All these were huge surgical challenges. Manikandan has recovered fully from the surgery and is ready for discharge,” said Dr Iyer.

As Manikandan’s parents are poor plantation workers, the cost of surgery was borne by Palakkad district administration and the tribal welfare department.

“We belong to the Marasar tribe and work in a plantation. I have five children, who are all normal and healthy, except Manikandan who was born with a swelling on the nose which kept growing. Because of the huge deformity on his face, he never went to school or mingled with other children, as people used to make fun of his appearance,” says Selvan, his father.

“After surgery, he is eager to go back home, start school and make friends. I thank the doctors from the bottom of my heart for enabling him to lead a normal life.”

Encephalocele is a rare congenital disorder – found in 1 in 5,000 births – in which bones of a baby’s skull do not close completely in the mother’s uterus. This creates an opening through which brain tissue and cerebro-spinal fluid protrude out of the head in a sac-like structure.

The condition can be fatal if the encephalocele hampers brain development. Once past infancy, patients usually live an isolated life, ashamed to show their face in public.