There are 12 cranial nerves in the body. Some esoteric textbooks of medicine mention 13, while someone who wanted a nerve named after himself added one extra to make it 14. But in the real world, we will stick to 12.
Twelve, a number woven into the fabric of sacred stories and celestial charts, often symbolises completeness or cosmic order. We have the 12 apostles of Jesus, 12 zodiac signs, and 12 months in the year. But even here, some people refute this by stating that there is an additional zodiac or that the original calendar had 13 months. Unfortunately, there are no direct descendants of the apostles who can fight for one more. So, once again, let’s stick to 12.
“I can’t smell anything,” Raj, a 55-year-old man, once came to me. His wife, sitting next to him, was dejected because he kept grumbling about how the taste of her food had changed. He had a perfectly round head with a significantly larger but perfectly round torso. “My physician asked me to get an MRI and see you because he felt something was amiss,” Raj told me, handing me the films.
Illustration: Deni Lal
I plugged the MRI films in the X-ray box and was amused to see a perfectly round tumour inside his head, nearly the size of a cricket ball. I was amused not because I didn’t have empathy for my patient but because the image of a round tumour, inside a round head, within a round body, reminded me of the Russian nesting dolls. I was also at peace because I knew for sure that this was not malignant.
“You can’t smell because this tumour is pushing down on your olfactory nerve,” I showed him, running my pointer around it. “The olfactory nerve is the first of the 12 cranial nerves,” I explained, “and it plays a significant role in our perception of taste, as many of the subtle nuances in flavour are actually due to the aroma of food. So, don’t blame your wife for the problem,” I said, smiling, getting some brownie points from her.
I told him I was impressed that his doctor had picked it up, because many brush aside a problem with smell as nothing. “You may have a cough or a cold, or some allergy,” is what some of my patients who complained of not smelling well were told before I ordered an MRI and found what Raj had: an olfactory groove meningioma, a tumour arising from the base of the skull where the olfactory nerves from the nose traverse the brain. In his case, the tumour was compressing the nerve badly, not allowing the transmission of any sensory function.
“We will fix it with a small operation,” I explained to them, talking about all the risks and benefits of an operation of this nature. “We don’t need to open up the entire head, like we did in the past; we will make a small incision in the eyebrow, get into the head, and remove it,” I drew some diagrams on the model of a skull I have in my office. They fixed a date for surgery with me. I always wonder how patients agree to an operation even when you explain that there is a small chance that they could lose their life from it.
Two weeks later, we made an incision just above Raj’s right eyebrow and removed a square piece of bone behind it. I gobbled up the tumour with an ultrasonic aspirator until the cricket ball became the size of a golf ball and then a pea. Finally, I peeled off the last portion of the flattened and displaced olfactory nerve with the hope that he’d smell again.
When he returned three months later for a routine check, the size of his torso had increased. I pointed at it, asking for the reason behind the prosperity. “The food now smells and tastes so good, what can I do!” he beamed.
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