I completed my superspecialisation in Neurosurgery from Sawai man Singh Medical College, Jaipur, India. It is one of the largest hospitals in India and a tertiary centre catering to the needs of nearly all sub specialities in Neurosurgery. I always wanted to subspecialise and learn further in vascular neurosurgery. I strongly believe in the value of visiting and learning in different neurosurgical departments in different countries. Recently, I was searching for a fellowship opportunity in a high case volume and world renowned centre through the WFNS website. The decision of choosing a centre in Japan was mainly because of the presence of some of the best vascular neurosurgeons in Japan. With this very goal in mind, I applied to Fujita Health University Banbuntane Hospital, Nagoya, Japan, and very luckily I was selected for a three month fellowship programme in cerebrovascular surgery.
I arrived in Nagoya from Narita airport in the evening and it was really cold, even though the month of February was ending. There was no confusion regarding accommodation, as an apartment just adjacent to the hospital was already ready. Thanks to Prof. Yoko Kato for her utmost caring attitude making it very easy for the stay in a completely foreign land. Late in the night, I met another fellow from Thailand Dr Treepob who was very helpful during the period of stay in Japan.
I reached the hospital in the morning with Dr Treepob and met secretary Neurosurgery Miss Toshiko Nose, who was very helpful and courteous and took us to Prof. Kato. Later I met the other faculty members in the OR, Dr T Kwase, Associate Professor and Dr. Yasuhiro Yamada, Assistant Professor Neurosurgery, from whom I got to learn many a new things during my stay. Later in the day, Dr Treepob took me around the hospital showing the wards, ICU, and emergency room.
The best part of the fellowship programme at FHU Banbuntane hospital is it exposes fellows to all sub specialities of Neurosurgery, of course with primary focus in Cerebrovascular surgery. It addresses clinical, academic, professional and practical aspects. The regular morning meetings, focused on case discussions, journal presentations, new methodologies, post operative discussion, computational flow dynamics (CFD) discussion, and video editing. The operative discussion before surgery makes a reflex habit to see the important aspects before, during and after surgeries. Assistance during surgeries by the stalwarts inculcates a habit of approach, tricks to avoid complications, and above all, the importance of patience and a cool mind during surgery. Regular practice of microsuturing under microscope makes a person more comfortable while dealing with in a real situation. Seeing a video many times for editing helps one to recognize the bail out situations and fine dissection strategies. I got to learn CFD – a pre operative evaluation of aneurysm hemodynamics in order to know the various characteristics of it, which I believe is a very important tool, although not being used around the globe. Discussion of the finer aspects before and after surgery with Prof. Kato helps one to realize the importance of deep observation and the philosophy behind the procedure. I also observed surgeries of Prof. Sameshima, a skull base surgeon, whose way to perform petrosectomies is really beautiful. One gets to see the textbook description while he is performing surgeries. Dr Kajita performed DBS for movement disorders.
At FHU Banbuntane hospital, I was also exposed to the surgeries of Prof. Katsumi Takizawa, a terrific vascular neurosurgeon, whose surgeries are a real treat to watch, assist and learn. From the very basic step of positioning to the bloodless field in surgery to retraction, it seems we are absorbing everything. Of course, discussion of the finer aspects of the surgery with him is a great opportunity from the master himself.
I also observed surgeries of Prof. Sameshima, a skull base surgeon, whose way to perform petrosectomies is really beautiful. One gets to see the textbook description while he is performing surgeries. Dr Kajita performed DBS for movement disorders.
I was also very interested in endovascular neurosurgery. I observed and assisted many cases in FHU. Prof. Yoko Kato also arranged to observe cases of Dr T Ohshima, a hybrid neurosurgeon, who is also a great teacher, as well of course a wonderful endovascular surgeon. I worked on two technical novel techniques papers with him, which have been submitted to journals.
Prof. Kato helped us for short visits to different centres of excellence to learn from experts. We visited Osaka City Hospital and met Prof. Ohata and Dr Goto, and it was really great to witness some wonderful skull base surgeries, and know the tricks and pitfalls in these cases. We visited Hiroshima Municipal Hospital and met Dr Fusao Ikawa. We learned a lot on CFD from Dr Toru Satoh, who himself is one of the pioneers in this new technique.
We even witnessed wonderful surgery of Prof Hirotoshi Sano, the legend himself. One of the greatest in my life to see Prof. Sano working his way out to the aneurysm, his understanding of it and his way of teaching us the fine intricacies of the whole procedure. Till now, he draws every aneurysm and AVM with coloured pencils to fully understand the fineness of it, which is a great lesson for the younger generation. He emphasized on one of the most important lesson in a neurosurgeon life- Watch 60% by your imaginative eye, rest 40% by imaging. Prepare everything before surgery, prepare in advance the clip you would require, how you would approach, and bailout of a situation. It’s a real treat to listen so many beautiful lessons, not just from neurosurgery but about life from the legend.
There was a short visit with Prof. Tetsuo Kanno. Experience teaches a person so many things. You get to hear so many beautiful lessons and history of the branch on which we are standing, and the path of which we, the next generation have to weave.
I visited some of the most academically enriched conferences during my stay here. The first was STROKE 2017 in Osaka. Listening to so many legends with huge series makes one feel so humble. I attended the 6th Japan Korean Neurorehabilitaion conference in Toyama, in which I presented a poster titled-Study of predisposing risk factors and etiology of chronic SDH in clipped patients of unruptured intracranial aneurysms – An Institutional experience.
I also attended 37th Japanese National Congress in Yokohama. Apart from this, there were regular meetings in Nagoya along with a Residents meeting.
Nagoya is a beautiful place to be in, the wonderful Japanese people with so much humbleness, politeness and ever helping nature leaves one mesmerized. Words cannot define the beautiful experience I had at FHU Banbuntane hospital, and the lessons I learnt from Prof. Kato and the many masters in Neurosurgery in Japan. I want to thank my co fellows Dr Sai Kalyan and Dr Brajesh, from India, both from whom I learnt a lot. I leave with a heavy heart from Japan, believing with what I have learnt and experienced in Japan, I would make justice in my part of the world. Hoping to keep learning further, carrying on the academic work and replicating everything and more which I have learnt.
See you again Japan.
Thank you very much