117 results on '"Waran, V"'
Search Results
2. The Evolution of Endoscopic Intracranial Surgeries
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Brand, Y, Tang, IP, Waran, V, Wong, E, and Prepageran, N
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- 2017
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3. Neuronavigation with the Universal Probe to Access Intracranial Targets
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Waran, V., Chandran, H., Devaraj, P., Ravindran, K., Rathinam, A. K., Balakrishnan, Y. K., and Tung, T. S.
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- 2014
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4. The Utilization of Cranial Models Created Using Rapid Prototyping Techniques in the Development of Models for Navigation Training
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Waran, V., Pancharatnam, Devaraj, Thambinayagam, Hari Chandran, Raman, Rajagopal, Rathinam, Alwin Kumar, Balakrishnan, Yuwaraj Kumar, Tung, Tan Su, and Rahman, Z. A.
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- 2014
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5. Consensus statement from the international consensus meeting on post-traumatic cranioplasty
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Iaccarino, C., primary, Kolias, A., additional, Adelson, P. D., additional, Rubiano, A. M., additional, Viaroli, E., additional, Buki, A., additional, Cinalli, G., additional, Fountas, K., additional, Khan, T., additional, Signoretti, S., additional, Waran, V., additional, Adeleye, A. O., additional, Amorim, R., additional, Bertuccio, A., additional, Cama, A., additional, Chesnut, R. M., additional, De Bonis, P., additional, Estraneo, A., additional, Figaji, A., additional, Florian, S. I., additional, Formisano, R., additional, Frassanito, P., additional, Gatos, C., additional, Germanò, A., additional, Giussani, C., additional, Hossain, I., additional, Kasprzak, P., additional, La Porta, F., additional, Lindner, D., additional, Maas, A. I. R., additional, Paiva, W., additional, Palma, P., additional, Park, K. B., additional, Peretta, P., additional, Pompucci, A., additional, Posti, J., additional, Sengupta, S. K., additional, Sinha, A., additional, Sinha, V., additional, Stefini, R., additional, Talamonti, G., additional, Tasiou, A., additional, Zona, G., additional, Zucchelli, M., additional, Hutchinson, P. J., additional, and Servadei, F., additional
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- 2020
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6. Rupture of the lateral ventricle secondary to a fourth ventricle tumour resulting in an indirect nontraumatic cerebrospinal fluid fistula
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Tan, S., Abdullah, B., Waran, V., and Liew, W.
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- 2003
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7. Three-dimensional anatomical accuracy of cranial models created by rapid prototyping techniques validated using a neuronavigation station
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Waran, V., Devaraj, P., Chandran, T. H., Muthusamy, K. A., Rathinam, A. K., Balakrishnan, Y. K., Tung, T. S., Raman, R., and Rahman, Z. A. A.
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Neuronavigation Rapid prototyping technique Surgical heads temporal bone surgery stereolithography technology fractures spine - Abstract
In neurosurgery and ear, nose and throat surgery the application of computerised navigation systems for guiding operations has been expanding rapidly. However, suitable models to train surgeons in using navigation systems are not yet available. We have developed a technique using an industrial, rapid prototyping process from which accurate spatial models of the cranium, its contents and pathology can be reproduced for teaching. We were able to register, validate and navigate using these models with common available navigation systems such as the Medtronic StealthStation S7 (R). (C) 2011 Elsevier Ltd. All rights reserved. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down.
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- 2017
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8. Shifting paradigms in surgical training - initial experience with the University Malaya neurosurgical simulation system
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Waran, V., VAIRAVAN NARAYANAN, Owen, S. L. F., and Aziz, T. Z.
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education ,ComputingMethodologies_IMAGEPROCESSINGANDCOMPUTERVISION - Abstract
In the past, neurosurgical training was essentially "See one, do one and teach one". In the current environment with reduction in training hours, less exposure to real operating environment and unusual surgical cases, the need for hands on training in a realistic environment is critical for surgeons and theatre staff. With modern technology using scanned images and 3-D laser printing techniques, it is possible to create near realistic surgical models for trainees to develop surgical skills. This technique also allows assessment of surgical competency by objective scoring to quantify training. We present our early experience in the use of such techniques at the University of Malaya in training residents in image guided neurosurgery.
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- 2013
9. Endoscopic transpterygoidal repair of a large cranial defect with cerebrospinal fluid leak in a patient with extensive osteoradionecrosis of the skull base: case report and technical note
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Brand, Y, primary, Lim, E, additional, Waran, V, additional, and Prepageran, N, additional
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- 2015
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10. Neuronavigation with the Universal Probe to Access Intracranial Targets
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Chandran, H., primary, Devaraj, P., primary, Ravindran, K., primary, Rathinam, A., primary, Balakrishnan, Y., primary, Tung, T., primary, and Waran, V., additional
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- 2013
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11. The Utilization of Cranial Models Created Using Rapid Prototyping Techniques in the Development of Models for Navigation Training
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Pancharatnam, Devaraj, primary, Thambinayagam, Hari, primary, Raman, Rajagopal, primary, Rathinam, Alwin, primary, Balakrishnan, Yuwaraj, primary, Tung, Tan, primary, Rahman, Z., primary, and Waran, V., additional
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- 2013
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12. Genetic polymorphisms of EGF 5'-UTR and NAT2 857G/A associated with glioma in a case control study of Malaysian patients
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Muthusamy, K.A., primary, Lian, L.H., additional, Vairavan, N., additional, Chua, K.H., additional, and Waran, V., additional
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- 2012
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13. A Haemostatic Agent Delivery System for Endoscopic Neurosurgical Procedures
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Waran, V., additional, Sek, K., additional, Bahuri, N., additional, Narayanan, P., additional, and Chandran, H., additional
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- 2011
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14. Minimally Invasive Image-Guided Removal of Retrobulbar Intraconal Foreign Body
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Vairavan, N., primary, Tajunisah, I., additional, Subrayan, V., additional, and Waran, V., additional
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- 2009
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15. Rare cause of airway obstruction in neonate
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Chong, M.Y.S., primary, Rahman, Z.A., additional, Ganesan, D., additional, and Waran, V., additional
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- 2009
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16. Neurenteric cyst of the cervicothoracic junction: A rare cause of paraparesis in a paediatric patient
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Sheaufung, S., primary, Taufiq, A., additional, Nawawi, O., additional, Naicker, M.S., additional, and Waran, V., additional
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- 2009
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17. Use of permeability surface area-product to differentiate intracranial tumours from abscess
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Ramli, N, primary, Rahmat, K, additional, Mah, E, additional, Waran, V, additional, Tan, LK, additional, and Chong, HT, additional
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- 2009
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18. Importance of intra-operative imaging for sphenoid sinus disease
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Philip, R, primary, Prepageran, N, additional, and Waran, V, additional
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- 2007
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19. Melioidosis presenting as spinal epidural abscess
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Ganesan, D, primary, Puthucheary, SD, additional, and Waran, V, additional
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- 2003
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20. Assessing outcome in lumbar disc surgery using patient completed measures.
