Neuroradiology in India took off in early 1950s with Dr Mahadevan Pillai working in Madras and Dr. Jacob Chandy at Vellore. At the same time in Bombay, Dr. R Ginde at Sir Jamshedjee Jeejeebhoy (JJ) Hospital and Dr. Homi Dastur at King Edward Memorial (KEM) Hospital were doing pioneering work in this field.

Earlier Dr. Mahadevan Pillai had arrived at Barnard Radiology Institute, Madras, after qualifying in Radiology from England in 1940. He joined hands with the doyen of Neurosurgery in India, Dr. B Ramamurthy. In 1952, they started doing percutaneous direct carotid angiography as routine diagnostic procedure. Before this only plain X-ray skull were performed to look for Sellar changes, bone erosion, hyperostosis and shifts in pineal gland calcification. Gradually pneumoencephalography, ventriculography and myelography were introduced. Dr. Pillai did a lot of Neuroradiology investigations and many at odd hours matching the hectic schedule of Dr. Ramamurthy. He made frequent jaunts to Europe and presented his research papers and got acquainted with great stalwarts in Radiology like Seldinger, JWD Bull and Lindgren. He also could bring home equipment like Seldinger needle and long rolls of catheters to be used in India.

Dr. Pillai moved to All India Institute of Mental Health, Bangalore which later became National Institute of Mental Health and Neurosciences (NIMHANS). Dr. Pillai joined NIMHANS in 1958 and started Neuroradiology department. The department was started in an extended room attached to one of the pavilions of Psychiatric ward. He procured Siemens Craniograph Skull unit and Telepantoscope myelogram unit. Dr. Varma was heading the Neurosurgery department there and these two people along with Dr.K S Mani made a wonderful team. Cerebral angiography by direct puncture, ventriculography and Myodil myelography were done frequently.

In 1962, on request of Chief Minister of Kerala, Shri R Sankar, Dr. Pillai moved to Trivandrum Medical College as Professor of Radiology. He diagnosed here the first ever case of Renal artery stenosis in India by performing angiography. He also started organizing Annual meetings of Radiological Society of India during this period. Here he worked on radiopelivimetry for cephalopelvic disproportion. 

Dr. Pillai joined SCTIMST in 1975 and continued till 1979. He set remarkably high-quality standard of radiological investigation in this place and made it one of the best institutes in India in Neuroradiology. Dr VRK Rao began his academic career at Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum as an assistant professor in 1977. It is here that Dr Rao collaborated with the scientists and engineers to synthesise monomers and particulate materials necessary for therapeutic embolisation. He demonstrated that the home-grown Indian technology is no less by developing stainless steel spring coils for intravascular use. Also, homegrown Lyophilised dura and Hydrogel microspheres for particulate embolization were developed.  This brought down the total cost of treatment for the patients as compared with imported implants. During his tenure, for the first time, Department of Radiology in SCTIMST was given the patient admission rights with provision of two beds in the neurological wards for patients undergoing neurointervention.

Dr Gajaraj was trained at Royal Victoria Infirmary and Newcastle General Hospital and after being appointed Director of Barnard Institute of Radiology in 1970, he established a separate section on Neuroradiology and set up nuclear imaging with the help of  Dr Rajagopalan and studied CSF circulation using Ytterbium DTPA.

Dr. R Ginde and Homi Dastur used floating muscle fiber through arteriotomies to treat caroticocavernous fistulas in 1955. Dr. JN Sidva established Schoenander skull table with film changer in Bombay. He did pioneering work on positive contrast cisternography. In 1961, Dadhich did first transfemoral vertebral angiogram at Bombay Hospital using Schonander skull table, tilting table for myelography and a serial changer. Dr. PE Billimoria started catheter angiography at JJ hospital in 1960. He also unequivocally demonstrated hemistenosis of lumbar canal in a patient with unilateral sciatica three years later. In 1969 Dr. Homi Dastur demonstrated collapse of cervical spinal cord on auto-tomography using air myelography.

