Prof. P Sarat Chandra: A Trailblazer in Neurosurgery, Scientific Research, and Mentorship

INTRODUCTION Professor P Sarat Chandra [Figure 1], a world-renowned neurosurgeon-scientist, is celebrated for his pioneering contributions to spine, epilepsy, minimally invasive surgery, and skull base surgery. With a career spanning over three decades, his influence extends across multiple domains, including patient care, teaching, research, and leadership in the medical field. Currently, Prof. Chandra serves as the Professor and Unit Head in the Department of Neurosurgery at the All India Institute of Medical Sciences (AIIMS), New Delhi, India. He is also the Chief of the Epilepsy and Functional Neurosurgery fellowship program at AIIMS and in charge of the center of excellence in epilepsy, where cutting-edge neuronal research takes place. In addition, he is part of the magnetoencephalography (MEG) and Brain Mapping Resource facility at the National Brain Research Center (NBRC), advancing the field of neuroimaging research.Figure 1: Prof. P Sarat ChandraI had the privilege of joining Prof. Chandra’s fellowship program in Epilepsy and Functional Neurosurgery. Through this experience, I not only learned the intricacies of epilepsy and functional neurosurgery but also adopted a patient-centric approach, developed essential research skills, and mastered the art of teaching others, thanks to his invaluable mentorship. Prof. Chandra’s students, now spread across the globe, carry forward his teachings and vision, ensuring that his legacy thrives in the neurosurgical community worldwide. FAMILY Prof. Chandra was born in Cuttack, raised in Berhampur and later shifted to Gopalpur-on-sea, a small and quaint seaside villlage when his parents shifted there after their retirement. His mother, Dr. PS Devi, a respected pediatrician, continues her lifelong work of providing free medical services and vaccinations to 60 tribal villages in Odisha – a project initiated by Prof. Chandra’s parents. His father, who passed away 2 years ago, remains an enduring influence on his commitment to excellence in patient care and innovation. He is happily married to Dr. Manjari Tripathi, who is currently the Head of Neurology, at AIIMS and is a very well-known neurologist in her own right, a teacher and a reputed academician. His daughter, Prarthana Chandra is currently pursuing her core psychiatry training at Oxford, UK, and is happily married now to Dr. Krishna Kankawadi. EARLY LIFE AND EDUCATION Prof. Chandra was born on September 21, 1968. After completing his early education at Stewart School and later at St. Vincent’s Convent in Berhampur from the 6th to 10th standard, he pursued his 12th standard from Kendriya Vidyalaya in Sambalpur. He was an average student till 10th standard, and then picked up academically from his 11th standard to top his school at Kendriya Vidyalaya. His journey into medicine began at MKCG Medical College, Berhampur, where he excelled academically, receiving the prestigious Pfizer Gold Medal and being named the best outgoing student, with honors and distinctions in physiology, surgery, and obstetrics and gynecology. NEUROSURGICAL TRAINING AND SPECIALIZATION Prof. Chandra’s neurosurgical training at the National Institute of Mental Health and Neurosciences, Bangalore, laid the foundation for his illustrious career. His mentors, such as Prof. BS Das and Prof. BA Chandramouli, played a crucial role in guiding him toward his specialization in craniovertebral junction anomalies. Prof. KV Sastry also guided him. His extensive experience in neurotrauma further solidified his expertise in complex neurosurgical conditions. In 1998, Prof. Chandra joined AIIMS, New Delhi, where he embarked on a career that would see him perform over 25,000 surgeries across a wide spectrum of pathologies. He has an impressive academic portfolio with over 650 publications in peer-reviewed journals and 25 book chapters, including contributions to the renowned Epilepsy: A Comprehensive Textbook. He is also the editor of two books, as well as the upcoming edition of Ramamurthy and Tandon’s textbook of Neurosurgery. Additionally, he holds nine patents and has actively led or participated in 14 extramural research projects. He was guided at AIIMS by his able mentors Prof. PN Tandon, Prof. VS Mehta, Prof. BS Sharma, and Prof. AK Mahapatra. His expertise spans craniovertebral junction anomalies, epilepsy surgery, vascular surgery, and minimally invasive techniques. Together with his wife, Prof. Manjari Tripathi, he has built a world-class epilepsy surgery program, cementing his status as a par excellence micro-neurosurgeon and endoscopic specialist. KEY CONTRIBUTIONS TO SPINE SURGERY Prof. Chandra has made groundbreaking advancements in spine surgery, particularly with the development of the distraction, compression, extension, and reduction (DCER) technique [Figure 2], which has transformed the management of atlantoaxial dislocation and basilar invagination by using spacers as a pivot (providing intraoperative manipulations in all directions) to achieve reduction of dislocations.[1-8] He also devised a universal reducer to reduce severe basilar invagination and atlanto-axial dislocations from a posterior only approach.