Displaying publications 41 - 47 of 47 in total

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  1. Jo Ee Sam, Nasser Abdul Wahab, Priya Sharda
    Malays Fam Physician, 2017;12(3):30-32.
    MyJurnal
    Introduction: Half of facial paralysis in children is idiopathic at origin. However, dismissing facial
    paralysis as being idiopathic without a thorough history and meticulous examination could be
    disastrous as illustrated by this case.

    Case report: We report a case of sphenoid wing meningioma in a 4-year-old girl. She first
    presented with only facial asymmetry that was noticed by her mother. Examination suggested a
    left upper motor neuron facial nerve palsy. A sphenoid wing meningioma was found on magnetic
    resonance imaging (MRI) of her brain. She underwent craniotomy and total tumour excision.
    Histopathological examination of the tumour showed a grade 1 transitional type meningioma.
    Meningiomas in children are rare compared to the adult population. Presentations in children
    may be delayed due to their inability to recognise or communicate abnormalities. Distinguishing
    between upper and lower motor neuron facial palsy is crucial in decision making for facial paralysis
    in children.
    Matched MeSH terms: Meningeal Neoplasms
  2. Kanesen D, Kandasamy R, Idris Z
    J Neurosci Rural Pract, 2016 Dec;7(Suppl 1):S95-S98.
    PMID: 28163517 DOI: 10.4103/0976-3147.196463
    The rarity of hemangiopericytoma (HPC) and its controversial histological classification result in its frequent misdiagnosis and thus make the treatment quite challenging. It is often difficult to distinguish these tumors from meningiomas based on clinical features and radiological findings. This is a case report of a man, diagnosed clinically and radiologically as meningioma, which turned out to be anaplastic HPC on histological examination. A 30-year-old man presented with 3 months of progressively worsening of headache and blurring of vision. Clinical examination revealed the right homonymous hemianopia with reduced visual acuity and papilledema bilaterally. Magnetic resonance imaging revealed a multilobulated and heterogenous extraaxial lesion attached to the occipital falx. It measured 9.0 cm (AP) × 5.5 cm (W) × 5.8 cm (CC) and expands bilaterally with major bulk on the left. An occipital craniotomy followed by a subtotal tumor excision was only achieved due to profuse bleeding intraoperatively. Histopathology confirmed an anaplastic HPC (WHO Grade 3). The importance of differentiation between HPCs and meningiomas cannot be overemphasized. A preoperative correct diagnosis is difficult, but it is important that it should be made. Multilobulated (mushroom appearance), prominent internal signal voids, relatively narrow dural attachment, and lytic destruction without calcifications are useful findings to distinguish HPCs from meningiomas.
    Matched MeSH terms: Meningeal Neoplasms
  3. Das, Priscilla, Naing, NyiNyi, Nadiah Wan-Arfah, Naing Noor Jan, K.O., Yee, Cheng Kueh, Rasalingam, Kantha
    JUMMEC, 2019;22(1):50-57.
    MyJurnal
    Background: This paper investigates the quality of life of brain pathology patients in relation to their sociodemographic
    profiles and clinical factors.

    Methods: This is a cross-sectional study done at a tertiary referral hospital in Kuala Lumpur. A total of 100
    patients were recruited in the study after excluding 22 patients who did not met the exclusion criteria. The
    European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) self-administered
    questionnaire was utilized in the study. The Global health status/QoL, Physical functioning, Role functioning,
    Emotional functioning, Cognitive functioning, Social functioning, Fatigue, Nausea and vomiting, Pain, Dyspnoea,
    Insomnia, Appetite loss, Constipation, Diarrhoea, and Financial difficulties were assessed in this study.

