Day 1 :
Keynote Forum
Koji Abe
Okayama University, Japan
Keynote: Neuroprotective therapy both for acute ischemic stroke and ALS
Time : 09:40-10:20
Biography:
Koji Abe is currently a Professor and Chairman of Neurology at Okayama University Medical School in Japan. He graduated MD from Tohoku University School of Medicine, and then got PhD title from Tohoku University under direction of Professor Kyuya Kogure. He has been publishing more than 350 papers on cerebral blood fl ow and metabolism and neurodegenerative diseases. His research interests cover many important fi elds of neurology especially in the mechanism of ischemic brain damage, gene and stem cell therapy, neuroprotection, and neuroimaging. He is the Past President of the International Society of Cerebral Blood Flow and Metabolism (CBFM), and organized World CBFM meeting in Osaka in 2007 and Japan-Asia CBFM meeting Okayama city in 2014. He is currently serving Presidents of both Vas-Cog Japan and Vas-Cog Asia societies.
Abstract:
Edaravone is a free radical scavenger, which is the first clinical drug for neuroprotection in the world which has been approved from 2001 in most ischemic stroke patients in Japan, and some of China and India. Edaravone scavenges hydroxyl radicals both in hydrophilic and hydrophobic conditions and is especially useful in thrombolytic therapy with tissue plasminogen activator (tPA). Combination therapy of Edaravone with tPA greatly increased survival of stroke animals, reduced infarct size, and inhibited molecular markers of oxidative damage in lipid, protein and DNA. Use of Edaravone greatly reduced hemorrhagic transformation accompanied by tPA treatment, and may also extend therapeutic time window with tPA therapy for more than 4.5 hrs in human stroke patients for preserving neurovascular unit (NVU). An intensive Edaravone therapy for 3 days now showed a favorite recovery in 3 European countries. Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurodegenerative disease caused by selective death of motor neurons. Among our own 390 ALS patients, 4.1% show familial ALS (FALS), in which 50% is associated with missense mutations of SOD1, 25% were TDP43 and FUS mutations, and 6.3% is an optineurin mutation. Although the underlying mechanism of ALS has not yet been fully clarified, several reports have implicated the involvement of oxidative stress under selective death of motor neurons in both ALS patients and animal models. A recent multicenter prospective double-blind placebo-control clinical trial with edaravone for ALS patients conducted in Japan showed a positive effect for delaying the clinical score (ALS FRS-R) during the course of examination (24 weeks). Serious or critical adverse eff ect was not noted in this clinical trial. Of particular was that this clinical benefit of edaravone was shown as an add-on therapy after anti-glutamatergic riluzole. These data strongly suggest a potential underlying mechanism of oxidative stress in ALS and a clinical delay by a free radical scavenger. These translational studies on a free radical scavenger Edaravone allowed governmental permissions both for acute ischemic stroke after 2001 and for ALS after 2015. Edaravone was approved for ALS at 2015 in Japan, 2016 in Korea, and 2017 in USA.
Keynote Forum
Tofael Hossain Bhuiyan
Rangpur Medical College Hospital, Bangladesh
Keynote: Management of traumatic unstable dorsolumbar spine injuries with transpedicular screw and rod fi xation: Our institutional experiences of 59 cases
Time : 10:20-11:00
Biography:
Tofael Hossain Bhuiyan is a senior Neurosurgeon of international repute with excellent management skills. He has over 19 years of experience in treating complex brain and spine problems like brain tumors, spinal disc prolapsed, brain stroke and subdural hematoma, spinal deformity with a special interest in childhood neurosurgical problems like hydrocephalus and spinal birth defects. After fi nishing his MBBS and MS, he had undergone many specialized courses in Pediatric Neurosurgery, a better part of which has been rendered in the Italy, USA, and China etc. He had been Professor at Dept. of Neurosurgery, Rangpur Medical College, Bangladesh.
Abstract:
Background: Dorsolumbar spine injury is the most common cause of paraparesis or paraplegia. Optimal goals of the management include establishment of a painless, balanced and stable spinal column with vertebral fusion.
Material & Methods: We reviewed various types of fractures of dorsolumbar spine, their management and outcome in a prospective study of 59 cases of dorsolumbar trauma managed surgically at our centre (January 2014-December 2017). All patients underwent complete neurological examination, X-ray and MRI imaging of the spine.
Study Design & Settings: Prospective observational descriptive study in a tertiary care hospital from January 2014 to December 2017.
Results: 59 consecutive patients of dorsolumbar spine injuries with neurological deficit ranged from 14-65 years were included in this study. Out of them 56 (94.91%) patients were male and remaining 3 (5.09%) were female. Most common D12 vertebra was fractured in 20 cases, L1 in 19 cases, L2 and L3 in 4 cases each; L4, D12/L1 and L1/L2 in 2 cases each and D9, D11, D10/D11, D11/D12, D12/L3, D5/D6 in one case each. Most common mode of injury was fall from height (84.85%), others due to road traffi c accident. Majority of the patients belonged to Frankel Grade A (71.18%) i.e. 42 cases presented with complete paraplegia while 17 presented with incomplete neurological deficit. All patients were operated using posterior approach, by decompression of the cord by laminectomy at the site of injury with stabilization by interpedicular screws and rods above and below the level if injured vertebral body.
