Displaying publications 1 - 20 of 43 in total

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  1. Xinyi, Deborah Yong, Affizal Ahmad
    MyJurnal
    Awareness, involvement and training in dysphagia management are essential to ensure that patients are appropriately
    assessed for dysphagia and provided with intervention. The study aimed to identify levels of awareness, involvement and
    training of medical officers in dysphagia management. A total of 51 medical officers from the family medicine, medical,
    otorhinolaryngology, surgery, and neurosurgery departments in Hospital Universiti Sains Malaysia participated in the
    study. Levels of awareness, involvement and training of medical officers in dysphagia management were reported using
    descriptive analysis. Results indicate that medical officers lacked awareness and training in dysphagia management.
    Referral rates to speech-language pathologists for dysphagia management were low with 58.4% of medical officers having
    had seldom or never referred patients. The results provide valuable information for addressing dysphagia management
    in the hospital.
    Matched MeSH terms: Neurosurgery
  2. Wittayanakorn N, Nga VDW, Sobana M, Bahuri NFA, Baticulon RE
    World Neurosurg, 2020 12;144:e164-e177.
    PMID: 32805466 DOI: 10.1016/j.wneu.2020.08.073
    OBJECTIVE: Neurosurgery departments worldwide have been forced to restructure their training programs because of the coronavirus disease 2019 (COVID-19) pandemic. In this study, we describe the impact of COVID-19 on neurosurgical training in Southeast Asia.

    METHODS: We conducted an online survey among neurosurgery residents in Indonesia, Malaysia, Philippines, Singapore, and Thailand from May 22 to 31, 2020 using Google Forms. The 33-item questionnaire collected data on elective and emergency neurosurgical operations, ongoing learning activities, and health worker safety.

    RESULTS: A total of 298 of 470 neurosurgery residents completed the survey, equivalent to a 63% response rate. The decrease in elective neurosurgical operations in Indonesia and in the Philippines (median, 100% for both) was significantly greater compared with other countries (P < 0.001). For emergency operations, trainees in Indonesia and Malaysia had a significantly greater reduction in their caseload (median, 80% and 70%, respectively) compared with trainees in Singapore and Thailand (median, 20% and 50%, respectively; P < 0.001). Neurosurgery residents were most concerned about the decrease in their hands-on surgical experience, uncertainty in their career advancement, and occupational safety in the workplace. Most of the residents (n = 221, 74%) believed that the COVID-19 crisis will have a negative impact on their neurosurgical training overall.

    CONCLUSIONS: An effective national strategy to control COVID-19 is crucial to sustain neurosurgical training and to provide essential neurosurgical services. Training programs in Southeast Asia should consider developing online learning modules and setting up simulation laboratories to allow trainees to systematically acquire knowledge and develop practical skills during these challenging times.

