MyMedR

Fulltext Refractory hypokalemia during barbiturate coma therapy used for treating refractory intracranial hypertension in traumatic brain injury

Wan Hassan WM, Najid NM, Muslim HS, Izaini Ghani AR

Asian J Neurosurg, 2015 3 15;10(1):59.

PMID: 25767595 DOI: 10.4103/1793-5482.151528

Barbiturate coma therapy (BCT) is a choice treatment for refractory intracranial hypertension after all surgical or medical managements have failed to control the intracranial pressure (ICP). It helps to reduce cerebral blood flow, cerebral metabolic rate of oxygen consumption and ICP. However, this therapy can also cause many complications. One of the underreported, but life-threatening complications is refractory hypokalemia, which can lead to subsequent rebound hyperkalemia after sudden cessation. We report our experience of managing unusual complication of refractory hypokalemia during BCT with thiopentone in postdecompressive craniectomy patient.

Matched MeSH terms: Craniotomy

Utility of multimaterial 3D printers in creating models with pathological entities to enhance the training experience of neurosurgeons

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: Craniotomy

Fulltext Neural oscillation, network, eloquent cortex and epileptogenic zone revealed by magnetoencephalography and awake craniotomy

Idris Z, Kandasamy R, Reza F, Abdullah JM

Asian J Neurosurg, 2014 Jul-Sep;9(3):144-52.

PMID: 25685205 DOI: 10.4103/1793-5482.142734

BACKGROUND: Magnetoencephalography (MEG) is a method of functional neuroimaging. The concomitant use of MEG and electrocorticography has been found to be useful in elucidating neural oscillation and network, and to localize epileptogenic zone and functional cortex. We describe our early experience using MEG in neurosurgical patients, emphasizing on its impact on patient management as well as the enrichment of our knowledge in neurosciences.
MATERIALS AND METHODS: A total of 10 subjects were included; five patients had intraaxial tumors, one with an extraaxial tumor and brain compression, two with arteriovenous malformations, one with cerebral peduncle hemorrhage and one with sensorimotor cortical dysplasia. All patients underwent evoked and spontaneous MEG recordings. MEG data was processed at band-pass filtering frequency of between 0.1 and 300 Hz with a sampling rate of 1 kHz. MEG source localization was performed using either overdetermined equivalent current dipoles or underdetermined inversed solution. Neuromag collection of events software was used to study brain network and epileptogenic zone. The studied data were analyzed for neural oscillation in three patients; brain network and clinical manifestation in five patients; and for the location of epileptogenic zone and eloquent cortex in two patients.
RESULTS: We elucidated neural oscillation in three patients. One demonstrated oscillatory phenomenon on stimulation of the motor-cortex during awake surgery, and two had improvement in neural oscillatory parameters after surgery. Brain networks corresponding to clinico-anatomical relationships were depicted in five patients, and two networks were illustrated here. Finally, we demonstrated epilepsy cases in which MEG data was found to be useful in localizing the epileptogenic zones and functional cortices.
CONCLUSION: The application of MEG while enhancing our knowledge in neurosciences also has a useful role in epilepsy and awake surgery.
KEYWORDS: Awake craniotomy; brain network; epilepsy; magnetoencephalography; neural oscillation

Matched MeSH terms: Craniotomy

Fulltext The history of awake craniotomy in hospital universiti sains malaysia

Wan Hassan WM

Malays J Med Sci, 2013 Oct;20(5):67-9.

PMID: 24643321 MyJurnal

Awake craniotomy is a brain surgery performed on awake patients and is indicated for certain intracranial pathologies. These include procedures that require an awake patient for electrocorticographic mapping or precise electrophysiological recordings, resection of lesions located close to or in the motor and speech of the brain, or minor intracranial procedures that aim to avoid general anaesthesia for faster recovery and earlier discharge. This type of brain surgery is quite new and has only recently begun to be performed in a few neurosurgical centres in Malaysia. The success of the surgery requires exceptional teamwork from the neurosurgeon, neuroanaesthesiologist, and neurologist. The aim of this article is to briefly describe the history of awake craniotomy procedures at our institution.

