MyMedR

Fulltext Regards to the History of Neurosurgery Malaysia: Past, Present and Future

Ismail MI, Ang SY, Fitzrol DN

Malays J Med Sci, 2022 Dec;29(6):176-187.

PMID: 36818908 DOI: 10.21315/mjms2022.29.6.19

Assessment of the level of knowledge of colorectal cancer among public at outpatient clinics in Serdang Hospital: a survey based study

Pan Y, Chieng CY, Haris AAH, Ang SY

Med J Malaysia, 2017 12;72(6):338-344.

PMID: 29308770 MyJurnal

OBJECTIVES: Colorectal cancer (CRC) is one of the most common gastrointestinal cancers in the world. In the Asia- Pacific region, it is the fastest emerging gastrointestinal cancer. Level of awareness on CRC warning signs and risk factors in the rural population of Malaysia is reported of very low. The aim of this study was to assess the level of knowledge of CRC among the public at medical outpatient clinics in Serdang Hospital. The association between sociodemographic factors with level of knowledge among the respondents was further studied.

STUDY DESIGN: A study was conducted among the non-CRC patients' relatives accompanying their relatives to the medical outpatient clinics in Serdang Hospital from 1st April to 31st August 2016. The study was carried out with cluster sampling method.

METHODS: The respondents were assessed using validated and modified Cancer Awareness Measures (CAM) questionnaire consists of three parts which are knowledge on warning signs, knowledge on risk factors and sociodemographic factors. All data were analysed using IBM SPSS Statistics 21.0.

RESULTS: Altogether 308 subjects completed the questionnaires. It was shown high percentage of good knowledge for warning signs and risk factors of CRC among the respondents. A significant association between age groups and level of income with level of knowledge on warning signs was observed.

CONCLUSIONS: The level of knowledge of CRC among the general public in Serdang Hospital was sufficient. The respondents with higher income or younger age had higher level of knowledge regarding CRC.

Perianaesthetic challenges in patients undergoing vagus nerve stimulation (VNS) placement

Yeap TB, Ab Mukmin L, Ang SY, Ghani AR

BMJ Case Rep, 2023 Feb 07;16(2).

PMID: 36750294 DOI: 10.1136/bcr-2022-252692

Patients with medically refractory epilepsy (MRE) are indicated for vagus nerve stimulation (VNS) placement. Anaesthesia for VNS placement is extremely challenging and requires several considerations. We present a man in his 20s with MRE who successfully underwent VNS placement. We review the mechanism of action of VNS, anaesthetic challenges and measures to prevent seizures.

Rare occurrence of polymyxin B-induced hyperpigmentation in a child with ventriculitis

Fitzrol DN, Ang SY, Suhaimi A, Yeap TB

BMJ Case Rep, 2023 Apr 11;16(4).

PMID: 37041040 DOI: 10.1136/bcr-2022-253959

Polymyxin B (PB) is a polypeptide bactericidal antibiotic that is commonly used for extensively drug-resistant (XDR) microorganisms such as Acinetobacter baumanii and Klebsiella pneumoniae It can be administered intravenously or intrathecally. Common side effects are nephrotoxicity, neurotoxicity, pruritus and skin hyperpigmentation (SH). The latter is an uncommon adverse reaction of intravenously administered PB. We report a rare occurrence of PB-induced SH secondary to intrathecal administration of PB in a child with A. baumanii XDR ventriculitis. We describe the management of him and a brief review of PB.

Perianaesthetic management on a child with Lennox-Gastaut Syndrome for vagus nerve stimulation (VNS) placement

Yeap TB, Koo TH, Ang SY, Ab Mukmin L

BMJ Case Rep, 2023 Nov 27;16(11).

PMID: 38011949 DOI: 10.1136/bcr-2023-255897

Vagus nerve stimulation (VNS) is a neurostimulatory modality in treating patients with medically resistant epilepsy (MRE). It was introduced in 1997 and has been proven to reduce patients' dependency on antiepileptic drugs and seizure frequency. However, the usage of VNS in children with MRE has been limited, especially those with Lennox Gastaut Syndrome (LGS). Our teenage boy with this syndrome developed MRE and successfully underwent VNS placement. We discuss the perianaesthetic challenges, a brief description of VNS and the reported successes in patients with LGS.

Neuroradiological Correlation of the Lateral Third Periventricular, Pituitary Gland and Stalk, Pineal Gland, Cerebral Aqueduct, and Foramen Magendie and Luschka With Intraventricular Neuroendoscopic Images: A Case Series

Zakaria Z, Ismail MI, Ang SY, Idris Z

Cureus, 2024 Mar;16(3):e56952.

PMID: 38665765 DOI: 10.7759/cureus.56952

Neuroendoscopy procedures in pediatrics have expanded beyond the endoscopic third ventriculostomy. As such, a direct and angled endoscope allows further visualization around the corner, capturing the surrounding anatomy. Intraoperative live images look different than radiological images. Hence, in this single institutional experience, we correlate neuroradiology images with intraoperative intraventricular endoscopic views of the third-fourth ventricle, pituitary, pineal gland, cerebral aqueduct, and foramen magendie and luschka. Our collective case series reveals a few interesting case scenarios of normal and abnormal findings during the procedure. Careful navigation of the neuroendoscope is crucial to prevent injury to the neurovascular bundle. A close relationship with normal anatomy from radiological imaging is necessary to prevent it from getting lost once inside the ventricular cavity.

