Sunday, December 21, 2008

Residual Gh secreting pituitary macroadenoma



What treatment do you suggest for this 30 year old man with a residual Growth hormone secreting pituitary adenoma? He was operated [trans-sphenoidal excision] one year back and his GH level is 28 ng/ml. [i dont have pre-op scans, as he was operated elsewhere]




What do you suggest?

1]Re-surgery [What approach?]
2]Radiosurgery [what are the risks of cranial nerve palsies due to proximity to cavernous sinus and optic nerves, What are the chances of hormonal remission? Target includes sella?]
3]Radiotherapy [Is this an acceptable option considering the time to remission?]

Tuesday, September 16, 2008

Neurosurgery is Carpentry.


I mean, aren't the similarities striking? At least, thats what it looks like from this early colour photograph of a carpenter at work on Douglas Dam, Tennessee in 1942. Look at all that blood, er, dirt on his scrub suit.

How tough can these two professions be? Depends on what your work is...A mayster does rough carpentry, a finish carpenter does exact work, and then there is the miyadaiku - the temple carpenter of Japan who use tools quite distinct from others, like a saw that cuts on the pull and he prefers to do the finest most delicate and aesthetic work in sitting position! And 98.5% of carpenters are men according to wikipedia. [95% of neurosurgeons are too...]
Find out! try your hand at carpentry! Be sure to protect your fingers though.

So, what carpenter are you?

Image source: [original] http://hdl.loc.gov/loc.pnp/fsac.1a35241 [Retouched one is available at wikipedia]

Tuesday, September 9, 2008

Ependymoma: the plastic monster, Outcome

Lesion: WHO Grade II Ependymoma
Residual tumor volume: 1.74 ml
Please watch the video for details ...
ThankYou, Nitin, Ari and Mithun for your thoughts.

Friday, August 22, 2008

Exoskeleton in neurosurgery

Well, I hope you don't think this is too weird.

But how many times have you wished your arms don't get tired while maintaining a particular posture while operating? Hand rests are there, but they don't move with your limbs. You lose time and patience adjusting them.

I was just thinking, wouldn't it be nice if you could have a operating suit (air conditioned one, of course) that adjust its external rigidity to enable one to effortlessly maintain different body postures for prolonged periods?

Is this possible?

Certain animals have muscle tissue that interlock without using further energy . Details escape my memory ... read it in some old physiology book . But hey, we are humans, and we need technology.

I guess we can use some form of electrorheological fluid or elctroactive polymers within the suit that instantaneously harden on applying a voltage. This should keep the total weight of the suit low. Of course we need lots of microprocessors and voice activated controls etc, but then these are easily done. It could even dampen out any unnecessary tremors or potentially hazardous inadvertent movements. {You could program a constrained movement zone at and near the operating field} Well that should definitely help if your assistants tend to fall asleep on your Leyla ;-)

By the way, did you know that chocolate is an electro-rheological fluid? No! no edible suit for you!

This still doesn't completely solve the issue of fatigue because there is no escaping the effort involved in lifting your arms against the pull of mother earth and maintaining it there with all the weight of the suit. [yeah... i know the French have removed a cyst in microgravity environment, but most of our patients are still or terra firma.

What about a powered exoskeleton for the 'supersurgeon'.



This is a Japanese Cyberdyne robosuit HAL. [image courtesy Cyberdyne Inc]

Some of the military guys have all the luck researching such cool stuff.

Just watch this video. [courtesy:berkeleybionics.com]



How much will you pay for a whole body powered exoskeleton neurosurgical operating suit which comes sterile and air conditioned. You don't even have to scrub! Just slip into it and plug in your fuel cells. yes, heads up display, and built in coffee maker are included.

More seriously, a non-obtrusive and slender powered exoskeleton which you can easily strap on to your body could be useful.

Now, where did you say the patent office was? $-)

Saturday, August 16, 2008

How do you deal with this plastic monster?

Lets plan an assault on this tumor!
Please go thru' the MRI pics in the video. The kid is 6 years old with a few months of raised intracranial pressure and nasal twang since two weeks. He has nystagmus but no gross deficits.
What do you suggest?



What would be the surgical approach? positioning?
What about adjuvant therapy - if completely excised/if not/in either case?
And what do you think is this tumor? (ok...I know... it looks obvious)

Sunday, July 20, 2008

How to upload an operative video to neurosurgeryatnimhans blog

This small clip should make it clear.
You need to have admin privileges as an author to add content once you have joined this team blog.

Friday, May 16, 2008

WFNS Education Course and Prof RF Spetzler’s Hands on practical course, May 2008, Goa, India: A review


Great opportunity to listen to some of the renowned experts of the field like A de sousa, Bricolo, Black, Spetzler, Kato and others. It’s a good thing… The hands on cadaveric workshop was little bit of a dampener. Too less time to dissect in a toxic, hot formaldehyde rich atmosphere straight out Venus. That’s probably why the video link was getting cut most of the time?! And why just OZ and far lateral? Eleven thousand rupees is a lot of money if you are not used to earning in tons of Dollars. You deserve a better deal.

By the way, no one came from nimhans. Mais pourquoi? Guys, this is Goa! Missing the workshop is pardonable but not the party. Do get hold of Spetzlers course DVD. The interactive DVD with pictures taken with a Zeiss MKM robotic scope with multilayer Image reconstruction technique is impressive.

Some other desirable stuff/ideas to consider:

Indocyanine green angiography

Spetzler Mallis disposable bipolar leads and lots of ice cubes!

Just edited this movie. Enjoy!


Tuesday, March 18, 2008

M. Gazi Yasargil. Ginde oration and Microneurosurgery CME, Bombay hospital


Amazing energy and intensity at 83!

Some of us could catch up with him at the banquet: Diane and MGY

Shall I quote some of his advices/exhortations?

"Sell your car and buy a CUSA!"
"no nimodipine, no triple H, they just dont help"
"Don't believe in these publications, don't believe in the books, don't believe me either"

His operative video DVD will soon be available. May be, we can watch the op-videos of those scary post fossa AVMS which he didnt have time to show.

A few things to remember...

  • Practice in a cadaver lab... especically microvascular skills
  • Mercilessly coagulate aneurysms in addition to clipping them : this is complete treatment.
  • Have a good set of bipolars, suction tubes and the finest softest cottonoids- don't hesitate to use them in large numbers
  • Have a Leyla retractor but just dont use it. [same goes for assistants]
  • As far as possible, operate on the rich and the famous [Italians] ;-)
A truly memorable event.

Sunday, January 6, 2008

Some more pics ... Neurocon '08


Focal cellular hyperplasia matters... but how do I convince the sheep?... Manish

find the rest at yahoo group site.

At the Taj Mahal ... Neurocon 08