|Year : 2021 | Volume
| Issue : 4 | Page : 50-55
Dr. Vedantam Rajshekhar – A Passionate Neurospinal Surgeon
Ranjith K Moorthy
Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
|Date of Submission||29-Sep-2021|
|Date of Acceptance||26-Oct-2021|
|Date of Web Publication||24-Dec-2021|
Ranjith K Moorthy
Department of Neurological Sciences, Christian Medical College, Vellore - 632 004, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Moorthy RK. Dr. Vedantam Rajshekhar – A Passionate Neurospinal Surgeon. J Spinal Surg 2021;8:50-5
| History|| |
Dr. Vedantam Rajshekhar is a rare breed of surgeon endowed with excellent clinical acumen, a questioning mind, and passion for searching for an answer to these questions. His career as a neurological surgeon and scientist is studded with incidents and anecdotes where he has crossed each obstacle that lay in his path. His ability to convert each obstacle as a stepping stone has seen him achieve several academic honors and recognition worldwide.
| Family and Background|| |
Dr. Rajshekhar was born in erstwhile Madras to Col. Vedantam Krishna Mohan (Retd. Training officer, Armed Forces Medical College, Pune) and Mrs. Vedantam Padmavathi (nee Mallela). He belonged to the Guntur and Krishna districts of Andhra Pradesh. He acquired the qualities of self-confidence, thriftiness, uprightness, and discipline from his parents. The exposure to the practice of medicine and a medical college environment at AFMC, Pune, during his school days, probably played a role in his decision to pursue medicine. His wife, Dr. Rupa, an ENT surgeon, has been a pillar of strength over the past three decades, supporting him in his career choice and patiently accepting his frequent absences from home due to long hours in the hospital or on out-of-town assignments. Their son, Aditya Vedantam, graduated as the best outgoing MBBS student from CMC, Vellore, and completed his neurosurgical residency at the Baylor College of Medicine in Houston, Texas, probably inspired by the father.
| The Formative Years|| |
Dr. Rajshekhar was admitted into the Christian Medical College as an MBBS student in 1975. During the selection process, he had mentioned in his autobiography that his ultimate goal was to become a neurosurgeon; this desire was further strengthened on exposure to neuroanatomy and neurophysiology in his 2nd-year MBBS. Undergraduate clinics in neurology made him observe the almost mathematical precision of adding up clinical symptoms and signs to arrive at a diagnosis. He still firmly believes that clinical neurology is among the most objective of all the clinical sciences. Undoubtedly, the late Prof. KV Mathai's approach to analyzing clinical symptoms and signs strengthened Dr. Rajshekhar's resolve to become a neurosurgeon. After completion of the internship, Dr. Rajshekhar joined neurosurgery residency as a 5-year candidate.
Due to a staff shortage during his residency, Dr. Rajshekhar had to quickly adapt himself and acquire skills to deal with emergencies and interpret radiological investigations. The dedication with which he studied clinical neurology and radiology is evident to date when he teaches residents and junior faculty how to correlate clinical findings with radiological findings as well as pick up the crucial radiological finding (not given attention to by most others) that would dictate further management of the patient. This aspect is crucial in making correct decisions in patients with multiple-level spinal pathologies.
A dissertation on the prognostic significance of somatosensory evoked potentials on a spinal cord injury model in monkeys was completed during the 3rd year anticipating time constraints later. Prof. Jacob Abraham, who had an animal laboratory in the department, was his guide. This ability to plan his work schedule and anticipate time constraints is evident when he plans his daily schedule and prepares his presentations at various academic forums. To his credit, one can never see him prepare a presentation or go through his presentation while he is sitting in attendance at a conference, as the presentation has already been prepared and rehearsed.
The latter years of his residency were spent in acquiring surgical skills from Dr. Mathai (who had a reputation for being meticulous in chasing every red blood cell), and Dr. Jacob Abraham (whose philosophy was to remove the tumor before the anesthetic poisons got to the patient) and his practice of surgery is an amalgamation of both these principles. He was one of the first neurosurgical residents exposed to an operating microscope throughout his/her training program. He qualified in March 1987.
