Neurosurgeons and electrocautery

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Role of surgery in cerebral venous sinus thrombosis

Cerebral venous sinus thrombosis (CVST) usually is taken care of by medical management or neuro-interventional vascular techniques. Some cases of CVST may take a malignant course if the intracranial pressure increases excessively. This increase in pressure is because of oedema in brain tissue due to impediment in venous return and/or intracerebral haemorrhage. Neurosurgical experience has shown remarkable recovery in these moribund patients if appropriate surgical intervention is done within reasonable time. Emergent decompressive craniotomy or other neurosurgical interventions are the only appropriate treatment in these malignant forms of CVST to prevent mortality and severe morbidity

B-cell lymphoma of the brainstem with central neurogenic hyperventilation

Non-Hodgkin\u27s lymphoma of the brainstem is a rare entity. Central Neurogenic Hyperventilation (CNH), an associated manifestation of this disease, is an even rarer event. We report a case of an immunocompetent individual who presented to us with tachypnea and facial nerve palsy. Neuroimaging showed a Cerebellopontine angle tumour which on histopathology showed feature consistent with a Non-Hodgkin\u27s B-Cell Lymphoma. The patient went on to develop severe respiratory alkalosis with findings consistent with CNH. Chemotherapy with Methotrexate was started and high dose Dexamethasone was added to the regimen a month later. Radiologically, the tumour size decreased by 50% but the patient\u27s clinical condition deteriorated. He eventually expired due to cardiopulmonary arrest. Some common clinical presentations of this disease and various diagnostic modalities and treatment options available to such patients are discussed

The antimicrobial activity of oil-in-water microemulsions is predicted by their position within the microemulsion stability zone

It has been shown previously that thermodynamically stable oil-in-water microemulsions have significant antimicrobial activity against planktonic cells and biofilm cells over short periods of exposure. It was the aim of this study to identify whether the position of the microemulsion within the microemulsion stability zone of the pseudo-ternary phase structure predicts the efficiency of the antimicrobial action of the microemulsion. Microemulsions were formulated at different points within the microemulsion stability zone. Experiments were performed to observe the kinetics of killing of these microemulsions against selected test microorganisms (Pseudomonas aeruginosa ATCC 9027, Candida albicans ATCC 10231, Staphylococcus aureus ATCC 6538 and Aspergillus niger ATCC 16404). The results indicated that the antimicrobial activity of the microemulsion is dependant upon its position within the zone of stability and is greater nearer the centre of that zone. The results indicate that significant antimicrobial activity can be observed at all points within the zone of microemulsion stability, but that maximal activity is to be found at the centre of that area

Establishment of a comprehensive epilepsy center in Pakistan: initial experiences, results, and reflections

Background. Developing countries, home to 80% of epilepsy patients, do not have comprehensive epilepsy surgery programs. Considering these needs we set up first epilepsy surgery center in Pakistan. Methods. Seventeen teleconferences focused on setting up an epilepsy center at the Aga Khan University (AKU), Karachi, Pakistan were arranged with experts from the University of Alberta Hospital, Alberta, Canada and the University of West Virginia, USA over a two-year period. Subsequently, the experts visited the proposed center to provide hands on training. During this period several interactive teaching sessions, a nationwide workshop, and various public awareness events were organized. Results. Sixteen patients underwent surgery, functional hemispherectomy (HS) was done in six, anterior temporal lobectomy (ATL) in six, and neuronavigation-guided selective amygdalohippocampectomy (SAH) using keyhole technique in four patients. Minimal morbidity was observed in ATL and, SAH groups. All patients in SAH group (100%) had Grade 1 control, while only 5 patients (83%) in ATL group, and 4 patients (66%) in HS group had Grade 1 control according to Engel\u27s classification, in average followups of 12 months, 24 months and 48 months for SAH, ATL, and HS, respectively. Conclusion. As we share our experience we hope to set a practical example for economically constrained countries that successful epilepsy surgery centers can be managed with limited resources