Urinary Incontinence In Women: Primary Healthcare Physicians' Knowledge And Practice In The Eastern Province, Saudi Arabia

Background:Morocco is one of the countries that has high burden of all forms of tuberculosis. The occurrence of this condition, though previously reported only in the developing world. Commonly presented as tubercular meningitis, post-tubercular meningitis hydrocephalus, and much more rarely as space-occupying lesions known as tuberculomas. Cerebral tuberculomas are a rare and serious form of tuberculosis (TB) due to the haematogenous spread of Mycobacterium Tuberculosis (MT).Objective :to review the clinical, epidemiological, computerized tomography and/or magnetic resonance imaging features, and treatment of intracranial tuberculoma.Methods:retrospective review of 25 patient's medical records treated for brain tuberculomas that had computerized tomography and/or magnetic resonance imaging brain scans and confirmed histopathological diagnoses, at Hassan II Hospital between January 2008 and June 2018.Results:in 25 cases imaging was available for review and were included in the study . There were 15 males and 10 females with age range being 2 to 65 years and with the Median age being 13 years. Twenty patients had computerized tomography and five patients had magnetic resonance imaging. Seizure 15/25 (60%) and headache 11/25 (44%) were the commonest presentation. Solitary or confluent large lesions were seen in 12/25 (48%) of patients. 14/25 (56%) of the lesions had their size between 2 cm and 5 cm. Majority of the lesions 15/25 (60%) were in the frontal and parietal lobes. The lesions were isodense on CTin 18/25 (72%) of the pre-contrast studies and 21/25 (84%) showed ring or rim enhancement after intravenous administration of the contrast medium.Conclusion:Tuberculoma, more frequently, presented with non-specific clinical findings and chronic seizure disorder and commonly occurred in young patients and often seen infratentorialy. It is often complicated with hydrocephalus in the pediatric age group. Computerized tomography scan and/or magnetic resonance imaging features are not different from reports from other countries

Roles of Stereotactic Surgical Robot Systems in Neurosurgery / 한양의대학술지

An important trend of surgical procedure is minimally invasive surgery (MIS). Neurosurgery is an important part of the surgical field that may lead in trends. The MIS provides surgeons use of a variety of techniques to operate with less injury to the body than with open surgery. In general, it is safer than open surgery and allows patients to recover faster and heal with less pain and scarring. There are various techniques and medical devices for improving the MIS. Recently, robotic surgery was introduced to MIS. Advanced robotic systems give doctors greater control and vision during surgery, allowing them to perform safe, less invasive, and precise surgical procedures. On the one hand, several robotic systems have been developed for use in neurosurgery. Some of those neurosurgical robots have been commercialized and used in clinical practice while others have not been used because of safety and ethical issues. This paper provides a brief review on robotic systems for neurosurgery, primarily focusing on commercially available systems.

On the structure of the macro-micro neurosurgical robots in stereotactic surgery / 한양의대학술지

Many different forms of the neurosurgical robots have been suggested for stereotactic surgery. Recently, their position accuracies exceed the ones of the conventional stereotactic devices and their assisting role for the surgeon are helpful by reducing the procedure and the operation time. Recent advancements of the position and image sensing technologies such as CT, MRI, dynamic position tracking sensing, etc., encourages the devotion of researchers to put more effort to treat the uncertainties such as brain shift, unexpected brain movements etc. In this trend, the more adequate, efficient, cost-effective structure of the surgical robot needs to be investigated. Thus, in this paper, the structure of the typical neurosurgical surgical robot and their position accuracies are reviewed and the desirable design aspects are addressed.

On the structure of the macro-micro neurosurgical robots in stereotactic surgery / 한양의대학술지

Many different forms of the neurosurgical robots have been suggested for stereotactic surgery. Recently, their position accuracies exceed the ones of the conventional stereotactic devices and their assisting role for the surgeon are helpful by reducing the procedure and the operation time. Recent advancements of the position and image sensing technologies such as CT, MRI, dynamic position tracking sensing, etc., encourages the devotion of researchers to put more effort to treat the uncertainties such as brain shift, unexpected brain movements etc. In this trend, the more adequate, efficient, cost-effective structure of the surgical robot needs to be investigated. Thus, in this paper, the structure of the typical neurosurgical surgical robot and their position accuracies are reviewed and the desirable design aspects are addressed.