Break: Networking & Refreshment Break 11:00-11:20 @ Dunedin Bar Area
- Neurology | Neurointensive Care Unit | Neurorehabilitation | Neurophysiology | Neurosurgery | Case Reports on Neurology & Neurosurgery | Skull base Neurosurgery
Location: Edinburgh, Scotland
Chair
Koji Abe
Okayama University, Japan
Co-Chair
Pedro Góes
Paulo Niemeyer State Brain Institute, Brazil
Session Introduction
David J. Banayan
Rush University Medical Center, USA
Title: Advanced and emerging concepts in neuroprotection: Unlocking the secrets of nerve cell resilience and recovery
Time : 11:20- 11:50
Biography:
David J Banayan MD, is an Assistant Professor in the Section of Psychiatry & Medicine at Rush University Medical Center. He is the Director of the Transplant Psychiatry Program, and Associate Director of Clinical Education for the Psychiatry Consultation Service. He is an board certified in General Psychiatry, Psychosomatic Medicine, and is a Fellow of the Royal College of Physicians of Canada. Following a Master’s degree in Clinical Epidemiology and Biostatistics at McMaster University, and Residency in Psychiatry at the University of Toronto, he completed a combined fellowship in Psychosomatic Medicine and Clinical Medical Ethics at the University of Chicago. His publications span the areas of intensive care medicine, deliruim, adolescent suicide, first episode psychosis, and research ethics. His areas of current academic interest include quality improvement in transplant psychiatry, neuroprotection, and the complex interface between general medicine, psychiatry, ethics, and the law.
Abstract:
Neuroprotection is a burgeoning area of scientific research. Certain pharmaceuticals and nutraceuticals have the potential to modify and enhance nerve cell response to toxic stimuli. This discovery has spawned intense interest in unlocking the cellular mechanisms that confer such resilience and recovery. Numerous biochemical pathways play a role in neuroprotection, such as: enhanced neutralization of molecular radicals; mitochondrial membrane integrity support; arresting generation of pro-inflammatory cell membrane metabolism products; activation of neurotrophic factors; modification of intracellular calcium homeostasis; inducing shifts in the resting endogenous balance of proapoptotic and anti-apoptotic factors within the cell; and others. This session introduces participants to fundamental and advanced concepts in neuroprotection through an examination of the downstream mechanisms of psychotropic agents and nutraceuticals. Recent advances in neuroprotection are also reviewed. The session will prepare clinicians to engage the literature on neuroprotection with an informed, critical eye. Proprietary animations developed by the author, bring to life difficult-to-understand abstract concepts, and provide a unique learning experience for participants. Comprehensive critical review of the biochemical sciences and biomedical literature through PubMed and EMBASE. While bench research and animal studies currently dominate the neuroprotection literature, as this nascent area of science evolves, it is hoped that it will culminate in the development of specific sub-cellular targets in humans. Human studies are costly, complicated, and require a large number of participants to show an effect, posing a potential barrier for real-world progress in neuroprotection.
Jacintha Vikeneswary Francis
Hospital Sultanah Nur Zahirah, Malaysia
Title: A challenge in managing posterior fossa cyst with hydrocephalus: A case report
Time : 11:50-12:20
Biography:
Jacintha Vikeneswary Francis is presently the Neurosurgeon, Ministry of Health Malaysia, Hospital Sultanah Aminah Johor bahru, Malaysia since June 2016. She served as Neurosurgical Medical Officer in Hospital Kuala Lumpur and Hospital Queen Elizabeth, Kota Kinabalu Sabah from November 2006 till 2012. She attended several Conferences and was Chairman for few.
Abstract:
Background: Posterior fossa cysts are benign but usually developmental lesions. There are patient usually asymptomatic. Some cysts might communicate with these subarachnoid spaces however non-communicating cyst could develop from communicating ones giving rise to complexity of diagnosis and further management.
Case Description: One year old baby girl presented with developmental delay which is gross motor and speech with increase ICP symptoms. CT brain and MRI revealed large posterior fossa cyst extending supratentorially causing compression to the third ventricle and showing gross hydrocephalus. We proceed with endoscopic fenestration of posterior fossa cyst and ommaya insertion and subsequently proceeded with ventricular peritoneal shunt. Due to previous history of necrotizing enterocolitis (NEC), patient developed malfunction of the shunt due to poor absorption of the shunt, eventually patient required ventriculo-cysto-atrial shunt. 6 months post-procedure, patient currently does not show any evidence of recurrent cyst and developmentally showing improvement.
Conclusion: Posterior fossa cyst is rare and contributes to challenges radiologically and surgically. Current surgical management mainly depends more on clinical features giving little insights on the exact pathology of posterior fossa cyst.
Tiziana Bonifacino
University of Genoa, Italy
Title: Excessive glutamate release and undelying synaptic mechanisms in a mouse model of amyotrophic lateral sclerosis
Time : 12:20-12:50
Biography:
Tiziana Bonifacino PhD, is an Assistant Professor at the Department of Pharmacy, University of Genoa, Italy. She got the degree in Chemistry and Pharmaceutical Technology (honors) in 2007 and the PhD in Neurochemistry and Neurobiology in 2011. The present scientific interests are related to neuronal transmission in the CNS and are focused on the cellular and molecular mechanisms of neurotransmitter release and receptor activity in physiological and pathological conditions, such as amyotrophic lateral sclerosis. She has established several scientific collaborations with national and international institutions. She has published 32 publications (25 papers, 6 abstract on journals and 1 graphical abstract) in peer-reviewed journals.
