Application And Histology-Driven Refinement Of Active Contour Models To Functional Region And Nerve Delineation: Towards A Digital Brainstem Atlas,
2015
Old Dominion University
Application And Histology-Driven Refinement Of Active Contour Models To Functional Region And Nerve Delineation: Towards A Digital Brainstem Atlas, Nimal Patel, Sharmin Sultana, Tanweer Rashid, Dean Krusienski, Michel A. Audette
Electrical & Computer Engineering Faculty Publications
This paper presents a methodology for the digital formatting of a printed atlas of the brainstem and the delineation of cranial nerves from this digital atlas. It also describes on-going work on the 3D resampling and refinement of the 2D functional regions and nerve contours. In MRI-based anatomical modeling for neurosurgery planning and simulation, the complexity of the functional anatomy entails a digital atlas approach, rather than less descriptive voxel or surface-based approaches. However, there is an insufficiency of descriptive digital atlases, in particular of the brainstem. Our approach proceeds from a series of numbered, contour-based sketches coinciding with slices …
A Microsurgical Anterior Cervical Approach And The Immediate Impact Of Mechanical Retractors: A Case Control Study,
2015
Universidad de Guadalajara
A Microsurgical Anterior Cervical Approach And The Immediate Impact Of Mechanical Retractors: A Case Control Study, Rodrigo Ramos-Zúñiga, Laura Rocio Díaz-Guzmán, Shannen Velasquez, Ana Magdelena Macías-Ornelas, Martín Rodríguez-Vázquez
Faculty Publications
Introduction: A microsurgical anterior cervical approach with discectomy and fusion (MACDF) is one of the most widely used procedures for treating radicular disorders. This approach is highly successful; however, it is not free from complications. These can be associated with soft tissue injuries. Aim of the Study: The recognition of the risks for these complications should be identified for timely prevention and safe treatment. Materials and Methods: Study Design: Retrospective case control study. This study includes a retrospective case series of 37 patients, paying special attention to immediate complications related to the use of mechanical retraction of soft tissue (dysphagia, …
The Impact Of Polio Eradication On Routine Immunization And Primary Health Care: A Mixed-Methods Study,
2014
Middlebury College, Middlebury
The Impact Of Polio Eradication On Routine Immunization And Primary Health Care: A Mixed-Methods Study, Svea Closser, Kelly Cox, Thomas M. Parris, R Matthew Landis, Judith Justice, Ranjani Gopinath, Kenneth Maes, Hailom Banteyerga Amaha, Ismaila Zango Mohammed, Rashid Jooma
Section of Neurosurgery
Background: After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC).
Methods: Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review.
Results: Our quantitative analysis did not find compelling evidence of widespread and …
A Unique Mri Presentation Of Fungal Infection In The Brain,
2014
Good Samaritan Hospital, Cincinnati, OH, USA.
A Unique Mri Presentation Of Fungal Infection In The Brain, Muhammad Bilal Salman Khan, Saad Shafqat, Ather Enam
Section of Neurology
Fungal infections of CNS are common in certain geographic locations. MRI with or without contrast is a useful prediagnostic tool. However, the findings may sometimes be misleading. In this case report, the authors present unusual imaging findings in the MRI of fungal infection in an immunocompetent host, whereby hyper-intense signals were seen on T2-weighted images and patchy post-contrast enhancement was observed with surrounding edema. These findings were suggestive of a neoplastic lesion but it was identified as aspergillosis on subsequent histopathology. This unusual MRI finding of CNS highlights the need to consider fungal infection as a differential diagnosis of all …
Magnetic Resonance Spectroscopy Of Enhancing Cerebral Lesions: Analysis Of 78 Histopathology Proven Cases,
2014
Aga Khan University
Magnetic Resonance Spectroscopy Of Enhancing Cerebral Lesions: Analysis Of 78 Histopathology Proven Cases, Muhammad Shahbaz Alam, Humera Ahsan, Zafar Sajjad, Madiha Beg, Umer Bhatti, Ather Enam, Mohammad Wasay
Department of Radiology
Objectives: To investigate the efficacy of magnetic resonance spectroscopy in differentiating various types of neoplastic and non-neoplastic enhancing cerebral lesions.
