Search

Background: Brain Arteriovenous Malformations (AVMs) located in proximity to eloquent brain regions are associated with poor surgical outcomes, which may be due to higher rates of postoperative neurological deterioration. Current treatment protocols include stereotactic radiosurgery, transarterial embolization, and surgical resection under general anesthesia. Awake Craniotomy (AC) allows intraoperative mapping of eloquent areas to improve post-operative neurologic outcomes. Objectives: We reviewed the current literature reporting surgical outcomes and assessed the feasibility of AC for AVM resection. Methods: The PRISMA guidelines were utilized as a template for the review. Three databases including PubMed, Scopus, and Cochrane Library were searched using a predefined search strategy. After removing duplicates and screening, full texts were analyzed. Outcomes including the extent of resection, intra-operative and post-operative complications, and long-term neurologic outcomes were assessed. Results: 12 studies were included with a total of 122 AVM cases. Spetzler–Martin grading was used for the classification of the AVMs. The asleep–awake–asleep protocol was most commonly used for AC. Complete resection was achieved in all cases except 5. Intraoperative complications included seizures (n = 2) and bleeding (n = 4). Short-term post-operative complications included hemorrhage (n = 3), neurologic dysfunctions including paresis (n = 3), hemiplegia (n = 10), dysphasia/aphasia (n = 6), cranial nerve dysfunction (n = 3), and pulmonary embolism (n = 1). Almost all neurological deficits after surgery gradually improved on subsequent follow-ups. Conclusion: AVMs may shift the anatomical location of eloquent brain areas which may be mapped during AC. All studies recommended AC for the resection of AVMs in close proximity to eloquent areas as mapping during AC identifies the eloquent cortex thus promoting careful tissue handling which may preserve neurologic function and/or predict the postoperative functional status of the patients We, therefore, conclude that AC is a viable modality for AVMs resection near eloquent language and motor areas.

In underground coal mines, uncontrolled accumulation of methane and fine coal dust often leads to serious incidents such as explosion. Therefore, methane and dust dispersion in underground mines is closely monitored and strictly regulated. Accordingly, significant efforts have been devoted to study methane and dust dispersion in underground mines. In this study, methane emission and dust concentration are numerically investigated using a computational fluid dynamics (CFD) approach. Various possible scenarios of underground mine configurations are evaluated. The results indicate that the presence of continuous miner adversely affects the air flow and leads to increased methane and dust concentrations. Nevertheless, it is found that such negative effect can be minimized or even neutralized by operating the scrubber fan in suction mode. In addition, it was found that the combination of scrubber fan in suction mode and brattice results in the best performance in terms of methane and dust removal from the mining face. Keywords: Dust, Methane, Mine ventilation, Mining machine

