0:03
This is the 16th
0:05
SNI and SNI digital bag to add a neurosurgery online meeting held in August 7th, 2022.
0:13
The meeting originator and coordinator of Samar Hawes
0:24
Video editors are Mustafa Ismail, the College of Medicine University of Baghdad, and Fatima Ayad, fourth year medical student university of Baghdad,
0:36
and the resources of the foundation supporting this program.
0:43
This is a section headed for young neurosurgeons and student speakers There will be three short presentations.
0:53
The young neurosurgeons and student speakers include Sally M. Mary, senior neurosurgery resident, a rocky board of neurosurgery, neurosciences hospital, and Baghdad.
1:06
Octemol Elcafaji, Department
1:10
of Surgery, College of Medicine, University of Baghdad, Baghdad, Iraq, and Hanine A. Selah, Department of Biology, College of Science, the Mustan
1:22
University, Baghdad, Iraq
1:30
The first presentation will be by Salah Mary, senior neurosurgery resident at the Iraqi Board of Neurosurgery, Neurosciences Hospital, and by dad, he will talk about the complications and outcomes
1:43
associated with the clipping of ruptured intracranial anterior circulation aneurysms, a single center experience. So I would like to introduce Salah, who is a final year
2:03
board resident Iraqi board, and he's very brilliant. And Salah, you
2:10
can share your presentation and please introduce yourself more and you have the stage
2:19
My presentation is complications and outconstrated with the rupture
2:26
clipping or proper sort
2:39
of interior circulation aneurysm. Can you make a full sickening, please? Yes, the background about the aneurysm is derived from the anterior cerebral circulation approximately 85 of all
2:44
intracranial aneurysms and due to a interrogated low distribution within the corrupted system and it's a closed anatomical connection through the surrounding brain parenchyma and the cranial nerves.
2:58
These aneurysms may be difficult to treat even more so following rupture. While the endovascular techniques such as the digital coils and the flow-diverting devices have improved patient outcomes and
3:11
established themselves as an attractive baseline treatment option for ruptured intracranial aneurysms. They remain inaccessible and many developing cataracts.
3:25
introspective with chart analysis performed on 81 cases who underwent micro-surgical clipping of observed aneurysm and tear circulation in period of October 2019 to October 2021. The study was
3:41
conducted at the neurosurgery teaching hospital in Baghdad in Iraq, based on
3:48
pre-operative information and operative data and post-operative informations Regarding pre-operative informations, patient demographics, comorbidities, clinical manifestations, CT findings,
4:02
aneurysm characteristics, regarding operative data, the time from meeting day to the operation day. The surgical approach used whether Therionov or subproorbital versus internal hemispheric
4:17
approach, whether Lemon and Turbinaus or Lelequist membrane for the installation. temporary clipping, intraoperative rupture occurrence, and intraoperative monitoring, intraoperative blood loss,
4:27
and need for any blood transfusion, papa very news, intraoperative rate, and gyro-sector resection. The
4:39
postoperative data, including clinical data, less co-coma scary, beating, buzzer, spasm, weakness, seizure, stroke, granular palsy, and dyspasia, image-finding, post-operatively, whether
4:55
ICH, high-vh, or residual neck, neurosom, on CT scan, CT angio, sorry, hydrokiphalos, CSF diversion devices, extended ventricular drain, or
5:04
ventricular tretonial, shown ventilator support, and the trichostomy, and formation on other local and systemic complications, such as occurrence of the infection.
5:23
want infection, VDT, and pulmonary embolism, chest infection. The follow-up data question focused on the following, Glasgow Outcome score used at discharge and six months interval and from the
5:35
last follow-up and also a residual next seizure of hydrocephalus. All these informations
5:43
were classified, related, and analyzed. The aim of our study is to closely document the procedure related complications and post-operative complications and outcomes and to look for links between
5:56
these outcome measures and various patient and then using specific features. The outcome measures
6:04
were regarding the seizure at discharge 99 and at the follow-up 13, regarding weakness 1 to 35 and
6:17
39 at follow-up. regarding hydraulic if I was 37 at discharge and 13 at follow-up. You can ask how it comes to store, have 5 days of recovery where 827 at discharge is increasing to 934 at
6:39
follow-up, moderate disability, 99 at discharge and at follow-up 53 Severe disability 12 at discharge and 13 at follow-up.