Matched MeSH terms: Craniotomy

Fulltext Awake Craniotomy: A Case Series of Anaesthetic Management using a Combination of Scalp Block, Dexmedetomidine and Remifentanil in Hospital Universiti Sains Malaysia

Mohd Nazaruddin WH, Lukman MF, Abd Mukmin L, Zamzuri I, Izaini Ghani AR, Mohamad Zaini RH

Med J Malaysia, 2013;68(1):64-6.

PMID: 23466770 MyJurnal

Awake craniotomy is a brain surgery in patients who are kept awake when it is indicated for certain intracranial pathologies. The anaesthetic management strategy is very important to achieve the goals of the surgery. We describe a series of our first four cases performed under a combination of scalp block and conscious sedation. Scalp block was performed using a mixture of ropivacaine 0.7% and adrenaline 5 5µg/ ml administered to the nerves that innervate the scalp. Conscious sedation was achieved with a combination of two recently available drugs in our country, dexmedetomidine (selective α 2-agonist) and remifentanil (ultra-short acting opioid). Remifentanil was delivered in a target controlled infusion (TCI) mode.

Matched MeSH terms: Craniotomy

Fulltext Venous Air Embolism during Elective Craniotomy for Parasagittal Meningioma

Hassan WMNW, Asmah Z, Saedah A

Med J Malaysia, 2013;68(1):69-70.

PMID: 23466772 MyJurnal

We report a case of a 59 year old man who developed venous air embolism (VAE) during an elective craniotomy for parasagittal meningioma resection. The surgery was done in the supine position with slightly elevated head position. VAE was provisionally diagnosed by sudden decreased in the end tidal carbon dioxide pressure from 34 to 18 mmHg, followed by marked hypotension and atrial fibrillation. Prompt central venous blood aspiration, aggressive resuscitation and inotropic support managed to stabilize the patient. Post operatively, he was admitted in neuro intensive care unit and made a good recovery without serious complications.

Matched MeSH terms: Craniotomy

Fulltext Intracranial bleeding following induction of anesthesia in a patient undergoing elective surgery for refractory epilepsy

Kandasamy R, Tharakan J, Idris Z, Abdullah JM

Surg Neurol Int, 2013;4:124.

PMID: 24232072 DOI: 10.4103/2152-7806.119006

BACKGROUND: A patient with refractory epilepsy due to underlying mesial temporal sclerosis underwent general anesthesia for an elective anterior temporal lobectomy and amgydalo-hippocampectomy. He was a known hypertensive and his blood pressure was well controlled on medication.

CASE DESCRIPTION: Following induction of general anesthesia and subsequent opening of the craniotomy flap it was noted that the patient had a very swollen brain that herniated out of the dural defect. There was an underlying spontaneous intraparenchymal bleed encountered in the region of the left temporal lobe with associated subarachnoid hemorrhage within the sylvian fissure. The clot was evacuated and subsequently brain swelling reduced allowing us to proceed with the intended surgery. Despite the intracranial findings there was no overt abnormality in the hemodynamic status from the time of induction of anesthesia to the craniotomy opening excepting a mild nonsustained elevation of blood pressure at the outset.

CONCLUSION: This case is of interest due to the fact that spontaneous intraparenchymal bleeding after induction of anesthesia has not been reported before in literature and should be considered in any patient in which brain swelling occurs in a setting of elective neurosurgery in which the primary lesion does not cause elevated intracranial pressure.

Matched MeSH terms: Craniotomy

Fulltext Multiple nail gun penetrating head injury: a case report

Sim, S.K., Theophilus, S.C., Noor Azman, A.R.

International Medical Journal Malaysia, 2013;12(2):75-78.

MyJurnal

Intracranial nail gun injury is a rare subset of penetrating head injury. Here we report a case of intracranial nail gun injury in a Vietnamese patient who attempted suicide with no neurological deficit. Three nails were launched. Because the nail head acted as a brake, the launched nail could make a hole into the skull but could not entirely pass it. A rational management strategy should permit these patients to be discharged with no additional injury. Some medical and surgical management in penetrating head injury are discussed. The use of antibiotics and antiepileptic drugs and the retraction of the nail aided by the performance of a craniotomy surrounding the entry point are recommended.

