9 research outputs found
Glioma histology at charlotte Maxeke Johannesburg academic hospital, a five year retrospective study
No full textA research report submitted in partial fulfillment of the requirements for the degree of Master of Medicine in Neurosurgery to the Faculty of Health Sciences, School of Clinical Medicine, University of Witwatersrand, Johannesburg 2024The epidemiology of gliomas has been described thoroughly by developed countries worldwide but information regarding gliomas is limited in developing countries including in our local setting in South Africa. This study will be describing glioma histology and the demographics of patients with gliomas for patients diagnosed at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) situated in Johannesburg South Africa.
The records of 44 patients ages between 12 and 70 years with histologically confirmed glioma from 2015 to 2919 was reviewed and our findings are as follows; In our sector we see more Black population than White, Coloured and Asians combined. Despite that literature commonly report gliomas to be more prevalent in males than females, we found females to be more prevalent than males (ratio 1,3:1) in our study group with males only showing prevalence over females with the advanced age group of 60 to 70 years.
Our mean age of glioma diagnosis is younger (43years) than the documented age group and we found the mean age to be even younger with patients confirmed HIV (38 years). The study demonstrated that females were diagnosed at early average age of 40 year and males average age of 47 years. In keeping with literature glioblastoma is the most common glioma in our study population. We also found gliomas to be more prevalent supratentorial in the temporal lobe than infratentorial and other lobes respectively in our study population. Patients with higher grade gliomas presented with varied number of symptoms than lower
grade.
With regard to biopsy procedures, most of our cases had undergone minimal invasive stereotactic biopsy and about seventy percent of the frozen biopsy cases were of patients who had minimal invasive stereotactic biopsy and only thirty percent had open biopsy. The study found that glioma size increased with increase in glioma grade and patients who are HIV positive. There was no significant relationship found between patients’ age groups and glioma size.
We found that immunochemistry is widely done , but molecular testing lacking behind with testing only started late 2017 and improving annually. For patients with HIV it was found that grade III gliomas are the most prevalent. Glioma grade increase with increase in age group and in patients wo are confirmed HIV positive. A formal national registry for gliomas will help to determine disease demographics, distribution, frequencies and associations for early detection and patients management strategies.MM202
Single surgeon series of myelomeningocoele repairs: factors influencing outcomes
No full textA research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of
Master of Medicine in Neurosurgery.
Johannesburg, 2018.This study reports on 24 Myelomeningocoeles (MMC) repaired at Chris Hani
Baragwanath Hospital by a single surgeon.
Mean gestation was 38.13 weeks, most MMCs were in the lumbosacral region and
mean MMC surface area was 19.4cm2. Cerebrospinal Fluid (CSF) leak at birth was
present in 50%, lower-limb neurology in 71%, lower cranial nerve dysfunction in 13%
and hydrocephalus in 54%. Clubfoot was present in 71%, congenital hip dysplasia
in 24%, neurogenic bladder in 82% and cutaneous abnormalities in 12%.
Mean time from birth to MMC repair was 13.6 days, 46% of infants had
ventriculoperitoneal shunt insertion and latex allergy was absent.
Complication wise, wound dehiscence arose in 21%, CSF leak in 12.5% and
infection in 25%. Neonates with CSF leak subsequently developed both wound
dehiscence and CSF infection.