CT Fluoroscopy-guided Aspiration of Intracerebral Hematomas: Technique and Outcomes

OBJECTIVE: The authors evaluated the feasibility and targeting accuracy of CT fluoroscopy (CTF)-guided catheter placement and aspiration of intracerebral hematoma (ICH)s. MATERIALS AND METHODS: Nine patients (mean age, 63.3 +/- 15.3 years) were treated by CTF-guided hematoma aspiration under local anesthesia. The targeting errors in the lesion center, volume of the aspirated hematoma, accuracy of the final catheter position, procedure time, and clinical outcomes were evaluated. RESULTS: All catheters were successfully placed in the center of the hematoma. The mean volume of the aspirated hematoma was 20.6 +/- 8.8 mL (pre-treatment, 44.7 +/- 20.1 mL; post-treatment, 24.1 +/- 13.8 mL). The average procedure time was 25.1 minutes (range, 18-32 minutes). In one case with a scanty residual hematoma, the catheter was removed at the end of the procedure. In the remaining eight cases, the catheter was left in the residual hematoma for drainage and all catheter tips were accurately located in the final position. There were no procedure-related complications, including rebleeding and infection. CONCLUSION: CTF-guided ICH aspiration is a feasible, quick, and accurate procedure which could substitute for stereotactic methods. The accurate catheter position provided by real-time observation enables an effective aspiration and drainage of hematomas.

Estimulación cerebral profunda bilateral para distonía cervical refractaria en el Hospital Universitario de San Ignacio de Bogotá, Colombia / Bilateral Deep Brain Stimulation for Refractory Cervical Dystonia. Hospital Universitario de San Ignacio in Bogotá, Colombia: A Case Report

La estimulación cerebral profunda (ECP) es una alternativa de manejo para los pacientescon distonía cervical, un síndrome de etiología múltiple, de presentación variada eincapacitante y refractario al manejo médico, que incluye la toxina botulínica. El artículopresenta el caso de una mujer de 56 años de edad con distonía cervical manifiesta conretrócolis e hiperextensión de columna dorsal, de cuatro años de evolución, consideradarefractaria al tratamiento y con indicación de ECP...

Deep brain stimulation (DBS) is a management alternative for patients with cervicaldystonia, syndrome of multiple etiology, presentation varied, disabling and refractoryto medical management, including botulinum toxin. A case of a 56 year old woman withcervical dystonia manifested by retrocollis and hyperextension dorsal spine of 4 yearsof evolution, considered resistant to treatment that is an indication of DBS is presented...

Skull Perforation and Depressed Fracture Following Skull Fixation for Stereotactic Surgery / 대한신경손상학회지

We report an unusual case of skull perforation and depressed fracture with epidural hematoma in a 61-year-old woman who has been undertaken a skeletal fixation for stereotactic evacuation of intracerebral hematoma. Most neurosurgeons secure the patient's head in a skeletal fixation device with a three- or four-pronged pin-type headrest for stereotactic procedure or microsurgery. Although a variety of complications have been reported secondary to the use of head fixation devices, these potential complications of skull fixation have been infrequently described in the medical literatures. Consideration of calvarial thickness, tightening force, and adequate location of skull fixation may reduce the risk of skull perforation and depressed fracture.

Clinical research of stereotactic surgery in treatment of moderate hypertensive intracerebral hemorrhage / 中国基层医药

Objective To explore the near-term therapeutic effect and long-term result of stereotactie surgery in treatment of moderate hypertensive intraeerebral hemorrhage and discuss related problems of the surgery.Methods 60 cases of moderate hypertensive intracerebral hemorrhage were divided into two groups at random.30 cases treated by stereotactie surgery,the others treated by nonsurgical method, the near-term rebleeding rate, mortality rate and longterm living quality of the two groups were analyzed and compared.Results There were no statistical differences in rebleeding rate and mortality rate between the two groups( all P >0.05 ).The long-term result indicated that there was statistical difference in GOS grades between the two groups( P <0.05).The surgical group had better result than nonsurgical group.Conclusion The patients suffered for moderate hypertensive intracerebral hemorrhage treated by stereotsefic surgery had better long-term therapeutic effect than those treated by nonsurgical method.

