Attitudes towards informed consent: a comparison between surgeons working in Saudi Arabia and the United Kingdom

Changes in legal standing and new guidelines for consent have generated changes in medical culture that doctors must adhere to. This study aims to highlight the differences in the way the surgeons in the two cultures view the informed consent for surgery processes. The attitudes towards informed consent of a group of surgeons working in Saudi Arabia [KSA] were compared with those of a similar group working in the United Kingdom [UK], a country with a longer medical history and a more established medico-legal system. The study shows that KSA surgeons tend to view informed consent not only as an ethical and legal obligation but also as a benefit to patients. In addition, KSA surgeons are more likely to adopt a paternalistic attitude during informed consent. They believe that information about harmful risks may dissuade their patients from undergoing the operation and they admit that the amount of information they provide to their patients is significantly influenced by a number of patient and non-patient related factors. It is concluded that surgeons in KSA should be more aware of the informed consent guidelines and they should adhere to them. In addition, there is room for the introduction of formal training on informed consent in both countries and for making written information more widely available particularly in KSA

Giant cerebral cavernous malformation

Cerebral cavernous malformations [CCMs] that are 6 cm or more in size have been loosely labeled as "giant" in the literature. Lesions of such size are rare with only 21 cases reported in the literature to date. We report a 27-year-old female patient who presented with raised intracranial pressure and focal neurological deficits which were related to a giant CCM. The pathology was documented by a preoperative MRI and confirmed by histopathological examination after the lesion was excised completely. A review of all the reported giant CCMs is carried out and it is hoped that the presentation will draw neurosurgeons attention to the clinical, radiological and histological features of giant CCMs and encourage a wider acceptance of giant CCMs as the subgroup of CCMs that are 6 cm or more in size

Pseudotumor cerebri and prolactin secreting pituitary adenoma. Association or coincidence?

The occurrence of pseudotumor cerebri [PTC] and hyperprolactinemia related to a prolactinoma are extremely rare, and the link between these pathologies has not been examined adequately in the post-MRI era. We report a patient with a small intrasellar prolactinoma who also developed PTC. Magnetic resonance venography did not show any evidence of compression of the cavernous or any other sinuses. She initially responded to treatment with acetazolamide and cabergoline. However 9 months later, her PTC symptoms recurred despite a normal serum prolactin level and a mild reduction of the pituitary tumor size on MRI. She improved after a lumboperitoneal shunt. We conclude that the findings in our patient do not support an association between PTC and hyperprolactinemia or prolactinoma. However, the case supports the need for clinicians to consider the diagnosis of PTC when patients with small pituitary lesions exhibit raised intracranial pressure features

Intramedullary tumors at king Khalid University Hospital

A retrospective analysis of 16 consecutive cases of intramedullary lesions treated at King Khalid University Hospital between 1985-1995 was conducted to provide data regarding the characteristics of patients with intramedullary tumours in Saudi Arabia in comparison with the existing literature. Ninety four% of the patients were unable to walk independently atpresentation. This series is unusual in that it included a case of intramedullary tuberculoma, in the low incidence of low grade astrocytoma [13%], the high incidence of malignant astrocytoma [25%] and the relatively high incidence of tumour located in the thoracic [31%] and cervicomedullay region [19%]. Our 4 malignant astrocytoma patients were unique in that two showed growth of their neoplasm into the medulla, one had a multicentric tumour and the other developed neuroaxial dissemination. At a median follow-up of 12 months, 6 of the 13 survivors had a "favourable" outcome in that they were able to function and ambulate independently. This study shows that there is a slight difference in the characteristics of intramedullary tumours in Saudi Arabia compared to what is reported in literature. Patients with intramedullary tumours should be diagnosed by MRI and referred early speciaIised neurosurgical units capable of performing a tumour resection, as completely as possible