Eastern Green Neurosurgery 2019-09-24T08:10:19+00:00 Dr. Pankaj Raj Nepal Open Journal Systems <p>Eastern Green Neurosurgery is published by the Department of Neurosurgery, B &amp; C Medical College Teaching Hospital and Research Center, Birtamode, Jhapa, Nepal.</p> Occupational Hazards among Neurosurgeons: Do We Need to Change Our Habit? 2019-09-23T14:11:38+00:00 Pankaj Raj Nepal <p>No abstract available.</p> 2019-09-23T00:00:00+00:00 ##submission.copyrightStatement## 3D rotational DSA: Diagnostic and therapeutic approach to cerebral aneurysms 2019-09-23T14:11:39+00:00 Karuna Tamrakar Karki Duan Chuan Zhi Li Tie Lin <p><strong>Background and purpose: </strong>Digital subtraction angiography (DSA), a minimally invasive procedure for an exceptional visualization of cerebrovascular angioarchitecture, has become an important imaging technique for inclusive evaluation and therapeutic embolization. Our purpose is to share the importance of DSA for evaluation of cerebral aneurysms.</p> <p><strong>Material and method: </strong>A total of 148 patients with suspected intracranial aneurysm underwent digital subtraction angiography during January 2005 to December 2009. Preliminarily aortogram was considered in old age group (&gt;50yrs) before supra-aortic angiography. Patient’s selection criterion included both ruptured and unruptured aneurysms. 3D rotational effect was applied for all complex cerebral aneurysms with unfavorable dome neck ratio. DSA was accomplished into 2- 6 standard projections for every vascular territory for optimal visualization and accurate evaluation of cerebral aneurysms.</p> <p><strong>Result: </strong>21 were males and 48 were females. Age difference was ranged between 26-78 years with an average of 51.5years. Among 288 patients, total detected aneurysms were 480. 32 presented with SAH, 21 presented with headache and 14 patients came with cranial nerve dysfunction during admission. 3 had negative angiography irrespective to spontaneous subarachnoid hemorrhage. Delineation of aneurysmal neck improved with rotation effect of 3D DSA in 80% of patients. Parent vessel and its relationship to adjacent vessels was better demonstrated with rotational angiography in &gt;50% of cases. Endovascular embolization was done in 80 patients in same setting.</p> <p><strong>Conclusion: </strong>DSA with 3D rotational technique is an essential radio-imaging tool for accurate characterization of cerebrovascular diseases and subsequently beneficial to elaborate on their potential treatment protocols.</p> 2019-09-23T00:00:00+00:00 ##submission.copyrightStatement## Prevalence of Sudden and Unexpected Natural Death due to Diseases of Central Nervous System 2019-09-23T14:11:45+00:00 Archana Chaudhary Tulsi Kadel Harihar Wasti Pramod Kumar Shreshta <p><strong>Background: </strong>The World Health Organization (WHO) has defined sudden unexpected death as a death, non-violent and not otherwise explained, occurring within 24 hours from the onset of symptoms. This study was performed with the objective to evaluate the different neurological causes of sudden and unexpected death.</p> <p><strong>Methods and materials: </strong>this is a cross-sectional analytical study with non-probability consecutive sampling technique over the period of one year. Data were collected, and analyzed using SPSS 20. Data were presented in percentages, and stratifications were used to control the modifiers.</p> <p><strong>Results: </strong>There were total 110 autopsies done during the period of one year for sudden and unexpected deaths, among which 19 (17.3%) were deaths due to neurological causes, where 17(89.5%) were males and 2(10.5%) were females. There were 68.43% deaths seen during cold weather. Smoking, alcohol and drug abuse all seems to have higher prevalence among the sudden death due to neurological cause. Most common causes were subarachnoid hemorrhage (58%) followed by ganglionic bleed (26%).</p> <p><strong>Conclusion: </strong>Common cause of sudden death due to neurological disease in our study seem to be due to intracerebral hemorrhage where subarachnoid hemorrhage was more common. The deaths were more common during the cold weather and most of them stopped their heart at emergency department during resuscitation.