[9] He described the concept of “pseudo-joint” for the placement of spacer in conditions where the joints were vertical, describing the technique of extra-articular distraction. In the various algorithms of DCER, he was the first to describe intra-operative manipulation in the three axis, i.e., distraction, extension, and C2 forward translation, thus creating techniques even to reduce the most severe basilar invagination. Over years, he has performed more than 1500 CV junction surgeries, making him perhaps one of the very few surgeons globally with such a vast experience in this complex pathology. More recently, he described a variation of DCER to reduce old displaced Dens fractures from the posterior only technique [Figure 3].Figure 2: The technique of distraction, compression, extension, and reduction (DCER) being demonstrated with the universal reducer. Severe basilar invagination attempted to be reduced using a standard DCER (a and b). As may be noted, the basilar invagination could be reduced completely, but the atlanto-axial dislocation could not be corrected completely. However, with the use of the Universal reducer (c: designed by Prof P Sarat Chandra), both the basilar invagination and atlanto-axial dislocation (d) could be reduced effectively (e). It may be noted that in severe basilar invagination, there is an additional retrolisthesis of C2 over O-C1. The Universal reducer has a C2 translator (f), which pushes the C2 forwards reducing this listhesis and providing an optimal correction. (c-e: UCVJR: Universal cranio-vertebral junction reducer)Figure 3: (a) Magnetic resonance imaging image showing an old displaced fracture of C2 with severe cord compression. (b) A modification of distraction, compression, extension, and reduction used to reduce this from a posterior-only approachHe contributed significantly in our understanding of embryological and genetic basis of congenital craniovertebral junction anomalies.[10,11] He demonstrated mutations occurring at the FBN1 gene in 78% of these cases. This is the same location that is affected in patients with Marfan’s disease. Based on this study, he suggested a unique “double hit” hypothesis stating that the presence of both sloping joints and weak ligaments (due to FBN1 gene mutation) leads to “slipping” of C2 over the O-C1 complex causing basilar invagination and atlanto-axial dislocation. He was the first to suggest a simple innovative treatment for spinal hemangiomas with myelopathy. He developed a technique of single-stage open absolute alcohol embolization, laminectomy, and single-level fixation [Figure 4]. The mean alcohol injected in each side of the vertebral body was around 6–7 cc. This technique proved to be revolutionary. Not only did it demonstrate that this was very safe, but it also proved highly effective, successfully “killing” the tumor cells and preventing long-term recurrences, with follow-up now exceeding 10 years. This procedure has now been performed in more than 70 patients, with very effective outcome. Over 22% of patients in the cohort who were paraplegic had a near-total recovery. Not only this, the cost of embolization was <1 USD! compared to the other highly expensive alternatives. Prof Chandra would often demonstrate at surgery, the vascular nature of this pathology by drilling a small bit of the lamina. As soon as a bit of lamina would be drilled, there would be a gush of bleeding. He would then demonstrate to inject absolute alcohol first around 3–4 cc within the vertebral body and then another 3–4 cc within the vertebrapedicular junction. Following this, the laminectomy would become completely “bloodless.” He would also emphasize that there was no need to perform any decompression of the tumor as the alcohol embolization would shrink and eliminate this. He taught this technique to his student Dr Pankaj Singh, who later on became a faculty to work under him and performed several cases himself.[12-17]Figure 4: The technique of open intravertebral absolute alcohol with laminectomy and single level fixation for vertebral hemanigomas with myelopathy. An example of a 34-year-old male presenting with paraplegia with D5 vertebral hemangioma (a-c). Following absolute alcohol injection, laminectomy and single-level fixation (d), the patient improved significantly. At follow-up on 6 months, he was walking without support and a repeat magnetic resonance imaging and a computed tomography scan demonstrated a complete resolution and shrinkage of the hemangioma (d and e)His extensive research on Potts spine has also provided valuable insights into the effective management and prognosis of this challenging condition.[18] OTHER AREAS OF CONTRIBUTIONS A leader in epilepsy surgery, Prof. Chandra first time showed in children the need for early surgery in cases of drug-resistant epilepsy through the only randomized controlled trial for this condition in pediatric patients, by publishing a landmark paper in NEJM.[19] He has developed endoscopic techniques for hemispherotomy and corpus callosotomy, procedures that are critical in the treatment of intractable epilepsy.[20] These techniques have also been included in the famous “Epilepsy: A Comprehensive Textbook by Jerome Engel and Solomon Moshe”. His development of the Robotic Thermocoagulative Hemispherotomy represents a significant advancement in minimally invasive epilepsy surgery.[21] This technique describes a blood-less way to do hemispherotomies making a remarkable way to decrease the morbidity, especially in small children. At AIIMS, Delhi, he helped establish a world-class epilepsy surgery program, center of excellence for epilepsy, and contributed to the development of a MEG unit at the NBRC, Manesar, further solidifying his commitment to improving epilepsy care. His contributions to the basic science of epilepsy have been truly exceptional.[22-31] He is currently the President of Indian Epilepsy Society and Chair, Epilepsy surgery in the Asiano-Oceanic region of International League Against Epilepsy (ILAE). ADVANCES IN SKULL BASE SURGERY In the realm of skull base surgery, Prof. Chandra’s contributions have significantly improved both patient outcomes and surgical precision by simplifying the complex procedures. He developed the EasyTRAC retractor, a tool that enhances the safety and efficiency of pituitary surgeries by working through the endoscopic transeptal corridor without any significant damage to the nasal cavity.