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Intramedullary spindle cell hemangioendothelioma of the thoracic spinal cord--case report

Abdullah JM, Mutum SS, Nasuha NA, Biswal BM, Ariff AR

Neurol. Med. Chir. (Tokyo), 2002 Jun;42(6):259-63.
PMID: 12116532

A 28-year-old Malay man presented with progressive paraparesis over a period of 6 months. Magnetic resonance imaging of the spine revealed a thoracic intramedullary spinal cord tumor at the T-7 level with homogeneous enhancement following intravenous gadolinium administration. Laminectomy and partial decompression of the tumor was performed. Histological examination of the tumor revealed features of spindle cell hemangioendothelioma. The patient was managed with limited field radiotherapy followed by systemic interferon therapy. Good neurological improvement was seen subsequently. The patient has survived 48 months with growth restraint at the primary site, although residual neurological deficit persists. Immunotherapy should be considered as a treatment modality for intramedullary hemangioendothelioma of the spinal cord after surgery and radiotherapy.
Fulltext Cost effectiveness analysis of using multiple neuromodalities in treating severe traumatic brain injury in a developing country like Malaysia

Ibrahim MI, Abdullah M, Naing L, Abdullah JM, Idris Z, Aljunid SM

Asian J Surg, 2007 Oct;30(4):261-6.
PMID: 17962129

The aim of this study was to determine the cost-effectiveness of using baseline neuromonitoring (BNM) compared with multimodality monitoring (M3) for severe traumatic brain injury (TBI).
Door-to-Skin Time in Patient Undergoing Emergency Trauma Craniotomy

Chockalingam K, A Rahman NA, Idris Z, Theophilus SC, Abdullah JM, Ghani ARI, et al.

Malays J Med Sci, 2023 Aug;30(4):71-84.
PMID: 37655152 DOI: 10.21315/mjms2023.30.4.7

BACKGROUND: Traumatic brain injury (TBI) is the third leading cause of death and disability worldwide in 2020. For patients with TBI with significant intracranial bleeds, urgent surgical intervention remains the mainstay treatment. This study aims to evaluate the time to definite surgical intervention since admission and its association with patient outcomes in a neurosurgery referral centre in Malaysia.
METHODS: This retrospective study was conducted at Hospital Sultanah Aminah Johor Bahru from 1 January 2019 to 31 December 2019. All patients with TBI requiring urgent craniotomy were identified from the operating theatre registry, and the required data were extracted from their clinical notes, including the Glasgow Outcome Score (GCS) at discharge and 6 months later. Logistic regression was performed to identify the factors associated with poor outcomes.
RESULTS: A total of 154 patients were included in this study. The median door-to-skin time was 605 (interquartile range = 494-766) min. At discharge, 105 patients (68.2%) had poor outcomes. At the 6-month follow-up, only 58 patients (37.7%) remained to have poor outcomes. Simple logistic regression showed that polytrauma, hypotensive episode, ventilation, severe TBI, and the door-to-skin time were significantly associated with poor outcomes. After adjustments for the clinical characteristics in the analysis, the likelihood of having poor outcomes for every minute delay in the door-to-skin time increased at discharge (adjusted odds ratio [AOR] = 1.005; 95% confidence interval [CI] = 1.002-1.008) and the 6-month follow-up (AOR = 1.008; 95% CI = 1.005-1.011).
CONCLUSION: The door-to-skin time is directly proportional to poor outcomes in patients with TBI. Concerted efforts from all parties involved in trauma care are essential in eliminating delays in surgical interventions and improving outcomes.
Examination Approach to the Dizzy and Swaying Patient

Said Mogutham NN, Abdullah JM, Idris Z, Ghani ARI, Abdul Halim S, Naesarajoo JJJ, et al.

