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M S Eljamel

Publications and source records attributed to M S Eljamel.

At least 19 recordsLinked to original sources
PubMed1998

The use of spring-eye needles in neurosurgery: a survey of neurosurgical theatres in the United Kingdom.

Spring-eye needles were commonly used in neurosurgery as a method of closure of craniotomy incisions because of the perceived, but not proven, advantages of easy handling, fast wound closure and reduced infection rate. However, these needles produce more tissue trauma and are more fragile. We surveyed 33 neurosurgical operating theatres in the UK to find out if spring eyed needles are still in use and, if they are not why not. We had a 91% response. The survey involved 117 British neurosurgeons, of whom spring-eye needles were used by 38 (13%). Both round body and cutting needles were used, but the cutting needles have a higher breakage rate. The use of 'eyed' needles is rare in other surgical specialties but they are still in use in neurosurgical theatres; however, their use has declined because of changes in surgical practice, the increased breakage rate of these needles, and reduction of their availability.

Equipment Failure↗
PubMed1998

Meningeal chondrosarcomas, a review of 31 patients.

We reviewed the literature to study the clinical features, the management and the outcome of meningeal chondrosarcomas. We included 31 patients in this review: 22 were mesenchymal and nine were non-mesenchymal. The mean age was 27 years and 64% arose from the cranial meninges. The treatment was mainly total surgical excision. Adjuvant therapy was given to 36% of patients. Spinal meningeal chondrosarcomas had a better prognosis (81% 1-year survival and 45% 3-year survival). There were no pathognomonic clinical or radiological features. We concluded that the best management of meningeal chondrosarcomas is total surgical excision whenever possible, followed by combined course of radiotherapy and chemotherapy as soon as possible.

Adult↗
PubMed1997

Accuracy, efficacy, and clinical applications of the Radionics Operating Arm System.

The aim of this study was to evaluate the accuracy and efficacy of the Radionics Operating Arm System (OAS; Radionics Applications Software, Burlington, MA) in a routine clinical setup. The OAS is a frameless stereotactic articulated arm that can be used in conjunction with computed tomography (CT) or magnetic resonance (MR) imaging to provide image-based intraoperative navigation. The system was used in 130 consecutive cases. It failed or was considered unreliable in 4.6% of patients. Among the remaining patients, 103 had OAS-guided craniotomies, 11 had frameless stereotactic biopsies, and 10 had OAS-guided anterior cervical surgery. Patients were imaged 3-12 hours prior to surgery. Skin markers were used in all cases. The OAS accuracy was evaluated by measuring the difference between the actual probe position and its analogous position on the images. Frameless stereotactic biopsies were performed using the OAS, a modified probe, and a twist-drill. Anterior cervical surgery was performed using the OAS, MRI images, and a rigid cervical collar. The duration of the procedure was recorded for the first 50 patients, and the value of the OAS in localizing the site of craniotomy, the margin of the lesion, and the extent of the resection was also recorded. The system was associated with insignificant prolongation of procedure setup and was sufficiently reliable and achieved a useful registration in 124 (95.4%) patients. The mean accuracy of the system, using skin markers, was 2.5 mm. The OAS was also adaptable for performing other tasks, such as an interactive needle biopsy without a frame. Its use in conjunction with a hollow probe, to perform biopsy or aspiration of 11 brain lesions, produced 100% positive results. Its use in conjunction with MRI and a cervical collar fiducial system, to perform anterior cervical surgery in 10 patients, localized the level in all patients. Overall, the Radionics OAS was sufficiently reliable and accurate in a wide range of routine neurosurgical procedures. Therefore, we integrated it into our routine neurosurgical practice.

Adolescent↗
PubMed1995

Total intraventricular migration of unisystem ventriculo-peritoneal shunt.

This is a report of an hydrocephalic adult, in whom a unishunt system migrated upwards into the ventricle despite using the appropriate clips (lock and slip). The shunt migration discovered 3 months following its insertion. Several mechanisms contributed to the migration; negative sucking intra-ventricular pressure, positive pushing intra-abdominal pressure, tortuous subcutaneous track and neck movements. It seams that lock and slip clips are not enough fixation. The best way of preventing such shunt migration is interposing a reservoir between the ventricular and peritoneal catheters.

Adult↗
PubMed1995

Localization of inactive cerebrospinal fluid fistulas.