Methods: The prospective study was conducted from January 2007 to December 2009 at the Department of Radiology, Aga Khan University Hospital, Karachi. All patients with enhancing brain lesions on magnetic resonance imaging who underwent magnetic resonance spectroscopy and a biopsy with histopathological analysis were included in study. The lesions were categorised into neoplastic and non-neoplastic lesions on the basis of spectroscopy findings. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of magnetic resonance spectroscopy were calculated. …
Prospective Validation Of A Blood Ordering Protocol For Elective Spine Arthrodesis And Its Impact On Cost Reduction,
2014
Aga Khan University
Prospective Validation Of A Blood Ordering Protocol For Elective Spine Arthrodesis And Its Impact On Cost Reduction, Muhammad Waqas, Muhammad Shahzad Shamim, Badar Uddin Ujjan, Saqib Kamran Bakhshi
Section of Neurosurgery
Background: On the basis of an institutional audit, the authors published an individual patient-based protocol for preoperative arrangement of blood products in patients undergoing elective spine arthrodesis. The present study was conducted for the prospective validation of the proposed protocol in reducing cross match to transfusion ratio, and its implications on overall cost.
Methods: This cross-sectional study was conducted over 1 year (2012). All adult patients who underwent elective spinal arthrodesis were included and prospectively observed. The actual transfusion index was calculated for individual patients with the formula C1/T, where C1 is the number of units of packed RBCs cross …
Lumbar Morphometry: A Study Of Lumbar Vertebrae From A Pakistani Population Using Computed Tomography Scans,
2014
Aga Khan University
Lumbar Morphometry: A Study Of Lumbar Vertebrae From A Pakistani Population Using Computed Tomography Scans, Muhammad M. Alam, Muhammad Waqas, Hussain Shallwani, Gohar Javed
Section of Neurosurgery
Study design: A cross-sectional study.
Purpose: To describe the characteristics of lumbar vertebrae of Pakistani patients reporting at a tertiary care hospital and compare with studies from other populations.
Overview of literature: Several studies have been conducted to determine morphometry of lumbar vertebrae. Most of the studies involve Caucasian populations, still data on other populations still sparse. This is the first study describing lumbar morphometry of a Pakistani population.
Methods: An observational study was conducted based on a review of thin-cut (3 mm) computed topographic images of lumbar vertebrae. Two-hundred and twenty vertebrae from forty-nine patients were studied, and various …
Polio Travel Restrictions: A Sledgehammer To Crack A Nut?,
2014
Aga Khan University
Polio Travel Restrictions: A Sledgehammer To Crack A Nut?, Rashid Jooma
Section of Neurosurgery
Imposition by WHO of mandatory vaccination for international travelers from Pakistan has caused confusion and panic amongst travelers besides the adverse effect on the country's image from the widely reported statement. It is felt that the announced measure is not primarily supported by science but is rather a response to disillusionment in the donors about the repeatedly missed eradication targets set by WHO. In the past few years, exportation of poliovirus from Pakistan has caused outbreaks in China, Iraq and Syria besides the ongoing two way transmission with Afghanistan, but the carriers in these spreads are mainly land route travelers. …
Thoracic And Lumbar Spinal Surgery Under Local Anesthesia For Patients With Multiple Comorbidities: A Consecutive Case Series,
2014
Aga Khan University
Thoracic And Lumbar Spinal Surgery Under Local Anesthesia For Patients With Multiple Comorbidities: A Consecutive Case Series, Muhammad Babar Khan, Rajesh Kumar, Ather Enam
Section of Neurosurgery
Background: Although some patients with symptomatic spinal disease may benefit greatly from surgery, their multiple attendant comorbidities may make general anesthesia risky or contraindicated. However, there is scarce literature describing the efficacy and safety of local anesthesia to perform these operations. Here we report seven patients who successfully underwent spinal surgery utilizing local anesthesia to limit the risks and complications of general anesthesia.
Methods: Seven patients for whom general anesthesia was contraindicated were prospectively followed for a minimum of 3 months following spinal surgery performed under local anesthesia. Pain and functional improvement were assessed utilizing the Visual Analog Scores (VAS) …
Novel Anticancer Agents In Clinical And Preclinical Trials,
2014
Aga Khan University
Novel Anticancer Agents In Clinical And Preclinical Trials, Adnan Salim
Section of Neurosurgery
No abstract provided.