Malays J Med Sci, 2020 Dec;27(6):89-101.
PMID: 33447137 DOI: 10.21315/mjms2020.27.6.9

Background: Dizziness is a common presenting complaint among patients in Malaysia. It is a vague term which could be associated with vertigo, imbalance, ataxia or syncope. In order to deal with this overwhelming complaint, a detailed history-taking is essential in confirming aetiology of disease and this should be followed by a meticulous clinical examination. The purpose of the video manuscript it to provide a step-by-step approach to a dizzy and swaying patient, specially catered for Malaysian medical students and trainees.
Methods: A series of videos were shot, which involved the eye, ear, vestibular system, cerebellar, proprioceptive sense and gait examination. These videos, conducted in Universiti Sains Malaysia (USM) School of Medical Sciences, will be first in Malaysia and will highlight the proper technique and rapport with patients and essential points of each examination. There will be summary at the end of each examination on how to report findings which is a common weakness among students.
Conclusion: We hope that students and junior doctors could be apply these methods in their daily assessment of dizzy patients and ultimately, reach an accurate diagnosis.
Fulltext Roles of EphA2 Receptor in Angiogenesis Signaling Pathway of Glioblastoma Multiforme

Baharuddin WNA, Yusoff AAM, Abdullah JM, Osman ZF, Ahmad F

Malays J Med Sci, 2018 Nov;25(6):22-27.
PMID: 30914876 DOI: 10.21315/mjms2018.25.6.3

Glioblastoma multiforme (GBM) is one of the most common primary brain tumours in adults, accounting for almost 65% of all cases. Among solid tumours, GBM is characterised by strong angiogenesis, including the highest degree of vascular proliferation and endothelial cell hyperplasia. Despite numerous improvements in existing treatment approaches, the prognosis of GBM patients remains poor, with a mean survival of only 14.6 months. Growing evidence has shown significant overexpression of the ephrin type-A receptor 2 (EphA2) receptor in various malignancies, including GBM, as well as a correlation to poor prognoses. It is believed that EphA2 receptors play important roles in mediating GBM tumourigenesis, including invasion, metastasis, and angiogenesis. Despite the clinical and pathological importance of tumour-associated vasculature, the underlying mechanism involving EphA2 is poorly known. Here, we have summarised the current knowledge in the field regarding EphA2 receptors' roles in the angiogenesis of GBM.
Fulltext History of Neurosurgery in Malaysia

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.
Intracerebral haematomas after deep brain stimulation surgery in a patient with Tourette syndrome and low factor XIIIA activity

Idris Z, Ghani AR, Mar W, Bhaskar S, Wan Hassan WN, Tharakan J, et al.

J Clin Neurosci, 2010 Oct;17(10):1343-4.
PMID: 20620064 DOI: 10.1016/j.jocn.2010.01.054

A 24-year-old male patient with refractory Tourette syndrome was treated with deep brain stimulation (DBS) and developed subsequent bilateral subcortical haematomas. Additional blood tests revealed abnormalities of plasma factor XIIIA and tryptophan levels, which may be associated with Tourette syndrome. Neurosurgeons who perform DBS surgery on patients with Tourette syndrome must be aware of possible disastrous complications resulting from factor XIIIA disorders of blood haemostasis. Routine screening for this condition is not typically performed prior to surgery in these patients.
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.
Persistence of cognitive deficits following paediatric head injury without professional rehabilitation in rural East Coast Malaysia

Abdullah JM, Kumaraswamy N, Awang N, Ghazali MM, Abdullah MR

Asian J Surg, 2005 Jul;28(3):163-7.
PMID: 16024307

To use data from a prospective, longitudinal study to determine whether psychomotor functions improve spontaneously during the first year following paediatric traumatic brain injury without modern rehabilitation facilities in a rural area of Malaysia.
Endoscopic fenestration at the splenial-habenular junctional area for symptomatic cavum and tumor at the foramen of Monro: case reports and anatomical review

Idris Z, Johnson JR, Abdullah JM

J. Neurosurg., 2015 Mar;122(3):504-10.
PMID: 25343181 DOI: 10.3171/2014.9.JNS132683

The splenial-habenular junctional area is an alternative site for neuroendoscopic fenestration to divert CSF flow into the quadrigeminal cistern in cases in which endoscopic third ventriculostomy is not amenable. In some patients with obstructive hydrocephalus, the splenium of the corpus callosum can be elevated from the habenular complex. This exposes the membranous connection between the splenium and habenula, which can be fenestrated to divert the CSF flow into the quadrigeminal cistern. This technique can be performed in patients in whom the foramen of Monro or the third ventricle is blocked by a lesion. Here, the authors present 3 complex cases that were managed by neuronavigation-guided transventricular transcavum endoscopic fenestration of the splenial-habenular junctional area. These cases may increase the knowledge and understanding of the anatomy of this region.
Addition of zygomatic arch resection in decompressive craniectomy