Because of the importance of preoperative localization of dural fistulas, many imaging modalities have been critically evaluated for their role in pinpointing the site of cerebrospinal fluid (CSF) leakage. Twenty-one consecutive patients who were suspected of having a CSF fistula were studied to evaluate magnetic resonance (MR) imaging in locating the fistula. These patients were also studied independently by fine-slice computerized tomography (CT). The MR images demonstrated lesions compatible with dural fistulas in 19 patients, whereas CT demonstrated only seven of these lesions. All of these patients underwent surgical dural repair. The remaining two patients underwent surgical exploration on the basis of the CT findings but no dural fistula was found in either patient. All patients made a good postoperative recovery. One patient developed a postoperative wound infection and in another CSF leakage recurred. Although MR imaging was very precise in locating the CSF fistulas, CT missed a significant number of these lesions and was falsely positive in 9.5% of cases. Therefore, it is concluded that MR imaging is an essential investigation in patients with a suspected dural fistula and should be performed before embarking upon surgery and before assuming natural healing of the CSF fistula.

Adolescent↗
PubMed1994

MRI cisternography, and the localization of CSF fistulae.

Accurate localization of CSF fistulae not only makes the planning of surgery easier, but it also increases the chances of successful dural repair and eliminates negative exploration. CSF fistulae localization has been a problem for many years, and several methods have been used to pin-point the site of CSF leakage with variable degree of success. Recently, contrast CT cisternography (CCTC) has replaced radio-isotope cisternography (RIC) in many centres. However, both methods are invasive, time consuming, contraindicated in patients with intracranial mass lesions and insensitive in detecting inactive CSF leaks. Furthermore, in both, ionizing radiation is used and both techniques may lead to allergic reactions or seizures. On the other hand, T2-weighted Magnetic Resonance Imaging (MRI) shows the CSF as a high signal without the need to inject contrast media intrathecally. Furthermore, MRI demonstrates the intracranial anatomy and pathology in detail in multiple planes within a relatively short time. MRI does not involve ionizing radiation and therefore is safely repeatable. MRI using T2-weighted sequences should be an ideal tool to locate precisely the site of CSF fistulae. This paper describes our experience with MRI cisternography in CSF fistulae localization. Eleven patients with inactive CSF fistulae were investigated. MRI cisternography localized the site of fistula in each case. All patients were explored surgically and the site of CSF fistula was confirmed and repaired intradurally with a pericranial graft and fibrin glue without recurrence or meningitis.

Adolescent↗
PubMed1994

Fractures of the middle third of the face and cerebrospinal fluid rhinorrhoea.

The incidence of cerebrospinal fluid (CSF) rhinorrhoea in patients with facial fractures is about 25%. Although the management of facial fractures is well documented, its timing and role in the presence of CSF leak is still open to debate. This study evaluates facial manipulation in 89 facial fractures associated with CSF rhinorrhoea, with a mean follow-up of 4 years. The facial fractures were reduced in 26 patients (29%) and the CSF fistula was repaired in 75 (84%). Twenty-three (25.8%) had both facial manipulation and dural repair with no deaths, post operative infection, failure or recurrence of CSF leak. On the other hand, when facial manipulation or dural repair was performed alone, the CSF rhinorrhoea either persisted or recurred in a significant number of patients requiring further intervention. Although this is a retrospective analysis of patients treated over several years and, there has been a change in the methods of investigation and treatment of these patients, one can conclude that manipulation of facial fractures and surgical dural repair can be carried out at the same sitting without increasing the surgical morbidity and mortality.

Adult↗
PubMed1993

Antibiotic prophylaxis in unrepaired CSF fistulae.

The value of antibiotic prophylaxis in patients with Cerebrospinal Fluid Leakage (CSF) is debatable. The aim of this study was to determine the value of prophylactic antibiotics in these patients. The study population comprised 253 patients with definite CSF leaks, of whom 106 received adequate antibiotic prophylaxis (Group A) and 109 were not treated with antibiotics (Group B). Thirty-eight patients were excluded from the analysis because they received antibiotics for reasons other than the CSF leakage. The two groups were closely matched for age, sex, type of CSF fistula, site, and duration of CSF leakage and presence or absence of skull fractures, but there were more patients with facial fractures and pneumocephalus in those who were treated with antibiotics. The first week meningitis rate was 6.6 and 9.17% in the treated and untreated groups, respectively, while the annual risk of meningitis was 7.6% in the treated and 11.9% in the untreated group. However, these differences did not reach significance (P > 0.05). The survival curves of meningitis-free survival were similar in the two groups, particularly during the first 4 weeks during which antibiotics were given (Log Rank test, p > 0.05). Furthermore, there were more cases of Gram-negative infection and of partially-treated meningitis in the treated group. Although this was a retrospective, non-randomized study, it confirms the conclusions of previous smaller series, that prophylactic antibiotics do not significantly reduce the risk of meningitis in these patients. It is ethically justifiable to withhold antibiotic prophylaxis in patients with CSF fistulae until a prospective controlled double blind trial has settled the question.

Adult↗