Baclofen Pump Implantation for Cerebral Palsy

Programmable baclofen pump implantation is used to provide the patient with minimal intrathecal dose of baclofen to provide relaxation when the oral permitted doses are no longer withstand able by the patient. We discussed the efficiency of programmable baclofen pump implantation in treating spasticity by reviewing several international papers. Satisfactory relaxation was noticed in most of the patients. The complications following intrathecal baclofen (ITB) surgeries are not uncommon. ITB is an advised method for treating spasticity whether due to cerebral or spinal causes. It has significant improvements with minor complications. It needs special trained multidisciplinary team to manage it

Study of target volume effect on efficiency index and paddick comformty index for arteriovenous malformation treatment plans by gamma knife

الهدف نظرًا   لأن الطاقة هي نتاج الحجم مرات الجرعة ، يتم إعطاء الأحجام ترجيحًا يتناسب مع الجرعة التي تلقتها. هذه نتيجة أن الطاقة هي مقياس لمقدار المادة التي تم امتصاصها. مؤشر الكفاءة عبارة عن إحصائية واحدة يمكن استخدامها لتقييم جودة الخطة بكفاءة من خلال مراعاة التغطية والانتقائية ومؤشر التدرج والحجم ، ومن الممكن استخدام هذه الإحصائية لقياس كفاءة خطتين مختلفتين لنفس الحجم المستهدف. مؤشر المطابقة هو قياس مدى توافق حجم توزيع الجرعة الإشعاعية مع حجم وشكل الحجم المستهدف. في هذا البحث تم دراسة تذبذب مؤشر الكفاءة والحقل مع فروق حجم الهدف. الطريقة تم حساب مؤشر الكفاءة وبيانات مؤشر المطابقة لكل من العلاجات السريرية الثلاثين التي تم جدولتها باستخدام خطة Leksell Gamma ومقارنتها بالحجم المستهدف. النتيجة: تراوحت قيمة 50٪ ل 30 خطة SRS السريرية من 44٪ إلى 84٪ بمتوسط ​​قيمة 63٪ وقيمة المطابقة 47٪ إلى 82٪ بمتوسط ​​قيمة 60.6٪ ، وأظهرت هذه الدراسة أيضًا علاقة قوية بين الهدف الحجم وهذه الفهارس. يتم إعطاء أحجام الاستنتاجات ترجيحًا يتناسب مع الجرعة التي امتصتها لأن الطاقة هي نتاج حجم مرات الجرعة ، حيث سيكون هناك ارتباط بين تحسينات الكفاءة والمطابقة وزيادة الحجم المستهدف

Functional Outcome Following Synthetic Vertebral Body Implantation in the Management of Spinal Disorders

OBJECTIVE: Synthetic vertebral body replacement has been widely used recently to treat different spinal conditions affecting the anterior column. They arrange from trauma, infections, and even tumor conditions. In this study, we assess the functional outcome of this modality in different spinal conditions. PATIENTS AND METHODS: Thirty-six cases operated from October 2010 to December 2017. Twelve patients had spinal type A3 fractures, 11 cases with spinal tuberculosis (TB), and 13 cases with spinal tumors. They were followed clinically for a mean period of 2.4 years. RESULTS: All the cases were approached anteriorly. Seven cases had a post-operative infection. No neurological worsening reported. We had dramatic neurological improvement in all spinal TB cases. Mortality recorded in only 4 cases with metastatic spinal tumor during the mean period of follow-up. Karnofsky performance status scale showed statistically significant change for spinal TB, and tumor cases during the follow-up period, but there was no significant change in cases of spinal type A3 fractures. CONCLUSION: The positive outcome of this surgery makes it recommended for properly selected patients, especially with spinal TB and tumors

Short Term Effectiveness of Gamma Knife Radiosurgery in the Management of Brain Arteriovenous Malformation