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Hutchinson, P. J. A., Laing, R. J., Waran, V., Hutchinson, E., and Hollingworth, W.
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DISCECTOMY ,INTERVERTEBRAL disk surgery - Abstract
Measuring outcome after spinal surgery is difficult. The objective of this study was to assess the use of four measures in establishing outcome in patients undergoing lumbar discectomy. Forty-six consecutive patients who had undergone two operations for lumbar disc prolapse and 54 patients who had undergone one operation for the same condition over the same period were identified. The SF-36 questionnaire was used to assess general health.The Roland-Morris questionnaire and a simple modification of the Roland-Morris questionnaire were used to assess back and leg related disability, respectively. Analogue pain scales were used to measure back pain and sciatica. The SF-36 scores revealed significantly worse health status in the two operation compared with the one operation patients and in all patients compared with the normal population. Using the Roland-Morris and the leg disability questionnaires, patients who had undergone two operations reported significantly worse disability (Roland-Morris, 53%, poor outcome) than those who had undergone one operation (RolandMorris, 19%, poor outcome).There was significantly greater back disability than leg disability in both groups of patients and this was confirmed by the analogue pain scales. In patients who had undergone two operations, 25% classified their back pain as very bad or unbearable, and 22.5% described very bad or unbearable leg pain. For the one operation patients these figures were 9.5 and 2.4%, respectively.The results demonstrate that both generic and condition specific patient completed measures have the potential to detect differences in outcome between patients who have undergone either one or two lumbar disc operations.The study provides support for the use of these patient completed measures in assessing outcome in lumbar disc surgery. [ABSTRACT FROM AUTHOR]
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- 2000
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21. Multimodality monitoring and the diagnosis of traumatic caroticocavernous fistula following head injury.
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Waran, V. and Menon, D. K.
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ARTERIOVENOUS fistula , *HEAD injuries - Abstract
Increases in jugular bulb saturations (SjO[sub 2]) following head injury are usually due to hyperaemia. Less commonly this may be due to the development of an arteriovenous fistula. We describe how SjO[sub 2] monitoring can be used in conjunction with transcranial Doppler ultrasound to make the distinction between these two conditions, which require distinct therapies. Multimodality monitoring in acute injury provides information regarding underlying pathophysiology and permits individualization of therapy. [ABSTRACT FROM AUTHOR]
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- 2000
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22. Surgical management of large acoustic neuromas: A review
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Philip, R., Prepageran, N., raman rajagopalan, Jennifer, L. P. H., and Waran, V.
23. Cerebrospinal fluid otorrhoea from an abnormal communication between the internal auditory meatus and the medial wall of the tympanic cavity
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Philip, R., Prepageran, N., raman rajagopalan, and Waran, V.
24. ATTENTION, MEMORY AND EXECUTIVE FUNCTION DEFICITS IN PATIENTS WITH COMPLICATED VS UNCOMPLICATED MILD TRAUMATIC BRAIN INJURY
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Narayanan, V., Veeramuthu, V., NORLISAH Ramli, Waran, V., Bondi, M. W., and Ganesan, D.
25. DIFFUSED TENSOR IMAGING METRICS IN ACUTE MILD TRAUMATIC BRAIN INJURY AND ITS CORRELATION WITH EARLY NEUROPSYCHOLOGICAL IMPAIRMENT
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Veeramuthu, V., Tan, L. K., VAIRAVAN NARAYANAN, Waran, V., Ramli, N., and Ganesan, D.
26. Growth hormone secreting adenoma with a Rathke's cleft cyst
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WARAN, V
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- 1997
27. Consensus statement from the international consensus meeting on post-traumatic cranioplasty
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F. La Porta, A. Cama, Konstantinos Fountas, Jussi P. Posti, Giuseppe Talamonti, Anna Estraneo, Amos Olufemi Adeleye, Andrew I R Maas, Kee B. Park, P. Palma, Tariq Khan, Mino Zucchelli, Gianluigi Zona, Andres M. Rubiano, E. Viaroli, Vicknes Waran, Robson Luis Oliveira de Amorim, Franco Servadei, Stefano Signoretti, Roberto Stefini, Corrado Iaccarino, I. Hossain, Alessandro Bertuccio, Rita Formisano, Andras Buki, Peter J. Hutchinson, Giuseppe Cinalli, Anthony Figaji, Randall M. Chesnut, Angelo Pompucci, P. De Bonis, Carlo Giussani, V. Sinha, Charalabos Gatos, Dirk Lindner, P. Peretta, Anastasia Tasiou, Angelos G. Kolias, S. K. Sengupta, P. D. Adelson, S. I. Florian, Wellingson Silva Paiva, A. Sinha, Antonino Germanò, P. Kasprzak, Paolo Frassanito, Apollo - University of Cambridge Repository, Kolias, Angelos [0000-0003-3992-0587], Hutchinson, Peter [0000-0002-2796-1835], Iaccarino, C, Kolias, A, Adelson, P, Rubiano, A, Viaroli, E, Buki, A, Cinalli, G, Fountas, K, Khan, T, Signoretti, S, Waran, V, Adeleye, A, Amorim, R, Bertuccio, A, Cama, A, Chesnut, R, De Bonis, P, Estraneo, A, Figaji, A, Florian, S, Formisano, R, Frassanito, P, Gatos, C, Germano, A, Giussani, C, Hossain, I, Kasprzak, P, La Porta, F, Lindner, D, Maas, A, Paiva, W, Palma, P, Park, K, Peretta, P, Pompucci, A, Posti, J, Sengupta, S, Sinha, A, Sinha, V, Stefini, R, Talamonti, G, Tasiou, A, Zona, G, Zucchelli, M, Hutchinson, P, and Servadei, F
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medicine.medical_specialty ,Statement (logic) ,medicine.medical_treatment ,media_common.quotation_subject ,Consensus Development Conferences as Topic ,Neurosurgery ,Decompressive craniectomy ,Brain tumors ,NO ,Cranioplasty ,Voting ,Brain Injuries, Traumatic ,Global health ,medicine ,Humans ,Ratification ,media_common ,Rehabilitation ,business.industry ,Subject (documents) ,Conference Report ,Plastic Surgery Procedures ,Italy ,Review Article - Conference Report ,Family medicine ,hydrocephalu ,Surgery ,hydrocephalus ,Neurology (clinical) ,Human medicine ,business ,Inclusion (education) ,Craniotomy ,Hydrocephalus - Abstract
Background Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. Methods The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. Results The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. Conclusions This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.
