Scientific Program

Day 1 :

Keynote Forum

Iago Tsertsvadze

Head of the Department Acad. Z. Tskhakaia West Georgian National Centre of Interventional Medicine Georgia

Keynote: Optimization and analysis for Endovascular treatment of ruptured aneurysms in acute phase.

Time :

Biography:

Dr. Iago Tsertsvadze is the Head of Neurosurgical Department at Acad. Z. Tskhakaia West Georgian National Centre of Interventional Medicine in Georgia. He is also the member of Georgian Young Neurosurgical Association, and the Member of The European Association of Neurological Societies. He has been as a Neurosurgeon in Acad. Z. Tskhakaia West Georgian National Centre of Interventional Medicine for about 3 years and has been as a Resident Neurosurgeon in High Technology Medical Centre University Hospital, Neurosurgical Department and Tbilisi First Hospital University Clinic, Neurosurgery Centre for about 5 years.

Abstract:

An untreated ruptured aneurysm is at high risk of rebleeding . (2,3). This new rupture may occur very early even before the patient has arrived at the hospital, but it usually happens several days later. Risk increases over time and without intervention the cumulative risk at 4 weeks is 40%.  (3)

In addition, rebleeding is associated with a poor prognosis and high morbidity and mortality (3). In the ISAT trial, 59% of patients who suffered an early rebleed died. (1)

It is therefore important to occlude the aneurysm promptly. Because of the estimated risk of recurrence of 4.1% within 24 hours after the initial rupture, ultra-early treatment of a ruptured aneurysm has been proposed. (4) But on the other hand, the advantages of this strategy are controversial (5), particularly in view of the increased risk of complications during procedures performed in the middle of the night, and also because there is currently no consensus on ultra-early treatment. According to current guidelines, the aneurysm should be excluded promptly, within 72 hours and if possible within 48 hours.

The ISAT trial is the only randomized multicenter international trial that has compared surgery to endovascular coiling for ruptured intracranial aneurysms. Its results supported endovascular treatment and showed a significant reduction in the risk of dependency or death at 1 year, (1) although the population in this study included a great majority of young patients in good clinical state (WFNS grades 1 or 2), (6) with anterior circulation aneurysms under 10 mm in size. The results of this study led to a large and unrestricted increase in endovascular treatment for ruptured intracranial aneurysms. These results have also been confirmed in other studies (7)   Currently, EVT is considered to be the first line treatment for intracranial aneurysms by most groups.

 

Keynote Forum

Antonio Daher

Neurosurgeon

Keynote: Microvascular Decompression for Primary Hemifacial Spam

Time : 9:40-10:20

Biography:

Dr. Antonio Daher Ramos is the Medical Doctor graduated from the University of Carabobo. Valencia, Venezuela 1982. He has received a National Award of Neurosurgery at Venezuela in the Year 2004. He is the Member of the French Neurosurgical Society. Member of the French Speaking Neurosurgical Society. Member of the North American Skull Base Society. Member of the Latin American Federation of Neurosurgery. Member of the Inter-American Society of Minimal Invasive Spinal Surgery (SICCMI). Member of the Venezuelan Neurosurgical Society. Member of the Latin American Society of Functional and Stereotaxic Neurosurgery (SLANFE). He has done his Fellow resident in the Service of Professor Gazi Yasargil. Zurich, 1987.Numerous works of him is being published in national and international journals.

Abstract:

Hemifacial spasm is a rare disease characterized by involuntary muscle contractions in one side of the face; it has an incidence of less than 1 in 100,000 people. It consists of a progressive, spontaneous and intermittent appearance of contractions of the muscles involved in facial expression.

Hemifacial spasm has an important psychological and cosmetic effect in patients; in advanced cases, vision may also be affected. In our experience, primary hemifacial spasm is a disease that usually begins between 41 and 60 years with an average of 50 years.

However, different literature series suggests that the age of appearance can vary between 18 and 77 years. Most patients are female with an incidence of 2.4 women over men. The most affected side of the face is the left side. It has been suggested that the predominance of the left side may be due to a predisposition of the embryological position in relation to the facial nerve compression and the compressed vessel in the entry zone of the nerve on the left side. The nerve compression at the brainstem is almost always seen on magnetic resonance imaging (MRI).