Martin AG, Abdullah JY, Jaafar A, Ghani AR, Rajion ZA, Abdullah JM

J Clin Neurosci, 2015 Apr;22(4):735-9.
PMID: 25564264 DOI: 10.1016/j.jocn.2014.09.021

Decompressive craniectomy (DC) is a surgical option in managing uncontrolled raised intracranial pressure refractory to medical therapy. The authors evaluate the addition of zygomatic arch (ZA) resection with standard DC and analyze the resulting increase in brain volume using three-dimensional volumetric CT scans. Measurements of brain expansion dimension morphometrics from CT images were also analyzed. Eighteen patients were selected and underwent DC with ZA resection. The pre- and post-operative CT images were analyzed for volume and dimensional changes. CT images of 29 patients previously operated on at the same center were retrieved from the picture archiving and communication system (PACS) and were similarly studied. The findings obtained from the two groups were compared and analyzed. Analysis from three-dimensional CT volumetric techniques revealed an significant increase of 27.97ml (95% confidence interval [CI]: 39.98-180.36; p=0.048) when compared with standard DC. Brain expansion analysis of maximum hemicraniectomy diameter revealed a mean difference of 0.82cm (95% CI: 0.25-1.38; p=0.006). Analysis of the ratio of maximum hemicraniectomy diameter to maximum anteroposterior diameter gave a mean difference of 0.04 (95% CI: 0.05-0.07; p=0.026). The addition of ZA resection to standard DC may prove valuable in terms of absolute brain volume gain. This technique is comparable to other maneuvers used to provide maximum brain expansion in the immediate post-operative period.
Fulltext Bilateral subtentorial empyema complicated with nosocomial acinectobacter ventriculitis: a case report

Sim SK, Ch'ng CH, Tan YC, Kandasamy R, Abdullah JM

Med J Malaysia, 2014 Apr;69(2):86-8.
PMID: 25241818 MyJurnal

Subtentorial subdural empyema is a rare and life threatening intracranial suppuration. It is usually an intracranial complication of otogenic infections. Early diagnosis and surgical drainage are the most important factors determining prognosis. The high mortality reported in the literature reflects the severity of subtentorial subdural empyema if proper management is delayed. Intracranial infections usually require between 4 to 6 weeks of intravenous antibiotics therapy. However, the prolonged duration of hospitalization as well as requirement for neurosurgically inserted indwelling devices may predispose these patients to new nosocomial infections.
Fulltext Pleomorphic xanthoastrocytoma in a case of tuberous sclerosis

Martin AG, Singh MS, Idris B, Abdullah JM

J Neurosci Rural Pract, 2014 Jul;5(3):258-60.
PMID: 25002765 DOI: 10.4103/0976-3147.133580

Tuberous sclerosis is a known phakomatosis and the associated finding of a subependymal giant cell astrocytoma is common with this disorder. A case of tuberous sclerosis with a finding not previously reported, i.e. that of a pleomorphic xanthoastrocytoma, is presented here.
Influence of education level on design-induced N170 and P300 components of event related potentials in the human brain

Begum T, Reza F, Ahmed I, Abdullah JM

J Integr Neurosci, 2014 Mar;13(1):71-88.
PMID: 24738540 DOI: 10.1142/S0219635214500058

