MyMedR

Intrasellar pituitary mucocele: diagnostic dilemma

Tang IP, Chai CK, Kumar G, Prepageran N, Waran V

Br J Neurosurg, 2014 Jun;28(3):390-2.

PMID: 23875880 DOI: 10.3109/02688697.2013.817535

Isolated intrasellar pituitary mucocele following transsphenoidal sinus surgery is extremely rare. The clinical features resemble a pituitary tumor, therefore careful radiological interpretation is crucial to reach the correct diagnosis. We report a case of intrasellar mucocele who had transsphenoidal sinus surgery performed 15 years prior.

A new modified speculum guided single nostril technique for endoscopic transnasal transsphenoidal surgery: an analysis of nasal complications

Waran V, Tang IP, Karuppiah R, Abd Kadir KA, Chandran H, Muthusamy KA, et al.

Br J Neurosurg, 2013 Dec;27(6):742-6.

PMID: 23647078 DOI: 10.3109/02688697.2013.791667

Abstract The endoscopic transnasal, transsphenoidal surgical technique for pituitary tumour excision has generally been regarded as a less invasive technique, ranging from single nostril to dual nostril techniques. We propose a single nostril technique using a modified nasal speculum as a preferred technique. We initially reviewed 25 patients who underwent pituitary tumour excision, via endoscopic transnasal transsphenoidal surgery, using this new modified speculum-guided single nostril technique. The results show shorter operation time with reduced intra- and post-operative nasal soft tissue injuries and complications.

Video clip transfer of radiological images using a mobile telephone in emergency neurosurgical consultations (3G Multi-Media Messaging Service)

Waran V, Bahuri NF, Narayanan V, Ganesan D, Kadir KA

Br J Neurosurg, 2012 Apr;26(2):199-201.

PMID: 21970777 DOI: 10.3109/02688697.2011.605482

The purpose of this study was to validate and assess the accuracy and usefulness of sending short video clips in 3gp file format of an entire scan series of patients, using mobile telephones running on 3G-MMS technology, to enable consultation between junior doctors in a neurosurgical unit and the consultants on-call after office hours.

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.

Pulmonary miliary tuberculosis with multiple intracerebral tuberculous granulomas--report of two cases

Muin IA, Zurin AR

Br J Neurosurg, 1998 Dec;12(6):585-7.

PMID: 10070474

Although intracerebral tuberculomas are common in countries where tuberculosis is still endemic, miliary tuberculosis with involvement of the central nervous system is exceptionally rare. We report two cases of pulmonary miliary tuberculosis with multiple intracerebral tuberculomas.

Outcome prediction in early management of severe head injury: an experience in Malaysia

Selladurai BM, Jayakumar R, Tan YY, Low HC

Br J Neurosurg, 1992;6(6):549-57.

PMID: 1472321

The outcome of 109 patients with severe head injury was studied in relation to clinical and computed tomographic (CT) criteria on admission, after resuscitation. Age, Glasgow Coma Score (GCS) and state of pupils strongly correlated with outcome. The presence of hypothalamic disturbances, hypoxia and hypotension were associated with an adverse outcome. The CT indicators associated with poor outcome were perimesencephalic cistern (PMC) obliteration, subarachnoid haemorrhage, diffuse axonal injury and acute subdural haematoma. The prognostic value of midline shift and mass effect were influenced by concomitant presence of diffuse brain injury. For the subset of patients aged < 20 years, with GCS 6-8 and patent PMC (n = 21), 71.4% correct predictions were made for a good outcome. For the subset of patients aged > 20 years, with GCS 3-5 and partial or complete obliteration of PMC (n = 28), 89.3% correct predictions were made for a poor outcome.

Intracranial suppuration caused by Micrococcus luteus

Selladurai BM, Sivakumaran S, Aiyar S, Mohamad AR

Br J Neurosurg, 1993;7(2):205-7.

PMID: 8098607

Micrococcus spp. are commensal organisms colonizing the body surfaces of humans. In a few instances these organisms have been reported to colonize ventricular shunts. We report a patient, with no overt evidence of immunosuppression, in whom Micrococcus luteus was responsible for intracranial suppuration at multiple sites.

Coagulopathy in acute head injury--a study of its role as a prognostic indicator

Selladurai BM, Vickneswaran M, Duraisamy S, Atan M

Br J Neurosurg, 1997 Oct;11(5):398-404.

PMID: 9474270

The aim of this investigation was to determine the prognostic value of coagulation abnormalities in a defined subset of patients with acute head injury. Prothrombin time, accelerated partial thromboplastin time (APTT), thrombin clotting time, fibrinogen assay, platelet count, fibrin degradation products (FDP) were assayed in 204 patients with acute closed head injury. Their values were graded on a score 0-3 and the sum score for each patient regarded as the disseminated intravascular coagulation (DIC) score. Moderate to severe DIC scores were evident in 38% of the cohort. At least one parameter was abnormal in 71% of patients. The DIC score correlated inversely with the Glasgow coma score (GCS) (p < 0.0001). In the GCS 13-15 subset, FDP scores were significant predictors of poor outcome (p < 0.001). In the GCS 6-12 subset, the APTT score (p < 0.001), and DIC score (p < 0.0001) predicted an adverse outcome. The DIC scores were significantly abnormal in most patients who had a poor outcome, without evidence of adverse predictors on CT. Logistic regression analysis confirmed the independent predictive capacity of APTT, FDP and DIC scores when values for GCS were fixed. Abnormal haemostatic parameters may enhance the predictive ability in subsets of patients with acute head injury defined by clinical or CT predictors.