Bilateral hemifacial spasm is very rare.

The definitive treatment is Microvascular Decompression (MVD) of the facial nerve in the cerebello-pontine angle, which cures the disease in 80 to 90% of patients.

  • Neurotraumatic Brain Injury

Session Introduction

Ravi Ichalakaranji

KLE Hospital of Nehru nagar India

Title: Penetrating brain injury in a young patient –the mystery revealed
Speaker
Biography:

Dr. Ravi Ichalakaranji is a Resident in General Surgery in BLDE Shri B M Patil medical college and research centre at Bijapur. He has been working as an Assistant professor, and as a Consultant at KLE Dr. Prabhakar medical hospital at Belgaum. Presently he is being in the field of Neurosurgery with various Cranial and Spine Surgery. He has published his articles in various journals. Dr. Ravi Ichalakarnji is the Member of member of Association of Surgeons of India and the Member of Neurological Society of India.

 

Abstract:

Penetrating brain injury (PBI) is a traumatic brain injury (TBI) caused by low-velocity sharp objects (e.g., a knife) or high-velocity projectiles (shell fragment or bullets); Penetrating brain injury (PBI), though less prevalent than closed head trauma, carries a worse prognosis. Based on current evidence,  computed tomography scanning will be helpful  as the neuroradiologic modality of choice for PBI patients. Cerebral angiography is recommended in patients with PBI, where there is a high suspicion of vascular injury. It is still controversial whether craniectomy or craniotomy is the best approach in PBI patients. The present recommendation for management of civilian penetrating brain injuries is craniotomy and débridement of the skull with replacement of the bone to avoid the future need for cranioplasty.

 

  • Spinal Neurosurgery
Speaker
Biography:

Soon Yee Tan is a Neurosurgical trainee currently working in Neurosurgery Department, Sibu Hospital in the state of Sarawak, Malaysia. He acquired his basic MBBS degree from University of Malaya, Malaysia and post-basic MRCS degree from The Royal College of Surgeons of Edinburgh. He has special interest in Spinal Neurosurgery and looking to pursue further in that particular field.

 

Abstract:

Lumbar puncture (LP) is a common bedside procedure performed for both diagnostic and therapeutic purposes. Injury to epidural venous plexus with resultant epidural hematoma is usually benign and self-limiting. However, lumbar subarachnoid haemorrhage (SAH) is a rare complication of LP resulting from injury to the spinal radicular arteries, usually with contributing factors from coagulopathy and anticoagulant therapy.

We report a case of 56 year-old gentleman with underlying T-cell acute lymphoblastic leukaemia undergoing chemotherapy. He initially presented to medical team with progressive multiple cranial nerves (CNs) deficit consisting of CNs 6, 7, 9, 10 and 12, which were thought to be due to leukaemic central nervous system (CNS) infiltration, tuberculous or viral infection. Multiple attempts of LP were performed to obtain cerebrospinal fluid (CSF) for diagnostic purpose but all returned as dry taps, with minimal blood oozing from LP sites. The patient subsequently developed acute onset paraparesis, urinary and bowel dysfunction a day after. Clinically power was reduced from bilateral L2 downwards with arreflexia, lax anal tone and weak bulbocavernosus reflex.

His blood parameters showed slightly deranged International Normalised Ratio (INR) of 1.21 and mild thrombocytopenia with platelets of 148 x103/uL. MRI Lumbosacral showed extensive intradural haematoma from L1 downwards occupying the whole thecal sac. A diagnosis of cauda equina syndrome secondary to iatrogenic lumbar intradural hematoma was made for which urgent partial L2, L3-L4 laminectomy was performed. Intra-operatively dense arachnoid adhesions noted around lumbosacral nerve roots circumferentially with thickened arachnoid membranes representing SAH.

Post-operatively, he recovered well and started ambulating on day 5. He was discharged with residual paraparesis and normal urinary and bowel functions.

In conclusion, lumbar SAH is a rare but potentially debilitating complication of LP, therefore it must be considered in patient who developed acute flaccid paraparesis and cauda equina syndrome shortly after LP. Early recognition with prompt surgical decompressive laminectomy is essential to prevent permanent neurological deficits.

 

  • Central Nervous System