AIM: To evaluate the short-term effectiveness of Gamma knife radiosurgery as a modality of treatment of brain arteriovenous malformation. METHODS: Sixty-three patients with arteriovenous brain malformations underwent Gamma knife radiosurgery included in this prospective study between April 2017 and September 2018 with clinical and radiological with MRI follow up was done at three months and six months post-Gamma knife radiosurgery. By the end of the 12th-month post-Gamma knife radiosurgery, the patients were re-evaluated using digital subtraction angiography co-registered with M.R.I. During the 12 months follow up, CT scan or MRI was done at any time if any one of the patients᾽ condition deteriorated or developed signs and symptoms of complications. The mean volume of the arteriovenous malformations treated was 26.0 ± 5 cm3 (range 12.5–39.5 cm3) in The Neurosciences Hospital, Baghdad/Iraq. RESULTS: By the end of the 12th month of follow up, the overall obliteration of the arteriovenous malformations was seen in six patients only (9.5%), while shrinkage was noticed in 57 patients (90.5%). Improvement or clinical stability was found in 24 out of 39 patients (61.5%) presented with epilepsy as a chief complaint before Gamma knife radiosurgery and 21 out of 24 patients (87.0%) complained of a headache before Gamma knife radiosurgery. Post-Gamma knife radiosurgery bleeding was found in only three patients (5.0%). CONCLUSION: Even with the short term follow up, Gamma knife radiosurgery has an excellent clinical outcome in most patients with arteriovenous brain malformations. The clinical symptoms like headache and seizure were either diminished or controlled with the same medical treatment dose before Gamma knife radiosurgery. Long term clinical and radiological follow up is recommended

Laminectomy versus interlaminar approach for Lumbar disc herniation

Background: Low back pain is the most common health problem in men and women between the ages of 20 and 50 years. The lumbar disc prolapse has a major role in this condition. Treatment is either conservative or surgical. The most common surgical interventions are either laminectomy or interlaminar approach. Objective: To determine which is the best surgical approach for the patient according to his/her type of disc herniation. Patients and methods: A comparative clinical study conducted in the Neurosciences Hospital, Baghdad, Iraq from January 2016 to January 2018. In this paper we evaluated the clinical outcome following both approaches Results: We studied sixty cases; thirty-four patients had interlaminar approach for lumbar discectomy while twenty-six patients had laminectomy with discectomy. Conclusion: Both methods can manage different types of lumbar disc prolapse, apart from far-lateral disc which favors laminectomy approach

New modified suction tip for trans nasal skull base surgery: Technical note

Background: We describe a modified suction tip for a suction device that used in rigid bronchoscope biopsy procedures. This redesign of the tip makes it suitable for work in endoscopic skull base surgery for taking specimens because it originally designed for use with minimal surgical trauma for suction and dissection simultaneously. Presentation: Since 2015, we have used the device on 37 patients with skull base tumors (25 pituitary adenomas, seven craniopharyngiomas, five meningiomas). The longitudinal sliced blunt margin suction tip facilitated the removal of masses of proper amounts of specimens and was less traumatic to nearby tissues.The suction tip did not adhere to structures. It used as a dissector with low-pressure suction. In comparison with conventional suction; it caused less bleeding because of its blunt margins and the right amount of biopsy collected in its attached container. It has less affinity to suck the surgicel or gelfoam. Conclusion: This modification of a rigid bronchoscope biopsy device was beneficial in addressing skull base lesions for dissection, aspiration and biopsy taking

Early magnetic resonance image volumetric changes of vestibular schwannoma after Gamma Knife radiosurgery: a prospective study of 18 cases

