Hemispherectomy: When Half a Brain Is Better than a Whole One

Introduction

Hemispherectomy is a very rare neurological procedure which involves total or partial removal of an affected cerebral hemisphere or removing/disconnecting the affected part from the unaffected part. It is a rare neurological procedure which is used to treat the variety of seizure disorders where the source of the epilepsy is localized to a wide region of a single hemisphere of the brain, notably Rasmussen's encephalitis

Rasmussen's encephalitis, maybe an uncommon inflammatory neurological disease, characterized by the visit and serious seizures, the loss of motor skills and speech, hemiparesis (weakness on one side of the body), encephalitis (inflammation of the brain), and dementia. The illness influences a single cerebral hemisphere and generally happens in children beneath the age of 15.

Almost one in three patients with epilepsy will proceed to have persistent seizures despite epileptic drug treatment. Hemispherectomy is reserved for the foremost extreme cases of this one-third in which the individual’s seizures are irresponsive to drugs or other less intrusive surgeries and essentially disable working or put the patient at the chance of further complications. The method effectively cures seizures in around 85%-90% of patients. Furthermore, it is additionally known to often uniquely improve the cognitive functioning and improvement of the individual. Subtotal hemispherectomy sparing sensorimotor cortex can be performed with successful seizure control expected in 70-80% of patients. Indeed with the presence of widespread one-sided epileptogenicity or anatomic/functional imaging anomalies, complete hemispherectomy can regularly be avoided, especially when there's little hemiparesis.

The removal of half brain sounds too radical to ever consider, much less perform. In the last century, many surgeons have performed it hundreds of times for disorders uncontrollable in another way. Unbelievably, the surgery has no apparent effect on personality or memory. The first known hemispherectomy was performed in dogin 1888 by a German Physiologists Friedrich Goltz.

What patients are appropriate for a hemispherectomy?

1. Medically intractable epilepsy with seizures arising from the pathological side.

2. The weakness of one side of the body with loss of dexterity of the hand with, or without, peripheral vision loss.

3. Developmental retardation or arrest of maturation due to intractable seizures.

4. Diffuse abnormality of one cerebral hemisphere which is contributing to intractable epilepsy.

What are the various types of hemispherectomy?

There are two types of hemispherectomy which is commonly performed.

Anatomical hemispherectomies include the removal of the frontal, parietal, temporal, and occipital lobes., though useful hemispherectomies only take out parts of a hemisphere, as well as separating the corpus callosum, the fiber bundle that connects the two parts of the brain. The deeper structures like basal ganglia, thalamus and brain stem are left in place.The evacuated cavity is left empty, filling with cerebrospinal liquid in a day or so. It is performed in the case of hemimegalencephaly.

The functional technique involves the removal of a smaller area of the affected hemisphere and disconnecting it from the remaining brain tissue.

Potential Complications of Hemispherectomy in Children

·         Nausea

·         Fatigue

·         Depression

·         Headache

·         Difficulty with speech and memory

·         Neuropsychological tests will be performed to detect any changes in your child’s function

·         Scalp numbness

Transoral robotic surgery

Transoral Robotic surgery is a procedure in which surgical robots as an assistant to remove the mouth and throat cancers or to remove the tumor from the mouth and the throat. This surgery gives the surgeons an enhanced view of the affected part and the surrounding tissues. In TORS, the arms of the robots are strategically placed inside the mouth or throat which allows the movements in tiny places in tiny spaces in a more precise and also gives the capability to the surgeons to work around corners by controlling the arms of the robots while sitting in his console. As compared to the traditional procedures, the TORS tends to result in a quicker recovery and fewer complications in mouth and throat surgeries.

Current Robotic System

The Da Vinci Surgical System comprises of three components: a surgeon’s support, a patient-side robotic cart equipped with four arms, and a high-definition three-dimensional vision cart with a centrally located endoscope. Articulating surgical instruments are mounted on the robotic arms, which are presented into the upper aerodigestive tract through the mouth of the patient and controlled remotely with master robot controllers from the surgeon’s support.

The working ends of the two instrument arms are equipped with greatly small (5-mm and 8-mm) mechanical “endowrists,” which have a 360° extent of movement and which are controlled with handles at the surgeon’s support. The system incorporates hand tremor filtration and movement scaling that translates the large developments of the surgeon’s hands to the little movements of the mechanical instruments. The dexterity and precision managed by the more agile developments of the small mechanical instruments permit more exact dealing with of tissues, improved definition of safe surgical margins, and the capacity to adjust surgical procedures to intraoperative discoveries.

Risks

As with any the procedure, there are risks that you need to be aware of. The level of  risk will vary depending on the extent and type of surgery you undergo:

1.    Bleeding, including hematoma: If there is severe bleeding after the procedure, your surgeon might need to quickly take you back to the operating room to stop the bleeding.