Abstract:
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease, characterized by upper and lower motor neuron degeneration. Glutamate(Glu)-mediated excitotoxicity plays a major role in cell death and Glu has been found elevated in serum of patients and animal models of ALS. The aim of this research was to investigate whether the augmentend extracellular Glu can be sustainend by alteration of its release. Glu release was studied from purified spinal cord synaptosomes of SOD1G93A mice at the early and the late phases of the disease (4 and 17 weeks of life, respectively). Both the spontaneous and the stimulus-evoked exocytotic Glu release were increased at the two stages studied. We also measured the expression/activation state of a number of pre-synaptic proteins involved in neurotransmitter release: few of them were found modified and synaptotagmin and actin resulted over-expressed in both 4 and 17 week-old mice. Increased pre-synaptic Ca2+ levels, over-activation of calcium/calmodulin-dependent kinase-II and ERK/MAP kinases correlate with hyper-phosphorylation of synapsin-I at both stages. In line with these findings, Glu exocytosis was paralleled by the increase of the readily releasable pool of vesicles and prevented by blocking synapsin-I phosphorylation, using specific antibodies. Our results highlight that abnormal glutamate release is present in the spinal cord of SOD1G93A mice at the pre-symptomatic and late stage of the disease, an event accompanied by marked plastic changes of specific pre-synaptic mechanisms supporting exocytosis, that in turn may represent targets to diminish exitotoxicity in ALS. Th e precociousness of this phenomenon may imply that it represents a cause rather than a consequence of the neuronal damage during disease progression.
Samih Hassan
Queen Elizabeth University Hospital, UK
Title: Does the speed of reduction in peripheral cortisol levels correlates with long term post hypophysectomy Cushing disease control?
Time : 12:50-13:20
Biography:
Samih Hassan has completed his Neurosurgical training in London between St. Georges Hospital and the National Hospital of Neurology and Neurosurgery; Queen Square. He then did a fellowship in pituitary surgery and neuroendoscopy at Queen Square Hospital. He is currently a Consultant Neurosurgeon at Queen Elizabeth University Hospital in Glasgow.
Abstract:
Objectives: To examine the relationship between the speed of peripheral cortisol level drop following pituitary surgery for Cushing disease (CD) and long-term CD recurrence.
Design: A retrospective study of patients presenting to our centre between 2007 and 2018.
Methods: We reviewed our centre’s database to identify all patients with confi rmed pituitary-driven CD. The target cortisol level for remission of CD was defined as, less than 50 nmol/l.
Results: We identified 148 patients (43 males and 105 females, age range: 17–84 years). Twenty patients were excluded due to being lost to follow-up. Median follow-up from diagnosis was 59 months (range: 4–126 months). Patients who achieved the target cortisol of <50 nmol/l within 48 h had a recurrence rate of 2.1% during the followup period. Patients who achieved that level within 48 to 96 h had a recurrence rate of 10%, and those who achieved this level after 96 h had recurrence rate of 33.3%. Interestingly, we identified 13 patients who attained long term CD remission during follow-up with a persistent cortisol level of >50 nmol/l post operatively (range: 59–270 nmol/l).
Conclusions: The speed of reduction in peripheral cortisol levels correlates with long term CD control. This can be used as a predicting factor to guide the treating physicians in counselling patients with CD. In addition, some individuals with cortisol levels above 50 nmol/l are in long term remission, suggesting a need to reconsider this threshold value.
Break: Lunch Break 13:20-14:20 @ Westview Restaurant
Itaru Yazawa
Hoshi University, Japan
Title: A study on functional interactions between the central nervous system using a decerebrated and arterially perfused in situ preparation
Time : 14:20-14:50
Biography:
Itaru Yazawa has been a Visiting Lecturer at Hoshi University School of Pharmacy and Pharmaceutical Sciences since 2015. He received his PhD in Physiology from Tokyo Medical and Dental University in 2002. With using the decebrated and arterially perfused preparation he developed, he found that there are autonomous reciprocal functional interactions between the brainstem and the spinal cord. The preparation is recognized as a vital tool for investigating functional interactions between the CNS in several research fields. Currently, he is focusing on constructing a new system where the preparation can be maintained at the same body temperature as living animals.
Abstract:
Most recent studies of motor behavior use in vitro preparations of the neonatal rodent brainstem-spinal cord and spinal cord. However, the relevance of these studies to the neural mechanisms of adult respiration/circulation and locomotion is unclear, because the neonatal brainstem and spinal cord are immature. Moreover, it has been reported that the oxygen tension in deep tissues in these preparations was extremely low compared to that in the in vivo preparations. Thus, the results obtained from these in vitro preparations might indicate the physiological phenomena produced in a hypoxic state. To overcome these difficulties in research fields using rodents, we have adapted a decerebrated and arterially perfused in situ preparation originally developed by Pickering etal., to the preparation that can investigate functional interactions between the central nervous system. For this purpose, the rodent (weighing about 5 g or more) was decerebrated and survived by a type of total artificial cardiopulmonary bypass as a means of extracorporeal circulation to deliver oxygen to the tissues of the entire body. The oxygen and ion components of body fluid required for the survival of the preparation were supplied via the blood vessels. The physiological state of this preparation resembles to that of unanesthetized rodents under hypothermia. Here we would like to introduce a decerebrated and arterially perfused in situ preparation, and talk about reciprocal functional interactions between the brainstem and the spinal cord found by using this preparation.
