This document provides an overview of the history and current state of neurosurgery in Jordan. It discusses how neurosurgery began in the 1960s with a few pioneering neurosurgeons and has grown significantly since. Today there are over 50 practicing neurosurgeons in Jordan, several residency programs, and Jordan provides neurosurgical care to over 100,000 patients from other countries in the Arab world each year. Infrastructure and supporting facilities for neurosurgery in Jordan have advanced greatly and are now on par with international standards.
Established In 1984 by Prof. Walid Maani, Started with one Neurosurgical Resident. Today it had graduated 20 of the 50 neurosurgeons practicing in Jordan
Established In 1984 by Prof. Walid Maani, Started with one Neurosurgical Resident. Today it had graduated 20 of the 50 neurosurgeons practicing in Jordan
Pediatric Brain Tumors: From Modern Classification System to Current Principl...Ahmad Ozair
Central nervous system (CNS) malignancies contribute significantly to the global burden of cancer. Brain tumors constitute the most common solid organ tumors in children and the second most common malignancies of childhood overall. Accounting for nearly 20% of all pediatric malignancies, these are the foremost cause of cancer-related deaths in children 0-14 years of age. This book chapter provides a state-of-the-art overview of pediatric brain tumors. It discusses their morbidity and mortality and introduces the WHO 2021 classification of CNS tumors, which is critical to therapeutic decision-making. It then describes the modern understanding of tumor grading and its clinical implications, followed by the general principles of diagnosis and management. The chapter then discusses, in detail, those brain tumors which have the highest disease burden in children, including medulloblastoma, astrocytoma, ependymoma, schwannoma, meningioma, amongst others. The landscape of treatment of pediatric brain tumors has been rapidly evolving, with several effective therapies on the horizon.
Percutaneous image-guided cryoablation of spinal metastases: A systematic reviewAhmad Ozair
Percutaneous cryoablation (PCA) is a minimally invasive technique that has been recently used to treat spinal metastases with a paucity of data currently available in the literature. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Prospective or retrospective studies concerning metastatic spinal neoplasms treated with current generation PCA systems and with available data on safety and clinical outcomes were included. In the 8 included studies (7 retrospective, 1 prospective), a total of 148 patients (females = 63%) underwent spinal PCA. Tumors were located in the cervical (3/109 [2.8%], thoracic (74/109 [68.8%], lumbar (37/109 [33.9%], and sacrococcygeal (17/109 [15.6%] regions. Overall, 187 metastatic spinal lesions were treated. Thermo-protective measures (e.g., carbo-/hydro-dissection, thermocouples) were used in 115/187 [61.5%] procedures. For metastatic spinal tumors, the pooled mean difference (MD) in pain scores from baseline on the 0–10 numeric rating scale was 5.03 (95% confidence interval [CI]: 4.24 to 5.82) at a 1-month follow-up and 4.61 (95% CI: 3.27 to 5.95) at the last reported follow-up (range 24–40 weeks in 3/4 studies). Local tumor control rates ranged widely from 60% to 100% at varying follow-ups. Grade I-II complications were reported in 9/148 [6.1%] patients and grade III-V complications were reported in 3/148 [2.0%]) patients. PCA, as a stand-alone or adjunct modality, may be a viable therapy in appropriately selected patients with painful spinal metastases who were traditionally managed with open surgery and/or radiation therapy.