    Matched MeSH terms: Neurosurgery/education*
  3. Waran V, Narayanan V, Karuppiah R, Pancharatnam D, Chandran H, Raman R, et al.
    J Surg Educ, 2014 Mar-Apr;71(2):193-7.
    PMID: 24602709 DOI: 10.1016/j.jsurg.2013.08.010
    The traditionally accepted form of training is direct supervision by an expert; however, modern trends in medicine have made this progressively more difficult to achieve. A 3-dimensional printer makes it possible to convert patients imaging data into accurate models, thus allowing the possibility to reproduce models with pathology. This enables a large number of trainees to be trained simultaneously using realistic models simulating actual neurosurgical procedures. The aim of this study was to assess the usefulness of these models in training surgeons to perform standard procedures that require complex techniques and equipment.
    Matched MeSH terms: Neurosurgery/education*
  4. Waran V, Narayanan V, Karuppiah R, Owen SL, Aziz T
    J. Neurosurg., 2014 Feb;120(2):489-92.
    PMID: 24321044 DOI: 10.3171/2013.11.JNS131066
    The advent of multimaterial 3D printers allows the creation of neurosurgical models of a more realistic nature, mimicking real tissues. The authors used the latest generation of 3D printer to create a model, with an inbuilt pathological entity, of varying consistency and density. Using this model the authors were able to take trainees through the basic steps, from navigation and planning of skin flap to performing initial steps in a craniotomy and simple tumor excision. As the technology advances, models of this nature may be able to supplement the training of neurosurgeons in a simulated operating theater environment, thus improving the training experience.
    Matched MeSH terms: Neurosurgery/education*; Neurosurgery/methods*
  5. Waran V, Selladurai BM, Bahuri NF, George GJ, Lim GP, Khine M
    J Trauma, 2008 Feb;64(2):362-5; discussion 365.
    PMID: 18301199 DOI: 10.1097/TA.0b013e318070cc88
    : We present our initial experience using a simple and relatively cost effective system using existing mobile phone network services and conventional handphones with built in cameras to capture carefully selected images from hard copies of scan images and transferring these images from a hospital without neurosurgical services to a university hospital with tertiary neurosurgical service for consultation and management plan.
    Matched MeSH terms: Neurosurgery*
  6. Waran V, Thillainathan R, Karuppiah R, Pickard JD
    World Neurosurg, 2022 01;157:135-142.
    PMID: 34687934 DOI: 10.1016/j.wneu.2021.10.112
    BACKGROUND: The provision of equitable and affordable health care has become increasingly challenging as advanced technology is introduced, particularly in developing countries. We explored the hypothesis that focused, small-scale mini-public-private partnerships have a potential role in providing equitable and affordable access to advanced technology for the benefit of all patients in developing nations, particularly middle-income countries.

    METHODS: A clinician-led financial plan was developed at the University of Malaya to create the Centre for Image Guidance and Minimally Invasive Therapy (CIGMIT) to provide an integrated platform for high-end care for Malaysian patients of all ages, both public and private, requiring complex neurosurgical and spinal procedures and stereotactic and intensity-modulated radiotherapy. The challenges faced during development of the plan were documented together with an audit of patient throughput and analyses of financial risk and return.

    RESULTS: CIGMIT opened in 2015. Patient throughput, both public and private, progressively increased in all facilities. In 2015-2019, 37,724 patients used the Centre's facilities. CIGMIT has become progressively more profitable for the University of Malaya, the public and private hospitals, and the investor. CIGMIT has weathered the challenges posed by coronavirus disease 19.

    CONCLUSIONS: Focused, small-scale mini-public-private partnerships have a potential role in providing advanced technology for the benefit of patients in developing nations, particularly middle-income countries, subject to an approach that balances equity of access between public and private health care systems with fair reward.

