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  • ISSN: 2373-9479
    Volume 3, Issue 2
    Clinical Image
    Kourosh Tavanaiepour, and George J. Kaptain*
    Introduction of air into the components of a VPS is a recognized cause of shunt failure. Pneumoventricle is particular seen more in noncompliant ventricles because when fluid is drained the ventricles do not collapse and subsequently allows air to fill the ventricles [1].
    Case Report
    Farid Yudoyono*, Ferry Senjaya, Mira Yuniarti, Vonny Gunawan, Muhammad Z. Arifin, and Ahmad Faried
    Abstract: Thoracic Outlet Syndrome (TOS) resulting from compression of irritation of the of the neurovascular structure at various level of the cervico-thoracic-brachial passages.
    Here, we describe a case in a 56-year- old woman. He initially experienced a right-sided shoulder pain and fingers numbness increase with exercise and persisted after cessation of activities diagnosed as Neurogenic Thoracic Outlet Syndrome (NTOS). Physical examination revealed chronic neurogenic changes in the hand muscles. Further investigation showed cervical rib on plain X-ray. The patient underwent surgical decompression was performed scalenectomy and long tranverse process and fibrous band resection. The pathophysiology, radiology, classification, and treatment strategy are discussed in the report.
    Research Article
    Agung Budi Sutiono*, Azela Glady, Muhammad Zafrullah Arifin, Ahmad Faried, Kazunari Yoshida, and Takeshi Kawase
    Background: Trigeminal schwannomas may originate from the root, the ganglion, or the peripheral branches of the trigeminal nerve. Trigeminal schwannomas are rare tumors that comprise of 0.2% of all intracranial tumors.
    Objective: To clarify the pattern of trigeminal schwannomas in relation with meninges for surgical considerations.
    Methods: We used 3 adults head cadaver specimens were used for surgical simulation and taken for immunohistochemical staining to observe the meninges pattern and applied in surgical technique.
    Results: This was confirmed qualitatively with Masson's Trichrome staining for collagen and elastin for the cranial dura. In our study we found that the dura wrapped the trigeminal nerve from the beginning of gaserian gangglion which change into interdural space. It becomes periosteal dura after passing through the foramen, we call it extracranial part. The Myelin basic protein staining shows the nerve filament which covered by piamater at the root entry zone.The arachnoid clearly covers the nerve bundle from entering Meckel cave and becoming perineurium in the interdural space. At the extracranial part the nerve filamen or bundle is only covered by periosteal dura or similar to epineurium structures.
    Conclusion: From our discussion get conclusion for surgical method, that is 1. We did surgery sub arachnoidal dissection in posterior fossa, 2. submeningoperisoteal dura dissection in middle fossa 3. subperiosteal dissection in infra temporal fossa.
    Vikram A. Mhaskar* and Sudhir N. Pai
    Background: To test the null hypothesis that epidural steroid injection and fenestration discectomy equally improve the quality of life over six months in patients with lumbar disc herniation and to compare the pain component of the SF 36 questionnaire and VAS scale with physical impairment.
    Methods: Prospective study of 51 patients, 27 of which underwent epidural steroid injection and 24 fenestration discectomy with evidence of lumbar disc herniation on MRI using the SPORT (Spinal Outcomes Research Trial) eligibility criteria from April 2009 and February 2012.
    Results: Of the 51 patients, 27 were treated with Epidural steroid injection and 24 with Fenestration Discectomy, at 6 months primary outcomes of Physical Functioning, Energy /Fatigue, Emotional, Pain and General health improved in both groups with no statistically significant difference between the two, Social Functioning did not improve significantly. There was a statistically significant variation of end line as well as percentage change in physical index score with SF36 and VAS scores.
    Conclusions: There was significant improvement in quality of life of life of patients treated with both epidural steroid injection and fenestration discectomy with no statistically significant difference between the two groups at all intervals till six months. There was no significant difference between the VAS and pain component of SF 36 scale in measuring improvement in pain. The improvement in quality of life co related with the improvement in physical signs and symptoms.
    Alvaro Baik Cho*, Gustavo Bersani Silva, Raquel Bernardelli Iamaguchi da Costa, Leandro Yoshinobu Kiyohara, Luiz Sorrenti, Marcelo Rosa de Rezende, Teng Hsiang Wei, and Rames Mattar Júnior
    Introduction: The aim of this retrospective study was to evaluate the restoration of shoulder flexion and external rotation by neurotization of the Suprascapular Nerve with the Spinal Accessory Nerve (SAN-SSN) in patients with severe traction injuries of the brachial plexus involving C-5 and C-6 cervical roots.
    Methods: Eleven SAN-SSN neurotizations by direct suture were performed. Inclusion criteria were: root avulsion/rupture of C-5 and C-6; suprascapular nerve and upper trunk not stimulable intraoperatively; Minimum follow-up: 12 months. Patient average age at surgery was 28 years (13-43). The mean interval between trauma and operation was 7 months (4-13). The mean follow-up was 31 months (13-60). Shoulder function was evaluated by determining the muscular strength of abduction and external rotation according to the British Medical Research Council.
    Results: 73 % of the patients (8/11) did not regain useful shoulder function after SAN-SSN. Only 3 patients reached muscle strength grade 3 or greater, and in only one child the neurotization had been the isolated procedure for shoulder reconstruction. The other two patients that recovered shoulder flexion and external rotation had an upper trunk reconstruction with sural nerve grafts concurrently with SAN-SSN neurotization.
    Discussion: Postoperative clinical evaluation of the SAN-SSN neurotization showed poor reestablishment of shoulder function and these results led to a critical analysis of this procedure - classic and widely popular among hand surgeons - especially when performed in isolation for restoration of shoulder flexion and external rotation. The authors recommend the transfer of accessory nerve to the Suprascapular nerve only when direct coaptation is possible and when other procedures for reinnervation of the shoulder, such as grafting to the upper trunk or radial nerve transfer to axillary nerve may be performed concurrently.
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