Stereotactic surgery for cerebellopontine hemorrhage / 中国微创外科杂志

Objective To investigate surgical techniques and curative effects of stereotactic operation in the treatment of cerebellopontine hemorrhage.Methods Ten cases of cerebellopontine hemorrhage were treated by using the model FY-98 Ⅱ stereotactic apparatus.Under the guidance of CT scanning,three-dimension coordinates of the target that was located at the center of the maximum section of the hematoma were calculated.Then a catheter was introduced into the target for aspiration and urokinase irrigation under the guidance of the stereotactic system.Results The operation was successfully completed in all the 10 cases.The operation time was 50~80 min(mean,60 min) and the intraoperative blood loss,25~40 ml(mean,30 ml).Postoperatively,3 fatal cases were encountered because of brainstem function failure or upper digestive tract bleeding.The remaining 7 cases survived after operation and were followed for 3~12 months(mean,8 months).The postoperative hospital stay was 16~30 days(mean,21 days).Assessment with the Activities of Daily Living(ADL) scale showed grade Ⅱ in 3 cases,grade Ⅲ in 2,Ⅳ in 1,and vegetative state in 1.Conclusions Stereotactic surgery in the treatment of cerebellopontine hemorrhage has advantages of accurate location,high reliability,and satisfactory effect.

Use of Laryngeal Mask Airway Proseal for Stereotactic Biopsy of Brain Tumor in which Difficult Intubation was Expected under General Anesthesia: A Case Report / 대한구급학회지

Stereotactic surgery is a technique allowing the operation of an intracranial lesion without the need for craniotomy. Now stereotactic technique is widely used for aspiration of brain abscess or hemorrhage, biopsy of brain tumor and treatment of movement disorder etc. Because of the frame of stereotactic system, that is fixed on the scalp, laryngoscopic endotracheal intubation may be disturbed. So, in this case, we used laryngeal mask airway Proseal (PLMA(TM)) for maintenance of airway during stereotactic biopsy of brain tumor under general anesthesia. It was easily to insert PLMA(TM) using the introducer at once. The ventilation during the operation was not impeded at all time. There were not excessively changes of vital sign during general anesthesia. We think that PLMA(TM) may be a good alternative method for maintenance of airway during stereotactic surgery under general anesthesia.

Development of a New Korean Neuronavigation System

OBJECTIVE: Image-guided surgical system has been widely used in neurosurgical field for minimally invasive surgery. We evaluate the efficacy of a new neuronavigation system developed by ourselves to neurosurgical procedures. METHODS: Application accuracy was estimated for evaluation of interactive localization of intracranial lesions. A phantom was mounted with ten frameless markers which were randomly distributed on its surface. Target points were digitized and the coordinates were recorded and compared with reference points. Root mean square (RMS) errors of the coordinates were calculated. The system was used in six cases with MR imaging. We evaluated for its utility, ease of integration, reliability, and intraoperative accuracy. RESULTS: Application accuracy is a crucial factor for stereotactic surgical localization system. The estimated RMS error was 1.2+/-0.5mm. This degree of accuracy was comparable to that of other reports. Clincally, it was helpful in preoperative planning, deciding the site and location of craniotomy and judging the anatomical position of intracerebral lesion. CONCLUSION: This system provides an accurate and reliable means for localizing lesions within the brain and identifying underlying anatomical structure. We could minimize surgical morbitidy and operation time.

Assessment of Imaging Distortion in Magnetic Resonance Imaging for Stereotactic Radiosurgery: Through Phantom Study

PURPOSE: To assess the distortion of MRI with the Leksell stereotactic radiosurgery system in variable pulse sequence and imaging plane through phantom study, to find most adequate imaging plane and pulse sequence for stereotactic radiosurgery system. MATERIALS AND METHODS: We made the phantoms for MRI and get images in variable conditions and analyzed the image distortion using image analysis program, and statistically using paired student t-test. RESULTS: The transeverse plane images had acceptable error ranges (less than 1.5mm) in all pulse sequence in both the analysis of fiducial marker in stereotactic G-frame and the phantom study. The coronal plane images had unacceptable large errors (more than 1.5mm) in the analysis of fiducial marker in the stereotactic G-frame, but had corrected small errors (less than 1.5mm) in the phantom study. CONCLUSION: We find from the phantom study that the present MR machines are adequate for stereotactic surgery system in frequently used pulse sequences, and imaging planes.

