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NSASL - Neurosurgeons Association of Sri Lanka
The Neurosurgeons Association of Sri Lanka was formed in 2006. Late Dr. Jaliya Lokuketagoda was instrumental in founding NSASL which envisions uplifting neurosurgical education and training in the country. The founder President was Dr. S C Abeysuriya. NSASL became an associate member of the WFNS in 2018. From 2024 it has launched numerous projects to disseminate knowledge, improve training and neurosurgical service in the country.
Neurosurgery in Sri Lanka
The Past, Present and the Future
Ancient and contemporary medical practice
Concept of organised health care in Sri Lankan is quite old. Chronicles such as Mahavamsa gives evidence of an organised health care system in the ancient times. The archaeological ruins of a 9th century hospital in Mihinthale, in Anuradhapura in the North Central Province, is the oldest hospital discovered in Sri Lanka and 9th Century hospital complex at Mihintale, Anuradhapura is perhaps the oldest archaeological evidence of a hospital in the world.
" 9th century hospital in Mihinthale, in Anuradhapura "
The 12th century hospital in Alahana Pirivena complex in Polonnaruwa is unique for in archaeological terms, it is the only hospital site from around the world in that a number of surgical instruments have been unearthed in addition to medical equipment. The variety of medical equipment and surgical instruments like probes, forceps, scalpels, scissors, and lancets points the way to medical practice in the past, and validates the truth of texts that surgical operations were indeed done in these hospitals.
" Surgical instruments unearthed from Alahana Pirirvena, Polonnaruwa "
In 1815 Sri Lanka became a colony of the British Empire and the native medical practice gradually changed into Western medical practice. In 1864 the Colombo General Hospital was built and the Colombo Medical School was inaugurated in 1870. In 1887 the Ceylon Medical Association and its journal was inaugurated. Many articles related to neurosurgery appeared thereafter. Eg: 1889 – depressed skull fracture removal, 1891 – cerebral tumour removal, 1938 –surgery for a brain tumour etc.
" General Hospital, Colombo - 1864 "
Early days
Dr. Shelton Cabraal, FRCS is known as the father of neurosurgery in Sri Lanka. In 1956 he formed the first organised neurosurgery unit in the country with 12 beds at the General Hospital Colombo (present National Hospital of Sri Lanka). It was an up-to-date unit at the time. It even had the facility to perform skull base surgery, which was a novelty at that time. In 1959 the unit was upgraded with 64 beds, a dedicated neurosurgical theatre and an ICU stationed in the Bandaranayaka building at NHSL. The second neurosurgical unit was established in Jaffna in 1960 and Dr Subramanium headed the unit. The first trainee under Dr. Cabraal was Dr. Darrel Weinman who joined the service in 1962.
Dr. Shelton Cabraal, FRCS is known as the father of neurosurgery in Sri Lanka. In 1956 he formed the first organised neurosurgery unit in the country with 12 beds at the General Hospital Colombo (present National Hospital of Sri Lanka). It was an up-to-date unit at the time. It even had the facility to perform skull base surgery, which was a novelty at that time. In 1959 the unit was upgraded with 64 beds, a dedicated neurosurgical theatre and an ICU stationed in the Bandaranayaka building at NHSL. The second neurosurgical unit was established in Jaffna in 1960 and Dr Subramanium headed the unit. The first trainee under Dr. Cabraal was Dr. Darrel Weinman who joined the service in 1962.
Dr. Darrel Weinman FRCS
Dr. Shelton Cabraal, FRCS is known as the father of neurosurgery in Sri Lanka. In 1956 he formed the first organised neurosurgery unit in the country with 12 beds at the General Hospital Colombo (present National Hospital of Sri Lanka). It was an up-to-date unit at the time. It even had the facility to perform skull base surgery, which was a novelty at that time. In 1959 the unit was upgraded with 64 beds, a dedicated neurosurgical theatre and an ICU stationed in the Bandaranayaka building at NHSL. The second neurosurgical unit was established in Jaffna in 1960 and Dr Subramanium headed the unit. The first trainee under Dr. Cabraal was Dr. Darrel Weinman who joined the service in 1962.
Dr. Colvin Samarasinghe FRCS
The third neurosurgical unit was opened at the General Hospital Kandy in 1972 by Dr. S C Abeysuriya. Unfortunately, the unit in Jaffna was closed due to the untimely death of Dr. Subramanium in 1987. In late 1980s Dr. Lal Gunasekera established a second neurosurgical unit in the Institute of Neurology at the General Hospital, Colombo. He introduced latest microneurosurgical techniques at that time to the neurosurgical practice. However, further development of neurosurgery in Sri Lanka faced a severe setback as during the short period from 1990 to 1993, four Neurosurgeons viz. Dr. Lal Gunasekara, Dr. Selladorai and Dr. Gunanandan left the country due to some internal disputes.
Leap to the future
In 1988, the first CT scanner at the General Hospital Colombo was installed. It was a donation from the German Government. The first MRI scanner of the country was installed in 2000 initiated by Dr. Colvin Samarasinghe.
In 1996 Dr. Sunil Perera assumed duties as the second neurosurgeon at the unit II of NHSL. He pioneered certain advanced techniques of spinal and brain surgeries. Functional neurosurgery was started for epilepsy in 2002 and Deep Brain Stimulation for Parkinson’s disease by Dr. Sunil Perera. By late 90’s and passing into the 2000s, the number of traumatic brain injuries increased. The national hospital in Colombo was receiving approximately 10,000 admissions with TBI annually of which around 3000 were severe TBI.
Dr. Sunil Perera FRCS, FRCSE
Over 3000 surgeries for TBI were performed and nearly 2000 deaths due to TBI were recorded. In this context The Neuro Trauma Centre at NHSL was built at a cost of 2.5 billion rupees jointly funded by the Government of Saudi Arabia and Sri Lanka. It was commissioned in 2010. The Neurotrauma centre at the NHSL has 320 beds, 66 ICU beds, 36 HDU beds, 12 ETU beds, also it has a 40 bedded spinal injury Unit and a 40 bed Rehabilitation Unit, 8 operating theatres with best equipment and separate MRI and CT imaging facilities.
During the last decade, the number of peripheral Neurosurgical Units increased. At present each of the nine administrative provinces has one neurosurgical unit in the main hospital of the province. All centres are equipped to manage all general neurosurgical operations. And the centre in Colombo is the final referral centre of the country.
Interventional neuroradiology pioneered by late Dr. Nihal Wijewardena was started in 2004. During the last decade the support of allied subspecialties like, ENT, Plastic surgery, Neurophysiology, anaesthesia was more widely incorporated in the neurosurgical practice that has enhanced the outcomes. However, subspecialisation is still not feasible due to the high demand for general neurosurgery and fewer numbers of neurosurgeons.
The Sri Lankan population is served by two systems of health care. The private healthcare system, and the free public healthcare system. Both systems offer reasonably good neurosurgery service to the population. All the private neurosurgical units are located in Colombo. They are affiliated to the private hospitals; Nawaloka hospital, Asiri Group (Central hospital), Durdans Hospital and Lanka Hospital. All these units are well equipped to offer state-of-the art neurosurgical care.