    Matched MeSH terms: Neurosurgery/organization & administration*
  7. Theophilus SC, Adnan JS
    Malays J Med Sci, 2011 Jan;18(1):30-7.
    PMID: 22135571
    BACKGROUND: A double-blind randomised control study was conducted on all patients who were admitted or referred to the Department of Neurosurgery, Sultanah Aminah Hospital, Johor Bahru, with a diagnosis of hydrocephalus where a ventriculoperitoneal shunt was indicated.
    METHODS: The period of study was from November 2005 to May 2007, and the follow-up period was 3 months after surgery. Randomisation was carried out in the operating room prior to the procedure. The scrub nurse selected a sealed envelope, which contained the assignment of each patient to 1 of 2 treatment groups: Group 1 patients were treated with topical methicillin, and Group 2 patients were not treated with topical methicillin. Prophylactic antibiotic, cefuroxime (25 mg/kg) was given intravenously at induction. Standard sterile operative technique was followed in preparing and draping the patients.
    RESULTS: A total of 90 patients were recruited in the study, and 13 (14.4%) patients developed an infection within 3 months post-operation. Group 1 had a 8.9% risk of infection, and Group 2 had a 20% risk; however, there was no statistically significant post-operative ventriculoperitoneal shunt (VPS) infection reduction with the use of topical methicillin in VPS surgery (P = 0.230). Multivariate analysis showed that only duration of surgery had a significant influence on the incidence of post-operative VPS infection in the non-methicillin group (P = 0.02). The non-methicillin group had an 8 times greater risk of developing post-operative VPS infection than the methicillin group if surgery lasted longer than 1 hour.
    CONCLUSION: Topical methicillin had no significance in the reduction of post-operative VPS infection.
    KEYWORDS: methicillin; neurosurgery; post-operative wound infection; topical administration; ventriculoperitoneal shunt
    Study site: Patient admitted or referred to Hospital Sultanah Aminah Johor Bahru, Johor, Malaysia
    Matched MeSH terms: Neurosurgery
  8. Sundaresan N
    Surg Neurol, 1984 Sep;22(3):316-7.
    PMID: 6463843
    Matched MeSH terms: Neurosurgery*
  9. Sriram PR
    Asian J Neurosurg, 2017 11 9;12(4):766-768.
    PMID: 29114307 DOI: 10.4103/1793-5482.185055
    Primary orbital lymphoma is a rare entity with only 1% of extranodal lymphomas. They usually present to ophthalmologist and surgical reserved for biopsy or tissue diagnosis. We present a patient who was referred to neurosurgery for a rapid growing orbital lymphoma. It grows from a small nodule in the eyelid to a huge, aggressive, disfiguring lesion invading bone and dura with intracranial extension within 3 months. The patient was treated with total surgical excision followed by systemic chemotherapy.
    Matched MeSH terms: Neurosurgery
  10. Simpson D
    Aust N Z J Surg, 1994 Aug;64(8):525-6.
    PMID: 8048887
    Matched MeSH terms: Neurosurgery
  11. Rethinasamy R, Alias A, Kandasamy R, Raffiq A, Looi MC, Hillda T
    Malays J Med Sci, 2019 Sep;26(5):139-147.
    PMID: 31728126 MyJurnal DOI: 10.21315/mjms2019.26.5.13
    Background: Neurosurgical patients are varied, encompassing cranial and spinal diseases and trauma, and are admitted under both elective and emergency settings. In all settings, neurosurgery patients are at risk of deep vein thrombosis. D-dimer and ultrasound Doppler have long been good screening and confirmatory tools for the diagnosis of deep vein thrombosis (DVT). We conducted a study to identify the factors associated with DVT among neurosurgical patients, and the overall rate of occurrence at our centre. We aimed to also compare our results to the incidence in similar studies elsewhere in which more judicious use of pharmacological prophylaxis was undertaken. We also included the Well's score to validate its usefulness in screening for DVT in our local setting.

    Methods: All patients admitted into our centre were screened for eligibility and those who underwent surgery from September 2016 to September 2017 had a D-dimer screening after surgery, followed by an ultrasound Doppler if the former was positive. The choice of anticoagulant therapy was not influenced by this study, and observation of the use was in keeping with usual practices in our centre was done.

    Results: A total number of 331 patients were recruited in this study, however, after the inclusion and exclusion criteria had been met, 320 patients remained eligible, i.e. suitable for analysis. The mean age of our patients was 46 years, with 66% being male patients. A majority of the cases in this study were cranial related, with only 5% being spine surgeries. On the multivariate analysis, the Well's score and the number of days in bed remained statistically significant, after adjusting for age group, gender, ethnicity, type of central venous access and type of DVT prophylaxis with an adjusted odd's ratio, and a confidence interval of 95%, and P < 0.05 for each.

    Conclusion: Well's scoring and number of days in bed were independent factors affecting the rate of DVT in patients undergoing neurosurgical procedures in our centre.