Central Nervous System Tuberculoma

The authors present a retrospective analysis of central nervous system(CNS) tuberculoma, describing the clinical manifestations, radiological findings, diagnosis, treatment, and prognosis. Between February 1984 to December 1996, 22 cases of CNS tuberculoma presenting as intracranial space occupying lesions were managed at Seoul National University Hospital. The age of patients ranged from two to 47 (mean, 28) years and the male-to-female ratio was 6 to 16. The diagnosis of CNS tuberculoma was pathologically confirmed in 18 cases, while the remaining four were diagnosed on the basis of clinical manifestations and radiological findings. The duration of follow-up ranged from 10 months to 7 years(median, 2 years). The results of treatment and prognosis were defined according to the status of patients on their final visit to the Outpatients' clinic. The symptoms of CNS tuberculoma were seizure(45% of cases), headache(36%), visual disturbance(18%), and hemiparesis(18%), and in 12 patients(55%), the presence of related pulmonary tuberculosis was noted. The most commom site of CNS tuberculoma was the frontal lobe; multiple lesions were present in five cases, and brain stem lesions in three. In 13 cases, CNS tuberculoma was seen as low signal intensity on T2 weighted magnetic resonance images(MRI). Gadolinium-enhanced T1 weighted MRI showed strong rim enhancement in ten cases and nodular enhancement in five, as well as characteristic grape-like conglomerated lesions in six cases. Surgical removal was performed in 13 cases, stereotactic biopsy in two, and biopsy via craniotomy in three. Although microbiologic study was negative in all 18 cases, diagnosis of CNS tuberculoma was possible on histological examination. After clinical or surgical diagnosis, a course of anti-tuberculosis medication was started in all patients. In 18 cases, intracranial lesions disappeared completely after anti-tuberculosis medication, and during the follow-up period, there was no evidence of recurrence. In three cases the lesions became smaller during treatment and symptoms improved. One patient died in spite of medication and decompressive surgery. Between the group of 13 patients who underwent decompressive surgery or lesionectomy via craniotomy, and the other group of nine, the outcome of treatment was not different(p=1.000, Fisher's exact test). In conclusion, the MRI findings of intracranial CNS tuberculoma are characteristic MRI findings. In cases of CNS tuberculoma, the treatment of choice is anti-tuberculous medication after histologic confirmation, though if sufficient clinical data support this diagnosis, then diagnostic and therapeutic medication without histologic confirmation is recommanded. Stereotactic biopsy is an ideal method for confirming a pathologic diagnosis of intracranial CNS tuberculoma, except in the cases in which intracranial pressure is high.

Stereotactic Surgery in the Management of Hypertensive Intracerebral Hemorrhage: Evaluation of the Efficacy Using Continuous Intracranial Pressure Monitoring

Persistently elevated intracranial pressure(ICP) has been associated with poor clinical outcome after intracerebral hemorrhage(ICH). Increased ICP is one of the main target of treatment in hypertensive ICH. To evaluate the efficacy of stereotactic surgery for the patients with hypertensive ICH, continuous ICP monitoring was done in these patients. This study is based on 30 patients(39-75 years of age, with a mean age of 59.4 years) between January 1996 and December 1997, who had suffered hypertensive supratentorial ICH. All patients underwent partial removal of the hematoma(mean 11.8cc in volume) through the stereotactically placed catheters and the residual hematoma was drained by urokinase irrigation for average of 3.4 days. ICP was monitored in all cases starting before the surgery and continuously until two days after the surgery. Patients were assigned into three categories(Category A; less than 20mmHg, Category B; 20-30mmHg, and Category C; above 30mmHg) according to the initial(preoperative) ICP. Ten patients(39.5cc in average volume of hematoma) were defined to category A, six(45cc) to category B, and fourteen(62.4cc) to category C. After partial removal of the hematoma, there was statistically significant difference in drop of ICP(average 8.4mmHg in category A, 16mmHg in category B, and 36.7mmHg in category C)(p<0.001) and postoperative ICP was maintained under 20mmHg in all patients by urokinase irrigation and external drainage through the stereotactically placed catheters. Cerebral perfusion pressure(CPP) was maintained more than 90mmHg after partial removal of hematoma in all patients. This study demonstrates that ICP was controlled effectively by stereotactic external drainage with intermittent mannitol infusion under the continuous ICP monitoring without large decompressive surgery under general anesthesia for patients whose ICH volume was more than 60cc. Exception to this would be those with rapid progression of neurologic deterioration.