Tamajit Chakraborty
Sir Ganga Ram Hospital, India
Title: A rare case of ossification of ligamentum flavum presenting as dorsal myelopathy in achondroplasia
Time : 14:50-15:20
Biography:
Tamajit Chakraborty pursuing his DNB (Diplomate National Board) Superspeciality Course (6 Years) in Neurosurgery at Sir Gangaram Hospital, New Delhi, India. He is always passionate about neurosurgery, with special interest in trauma and vascular neurosurgery. He has been awarded Dr. A.D.SEHGAL award for the best post graduate Student in Neurosurgery (Sir Gangaram Hospital and Research Centre) in the year 2016. He is also actively involved in various research activities on traumatic brain injury in his institution.
Abstract:
Ossified ligamentum flavum (OLF) is a condition of heterotopic lamellar bone formation within the yellow ligament. Ossification of the ligamentum Flavum (OLF) was discovered by Polgar and further described by Yamaguchi and Isuruni. It is mostly prevalent in Japan and other East Asian countries such as Korea and China. Achondroplasia is a genetic disorder of bone growth with congenital spinal stenosis being a well-known complication. Degenerative changes of the spine, such as disc herniation, degenerative spondylosis and arthrosis result in worsening of stenosis. However, symptomatic spinal stenosis due by ossification of the ligamentum flavum (OLF) in achondroplasia is extremely rare. The case presented here is a rare case of spinal stenosis due to ossified ligamentum flavum in a 30 year old Indian female of achondroplasia, who presented with difficulty in walking along with flexor spasms and along with bilateral lower limb progressive sensory loss. Clinical examination and radiological findings were suggestive of dorsal myelopathy at D10-D11-D12 level. We did bilateral D10-11-12 pedicle screw and rod fixation and D10-D12 laminectomy with cord decompression with good post-operative recovery.
Koji Abe
Okayama University, Japan
Title: Neuroprotective therapy with antioxidative drugs and supplements
Time : 15:20-15:50
Biography:
Koji Abe is currently a Professor and Chairman of Neurology at Okayama University Medical School in Japan. He graduated MD from Tohoku University School of Medicine, and then got PhD title from Tohoku University under direction of Professor Kyuya Kogure. He has been publishing more than 350 papers on cerebral blood flow and metabolism and neurodegenerative diseases. His research interests cover many important fields of neurology especially in the mechanism of ischemic brain damage, gene and stem cell therapy, neuroprotection, and neuroimaging. He is the Past President of the International Society of Cerebral Blood Flow and Metabolism (CBFM), and organized World CBFM meeting in Osaka in 2007 and Japan-Asia CBFM meeting Okayama city in 2014. He is currently serving Presidents of both Vas-Cog Japan and Vas-Cog Asia societies.
Abstract:
Neuroprotection is essential for potential therapy not only in acute stage of stroke but also in chronic progressive neurodegenerative diseases such as ALS, Parkinson’s disease (PD), and Alzheimer’s disease (AD). Free radical scavenger can be such a neuroprotective candidate with inhibiting death signals and potentiating survival signals under cerebral ischemia and even neurodegenerative cellular processes. Edaravone is one such free radical scavenger, which is the first clinical drug for neuroprotection in the world and has been used from 2001 in most ischemic stroke patients in Japan. A recent multicenter prospective double-blind placebo-control clinical trial with edaravone for ALS patients conducted in Japan showed a positive effect for delaying the clinical score (ALSFRS-R) during the course of examination (24 weeks). Serious or critical adverse eff ect was not noted in this clinical trial. Of particular was that this clinical benefit of edaravone was shown as an add-on therapy after anti-glutamatergic riluzole. These data strongly suggest a potential underlying mechanism of oxidative stress in ALS and a clinical delay by a free radical scavenger. Antioxidative supplements are also important choices to prevent or even treat neurological disorders such as ischemic stroke and dementia. Many basic and clinical studies suggest that antioxidative supplements such as Tocovid® (mainly tocotrienol) and TwendeeX® (coenzyme Q+multivitamin) may be effective to ameliorate acute ischemic stroke, chronic cerebral white matter damage, and Alzheimer’s dementia.
Recent Publications:
1. Abe K et al., (1988) Strong attenuation of ischemic and postischemic brain edema in rats by a novel free radical scavenger. Stroke 19: 480-485.
2. Abe K et al., (2017) Safety and efficacy of edaravone in well-defined patients with ALS: a randomized, doubleblind, placebo-controlled trial. Lancet Neurol. 16: 505-512
3. Gopalan Y and Yuen K H (2014) Clinical investigation of the protective eff ects of palm vitamin E tocotrienols on brain white matter. Stroke 45:1422-1428.
Pedro Góes
Paulo Niemeyer State Brain Institute, Brazil
Title: The keyhole concept for the management of ruptured and unruptured aneurysms
Time : 15:50-16:20
Biography:
Pedro Góes is a young Neurosurgeon graduated from the Federal University of São Paulo, currently acting as a Member of the Vascular Neurosurgery group of
the Paulo Niemeyer State Brain Institute in Rio de Janeiro. In addition to aneurysms, he is interested in arteriovenous malformations, cavernomas and tumors of the central nervous system, with a recent publication on the role of necrosis in intracranial meningiomas.
Abstract:
For the treatment of aneurysms, clipping still offers higher occlusion rates and its technique continues to evolve, resulting in smaller exposures and reduced manipulation to brain tissue. We report our experience with minipterional craniotomy for anterior circulation aneurysms, exploring our routine use of this approach for managing both ruptured and unruptured aneurysms in a high-volume institution in Brazil. This presentation includes vídeos of different treated cases.
Recent Publications:
1. Figueiredo et al. (2016) Surgical experience of minipterional craniotomy with 102 ruptured and unruptured anterior circulation aneurysms. Journal of Clinical Neuroscience 27:34-9.
