New Delhi, Sep 1: In a remarkable demonstration of multi-specialty resilience, doctors at Fortis Hospital, Shalimar Bagh, have given a second chance at life to a 53-year-old man, an independent life after a harrowing two-and-a-half-year medical ordeal. What began as a life-threatening brain hemorrhage escalated into a complex medical battle involving nine hospital admissions, six surgeries, and an exceptionally rare case of skull bone tuberculosis. Against all odds, the patient has made a full recovery, transitioning from a semi-comatose state to walking and living completely unassisted. The case was led by Dr. Sonal Gupta, Principal Director & HOD, Neuro and Spine Surgery, Fortis Hospital, Shalimar Bagh.
The patient was rushed to the emergency department after suddenly losing consciousness due to a spontaneous brain hemorrhage, which caused severe swelling inside the brain. His condition was further complicated by an underlying bleeding disorder, low platelet levels and the use of Ecosprin for a heart condition. These factors made emergency surgery extremely high-risk because of the possibility of uncontrolled bleeding.
Doctors immediately performed an emergency decompressive brain surgery to remove the blood clot. As the brain had swollen extensively, a portion of the skull was temporarily left open to relieve pressure and prevent permanent brain damage. The patient required prolonged ventilator support, underwent a tracheostomy and remained under intensive care for nearly a month before regaining full consciousness and recovering sufficiently to be discharged.
However, the patient’s recovery was far from straightforward. Within weeks, he developed seizures and subsequently underwent surgery to replace the skull bone. His own skull bone, which had been preserved in a bone bank, was used during the procedure. Soon afterwards, another blood clot formed beneath the replaced skull bone, requiring an immediate repeat brain surgery. Several months later, he developed discharge from the surgical wound. Detailed investigations revealed tuberculosis of the skull bone, an exceptionally uncommon condition rarely seen after brain surgery. The infected bone had to be removed, and prolonged anti-tuberculosis treatment was initiated. During treatment, doctors also diagnosed tuberculosis involving the brain and spine, making the case even more challenging.
The prolonged recovery was further marked by repeated neurological weakness, recurrent infections requiring multiple hospital admissions, and a fracture of the thigh bone following a fall. In a coordinated multidisciplinary procedure, doctors repaired the fractured bone while simultaneously reconstructing the skull using a custom designed PEEK (Polyether Ether Ketone) cranial implant, an advanced patient specific artificial skull implant designed from detailed imaging to restore the missing portion of the skull with precision. Towards the end of treatment, the patient also developed optic neuritis as a complication of anti-tuberculosis medication, resulting in partial loss of vision. The condition was recognized early; treatment was modified and rehabilitation continued under close medical supervision.
Over nearly two and a half years, specialists from neurosurgery, orthopaedics, infectious diseases, critical care, cardiology, pulmonology, nephrology, urology, ophthalmology, endocrinology, gastroenterology and rehabilitation medicine worked together through every phase of treatment, ensuring continuity of care despite the repeated setbacks.
Dr. Sonal Gupta, Principal Director & HOD, Neuro and Spine Surgery, Fortis Hospital, Shalimar Bagh, said,
“The biggest challenge here was not just performing emergency brain surgery in a patient with a very high risk of bleeding but successfully navigating every complication that followed over the next two and a half years. The development of tuberculosis involving the skull bone after brain surgery is exceptionally uncommon, and managing it alongside brain and spine tuberculosis, repeated surgeries, recurrent neurological complications and treatment related side effects required constant reassessment and close collaboration between multiple specialties. Overall incidence of infection of cranioplasty bone flap is about 5-6% but most of these are bacterial infections. There are only few case (3-4) reports in the literature of TB infection of bone flap. The patient’s recovery and return to an independent life reflects the value of timely intervention, evidence-based decision-making and continuity of care.”
Mr. Naveen Sharma, Facility Director, Fortis Hospital, Shalimar Bagh, said,
“This case exemplifies the strength of comprehensive multidisciplinary care. Managing a patient through nine hospital admissions over nearly two and a half years requires not only clinical expertise but also an institutional commitment to delivering consistent, patient centred care. Seeing the patient return to an active and independent life is a testament to that collective effort.”