Simple geometric and organic shapes and their arrangement are being used in different neuropsychology tests for the assessment of cognitive function, special memory and also for the therapy purpose in different patient groups. Until now there is no electrophysiological evidence of cognitive function determination for simple geometric, organic shapes and their arrangement. Then the main objective of this study is to know the cortical processing and amplitude, latency of visual induced N170 and P300 event related potential components on different geometric, organic shapes and their arrangement and different educational influence on it, which is worthwhile to know for the early and better treatment for those patient groups. While education influenced on cognitive function by using auditory oddball task, little is known about the influence of education on cognitive function induced by visual attention task in case of the choice of geometric, organic shapes and their arrangements. Using a 128-electrode sensor net, we studied the responses of the choice of the different geometric and organic shapes randomly in experiment 1 and their arrangements in experiment 2 in the high, medium and low education groups. In both experiments, subjects push the button "1" or "2" if like or dislike, respectively. Total 45 healthy subjects (15 in each group) were recruited. ERPs were measured from 11 electrode sites and analyzed to see the evoked N170/N240 and P300 ERP components. There were no differences between like and dislike in amplitudes even in latencies in every stimulus in both experiments. We fixed geometric shapes and organic shapes stimuli only, not like and dislike. Upon the stimulus types, N170 ERP component was found instead of N240, in occipito-temporal (T5, T6, O1 and O2) locations where the amplitude is the highest at O2 location and P300 was distributed in the central (Cz and Pz) locations in both experiments in all groups. In experiment 1, significant low amplitude and non-significant larger latency of the N170 component are found out at O1 location for both stimuli in low education group comparing medium education groups, but in experiment 2, there is no significant difference between stimuli among groups in amplitude and latency. In both experiments, P300 component was found in Cz and Pz locations though the amplitudes are higher at Cz than Pz areas. In experiment 1, medium education group evoked significantly (geometric shape stimuli, P = 0.05; organic shape stimuli, P = 0.02) higher amplitude of P300 component comparing low education group at Cz location. Whereas, there is no significant difference of amplitudes among groups across stimuli in Cz and Pz locations in experiment 2. Latencies have no significant differences in both experiments among groups also, but longer latency are found in low education group at Cz location comparing medium education group, though not significant. We conclude that simple geometric shapes, organic shapes and their arrangements evoked visual N170 component at temporo-occipital areas with right lateralization and P300 ERP component at centro-parietal areas. Significant low amplitude of N170 and P300 ERP components and longer latencies during different shape stimuli in low education group prove that, low education significantly influence on visual cognitive functions in low education group.
Normabaric Hyperoxia Treatment Improved Locomotor Activity of C57BL/6J Mice through Enhancing Dopamine Genes Following Fluid-Percussion Injury in Striatum

Muthuraju S, Taha S, Pati S, Rafique M, Jaafar H, Abdullah JM

Int J Biomed Sci, 2013 Dec;9(4):194-204.
PMID: 24711754

Closed traumatic brain injury (CTBI) leads to increase mortality rates in developing countries. However, a sustainable therapeutic approach has not been established yet. Therefore, the present study was designed to evaluate the impact of normabaric hyperoxia treatment (NBOT) on striatum associated Locomotor Activity (LA) in IntelliCage after Fluid-Percussion Injury (FPI). Animals were divided in four groups: Group I control (n=24), Group II sham (n=24), Group III FPI (n=24) and Group IV FPI with NBOT (n=24). Animals were habituated in IntelliCage for 4 days following transponder implanted in mice neck region on day 5. Then the LA of all groups was assessed 6hr daily for 5 days before inducing FPI. On day 6, cannula was implanted on the striatum, on day 7 FPI was performed in Group III (kept in normal environment) and IV (immediately exposed to NBOT for 3 hr). LA (in terms of number of visits in all four corners) was assessed 6 hr at days 1, 7, 14, 21 and 28 following FPI. After the animals were sacrificed to study the neuronal damage, dopamine receptors and transporters expression in striatum. The results suggested that the LA of FPI impaired mice as compared to the control and sham showed less number of visits in all four corners in IntelliCage. Morphological results revealed that FPI induced neuronal damage as compared to sham and control. Dopamine receptors and transporters were down regulated in the FPI group as compared to the control. Immediate exposure to NBOT improved LA in terms of increased number of visits in all four corners, reduced number of cell death and improved receptor expression as compared to FPI. In conclusion, NBOT exposure could improve the LA of mice following FPI through prevention of neuronal damage, improved dopamine receptors and transporters.
A preliminary study of using active vision guided robotic arm for bone drilling in a developing country

Abdullah MZ, Awang MS, Tan YC, Abdullah JM

J Neurol Surg A Cent Eur Neurosurg, 2014 Mar;75(2):155-7.
PMID: 23636911 DOI: 10.1055/s-0032-1330954

The study assesses the capability and accuracy of a robotic arm to perform burr holes.
Fulltext Viability reduction and Rac1 gene downregulation of heterogeneous ex-vivo glioma acute slice infected by the oncolytic Newcastle disease virus strain V4UPM

Mustafa Z, Shamsuddin HS, Ideris A, Ibrahim R, Jaafar H, Ali AM, et al.