Fulltext Progress of Brain, Mind and Neurosciences in Universiti Sains Malaysia both Nationally and Internationally, and the Establishment of an Integrated Cerebrovascular Services and Clinic

Ismail MI, Ang SY, Fitzrol DN, Zakaria Z

Malays J Med Sci, 2023 Dec;30(6):175-187.

PMID: 38239250 DOI: 10.21315/mjms2023.30.6.18

Minimally Invasive Intervention for Trigeminal Neuralgia

Ismail MI, Ang SY, Fitzrol DN, Zakaria Z

Malays J Med Sci, 2024 Aug;31(4):228-229.

PMID: 39247113 DOI: 10.21315/mjms2024.31.4.20

A Clinical Test for a Newly Developed Direct Brain Cooling System for the Injured Brain and Pattern of Cortical Brainwaves in Cooling, Noncooling, and Dead Brain

Idris Z, Ang SY, Wan Hassan WMN, Hassan MH, Mohd Zain KA, Abdul Manaf A

Ther Hypothermia Temp Manag, 2021 Jan 29.

PMID: 33513054 DOI: 10.1089/ther.2020.0033

To ensure the direct delivery of therapeutic hypothermia at a selected constant temperature to the injured brain, a newly innovated direct brain cooling system was constructed. The practicality, effectiveness, and safety of this system were clinically tested in our initial series of 14 patients with severe head injuries. The patients were randomized into two groups: direct brain cooling at 32°C and the control group. All of them received intracranial pressure (ICP), focal brain oxygenation, brain temperature, and direct cortical brainwave monitoring. The direct brain cooling group did better in the Extended Glasgow Outcome Scale at the time of discharge and at 6 months after trauma. This could be owing to a trend in the monitored parameters; reduction in ICP, increment in cerebral perfusion pressure, optimal brain redox regulation, near-normal brain temperature, and lessening of epileptic-like brainwave activities are likely the reasons for better outcomes in the cooling group. Finally, this study depicts interesting cortical brainwaves during a transition time from being alive to dead. It is believed that the demonstrated cortical brainwaves follow the principles of quantum physics.

Commentary: Tractography-Guided Anterior Capsulotomy for Major Depression and Obsessive-Compulsive Disorder: Targeting the Emotion Network

Idris Z, Zakaria Z, Fitzrol DN, Ang SY, Yee SV, Ghani ARI, et al.

Oper Neurosurg (Hagerstown), 2021 03 15;20(4):E281-E283.

PMID: 33475706 DOI: 10.1093/ons/opaa473

Commentary: Demonstration of Microsurgical Technique and Nuances for the Resection of a Midbrain Tectal Glioma via the Transcollicular Approach: 3-Dimensional Operative Video

Yee SV, Fitzrol DN, Ang SY, Zakaria Z, Ghani ARI, Idris Z, et al.

Oper Neurosurg (Hagerstown), 2021 03 15;20(4):E308-E311.

PMID: 33452879 DOI: 10.1093/ons/opaa465

Commentary: Radiofrequency Ablation for Movement Disorders: Risk Factors for Intracerebral Hemorrhage, a Retrospective Analysis

Zakaria Z, Ghani ARI, Idris Z, Fitzrol DN, Ang SY, Abdullah JM

Oper Neurosurg (Hagerstown), 2021 08 16;21(3):E221-E223.

PMID: 34114025 DOI: 10.1093/ons/opab190

Vacuum Drains versus Passive Drains versus No Drains in Decompressive Craniectomies-A Randomized Controlled Trial on Subgaleal Drain Complication Rates (VADER Trial)

Sam JE, Kandasamy R, Wong ASH, Ghani ARI, Ang SY, Idris Z, et al.

World Neurosurg, 2021 12;156:e381-e391.

PMID: 34563715 DOI: 10.1016/j.wneu.2021.09.074

OBJECTIVE: Subgaleal drains are generally deemed necessary for cranial surgeries including decompressive craniectomies (DCs) to avoid excessive postoperative subgaleal hematoma (SGH) formation. Many surgeries have moved away from routine prophylactic drainage but the role of subgaleal drainage in cranial surgeries has not been addressed.

METHODS: This was a randomized controlled trial at 2 centers. A total of 78 patients requiring DC were randomized in a 1:1:1 ratio into 3 groups: vacuum drains (VD), passive drains (PD), and no drains (ND). Complications studied were need for surgical revision, SGH amount, new remote hematomas, postcraniectomy hydrocephalus (PCH), functional outcomes, and mortality.

RESULTS: Only 1 VD patient required surgical revision to evacuate SGH. There was no difference in SGH thickness and volume among the 3 drain types (P = 0.171 and P = 0.320, respectively). Rate of new remote hematoma and PCH was not significantly different (P = 0.647 and P = 0.083, respectively), but the ND group did not have any patient with PCH. In the subgroup analysis of 49 patients with traumatic brain injury, the SGH amount of the PD and ND group was significantly higher than that of the VD group. However, these higher amounts did not translate as a significant risk factor for poor functional outcome or mortality. VD may have better functional outcome and mortality.

CONCLUSIONS: In terms of complication rates, VD, PD, and ND may be used safely in DC. A higher amount of SGH was not associated with poorer outcomes. Further studies are needed to clarify the advantage of VD regarding functional outcome and mortality, and if ND reduces PCH rates.

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