The effect of clonidine on peri operative neuromuscular blockade and recoveryAhmad Ozair
Background: Alpha-2-agonists are as used adjunct for anaesthesia. We conducted this study with the aim to determine whether the addition of clonidine, an α-2-agonist, decreases the time to recovery from neuromuscular blockade caused by non-depolarising muscle relaxant. Secondary objectives were to know whether clonidine as an adjuvant improves hemodynamic stability, decreases stress hyperglycaemia, pain and time to discharge from Post-Anaesthesia Care Unit (PACU). Methods: This placebo-controlled clinical trial, enrolled 64 patients into clonidine (n = 32) or placebo (saline) group (n = 32). Study drug was given 1.5 mcg/kg IV bolus at the time of induction followed by infusion (1.5 mcg/kg/hour) intra-operatively. Extubation was started when train-of-four (TOF) count was ≥ 2. Primary outcome measure was time to achieve TOF ratio of ≥ 70% and ≥ 90%, assessed at 5, 15, 30- and 60-min intervals following extubation. Results: 2 patients in each group were excluded due to intra-operative requirement of additional supportive medications, hence in each group 30 were analysed. Significant difference was observed between clonidine and placebo groups in terms of time to achieve TOF ratio ≥ 70% and ≥ 90%, stress hyperglycemia, hemodynamic and pain profile, no statistical difference in the Ramsey sedation score and modified Aldrete score between groups. Patients given clonidine required repeat doses of non-depolarising muscle relaxant at longer intervals, with decrease in total amount administered. Clonidine group had a median time to achieve TOF ratio ≥ 70% at 15 min compared to 60 min in placebo group. Conclusion: Clonidine hastens the recovery from neuromuscular block with reduced stress hyperglycaemia and post-operative pain, along with unaffected Ramsey sedation score and modified Aldrete score.
The WASCE is a new method of medical exam that was developed by Prof Faisal Alnaser to test medical students' knowledge, skills, and attitude within a reasonable time and in an effective method. This presentation shows the process of WASCE examination
Pediatric Brain Tumors: From Modern Classification System to Current Principl...Ahmad Ozair
Central nervous system (CNS) malignancies contribute significantly to the global burden of cancer. Brain tumors constitute the most common solid organ tumors in children and the second most common malignancies of childhood overall. Accounting for nearly 20% of all pediatric malignancies, these are the foremost cause of cancer-related deaths in children 0-14 years of age. This book chapter provides a state-of-the-art overview of pediatric brain tumors. It discusses their morbidity and mortality and introduces the WHO 2021 classification of CNS tumors, which is critical to therapeutic decision-making. It then describes the modern understanding of tumor grading and its clinical implications, followed by the general principles of diagnosis and management. The chapter then discusses, in detail, those brain tumors which have the highest disease burden in children, including medulloblastoma, astrocytoma, ependymoma, schwannoma, meningioma, amongst others. The landscape of treatment of pediatric brain tumors has been rapidly evolving, with several effective therapies on the horizon.
Percutaneous image-guided cryoablation of spinal metastases: A systematic reviewAhmad Ozair
Percutaneous cryoablation (PCA) is a minimally invasive technique that has been recently used to treat spinal metastases with a paucity of data currently available in the literature. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Prospective or retrospective studies concerning metastatic spinal neoplasms treated with current generation PCA systems and with available data on safety and clinical outcomes were included. In the 8 included studies (7 retrospective, 1 prospective), a total of 148 patients (females = 63%) underwent spinal PCA. Tumors were located in the cervical (3/109 [2.8%], thoracic (74/109 [68.8%], lumbar (37/109 [33.9%], and sacrococcygeal (17/109 [15.6%] regions. Overall, 187 metastatic spinal lesions were treated. Thermo-protective measures (e.g., carbo-/hydro-dissection, thermocouples) were used in 115/187 [61.5%] procedures. For metastatic spinal tumors, the pooled mean difference (MD) in pain scores from baseline on the 0–10 numeric rating scale was 5.03 (95% confidence interval [CI]: 4.24 to 5.82) at a 1-month follow-up and 4.61 (95% CI: 3.27 to 5.95) at the last reported follow-up (range 24–40 weeks in 3/4 studies). Local tumor control rates ranged widely from 60% to 100% at varying follow-ups. Grade I-II complications were reported in 9/148 [6.1%] patients and grade III-V complications were reported in 3/148 [2.0%]) patients. PCA, as a stand-alone or adjunct modality, may be a viable therapy in appropriately selected patients with painful spinal metastases who were traditionally managed with open surgery and/or radiation therapy.