    Matched MeSH terms: Neurosurgery
  12. Raffiq A, Abdullah JM, Haspani S, Adnan JS
    Malays J Med Sci, 2015 Dec;22(Spec Issue):5-8.
    PMID: 27006632 MyJurnal
    The development of neurosurgical services and training in Malaysia began in 1963, with the first centre established in its capital city at Hospital Kuala Lumpur, aimed to provide much needed neurosurgical services and training in the field of neurology and neurosurgery. This center subsequently expanded in 1975 with the establishment of the Tunku Abdul Rahman Neuroscience Institute (IKTAR); which integrated the three allied interdependent disciplines of neurosurgery, neurology and psychiatry. The establishment of this institute catalysed the rapid expansion of neurosurgical services in Malaysia and paved the way for development of comprehensive training for doctors, nurses, and paramedics. This culminated in the establishments of a local comprehensive neurosurgery training program for doctors in 2001; followed by a training program for nurses and paramedics in 2006. To date, there are more than 60 neurosurgeons providing expert care in 11 centers across Malaysia, along with trained personnel in the field of neurosciences.
    Matched MeSH terms: Neurosurgery
  13. Othman AK, Udin N, Shab MS, Hamzah NA, Mat Azmi IS, Naing NN
    Med J Malaysia, 2020 11;75(6):705-709.
    PMID: 33219181
    INTRODUCTION: Brain tumour (BT) is a tremendous burden on patients, families as well as the surrounding communities, especially the healthcare services. It can be classified into either a benign slow growing tumour (non-cancerous) and malignant tumour (cancerous). The purpose of this study was to determine the incidence and pattern of brain tumour admitted to the Neurosurgery Department in Hospital Sultanah Nurzahirah (HSNZ), Terengganu, Malaysia.

    METHODS: This is a retrospective study of incidence and pattern of BT admitted to the Neurosurgery Department in HSNZ. Data was collected from the yearly census of BT registered from 2013 to 2018.

    RESULTS: A total number of 386 new cases of primary BT were registered. The number of cases of BT was found to be lowest among children (0 to 10 years old) with only 4.4% but at peak among elderly aged between 51 to 60 years old (26.2%). As for gender, males constituted about 44.5% (n=172) whereas females accounted for 55.5% (n= 214) of the cases. In total, meningioma was found to have the highest incidence (27.2%) followed by metastases brain tumour (18.1%) and glioma (17.4%).

    CONCLUSIONS: This study has shown that the incidence of BT was led by meningioma which had a high prevalence among the elderly population, followed by metastasis BT and gliomas.

    Matched MeSH terms: Neurosurgery
  14. Obaid, Kadhim Jawad, Sood, Suneet
    Medical Health Reviews, 2009;2009(1):59-73.
    MyJurnal
    Robotic surgery is a technique that uses mechanical, computercontrolled arms to conduct surgical operations. It carries the advantages of minimal access associated with laparoscopic surgery, and of precision associated with open surgery. It is also feasible to conduct robotic surgery with the surgeon far away, by “telerobotics”. The robot is more versatile than the human arm, and less susceptible to tremors. The view is excellent, and it is possible to conduct more intricate procedures than are possible with the human hand. Robotics has been in use for over seven years, and the initial experience shows that the success rate is over 90%, with only about 10% of cases needing to be converted to open surgery. Blood loss is low, and tumour margins in cancer surgery are satisfactory. Surgeons have used robotics for procedures in urology, gastrointestinal surgery, gynecology, cardiac surgery, neurosurgery, orthopedics, and other specialties. Presently, robotics suffers from two major disadvantages: one, that it is very expensive, and two, that robotic procedures take significantly longer than do open or laparoscopic procedures.
    Matched MeSH terms: Neurosurgery
  15. Ng WP, Liew BS, Idris Z, Rosman AK
    Malays J Med Sci, 2017 Mar;24(2):78-86.
    PMID: 28894407 MyJurnal DOI: 10.21315/mjms2017.24.2.10
    BACKGROUND: High grade gliomas (HGGs) are locally invasive brain tumours that carry a dismal prognosis. Although complete resection increases median survival, the difficulty in reliably demonstrating the tumour border intraoperatively is a norm. The Department of Neurosurgery, Hospital Sungai Buloh is the first public hospital in Malaysia to overcome this problem by adopting fluorescence-guided (FG) surgery using 5-aminolevulinic acid (5-ALA).