Matched MeSH terms: Craniotomy

Fulltext Psychosis post craniotomy for craniopharyngioma

Siti Rohana Abdul Hadi, Saminah Md Kassim, Suriati Mohamed Saini

ASEAN Journal of Psychiatry, 2013;14(2):183-186.

MyJurnal

Objective: This case report highlights psychosis post craniopharyngioma surgery.

Methods: We report a case of a young Malay lady who presented with psychotic symptoms after she underwent craniotomy for craniopharyngioma.

Results: Presence of prominent hallucinations and delusions after removal of the tumour and the symptoms lasted more than a month. The psychosis subsided with antipsychotic.

Conclusion: Psychosis post craniopharyngioma surgery is still possible whether possibly due to the residual tumour or as a result of treatment sequealae.

Matched MeSH terms: Craniotomy

Fulltext Risk factors for neurosurgical site infections after a neurosurgical procedure: a prospective observational study at Hospital Kuala Lumpur

Buang SS, Haspani MS

Med J Malaysia, 2012 Aug;67(4):393-8.

PMID: 23082448

Surgical site infection (SSI) after craniotomy even though rare, poses a real risk of surgery and represents a substantial burden of disease for both patients and healthcare services in terms of morbidity, mortality and economic cost. The knowledge of risk factor for surgical site infection after craniotomy will allow the authority to implement specific preventive measures to reduce the infection rate. Therefore, the objectives of this study are to determine the incidence and the risk factors of surgical site infection after craniotomy.

Matched MeSH terms: Craniotomy/adverse effects*

Fulltext Breast carcinoma occurring from chronic granulomatous mastitis

Mazlan L, Suhaimi SN, Jasmin SJ, Latar NH, Adzman S, Muhammad R

Malays J Med Sci, 2012 Apr;19(2):82-5.

PMID: 22973142 MyJurnal

Chronic granulomatous mastitis is known as a benign and relatively rare disorder that is often difficult to differentiate from breast carcinoma. We highlight the case of a 34-year-old woman who had recurrent episodes of right breast swelling and abscess for 8 years. These were proven to be chronic granulomatous mastitis by tissue biopsies on 3 different occasions. Her condition improved on similar courses of antibiotics and high-dose prednisolone. However, she subsequently developed progressive loss of vision due to an orbital tumour. She then underwent a craniotomy and left orbital decompression with excision of the tumour, which proved to be a metastatic carcinoma. A trucut biopsy of the right breast was then done and showed features consistent with an infiltrating ductal carcinoma. This case illustrates the possibility that chronic granulomatous mastitis could be a precursor for malignancy and the difficulty in differentiating one from the other. The possible mechanisms of development and the implications for future management are also discussed.

Matched MeSH terms: Craniotomy

Fulltext Treatment outcome of superficial cerebral abscess: an analysis of two surgical methods

Tan WM, Adnan JS, Mohamad Haspani MS

Malays J Med Sci, 2010 Jan;17(1):23-9.

PMID: 22135522 MyJurnal

The purpose of the study is to compare the two surgical methods (burr hole and craniotomy) used as treatment for superficial cerebral abscess and its outcome in terms of radiological clearance on brain CT, improvement of neurological status, the need for repeated surgery, and survival and morbidity at three months after surgery. This report is a retrospective case review of the patients who were treated surgically for superficial cerebral abscess in Hospital Kuala Lumpur (HKL) and Hospital Sultanah Aminah (HSA) over a period of four years (2004 to 2007).

Matched MeSH terms: Craniotomy

Two surgical methods used in 90 patients with intracranial subdural empyema

Mat Nayan SA, Mohd Haspani MS, Abd Latiff AZ, Abdullah JM, Abdullah S

J Clin Neurosci, 2009 Dec;16(12):1567-71.