6:55
Persistent disability status was 0 and that was 5 cases. The following factors are straighted with poor outcome, the glass cloud comes to a discharge and lost a lot. The weakness with P-value less
7:14
than or 3 significant factors. and post-operative vaseous spasm with p-vibial list and 003 and need for ventrator and take systems support with p-vibial list and 001 and
7:33
pulmonary embolism with p-vibial list and 001 to the final outcome on our study of patients with the clipping of certain aneurysms was 94 alive and 6 dead. Thank you.
7:56
Thank you. Thank you, Sara, for your presentation.
8:03
You can stop the sharing and let's have a comment and the question
8:11
The second talk will be given by Octom O al-Kafaji of the Department of Surgery, the College of Medicine, the University of Baghdad,
8:22
on the impact of the neurosurgery mentorship in which he participated. And now I want to introduce Aktham. Aktham was a medical student, sorry, and he's just graduated from medical school in
8:30
Baghdad, and
8:43
he's one of those in the first rung in the college. And he will present his experience, tell us now, and yeah, you have
8:58
the stage, Aktham. Thank you, Dr. Summer. Thank you, professors, esteemed colleagues and residents and everyone who is sitting. Thank you.
9:11
the opportunity to present my experience with
9:18
you. So as Dr. Sammer said, I graduated from the Dad University School of Medicine in 2021. And I was fortunate enough to be an alumnus of the sixth Haas neurosurgery mentorship program in 2019.
9:36
So today I'd like to talk to you about how that program helped kickstart a potential career from me and my colleagues in that mentorship in neurosurgery and in medicine in general.
9:48
I hate to talk about myself, so I'm sorry. You have to bear with me. But this is about navigating life and navigating our medical lives post the Haas neurosurgery mentorship program. So here's a
10:03
picture of me and my colleagues during the mentorship in 2019 I just want to point out here that's every single one of us. found his own pathway, whether it be neurosurgery, neurology,
10:16
neuroradiology,
10:18
medical education, and other medical fields that we were introduced to through the mentorship program. So the mentorship started in late 2019 and had a great focus on clinical exposure bridging the
10:36
gap between theory and practice for us.
10:40
As many of my colleagues know, this is kind of hard to come by in classical medical education through medical school in Iraq. So it was very fortunate for us to be able to attend wet labs,
10:56
simulations, and even chances to observe and scrubbing on complex neurosurgical procedures And to be honest, we took these experiences, we took these connections that we made through And we built
11:11
upon them to get more and more clinical exposure. So that me and a lot of my colleagues who were with me had the chance and the privilege to attend hundreds of hours in neurosurgical OR to attend
11:27
neuro ICU, to be in the wards, to see patients, talk to them, to have shifts in neurosurgical emergency rooms, even to be involved and to see, be involved in CAF
11:43
suite and in geographic procedures, neuro-interventional procedures. So that was in terms of the clinical exposure. The other big part of the mentorship program focused on education and
11:56
specifically peer education was a big thing for our mentorship program
12:03
It had a focus on giving us the confidence to present in front of an audience whether it be large or small. And we took that and went out there. Some of us, this helped them kick start their career
12:14
in peer education, in medical education. Some gave talks on neurosurgical TV. Others, including me, got the great opportunity to present on SNI meetings in front of such esteemed audience, such
12:29
as this one. So it was a really big opportunity to get us past the stage fright
12:39
that allowed of medical students have and present on an international level, which was something we had never participated in before. And you can see here, this is my colleague. So much, she was
12:50
a first-year medical student. So she was at least three, four years behind every other participant in the mentorship. And here she is explaining the Venus system to us. So peer education was a big
13:01
thing in our mentorship program. And then comes research, which is, I think, like the biggest part of. of the Haas Neurosurgery Mentorship Program and something that Dr. Haas has strongly
13:13
instilled in each and every one of us, a focus on the scientific process, a focus on publishing new ideas and making your voice heard in the world, which is something that also Professor Osman
13:25
emphasizes on a
13:28
lot. So the story starts like this. The topic of this research is very rare. It's not something that we see a lot in clinical practice, but we were fortunate or unfortunate, I don't know enough,
13:45
to encounter a case of a patient who presented to the neurosurgical teaching hospital with classical features of subarachnoid hemorrhage. We did a CT angiogram, which you can see here, and the CT
13:58
angiogram showed an
14:01
ACOM aneurysm, secular aneurysm in the anterior communicating artery, But it showed something else, which was very. surprising to us, which was that there was no internal carotid artery on one of
14:13
the sites. It was obliterated. It was a plastic internal carotid artery, which was later confirmed by angiography. Okay. So, as you saw in the CTNG, he had an e-coloneurism, and the ICA was
14:30