2.    Infection: The tongue and the pharynx have a strong blood supply, and as such, infections of the tongue are extremely uncommon. Still, as with any surgical procedure, there is always the risk of an infection after the surgery, particularly if the glossectomy is associated with additional procedures that might connect the mouth with the neck. This might require antibiotics and/or drainage of the infection.

3.    Dysarthria, or difficulty speaking: The extent your speech is affected will depend on how much and what part of the tongue is removed. You may consult with a speech and swallowing specialist to improve your function.

4.   Dysphagia, or difficulty swallowing: The extent that your swallowing is affected will depend on how much and what part of the tongue or pharynx is removed.

5.    Salivary fistula: This means that saliva is leaking from the mouth into the neck. Avoidance of this problem is why some surgeons choose to delay the neck dissection for a few weeks after the TORS procedure. The chances of this increase, if you have had previous treatment including radiation and/or chemotherapy. This is because wound healing might be impaired in these cases.

Typical treatment for usually to place a drain to divert the saliva away from critical structures within the neck and afterward to put packing into that diverted tract and let the body heal it up on its own. In a few cases, an extra surgical method can be required to close the leak.

Open heart surgery outperforms stents in patients with multivessel disease

Introduction:

Coronary Artery Bypass Grafting (CABG) is a type of surgical procedure that is done to restore normal blood to an obstructed coronary artery. This process is done in case of severe Coronary Heart Disease (CHD).

Coronary Heart Disease or CHD is the most common type of heart disease in which a substance called plaque (plak) builds up inside the arteries. Arteries supplies oxygen-rich blood to the heart which will be affected by the formation of Plaque. Plaque can be narrow and is made up of fat, cholesterol, calcium and other substances found in the blood which ultimately results in the blockage of the coronary arteries and slows the flow of blood to the heart muscle. If the blockage is severe, then it will cause angina (chest pain or discomfort that occurs if an area of your heart muscle when it does not get enough oxygen-rich blood) and heart attack.

Why CABG is important

Coronary artery bypass grafting (CABG) surgery may be the leading treatment choice for most patients with more than one blocked heart artery, according to new research. Analysts information demonstrate a noteworthy mortality advantage with CABG over percutaneous coronary intervention (PCI), and this advantage is reliable over essentially all major patient groups, recommending that CABG ought to be considered in broader patient populations, not fair in cases of patients with diabetes and left ventricular dysfunction, which is what is commonly practiced.

A new study found that from the last several years have seen a shift toward more PCI over CABG. While there may be valid reasons from the research data which show CABG outperforming PCI in almost every patient group, should push us to further, discuss all of the options."

PCI, often referred to as angioplasty, is a nonsurgical procedure that uses a thin, flexible catheter placed into an artery in the groin or arm. A balloon on the end of the catheter is positioned in the narrowed coronary artery and inflated to open up the blockage. A stent is a metal mesh tube that is left behind to help the artery from collapsing. Drugs attached to the stent, help to prevent the body from reacting to the stent and shutting down the artery again.

CABG, the most commonly performed heart operation in the United States is designed to bypass the blockages in the coronary arteries in order to create a new path for blood flow to the heart. The surgeon removes a healthy blood vessel, usually from the leg, arm, chest, or abdomen, and connects it to the other arteries (usually the aorta) in the heart. This enables blood flow to "bypass" or goes around the affected or blocked portion of the coronary artery.

The decision between open heart surgery and PCI for the treatment of patients with multiple narrowed arteries are not always straightforward, according to Researcher. Thus, these more complex treatment decisions should be made with the guidance of a heart care team.

"Both cardiac surgery and stenting have roles among patients with coronary artery disease," said Researcher. "Because of this, it is important to deliberate carefully with the help of a heart team. The team can ensure that a multidisciplinary approach is used when offering recommendations to patients and assisting them in making informed decisions."

A heart care team generally includes cardiothoracic surgeons and cardiologists. Other health care providers such as primary care physicians, physician assistants, nurse practitioners, imaging specialists, and anesthesiologists also may be part of the team. This approach is following more for the expertise of these advanced practice providers in an effort to improve the efficiency and advance the quality of care for patients.

Cryosurgery

Cryosurgery is also known as cryoablation, cryosurgical ablation or cryotherapy. It is a surgery which involves the usage of extreme cold produced by liquid nitrogen or carbon dioxide to freeze and destroy abnormal cells in the body.

Previously, it is used to treat the tumors present outside of the body but nowadays it is also used for the treatment of internal tumors. Cryotherapy is a procedure in which an extremely cold liquid or an instrument (called cryoprobe) is cooled with substances such as liquid nitrogen, liquid nitrous oxide, or compressed argon gas to freeze and destroy abnormal tissue. Cryotherapy is used to treat both cancer cells and going to be cancer cells.