Objective: The objective of this systematic review is to determine the fate of spinal implants when patients develop postoperative wound infection after posterior instrumental fusion in a degenerative spine., Methods: A systematic review of the English-language literature (published between January 2001 and July 2020) was undertaken to identify articles documenting the management strategy for surgical site infections (SSIs) after posterior lumbar spinal fusion. Studies on pedicle screw fixation after trauma, immunocompromised, metastatic spine disease, and combined anterior/posterior approach were excluded. Two independent reviewers assessed the level of evidence quality using the criteria set by the North American Spine Society, and disagreements were resolved by consensus., Results: Of the 3071 citations identified, 49 met the criteria to undergo full-text review. Outcomes after SSIs were studied from a combined pool of 1150 patients who had undergone instrumental spinal fusion. The collected data showed that 456 patients (39.97%) had undergone spinal implant removal after SSI while 694 patients (60.03%) had their implants retained until the resolution of SSI. There was an absolute risk reduction (ARR) of 29% (-0.292) and a relative risk reduction (RRR) of 50.3% (-0.503) of implant removal if the patient underwent wound debridement following SSI. The number needed to treat (NNT) for wound debridement was calculated at 3.31 from our pooled cohort. The ARR in implant removal following vacuum-assisted closure (VAC) therapy was 16.6% and RRR was noted at 40.4%. This led to a high value of NNT at 6.0 patients. There was an ARR of 33.5% and a RRR of 70.7% was estimated in patients undergoing continuous irrigation., Conclusions: Our review of the literature suggests that surgeons prefer early wound debridement with or without negative pressure wound therapy under antimicrobial coverage for eradication of SSI after posterior lumbar spinal fusion. Implant removal is generally reserved for cases refractory to the other treatment modalities., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Routine preoperative blood testing has become a dogma. The general practice is to order preoperative workup as a knee-jerk response rather than individualize it for each patient. The fact that the bleeding brain tends to swell, which coupled with limited options for proximal control, packing, and overall hemostasis, leads to an overemphasis on the preoperative coagulation profile., Material and Methods: This is a retrospective review of the medical records of patients admitted at Aga Khan University Hospital from January 2010 to December 2015 for an elective craniotomy. The hospital registry was used to identify files for review. Data were collected on a predefined proforma. A nationwide survey was performed, and 30 neurosurgery centers were contacted across Pakistan to confirm the practice of preoperative workup., Results: The survey revealed that all centers had a similar practice of preoperative workup. This included complete blood count, serum electrolytes, and coagulation profile, including prothrombin time, activated partial thromboplastin time (aPTT), and international normalized ratio (INR). A total of 1800 files were reviewed. Nine (0.5%) patients were found to have deranged clotting profile without any predictive history of clotting derangement; 56% were male and 44% were female. Median age was 32 years with an interquartile range of 27 years. Median aPTT was (40.8 with 20.8 IQR). Median INR was (1.59 with 0.48 IQR). Median blood loss was (400 with 50 IQR). No significant association between coagulation profile (aPTT, INR) and blood loss was found (P = 0.85, r = -0.07)., Conclusions: We conclude that patients without a history of coagulopathy and normal physical examination do not require routine coagulation screening before elective craniotomy., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Congenital hydrocephalus (CH) is a frequently encountered birth anomaly that can hinder long-term neurologic maturity and social well-being of affected children. This study was undertaken to assess quality of life (QOL) 10-15 years after surgical treatment for primary CH during infancy at a tertiary care hospital in a developing country., Methods: This retrospective cohort study included individuals who presented to Aga Khan University Hospital, Karachi, Pakistan, between 1995 and 2005 at <1 year old and underwent surgery for primary CH. The Hydrocephalus Outcome Questionnaire was used to assess outcomes with respect to QOL., Results: Of 118 patients, 90 patients participated in the study. Mean age at first admission was 6.2 months. Mean length of follow-up was 5.4 years. Of these, 28 patients had died after surgery. Shunt infection (P = 0.012) and delayed milestones (P = 0.003) were found to be statistically significant factors affecting mortality in the patients who died. The mean overall health score was 0.67 ± 0.30. Age <6 months at the time of first surgery was a poor predictor of overall health on the Hydrocephalus Outcome Questionnaire (P = 0.039)., Conclusions: In our analysis, we assessed the QOL associated with CH. We hope that these results will provide insight for future prospective work with the ultimate goal of improving long-term QOL in children with CH., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Neurorehabilitation is an important aspect of continuing care for neurosurgical patients with functional disability. In developing countries, where formal home nursing frequently is unavailable, ensuring care after discharge is a difficult task. Training attendants to provide nursing care is an alternate option. In this study, we compared the outcomes of patients nursed by family members versus those looked after by a professional nurse., Methods: This was a retrospective observational study conducted at the Aga Khan University Hospital Karachi. The study consisted of 2 groups. Group 1 (consisting of patients cared for by a professional nurse) included 94 patients and group 2 (patients cared for by family members) included 102. All these patients had activity of daily living score of ≥3. Glasgow Outcomes Scale score, time to decannulation, development/worsening of bedsores, and mortality were recorded and compared between the groups at follow-up., Results: The study included 196 patients. Traumatic brain injury was the most common diagnosis. Nursing requirements were similar between the 2 groups and included tracheostomy care, percutaneous endoscopic gastrostomy tube care, peripherally inserted central catheter line care, care of patients with no bone flap, and log-rolling. The outcomes of the 2 groups were comparable and included bedsore development/worsening of grade, Glasgow Outcomes Scale score at follow-up, time to decannulation, and 30-day mortality., Conclusions: There was no statistically significant difference in outcomes of patients nursed by family members compared with the patients looked after by professional nurses., (Copyright © 2016 Elsevier Inc. All rights reserved.)