Computed Tomographic Morphometric Analysis of C1 and C2 for Lamina Cross Screw Placement in Malay Ethnicity

Methods@#A total of 330 CT cervical images were measured to establish the bicortical diameter of the C1 and C2 laminas as well as their height and length. The C1 posterior tubercle bicortical diameter and height were also determined from these images. All parameters were measured up to 0.1 mm, and statistical analysis was performed using IBM SPSS Statistics ver. 24.0 (IBM Corp., Armonk, NY, USA). An independent t -test and the Pearson chi-square test were used to determine the mean difference and screw acceptance. @*Results@#The means of the C1 lamina measurements were 5.79±1.19 mm in diameter, 9.76±1.51 mm in height, and 20.70±1.86 mm in length. The means of the measurements of the posterior tubercle were 7.20±1.88 mm in diameter and 10.51±1.68 mm in height. The means of the C2 lamina measurements were 5.74±1.31 mm in diameter, 11.76±1.69 mm in height, and 24.96±2.56 mm in length. Overall 65.5% of C1 and 80.3% of C2 laminas are able to accept 3.5-mm screws in a cross configuration. Screw acceptability is similar between the right and left sides (p >0.05). However, males have a higher screw acceptability compared with females (p <0.05), except for the C2 left lamina. @*Conclusions@#It is feasible to insert a 3.5-mm screw in a cross configuration in the C1 and C2 laminas of the Malaysian Malay population, especially in males. However, a CT scan should be performed prior to the operation to determine screw acceptability and to estimate screw sizes.

MR Volumetry of Hippocampus in Normal Adult Malay of Age 50 Years Old and Above

Background: Hippocampal volume is affected by several psychiatric illnesses of old age, as well as by normal aging. It is important to have a normal data in a population to assist in diagnosis. The aim of this study is to determine hippocampal volume in normal Malay people aged 50 years old and older. Methods: This was a cross-sectional study of the normal Malay population aged 50 to 77 years. We included 43 participants, representing 19 men and 24 women. Magnetic resonance imaging (MRI) was performed using a GE Signa Horizon LX 1.0 Tesla. Oblique coronal images of temporal lobes were obtained and hippocampal volumetry was done manually and normalised with intracranial volume. Results: Mean right and left hippocampal volumes (HCVs) were 3.43 cm3 (SD 0.32) and 3.26 cm3 (SD 0.34), with a significant difference between them (P < 0.001). Total mean HCVs exhibited no significant difference between men and women (P = 0.234). The means of the normalised right and left HCVs were 3.42 cm3 (SD 0.31) and 3.26 cm3 (SD 0.32). Conclusion: The mean right and left hippocampal volumes were significantly different in this study. Men had slightly larger mean HCVs but the difference was not statistically significant. It was found that normalisation further reduces the mean volume difference between the genders.

Normalised MRI Volumetry of the Hippocampus among Normal Malay Children and Adolescents

Background: Magnetic resonance imaging (MRI) is a noninvasive method for determining brain morphology and volumetry. Hippocampal volume changes are observed in conjunction with several diseases. This study aimed to determine the normalised volume of the hippocampus in normal Malay children and adolescents. Methods: This was a cross-sectional study performed from January 2009 to June 2010. Brain and temporal lobe MRI was performed for 81 healthy normal Malay individuals aged 7–18 years. Manual volumetry was performed. The hippocampal volumes were normalised with the total intracranial volume. Results: The original right, left, and total hippocampal volumes (mean and standard deviation) were 3.05 (0.48) cm3, 2.89 (0.44) cm3, and 5.94 (0.90) cm3, respectively. Normalised hippocampal volumes for the right, left, and total volume were 3.05 (0.41) cm3, 2.89 (0.41) cm3, and 5.94 (0.79) cm3, respectively. Pearson’s correlation coefficient for the right and left hippocampal volumes with intracranial volume were 0.514 and 0.413, respectively (P < 0.001). Both the original and normalised hippocampal volumes of the right hippocampus were significantly larger than those of the left (P < 0.001). Conclusion: This is a data set for the local Malay paediatric population. There was no significant difference between the actual and normalised values of hippocampal volume in our study.