Stereotaxy in Brain Abscess

Despite a reduction in the mortality of patients with brain abscess since the introduction antibiotics and computed tomography controversy persists as to the preferred method of treatment for this condition. Twenty two patients were treated by CT or MRI guided stereotactic aspiration or excision with appropriate antibiotic therapy. Thirteen patients who were treated by aspiration recieved a total of 6 to 8 weeks of antibiotic therapy. Eight patients who were treated by excision recieved a total of 1 to 2 weeks of antibiotic therapy. One patient was managed with biopsy followed by antibiotic therapy, but due to increase in size of abscess, open craniotomy was performed. Stereotaxy is a procedure with minimal morbidity and mortality. It should be considered in patients with small, multiple, or deep-seated abscesses, in those who are poor operative candidates, and in those who have failed prior therapy. Stereotactic excision may be considered in patients with small(< 20mm) superficially located abscesses.

Evaluation of Stereotactic Aspiration of Spontaneous Intracerebral Hematoma using Multiple Catheters

The treatment modality of patients with spontaneous intracerebral hematoma is still controversial. With remarkable development of CT-guided stereotactic techniques, stereotactic evacuation is preferable to conventional craniotomy due to local anesthesia and minimal brain damage. We reviewed 60 patients with hypertensive intracerebral hematoma, treated with CT-guided stereotactic aspiration and conventional craniotomy from Jan. 1995 to Dec. 1995. The patients were divided into three groups. Group I included the patients who had hematoma less than 30cc in volume and treated stereotactically using a single catheter. Group II was consisted of patients who had hematoma more than 30cc and treated stereotactically using 2 or more catheters. Group III was composed of the patients who showed neurologically rapid progression and treated with conventional craniotomy. We compared the results of the three groups of therapeutic modalities and made conclusions. Most of the spontaneous intracranial hematomas were removed com pletely within 5 days by the stereotactic method. This method was feasible to the patients, who had large volume of hematomas using multiple catheters.

Evaluation of Stereotactic Aspiration of Spontaneous Intracerebral Hematoma using Multiple Catheters

The treatment modality of patients with spontaneous intracerebral hematoma is still controversial. With remarkable development of CT-guided stereotactic techniques, stereotactic evacuation is preferable to conventional craniotomy due to local anesthesia and minimal brain damage. We reviewed 60 patients with hypertensive intracerebral hematoma, treated with CT-guided stereotactic aspiration and conventional craniotomy from Jan. 1995 to Dec. 1995. The patients were divided into three groups. Group I included the patients who had hematoma less than 30cc in volume and treated stereotactically using a single catheter. Group II was consisted of patients who had hematoma more than 30cc and treated stereotactically using 2 or more catheters. Group III was composed of the patients who showed neurologically rapid progression and treated with conventional craniotomy. We compared the results of the three groups of therapeutic modalities and made conclusions. Most of the spontaneous intracranial hematomas were removed com pletely within 5 days by the stereotactic method. This method was feasible to the patients, who had large volume of hematomas using multiple catheters.

Stereotactic Surgery for the Nail-Gun Injury of the Head: Case Report

The authors report a rare case of gunshot injury to the head by a nail-gun which was treated by stereotactic surgery. In the case, a 23-year-old male patient, presented with semicomatose mentality and decerebrated rigidity. The large nail was located in the 3rd ventricular area in the mid-line with vertical stature. The entry point was identified 1cm anterior to the coronal suture line and just lateral to the sagittal suture line. The foreign body was removed stereotactically with the guidance of gluoroscope. But the died of initial severe brain damage.

Stereotactic Surgery of Neurocysticercosis

The authors had performed stereotactic surgery to diagnose and treat 2 cases of neurocysticercosis under the local anethesia. Generally, such the open surgery need a general anethesia which may increase the chance of brain parenchyml injury. However, the stereotactic surgery has the advantage of being an easy and precise procedure under local anethesia. The authors reviewed the literature and discussed the stereotactic surgery in the diagnosis, and treatment of neurocysticercosis.

A Case of Cerebral Sparganosis Involving Bilateral Cerebral Hemispheres

Cerebral sparganosis is a rare parasitic CNS disease. Recently we have experienced a case of sparganosis involving bilateral cerebral hemispheres. The brain CT scan and MRI with administration of the contrast material demonstrated an intensely enhanced lesion in the left parietal area, and low density lesions in the right parieto-occipital area and left occipital area with cerebromalacia. The titer of the anti-spargasnum IgG antibody in serum and CSF was high. The parasitic granulation capsule and inflammatory tissue were removed from the left parietal area using the Cosman-Roberts-Wels stereotactic guide.