After 6 Surgeries, Delhi Man Recovers From Rare Skull Bone TB After 2.5-Year Ordeal

 A 53-year-old man who was admitted to a Delhi hospital in a semi-comatose state following a brain haemorrhage has recovered and returned to an independent life after a two-and-a-half-year medical ordeal involving nine hospitalisations and six surgeries.

Doctors at Fortis Hospital, Shalimar Bagh, said the patient's treatment became particularly challenging after he developed tuberculosis of the skull bone, an exceptionally rare complication following brain surgery.

The patient was brought to the emergency department after suddenly losing consciousness due to a spontaneous brain haemorrhage that caused severe swelling inside the brain. His condition was further complicated by a bleeding disorder, low platelet levels and the use of Ecosprin for a heart condition, making emergency surgery highly risky.

Doctors performed an emergency decompressive brain surgery to remove the blood clot. Since the brain had swollen extensively, a portion of the skull was temporarily left open to relieve pressure and prevent permanent brain damage.

He subsequently required prolonged ventilator support and a tracheostomy and remained in intensive care for nearly a month before regaining consciousness and recovering enough to be discharged, according to the hospital.

His recovery, however, was complicated by seizures, following which doctors performed another surgery to replace the skull bone. The patient's own skull bone, which had been preserved in a bone bank, was used for the procedure.

Soon afterwards, another blood clot developed beneath the replaced skull bone, necessitating an immediate repeat brain surgery, doctors said.

Several months later, the patient developed discharge from the surgical wound. Investigations revealed tuberculosis of the skull bone, an exceptionally uncommon condition rarely seen after brain surgery, according to the hospital.

The infected bone was removed and prolonged anti-tuberculosis treatment was started. During the course of treatment, doctors also diagnosed tuberculosis involving the brain and spine.

The patient subsequently suffered repeated neurological weakness and recurrent infections, requiring multiple hospital admissions. He also sustained a thigh-bone fracture following a fall.

In a multidisciplinary procedure, doctors repaired the fracture while simultaneously reconstructing the skull with a custom-designed PEEK (Polyether Ether Ketone) cranial implant, a patient-specific artificial skull implant created using detailed imaging, the hospital said.

Towards the end of the treatment, the patient developed optic neuritis as a complication of anti-tuberculosis medication, resulting in partial loss of vision. The condition was detected early, treatment was modified and rehabilitation was continued under medical supervision, according to the hospital.

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 were involved in his care.

Dr Sonal Gupta, principal director and HOD, Neuro and Spine Surgery, Fortis Hospital, Shalimar Bagh, said the biggest challenge was not only performing emergency brain surgery on a patient at high risk of bleeding but also managing the complications that followed over the next two-and-a-half years.

"The development of tuberculosis involving the skull bone after brain surgery is exceptionally uncommon," Gupta said, adding that managing it alongside brain and spine tuberculosis, repeated surgeries, neurological complications and treatment-related side effects required constant reassessment and coordination between specialties.

Gupta said infection of cranioplasty bone flaps has an overall incidence of around 5-6 per cent, but most such infections are bacterial, while only a few cases of tuberculosis infection of the bone flap have been reported in medical literature.

The patient's recovery and return to an independent life highlighted the importance of timely intervention, evidence-based decision-making and continuity of care, she said. 

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