missing Now, one thing that we usually do in open clipping of aneurysms is that we need to achieve proximal control, proximal and distal controls. And sometimes we have to do temporary clipping to
14:44
achieve that control, especially in cases that the aneurysm ruptures intraoperatively or the flow is very high and we each control it to be able to clip it safely So that is something we have to do
14:58
in
14:60
aneurysm surgery. And usually in acorn surgery we can do that safely because there is a collateral network because the circle of a list does its job. and the patient gets blood from the other
15:11
internal carotid artery. In our case, we had a problem because
15:18
our patient did not have an internal carotid artery, okay, on one side. This was absent. So this presents a problem for my younger colleagues. I'm sorry for the professors, but I have to explain
15:29
this for the younger colleagues. If you don't have an internal carotid artery on this side, then all the blood to this side of the brain is coming from the contralateral internal carotid artery or
15:40
from the posterior circulation. So it becomes kind of a problem if you have to temporarily clip this artery, which is the first segment of the anterior cerebral artery because there is no ICA here
15:54
and you clip this one, you are basically cutting off the blood supply through the acone that goes to the other side of the brain because it doesn't have an internal carotid artery So this was a major
16:04
issue, this was a problem for us. So what did we do? We went back to the literature. We tried to look at things from a new perspective. And we found two interesting things in the literature.
16:17
First off, we found that there are very few, if not at all literature, on the subject of internal carotid artery being absence with an anterior communicating artery aneurysm. We tried all our best
16:34
We found about 34, I think, case reports and technical notes on this particular condition being combined with an acholanieurysm. So we didn't have a lot of evidence to start off with. We had to
16:48
depend on anecdotal evidence, so to speak. And secondly, we found a wonderful classification by Dr. Lai, which classifies the patterns of anastomosis and collateral flow in the context of an
16:59
app-plastic internal carotid artery.
17:05
we saw that in something called a Li-type A, the
17:09
MCA gets its blood supply from the posterior circulation. In Li-type B, we found out that the anterior communicating artery provides, from the other contralateral site, provides the blood supply
17:22
to all of the brain on the ipsilateral side that has no carotid artery. And so as can be found in the full classification of Li So the task was simple. We looked at all the reported case reports on
17:39
this condition, in particular, in terms of their light classification. We modified it to just the ones that are relevant to econionarisms. And we proposed a treatment algorithm to clip, as I said,
17:53
to clip or not to clip the aneurysm, based on the risk of compromising the collateral flow to the part that has no internal carotid artery And that's it. That was the. article, we just had to
18:05
write it. The idea was complete. So it was written by me and my colleagues under the supervision of Dr. Sammer. And lo and behold, it was published in SI. It was my first neuro-surgical article
18:19
that I had contributed to to be published, and it was a very proud moment. And since then, I have had the great honor and opportunity to participate in over 10 neuro-surgical papers with Dr. Ho's
18:32
and his team So that is something great for me.
18:39
That lasts all the lessons I learned, how to share knowledge from Dr. Ho's, how to appreciate research, and how to be enthusiastic about it. All drove me and my colleagues to start a new project
18:52
by Statistics Central. Where are we aiming to share a passion for the scientific process with a wider audience, sharing knowledge and experience in the research in a modern way. matching people
19:04
with mentors in different medical specialties so they can all start and accomplish their aspirations to be young researchers, to be the physician scientist model.
19:17
That's all. Thank you all for listening to me and I hope my presentation was not too boring. Thank you very much.
19:25
Thank you. Thank you. You can stop the share. Yes. Thank you for this nice presentation. I am biased definitely with your achievement and proud of it. I will wait for comment from the panel and
19:45
the colleague of
19:48
anyone have a comment. Do you have a comment Dr. Osman? There is a comment from Musama there I think. Yeah. You might have a question. Yeah. Musama introduce yourself first and please go. Sure,
20:04
hello everyone. My name is Usamand Della, a four-tier medical student at RCSI behind, so much to work on for the presentation. And that was really fascinated by the unilateral absence of the
20:15
internal coronavirus artery. My question is, like it's well known that the primary collateral pathway is from the alternate circulation through the AECOM and the EECOM. So what about the secondary
20:29
collateral pathways for the
20:33
ophthalmic and
20:38
leptaminin-geal collateral? Were they present? Yeah, thank you for your question, Asama. The secondary collateral pathways were not really mentioned in the literature. We tried to look at it
20:44
from that perspective and even looking at the live classification, it does not mention secondary collateral. It mentions some remnants of fetal pathways such as the trans cavernous pathway, but
20:58
there was no mention of secondary collateral because maybe they don't contribute as much. and we haven't seen it in our patient either. So yeah.
