Magdy Mohamed Kamal Yousef,Ahmed Mohamed Rateb,Ahmed Mohsen Hassan Mohamed
Issue:
Volume 2, Issue 4, December 2021
Pages:
62-68
Received:
3 November 2021
Accepted:
19 November 2021
Published:
11 December 2021
DOI:
10.11648/j.wjmcr.20210204.11
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Abstract: Background: Abnormally invasive placenta (AIP) is a term that describes cases in which there is complete or partial failure of separation of the placenta from the uterine wall following delivery of the fetus. Objective: to detect the role of bilateral internal iliac artery ligation in minimizing blood loss, prior to performing Cesarean Hysterectomy in cases with confirmed preoperative or intraoperative diagnosis of Abnormally invasive placenta. Patients and Methods: The study was carried out at Ain shams university maternity hospital in 2019. Women were recruited from the labor ward who underwent CS Hysterectomy. The total number of pregnant women enrolled in the study was 95 women. Approval from the Medical Ethics Committee were obtained. Results: Our study showed that internal iliac artery ligation in CS hysterectomy cases for AIP has non significant lower blood loss than cases who did not underwent internal iliac artery ligation. In stead, it had increased the operative time. In comparison of 45 patients underwent internal iliac artery ligation and 45 without ligation blood loss was non significantly lower in the group who underwent ligation with mean 1933 ml blood loss in comparison with 2117 ml in the group who did not. Conclusion: Bilateral internal iliac artery ligation, in cases of AIP undergoing caesarean hysterectomy, is not recommended for routine practice to minimize blood loss intraoperatively.Abstract: Background: Abnormally invasive placenta (AIP) is a term that describes cases in which there is complete or partial failure of separation of the placenta from the uterine wall following delivery of the fetus. Objective: to detect the role of bilateral internal iliac artery ligation in minimizing blood loss, prior to performing Cesarean Hysterectomy...Show More
Abstract: Background: Chiari malformation is a group of congenital abnormalities involving the cerebellar tonsillar herniation through the foramen magnum which affects the relationships between the cerebellum, brainstem, upper cervical cord, and the base of the cranium. CM-I (Chiari Malformation 1), is seen in adult patients and is associated with cranio-cervical abnormalities. Most of the patients with CM-I get symptoms when a cerebellar tonsillar herniation is greater than 5 mm. Case Information: This case report highlights the anaesthetic management of Chiari malformation with 8 mm cerebellar tonsillar descent in a pregnant patient with known difficult airway due to concurrent Temporo-mandibular joint dysfunction, who presented to the hospital for an elective cesarean section. Discussion: Childbearing women with Type I CM have concerns related to an increased cranial CSF pressure during pregnancy and labor. This difference in pressure above and below the foramen magnum may become worse following a lumbar puncture or spinal injection for spinal anesthesia and may lead to worsening of the cerebellar herniation leading to strangulation of the brainstem. These risk factors affect the choice of anaesthetic in these patients. Conclusion: As shown in this case report, the multidisciplinary discussion raised concerns with competing safety concerns of difficult airway if given general anesthesia and the risk of brainstem herniation with neuraxial anesthesia, despite evidence showing infrequent complications regardless of choice of anesthetic. Careful administration of the anesthetic technique, general or regional anesthesia in this group of patients can lead to favorable outcomes following multi-disciplinary discussion.Abstract: Background: Chiari malformation is a group of congenital abnormalities involving the cerebellar tonsillar herniation through the foramen magnum which affects the relationships between the cerebellum, brainstem, upper cervical cord, and the base of the cranium. CM-I (Chiari Malformation 1), is seen in adult patients and is associated with cranio-cer...Show More
Manuel De Jesus Encarnacion,Rossi E. Barrientos Castillo,Durdica Lopez Vujnovic,Arturo Ayala Arcipreste,Juan Sebastian Castro,Alexander Volovich,Medet Dosanov,Renat Nurmukhametov,Boris Oleinikov,Ibrahim E. Efe
Issue:
Volume 2, Issue 4, December 2021
Pages:
73-75
Received:
24 November 2021
Accepted:
14 December 2021
Published:
29 December 2021
DOI:
10.11648/j.wjmcr.20210204.13
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Abstract: Background. Cervical intramedullary tumors typically present with significant morbidity. Early surgical treatment is paramount to prevent neurological deterioration. Due to the complexity of the anatomy, these lesions still present a technical challenge to the neurosurgeon. We here present the surgical management of a large intramedullary tumor with the help of microsurgical tools and intraoperative monitoring. Case information. A 55-year-old woman presented with significantly reduced strength in her upper and lower extremities and subtle deficits in epicritic and proprioceptive sensation. MRI revealed a large intramedullary tumor in her cervical spinal cord, suggestive of ependymoma. Immediate surgical intervention was indicated. We made use of microsurgical techniques, ultrasound aspiration and monitoring of somatosensory and cortical potentials to achieve a maximally safe removal of the mass. To minimize mechanical stress on the spinal cord, we aimed to debulk the tumor first before resecting it along a dissection plane. Twenty-four hours following the surgery, the patient reported a discreet improvement of upper and lower limb strength and was discharged on postoperative day five in good condition. Result. Multimodal monitoring helped us limit our extent of resection and to achieve a maximally safe near-total removal of the mass. Conclusion. Microsurgical removal of large cervical intramedullary tumors under multimodal monitoring is safe and feasible.Abstract: Background. Cervical intramedullary tumors typically present with significant morbidity. Early surgical treatment is paramount to prevent neurological deterioration. Due to the complexity of the anatomy, these lesions still present a technical challenge to the neurosurgeon. We here present the surgical management of a large intramedullary tumor wit...Show More