PMID: 19793660 DOI: 10.1016/j.jocn.2009.01.036

We studied the efficacy of two surgical methods used for the treatment of intracranial subdural empyema (ISDE) at our centre. A cross-sectional study (1999-2005) of 90 patients with non-traumatic supratentorial ISDE revealed that the two surgical methods used for empyema removal were burr hole/s and drainage (50 patients, 55.6%) and a cranial bone opening procedure (CBOP) (40 patients, 44.4%). Patients in the CBOP group had a better result in terms of clinical improvement (chi-squared analysis, p=0.006) and clearance of empyema on brain CT scan (chi-squared analysis, p<0.001). Reoperation was more frequent among patients who had undergone burr hole surgery (multiple logistic regression, p<0.001). The outcome and morbidity of ISDE survivors were not related to the surgical method used (p>0.05). The only factor that significantly affected the morbidity of ISDE was level of consciousness at the time of surgery (multiple logistic regression, p<0.001). We conclude that CBOP and evacuation of the empyema is a better surgical method for ISDE than burr hole/s and drainage. Wide cranial opening and empyema evacuation improves neurological status, gives better clearance of the empyema and reduces the need for reoperation. Level of consciousness at the time of presentation is a predictor of the morbidity of ISDE. Thus, aggressive surgical treatment should occur as early as possible, before the patient deteriorates.

Matched MeSH terms: Craniotomy/methods*

Post traumatic cerebral oedema in severe head injury is related to intracranial pressure and cerebral perfusion pressure but not to cerebral compliance

Nujaimin U, Saufi A, Rahman AG, Badrisyah I, Sani S, Zamzuri I, et al.

Asian J Surg, 2009 Jul;32(3):157-62.

PMID: 19656755

This was a prospective cohort study, carried out in the Neuro Intensive Care Unit, Department of Neurosciences, Hospital Universiti Sains Malaysia, Kubang Kerian Kelantan. The study was approved by the local ethics committee and was conducted between November 2005 and September 2007 with a total of 30 patients included in the study. In our study, univariate analysis showed a statistically significant relationship between mean intracranial pressure (ICP) as well as cerebral perfusion pressure (CPP) with both states of basal cistern and the degree of diffuse injury and oedema based on the Marshall classification system. The ICP was higher while CPP and compliance were lower whenever the basal cisterns were effaced in cases of cerebral oedema with Marshall III and IV. In comparison, the study revealed lower ICP, higher mean CPP and better mean cerebral compliance if the basal cisterns were opened or the post operative CT brain scan showed Marshall I and II. These findings suggested the surgical evacuation of clots to reduce the mass volume and restoration of brain anatomy may reduce vascular engorgement and cerebral oedema, therefore preventing intracranial hypertension, and improving cerebral perfusion pressure and cerebral compliance. Nevertheless the study did not find any significant relationship between midline shifts and mean ICP, CPP or cerebral compliance even though lower ICP, higher CPP and compliance were frequently observed when the midline shift was less than 0.5 cm. As the majority of our patients had multiple and diffuse brain injuries, the absence of midline shift did not necessarily mean lower ICP as the pathology was bilateral and even when after excluding the multiple lesions, the result remained insignificant. We assumed that the CT brain scan obtained after evacuation of the mass lesion to assess the state basal cistern and classify the diffuse oedema may prognosticate the intracranial pressure and cerebral perfusion pressure thus assisting in the acute post operative management of severely head injured patients. Hence post operative CT brain scans may be done to verify the ICP and CPP readings postoperatively. Subsequently, withdrawal of sedation for neurological assessment after surgery could be done if the CT brain scan showed an opened basal cistern and Marshall I and II coupled with ICP of less than 20 mmHg.

Matched MeSH terms: Craniotomy

Fulltext Intraventricular teicoplanin

Shanti, R., Sam, I.C., Hany Ariffin

JUMMEC, 2009;12(1):35-38.

MyJurnal

Following craniotomy for an atypical rhabdoid tumour of the posterior cranial fossa, a fourteen-month-old boy developed a ventriculitis with methicillin resistant Staphylococcus epidermidis (MRSE) which is associated with the use of a ventriculoperitoneal shunt. Treatment with intravenous vancomycin resulted in a severe allergic skin reaction. Substitution with intravenous teicoplanin resulted in negative blood culture and MRSE ventriculitis was successfully eradicated with concomitant use of intraventricular teicoplanin. No signs of recurrent infection or adverse events occurred. Intraventricular teicoplanin is safe and effective for the treatment of staphylococcal neurosurgical shunt infections.

