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Efficacy of Intraoperative Ultrasound in Resection of Posterior Fossa Lesions
Ahmed Nagaty,
Ahmad Elsabaa,
Hisham Anwer
Issue:
Volume 3, Issue 2, December 2019
Pages:
13-20
Received:
3 September 2019
Accepted:
8 October 2019
Published:
20 October 2019
Abstract: To evaluate the important role of Intraoperative Ultrasound (IOUS) in measurement of pre & postoperative resection volume of an intra-axial posterior fossa lesions and to compare these results with that measured in pre and post-operative MRI brain. Also, to assess the principal surgeon opinion regarding the ability of IOUS in localization and differentiating the borders of those lesions, and his comfortability during handling of this device. There are different methods, which are helpful to localize precisely and allow maximum tumor resection, such as neuro-navigation, intraoperative MRI, 5-aminolevulinic acid, as well as IOUS. Every method has its pros & cons. Although Intraoperative MRI Provides real time updated images, however it’s not available in most of neurosurgery centers in developing countries. So, with these financial and ergonomic limitations of the Intraoperative MRI, usage of Intraoperative Ultrasound could be considered as a potential competitor in developing world. This is a prospective study conducted at Ain Shams University hospital in the period from February 2016 to July 2018, we enrolled 23 patients presented with posterior fossa intra axial neoplasms that operated with Intra Operative Ultrasound (IOUS) assistance. IOUS was able to well localize the lesions in 96% of cases and it was able to differentiate solid and cystic parts in all the cases. IOUS was able to define well the lesion borders in 20/23 (87%) of cases. There was no difference between volumes calculated from preoperative MRI and the pre-resection IOUS, also there was no significant difference between the residual volume detected by the IOUS and the postoperative MRI brain. Principal surgeon reported overall great impression of the IOUS in 18/23 (78%) of cases. Mean total additional time of usage of the IOUS was 27min. IOUS was found to be valuable in localization of the lesions, differentiating solid and cystic parts and detection of the residual volume in the posterior fossa intra axial tumors.
Abstract: To evaluate the important role of Intraoperative Ultrasound (IOUS) in measurement of pre & postoperative resection volume of an intra-axial posterior fossa lesions and to compare these results with that measured in pre and post-operative MRI brain. Also, to assess the principal surgeon opinion regarding the ability of IOUS in localization and diffe...
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Commonly Used Assistive Devices in Neurological Conditions
Fabiha Alam,
Nadia Afrin Urme,
Firoz Ahmed Mamin
Issue:
Volume 3, Issue 2, December 2019
Pages:
21-25
Received:
27 October 2019
Accepted:
19 November 2019
Published:
25 November 2019
Abstract: Background: Assistive devices used externally which made for adaptation with appropriate assisted an impaired person to perform their daily functions. It may be simple, low cost types and also controlled by specialized computer software. Various types of positional devices, mobility devices, daily living devices & also prosthetics, orthotics were used for support. Some evidence suggested that assistive devices helped for ambulation & ambulatory function assessment should be depending on the requirements of assistive device uses in neurological conditions especially on stroke and SCI. Study focused that applicationof stretch splint on experimental thumb where reduced the space. But resultshowed that intensive stretch which applied regularly for three months did not reduce thumb web-space contractures. On the other hand, other study suggested everyday used of assistive devices with environmental modification improves GMFS levels in CP children. Another RCT discussed that h-AFO may reduce toe walking on the hemi paretic side into a heel–toe gait pattern & it also controlled excessive ankle plantar flexion in swing phase. This study also focused that h AFO was more effective than dynamic AFO in gait rehabilitation for hemiplegic CP. Objective: To focus on the uses of assistive devices in neurology. Methodology: Study was done by narrative review. Conclusion: Assistive device helped a physiotherapist to achieve maximum goal during rehabilitation in neurological conditions. Some assistive devices were used for treatment purpose as well as ADL modification & it improved, maintain their quality of life. But it was very much important to know the proper use of devices with their rational and important concerning issue about the overuses and inappropriate uses of assistive devices which may lead to more dependency of neurological patients and also negatively impact on their rehabilitation process. If more RCT will be done about the use and effect of assistive devices may help us to clear conception about the uses of assistive devices and its importance on rehabilitation of neurological conditions.
Abstract: Background: Assistive devices used externally which made for adaptation with appropriate assisted an impaired person to perform their daily functions. It may be simple, low cost types and also controlled by specialized computer software. Various types of positional devices, mobility devices, daily living devices & also prosthetics, orthotics were u...