[32] This innovation has been widely adopted, setting new benchmarks in the surgical techniques. He has described the fronto-orbital variant of the supraorbital keyhole approach (f-SOKHA) for clipping anterior circulation aneurysms.[33] In addition, his extensive work on foramen magnum tumors, one of the largest series in the literature, underscores his expertise in handling intricate cases.[34] It is no surprise that he was appointed President of the Skull Base Surgery Society of India, a role that perfectly complements his profound impact in the field. ADVANCES IN PERIPHERAL NERVE SURGERY Prof. Chandra’s work on carpal tunnel syndrome has been truly remarkable. In a landmark randomized controlled trial, he demonstrated that early intervention in resistant cases of carpal tunnel syndrome leads to significantly better outcomes compared to delayed treatment. To further advance the field, he developed an indigenous endoscopic system, making the procedure minimally invasive and more patient-friendly.[35] PASSION FOR TEACHING AND MENTORSHIP Prof. Chandra’s dedication to teaching is widely recognized. He is highly regarded by his students and fellows, and his influence extends far beyond the operating room. He has delivered numerous orations and more than 400 lectures at national and international conferences, sharing his knowledge and expertise with the global neurosurgical community. His mentorship has shaped the careers of many neurosurgeons, including mine [Figure 5], and his former students now occupy prominent positions worldwide.Figure 5: The author with his mentor Prof PS ChandraRESEARCH AND ACADEMIC CONTRIBUTIONS An avid researcher, Prof. Chandra has published over 650 papers in high-impact journals, including “The New England Journal of Medicine,” “Nature,” “Genomics,” “Journal of Neurosurgery,” and “Neurosurgery” [Tables 1 and 2]. He holds more than nine patents and has led or contributed to 14 extramural research projects. His research interests are diverse, ranging from neuron connectomics and microcellular neuronal connectivity to genomics and the genetics of congenital craniovertebral junction anomalies. He has a research lab with over 40 staff members, including PhD candidates and researchers, where he continues to push the boundaries of neurosurgical science.Table 1: High-impact publications in the field of spine surgery (either as a lead author or senior author)Table 2: High-impact publications other than spine surgery (either as a lead author or senior author)INTERNATIONAL AND NATIONAL RECOGNITION AND COLLABORATIONS Prof. Chandra’s contributions to neurosurgery have earned him international recognition. He completed a postdoctoral fellowship at UCLA and holds fellowships from the National Academy of Sciences and the Indian National Science Academy. His global influence is further underscored by his roles as a visiting professor at prestigious institutions such as INU Hannover, Airlangaa University in Indonesia, and the University of Rabat in Morocco. He has occupied numerous prominent positions in academic bodies, which include President of Skull Base Surgery Society of India, President of Cerebrovascular Society of India, President of Neuroendoscopic Society of India and President of Indian Epilepsy Society. He has given several orations, some of which include the AirLanga University Adjunct Professor Oration, Prof PN Tandon oration in the Indian Academy of Neurosciences, Prof KS Mani oration for Indian Epilepsy Society, JIPMER Research day oration, and Prof BS Sharma oration, apart from the presidential orations for various societies. He has also conducted grand rounds at UCLA, UCSF, and Thomas Jefferson University. Prof. Chandra has held numerous leadership positions in neurosurgical and medical societies, including Editor of Neurology India. His leadership extends to the international stage, where he has played key roles in the ILAE, serving as Secretary-General of the Asian Epilepsy Surgery Congress and as Co-Chair of Epilepsy Surgery for the ILAE-Asian Oceanic region. Awards and Honors Throughout his career, Prof. Chandra has been recognized with numerous awards, including the Pfizer Best Graduate Gold Medal, the Todokaro Award from ILAE, and the AIIMS Excellence Award. He has also received the Life Time Outstanding Achievement Award from the ILAE, the Sun Pharma Award for Best Clinical Researcher, and the Vaswik Industrial National Award for Innovation and the Career 360 award for excellence. Personal Philosophy and Vision for the Future of Neurosurgery Prof. Chandra’s philosophy centers on a patient-first approach, balancing cutting-edge technology with compassionate care. He has remarkable sense toward innovation and thinking out of box. His vision for the future of neurosurgery and spine surgery includes greater integration of technology, robotics and minimally invasive techniques, and personalized treatment plans based on genetic and molecular profiling. He is passionate that Spine surgery in India should bloom and then show the way to the rest of the world. He is committed to making neurosurgical care accessible to underserved populations, both in India and internationally. Prof. Chandra’s career is a testament to his unwavering dedication to neurosurgery, his passion for teaching, and his commitment to advancing the field through innovation and research. His contributions have had a lasting impact on the global neurosurgical community, and his legacy continues to inspire the next generation of neurosurgeons. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.