The effect of clonidine on peri operative neuromuscular blockade and recoveryAhmad Ozair
Background: Alpha-2-agonists are as used adjunct for anaesthesia. We conducted this study with the aim to determine whether the addition of clonidine, an α-2-agonist, decreases the time to recovery from neuromuscular blockade caused by non-depolarising muscle relaxant. Secondary objectives were to know whether clonidine as an adjuvant improves hemodynamic stability, decreases stress hyperglycaemia, pain and time to discharge from Post-Anaesthesia Care Unit (PACU). Methods: This placebo-controlled clinical trial, enrolled 64 patients into clonidine (n = 32) or placebo (saline) group (n = 32). Study drug was given 1.5 mcg/kg IV bolus at the time of induction followed by infusion (1.5 mcg/kg/hour) intra-operatively. Extubation was started when train-of-four (TOF) count was ≥ 2. Primary outcome measure was time to achieve TOF ratio of ≥ 70% and ≥ 90%, assessed at 5, 15, 30- and 60-min intervals following extubation. Results: 2 patients in each group were excluded due to intra-operative requirement of additional supportive medications, hence in each group 30 were analysed. Significant difference was observed between clonidine and placebo groups in terms of time to achieve TOF ratio ≥ 70% and ≥ 90%, stress hyperglycemia, hemodynamic and pain profile, no statistical difference in the Ramsey sedation score and modified Aldrete score between groups. Patients given clonidine required repeat doses of non-depolarising muscle relaxant at longer intervals, with decrease in total amount administered. Clonidine group had a median time to achieve TOF ratio ≥ 70% at 15 min compared to 60 min in placebo group. Conclusion: Clonidine hastens the recovery from neuromuscular block with reduced stress hyperglycaemia and post-operative pain, along with unaffected Ramsey sedation score and modified Aldrete score.
The WASCE is a new method of medical exam that was developed by Prof Faisal Alnaser to test medical students' knowledge, skills, and attitude within a reasonable time and in an effective method. This presentation shows the process of WASCE examination
CRANIO CEREBRAL INJURIES FOR MEDICAL STUDENTSwalid maani
This is a simple outline of traumatic injuries which occures to the scalp, skull and brain with some simplified classifications and outlined management
Tofiq journal of medical sciences (tjms) supplement, 1,vol 3 (2016)Taghreed Al-Noor
It is our pleasure to tell you that this is the third year of publication of Tofiq Journal of Medical Sciences, TJMS. Our contributors are mainly the blossoming Iraqi medical professionals and scientists. Also we have a rich share by leading Iraqi scholars from the U.S., U.K., New Zealand and Jordan with contribution from our American colleagues. As part of our objectives and aims in helping Iraqi higher education, the Editorial Board have decided to publish the abstracts of the dissertations and theses of Iraqi postgraduate scholarship students at the United States Universities in supplements to help researchers all over the world to learn about the good work and achievements of our students.
Medical Students in Global Neurosurgery: Rationale and RoleAhmad Ozair
Approximately 5 million essential neurosurgical cases are unmet each year, all in low- and middle-income countries (1). After the Lancet Commission on Global Surgery described the absence of global surgery from global health discourse in January 2014 (2), the field of neurosurgery quickly recognized the importance of increasing equity in care globally (3-5). Although existing initiatives in global neurosurgery have focused on neurosurgeons and trainees, medical students represent a promising group for sustainable long-term engagement. We characterize why medical students are fundamental to success, outline the importance of incorporating medical students, and delineate how to increase medical student interest and participation in global neurosurgery.