2. Tra et al. (2017) Minipterional and supraorbital keyhole craniotomies for ruptured anterior circulation aneurysms: experience at single center. World Neurosurgery doi: 10.1016/j.wneu.2017.09.058.
3. Cavalcanti et al. (2017) Engaging in a keyhole concept for the management of ruptured and unruptured aneurysms. World Neurosurgery 102:466-476.
4. Alkhalili et al. (2017) The minipterional approach for ruptured and unruptured anterior circulation aneurysms: Our initial experience. Asian Journal of Neurosurgery doi: 10.4103/1793-5482.180951.
5. Caplan et al. (2014) The minipterional craniotomy for anterior circulation aneurysms: initial experience with 72 patients. Neurosurgery 10(2):200–207.
Break: Networking & Refreshment Break 16:20-16:40 @ Dunedin Bar Area
Ekaterina Drozhevskaia
The Turner Scientific Research Institute for Children’s Orthopedics, Russia
Title: Complex clinical and functional study of children with idiopathic tip-toe walking
Time : 16:40-17:10
Biography:
Ekaterina Drozhevskaia graduated from St. Petersburg State Pediatric Medical Academy in 2008, finished Residency in Clinical Neurophysiology at North- Western State Medical University in 2014. She was Head of Diagnostic Department in Institute of Human Brain, St. Petersburg, Russia and now working
as Clinical Neurophysiologist in Turner Scientific Research Institute for Children's Orthopedics and is Chairman of Neuromuscular Disorders Society in St. Petersburg from 2015.
Abstract:
Tip-toe walking is a well-known problem in children which leads their parents to consult a specialist. This condition usually is difficult to differentiate between neurological and orthopedic disorder that’s why it needs a multidisciplinary approach and cooperation of different specialists to find a diagnosis and determine the correct treatment. 25 children with tip-toe walking (aged 1-15 years) were examined by neurologist and orthopedist. To find out the main reason of walking disorder a number of neurophysiological and radiodiagnostic methods were used. The neurophysiological investigations included EMG of lower limb muscles, NCS, TMS. Imaging included US and MRI of lower limbs muscles. Radiological method was chosen according to the age of a child. Based on the results of all examinations and investigations children were put to a diff erent group: CNS disorder, neuromuscular disorder, orthopedic disorder - and they got treatment accordingly. These results show the importance of considering not only clinical examination by specialists, but also different types of investigations (neurophysiological and imaging) for optimizing the approach to full diagnostic and proper treatment and rehabilitation approach to children with idiopathic tip-toe walking.
Rahul Srinivasan
Medical Trust Hospital, India
Title: Cervical perimedullary AVF with feeding artery aneurysm - endovascular treatment with review of literature
Time : 17:10-17:40
Biography:
Rahul Srinivasan is pre final resident in Neurosurgery Department at Medical Trust Hospital Kochi, Kerala. He is also member of Cochin Neurological Society
and Neurological Society of India. He has co-authored various articles in field of Neurotrauma. Last article related to ICP monitoring was published in Acta Neurochirurgica in 2018. During his post-graduation he has assisted multiple cranial, spinal surgeries and endovascular procedure. He has won best poster award at PULSUS Conference at Singapore conducted in September 2018. His current research also continues in field of Neurotrauma.
Abstract:
Perimedullary AV fistula is not common disease. Here we present a case of 11-year-old boy who presented with sudden onset of severe headache and neck pain for one day. He was having similar episodes in the past and treated as migraine. Imaging revealed SAH in posterior fossa and cervical subarachnoid space. There were multiple flow voids around lower cervical cord suggesting vascular malformation. Patient underwent spinal and brain DSA, which revealed diagnosis of single hole single feeder cervical perimedullary AVF with feeding artery aneurysm as a cause of SAH. He was treated by endovascular means with 5 month imaging follow up.
Guive Sharifi
Shahid Beheshti University of Medical Sciences, Iran
Title: Endoscopic endonasal transsphenoidal approach in patients with Rathke’s cleft cyst
Time : 17:40-18:10
Biography:
Guive Sharifi is an Associate Professor of Neurosurgery from Shahid Beheshti University of Medical Sciences, Tehran, Iran. He is a faculty member of Shahid Beheshti University of Medical Sciences. He has conducted studies in the field of neurosurgery, especially endoscopic pituitary surgery and skull base surgery. He has published about 83 scientific articles in local and international medical journals. He is also a member of the specialized association of neurosurgical societies, including the American Association of Neurological Surgeons.
Abstract:
Rathke’s cleft cysts are bengin lesions that originate from congenital remnants of Rathke pouch. The cyst could be filled with different fluids which can affect imaging characteristics. They are frequently found on autopsy, but contrary in rare cases these lesions could exhibit symptomatic growth or present as pituitary apoplexy. 19 patients (eight females) were considered for a non-aggressive surgical strategy of partial cyst wall removal and drainage of cyst contents was performed via endoscopic endonasal transsphenoidal approach (EETA) on all patients. The anterior face of the cyst wall were excised and sent off for pathologic examination. All nineteen procedures were subtotal resections and this was defined as decompression and drainage of cyst contents and partial resection of the ventral cyst wall. Diabetes insipidus resolved for one patient as postoperative complications after six months. There were no postoperative CSF leaks and no permanent neurological or endocrine deficits and all patients had improvement of initial preoperative symptoms. Th e EETA as a non-aggressive strategy for partial cyst wall removal and simple drainage of cyst contents is a feasible approach for surgical treatment of Rathke’s cleft cysts. However, more aggressive strategy may indicated in patients with repeated recurrences. Not to mention that endoscopic approach provides wide panoramic visualization to facilitate extracapsular resection with preservation of pituitary stalk and gland.