Primary Elective Spine Arthrodesis: Audit Of Institutional Cross Matched To Transfused (C/T) Ratio To Develop Blood Product Ordering Guidelines,
2013
Aga Khan University
Primary Elective Spine Arthrodesis: Audit Of Institutional Cross Matched To Transfused (C/T) Ratio To Develop Blood Product Ordering Guidelines, Muhammad Mehboob Alam, Zain A. Sobani, Muhammad Shahzad Shamim, Khabir Ahmad, Fouzia Minai
Section of Neurosurgery
Background: Currently, there are no uniform guidelines regarding the appropriate amount of blood products ordered prior to spine surgery. Here, we audited our own institution's practices along with preoperative variables that contributed to perioperative transfusion requirements for elective spinal arthrodesis.
Methods: This study utilized a single institution retrospective chart review of patients undergoing elective spinal fusion over a 2 year period. The cross matched to transfused (C/T) ratio was utilized to compare different patient groups. Sub-group multivariate analysis enabled us to identify possible predictors of transfusion for this patient population.
Results: Eighty-five patients were included in the study. Of the …
Why We Must Provide Better Support For Pakistan's Female Frontline Health Workers,
2013
Middlebury College, Middlebury, Vermont, United States of America
Why We Must Provide Better Support For Pakistan's Female Frontline Health Workers, Svea Closser, Rashid Jooma
Section of Neurosurgery
Svea Closser and Rashid Jooma argue that achieving polio eradication and strengthening Pakistan's health system must focus not just on international engagement but also on local partnerships with Lady Health Workers and other ground-level staff. Please see later in the article for the Editors' Summary.
Safety Of Untreated Autologous Cranioplasty After Extracorporeal Storage At -26 Degrees Celsius,
2013
Aga Khan University
Safety Of Untreated Autologous Cranioplasty After Extracorporeal Storage At -26 Degrees Celsius, Muhammad Zubair Tahir, Muhammad Shahzad Shamim, Zain-Ul-Abdeen Sobani, Syed Nabeel Zafar, Mohsin Qadeer, Muhammad Ehsan Bari
Section of Neurosurgery
Background: Given the improved survival of patients requiring decompressive craniectomies, the frequency of subsequent cranioplasties are on the rise. The most feared complication of autologous cranioplasty is infection and one method for reducing the rate of infection, is to store the bone flaps at subnormal temperatures. However, to date there is no defined temperature for flap storage and temperature ranges from - 18 to - 83°C have been described in literature. Considering our limited resources it has been the practice at our center to store bone flaps at - 26°C. In this study, we have retrospectively reviewed our practice and …
Surgical Management Of Traumatic Extra Dural Hematoma In Children: Experiences And Analysis From 24 Consecutively Treated Patients In A Developing Country,
2013
Aga Khan University
Surgical Management Of Traumatic Extra Dural Hematoma In Children: Experiences And Analysis From 24 Consecutively Treated Patients In A Developing Country, Muhammad Babar Khan, Muhammad Riaz, Gohar Javed, Fauzan Alam Hashmi, Maryam Sanaullah, Syed Ijlal Ahmed
Medical College Documents
Background: Children with epidural hematoma (EDH) present differently than adults. The outcome of treatment is also different. We aim to report our experiences with EDH in pediatric age group in terms of mode of injury, presenting features, management, and outcomes. We also aim to identify different prognostic indicators in pediatric patients with EDH.
Methods: We prospectively collected data from 24 consecutively surgically treated pediatric patients. The data collected included presenting features, radiological imaging, details of management, and outcomes. Descriptive analysis was performed and different variables were tested for any statistical significance with Glasgow Outcome Score (GOS).