Biomed Res Int, 2013;2013:248507.
PMID: 23586025 DOI: 10.1155/2013/248507

Oncolytic viruses have been extensively evaluated for anticancer therapy because this virus preferentially infects cancer cells without interfering with normal cells. Newcastle Disease Virus (NDV) is an avian virus and one of the intensively studied oncolytic viruses affecting many types of cancer including glioma. Nevertheless, the capability of NDV infection on heterogeneous glioma tissue in a cerebrospinal fluid atmosphere has never been reported. Recently, Rac1 is reported to be required for efficient NDV replication in human cancer cells and established a link between tumourigenesis and sensitivity to NDV. Rac1 is a member of the Rho GTPases involved in the regulation of the cell migration and cell-cycle progression. Rac1 knockdown leads to significant inhibition of viral replication. In this work, we demonstrated that NDV treatment led to significant reduction of tumour tissue viability of freshly isolated heterogeneous human brain tumour slice, known as an ex vivo glioma acute slice (EGAS). Analysis of gene expression indicated that reduced tissue viability was associated with downregulation of Rac1. However, the viability reduction was not persistent. We conclude that NDV treatment induced EGAS viability suppression, but subsequent downregulation of Rac1 gene may reduce the NDV replication and lead to regrowth of EGAS tissue.
Fulltext Platelet alloantigen polymorphism and migraine headaches

Bhaskar S, Abdullah JM

Neurosciences (Riyadh), 2013 Apr;18(2):185-6.
PMID: 23545624
Fulltext The role of repeat head computed tomography in the management of mild traumatic brain injury patients with a positive initial head CT

Sharifuddin A, Adnan J, Ghani AR, Abdullah JM

Med J Malaysia, 2012 Jun;67(3):305-8.
PMID: 23082423 MyJurnal

This was a prospective observational study done to evaluate the role of a repeat head CT in patients with mild traumatic brain injury. The aim was to evaluate wether the repeat head CT were useful in providing information that leads to any neurosurgical intervention. 279 adult patients with a mild head injury (GCS 13-15) were enrolled, and these comprised of patients with an initial traumatic intracranial haemorrhage not warranting any surgical intervention. All patients were subjected to a repeat head CT within 48 hours of admission and these showed no change or improvements of the brain lesion in 217 patients (79.2%) and worsening in 62 patients (20.8%). In thirty-one patients, surgical intervention was done following the repeat head CT. All of these patients had a clinical deterioration prior to the repeat head CT. Even if a repeat head CT had not been ordered on these patients, they would have had a repeat head CT due to deteriorating neurological status. When the 62 patients with a worsening repeat head CT were compared with the 217 patients with an improved or unchanged repeat head CT, they were found to have older age, lower GCS on admission, presenting symptoms of headache, higher incidence of multiple traumatic intracranial pathology and lower haemoglobin level on admission. On stepwise multiple logistic regression analysis, three factors were found to independently predict a worse repeat head CT (Table IV). This includes age of 65 years or older, GCS score of less than 15 and multiple traumatic intracranial lesion on initial head CT. As a conclusion, we recommend that, in patients with a MTBI and a normal neurological examination, a repeat cranial CT is not indicated, as it resulted in no change in management or neurosurgical intervention. Close monitoring is warranted in a subset of patients with risk factors for a worsening repeat head CT.
Keywords: Computed tomography, brain injury, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
Neuronavigation-guided endoscopic management of a pineal region tumour with obscured floor of the third ventricle: case report

Idris Z, Ghani AR, Idris B, Muzaimi M, Awang S, Pal HK, et al.

Minim Invasive Neurosurg, 2011 Jun;54(3):125-7.
PMID: 21863520 DOI: 10.1055/s-0031-1277198

Shunt surgery is frequently chosen to manage periventricular metastasis of pineal region tumours which obscured the floor of the third ventricle. However, this procedure falls short due to distant metastasis. Neuronavigation-guided endoscopic surgery offers a viable alternative.

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