The Dandy-Walker complex is a rare congenital brain malformation characterized by cystic dilation of the 4th ventricle and partial or complete absence of the cerebellar vermis. It ranges from mega cisterna magna to Dandy-Walker variant to Dandy-Walker malformation based on severity. Associated anomalies are common. The cause is unknown but likely involves abnormal development of the hindbrain. Treatment involves managing hydrocephalus, often with shunt procedures. Prognosis depends on severity and associated anomalies, with higher mortality and developmental delays in more severe forms.
Hydrocephalous is a serious disease of the central nervous system which has both congenital and aquired subtypes. the congenital variety affects the children and is a considerable burden especially is the developing countries. I tleads to long term morbidity and high rates of mortality
This ppt describes various movement disorders found commonly in elderly persons. It also describes hyper and hypokinetic disorder categorization with cause and pathophysiology of movement disorders.
Hydrocephalous is a serious disease of the central nervous system which has both congenital and aquired subtypes. the congenital variety affects the children and is a considerable burden especially is the developing countries. I tleads to long term morbidity and high rates of mortality
This ppt describes various movement disorders found commonly in elderly persons. It also describes hyper and hypokinetic disorder categorization with cause and pathophysiology of movement disorders.
Water dynamic of UBE Unilateral Biportal Endoscopy.pptxsuresh Bishokarma
Unilateral Biportal Endoscopy (UBE) is a fluid medium surgery. Continuous saline output is critical
Hydrostatic pressure. Managing the fluid is the key to successful surgery. It use the principle of Bernauli’s and Pascal law. Explore the water dynamic of UBE surgery.
Posterior lumbar fusion vs Lumbar interbody fusion Evidence based.pptxsuresh Bishokarma
Lumbar degenerative disc diseases (LDDD): irreversible process in lumbar disk architecture.
Sparse literature to choose proper technique to address these pathology with or without fusion surgery.
A clear benefit of lumbar fusion surgery: lowered pain and disability scores.
Lumbar surgery rates have increased steadily over time, and hence related complications.
Evidence of the superiority of one technique over the other is sparse.
Surgery offers greater improvement compared with non-operative treatment in LDDD.
Surgery in disc herniation resulted in faster recovery, However no added benefit of fusion surgery.
There was no obvious disadvantage of posterolateral fusion without internal fixation in patient with spondylosis.
Among patients with lumbar spinal stenosis without spondylolisthesis, decompression plus fusion surgery may not result in better clinical outcomes.
In patient with spondylolisthesis with or without stenosis, fusion is more effective than laminectomy in achieving a satisfactory outcome. Decompression only had the least satisfactory outcome.
Patients who underwent interbody fusion may have significantly higher fusion rates compared to posterior lumbar fusion only.
TLIF has advantages over PLIF in the complication rate, blood loss, and operation duration. The clinical outcome is similar, with a slightly lower postoperative ODI score for TLIF.
In the end, The choice of technique is still greatly based on the surgeons’ preference and experience.
Brain abscess may have hematogenous spread: Pneumococcus common or via Contiguous spread. Risk factors includes pulmonary abscess or AV fistulas, congenital cyanotic heart disease, immunocompromised, chronic sinusitis/otitis, dental procedures. Intraventricular rupture of abscess is life threatening. Timely diagnosis and treatment is the goal.
Pituitary tumor accounts for ~10% ICT. They are common in 3-4 decade and shows association with MEN I.
About 5% of PT are invasive usually with giant tumor (>4cm). Tumor can be classified as functional (hormone secreting) or non functional. This slides details the algorithmic approach in management of pituitary tumors.
Medulloblastoma- A primitive neuroectodermal tumors (PNETs) is the most common malignant brain tumor of childhood (WHO IV)
arising from the vermis in the inferior medullary velum.
It comprises up to 18% of all pediatric brain tumors.
WNT and Shh pathway plays major role in its pathogenesis.
c-erbB-2 (HER2/neu) oncogene expression has prognostic value. Norcantharidin, Vismodegib, Sonidegib are the future in medulloblastoma.
Pineal gland is essentially an extra axial midline structure lying at the roof of dienchephalon rostral to the quadrigeminal cistern surrounded by important neurovascular structure, occurring in the geometric center of brain with same depth of trajectory had made the surgery in this region a formidable challenge to neurosurgeons, however radical resection must be the goal in selected pathologies, if not pure germ cell tumor.
Before embarking on an approach, the surgeon should be familiar with both the ventricular anatomy and the options for optimally Accessing lesions in third ventricle is a surgical challenge because of its difficult corridor as well as deeper location, need of neural incision, preservation of vascular, thalamus and hypothalamus and likely risk of fornix injury.