Matched MeSH terms: Craniotomy

Fulltext End-tidal to arterial carbon dioxide partial pressure difference during craniotomy in anaesthetised patients

Husaini J, Choy YC

Med J Malaysia, 2008 Dec;63(5):384-7.

PMID: 19803296 MyJurnal

This study to evaluate the relationship between end-tidal carbon dioxide pressure (ETCO2) and arterial partial pressure of carbon dioxide (PaCO2) included 35 patients between the ages of 18 and 65 years, ASA grade 1 and 2, who had elective craniotomies. Measurements of PaCO2 and ETCO2 were taken simultaneously: 1) 10 minutes after induction of general anaesthesia, 2) after cranium opening prior to dural incision, 3) start of dural closure. There was significant correlation between ETCO2 and PaCO2 (correlation coefficient: 0.571, 0.559 and 0.629 respectively). The mean (SD) difference for PaCO2 and ETCO2 were: 3.84 (2.13), 4.85 (5.78) and 3.91 (2.33) mmHg respectively. Although there was agreement, the bias is of significant clinical importance. In conclusion, we find that ETCO2 consistently underestimated the value of PaCO2 during craniotomy.

Matched MeSH terms: Craniotomy*

Fulltext Visual epilepsy in glioblastoma multiforme

Chong PK, Loo AV

Med J Malaysia, 2008 Dec;63(5):406-7.

PMID: 19803301 MyJurnal

We report a 33-year-old Chinese gentleman who presented with visual epilepsy and symptoms of raised intracranial pressure in which clinical examination revealed normal visual fields and acuity despite Magnetic Resonance Imaging (MRI) brain showing large contrast enhancing mass at the right occipital lobe. Craniotomy and excision of tumour was done and the histology confirmed glioblastoma multiforme (GBM). He completed radiotherapy and recovered well except developing left inferior homonymous quadrantropia post operatively which improved with time.

Matched MeSH terms: Craniotomy

Outcome of 2 different types of operative techniques practiced for chronic subdural hematoma in Malaysia: an analysis

Zakaraia AM, Adnan JS, Haspani MS, Naing NN, Abdullah JM

Surg Neurol, 2008 Jun;69(6):608-15; discussion 616.

PMID: 18486703 DOI: 10.1016/j.surneu.2007.01.054

Traumatic chronic subdural hematomas in Malaysia are increasingly common in young patients after road traffic accidents as well as the elderly who fall at home. Most surgeons in this country manage these pathologies without irrigation, with only a drainage system. This has led to criticism that the recurrence rate might be higher when no irrigation is done and that rates are lower with irrigation and drainage. Thus, a study was done to look into the outcome of TCSH operated with and without irrigation, followed by drainage, to guide the surgeons in Malaysia as to what best could be done for these cases.

Matched MeSH terms: Craniotomy*

Post-traumatic pericallosal artery aneurysm presenting with subdural haematoma without subarachnoid haemorrhage

Suhara S, Wong AS, Wong JO

Br J Neurosurg, 2008 Apr;22(2):295-7.

PMID: 18348031 DOI: 10.1080/02688690701687678

A 27-year-old patient presented with severe headache and seizures about a month after the initial head trauma. Computed tomography (CT) brain scan revealed acute subdural bleed continuous into the interhemispheric region, with no subarachnoid haemorrhage. This was due to rupture of a traumatic pericallosal artery aneurysm. This represents a rare case of traumatic pericallosal artery aneurysm presenting with subdural haematoma without subarachnoid haemorrhage.

Matched MeSH terms: Craniotomy/methods

Cerebellar intra-axial dermoid cyst: a case of unusual location

Pant I, Joshi SC

Childs Nerv Syst, 2008 Jan;24(1):157-9.

PMID: 17657495

Intra-axial dermoid cysts are rare intracranial space occupying lesions, more so in the pediatric age group. Dermoid cysts account for about 0.2 to 1.8% of all intracranial tumors and are commonly located in the cisternal spaces, mainly in the cerebellopontine angle and parasellar cisterns. A purely intra-axial position as reported in this paper is quite exceptional.

Matched MeSH terms: Craniotomy/methods

Displaying publications 21 - 40 of 51 in total