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- 2021
28. Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury: Consensus statement
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Giuseppe Citerio, Angelos G. Kolias, Anthony Figaji, Mathew Joseph, Andres M. Rubiano, Paul N. Manson, Chris Uff, Dhananjaya I Bhat, Weiming Liu, Franco Servadei, Kostas N. Fountas, Idara Edem, Nasser M F El-Ghandour, Adam J. Wells, Kee B. Park, Ivan Timofeev, Oleg V. Levchenko, Marek Czosnyka, Tsegazeab Laeke, David K. Menon, Abenezer Tirsit Aklilu, Geoffrey T. Manley, Mark Wilson, Ernest J. Barthélemy, Clare N. Gallagher, Nino Stocchetti, Gail Rosseau, Anna Teresa Mazzeo, Gregory W.J. Hawryluk, Alex B. Valadka, Diederik Bulters, Daniel B. Michael, B Indira Devi, Vicknes Waran, Andrew I R Maas, Shelly D. Timmons, Jeffrey V. Rosenfeld, Tamara Tajsic, Jamie S. Ullman, Baiyun Liu, D. Jamie Cooper, David O. Okonkwo, Tedy Apriawan, Hamisi K. Shabani, Randall M. Chesnut, Peter J. Hutchinson, Amos Olufemi Adeleye, Corrado Iaccarino, Susanne Muehlschlegel, Tariq Khan, Abdul Hafid Bajamal, Hutchinson, P, Kolias, A, Tajsic, T, Adeleye, A, Aklilu, A, Apriawan, T, Bajamal, A, Barthélemy, E, Devi, B, Bhat, D, Bulters, D, Chesnut, R, Citerio, G, Cooper, D, Czosnyka, M, Edem, I, El-Ghandour, N, Figaji, A, Fountas, K, Gallagher, C, Hawryluk, G, Iaccarino, C, Joseph, M, Khan, T, Laeke, T, Levchenko, O, Liu, B, Liu, W, Maas, A, Manley, G, Manson, P, Mazzeo, A, Menon, D, Michael, D, Muehlschlegel, S, Okonkwo, D, Park, K, Rosenfeld, J, Rosseau, G, Rubiano, A, Shabani, H, Stocchetti, N, Timmons, S, Timofeev, I, Uff, C, Ullman, J, Valadka, A, Waran, V, Wells, A, Wilson, M, Servadei, F, Hutchinson, Peter [0000-0002-2796-1835], Kolias, Angelos [0000-0003-3992-0587], Menon, David [0000-0002-3228-9692], and Apollo - University of Cambridge Repository
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Traumatic ,Decompression ,medicine.medical_specialty ,Decompressive Craniectomy ,Physical Injury - Accidents and Adverse Effects ,Consensus ,Traumatic brain injury ,Statement (logic) ,medicine.medical_treatment ,Clinical Sciences ,Neurosurgery ,Cranioplasty, Decompression, Neurosurgery, Neurotrauma ,Cranioplasty ,Neurotrauma ,Brain Injuries, Traumatic ,Humans ,Intracranial Hypertension ,Traumatic Brain Injury (TBI) ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Intensive care medicine ,Traumatic Head and Spine Injury ,Neurology & Neurosurgery ,business.industry ,Neurosciences ,Injuries and accidents ,medicine.disease ,Brain Disorders ,nervous system diseases ,3. Good health ,Good Health and Well Being ,Brain Injuries ,Surgery ,Decompressive craniectomy ,Neurology (clinical) ,Human medicine ,business ,030217 neurology & neurosurgery - Abstract
Background: Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach. Methods: The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries. Results: The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval. Conclusions: In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction. publishedVersion
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- 2019
29. An international, prospective observational study on traumatic brain injury epidemiology study protocol: GEO-TBI: Incidence .
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Joannides A, Korhonen TK, Clark D, Gnanakumar S, Venturini S, Mohan M, Bashford T, Baticulon R, Bhagavatula ID, Esene I, Fernández-Méndez R, Figaji A, Gupta D, Khan T, Laeke T, Martin M, Menon D, Paiva W, Park KB, Pattisapu JV, Rubiano AM, Sekhar V, Shabani H, Sichizya K, Solla D, Tirsit A, Tripathi M, Turner C, Depreitere B, Iaccarino C, Lippa L, Reisner A, Rosseau G, Servadei F, Trivedi R, Waran V, Kolias A, and Hutchinson P
- Abstract
Background: The epidemiology of traumatic brain injury (TBI) is unclear - it is estimated to affect 27-69 million individuals yearly with the bulk of the TBI burden in low-to-middle income countries (LMICs). Research has highlighted significant between-hospital variability in TBI outcomes following emergency surgery, but the overall incidence and epidemiology of TBI remains unclear. To address this need, we established the Global Epidemiology and Outcomes following Traumatic Brain Injury (GEO-TBI) registry, enabling recording of all TBI cases requiring admission irrespective of surgical treatment., Objective: The GEO-TBI: Incidence study aims to describe TBI epidemiology and outcomes according to development indices, and to highlight best practices to facilitate further comparative research., Design: Multi-centre, international, registry-based, prospective cohort study., Subjects: Any unit managing TBI and participating in the GEO-TBI registry will be eligible to join the study. Each unit will select a 90-day study period. All TBI patients meeting the registry inclusion criteria (neurosurgical/ICU admission or neurosurgical operation) during the selected study period will be included in the GEO-TBI: Incidence., Methods: All units will form a study team, that will gain local approval, identify eligible patients and input data. Data will be collected via the secure registry platform and validated after collection. Identifiers may be collected if required for local utility in accordance with the GEO-TBI protocol., Data: Data related to initial presentation, interventions and short-term outcomes will be collected in line with the GEO-TBI core dataset, developed following consensus from an iterative survey and feedback process. Patient demographics, injury details, timing and nature of interventions and post-injury care will be collected alongside associated complications. The primary outcome measures for the study will be the Glasgow Outcome at Discharge Scale (GODS) and 14-day mortality. Secondary outcome measures will be mortality and extended Glasgow Outcome Scale (GOSE) at the most recent follow-up timepoint., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Joannides A et al.)
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- 2024
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30. Consensus-Based Development of a Global Registry for Traumatic Brain Injury: Establishment, Protocol, and Implementation.