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Predictors of Cerebrospinal Fluid Leaks in Endoscopic Surgery for Pituitary Tumors
Mahmoud Saad,
Mohamed Elkahwagi,
Ahmed Musaad,
Yasser Khafagy,
Ahmed Nageeb Taha
Issue:
Volume 3, Issue 2, December 2019
Pages:
26-31
Received:
19 November 2019
Accepted:
2 December 2019
Published:
10 December 2019
Abstract: Background: Cerebrospinal fluid (CSF) leak is a serious complication of endoscopic endonasal surgery for pituitary adenoma; leading to a more serious and financial burden of the surgery. Prediction of the occurrence of such sequale and proper plaining for reconstruction can reduce its prevalence and associated morbidities. Purpose: To determine the predictors and risk factors associated with intra/and postoperative cerebrospinal fluid (CSF) leaks in endoscopic endonasal pituitary surgery. Methods: A retrospective study included 150 patients who underwent endoscopic endonasal approach for resection of pituitary adenomas between 2015 and 2018. We analyzed the association between CSF leaks (intra/post-operative) and perioperative variables including patients’ demographic data, medical comorbidities, tumor characteristics and operative data (rates of intraoperative leak, reconstructive techniques). Results: 34 patients (22.6%) out of the 150 patients had an overall, CSF leak: 26 (76.5%) patients had intraoperative leaks; 5 patients out of them continued to have a postoperative leak. 8 patients (23.5%) had postoperative leak. Based on multiple logistic regression model analysis; increased body mass index (BMI), associated hydrocephalus, suprasellar extension and recurrent tumors had a significant association with intraoperative CSF leaks, while only BMI and hydrocephalus predicted postoperative CSF leaks. Conclusion: Elevated BMI, suprasellar extension of the tumor, recurrence or previous radiation are all important risk factors that have been proved in this study to have statistically significant association with the incidence of CSF leak. In high risk patients for CSF leakage: adequate reconstruction planis advised to avoid such morbidity.
Abstract: Background: Cerebrospinal fluid (CSF) leak is a serious complication of endoscopic endonasal surgery for pituitary adenoma; leading to a more serious and financial burden of the surgery. Prediction of the occurrence of such sequale and proper plaining for reconstruction can reduce its prevalence and associated morbidities. Purpose: To determine the...
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Outcome of Choroid Plexus Cauterization with Endoscopic 3rd Ventriculostomy vs Ventricular Shunting in Management of Hydrocephalus Secondary to Neural Tube Defect
Ahmed Zahe,
Mahmoud Saad,
Abdelghany Elshamy
Issue:
Volume 3, Issue 2, December 2019
Pages:
32-37
Received:
20 November 2019
Accepted:
3 December 2019
Published:
10 December 2019
Abstract: Background: Different surgical management of infants suffering neural tube defects (NTD) associated hydrocephalus were reported in the literature. Great debate whether combining endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) is more effective than ventriculoperitoneal (VP) shuntfor management of congenital hydrocephalus secondary to neural tube defects ininfants younger than 1 year of age. Purpose: To evaluate and compare the therapeutic efficacy of ETV combined with CPC versus VP shunts in infants with infantile hydrocephalus associated with NTD. Methods: Thirty infants with infantile NTD associated hydrocephalus (de novo), were equally divided and randomly allocated to each intervention group either ETV/CPC or VP shunts). They were monitored for at least 6 months for any sign of raised intracranial pressure (rICP) and/or hydrocephalic metrics (fontanelle quality, HC, and ventricular size) were also documented and compared between two groups. Statistical Analysis: The association between intervention group and outcome was tested with Chi-square test and P=0.05 or less was considered statistically significant. Results: Of the total thirty patients included in the study, thirteen patients (43.3%) were male and seventeen were female (56.7%) with mean age of 80.3±11.5 days. Twenty patients (66%) were under 6 months of age. The overall success rate in 1-year follow-up was 54% and 60% for VP shunt and ETV/CPC, respectively; with the difference being not statistically significant. Conclusion: Combined ETV-CPC is considered a successful surgical option for treatment of infantile hydrocephalus associated with NTD; achieving success rate better than VPS implantation.
Abstract: Background: Different surgical management of infants suffering neural tube defects (NTD) associated hydrocephalus were reported in the literature. Great debate whether combining endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) is more effective than ventriculoperitoneal (VP) shuntfor management of congenital hydrocepha...
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