    METHODS: A total of 74 patients with histologically proven HGGs treated between January 2008 and December 2014, who fulfilled the inclusion criteria, were enrolled. Kaplan-Meier survival estimates and Cox proportional hazard regression were used.

    RESULTS: Significant longer survival time (months) was observed in the FG group compared with the conventional group (12 months versus 8 months, P < 0.020). Even without adjuvant therapy, HGG patients from FG group survived longer than those from the conventional group (8 months versus 3 months, P = 0.006). No significant differences were seen in postoperative Karnofsky performance scale (KPS) between the groups at 6 weeks and 6 months after surgery compared to pre-operative KPS. Cox proportional hazard regression identified four independent predictors of survival: KPS > 80 (P = 0.010), histology (P < 0.001), surgical method (P < 0.001) and adjuvant therapy (P < 0.001).

    CONCLUSION: This study showed a significant clinical benefit for HGG patients in terms of overall survival using FG surgery as it did not result in worsening of post-operative function outcome when compared with the conventional surgical method. We advocate a further multicentered, randomised controlled trial to support these findings before FG surgery can be implemented as a standard surgical adjunct in local practice for the benefit of HGG patients.

    Matched MeSH terms: Neurosurgery
  16. Narenthiranathan NR, Adnan JS, Haspani MS
    Stud Health Technol Inform, 2010;161:112-21.
    PMID: 21191164
    Teleconsultation in Neurosurgery was introduced in Malaysia in 2006 with the aims of enhancing quality services in the field of Neurosurgery. The present teleconsultation system is equipped with user friendly features which allow physicians to send and neurosurgeons to gain access to patient data in a swift and effective manner. In the past, teleconsultation in neurosurgery was tied with teleradiology, however we have now developed a multimodality system to cater specifically for neurosurgery. In Malaysia, the teleconsultation service is gaining momentum as evidenced by the large volume of cases channeled through this system. 944 cases within a span of 4 months were recorded on the system. 54.5% of the cases were trauma, 33.2% stroke, 6.1% intracranial tumours, 2% of cases were of spinal pathology, 2% pediatric anomalies and 2.2% intracranial infections. 50.2% of the referrals were after regular working hours reflecting the need for dedicated teleneurosurgery consultative services and the ability to review referrals outside of hospitals. Only 36% of cases needed emergency transfers and 9.9% of the cases were managed remotely at distant hospitals. Another 9.4% of the cases were either transferred electively or brought to the clinic for consultation. The above findings emphasise the importance of teleconsultation as a means to provide wide medical coverage within the region.
    Matched MeSH terms: Neurosurgery*
  17. Munusamy T, Karuppiah R, Bahuri NFA, Sockalingam S, Cham CY, Waran V
    World Neurosurg, 2021 01;145:e53-e60.
    PMID: 32956888 DOI: 10.1016/j.wneu.2020.09.076
    OBJECTIVE: The coronavirus disease 2019 pandemic poses major risks to health care workers in neurocritical care. Recommendations are in place to limit medical personnel attending to the neurosurgical patient as a protective measure and to conserve personal protective equipment. However, the complexity of the neurosurgical patient proves to be a challenge and an opportunity for innovation. The goal of our study was to determine if telemedicine delivered through smart glasses was feasible and effective in an alternative method of conducting ward round on neurocritical care patients during the pandemic.

    METHODS: A random pair of neurosurgery resident and specialist conducted consecutive virtual and physical ward rounds on neurocritical patients. A virtual ward round was first conducted remotely by a specialist who received real-time audiovisual information from a resident wearing smart glasses integrated with telemedicine. Subsequently, a physical ward round was performed together by the resident and specialist on the same patient. The management plans of both ward rounds were compared, and the intrarater reliability was measured. On study completion a qualitative survey was performed.