Professor IM Rao, from All India Institute of Medical Sciences, New Delhi, was a pioneering cardiac surgeon
who, against overwhelming odds, developed congenital heart surgery in India. He made many contributions
to the evolution of his specialty, spanning more than four decades and three countries. This is a brief report of
his professional life and accomplishments
RETINOPATHY OF PREMATURITY FOR PEDIATRICIANSvbwani
A TALK on Retinopathy of Prematurity (ROP) mainly for pediatricians
THE POWERPOINT presentation describes the important diseaee ofROP KEEPING in view teh responsibilities of neonatologists and pediatricians.
Which babies are to be screened and when should they be referred for ROP screening are described.
It describes the criteria for screening for ROP, screening regimen, when to treat what are the complications, different methods of treatment an their rationale is described .
Tofiq journal of medical sciences (tjms) supplement, 2 (2016)Taghreed Al-Noor
To our distinguished readers, Following the positive response we have to our first TJMS supplement it is our pleasure to publish this second supplement. It is TOFIQ’s objective to help our students anywhere inside and outside Iraq. This second issue is dedicated to our scholar ship PhD students in Canada.
I LOVE NEUROSURGERY INITIATIVE: INTRACRANIAL TUMORS.pptwalid maani
A complete presentation to help medical students and junior neurosurgical residents to understand the topic of intracranial tumors. Complete with Illustrations and imaging.
I LOVE NEUROSURGERY INITIATIVE: Spinal Tumorswalid maani
A comprehensive presentation about spinal tumors. Some concentration on anatomy. Discussion of presentation, diagnosis and management. Plenty of images.
I LOVE NEUROSURGERY INITIATIVE: Cranio-cerebral Injuries part 1walid maani
A comprehensive presentation about the primary injuries of the scalp, skull and brain occurring in head injuries. Directed to medical students and junior hospital doctors.
A short talk about two of the traumatic intracranial bleeds, namely extra and subdural hematomas. Directed to med students moving from basic into clinical teaching.
Introduction to neurosciences to 4 th year medical students
History of neurosurgery in jordan
1. HISTORY OF
NEUROSURGERY
IN JORDAN
PROF. WALID MAANI, MD, FRCSEd
Jordan University Hospital and Medical School
2. Jordan is a small country with big dreams,
and many of its aspirations have become
physical realities in our lifetime.
In order to be worthy of the global respect we
currently enjoy, we must aspire to continue
our progress and development
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3. GENERAL INFORMATION
POPULATION: 6 MILLIONS
50% BELOW 25 YEARS
22 UNIVERSITIES
100 HOSPITALS
AREA : 96,000 SQ. KLMS
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4. HEALTH STATISTICS
• CRUDE BIRTH RATE: 29.1/1000
• CRUDE DEATH RATE: 7/1000
• INFANT MORTALITY: 19/1000
• MATERNAL MORTALITY: 0.4/1000
• EXPECTED AGE AT BIRTH: 73 YEARS
• PHYSICIANS: 26.7/10000
• DENTISTS: 8.5/10000
• NURSES: 33.6/10000
• HOSPITAL BEDS: 18/10000
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5. HEALTH STATISTICS
• SOURCES OF HEALTH CARE FINANCE:
• PUBLIC: 36.5%
• PRIVATE: 58.9%
• DONORS: 4.7%
• HEALTH EXPENDITURE AS PERCENTAGE
OF GDP 9.6%
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6. PRELUDE
The progress in medical care in Jordan was a
translation of the concept that human power
was the main asset of the country since it
lacks natural resources.
Therefore emphases were placed on education
and health.
Hence, primary health care indices & literacy
rates are the best in the Arab world.
25% of the population are students
5% attend university and community colleges
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7. PRELUDE
To look at just 2 indices of health will tell the
story of medical care progress in this country.
In 1950 the infant mortality rate was 63/1000,
today it is 19
In 1950 the expected age at birth was 47 years
today it is 73
Not a single case of poliomyelitis was reported
since 1993
The immunization rate in infants is above 98%
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8. PRELUDE
• The progress in medical care was across the
board in all care levels; primary, secondary
and tertiary.