    Results: The most severe impairment in functioning was with lowest score of cognitive functioning (mean
    score=61) and the most severe symptom was fatigue (mean score=45). There were significant differences in
    quality of life scores in different socio-demographic groupsand types of brain pathology patients. Patients aged
    below 40 years old or less had better physical functioning, less symptoms of fatigue and insomnia compared
    to patients who were more than 40 years old. Male patients faced more financial difficulties compared with
    female patients. Patients who were married had increased insomnia compared to the single patients. Employed
    patients had better physical functioning and less financial difficulties compared with patients who were
    unemployed. Patients who earned >RM 2500.00 monthly had better physical functioning, less symptoms of pain and less financial difficulties than patients who earned ≤RM 2500.00. Patients with qualifications lower
    than SPM tended to face more financial difficulties compared to patients with qualifications of SPM or higher.
    Meningioma patients had better social functioning compared with others, whereas Carvenoma patients had
    better physical functioning. Meningioma patients had more symptoms of insomnia compared with other
    patients. All the findings were with p value less than 0.05.

    Conclusion: The quality of life of patients with brain pathology is affected by socio-demographic factors and
    clinical diagnoses. Efforts should be made to improve the overall quality of life of these patients.
    Matched MeSH terms: Meningeal Neoplasms
  4. Sam JE, Priya S, Nasser AW
    Malays Fam Physician, 2017;12(3):30-32.
    PMID: 29527278
    Introduction: Half of facial paralysis in children is idiopathic at origin. However, dismissing facial paralysis as being idiopathic without a thorough history and meticulous examination could be disastrous as illustrated by this case.

    Case report: We report a case of sphenoid wing meningioma in a 4-year-old girl. She first presented with only facial asymmetry that was noticed by her mother. Examination suggested a left upper motor neuron facial nerve palsy. A sphenoid wing meningioma was found on magnetic resonance imaging (MRI) of her brain. She underwent craniotomy and total tumour excision. Histopathological examination of the tumour showed a grade 1 transitional type meningioma. Meningiomas in children are rare compared to the adult population. Presentations in children may be delayed due to their inability to recognise or communicate abnormalities. Distinguishing between upper and lower motor neuron facial palsy is crucial in decision making for facial paralysis in children.
    Matched MeSH terms: Meningeal Neoplasms
  5. Kong CC, Kandasamy R, Haspani S, Idris Z, Abdullah JM
    Malays J Med Sci, 2018 May;25(3):88-102.
    PMID: 30899190 MyJurnal DOI: 10.21315/mjms2018.25.3.9
    Background: Meningiomas are the most common intracranial tumours; they account for 13%-26% of all the primary intracranial tumours. Skull base meningiomas make up 25% of all meningiomas and are one of the most difficult intracranial tumours to be managed surgically. This is due to the fact that it is difficult to approach the lesions which are also close to vital structures such as cranial nerves and major blood vessels. Despite the abundance of these cases in Malaysia, local data on meningiomas is scarce.

    Methods: This is a retrospective study consisting of 199 patients with meningiomas who have been operated at the Kuala Lumpur General Hospital from January 2010-December 2014. They were categorised into skull base and non-skull base groups. Demography, tumour characteristics, and patient outcomes were analysed. Kaplan-Meier survival curves as well as Cox hazard univariable and multivariable regressions for the possible predictors of survival were analysed.

    Results: 97.5% of the patients (n = 194) had WHO grade I meningioma and only five patients had WHO grade II meningioma. There was a female predominance (n = 134; 67.3%), with a male-to-female ratio of 1:2. Some 27.1 % patients had skull base meningiomas. Patients with skull base meningiomas had poorer outcomes and discharge conditions (n = 23; 42.6% P < 0.01), in addition to higher risk of incomplete resections (n = 34; 63% P < 0.01). Multivariate cox hazard regressions showed that the skull base meningioma group had four times the risk of death of the non-skull base group.

    Conclusions: Symptomatic meningiomas can be curative if the tumour is completely removed. Our study has revealed that skull base meningiomas which were operated locally had higher rates of incomplete resection and poorer surgical outcomes as compared to the non-skull base group. Patients with skull base meningiomas had four times the risk of death vis-à-vis non-skull base ones. More local studies are needed to look into skull base meningiomas for the improvement of its surgical outcomes.