    RESULTS: Ten paired ward rounds were performed on 103 neurocritical care patients with excellent overall intrarater reliability. Nine out of 10 showed good to excellent internal consistency, and 1 showed acceptable internal consistency. Qualitative analysis indicated wide user acceptance and high satisfaction rate with the alternative method.

    CONCLUSIONS: Virtual ward rounds using telemedicine via smart glasses on neurosurgical patients in critical care were feasible, effective, and widely accepted as an alternative to physical ward rounds during the coronavirus disease 2019 pandemic.

    Matched MeSH terms: Neurosurgery/statistics & numerical data*
  18. Mehbodniya AH, Moghavvemi M, Narayanan V, Waran V
    World Neurosurg, 2019 Feb;122:e449-e454.
    PMID: 30347306 DOI: 10.1016/j.wneu.2018.10.069
    BACKGROUND: Navigation (image guidance) is an essential tool in modern neurosurgery, and most surgeons use an optical tracking system. Although the technology is accurate and reliable, one often is confronted by line of sight issues that interrupt the flow of an operation. There has been feedback on the matter, but the actual problem has not been accurately quantified, therefore making this the primary aim of this study. It is particularly important given that robotic technology is gradually making its way into neurosurgery and most of these devices depend on optical navigation when procedures are being conducted.

    METHODS: In this study, the frequency and causes of line of sight issues is assessed using recordings of Navigation probe locations and its synchronised video recordings.

    RESULTS: The mentioned experiment conducted for a series of 15 neurosurgical operations. This issue occured in all these surgeries except one. Maximum duration of issue presisting reached up to 56% of the navigation usage time.

    CONCLUSIONS: The arrangment of staff and equipment is a key factor in avoiding this issue.

    Matched MeSH terms: Neurosurgery
  19. Low PH, Mangat MS, Liew DNS, Wong ASH
    World Neurosurg, 2020 12;144:e710-e713.
    PMID: 32949798 DOI: 10.1016/j.wneu.2020.09.045
    BACKGROUND: The novel coronavirus disease 2019 (COVID-19) pandemic has set a huge challenge to the delivery of neurosurgical services, including the transfer of patients. We aimed to share our strategy in handling neurosurgical emergencies at a remote center in Borneo island. Our objectives included discussing the logistic and geographic challenges faced during the COVID-19 pandemic.

    METHODS: Miri General Hospital is a remote center in Sarawak, Malaysia, serving a population with difficult access to neurosurgical services. Two neurosurgeons were stationed here on a rotational basis every fortnight during the pandemic to handle neurosurgical cases. Patients were triaged depending on their urgent needs for surgery or transfer to a neurosurgical center and managed accordingly. All patients were screened for potential risk of contracting COVID-19 prior to the surgery. Based on this, the level of personal protective equipment required for the health care workers involved was determined.

    RESULTS: During the initial 6 weeks of the Movement Control Order in Malaysia, there were 50 urgent neurosurgical consultations. Twenty patients (40%) required emergency surgery or intervention. There were 9 vascular (45%), 5 trauma (25%), 4 tumor (20%), and 2 hydrocephalus cases (10%). Eighteen patients were operated at Miri General Hospital, among whom 17 (94.4%) survived. Ninety percent of anticipated transfers were avoided. None of the medical staff acquired COVID-19.

    CONCLUSIONS: This framework allowed timely intervention for neurosurgical emergencies (within a safe limit), minimized transfer, and enabled uninterrupted neurosurgical services at a remote center with difficult access to neurosurgical care during a pandemic.

    Matched MeSH terms: Neurosurgery*
  20. Loewenthal J, Kenny PG, Seng YG
    Aust N Z J Surg, 1974 Jul;44(3):211-4.
    PMID: 4618111
    Matched MeSH terms: Neurosurgery/history*
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