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Article
Shunt Revision Overview in Patients with Hydrocephalus

Author: Mohamed A. Al-Tamimi
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2014 Volume: 13 Issue: 2 Pages: 24-27
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Hydrocephalus is a notorious neurosurgical disease thatcarries the adage “once a shunt always a shunt.” Most patients withhydrocephalus are treated with ventriculo‐peritoneal (VP) shunt placement;however, malfunction is common and is usually caused by mechanicalfailure.Aim: To evaluate the patients who were in need for shunt revision, analyzingthem according to their age, sex, and causes of their hydrocephalus, andinvestigating the etiological causes for their revisions.Patients and Methods: In a retrospective study, the records of 90 patientswho underwent their shunt revision in the Neurosurgical hospital andneurosurgical departments of AL‐Kadhmia teaching hospital and thehospital of surgical specialties between January 2000 till June 2002 wereanalyzed peri‐operativelyResults: It was revealed that most of the revised patients were children(their age≤10). The majority of them were shunted at first due to congenitalhydrocephalus and acquired hydrocephalus respectively. Regarding thefrequency of revision in these patients the majority were revised once andfew of them were revised for more than one time. Peri‐operatively clinicalstatus of shunt function was determined which showed upper end block in27.8%, post‐operative meningitis in 13.3%. Yet, lower end block was found in10% of the cases.Conclusion: Shunt failure is still far too common especially in pediatric agegroups. Upper end block together with surgical errors and suboptimaltechniques plays a significant role in shunt revision.


Article
Characteristics of Cerebrospinal Fluid Shunt–Associated Infections in Iraqi Children patients: A Retrospective Analysis over a 2-Year Period

Author: Mohamed A. Al-Tamimi
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2016 Volume: 15 Issue: 2 Pages: 20-23
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Cerebral shunts are commonly used to treat hydrocephalus, the swelling of the brain would be either due to excess of CSF build up or to obstruction of its drainage. Aim: To evaluate the Iraqi paediatric patients with infected shunts, analyzing them according to their age, sex, sort of causative microorganism, clinical presentation and time of infection postoperatively teeming with causes of their hydrocephalus, investigating the etiological causes for their infection. Patients and Methods: In a retrospective study, 23 children 0–12 years of ages who underwent initial CSF ventriculo-peritoneal shunt placement with a discharge dates between January 1, 2001, and December 31, 2002 were identified from Neurosurgical hospital in Baghdad. For every child who developed shunt infection we extracted information from the medical record about patient factors including gender, age at initial shunt placement, sort of infection, causative microorganism and timing between initial CSF shunt and initial infection and analyze them Results: It was revealed that a higher incidence of infection occurred at a young age (<1 year old). The majority of them were shunted at first due to congenital hydrocephalus (with our without myelomeningocele 39.2% and 21,7% respectively). Most of the infection happened in the first week after shunt insertion (47.8%) presenting themselves mostly with meningitis (52.1%). Staphylococcus Epedermidis and Aureus were the most common isolated causative organism. Conclusion: patient factors such as age and pathological cause behind hydroce


Article
STANDARD DISSCECTOMY VERSUS MICRODISCECTOMY: SHORT TERM AND LONG TERM OUTCOME COMPARISON IN TREATMENT OF LATERAL LUMBAR DISC HERNAIATION

Author: Mohamed A. Al-Tamimi محمد التميمي
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2016 Volume: 14 Issue: 4 Pages: 366-372
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Despite the high incidence of coincident spinal degenerative changes due to the high dynamic interplay between adjacent spinal elements leading to the clinical pain syndromes, yet the diagnostic approach and therapeutic options are still diverse and often inconsistent.Objective:To evaluate the short and long term outcome of two different surgical approaches in the treatment of lateral lumbar disc prolapse associated with spondylosis.Methods:Twenty patients presenting with a comparable complaints of radicular low back pain falling in the age group of 40-50 who attended the outpatient clinic in Science and Technology Hospital in Sanaa from 1st January 2008 to 1st of June 2009 and who were diagnosed to have lumbar lateral disc prolapse with mild spondylotic changes in need for surgery were divided into two groups. Group A offered microdiscectomy while group B offered standard discectomy. They were followed up and evaluated both clinically and radiologically at fixed postoperative intervals (day of discharge, three months, and one year post operatively). Results:It has been revealed that most of cases showed improvement of their presenting complaints due to the acute decompression offered to the neural tissue by either approach though was initially much higher with the minimally invasive microdiscectomy. However, the picture changed at three months interval where (30%) of patients from group A had complaints, two cases (66.6%) of the incompletely responding cases presented with new symptoms mostly due to incompletely treated spondylotic changes and 1 patient (33.3%) of the incompletely responding cases presented with persistence of symptoms due to incomplete disc removal. In contrast, only one case from group B had the persistence of symptoms, which was due to the effect of spondylosis. With further follow up at 1 year interval 40% of cases from group A had complaints mostly in form of bilateral radiating pain due to incompletely treated spondylotic changes, while only (20%) from group B had complaints either as ipsilaterally radiating pain due to incomplete disc resection or as bilaterally radiating pain due to postoperative adhesions.Conclusion:Treatment with the first modality though has the advantages of a shorter duration of surgery, less invasion, less postoperative stay at hospital and comparable clinical response on short term follow up to that of second group, yet data at long term follow up showed that it is associated with a higher incidence of recurrence or incomplete resolve of the presenting complaint as well as evident evolving radiological complications in contrast to treatment by the second modality.Keywords:Lateral disc prolapse, spondylosis, micro discectomy, standard discectomy.

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