In case of external surgery, the liq. Nitrogen is applied directly to the cancer cells with a cotton swab or spraying device, this is mostly used in the skin. But in internal tumors, the liq. Nitrogen is circulated through a hollow instrument (cryoprobe) which is placed in contact with the tumors. The surgeons use ultrasound or MRI to guide the cryoprobe and monitor the freezing of the cells, thus limits the damaging of the nearby healthy cells/tissues.

(In ultrasound, sound waves are bounce off on organs and other tissues to form a picture i.e. sonogram.) A ball of ice crystals forms around the probe and solidify the adjacent cells. Now and then more than one probe is utilized to convey the liquid nitrogen to various parts of the tumor. The probes may be put into the tumor during surgery or through the skin (percutaneously). After cryosurgery, the solidified tissue defrosts and is either normally ingested by the body (for inside tumors), or it breaks down and forms a scab (for outside tumors).

Types:

Cryosurgery is used to treat several types of cancer and a few precancerous or noncancerous conditions. In addition to prostate and liver tumors, cryosurgery can be a viable treatment for the following:

1.    Retinoblastoma (a childhood cancer affects the retina of the eye). Surgeons found that cryosurgery is most effective when the tumor is small and only in certain parts of the retina.

2.    Early-stage skin cancers (both basal cell and squamous cell carcinomas).

3.    Precancerous skin growths are known as actinic keratosis. Precancerous conditions of the cervix known as cervical intraepithelial neoplasia (when abnormal cell develops in the cervix it leads to cervical cancer).

Benefits vs. Risks?

Benefits

1.    In an open surgical approach, the recovery period of kidney and liver tumor is less as compared to open, surgical removal of the tumor.

2.    But in the case of percutaneous cryotherapy, the patient may stay overnight or be released a few hours after the procedure (In some cases Overnight stays for pain control is usually not needed).

3.    Percutaneous cryotherapy is less traumatic than open surgery since only a small incision is needed to pass the probe through the skin, which limits damage to healthy tissue. Also, percutaneous cryotherapy is cheap and results in fewer side effects than open surgery. Usually, a patient resumes their daily living activities in 24 hours after the procedure, if not sooner. However, patient is not allowed for heavy lifting for several days after abdominal treatment.

4.   For the treatment of fibroadenomas, cryotherapy causes minimal scar tissue and no apparent post-treatment calcifications.

Risks

1.    Like several percutaneous strategies, bleeding may result—both from the cut and the solidifying of tissues such as the liver, kidney or lung.

2.    Damage to normal structures may happen. During liver cryotherapy, the bile ducts may be harmed. During kidney cryotherapy, the ureter or collecting framework may be harmed. The rectum may be damaged during prostate cryotherapy. Any treatment of the abdomen may result in damage to the bowel and cause a hole in the bowel, which may discharge bowel substance into the abdomen that can lead to potentially life-threatening infection. If solidifying happens to close the stomach, fluid can accumulate in the space around the lungs.

3.    In case the procedure is in or close the lung, the lung may collapse. Nerve damage may result. Totally solidified nerves can cause motor weakness or deadness in the region provided by the nerves. Complications related to medications, including anesthesia, managed during the procedure may occur. Women should continuously educate their doctor or x-ray technologist in case there's any possibility that they are pregnant.

4.   Specific possible complications related to the cryotherapy of prostate cancer: Permanent feebleness since nerves controlling sexual potency are commonly included within the freezing process. However, nerves can recover, resolving the issue in a few patients. While the patient is under anesthesia, a bladder tube is positioned to deplete pee until the swelling of the bladder neck—as a result of the procedure—resolves. May cause urethral sloughing; that is, blocking of the pee stream with dead tissue. Sloughing is diminished by keeping the urethra warm with sterile water circulating persistently through a catheter set in the urethra during the procedure.

TUBOPLASTY: BENEFITS, AND EXPECTED RESULTS

Introduction:

A tuboplasty refers to a number of surgical strategies which is performed when the fallopian tubes are obstructed or if the patient wishes to reverse the impacts of tubal ligation, a surgical birth control strategy that includes severing and tying the fallopian tubes. The objective of tuboplasty is to increase a woman's chances of getting pregnant. The fallopian tubes are integral parts of the female regenerative system and are responsible for the entry of the ova (egg cells) from the ovary into the uterus. However, certain variables and conditions can lead to their obstacle including infection and the formation of scar tissue. In such cases, the egg cell is avoided from coming to the uterus resulting in female infertility.

Tuboplasty can be performed utilizing either traditional open surgery or through minimally obtrusive techniques, depending on the cause of the obstacle and the patient’s uncommon circumstances. The surgeon—typically one trained in obstetrics and gynecology— usually performs diagnostic and imaging procedures (such as ultrasound) as well as considers all factors surrounding each particular case when deciding which strategy is the finest for individual patients.