Brain arteriovenous malformations (bAVM) are abnormal connections of arteries and veins in the brain, forming a tangled web of vessels instead of a normal capillary network treated with multimodalities including, SRS, embolisation and Microneurosurgery.
This slides updates the management of AVM highlighting the importance of SM grading, Pollock radiation grading etc.
Brain abscess is a common neurosurgical emergencies, of which periventricular warrants urgent attention either medically or surgically. This algorithmic approach may help understand the very essentials of Brain abscess.
Angulation, trajectory and depth of screw placement in spine is not everyone's cup of tea unless you have a very clear idea of its ergonomics and dynamics.
Radiosurgery is a discipline that utilizes externally generated ionizing radiation in certain cases to inactivate or eradicate a defined target(s) in the head or spine without the need to make an incision. Its uses in Neurosurgery is immense.
Gliomas are the commonest tumor of brain arising from the supportive cells of the brain with diverse form and presentation the treatment of which is surgical and demands adjuvant therapy for most of circumstances.
Foramen magnum meningiomas are challenging tumors, requiring special considerations because of the vicinity of the medulla oblongata, the lower cranial nerves, and the vertebral artery. It accounts for 1-3% of all intracranial Meningioma.
Brain metastasis is an advance diseases with poor overall prognosis management of which is full of controversies. This slide aims to make metastasis simplified.
The caroticocavernous fistula is a specific type of dural arteriovenousfistula characterized by abnormal arteriovenous shunting within the cavernous sinus.
A caroticocavernous fistula results in high-pressure arterial blood entering the low-pressure venous cavernous sinus.
This interferes with normal venous drainage patterns and compromises blood flow within the cavernous sinus and the orbit.
Vascular crowding in the ventricle of brain is the chorioid plexus, the primary function of which is to secrete CSF has immensely diverse function which is still the huge scope in neuroscience exploration.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. The Dandy-Walker complex is a rare congenital intracranial malformation
that comprises a spectrum of abnormalities of the posterior fossa which are
classified as
1. Dandy-Walker malformation (cystic dilatation of the 4th ventricle,
complete or partial agenesis of the cerebellar vermis and an enlarged
posterior fossa)
2. Dandy-Walker variant (cystic posterior fossa mass with variable
hypoplasia of the cerebellar vermis and no enlargement of the posterior
fossa)
3. Mega cisterna magna (enlarged cisterna magna with normal cerebellar
vermis)
Dandy-Walker complex
3. It is a continuum of posterior fossa cystic abnormalities with varying
degrees of vermian agenesis.
Mega cisterna magna Dandy-Walker variant Dandy-Walker
malformation
4. • DWM and DWV cases show so many similarities that a clear-cut
distinction is difficult.
• There was no significant difference in the spectrum of associated
anomalies and postnatal prognosis between DW and DWV cases
5. • Specific size criteria to denote a normal-sized posterior fossa and vermian
hypoplasia are not established in the literature.
• DWV: The cerebellar hemispheres may be small but morphologically
normal
6. • The severity of the diagnosis is based on the size of the posterior fossa,
the presence of cystic dilatation of the fourth ventricle, and the degree of
vermian hypoplasia.
7. • First described in 1914 by W Dandy and K Blackfan and was designated
as Dandy-Walker syndrome in 1954 by C Benda
History
8. • The precise aetiology is unknown. The reported incidence varies between
one per 2500 births to one per 100,000 births. Environmental factors
including viral infections, alcohol and diabetes have also been suggested
to play a role in the genesis of Dandy-Walker malformation but the
evidence is uncertain
Epidemiology
9. • The cerebellum is formed by 2 distinct germinal matrices; 1
periventricular and 1 along the rhombic lip, which gives rise to the
cerebellar hemispheres.
• The cerebellar vermis develops as a thickening of the midline
primordium of the rhomboencephalon during the 5th gestational week.
By 16 weeks, the vermis fold and begins to cover the roof of the fourth
ventricle. By 19 weeks of gestation the cranial/caudal length of the
vermis is equal to that of the cerebellar hemisphere.
Embryology
10. • The pathophysiological mechanism underlying the Dandy–Walker complex is not
clearly elucidated. Initially, it was proposed that congenital obstruction of the foramina
of Luschka and Magendie resulted in cystic dilatation of the fourth ventricle and the
resulting malformed posterior fossa. In later studies investigators have suggested that
it is a manifestation of abnormal development of the rhomboencephalon, with
incomplete formation of the vermis, or due to a defect within the tela choroidea, which
leads to cystic dilation of the fourth ventricle. Given its comparable appearance to
DWM, it is likely that DWV develops along the same embryological pathway. One is
embryonic arrest of the rhombencephalon, with failure of cerebellum fusion in the
midline between weeks 7 and 10 of gestation. This leads to persistence and interposes
itself between the hypoplastic vermis and the choroid plexus. Furthermore, the roof of
the fourth ventricle expands upward through an agenetic corpus callosum.