• The advance in tertiary care covered all fields
of medicine, so it was not a surprise that
Jordan was the eighth country in the world to
perform a cardiac transplant in 1984 at the
KHMC by Dr. D. Hanania.
• The advancement in neurosurgery in Jordan
is a part of this success story.
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9. THE BEGINNINGS (1960-1980)
• Jordan population 1,500,000
• In 1962 Dr. Anton Tarazi (Canadian trained) practiced
neuro-surgery in Jordan, his base was in Jerusalem
at the St. Augusta hospital
• Many patients went to the AUB in Lebanon
• Some sought care in Egypt
• The wealthy traveled to Europe
12/05/12 APPLIED SCIENCES UNIVERSITY 9
10. 1969
Two more neurosurgeons practiced in Jordan:
• Ahmad Hanieh, who later (1976) immigrated to
Australia to practice in Adelaide
• Tawfiq Abu Rob re-located from Kuwait
12/05/12 APPLIED SCIENCES UNIVERSITY 10
11. 1973
Neurosurgery started at the KHMC by the return of
Dr. Ishaq Maraqa after training in the UK, this service was
to grow until it becomes one of the main neurosurgical
facilities in Jordan. He and Dr. Ashraf Kurdi (neurologist),
established the 1st. neuroscience center in Jordan
with the support of Dr. M. Fayyad a neuro-radiologist and
Dr. I. Ayesh a neuro- ophthalmologist.
12/05/12 APPLIED SCIENCES UNIVERSITY 11
12. 1975
Dr. Sartawi returns to Jordan from Canada and
starts practice in the private sector at the Palestine
hospital, he also managed patients at the university
hospital for a short while. He died in an accident in
1977.
12/05/12 APPLIED SCIENCES UNIVERSITY 12
13. 1977
This year saw the arrival of the first
CT to Jordan. It was installed at
the KHMC (the main military
hospital in Jordan). This was 4
years after the instalment of the first
CT scanner in the world at the
Atkinson Morley’s Hospital in
Wimbledon in London
12/05/12 APPLIED SCIENCES UNIVERSITY 13
14. 1977
Professor Maani returns from Britain and starts the neuro-
surgical service at the University Hospital, today it is one
of the major facilities.
The 1st. Sitting position surgery was performed
The 1st. Intracranial aneurysm was operated
12/05/12 APPLIED SCIENCES UNIVERSITY 14
15. 1982
The second CT scanner (EMI) was introduced to the
Jordan University Hospital. Images were reported by
neurosurgeons due to the lack on neuroradiology.
The availability of the scanner to the civilian population
was given such importance that H.M. Queen Noor
was present at the inauguration ceremony
12/05/12 APPLIED SCIENCES UNIVERSITY 15
16. 1978 and 1983
Professor Maani establishes the first Neurosurgical
Residency Program in Jordan. It started as a professional
program but later in 1983 it became academic ending in a
university degree in addition to the Residency.
It graduated 22 out of the 50 neurosurgeons practicing
today in Jordan
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17. 1979
The whole of the public sector i.e. The Ministry of Health
Hospitals, the Military Hospital (KHMC) and the University
Hospital were served by one neurosurgical team of one
neurosurgeon and one resident.
The rest of the neurosurgeons (2) worked in the private
sector
12/05/12 APPLIED SCIENCES UNIVERSITY 17
18. 1979
Two more neurosurgeons arrive:
Dr. Salah Salah (Austrain trained), who worked at the
KHMC.
Dr. Saleh Tawalbeh (German trained).
12/05/12 APPLIED SCIENCES UNIVERSITY 18
19. 1984
The “Jordanian Neurosciences Society” was
established through the efforts of Dr. Maraqa,
Prof. Maani and Dr. Kurdi (neurologist). The general
assembly consisted of 18 neurosurgeons,
neurologists and allied disciplines’ specialists.
Dr. Kurdi was elected as its 1 st. President.