- Clinical Neurophysiology | Neuronal functions and disorders | Neurorehabilitation| Neuroimaging | Spinal Surgery | Neurosurgery | Brain Tumour
Location: Edinburgh, Scotland
Chair
Felix-Martin Werner
Euro Akademie Pößneck, Germany
Session Introduction
Ludmila Zylinska
Medical University of Lodz, Poland
Title: Neuronal calcium dyshomeostasis as a crucial process in neuropathologies
Time : 11:20-11:50
Biography:
Ludmila Zylinska PhD, DSc, is a Full Professor and Head of the Department of Molecular Neurochemistry, Medical University of Lodz, Poland. Her scientific interests are related to regulation of neuronal calcium homeostasis with particular attention brought on plasma membrane calcium pumps in the CNS, as well as on molecular mechanisms of calcium-dependent processes that regulate neuronal transmission in physiological and pathological conditions. She has published more than 60 papers in the areas of Biochemistry, Neuroscience and Cell Biology.
Abstract:
Oscillations of cytosolic Ca2+ are necessary for cellular signaling and propagation of Ca2+ signal is an absolute requirement for the functioning of neuronal cells. Ca2+ appears to be a universal and ubiquitous signaling molecule, thereby in resting neuronal cells its concentration is kept at ~100 nM against 1-2 mM outside the cell. Inability to maintain calcium homeostasis in neurons underlies many neuropathologies. Ca2+ may elicit a variety of diff erent responses based on the type of targeted neurotransmission pathways, and it regulates synaptic plasticity, controls neuronal growth and neuronal survival. The plasma membrane contains a high affinity Ca2+-ATPase (PMCA) that translocates Ca2+ from the cytosol to the extracellular environment. The enzyme is coded by four separate genes (PMCA1-4), among which PMCA2 and PMCA3 are considered as neuron-specific forms. In the brain, PMCA function declines progressively during aging, thus impaired calcium homeostasis may contribute to neurodegeneration. We have developed the stable transfected differentiated PC12 cells with reduced level of PMCA2 or PMCA3, and the most critical finding was permanently increased resting Ca2+ concentration. Altered PMCA composition affected the expression level of several Ca2+-associated proteins (SERCA, calmodulin, calcineurin, neuromodulin) and certain types of voltage-gated calcium channels. We have also evidenced a novel PMCA role in regulation of bioenergetic pathways and mitochondrial activity. Interestingly, some changes could occur as adaptive processes protecting cells against calcium overload. Since age-related PMCA decrease has been documented, our modified PC12 cells may be a useful model to clarify the biological changes in neurons as well as to study the vulnerability of cells to neurodegenerative insults.
Benjamin Fleming
The Royal Melbourne Hospital, Australia
Title: Robot-aided spinal surgery: Lessons learned from our first 70 patients
Time : 11:50-12:20
Biography:
Benjamin Fleming is an aspiring Neurosurgeon and has a particular interest in complex spinal cases. He is a current unaccredited Neurosurgical Registrar at the Royal Melbourne Hospital.
Abstract:
Robotics has grown to be commonplace in a range of surgical fields. In spine surgery, however, it remains relatively novel. There is a burgeoning body of evidence to suggest that spinal robotics may improve surgical ergonomics, eliminate human errors, minimize radiation exposure, and improve patient outcomes. Its application in spinal surgery is thus particularly appealing. However, the technology’s potential benefits must be weighed against concerns regarding cost and workflow. As with any evolving technology, careful clinical evaluation of its application and limitations must be well-considered and defined. The purpose of this piece was to evaluate the outcomes and lessons learned through the use of robot-assisted screw placement using the Mazor Robotics technology in a series of 70 patients at one centre in Melbourne, Australia. We evaluated pre-operative screw planning and compared this to post op CT scans. We also assessed x-ray exposure times and length of hospital stay. In our series we found that we had a 98.9% rate of accuracy and both a reduced radiation exposure time and reduced hospital stay, when compared with open free-hand surgery. In conclusion, we found robotic surgery to be safer for both the patient and theatre staff .
Pedro Góes
Paulo Niemeyer State Brain Institute, Brazil
Title: The role of necrosis in the worse prognosis of meningiomas
Time : 12:20-12:50
Biography:
Pedro Góes is a young Neurosurgeon graduated from the Federal University of São Paulo, currently acting as a Member of the Vascular Neurosurgery Group of the Paulo Niemeyer State Brain Institute in Rio de Janeiro. In addition to aneurysms, he is interested in arteriovenous malformations, cavernomas and tumors of the central nervous system, with a recent publication on the role of necrosis in intracranial meningiomas.
Abstract:
Meningiomas are the most frequently reported primary intracranial tumours, accounting for more than 35%. The 2016 WHO classification of central nervous system tumors stratifies meningiomas in grades I (benign), II (atypical), and III (malignant), according to histopathological aspects and the risk of progression or recurrence. In this current edition, the classification and grading of meningiomas did not undergo revisions, except for the introduction of brain invasion as a criterion for the diagnosis of atypical meningiomas, WHO grade II. The presence of spontaneous necrosis is an atypical feature only considered a criterion if added to other two atypical features. We evaluated spontaneous necrosis as a possible isolated factor for progression and recurrence in grade I meningiomas classified according to the current WHO classification. In our study, necrosis was a consistent factor not only for recurrence, but also morbidity, mortality and malignant transformation rates. Thus, a significant role of this histological finding is highlighted in the worst prognosis. The role of necrosis in the higher rate of recurrence and worse prognosis in intracranial meningiomas presented in this study raises the need to evaluate this criterion alone for the follow-up of patients with these tumors.