Results: There were 19 …
Giant Cell Tumour Of The Sacrum: Function-Preserving Surgery With Extended Curettage And Ilio-Lumbar Fusion,
2013
Aga Khan University
Giant Cell Tumour Of The Sacrum: Function-Preserving Surgery With Extended Curettage And Ilio-Lumbar Fusion, Riaz Hussain Lakhdawala, Tashfeen Ahmad, Ather Enam
Section of Orthopaedic Surgery
Giant cell tumours of the sacrum pose a unique therapeutic challenge due to the inaccessibility of the tumour, significant intra-operative blood loss from extensive vascularity, high rate of local recurrence with conservative surgery, and loss of neurological function and mechanical instability with en-bloc excision. We present a case where successful outcome was achieved by tailoring treatment in consideration of the above issues. A 28 year old male diagnosed on biopsy to have giant cell tumour of the sacrum presented to us with low-back pain, left-sided S1 radiculopathy, ankle weakness and urinary incontinence. MRI showed a tumour involving the S1 and …
How Effective Is The Local Anesthetic Infiltration Of Pin Sites Prior To Application Of Head Clamps: A Prospective Observational Cohort Study Of Hemodynamic Response In Patients Undergoing Elective Craniotomy,
2013
Aga Khan University
How Effective Is The Local Anesthetic Infiltration Of Pin Sites Prior To Application Of Head Clamps: A Prospective Observational Cohort Study Of Hemodynamic Response In Patients Undergoing Elective Craniotomy, Ayesha Arshad, Muhammad Shahzad Shamim, Muhammad Waqas, Hina Enam, Syed Ather Enam
Section of Neurosurgery
Background: Use of Mayfield clamps is associated with potentially hazardous hemodynamic effects. Use of local anesthetic infiltration has yielded varying results in blunting of this response. The authors' objective was to study the effect of lidocaine with adrenaline infiltration at Mayfield pin sites on hemodynamic response in comparison with no intervention.
Methods: This was a prospective cohort study conducted at a tertiary care center from January 2012 to July 2012. Patents undergoing elective craniotomies over the study period were included and divided in two groups, Group A received lidocaine infiltration of the pin sites prior to insertion, while Group B …
Craniocerebral Injuries In War Against Terrorism --- A Contemporary Series From Pakistan,
2013
Aga Khan University
Craniocerebral Injuries In War Against Terrorism --- A Contemporary Series From Pakistan, Muhammad-Umair Bashir, Muhammad-Zubair Tahir, Ehsan Bari, Sehreen Mumtaz
Section of Neurosurgery
Objective: Terrorism-related bomb attacks on civilian population have increased dramatically over the last decade. Craniocerebral injuries secondary to improvised explosive devices have not been widely reported in the context of unarmored civilians. This series intends to report the spectrum of these injuries secondary to suicidal and implanted bombs as encountered at the Aga Khan University Hospital, Pakistan (AKUH). Further, a few pertinent management guidelines have also been discussed.
Methods: The hospital database and clinical coding during a 5-year period were examined for head injuries secondary to terrorism-associated blasts. In addition to patient demographics, data analysis for our series included initial …
Lateral Access Surgery For The Thoracolumbar Spine,
2013
Instituto de Patologia da Coluna
Lateral Access Surgery For The Thoracolumbar Spine, Luiz Pimenta, William Smith, William Taylor, Juan Uribe
Neurosurgery and Brain Repair Faculty Publications
No abstract provided.
Observer Variation In Mri Evaluation Of Patients With Suspected Lumbar Disc Herniation And Nerve Root Compression: Comparison Of Neuroradiologist And Neurosurgeon's Interpretations,
2012
Aga Khan University
Observer Variation In Mri Evaluation Of Patients With Suspected Lumbar Disc Herniation And Nerve Root Compression: Comparison Of Neuroradiologist And Neurosurgeon's Interpretations, Imaad-Ur Rehman, Rana Shoaib Hamid, Waseem Akhtar, Muhammad Shahzad Shamim, Rohana Naqi, Haji Ismail Siddiq
Department of Radiology
Objective: To analyse inter-observer variation between a neuroradiologist and neurosurgeon in the MRI diagnosis of lumbar nerve root compression. Although lumbar MFI is primarily analyzed and reported by a radiologist, neurosurgeons often analyse it independently as they have sufficient clinical background as well as radiological expertise to diagnose most spinal pathologies on Magnetic Resonance Imaging (MRI).
Methods: Retrospective analysis was carried out for images of 54 patients who underwent MRI between March and July 2010 of lumbar spine with suspected lumbar disc herniation and nerve root compression, at Aga Khan Hospital, Karachi, Pakistan. One fellowship trained neuroradiologist and one neurosurgeon …
Neurosurgical Electives: Operating Room Survival Guide,
2012
Aga Khan University
Neurosurgical Electives: Operating Room Survival Guide, M Shahzad Shamim, Zain A. Sobani
Section of Neurosurgery
No abstract provided.