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Joannides AJ, Korhonen TK, Clark D, Gnanakumar S, Venturini S, Mohan M, Bashford T, Baticulon R, Bhagavatula ID, Esene I, Fernández-Méndez R, Figaji A, Gupta D, Khan T, Laeke T, Martin M, Menon D, Paiva W, Park KB, Pattisapu JV, Rubiano AM, Sekhar V, Shabani HK, Sichizya K, Solla D, Tirsit A, Tripathi M, Turner C, Depreitere B, Iaccarino C, Lippa L, Reisner A, Rosseau G, Servadei F, Trivedi RA, Waran V, Kolias A, and Hutchinson P
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- Humans, Consensus, Benchmarking, Longitudinal Studies, Registries, Brain Injuries, Traumatic therapy, Brain Injuries, Traumatic surgery
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Background and Objectives: Global disparity exists in the demographics, pathology, management, and outcomes of surgically treated traumatic brain injury (TBI). However, the factors underlying these differences, including intervention effectiveness, remain unclear. Establishing a more accurate global picture of the burden of TBI represents a challenging task requiring systematic and ongoing data collection of patients with TBI across all management modalities. The objective of this study was to establish a global registry that would enable local service benchmarking against a global standard, identification of unmet need in TBI management, and its evidence-based prioritization in policymaking., Methods: The registry was developed in an iterative consensus-based manner by a panel of neurotrauma professionals. Proposed registry objectives, structure, and data points were established in 2 international multidisciplinary neurotrauma meetings, after which a survey consisting of the same data points was circulated within the global neurotrauma community. The survey results were disseminated in a final meeting to reach a consensus on the most pertinent registry variables., Results: A total of 156 professionals from 53 countries, including both high-income countries and low- and middle-income countries, responded to the survey. The final consensus-based registry includes patients with TBI who required neurosurgical admission, a neurosurgical procedure, or a critical care admission. The data set comprised clinically pertinent information on demographics, injury characteristics, imaging, treatments, and short-term outcomes. Based on the consensus, the Global Epidemiology and Outcomes following Traumatic Brain Injury (GEO-TBI) registry was established., Conclusion: The GEO-TBI registry will enable high-quality data collection, clinical auditing, and research activity, and it is supported by the World Federation of Neurosurgical Societies and the National Institute of Health Research Global Health Program. The GEO-TBI registry ( https://geotbi.org ) is now open for participant site recruitment. Any center involved in TBI management is welcome to join the collaboration to access the registry., (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)
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- 2024
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31. Outcome of 1939 traumatic brain injury patients from road traffic accidents: Findings from specialist medical reports in a low to middle income country (LMIC).
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Teh J, Mazlan M, Danaee M, Waran RJ, and Waran V
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- Young Adult, Humans, Male, Adolescent, Adult, Middle Aged, Female, Accidents, Traffic, Aftercare, Cross-Sectional Studies, Retrospective Studies, Patient Discharge, Inpatients, Developing Countries, Brain Injuries, Traumatic therapy
- Abstract
Objective: Road traffic accident (RTA) is the major cause of traumatic brain injury (TBI) in developing countries and affects mostly young adult population. This research aimed to describe the factors predicting functional outcome after TBI caused by RTA in a Malaysian setting., Methods: This was a retrospective cross-sectional study conducted on specialist medical reports written from 2009 to 2019, involving patients who survived after TBI from RTA. The functional outcome was assessed using the Glasgow Outcome Scale-Extended (GOSE). Factors associated with good outcome were analysed via logistic regression analysis. Multivariate logistic regression analysis was used to derive the best fitting Prediction Model and split-sample cross-validation was performed to develop a prediction model., Results: A total of 1939 reports were evaluated. The mean age of the study participants was 32.4 ± 13.7 years. Most patients were male, less than 40, and with average post RTA of two years. Good outcome (GOSE score 7 & 8) was reported in 30.3% of the patients. Factors significantly affecting functional outcome include age, gender, ethnicity, marital status, education level, severity of brain injury, neurosurgical intervention, ICU admission, presence of inpatient complications, cognitive impairment, post-traumatic headache, post traumatic seizures, presence of significant behavioural issue; and residence post discharge (p<0.05). After adjusting for confounding factors, prediction model identified age less than 40, mild TBI, absence of post traumatic seizure, absence of behaviour issue, absence of cognitive impairment and independent living post TBI as significant predictors of good functional outcome post trauma. Discrimination of the model was acceptable (C-statistic, 0.67; p<0.001, 95% CI: 0.62-0.73)., Conclusion: Good functional outcome following TBI due to RTA in this study population is comparable to other low to middle income countries but lower than high income countries. Factors influencing outcome such as seizure, cognitive and behavioural issues, and independent living post injury should be addressed early to achieve favourable long-term outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Teh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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32. Supratentorial cerebrospinal fluid diversion using image-guided trigonal ventriculostomy during retrosigmoid craniotomy for cerebellopontine angle tumors.
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Roethlisberger M, Eberhard NE, Rychen J, Al-Zahid S, Jayapalan RR, Zweifel C, Karuppiah R, and Waran V
- Abstract
Background: Cerebellar contusion, swelling and herniation is frequently encoutered upon durotomy in patients undergoing retrosigmoid craniotomy for cerebellopontine angle (CPA) tumors, despite using standard methods to obtain adequate cerebellar relaxation., Objective: The aim of this study is to report an alternative cerebrospinal fluid (CSF)-diversion method using image-guided ipsilateral trigonal ventriculostomy., Methods: Single-center retro- and prospective cohort study of n = 62 patients undergoing above-mentioned technique. Prior durotomy, CSF-diversion was performed to the point where the posterior fossa dura was visibly pulsatile. Outcome assessment consisted of the surgeon's intra- and postoperative clinical observations, and postoperative radiological imaging., Results: Fifty-two out of n = 62 (84%) cases were eligible for analysis. The surgeons consistently reported successful ventricular puncture and a pulsatile dura prior durotomy without cerebellar contusion, swelling or herniation through the dural incision in n = 51/52 (98%) cases. Forty-nine out of n = 52 (94%) catheters were placed correctly within the first attempt, with the majority of catheter tips ( n = 50, 96%) located intraventricularly (grade 1 or 2). In n = 4/52 (8%) patients, postoperative imaging revealed evidence of a ventriculostomy-related hemorrhage (VRH) associated with an intracerebral hemorrhage [ n = 2/52 (4%)] or an isolated intraventricular hemorrhage [ n = 2/52 (4%)]. However, these hemorrhagic complications were not associated with neurological symptoms, surgical interventions or postoperative hydrocephalus. None of the evaluated patients demonstrated radiological signs of upward transtentorial herniation., Conclusion: The method described above efficiently allows CSF-diversion prior durotomy to reduce cerebellar pressure during retrosigmoid approach for CPA tumors. However, there is an inherent risk of subclinical supratentorial hemorrhagic complications., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Roethlisberger, Eberhard, Rychen, Al-Zahid, Jayapalan, Zweifel, Karuppiah and Waran.)
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- 2023
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33. The Role of Endonasal Endoscopic Skull Base Repair in Posttraumatic Tension Pneumocephalus.