Break: Lunch Break 12:50-13:50 @ Westview Restaurant
Jaideep Jesson Rayapudi
Pondicherry Institute of Medical Sciences, India
Title: Challenges to human intelligence in a future with artificial intelligence
Time : 14:30-15:00
Biography:
Jaideep J Rayapudi, completed MD Physiology in 2003 and has been involved in training & development of Medical Students with a keen interest in the process of learning & memory. He has been at the cutting-edge of developing & implementing technology-based education systems and advocates greater use of artificial intelligence to improve healthcare and healthcare education. He believes that the only way to know the future is to build it and that begins by challenging the status quo.
Abstract:
A lot of discussion abounds today about the future of Humanity, society and community with respect to the advancing prospects of all-pervasive artificial intelligence in the coming days; be it the voice activated devices, self-driven cars, financial trading or even robot-driven healthcare. In the background of all these massive and quick changes how does the human brain respond & react? The industrial revolution took away jobs which had traditionally required human muscle power and now in the information age we are poised to lose out jobs to machines where Human Intellectual work is required. Outside of the job space too, much of decision-making and thought has been aided heavily by data driven machine learning algorithms. Neuroplasticity can enable the brain to get better and learn more; can the opposite be true with disuse of critical components of our cognitive behaviour? The future challenge for cognitive neuroscientists would be to guard & guide brains with suitable strategies to minimise the damage due to the onslaught of machine intelligence. Steps must be taken to recognise relevant issues and diagnose & intervene wisely globally. While apocalyptic scenarios like in the Terminator / Matrix may be prevented by sound policy; neural responses and its subsequent effects in areas of Psychology, society, polity, culture, art, design, relationships, religion etc must be prepared for and countered / augmented if needed. This proposed talk seeks to highlight some of these concerns and generate dialogue, response and action in this matter.
Samih Hassan
Queen Elizabeth University Hospital, UK
Title: CNS involvement in IgG4 related disease, a new diagnostic challenge for neuroscientists
Time : 15:00-15:30
Biography:
Samih Hassan has completed his neurosurgical training in London between St Georges Hospital and the National Hospital of Neurology and Neurosurgery; Queen Square. He then did a fellow ship in pituitary surgery and neuroendoscopy at Queen Square Hospital. He is currently a Consultant Neurosurgeon at Queen Elizabeth University Hospital in Glasgow.
Abstract:
Objectives: Central nervous system (CNS) involvement in IgG4-related disease (IgG4-RD) is a relatively recent discovery, first reported in 2006. The disease can present a diagnostic challenge, as the clinical and neurological findings can mimic multiple oncological and inflammatory conditions. Here, we review our center’s experience of IgG4-RD.
Design: A retrospective study of patients presenting to our centre between 2013 and 2018.
Subjects: All patients with a histopathologically suspected diagnosis of IgG4-RD.
Methods: Review of our center’s neuropathology database.
Results: We identified 10 patients (5 males and 5 females, age range: 26-73 years) with a histopathological diagnosis of IgG4-RD. Median follow-up from diagnosis was 36 months. All patients presented with CNS manifestation of
IgG4-RD, and none had any manifestations of the disease. Two patients presented with cranial or peripheral nerve involvement and seizures, and the remaining 8 with clinical evidence of hypophysitis. All had biochemical evidence of panhypopituitarism at the time of presentation, and none had visual impairment. All patients underwent biopsy/ debulking) and five were subsequently treated with steroids/immunosuppressants. At last follow-up, all were alive.
Conclusions: IgG4-RD is a rare cause of neurological and endocrine dysfunction and requires individualized management. Once confirmation of the diagnosis has been obtained, some patients can be managed conservatively, although some require treatment with steroids and immunosuppressants, for example rituximab.
Biography:
Rebecca B Baker holds two Bachelors degrees: one in Nursing from the University of Tennessee, the Health Science Center in Memphis and one in Education from the University of Memphis. Currently she is completing pre-requisites to purue a Doctor of Nursing Practice. She serves as the Chief Clinical Officer at Utilize Health, a population health compamy that specializes in care management services for patients with severe neurological conditions. She is a veteran nurse with over twenty-six years of clinical experience working with patients and care teams in a variety of settings.
Abstract:
Why aren’t long term post acute outcomes and recovery documented in patients with neurological conditions such as severe spinal cord injury (SCI)? As a healthcare system, how far should we reach in documenting outcomes and recovery and for what length of time so that current knowledge aligns with rehabilitation approaches for mobility recovery? Historically, research for the severe SCI patient population has looked at smaller sample sizes and the patients are less than 1-2 years post injury or diagnosis. In this presentation, we explore what patient reported outcomes can do to shift the conversation around what mobility recovery and tarteged rehabilitation therapies in SCI looks like. A key factor in moving the conversation regarding expected outcomes requires a fundamental hypothesis that recovery from severe spinal cord injury is a life-long process. Therefore, with research and data collection at scale (tens of thousand of patients), we can start to tie causation to pieces of recovery and even rehabilitation timelines and therapies that may not have been considered in the past. Case studies will be presented and explores a sample case: a 17 year old sustained an Asia A complete SCI at C6-T5. Aft er nearly 6 years, she learned to walk unasissted. Even after 14 years (she is 31 today), she continues to recover. Collecting and analyzing patient reported outcomes at scale can shed light on long term recovery and what is possible in a poulation that has historcially been given little to no hope in mobility recovery.