Who Should Undergo and Expected Results

Women with the hindrance in their fallopian tubes—especially those who need to increase their chances of having a successful IVF procedure—can undergo a tuboplasty. Obstruction within the fallopian tubes can be caused by a variety of factors including the following: Pelvic inflammatory disease, or PID – This refers to an infection that influences the upper part of the female regenerative system, including other organs such as the uterus, fallopian tubes, and ovaries. Symptoms include unusual vaginal release, pain within the lower abdomen, fever, burning sensation during urination or sexual intercourse, and irregular menstruation.

Infections after childbirth

Endometriosis, which includes the inflammation of the inner lining of the uterus, known as the endometrium Intraabdominal infections, such as appendicitis (inflammation of the appendix) and peritonitis (irritation of the peritoneum, the thin lining of the tissue in the inner wall of the abdomen) Ectopic pregnancy (where the fertilization of the ovum happened outside the uterus) Formation of scar tissue Damage to the fallopian tubes, which is regularly caused by complications of an earlier surgery in the female regenerative system.

As for the expected result, ladies who have undergone tuboplasty and who are attempting to conceive through common or artificial means will have an increased chance of getting pregnant.

How is the Procedure Performed?

Before tuboplasty is performed, the patient experiences an ultrasound to see the fallopian tubes and determine the area of the blockage. Depending on the patient’s condition and unique circumstances, as well as the surgeon’s suggestions, a tuboplasty can then be performed utilizing any of the following methods:

Tubal reanastomosis - It includes the resectioning of occluded or damaged tissues within the fallopian tubes and after that suturing the remaining healthy fragments together.

Fimbrioplasty. Also known as laparoscopic neosalpingostomy, this method includes the reconstruction of the fimbria, a portion of the fallopian tube associated with the ovary, which facilitates the entrance of egg cells into the fallopian tube.

Salpingostomy. This procedure essentially opens the fallopian tubes by expelling the hindrance, without performing surgical intervention on other parts of the organ.

Salpingolysis. This includes cutting away scar tissue that obstructs the fallopian tubes.

Cornual implantation. This involves the resection of an obstructed or damaged section of the fallopian tubes. The ends of the resected fallopian tubes are then connected to the uterus and linked to the endometrial cavity.

Tuboplasty can be performed using the following techniques:

Laparotomy – This involves a large incision through the wall of the abdomen to access the abdominal cavity

Laparoscopy – This requires a small incision in the abdomen or pelvis where small surgical instruments—including a camera—are inserted to perform minimally invasive procedures

Microsurgery – This uses an operating microscope

Laser surgery

Electrocauterisation - This destroys tissue through heat conduction and electric currents

Hydrodissection

Use of devices such as adhesion barriers, hoods, and surgical stents

Mechanical dissection

Possible Risks and Complications

A tuboplasty can result in:

·         Excessive bleeding

·         Infection

·         Adverse reactions to the anesthesia used

·         Damage or perforation of surrounding organs

·         Ectopic pregnancy

Osteo-odonto-keratoprosthesis: Blind person Sees With 'Tooth-in-Eye' Surgery

Introduction:

Osteo-odonto-keratoprosthesis (OOKP) is also known as ‘Tooth is eye Surgery’, is a  medical procedure to restore the vision of the person who is suffering from the most severe cases of the corneal and ocular surface, end-stage forms of corneal blindness that are amenable to corneal transplantation or other forms of surgery. This surgery involves the removal of the patient’s tooth and followed by inserting a tiny artificial lens inside it.

Procedures:The tooth in eye surgery is a medical procedure in which a tooth with its root and part of the adjacent bone is removed from the patient and fashioned into a cube with a hole drilled into its center, then an artificial tiny the lens is implanted to that hole. After implanting the lens to the tooth it is then inserted to the patient’s cheek to grow new blood vessels. Simultaneously scar tissues from the surface of the eye are carefully excised and the tissues from the inner mucosal lining of the cheek are harvested onto it.

The patient’s damaged eye which was previously covered with the cheek lining is opened. A circular opening is made in the cornea and the iris and the lens is removed from the eyes. Then the tooth structured tooth is removed from the patient’s cheek, implanted within the eyes and covered with the cheek linings.

Medical Issues:
Osteo-odonto-keratoprosthesis is mostly performed for the patients with a rare type of corneal blindness and whom a conventional corneal transplant would not work. This is an unusual surgery with the last chance to recover eye-sight. But this procedure is now without risk, if it became unsuccessful then any remaining sight the patient had before would be lost.

There are a few surgeons who perform this surgery it is only reserved for the patients with rare types of corneal blindness and for whom a conventional corneal transplant would not work.