Syringomyelia associated with a cauda equina meningioma involving the conus medullaris

Chee CP, Tan CT, Nuruddin R

Br J Neurosurg, 1990;4(6):529-33.

PMID: 2076215

An unusual case of syringomyelia secondary to a cauda equina meningioma involving the conus medullaris is described. The tumour was totally removed with decompression of an adjacent cyst and syrinx resulting in resolution of the symptoms and radiological appearance.

Melioidosis presenting as spinal epidural abscess

Ganesan D, Puthucheary SD, Waran V

Br J Neurosurg, 2003 Dec;17(6):568-71.

PMID: 14756491

Central nervous system melioidosis is an unusual infection in humans. This article reports a case of melioidosis presenting as an acute spinal epidural abscess. A discussion of this case and its management together with a brief review of melioidosis of the central nervous system is presented.

Cavernous sinus fungal infection: a rare case

Ng BHK, Kho GS, Sim SK, Liew DNS, Tang IP

Br J Neurosurg, 2017 Jun 09.

PMID: 28597698 DOI: 10.1080/02688697.2017.1335857

Intracranial fungal infection of the cavernous sinus is a condition that usually affects immunocompromised individuals and is rarely seen in immunocompetent individuals. It is a potentially life threatening condition which requires prompt treatment. Here we present a case of an immunocompetent patient with a fungal infection of the cavernous sinus.

Introduction of a newly created AW stereotactic frame: a phantom-based accuracy evaluation and an initial experience in clinical usage

Lau BL, Idris Z, Abdullah JM, Bujang MA, Wong ASH

Br J Neurosurg, 2023 Dec;37(6):1572-1579.

PMID: 33191803 DOI: 10.1080/02688697.2020.1837728

BACKGROUND: A new stereotactic frame was created in 2015, based on a linear algorithm. It is called Albert Wong (AW) frame. A simple AW stereo-calculator was also designed based on Excel® (Microscoft Corporation, Redmond, WA) programme for the frame.

OBJECTIVE: The aim of this study is to test the accuracy of the AW frame by a direct head to head comparison with CRW® frame (Integra Life Sciences, Plainsboro, NJ) on a phantom.

METHODS: This is a prospective pilot cross-sectional phantom study with a total of 42 (21 for AW and 21 for CRW®) laboratory testings performed in 2017 at our institute to compare the accuracies of both frames in a consecutive manner. A phantom (BL phantom) was newly created, where targets can be placed at different heights and positions on a platform attached under the frame for accuracy testing comparing between the AW and CRW® frames.

RESULTS: A comparable accuracy testing results were observed between the AW and CRW® frames of 0.64 mm versus 1.07 mm respectively. Approval from the local ethics committee for a clinical trial was obtained. We report on three case illustrations who had the AW frame-based biopsies with definitive diagnoses and without any post-biopsy related complication.

CONCLUSION: AW frame successfully demonstrated a good accuracy of 0.64 mm in phantom testing using the BL phantom by a linear algorithmic calculation. The clinical trial with three patients demonstrated definitive diagnoses and safety with its use.

The use of intraoperative CT navigation for posterior cervical spine foraminotomy

Tan BH, Sockalingam S, Ganesan D

Br J Neurosurg, 2023 Jun 22.

PMID: 37345453 DOI: 10.1080/02688697.2023.2225611

OBJECTIVES: Posterior cervical foraminotomy is a surgical procedure used to treat unilateral cervical radiculopathy. It provides direct decompression of the nerve root without the necessity of fusion while maintaining cervical mobility. With the advancement in image-guidance technology and minimal access techniques, intra-operative CT has provided a safer, more accurate instrumentation placement with less radiation exposure to operative staff and provides better anatomical visualization quality compared to traditional intra-operative imaging techniques. This case series aims to address the applications of advanced image guidance in posterior cervical foraminotomy and describe the nuances.

METHOD: A technical report on a series of seven cases on intraoperative CT navigation for posterior cervical foraminotomy surgery. Posterior cervical foraminotomy was performed in all patients under CT guided navigation system without an image intensifier. In one case after the foraminotomy, the extruded disc was carefully removed by gentle retraction.

RESULT: From 1 January 2020 to 31 December 2021, a total of seven patients with nine cervical foraminotomy procedures were performed using the aid of CT-guided navigation. The series comprised five women and two men whose mean age was 50.6 years. In all cases, the radiculopathy symptoms were diminished significantly. There were no cases of instability on the dynamic cervical radiograph. There were no complications during the surgical procedure.

CONCLUSION: The navigation also allows the surgeon to localise the index level accurately and appraise the adequacy of the intended decompression in three planes of the CT scan image. The ability to perform accurate spine navigation would be the precursor for robotic spinal surgery.

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