Angioarchitecture of Brain Arteriovenous Malformations and the Risk of Bleeding: An Analysis of Patients in Northeastern Malaysia

Background: Central nervous system arteriovenous malformation (AVM) is a vascular malformation of the brain and involves entanglement of veins and arteries without an intervening capillary bed. Affecting predominantly young male patients, AVM presents with different clinical manifestations namely headache, seizures, neurological deficit and intracranial haemorrhage. The patients who present acutely with intracranial bleeding have a significant morbidity and mortality. The aim is to study the angioarchitecture of brain AVM (BAVM) and determine the risk factors for intracranial bleeding. Ultimately, the goal of the study is to look for the association between volume of haematoma and architecture of BAVM. Methods: A cross-sectional study of 58 patients was conducted at the Hospital Universiti Sains Malaysia. Data were collected over a period of seven years (2000 to 2007) to look for the association between the angioarchitecture of brain arteriovenous malformations (BAVM), haemodynamics and the natural history and risk of intracranial haemorrhage. Results: BAVM was predominantly found in young male patients in 65.5%. Small nidal size (P-value=0.004), deep location (P-value=0.003) and deep venous drainage (P-value=0.006) were found to be significant factors contributing to intracranial haemorrhage. All patients with coexisting intranidal or prenidal aneurysms presented with intracranial haematoma. Conclusion: The angioarchitecture of BAVM like nidal size, deep location and deep venous drainage can predict the risk of intracranial bleeding and can help in the management of high risk patients without any delay. Small sized and deep seated lesions have a diffuse type of intracranial bleed which eventually need more attention to the managing team as diffuse haematoma indicates more insult to brain.

Correlations between subdural empyema and paraclinical as well as clinical parameters amongst urban Malay paediatric patients

Paediatric subdural empyema is frequently seen in developing Asean countries secondary to rinosinusogenic origins. A cross-sectional analysis on the surgical treatment of intracranial subdural empyema in Hospital Kuala Lumpur (HKL), a major referral center, was done in 2004. A total number of 44 children who fulfilled the inclusion criteria were included into this study. The methods of first surgery, volume of empyema on contrasted CT brain, improvement of neurological status, re-surgery, mortality and morbidity, as well as the demographic data such as age, gender, sex, duration of illness, clinical presentation, probable origin of empyema, cultures and follow-up were studied. Chi-square test was performed to determine the association between surgical methods and the survival of the patients, neurological improvement, clearance of empyema on CT brain, re-surgery and long morbidity among the survivors. If the 20% or more of the cells were having expected frequency less than five, then Fisher’s Exact test was applied. The level of significance was set at 0.05. SPSS version 12.0 was used for data entry and data analysis. There were 44 patients who were less than 18 years. Their mean age was 5.90 ± 6.01 years. There were 30 males (68.2%) and 14 females (31.8%) involved in the study. Malays were majority with 28 (63.6%) followed by Indian 8 (18.2%), Chinese 5 (11.4%) and others 3 (6.8%). The variables which were under interest were gender, race, headache, vomiting, seizures, sign of meningism, cranial nerve palsy, thickness site of abscess, first surgical treatment, improvement in neurological deficit, clearance of CT and whether re-surgery was necessary. All variables were found not to be associated with Henk W Mauser Score for PISDE grading. Comparison between this urban study and a rural setting study by the same corresponding author in the same period on subdural empyema was done. Common parameters were compared and it was found out that seizures were more prevalent in urban study where the patients are more than one year old (p=0.005). Mortality was much higher in urban study than the rural one (p=0.040). The larger proportion of urban group had volume of abscess less than or equal to 50 ml (p=< 0.001).