Thursday, October 27, 2011

World Stroke Day 2011

29 th October 2011 is World Stroke Day

Point your smart phone with a qrcode reader application on to this cube to activate link. Feel free to download this design  for stroke day campaigns at your hospital.

The World Stroke Organization (WSO) is calling for urgent action to address the silent stroke epidemic by launching the “1 in 6” campaign on World Stroke Day, 29 October 2010.

The “1 in 6” campaign celebrates the fact that not only can stroke be prevented, but that stroke survivors can fully recover and regain their quality of life with the appropriate long-term care and support. The two-year campaign aims to reduce the burden of stroke by acting on six easy challenges:

1. Know your personal risk factors: high blood pressure, diabetes, and high blood cholesterol.

2. Be physically active and exercise regularly.

3. Avoid obesity by keeping to a healthy diet.

4. Limit alcohol consumption.

5. Avoid cigarette smoke. If you smoke, seek help to stop now.

6. Learn to recognize the warning signs of a stroke and how to take action.

You can read further at http://www.worldstrokecampaign.org/2011/Pages/Home.aspx

The  qr code  was generated using http://qrcode.kaywa.com and then transforming the code using GIMP to create this cube design. Isn't it interesting that the qr code has a large error tolerance (redundancy of information or function) that it allows a custom design to be placed in it without loss of readability... much like the human brain!

Sunday, August 28, 2011

Mother ship is calling you home! Will you be there on 16 th December 2011?

NIMHANS is organising an alumni meet on Dec 16 th 2011.
You can click on picture above or download your invitation here.

Tuesday, July 12, 2011

How many millihelen is your craniotomy?

Beauty, they say, lies in the eyes of the beholder. If one wants to be technically accurate, aesthetic appreciation centre of the human brain is perhaps the medial orbito-frontal cortex [neuro­bi­ol­o­gist Semir Zeki's fMRI study]. Human brain appreciates beauty looking primarily for symmetry and congruence when it compares a given pattern with those in its memory that once evoked a pleasurable sensation.

So if one Helen is the unit of beauty that could launch a thousand ships, how many millihelen is your craniotomy?

So, what do we do routinely to preserve aesthetics in neurosurgery?

Shaveless craniotomy, sinusoidal stealth incision, bone flap fixation implants, burrhole buttons, minimal access or natural foramen access (endoscopic endonasal), or may be, avoid a scalp incision altogether as in radiosurgery/endovascular surgery…to name a few

How important do you think aesthetics is in neurosurgery (assuming equivalent care inside the brain too) and could you suggest a few tips which one could use in routine practice? Or do you think it is not that much of a concern as in Westerners? I myself had many patients preferring to have a ‘full head shave’!

Cheers,
Gopalakrishnan.

Responses copied from yahoo group site:

Re: [neurosurgery_nimhans] How many millihelen is your craniotomy?

Very interesting topic of discussion I must say. I agree about the cosmetic benefits of non-shaved craniotomy. Wound care does however become a little more frustrating...and people often complain of increased wound infection rates. At TMH I did a small prospective study looking at infection rates following non shaved surgeries. we had about 75 tumor craniotomies. We also looked at scalp swabs before and after scrubbing in these patients....and I devised a VAS based 4 point questionairre for assessing cosmetic outcome also...The results are still being anlysed and maybe I can update you all in a short while. On preliminary look we did not find a higher infection rate.
If I may ask, what are the wound infection rates at your centres....though I don't have exact figures my experience shows it to hover around the 5-10% mark. A lot of them are related to wound leaks and I have a feeling (though no objective evidence) that by fixing the bone flap the leaks decrease and so also the infections.
Also, what antibiotic policy do you all follow (which antibiotic and for how long). These may sound very mundane issues, but I think they are as much crucial to the overall outcome .

Ali

Sent: Wednesday, July 13, 2011 1:25 PM
Subject: Re: [neurosurgery_nimhans] How many millihelen is your craniotomy?
 
Hi Gopal,
this is a good topic u asked for.
We started practising preserving hair for all kinds of craniotomy since 4 yrs and the response from the patients is very good especially from the xx chromosomes.
some of the patients went back to working early because of good aesthetic look because u have taken care of it.
regarding burrhlole buttons -- the cost factor adding to overall budget makes us use it less as compared to preserving hair. some patients do complain of deppression at burrhole sites especially chronic SDH.
bone fixation --- frontal region -yes good for cosmesis and other areas depending on the budget.

overall if u take care of cosmesis for the people, its an additional bonus.
  Dr.Praveen Ganigi
MBBS MCh Neurosurgery
Consultant Neurosurgeon & Spine Surgeon
Manipal Hospital,
HAL Airport road
Bangalore-560017                                                                   

Sunday, April 24, 2011

Juha Hernesniemi, Ginde oration, Bombay hospital, 2011

Battling thousands of aneurysms at minus 22 degrees. What does that turn you into?

A steady handed super-vascular surgeon who clips them in the blink of an eye or in short - Juha Hernesniemi.

A focused and fast approach to common aneurysms is  the message he tried to convey. These are the few points I could gather

A standardized limited lateral supraorbital approach using a hemi-arc of the classical pterional craniotomy incision takes care of most of the anterior circulation aneurysm. [estimated time for craniotomy: 15- 20 minutes]

Operative site preparation is with a few  gentle swabbing of povidone after a limited shave. No time wasted there compared to hyper -enthusiastic scrubbing with multiple agents over and over. After all it is just the contact time of five minutes that kills pathogenic bacteria rather than one's enthusiasm! And we are not trying to clean up a radioactive leak, are we?

Sujita retractor hooks help reach the orbital rim. Single myocutaneous flap. [no interfascial dissection, and hence no loss of facial nerve branch. another 5 min saved]

A single burr hole which is at the posterior part of the craniotomy rather than at the psychopathic (key) burr site.Snap the bone flap at the sphenoid wing after cutting there with a naked craniotome blade.

A focal opening of the sylvian fissure going straight for the aneurysm in contrast to the Yasargilian concept of wide opening of the sylvian fissure. [Time saved: up to half and hour].

He uses a microscissors in right hand, cutting arach-strands rapidly and retracting with it and the suction to acheive focal opening of fissure to reach the target site.In case of acom aneurysm, an essentially sub-frontal approach is used, releasing CSF from the lamina terminalis which then relaxes the frontal lobe to accept a single blade of a retractor.

Find neck - Clip tentatively after short temporary clipping- Dissect further- adjust clip. [not a 360 degree dissection ]

Close and go to the fourth case!

The efficiency of a well organised team, saving of time from systematisation of procedure eliminating 'non-mandatory' steps, skill that comes from a huge and pure vascular surgical volume are all happening at Helsinki.

A few snaps at the dinner at Wellington club follows.

From left to right: Bhagwati, Martin, Juha Hernesniemi and umm ... Charlie's angels pretending to be scrub sisters.

Above all, I am sure you would agree with me, that angels are key to any successful surgical mission ;-)

Friday, January 7, 2011

The Plastic Tumor Returns!


Hi!

Any late night suggestions on dealing with this recurrent grade II ependymoma which had been near totally excised and given conformal radiotherapy in 2008 ? You can see the latest scan here,  previous post here and the initial discussion here . Patient presented with headache and has hearing loss on right side on examination. Shunt is functioning and ventricles are small.
Gopalakrishnan.