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Dalolio M, Cordier D, Al-Zahid S, Bennett WO, Prepageran N, Waran V, Mariani L, Koeppl R, Brand Y, and Roethlisberger M
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- Endoscopy adverse effects, Humans, Nose, Postoperative Complications etiology, Retrospective Studies, Skull Base diagnostic imaging, Skull Base surgery, Pneumocephalus diagnostic imaging, Pneumocephalus etiology, Pneumocephalus surgery
- Abstract
Objectives: Information about the endonasal endoscopic approach (EEA) for the management of posttraumatic tension pneumocephalus (PTTP) remains scarce. Concomitant rhinoliquorrhea and posttraumatic hydrocephalus (PTH) can complicate the clinical course., Methods: The authors systematically reviewed pertinent articles published between 1961 and December 2020 and identified 6 patients with PTTP treated by EEA in 5 reports. Additionally, the authors share their institutional experience including a seventh patient, where an EEA resolved a recurrent PTTP without rhinoliquorrhea., Results: Seven PTTP cases in which EEA was used as part of the treatment regime were included in this review. All cases presented with a defect in the anterior skull base, and 3 of them had concomitant rhinoliquorrhea. A transcranial approach was performed in 6/7 cases before EEA was considered to treat PTTP. In 4/7 cases, the PTTP resolved after the first intent; in 2/ 7 cases a second repair was necessary because of recurrent PTTP, 1 with and 1 without rhinoliquorrhea, and 1/7 case because of recurrent rhinoliquorrhea only. Overall, PTTP treated by EEA resolved with a mean radiological resolution time of 69 days (range 23-150 days), with no late recurrences. Only 1 patient developed a cerebrospinal fluid diversion infection probably related to a first incomplete EEA skull base defects repair. A permanent cerebrospinal fluid diversion was necessary in 3/7 cases., Conclusions: Endonasal endoscopic approach repair of air conduits is a safe and efficacious second-line approach after failed transcranial approaches for symptomatic PTTP. However, the strength of recommendation for EEA remains low until further evidence is presented., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by Mutaz B. Habal, MD.)
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- 2022
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34. Equitable Access to State-of-the-Art Medical Technology-a Malaysian Mini-Public-Private Partnership Case Study.
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Waran V, Thillainathan R, Karuppiah R, and Pickard JD
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- COVID-19, Developing Countries, Humans, Malaysia, SARS-CoV-2, Health Services Accessibility organization & administration, Neurosurgery organization & administration, Public-Private Sector Partnerships organization & administration
- Abstract
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., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2022
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35. Employment status after traumatic brain injury and the effect of concomitant injuries on return to work.
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Thor JA, Mazlan M, and Waran V
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- Abbreviated Injury Scale, Employment, Humans, Retrospective Studies, Brain Injuries, Traumatic complications, Brain Injuries, Traumatic epidemiology, Return to Work
- Abstract
Purpose: This study aims to describe the employment status and pattern among survivors of traumatic brain injury after motor vehicle accidents, and to explore the effects of demographic, injury variables and concomitant injuries on the employment status ., Method: A retrospective analyses of 370 medical reports written for patients who sustained traumatic brain injury from motor vehicle accidents was conducted. To establish the employment pattern, the pre-injury employment history was compared to the latest employment status documented. Types and severity of concomitant injuries were rated according to Abbreviated Injury Scale criteria. All significant variables were further analyzed using logistic regression to explore predictors of employment., Results: Up to 87% of the patients sustained concomitant injuries, with more than two-thirds (72%) scoring ≤ 2 on the Abbreviated Injury Scale. One hundred and eighty-two patients (49.2%) successfully returned to work. Among those who returned to work, 34% returned to former employment with pre-injury job description. Severity of traumatic brain injury, length of acute hospital stay, ambulation status and cognitive status were found to be significant predictive factors for employment status post traumatic brain injury. Presence of concomitant extremity injuries was found to influence the employment pattern among traumatic brain injury survivors., Conclusion: The return to work rate was somewhat low and was not influenced by presence of concomitant injuries. .
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- 2021
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36. Clinical Studies and Pre-clinical Animal Models on Facial Nerve Preservation, Reconstruction, and Regeneration Following Cerebellopontine Angle Tumor Surgery-A Systematic Review and Future Perspectives.
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Hostettler IC, Jayashankar N, Bikis C, Wanderer S, Nevzati E, Karuppiah R, Waran V, Kalbermatten D, Mariani L, Marbacher S, Guzman R, Madduri S, and Roethlisberger M
- Abstract
Background and purpose: Tumorous lesions developing in the cerebellopontine angle (CPA) get into close contact with the 1st (cisternal) and 2nd (meatal) intra-arachnoidal portion of the facial nerve (FN). When surgical damage occurs, commonly known reconstruction strategies are often associated with poor functional recovery. This article aims to provide a systematic overview for translational research by establishing the current evidence on available clinical studies and experimental models reporting on intracranial FN injury. Methods: A systematic literature search of several databases (PubMed, EMBASE, Medline) was performed prior to July 2020. Suitable articles were selected based on predefined eligibility criteria following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Included clinical studies were reviewed and categorized according to the pathology and surgical resection strategy, and experimental studies according to the animal. For anatomical study purposes, perfusion-fixed adult New Zealand white rabbits were used for radiological high-resolution imaging and anatomical dissection of the CPA and periotic skull base. Results: One hundred forty four out of 166 included publications were clinical studies reporting on FN outcomes after CPA-tumor surgery in 19,136 patients. During CPA-tumor surgery, the specific vulnerability of the intracranial FN to stretching and compression more likely leads to neurapraxia or axonotmesis than neurotmesis. Severe FN palsy was reported in 7 to 15 % after vestibular schwannoma surgery, and 6% following the resection of CPA-meningioma. Twenty-two papers reported on experimental studies, out of which only 6 specifically used intracranial FN injury in a rodent ( n = 4) or non-rodent model ( n = 2). Rats and rabbits offer a feasible model for manipulation of the FN in the CPA, the latter was further confirmed in our study covering the radiological and anatomical analysis of perfusion fixed periotic bones. Conclusion: The particular anatomical and physiological features of the intracranial FN warrant a distinguishment of experimental models for intracranial FN injuries. New Zealand White rabbits might be a very cost-effective and valuable option to test new experimental approaches for intracranial FN regeneration. Flexible and bioactive biomaterials, commonly used in skull base surgery, endowed with trophic and topographical functions, should address the specific needs of intracranial FN injuries., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Hostettler, Jayashankar, Bikis, Wanderer, Nevzati, Karuppiah, Waran, Kalbermatten, Mariani, Marbacher, Guzman, Madduri and Roethlisberger.)
- Published
- 2021
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37. The utilisation of 3D printing in paediatric neurosurgery.
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Karuppiah R, Munusamy T, Bahuri NFA, and Waran V
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- Child, Humans, Models, Anatomic, Neurosurgical Procedures, Printing, Three-Dimensional, Neurosurgery education, Simulation Training
- Abstract
3D printing technology has evolved over the years and there is a growing interest in its application in paediatric neurosurgery. Modern 3D printers have enabled the development of patient-specific 3D models that provide a realistic representation of complex anatomies and will aid in planning complex procedures. Paediatric neurosurgical operations are challenging and hands-on training is restricted. Surgical simulation training with biomodel has provided a new paradigm for trainees to master their surgical skills before encountering similar scenarios in real-life environment. This paper reviews the aspects of 3D printing for preoperative planning and simulation-based surgical training in paediatric neurosurgery.
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- 2021
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38. Telemedicine via Smart Glasses in Critical Care of the Neurosurgical Patient-COVID-19 Pandemic Preparedness and Response in Neurosurgery.