Career in neurosurgery
Dr. Rajshekhar joined the Department of Neurological Sciences in his alma mater as soon as he finished his M.Ch. course in April 1987 and has remained there since then. He was encouraged by Dr. Mathew Chandy to learn and introduce new techniques. He refined his skills with the operating microscope. He reintroduced and developed stereotaxy in our institution, as well as help in its popularization across the country by conducting a series of courses on stereotaxy during the 1990s. He also introduced and started stereotactic radiosurgery at CMC, Vellore, in 1995 and was responsible for putting together a team that has expanded and continues to maintain the quality assurance practices he initiated.
As mentioned earlier, Dr. Rajshekhar paved the path for the department to acquire new techniques and was instrumental in developing subspecialization in the department. He believes in the policy that “one should never be the first or the last to employ a newly developed innovation or technique.” He would evaluate any recent innovation or technique and wait till its safety and efficacy were established and validated before accepting it. He introduced uninstrumented central corpectomy for cervical spondylotic myelopathy (CSM) in 1992, cranial endoscopy in 1997, endoscopic pituitary surgery in 2002, and surgical protocols for spinal dysraphism in 2008.
| Contribution as an Academic Neurosurgeon|| |
Dr. Rajshekhar firmly believes that one can operate on between 6000 and 15000 patients during a 30-year career as a neurosurgeon. However, by teaching residents and junior faculty, auditing one's work, identifying deficiencies in management, and posing questions, the answers to which can correct these deficiencies, a neurosurgeon in an academic institution can help hundred to thousand-fold number of patients in his career as well as after his career is over. This forms the basis of his daily clinical work, wherein he identifies clinical problems on routine ward rounds and tries to address them. [Table 1] summarizes a few instances of clinical problems that he identified on the regular ward round and solved through audits or clinical research and then made an effort to disseminate this information through scientific publications so that this and future generations could benefit.
|Table 1: Common clinical problems that were identified to make contributions|
Click here to view
Dr. Rajshekhar has contributed to rationalizing the management of patients with solitary cysticercus granuloma, an entity that he and his team described for the first time in the world in 1989. Since then, he has been involved in several research projects on Neurocysticercosis (NCC) that have evolved into molecular profiling and studying the genomics of patients with NCC. NCC is generally not considered a neurosurgical disease, and less than a handful of neurosurgeons worldwide have been involved in researching this disease. His efforts have resulted in several international grants being awarded to further research in NCC. He is a member of the expert group that makes recommendations on the diagnosis and management of NCC. The Indian Council of Medical Research recognized his scientific contributions in NCC by awarding him one of their highest honors, the Basanti Devi Amir Chand Award for the year 2009. He also received the Rev. L. F. Yeddanapalli Award for Research from CMC, Vellore, in 1999. He became a fellow of the Indian Academy of Medical Sciences in 2009. The Indian Academy of Sciences, Bangalore, awarded him the fellowship in 2012.
Dr. Rajshekhar takes pride in his work as an academic neurosurgeon. He feels that he has placed India on the scientific map with his work and contribution, and we must not depend on publications or research from the west to solve our problems. He is firmly committed to solving problems relevant to India and other lower-middle-income countries and, in his own words, has “the courage of conviction” to send out his research findings for peer review when results are quite contrary to what has been reported earlier. His efforts led to the Vellore grading for tuberculous meningitis which is being recognized the world over.
| Contribution to Spine Surgery|| |
Dr. Richard Saunders at Dartmouth introduced Dr. Rajshekhar to the technique of uninstrumented corpectomy for CSM, which he used successfully in over 500 patients over the next quarter of a century. He has gone on to teach this technique to several of his junior faculty. Our institution is perhaps the only one in this country where uninstrumented cervical corpectomy for CSM is still practiced. He firmly stood against the tide in the wave of disc replacement surgery. He continued to practice anterior cervical discectomy without fusion for single-level disc degeneration, his stand being vindicated by recent studies describing fusion despite artificial disc placement. In our institution, he was also instrumental in introducing transoral decompression procedures in patients with basilar invagination or atlantoaxial dislocation.