</p> 2019-09-23T00:00:00+00:00 ##submission.copyrightStatement## Usefulness of Neuronavigation During Cranial Surgery 2019-09-23T14:11:48+00:00 Pankaj Raj Nepal Suman Rijal <p class="Default"><strong><span style="font-size: 11.0pt;">Background</span></strong><span style="font-size: 11.0pt;">: Neuronavigation helps neurosurgeons by providing intraoperative three dimensional (3D) view of CT/MRI of the patients thus helping the surgeon in different steps of surgery. With the objective to evaluate the usefulness of neuronavigation in early years after installment, this study was conducted at a tertiary care center in Nepal. </span></p> <p class="Default"><span style="font-size: 11.0pt;"><strong>Methodology</strong>: This is a prospective analytical study, where all the consecutive cases of the neurosurgical cranial cases using frameless stereotactic (Medtronics stealth station 7), were considered during May 2014 to March 2017. All the lesions were categorized according to the location and were evaluated using the Image guided surgery (IGS) score. Analysis was done using stratification and percentage system. </span></p> <p class="Default"><strong><span style="font-size: 11.0pt;">Result</span></strong><span style="font-size: 11.0pt;">: There were total 122 cases operated using neuronavigation during the study period, with ages ranged between 5 to 83 years with mean age 38.32(SD16.09) years. 57.4% were male and 42.6% were female. Overall IGS scoring of the neuronavigation in the different location showed irreplaceability in 100% cases of convexity, ganglionic/ deep seated/ ventricle and brain stem lesion; however, it was more useful than conventional methods in 70.37% of lobar cases. Similarly, overall IGS scoring of neuronavigation in the different type of lesions showed irreplaceable in 80% of meningiomas, and 41.17% of gliomas; however, was more useful than conventional methods in 56.86% of gliomas </span></p> <p class="Default"><strong><span style="font-size: 11.0pt;">Conclusion</span></strong><span style="font-size: 11.0pt;">:Use of neuronavigation seems to be irreplaceable for planning and raising flaps, in cases of convexity lesions and most of the cases of lobar and ganglionic/ deep seated leasions. </span></p> 2019-09-23T00:00:00+00:00 ##submission.copyrightStatement## Anaesthetic Management of Cerebral Aneurysm Surgery 2019-09-23T14:11:41+00:00 Raju Shrestha <p class="Default"><span style="font-size: 11.0pt;">Management of cerebral aneurysm is always a challenge for a neurosurgeon and anaesthesiologist. Proper knowledge, experience, timely intervention and goal directed therapy will definitely save a lot of lives. The leading causes of death and disability were, in descending order, vasospasm, the direct effects of the initial bleed (massive subarachnoid, subdural, or intracerebral hematoma, permanent ischemic effects of increased intracranial pressure, rebleeding, and surgical complications. This article revises the anaesthetic challenges during managing the cerebral aneusysms.</span></p> 2019-09-23T00:00:00+00:00 ##submission.copyrightStatement## An Unusual Case of Penetrating Ocular Trauma with a Pressure Cooker Whistle 2019-09-24T08:10:19+00:00 Dinesh Kumar Thapa Shyam Vyas Rohit Saiju Pravash Rajbhandari Basant Pant <p>Worldwide blindness in 1.6 million people is due to ocular trauma. Trauma is the most common cause of unilateral loss of vision in developing countries and about 5 % of all bilateral blindness is directly due to trauma. In Nepal, ocular trauma is considered a major cause of unilateral blindness and caused 7.9 % of all blindness in Nepal. It is the second leading cause of blindness after cataract. Pressure cooker is a cooking utensil that works with high pressure and heat, consuming less time and fuel but as seemingly easy, the trouble handling with it could be horrible. It may cause serious injury to someone nearby. Here by, we would like to report a case that could rarely happen in kitchen as a worst accident.</p> 2019-09-23T00:00:00+00:00 ##submission.copyrightStatement## A Rare Presentation of Orbital Roof Blow-out Fracture with Intact Vision 2019-09-23T14:11:47+00:00 Arbindra Kumar Yadav Manohar Kumar Ray Birat Thapa Magar Dinesh Kumar Thapa Karuna Tamrakar Karki Pankaj Raj Nepal <p class="Default"><span style="font-size: 11.0pt;">The orbital blowout fracture is most common in its inferior and medial wall; however we are presenting here a rare case of superior orbital wall blowout fracture with intact vision. This is a presentation of a 55 year-old right handed gentleman following road traffic accident had left orbital injury causing orbital roof fracture. Despite of such a huge injury there was no deterioration of his vision and his movements of the eye balls were also absolutely preserved.</span></p> 2019-09-23T00:00:00+00:00 ##submission.copyrightStatement## Neurocritical Care in Eastern Nepal: Challanges and Opportunities 2019-09-23T14:11:43+00:00 Niraj Kumar Keyal <p>No abstract available.</p> 2019-09-23T00:00:00+00:00 ##submission.copyrightStatement## Safety Measures In Neuro-Surgical Theatre: An Institutional Protocal 2019-09-23T14:11:44+00:00 Kaushila Dhimal Punam Limbu Pushpa Biswakarma <p>&nbsp;Effective teamwork in the operating theatre is of vital importance for same and smooth surgery. The main goal of safety measures is to reduce mortality, morbidity, improves communication and team work ,reduce operation time, ensuring the patient is secure in operation table, and also to ensure the operating staff and surgeons from advertent injuries.</p> 2019-09-23T00:00:00+00:00 ##submission.copyrightStatement##