12/05/12 APPLIED SCIENCES UNIVERSITY 19
20. FIRST ACTIVITY
As its inaugural activity it organized the 3 rd. Pan
Arab neurosciences conference in May 1984 and
the combined E.A.N.S - Pan Arab graduate
course in neurosurgery
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21. REGIONAL COOPERATION
Jordanian neurosurgeons were instrumental
in establishing the Pan Arab Neurosurgical
Society.
Jordanian residency programs had helped
through graduating neurosurgeons for
countries like Yemen, Palestine and Iraq.
12/05/12 APPLIED SCIENCES UNIVERSITY 21
22. 2005
In February 2005 this society was split
into “The Jordanian Neurological
Association” and the “Society of
Jordanian Neurological Surgeons”.
Prof. Maani was elected as its first
president.
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23. 2008
October 2008 saw the establishment
of the ‘ Jordanian Society for Skull
Base Surgery ’. Prof. I. Sbeih becomes
its 1st. President.
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24. 1980-2008
• Jordan population grew to 6.000.000
• More neurosurgeons were graduated and
many returned after finishing their training
abroad.
• The Society of Jordanian Neurological
surgeons has a membership of 47
• Five Residency programs are functioning.
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25. NEUROSURGICAL RESIDENCY PROGRAMS AND
DATES OF RECOGNITION BY THE JMC
• The Jordan University Hospital, 1983
• The Royal Medical Services, 1987
• The University of Science and Technology King
Abdulla Hospital, 1997
• The Jordan Hospital, 2004
• The Islamic and Ibn Haytham Hospitals 2006
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26. TYPES OF NEUROSURGERY PERFORMED
• ALL TYPES OF CRANIAL SURGERY
• ALL TYPES OF SPINAL SURGERY
• FUNCTIONAL NEUROSURGERY
• ENDOVASCULAR
• EPILEPSY SURGERY
• PAIN MANAGEMENT
12/05/12 APPLIED SCIENCES UNIVERSITY 26
28. SUPPORTING FACILITIES
MEDICAL FACILITIES
• THE KING HUSSEIN CANCER CENTER
• THE FARAH REHABILITAION CENTER
• THE NATIONAL CENTER FOR ENDOCRINOLOGY,
DAIBETES AND METABOLISM
• THE GAMMA KNIFE CENTER AT IBN HAYTHAM
HOSPITAL
• THE ACCELERATORS AT THE KHCC
• THE RADIOTHERAPY UNIT AT AL BASHIR
HOSPITAL
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29. SUPPORTING FACILITIES
EDUCATIONAL FACILITIES
• 4 MEDICAL SCHOOLS
• 8 NURSING SCHOOLS
• 1 SCHOOL OF REHABILITAION SCIENCES
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30. RECOGNITION
Jordan bid to host the WFNS 2013 conference
was submitted in Nagoya in 2007.
Many believe that the 3rd. position was less than
what we deserved.
12/05/12 APPLIED SCIENCES UNIVERSITY 30
31. RECOGNITION
In 2008 around 100,000 patients from the Arab
world came to Jordan for treatment.
Neurosurgery was in the forefront of the
subspecialties sought by these patients who
came from countries like Syria, Iraq, Yemen,
Libya, Algeria, Saudi Arabia, Palestine, Sudan
and the Arabian Gulf states.
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32. RECOGNITION
MAJOR NEUROSURGICAL
FACILITIES
PUBLIC SECTOR PRIVATE SECTOR
KING HUSSIEN MEDICAL IBN AL HAYTHAM
CENTER HOSPITAL
JORDAN UNIVERSITY THE JORDAN HOSPITAL
HOSPITAL THE PALESTINE
KING ABDULLA THE 1ST. HOSPITAL
HOSPITAL THE KHALIDI HOSPITAL
KING HUSSIEN CANCER THE ARAB CENTER
CENTER THE ISLAMIC HOSPITAL
12/05/12 APPLIED SCIENCES UNIVERSITY 32