True to his philosophy and dedication toward academic neurosurgery, Dr. Rajshekhar contributed to CSM literature through close follow-up of the patients he operated upon. This translated into a large number of original articles as well as reviews that are summarized in [Table 2]. To cite a few, an audit on the slippage of the graft showed that with constant practice in fashioning the mortice, slippage of the graft placed after central corpectomy could be avoided in the absence of instrumentation. Short- and long-term outcomes on patients with CSM added to the existing natural history of this disease pertinent to the Indian population. In order to study the functional outcomes, he employed a simple patient-perceived score that was validated against the Nurick grade recovery. As the existing Nurick and modified Japanese Orthopaedic Association scales were relevant to western social practices, he modified them to suit the Indian population's day-to-day activities. His articles and academic presentations on CSM and other problems are studded with a focus on long-term outcomes and functional outcomes of patients with pre- and postoperative images taking a background. Two, an excellent postoperative radiograph without sustained long-term benefit to the patient does not constitute a good surgical outcome.
|Table 2: Publications in the field of spinal neurosurgery (either as lead author or senior author)|
Click here to view
His other research interest is in infections of the brain and spine. This has translated into publications reporting successful outcomes in patients with craniovertebral junction and subaxial spine tuberculosis managed with conservative surgery with limited instrumentation. He has highlighted the rise in multidrug-resistant spinal tuberculosis in a recent publication. The most common challenge in spine surgery is probably that of ensuring the correct level. As he evolved as a spine surgeon, he practiced a hemilaminectomy technique to remove intradural tumors. In order to ensure that minimal access surgery was at the correct level, he devised a technique of preoperative MR localization that proved to be more successful than X-ray localization.
Our institution was the first to employ intraoperative neurophysiological monitoring in the routine management of patients. Although initially performed for cranial cases, Dr. Rajshekhar encouraged the application of motor-evoked potentials for intraoperative monitoring in collaboration with Dr. Srinivas Babu, a neurophysiologist. He led the team of neurophysiologists and neuroanesthetists in establishing protocols to ensure motor-evoked potentials can be successfully obtained in the large majority of adult and pediatric patients.
Although he did not perform instrumented fusion for degenerative spine diseases, he encourages the junior faculty and mentors them as they start performing these surgeries. He is up to date with knowledge regarding the latest techniques in instrumentation. He provides a balanced viewpoint to the team while discussing the management of each patient with spine or spinal cord disease – be it degenerative spine disease or developmental anomalies of the spine.
| Role in National and International Societies|| |
Dr. Rajshekhar was the founder-secretary of the Indian Society of Stereotactic and Functional Neurosurgery, formed through his efforts in 1994. He was the President of the Indian Society of Neurooncology in 2015 and served as the Chairman of the World Federation of Neurosurgical Societies Radiosurgery Committee from 2014 to 2017.
He made several contributions to the Neurological Society of India (NSI). Dr. Rajshekhar was in different leadership roles of NSI for nearly 12 years: as Executive Committee (EC) member (2005–2008), Honorary Secretary (2009–2011), convener for the Continuing Medical Education Program of NSI (2005–2008), President-Elect in 2013, President in 2014, and recently as first Chairman of the Neurosurgery Board of Education (2015–2017). As the Secretary of NSI, Dr. Rajshekhar was instrumental in initiating and consolidating a web-based approach to NSI activities. This included the introduction of online submission of abstracts for the annual conference for the first time in 2010. His contribution to the NSI highlights his giving more than 100% to a cause once he takes it up. It is worth highlighting that all these extramural activities did not prevent him from contributing to patient care, research, or teaching within CMC, Vellore.
Advice and take-home message
Dr. Rajshekhar has stood out as a man of principles who does not hesitate to state and conform to his stand and standards. He stresses the importance of evaluating any treatment modality and awaiting the result of its independent validation before adopting it. He believes that one should follow the principle of “primum non nocere” – “first, to do no harm” while deciding upon the management of a patient. He strongly believes in the practice of ethical neurosurgery. He asks his residents to treat every patient with the same zeal, empathy, and sincerity “as they would like their relatives to be treated.”
He believes that surgical training involves keen observation of the procedure preceded by an excellent theoretical knowledge of anatomy and pathology. His constant advice to his residents and other faculty is to study the relevant anatomy on imaging and texts and prepare for the surgical procedure by rehearsing the steps several times in one's mind before entering the operating room. This would reduce the operative time, make one more confident during the surgical procedure, and reduce postoperative morbidity.
He would like to stress the need for a good history and clinical examination, particularly in decision-making in spine surgery. He also believes that any individual who takes up every opportunity and practices with passion paying attention to every small detail, can succeed and excel as a neurosurgeon.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Rajshekhar V. Widening the circle of service: The gift of academic neurosurgery. Neurol India 2018;66:637-41.
] [Full text]
Rajshekhar V. Neurosurgery: A legacy of excellence. Neurol India 2015;63:468-75.
] [Full text]
[Table 1], [Table 2]