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Munusamy T, Karuppiah R, Bahuri NFA, Sockalingam S, Cham CY, and Waran V
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- Delivery of Health Care, Feasibility Studies, Humans, Observer Variation, Reproducibility of Results, COVID-19, Critical Care methods, Neurosurgery statistics & numerical data, Neurosurgical Procedures methods, Pandemics, Smart Glasses, Telemedicine methods
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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., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2021
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39. Management and outcomes following emergency surgery for traumatic brain injury - A multi-centre, international, prospective cohort study (the Global Neurotrauma Outcomes Study).
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Clark D, Joannides A, Ibrahim Abdallah O, Olufemi Adeleye A, Hafid Bajamal A, Bashford T, Bhebhe A, Biluts H, Budohoska N, Budohoski K, Cherian I, Marklund N, Fernandez Mendez R, Figaji T, Kumar Gupta D, Iaccarino C, Ilunga A, Joseph M, Khan T, Laeke T, Waran V, Park K, Rosseau G, Rubiano A, Saleh Y, Shabani HK, Smith B, Sichizya K, Tewari M, Tirsit A, Thu M, Tripathi M, Trivedi R, Villar S, Devi Bhagavatula I, Servadei F, Menon D, Kolias A, and Hutchinson P
- Abstract
Introduction: Traumatic brain injury (TBI) accounts for a significant amount of death and disability worldwide and the majority of this burden affects individuals in low-and-middle income countries. Despite this, considerable geographical differences have been reported in the care of TBI patients. On this background, we aim to provide a comprehensive international picture of the epidemiological characteristics, management and outcomes of patients undergoing emergency surgery for traumatic brain injury (TBI) worldwide., Methods and Analysis: The Global Neurotrauma Outcomes Study (GNOS) is a multi-centre, international, prospective observational cohort study. Any unit performing emergency surgery for TBI worldwide will be eligible to participate. All TBI patients who receive emergency surgery in any given consecutive 30-day period beginning between 1st of November 2018 and 31st of December 2019 in a given participating unit will be included. Data will be collected via a secure online platform in anonymised form. The primary outcome measures for the study will be 14-day mortality (or survival to hospital discharge, whichever comes first). Final day of data collection for the primary outcome measure is February 13th. Secondary outcome measures include return to theatre and surgical site infection., Ethics and Dissemination: This project will not affect clinical practice and has been classified as clinical audit following research ethics review. Access to source data will be made available to collaborators through national or international anonymised datasets on request and after review of the scientific validity of the proposed analysis by the central study team., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 The Authors.)
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- 2020
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40. Identifying the Sources of Error When Using 3-Dimensional Printed Head Models with Surgical Navigation.
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Mehbodniya A, Moghavvemi M, Narayanan V, Muthusamy KA, Hamdi M, and Waran V
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- Humans, Imaging, Three-Dimensional methods, Neuronavigation methods, Surgery, Computer-Assisted methods, Imaging, Three-Dimensional standards, Neuronavigation standards, Phantoms, Imaging standards, Printing, Three-Dimensional standards, Surgery, Computer-Assisted standards
- Abstract
Objectives: The evaluation of sources of error when preparing, printing, and using 3-dimensional (3D) printed head models for training purposes., Methods: Two 3D printed models were designed and fabricated using actual patient imaging data with reference marker points embedded artificially within these models that were then registered to a surgical navigation system using 3 different methods. The first method uses a conventional manual registration, using the actual patient's imaging data. The second method is done by directly scanning the created model using intraoperative computed tomography followed by registering the model to a new imaging dataset manually. The third is similar to the second method of scanning the model but eventually uses an automatic registration technique. The errors for each experiment were then calculated based on the distance of the surgical navigation probe from the respective positions of the embedded marker points., Results: Errors were found in the preparation and printing techniques, largely depending on the orientation of the printed segment and postprocessing, but these were relatively small. Larger errors were noted based on a couple of variables: if the models were registered using the original patient imaging data as opposed to using the imaging data from directly scanning the model (1.28 mm vs. 1.082 mm), and the accuracy was best using the automated registration techniques (0.74 mm)., Conclusion: Spatial accuracy errors occur consistently in every 3D fabricated model. These errors are derived from the fabrication process, the image registration process, and the surgical process of registration., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2020
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41. Evolving Strategies for Resection of Sellar/Parasellar Synchronous Tumors via Endoscopic Endonasal Approach: A Technical Case Report and Systematic Review of the Literature.
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Roethlisberger M, Jayapalan RR, Hostettler IC, Bin Abd Kadir KA, Mun KS, Brand Y, Mariani L, Prepageran N, and Waran V
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- Female, Humans, Middle Aged, Adenoma surgery, Meningeal Neoplasms surgery, Meningioma surgery, Neoplasms, Multiple Primary surgery, Neuroendoscopy methods, Pituitary Neoplasms surgery
- Abstract
Background: Data on the endonasal endoscopic approach (EEA) to treat sellar/parasellar synchronous tumors remain sparse. This work aims to describe a minimally invasive approach with intraoperative magnetic resonance imaging (MRI) to remove a large sellar/parasellar synchronous tumor, and presents a systematic literature review., Methods: The preoperative MRI of a 54-year-old woman revealed a sellar lesion (28 × 19 × 16 mm), presumably a pituitary macroadenoma, and a second extra-axial lesion (22 × 36 × 20 mm) expanding from the tuberculum sellae to the planum sphenoidale with encasement of the anterior communicating complex, presumably a meningioma. We used intraoperative MRI to assess the extent of the resection before reconstructing the large skull base defect. Furthermore, we systematically reviewed pertinent articles retrieved by a PubMed/Embase database search between 1961 and December 2018., Results: Out of 63 patients with synchronous tumors reported in 43 publications, we found 3 patients in which the tumor was removed by EEA. In these 3 patients and the presented case, the resection of both lesions was successful, without major approach-related morbidity or mortality. More extensive removal of endonasal structures to gain an adequate tumor exposure was not necessary. We did not find any previous reports describing the benefits of intraoperative MRI in the presented setting., Conclusions: In the rare case of a synchronous meningioma and pituitary adenoma of the sellar region, intraoperative MRI might be beneficial in confirming residual disease before skull base reconstruction, and therefore radiologic follow-up., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2020
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42. Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury : Consensus statement.
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Hutchinson PJ, Kolias AG, Tajsic T, Adeleye A, Aklilu AT, Apriawan T, Bajamal AH, Barthélemy EJ, Devi BI, Bhat D, Bulters D, Chesnut R, Citerio G, Cooper DJ, Czosnyka M, Edem I, El-Ghandour NMF, Figaji A, Fountas KN, Gallagher C, Hawryluk GWJ, Iaccarino C, Joseph M, Khan T, Laeke T, Levchenko O, Liu B, Liu W, Maas A, Manley GT, Manson P, Mazzeo AT, Menon DK, Michael DB, Muehlschlegel S, Okonkwo DO, Park KB, Rosenfeld JV, Rosseau G, Rubiano AM, Shabani HK, Stocchetti N, Timmons SD, Timofeev I, Uff C, Ullman JS, Valadka A, Waran V, Wells A, Wilson MH, and Servadei F
- Subjects
- Brain Injuries, Traumatic complications, Consensus, Humans, Intracranial Hypertension etiology, Brain Injuries, Traumatic surgery, Decompressive Craniectomy methods, Intracranial Hypertension surgery
- Abstract
Background: Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach., Methods: The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries., Results: The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval., Conclusions: In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.