    Matched MeSH terms: Meningeal Neoplasms
  6. Sriram PR, Sellamuthu P, Ghani ARI
    Malays J Med Sci, 2017 Dec;24(6):58-67.
    PMID: 29379387 DOI: 10.21315/mjms2017.24.6.7
    Background: Despite the broad category of differentials for sellar region, most of them present with similar clinical signs and symptoms. Headache and visual disturbance are among the frequently seen as presenting symptom. Visual field (VF) assessment is one of the crucial component of neuroophtalmologic assessment and mean deviation (MD) value from automated perimetry allows quantification of the visual field defect. We formulated a study to look into the factors that affect the visual field outcome after surgery.

    Methods: All patients with sellar region tumor who has underwent surgery in Queen Elizabeth Hospital from July 2010 to July 2016 were retrospectively analysed through hospital notes. VF assessment via Humphrey visual assessment for these patient pre and post-surgery were reviewed for MD value.

    Results: Eighty four patients were recruited and out of them, 151 eyes were taken into analysis after excluding eyes with missing data. Mean age of patients were 45.4 years with 70.2% of them were male. Visual disturbance is the commonest presenting symptom with mean duration of symptom prior to surgery is 9.7 months. Majority of them were pituitary adenomas (75%) followed by sellar meningioma (19%), craniopharyngioma (4.8%), and rathke cleft cyst (1.2%). 70.9% of patients showed improvement in VF based on MD outcome. Mean MD for pre surgery and post-surgery were -14.0 dB and -12.4 dB, respectively. Univariate analysis reveals younger age, female sex, shorter duration of symptom, pituitary adenoma, transsphenoidal approach, and transcranial approach favours improvement in VF. Multivariate analysis shows only shorter symptom duration, transphenoidal approach, and transcranial approach are significant for favourable VF outcome when other factors adjusted.

    Conclusion: Symptom duration and surgical approach were independent factors that affects the visual field after surgery in patients with sellar region tumors.

    Matched MeSH terms: Meningeal Neoplasms
  7. Palaniandy K, Haspani MSM, Zain NRM
    Malays J Med Sci, 2017 May;24(3):33-43.
    PMID: 28814931 MyJurnal DOI: 10.21315/mjms2017.24.3.5
    BACKGROUND: Meningioma is the commonest primary intracranial tumour in adults. Excision is curative for low grade meningioma, whereas high-grade meningioma requires adjuvant therapy following surgery. Several studies have examined the association between peritumoural brain Edema - a common feature in meningioma - and histological grading with mixed results. The present study attempted to elucidate this association and if peritumoural brain Edema affects the intra-operative judgement of surgeons on the completeness of resection.

    METHODS: An observational study was conducted among those who underwent surgery for meningioma. Eighteen subjects were recruited each for low- and high-grades, respectively. Magnetic resonance imaging (MRI) prior to surgery was employed for interpreting the Edema index and MRI after surgery was used to determine residual tumour.

    RESULTS: Median age was 50 years, male to female ratio was 1:3.5, 69.4% had peritumoural brain Edema and 75% had reported gross resection. Among the reported gross total resection cases, 40.7% had residual tumour. Analysis showed statistically significant association between peritumoural brain Edema (P = 0.027) and tumour volume (P = 0.001) with high-grade meningioma, however multivariate analysis did not present any association. No association was noted between judgement of tumour resection by surgeons and peritumoural brain Edema.

    CONCLUSION: Odds ratio for peritumoural brain Edema remained high and the tumour volume exhibited marginal P-value marginal significance for prediction of high grade meningioma. These two factors may still contribute to the tumour grade and should be included in further studies on the prognosis of meningioma.

    Matched MeSH terms: Meningeal Neoplasms
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