Maternal HIV prevalence within the series was 28% and there was potential
correlation between CSF infection and birth to a positive mother.LG201
Molecular mechanisms in schwann cell survival and death during peripheral nerve development, injury and disease
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Resection of Symptomatic Pineal Cysts Provides Durable Clinical Improvement A Breakdown of Presenting Symptoms and Lessons Learned
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Single surgeon case series of myelomeningocele repairs in a developing world setting: Challenges and lessons
No full textPurpose: Neural Tube Defects are the second most common group of birth malformations following congenital heart anomalies, with myelomeningoceles being the most severe manifestation (MMC). They require expedited surgical repair, preferably within 72 h of birth. In low- and middle-income countries (LMIC) where resources are limited, timing to MMC repair is not optimal and leads to undesirable outcomes. The purpose of this study was to determine whether a proactive approach in a setting from a LMIC could achieve repair within 72 h. Methods: A concerted effort to expedite repair of all neonates referred with a MMC was undertaken from 01 January 2014 to 1 August 2015. A consensus was reached between neonatologists and neurosurgeons that neonates born or admitted with a MMC are referred immediately to surgeons and that repair will be performed within 72 h of birth. Hospital records of neonates who had MMC repaired during this period were reviewed for infant characteristics and hospital outcomes. Results: 24 patients with a MMC were operated upon by the senior author (CP) during the study period. Only 13 of these patients were born at the treating institution and 11 were referred from outside hospitals. Most MMCs were in the lumbosacral region and mean MMC surface area was 19.4 cm2. Mean time to repair for the entire series was 13.6 days. Patients born at the treating institution has a mean time to repair of 10.5 days and patients referred from outside had a mean time to repair of 17.3 days. Series wide, only 21% of neonates were operated upon in less than 72 h. Conclusion: Despite a pro-active commitment to repairing MMCs within 72 h for the duration of this series, satisfactory time to repair was not achieved. Late referral, referral from outside hospitals and operating theatre availability were the predominant factors leading to delay in MMC repair. Nevertheless, time to repair in our series was significantly shorter than that reported in MMC repair series based in similar environments. This suggests that even if the gold-standard of a 72-h window cannot be achieved, neonates benefit from much quicker repair when a concerted effort to minimise repair time is employed. This study also highlights the urgent need to address health care constraints in LMIC to improve outcomes for this vulnerable group
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Interventional neurorehabilitation for promoting functional recovery post-craniotomy: a proof-of-concept.
No full textThe human brain is a highly plastic 'complex' network-it is highly resilient to damage and capable of self-reorganisation after a large perturbation. Clinically, neurological deficits secondary to iatrogenic injury have very few active treatments. New imaging and stimulation technologies, though, offer promising therapeutic avenues to accelerate post-operative recovery trajectories. In this study, we sought to establish the safety profile for 'interventional neurorehabilitation': connectome-based therapeutic brain stimulation to drive cortical reorganisation and promote functional recovery post-craniotomy. In n = 34 glioma patients who experienced post-operative motor or language deficits, we used connectomics to construct single-subject cortical networks. Based on their clinical and connectivity deficit, patients underwent network-specific transcranial magnetic stimulation (TMS) sessions daily over five consecutive days. Patients were then assessed for TMS-related side effects and improvements. 31/34 (91%) patients were successfully recruited and enrolled for TMS treatment within two weeks of glioma surgery. No seizures or serious complications occurred during TMS rehabilitation and 1-week post-stimulation. Transient headaches were reported in 4/31 patients but improved after a single session. No neurological worsening was observed while a clinically and statistically significant benefit was noted in 28/31 patients post-TMS. We present two clinical vignettes and a video demonstration of interventional neurorehabilitation. For the first time, we demonstrate the safety profile and ability to recruit, enroll, and complete TMS acutely post-craniotomy in a high seizure risk population. Given the lack of randomisation and controls in this study, prospective randomised sham-controlled stimulation trials are now warranted to establish the efficacy of interventional neurorehabilitation following craniotomy
Spinal diffuse midline glioma: An unusual case presentation
No full textPrimary spinal cord neoplasms are rare, accounting for 1% of paediatric central nervous system tumours. The majority of which are low-grade gliomas (LGG). A teenage male presented with rapidly progressive lower limb paralysis. He subsequently underwent a near-total resection of an intramedullary thoracic tumour. Although the initial histopathology report suggested a LGG, closer review of the morphology and immunohistochemical staining revealed a diffusely infiltrating high-grade astrocytoma. Methylation profiling later confirmed a H3K27M-mutated spinal DMG. He underwent spinal radiation to the tumour bed soon after surgery but succumbed to his disease 8 days after completing radiation, and 3 months after presentation.
Conclusion: Spinal DMGs are rare, can lead to diagnostic challenges and have a poor prognosis