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- 2019
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43. Frequency and Causes of Line of Sight Issues During Neurosurgical Procedures Using Optical Image-Guided Systems.
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Mehbodniya AH, Moghavvemi M, Narayanan V, and Waran V
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- Humans, Neuronavigation instrumentation, Neurosurgical Procedures instrumentation, Optical Imaging instrumentation, Surgery, Computer-Assisted instrumentation, Clinical Competence, Neuronavigation methods, Neurosurgeons, Neurosurgical Procedures methods, Optical Imaging methods, Surgery, Computer-Assisted methods
- Abstract
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., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2019
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44. Endoscopic Transsphenoidal Resection of Craniopharyngioma.
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Liew KY, Narayanan P, and Waran V
- Abstract
Objectives To demonstrate, step-by-step, the technique and efficacy of endoscopic transsphenoidal approach in resection of a suprasellar craniopharyngioma. Design The video shows a step-by-step approach to the resection, covering the exposure, access, resection, and confirmation of resection and reconstruction. Setting The surgery was performed in the University of Malaya Medical Centre, a tertiary referral center in the capital of Malaysia. Participants Surgery was performed jointly by Professor Prepageran from the department of otorhinolaryngology and Professor Vicknes Waran from the division of neurosurgery. Both surgeons are from the University of Malaya. Video compilation, editing, and voice narration was done by Dr. Kong Yew Liew. Main Outcome Measures Completeness of resection and avoidance of intra- and postoperative complications. Results Based on intraoperative views and MRI findings, the tumor was completely resected with the patient suffering only transient diabetes insipidus. Conclusion Central suprasellar tumors can be removed completely via an endoscopic transsphenoidal approach with minimal morbidity to the patient. The link to the video can be found at: https://youtu.be/ZNIHfk12cYg .
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- 2018
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45. Neuropsychological Outcomes in Patients with Complicated Versus Uncomplicated Mild Traumatic Brain Injury: 6-Month Follow-Up.
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Veeramuthu V, Narayanan V, Ramli N, Hernowo A, Waran V, Bondi MW, Delano-Wood L, and Ganesan D
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- Adult, Brain Concussion diagnosis, Brain Concussion psychology, Causality, Cognition Disorders diagnosis, Cognition Disorders psychology, Comorbidity, Female, Humans, Incidence, Malaysia epidemiology, Male, Nervous System Diseases diagnosis, Nervous System Diseases psychology, Risk Factors, Treatment Outcome, Brain Concussion epidemiology, Cognition Disorders epidemiology, Nervous System Diseases epidemiology, Trauma Severity Indices
- Abstract
Objective: To compare the extent of persistent neuropsychological impairment in patients with complicated mild traumatic brain injury (mTBI) and those with uncomplicated mTBI., Methods: Sixty-one patients with mTBI (Glasgow Coma Scale score 13-15) were recruited prospectively, categorized according to baseline computed tomography findings, and subjected to neuropsychological assessment at initial admission (n = 61) as well as at a 6-month follow-up (n = 30). The paired t test, Cohen's d effect size calculation, and repeated-measures analysis of variance were used to establish the differences between the 2 groups in terms of neuropsychological performance., Results: A trend toward poorer neuropsychological performance among the patients with complicated mTBI was observed during admission; however, performance in this group improved over time. In contrast, the uncomplicated mTBI group showed slower recovery, especially in tasks of memory, visuospatial processing, and executive functions, at follow-up., Conclusions: Our findings suggest that despite the broad umbrella designation of mTBI, the current classification schemes of injury severity for mild neurotrauma should be revisited. They also raise questions about the clinical relevance of both traumatic focal lesions and the absence of visible traumatic lesions on brain imaging studies in patients with milder forms of head trauma., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2017
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46. Electroacupuncture-Assisted Craniotomy on an Awake Patient.
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Sidhu A, Murgahayah T, Narayanan V, Chandran H, and Waran V
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- Aged, Humans, Male, Craniotomy methods, Electroacupuncture methods, Wakefulness physiology
- Abstract
Although acupuncture has existed for over 2000 years, its application as an anesthetic aid began in the 1950s in China. The first surgical procedure performed under acupuncture anesthesia was a tonsillectomy. Soon thereafter, major and minor surgical procedures took place with electroacupuncture alone providing the anesthesia. The procedures performed were diverse, ranging from cardiothoracic surgery to dental extractions. Usage of acupuncture anesthesia, specifically in neurosurgery, has been well documented in hospitals across China, especially in Beijing, dating back to the 1970s. We present a case of a 65-year-old man who presented with right-sided body weakness. He had a past medical history of uncontrolled diabetes mellitus, hypertension, and obstructive sleep apnea requiring use of a nasal continuous positive airway pressure device during sleep. We performed a computed tomography brain scan, which revealed a left-sided acute on chronic subdural hemorrhage. Due to his multiple comorbidities, we decided to perform the surgical procedure under electroacupuncture anesthesia. The aim of this case report is to describe a craniotomy performed under electroacupuncture on an elderly patient with multiple comorbidities who was awake during the procedure and in whom this procedure, if it had been performed under general anesthesia, would have carried high risk., (Copyright © 2016 Medical Association of Pharmacopuncture Institute. Published by Elsevier B.V. All rights reserved.)
- Published
- 2017
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47. Missense Mutation of Brain Derived Neurotrophic Factor (BDNF) Alters Neurocognitive Performance in Patients with Mild Traumatic Brain Injury: A Longitudinal Study.