Lt General Prataprao was the architect of neuroradiology in Armed Forces Medical Services. He was trained in Neuroradiology at Guy’s Hospital, London and had keen interest in neuroradiological evaluation of Epilepsy and Stroke.

Dr. Sneh Bhargava started the work in AIIMS in 1963 deploying Lysohlm skull table, manual film changers and Fluoroscopic unit and in 1971 A.O.T. and “Puck” changers and “Mimer III” was also procured. In 1978 the first CT scanner “EMI 1010” was established at AIIMS and by mid-eighties they were installed across the country. With the arrival of CT scan, pneumoencephalography was soon rendered obsolete. Prof. Goulatia headed the neuroradiology department and Prof. NK Mishra started doing interventional procedures. Balloon embolization of caroticocavernous fistula was one of the earliest procedure done. In 1986 Neurosciences centre was established at AIIMS and first DSA system “Angiotron” established. First MRI in India was installed at INMAS, Delhi in 1987. The first MR machine in AIIMS was installed in 1992, which was a 4.7T animal MR machine (BIOSPEC) to test the sequences and pulse programming on plants and animals and first clinical MRI was installed in 1993, which was 1.5T MAGNETOM 63SP. 

The branch of Neurointervention was born with cooperation and mutual understanding between the neurosurgeons and neuroradiologists. By early eighties free flow muscle embolization for treatment of large inaccessible arteriovenous malformations (AVM) was in vogue. Animal experiments with the use of liquid polymer embolic agents were done and with this experience superselective catheterisation and embolization of cerebral and spinal AVMs with isobutyl 2-cyanoacrylte was done in patients. Techniques using coaxial microcatheters for detaching balloons and coils in carotidocavernous fistulas and aneurysms of carotid were perfected. In 1985 Dr. Ravi Ramakantan did a workshop on Endovascular Neurointervention at KEM hospital, first of its kind in India. In 1997, ISNR and ISVIR societies were formed.

At present in India there are several MRI and CT units and more than 200 Angiographic suites. DM course in Neuroradiology is conducted at more than 5 centres viz, SCTIMST, AIIMS, NIMHANS, PGI Chandigarh, SRMC Chennai and JIPMER to name a few. Training in Neurointervention  is being imparted at more than 20 institutes.

Disclaimer: This is a brief history about the field of Neuroradiology in India and is in no way complete. It will be updated as and when the relevant inputs are received from credible sources.

 Prepared by Dr. Vikas Chauhan, SCTIMST

REFERENCES:

  1. Rao VRK. www.neuroradiology.in: Neurosciences in India. Retrospect and Prospect. Pandya SK (Ed). 1989. Neurological Society of India and the Council for Scientific and Industrial Research, New Delhi.
  1. Neurosciences in India: Retrospect and prospect. SK Pandya – 1989 – Neurological Society of India.
  1. Mani K. S. Reminiscences of an old man. Souvenir. 43rd Annual Conference of the Neurological Society of India. Bangalore.1994.
  1. Prof. K. Mahadevan Pillai. The Pioneer in Neuroradiology in India K. Rajasekharan Nair. Neurosocietyindia.org.
  1. Ramamurthi B. Autobiography (Unpublished). A Chapter from a forthcoming publication by K. R. Nair titled “The lore of medical men in Kerala”.
  1. VRK Rao – A true pioneer. Express Healthcare article dated 09 Oct 2013.
  1. Rao VVS, Pratapa Lt. Gen.: Epilepsy – clinico – radiological assessment of epilepsy. Sir Jagadish Chandra Bose Memorial Oration – 1976. Indian Journal of Radiology 30,311-328, 1976.
  1. Rao VRK, Mandalam KR, Gupta AK, Kumar S, Joseph S. Dissolution of isobutyl 2-cyanoacrylate on long-term follow-up. AJNR Am J Neuroradiol. 1989 Jan-Feb;10(1):135-41. PMID: 2492713.

9. History and Foundation of ISNR. JP Barton – 2009.