Break: Networking & Refreshment Break 16:00-16:20@ Dunedin Bar Area
Dharitri Parmar
Government Medical College, India
Title: Review on omega fatty acids and neurophysiology
Time : 16:20-16:50
Biography:
Dharitri Parmar is working as Professor in Physiology since 2007 and as Teacher in medical college since 1992. She has contributed almost 22 years as teacher is in Government Medical College, Surat, India which is affiliated to Veer Narmad South Gujarat University. She is multifaceted personality who is interested in administration and academic activities. Currently holding the post of Addittional Dean of the Government Medical College. She has worked on few reserch topics and floated presentation online. She has visited nearly 50 medical schools in India and overseas as assessor (deputed by Medical council of India) : as an examiner or as an interviewer. She has also reviewd number of publications for journals.
Abstract:
Omega 3 and 6 are different types of PUFA having distinct effects on human systems. EFA is most debatable and important nowadays while studying nutritional role of lipids and its effects in physiology. This oral presentation is to focus on recent advances in importance of ratio (omega 6: omega 3) for clinical purposes physiologically. Omega 3 and Omega 6 compete for enzymes to produce signaling molecules, to modulate gene expression and to consolidate cell-membrane. The ratio of omega 6 to omega 3 is of importance according to various studies and its effects on nervous system physiologically, which may differ for different tissues or functions. Many hypothesis and various mechanisms are discussed herewith in context to BBB, membrane fluidity, myelin sheath, neurotransmitters etc. As a researcher it is studied for physiology of Learning, memory, sleep, early development, aging, and stress with EFA. Results conclude that 4:1 ratio has protective and stabilizing effects on neuron and its functions.The ratio may be a key factor in modulating behavioral, developmental, pharmacological effects of lipids.
Felix-Martin Werner
Euro Akademie Pößneck, Germany
Title: Update of the neural networks involved in generalized epilepsy
Time : 16:50-17:20
Biography:
Felix-Martin Werner studied Human Medicine at the University of Bonn. He has been working as a medical teacher in the formation of geriatric nurses, occupational therapists and assistants of the Medical Doctor at the Euro Academy in Pößneck since 1999. He has been doing scientific work at the Institute of Neurosciences of Castilla and León (INCYL) in Salamanca, Spain since 2002. With Professor Rafael Coveñas, he assisted at over 30 national and 12 international Congresses of Neurology and published over 40 reviews and two books about neural networks in neurological and psychiatric diseases. Since 2014, he has belonged to the Editorial Board of the Journal of Cytology & Histology.
Abstract:
We reviewed the alterations of neurotransmitters and neuropeptides in the following brain areas involved in generalized epilepsy: hippocampus, hypothalamus, thalamus and cerebral cortex. In these brain areas, neural networks are also actualized. Th e mechanisms of action of newer antiepileptic drugs, for example a GABAB agonist, an AMPA receptor antagonist and brivaracetam, used in the treatment of generalized epilepsy are also discussed. Updating the neural networks, we suggest that in the hippocampus GABAergic neurons presynaptically inhibit, via GABAB receptors, epileptogenic neurons. GABAergic, glutamatergic, serotonergic and dopaminergic neurons form the principal neural network, while GABA and serotonin deficiency and dopamine and glutamate hyperactivity have a proconvulsant effect. In preclinical studies, the GABAB receptor agonist GS-39,783 exerted a good antiepileptic effect. Perampanel, an AMPA receptor antagonist, showed good anticonvulsant eff ects in the treatment of partialonset seizures and primary generalized tonic clonic seizures. In this treatment, perampanel can be combined with other antiepileptic drugs. Brivaracetam, whose mechanism of action will be explained in detail, showed a good efficacy in the treatment of adult focal seizures and secondarily generalized tonic-clonic seizures.
Rahul Srinivasan
Medical Trust Hospital, India
Title: Evaluation and efficacy of optic sheath measurement by sonography means to detect raised intracranial pressure
Time : 17:20-17:50
Biography:
Rahul Srinivasan is pre final resident in Neurosurgery Department at Medical Trust Hospital Kochi, Kerala. He is also member of Cochin Neurological Society
and Neurological Society of India. He has co-authored various articles in field of Neurotrauma. Last article related to ICP monitoring was published in Acta Neurochirurgica in 2018. During his post-graduation he has assisted multiple cranial, spinal surgeries and endovascular procedure. He has won best poster award at PULSUS Conference at Singapore conducted in September 2018. His current research also continues in field of Neurotrauma.
Abstract:
The advent of routine direct monitoring of intracranial pressure began in 1960 and is credited to LUNDBERG who described method of directly monitoring intracranial pressure by measuring fluid pressure in ventricle. Next milestone of monitoring intracranial pressure was in 1973 with introduction of various invasive devices like subarachnoid bolts and catheters. Even though precise measurement, but associated with multiple complication like difficulty in placement, incorrect position, infection and hemorrhage. Idea of non-invasive method of measuring intracranial pressure is gaining popularity and captivating. Best advantage is that it is associated with no major complication and can be learned swiftly. We at our institute use one such non invasive method, measuring optic sheath diameter to identify raised intracranial pressure by sonography means.