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Narayanan V, Veeramuthu V, Ahmad-Annuar A, Ramli N, Waran V, Chinna K, Bondi MW, Delano-Wood L, and Ganesan D
- Subjects
- Adult, Alleles, Demography, Female, Humans, Longitudinal Studies, Male, Neuropsychological Tests, Polymorphism, Single Nucleotide genetics, Brain Concussion genetics, Brain Concussion physiopathology, Brain-Derived Neurotrophic Factor genetics, Cognition physiology, Mutation, Missense genetics
- Abstract
The predictability of neurocognitive outcomes in patients with traumatic brain injury is not straightforward. The extent and nature of recovery in patients with mild traumatic brain injury (mTBI) are usually heterogeneous and not substantially explained by the commonly known demographic and injury-related prognostic factors despite having sustained similar injuries or injury severity. Hence, this study evaluated the effects and association of the Brain Derived Neurotrophic Factor (BDNF) missense mutations in relation to neurocognitive performance among patients with mTBI. 48 patients with mTBI were prospectively recruited and MRI scans of the brain were performed within an average 10.1 (SD 4.2) hours post trauma with assessment of their neuropsychological performance post full Glasgow Coma Scale (GCS) recovery. Neurocognitive assessments were repeated again at 6 months follow-up. The paired t-test, Cohen's d effect size and repeated measure ANOVA were performed to delineate statistically significant differences between the groups [wildtype G allele (Val homozygotes) vs. minor A allele (Met carriers)] and their neuropsychological performance across the time point (T1 = baseline/ admission vs. T2 = 6th month follow-up). Minor A allele carriers in this study generally performed more poorly on neuropsychological testing in comparison wildtype G allele group at both time points. Significant mean differences were observed among the wildtype group in the domains of memory (M = -11.44, SD = 10.0, p = .01, d = 1.22), executive function (M = -11.56, SD = 11.7, p = .02, d = 1.05) and overall performance (M = -6.89 SD = 5.3, p = .00, d = 1.39), while the minor A allele carriers showed significant mean differences in the domains of attention (M = -11.0, SD = 13.1, p = .00, d = .86) and overall cognitive performance (M = -5.25, SD = 8.1, p = .01, d = .66).The minor A allele carriers in comparison to the wildtype G allele group, showed considerably lower scores at admission and remained impaired in most domains across the timepoints, although delayed signs of recovery were noted to be significant in the domains attention and overall cognition. In conclusion, the current study has demonstrated the role of the BDNF rs6265 Val66Met polymorphism in influencing specific neurocognitive outcomes in patients with mTBI. Findings were more detrimentally profound among Met allele carriers.
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- 2016
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48. A Cost-Effective Delivery System for FloSeal During Endoscopic and Microscopic Brain Surgery.
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Brand Y, Narayanan V, Prepageran N, and Waran V
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- Cost-Benefit Analysis, Gelatin Sponge, Absorbable economics, Hemostatic Techniques economics, Hemostatic Techniques instrumentation, Humans, Nasal Cavity surgery, Prospective Studies, Gelatin Sponge, Absorbable administration & dosage, Microsurgery economics, Microsurgery instrumentation, Neuroendoscopy economics, Neuroendoscopy instrumentation, Skull Base surgery
- Abstract
Objective: To share our experience with a new delivery system for the flowable hemostatic matrix, FloSeal, in endoscopic and microscopic skull base surgery., Methods: We prospectively analyzed the use of FloSeal with a hemostatic delivery system in transnasal endoscopic and microscopic skull base procedures performed at the authors' institution from January 1, 2015, to June 30, 2015. In all cases the number of aliquots was noted for the entire operation, and the total number of FloSeal ampules of 5 mL was also recorded., Results: Our device allowed controlled application of small amounts (0.5-1 mL) of FloSeal to the site of bleeding. This controlled application resulted not only in increased visibility during its application, but it also reduced the amount of FloSeal required during the procedure. We were able to use 5-10 applications per 5-mL ampule of FloSeal within an individual procedure. No procedure required more than one 5-mL ampule of FloSeal. Therefore, the use of our device results in a reduction of costs. Prior to the use of our device, we were often only able to use 1 vial of 5 ml of material for 1 or 2 applications, especially in transnasal endoscopic procedures when working along a deep corridor., Conclusions: Our results indicate that our delivery device of FlowSeal can effectively control hemostasis by applying small amounts of FlowSeal to the site of bleeding. This results in increased visibility during hemostasis and a reduction of cost., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
49. Laparoscopic management of mesh erosion into small bowel and urinary bladder following total extra-peritoneal repair of inguinal hernia.
- Author
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Aggarwal S, Praneeth K, Rathore Y, Waran V, and Singh P
- Abstract
Mesh erosion into visceral organs is a rare complication following laparoscopic mesh repair for inguinal hernia with only 15 cases reported in English literature. We report the first case of complete laparoscopic management of mesh erosion into small bowel and urinary bladder. A 62-year-male underwent laparoscopic total extra-peritoneal repair of left inguinal hernia at another centre in April 2012. He presented to our centre 21 months later with persistent lower urinary tract infection (UTI). On evaluation mesh erosion into bowel and urinary bladder was suspected. At laparoscopy, a small bowel loop was adhered to the area of inflammation in the left lower abdomen. After adhesiolysis, mesh was seen to be eroding into small bowel. The entire infected mesh was pulled out from the pre-peritoneal space and urinary bladder wall using gentle traction. The involved small bowel segment was resected, and bowel continuity restored using endoscopic linear cutter. The resected bowel along with the mesh was extracted in a plastic bag. Intra-operative test for leak from urinary bladder was found to be negative. The patient recovered uneventfully and is doing well at 12 months follow-up with resolution of UTI. Laparoscopic approach to mesh erosion is feasible as the plane of mesh placement during laparoscopic hernia repair is closer to peritoneum than during open hernia repair.
- Published
- 2016
- Full Text
- View/download PDF
50. Combined endoscopic transnasal and transoral approach for extensive upper cervical osteoradionecrosis.
- Author
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Tan SH, Ganesan D, Rusydi WZ, Chandran H, Prepageran N, and Waran V
- Subjects
- Carcinoma, Debridement methods, Endoscopy methods, Female, Humans, Middle Aged, Mouth, Nasal Cavity, Nasopharyngeal Carcinoma, Nasopharyngeal Neoplasms radiotherapy, Osteoradionecrosis diagnostic imaging, Tomography, X-Ray Computed, Osteoradionecrosis surgery, Spinal Fusion methods
- Abstract
Purpose: Osteoradionecrosis (ORN) is a rare yet well-recognized complication following radiotherapy to the head and neck. We illustrate the only case of a spontaneous extrusion of the sequestered C1 arch through the oral cavity and discuss our experience with a combined endoscopic transnasal and transoral approach for cervical ORN., Methods: A 56-year-old female presented with a 3-month history of blood-stained nasal discharge. She had been treated with radiotherapy for nasopharyngeal carcinoma 25 years earlier. Flexible nasal endoscopy demonstrated an exposed bone with an edematous posterior nasopharyngeal mass. Computed tomography showed a pre-vertebral mass with destruction of C1 and C2. She underwent occipito-cervical fusion followed by a combined transnasal and transoral endoscopic debridement of non-viable bone in the same perioperative setting. Healing of the raw mucosa was by secondary intention and reconstruction was not performed., Results: Histopathological examination reported ulcerated inflamed granulation tissue with no evidence of malignancy. During follow-up, she remained neurologically intact with no recurrence., Conclusion: Using both nasal and oral spaces allows placement of the endoscope in the nasal cavity and surgical instruments in the oral cavity without splitting the palate. Hence, the endoscopic transnasal and transoral approach has vast potential to be effective in carefully selected cases of cervical ORN.
- Published
- 2015
- Full Text
- View/download PDF
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