Abstract Background Gamma Knife radiosurgery is the principal alternative to microsurgical resection for acoustic neuromas (vestibular schwannomas). However; its increasing use worldwide and evolution of Gamma Knife device precision and safety had led to its acceptance as primary management for small- and medium-sized vestibular schwannomas. We tried to evaluate the tumor volume changes that occur with these tumors following Gamma Knife radiosurgery. Methods Eighteen patients with stereotactic radiosurgery with Gamma Knife through the year 2016 completed 1-year MRI follow-up at the 3rd, 6th, and 12th month after the Gamma Knife treatment. All the patients had unilateral vestibular schwannomas; the mean dose of radiation to the tumors was 12 Gy (range 10–14 Gy). Post treatment imaging was done with a high-resolution 3 T MRI scanner. Tumor sizes are calculated by using Onis software. Results Four patterns of volumetric changes were noticed. Most of the tumors increased in size on the third month follow-up MRI (89%); 15 (83%) tumors on the sixth month returned to their initial pre-Gamma Knife radiosurgery (PGKR) sizes. On the last (12th month) follow-up MRI with tumor sizes compared to initial PGKR sizes, 8 (44%) tumors showed no change, 6 (33%) tumors became smaller, and 4 (22%) tumors increase in size. Tumor control rate was 78% for the first year after Gamma Knife radiosurgery. Conclusions The third month follow-up MR images are practically not informative and might lead to unnecessary intervention; sixth month follow-up MR images are a crucial point and they may predict tumor behavior. Age, gender, and Koos stage whether stage II or III are not affecting tumor control. Gamma Knife radiosurgery is an effective intervention for Koos II and Koos III vestibular schwannomas

A Novel Eddy Current Testing Error Compensation Technique Based on Mamdani-Type Fuzzy Coupled Differential and Absolute Probes

Eddy current testing (ECT) is an accurate, widely used and well-understood inspection technique, particularly in the aircraft and nuclear industries. The coating thickness or lift-off will influence the measurement of defect depth on pipes or plates. It will be an uncertain decision condition whether the defects on a workpiece are cracks or scratches. This problem can lead to the occurrence of pipe leakages, besides causing the degradation of a company’s productivity and most importantly risking the safety of workers. In this paper, a novel eddy current testing error compensation technique based on Mamdani-type fuzzy coupled differential and absolute probes was proposed. The general descriptions of the proposed ECT technique include details of the system design, intelligent fuzzy logic design and Simulink block development design. The detailed description of the proposed probe selection, design and instrumentation of the error compensation of eddy current testing (ECECT) along with the absolute probe and differential probe relevant to the present research work are presented. The ECECT simulation and hardware design are proposed, using the fuzzy logic technique for the development of the new methodology. The depths of the defect coefficients of the probe’s lift-off caused by the coating thickness were measured by using a designed setup. In this result, the ECECT gives an optimum correction for the lift-off, in which the reduction of error is only within 0.1% of its all-out value. Finally, the ECECT is used to measure lift-off in a range of approximately 1 mm to 5 mm, and the performance of the proposed method in non-linear cracks is assessed

The efficiency of the prescribed dose of the gamma knife for the treatment of trigeminal neuralgia

Background: This study designed to evaluate the clinical response of the gamma knife (GK) treatment of primary trigeminal neuralgia (TN) with two modalities of radiation doses. We tried to determine the best of these modalities for the treatment. Patients and methods: A randomized clinical prospective study conducted in the Gamma Knife Center, Neuroscience Hospital, Baghdad, Iraq. It extended from July 2016 to June 2017. Forty-five patients with essential TN included in this study. All the patients had either IV and V score of Barrow Neurological Institute Pain scale (BNI) before the Gamma Knife (GK) therapy. Twenty Patients treated with a dose of 80 Gy and twenty-five patients exposed to 89 Gy. The clinical response monitored at fixed time intervals. Imaging evaluation of the nerve thickness used with 3 Tesla MRI before and following the GK therapy. Results: 32% of the patients treated with 89 Gy reached pain-free status after one year of GK treatment, while no one of the treated patients with the dose 80 Gy reached that scores. A significant increase in nerve thickness was obtained by the radiation dose 89 Gy as compared to the effect of 80 Gy six-month post GK. After twelve months 32% of those patients treated with 80 Gy had a recurrence, while 19.5% recurrence found in patients treated with 89 Gy. Conclusion: The clinical outcome for a longer duration is better when applying the dose 89 Gy. Keywords: Trigeminal neuralgia, Gamma knife, Pain therap