• Chromosomal abnormalities were observed in this study and included defects on
chromosomes 9, 11, 13, and 8. Deletions on chromosome 8; a long-arm deletion of
chromosome 3 was observed in a patient with DWV and associated craniofacial
anomalies; and partial trisomy 3 and monosomy 11 (a partial imbalance of
chromosomes 6 and 11) have also been described. The gene locus for DWM is 3q24.
• Trisomy-18, tri- ploidy and trisomy-13.
pathophysiology
11. • Developmental Status
• Poor developmental outcome in association with posterior fossa
malformations is reported in 55–100% of patients.
• It is estimated that moderate-to-severe developmental delay is observed in
approximately one-third of patients with DWM, and
• of those 11–16% have a diagnosis of severe delay and require significant
assistance in their daily functioning.
• Hydrocephalus is common prenatally or during the neonatal period, although
this is a complication rather than part of the disease. Most cases are
diagnosed during infancy.
• Older patients might be asymptomatic, with normal or near-normal
neurological examinations. They usually pre- sent with neurological
manifestations such as developmental delay, spasticity, poor head control and
seizures.12 Some children present with symptoms suggestive of increased
intracranial pressure and posterior fossa tumour, like nystagmus, cranial
nerve palsy or truncal ataxia.
Clinical presentation
12. INTRACRANIALANOMALIES:
1. Brainstem dysplasia
2. Agenesis of corpus callosum
3. Holoprosencephaly
4. Occipital encephaloceles
Two thirds of patients have associated
central nervous system abnormalities.
Association
EXTRACRANIAL ANOMALIES
1. The incidence of extracranial
anomalies was 54% in DWV,
compared with the 12–86%
reported in patients with DWM
2. Genitourinary: polycystic kidneys
3. Musculoskeletal systems:
polydactyly
4. Gastrointestinal:
5. Ocular abnormalities
The severity of Dandy Walker syndrome depends on the presence of associated anomalies.
DWV has been associated with Menkes syndrome (kinky-hair disease), Coffin–Siris
syndrome, and Ehlers–Danlos syndrome, as well as neurocutaneous melanosis
13. Retrocerebellar arachnoid cyst
underlying brain is normal.
The cerebellar hemispheres are not
separated by a cystic mass,
rather displaced en-bloc.
Diagnosis
The diagnosis is challenging because of a lack of specific symptomatology.
Unless the syndrome is detected prenatally, by ultrasound or magnetic resonance imaging
or increased head circumference (prenatally or postnatally)
Definitive criteria have not been firmly established.
The prenatal differentiation between Dandy-Walker variant and mega-cisterna magna
should be made with caution, especially in the early second trimester because the
relatively large fourth ventricle and the incompletely formed inferior cerebellar vermis
may give a false impression of vermian defect and a follow-up scan at 18 weeks or later
should be done.
Cisterna magna:
Depth greater than
10 mm.
DWM:
thin communication
is found between
the fourth ventricle
and the cisterna
magna
14. • The treatment of Dandy Walker syndrome consists of dealing with
hydrocephalus by various approaches, although this is still controversial.
• Membrane excision was initially proposed by Dandy for the treatment of
DWM.
• The results using this form of therapy have been poor initially, with a high
failure rate. mortality rate of 10% and a failure rate of 70%.
• Few still advocate this treatment by way of cyst wall excision in children
aged over 3 years.*
• Endoscopic third ventriculostomy may be considered an acceptable
alternative, especially in older children, with the aim to reduce the shunt-
related problems.
• Endoscopic methods of transaqueductal placement of a single-catheter cyst-
ventriculoperitoneal shunt has also been noted to be with good results.
Treatment
* Udvarhelyi and Epstein
15. • The prognosis depends largely on the associated anomalies.
• The mortality rate ranges from 27% to 50%, and hearing and/or visual
problems are associated with poor intellectual development.
Prognosis
16. • Recurrence risk in subsequent pregnancies of 1-5% is suggested.
Genetic counselling
17. Thank you
NATIONAL INSTITUTE OF NEUROLOGICAL AND ALLIED SCIENCES, BANSBARI, KATHMANDU
DANDY-WALKER COMPLEX
NATIONAL INSTITUTE OF NEUROLOGICAL AND ALLIED SCIENCES, BANSBARI, KATHMANDU