21:07
All right, thank you so much again. Your most book. Thank you, Osama. That's a brilliant question. Maybe you will. I'll just, I'll just make it, I could talk about this for a long time, I
21:19
won't. But the reason you didn't find much in the literature is because most people don't do four vessel angiograms.
21:27
And the literature is filled with that, which means it leaves you with only information about the anterior circulation and not the posterior circulation. So it was Samus' question is excellent. And
21:38
what I think you would find, particularly if that occlusion is chronic, that there would be collateral circulation, which is what Samus' referring to, through the vertebral otters, through the
21:48
posterior communicating arteries, probably even in the hemisphere. And even the carotid endorectomy trials that were done with randomized controlled studies in the 1980s did not require. for vessel
22:03
angiograms, that's not a useful study, but major decisions were made on that basis. So unless you know all the things you can about the circulation, it's very difficult to make a conclusion. The
22:17
second thing is the reason why you have aneurysms developing is because the flow patterns have been changed and the flow will contribute to aneurysm formation and you'll find that again, people who
22:31
have absent carotid arteries. If it's an acute occlusion, which I doubt because it had been asymptomatic, it's probably chronic, my guess is that we're collateral. So I think it's a very good
22:43
outcome, it's very good. I enjoyed hearing about your experience. I think it reflects the experience of all the people there and you continue to do what you're doing. Thank you, sir, much
22:55
appreciate it Very, very impressive presentation, really, and in all aspects, including your time issues.
23:05
Thank you. I'm very proud of this group which you have, the Oz mentorship, really proud. And it is an opening, opening a gate for Briel and Sam and the way of developing research and studying
23:25
medicine in the proper way. And that will be, hopefully, to be an example for other specialties to follow.
23:32
So thank you both. Thank you. Thank you. That is the hope. Thank you, sir. Thank you, Professor. Thank you, Akram. I should give the credit to Akram. This paper, exactly, I give him the
23:38
idea, the case, and
23:44
receive it as it is. That's the first paper for him. So, you know, it's what they say that it's from the egg. It's there, the chicken is there. So, yeah, he's from the first writing that he
23:59
put, he's at the front level, and. I'm really happy with the time that he spent and I'm really more proud now that he has his project and he's advancing toward it. And he has the full support from
24:17
all of us. All the best, thank you, Aktham. And I will go rapidly to the next step. The last talk in the young neurosurgeon and student speaker section
24:29
We'll be given by Hanine A. Salah of
24:33
the Department of Biology, College of Science, and the Maston Syria
24:39
University in Baghdad, Iraq. Presenter will be Hanine.
24:49
Hanine is a student and she will take less than 10 minutes. I think around seven minutes also And from that, we will go to Dr. Osman presentation.
25:07
question and then, yeah, honey, you can share the screen and start your presentation. Thank you, Dr. Samar. Hi, everyone. My name is Haneen and I'll tell you about my story with the house
25:15
nurse surgery mentorship. I joined this mentorship in 2021 while I was a solo senior student. I think I have some poor connection.
25:27
We can hear it clear. So it's not the beginning of an email that I sent to Dr. Sammer. He was very kind that he sent me his phone number to talk about it directly. So at the beginning of the
25:38
mentorship was intensive lectures of neuroimaging and neuroanatomy. They were very, very helpful. Another effective way of learning, I have found this mentorship was the student's feedback because
25:51
each student's after they attend the operations, they have to write a
25:58
description about the cases and they send pictures and videos.
26:11
of MRI's and CT scans, until my time came to attend. These are the sweating speed back, and I don't know if you can see here, this is the videos and the pictures they sent. Yes, we can. The
26:18
operations. Okay, so I think that was very helpful to learn more even if you weren't there.
26:28
Until my time came to attend, the operations was about after five months, after I joined this mentorship.
26:36
I attended these operations and also I have attended many diagnostic, and therapeutic, and geographic characterizations. I'll tell you today about my favorite cases. The first one is the motor
26:49
cartoecabernoma. What's a 30-year-old male referred to the hospital go to two-month history of focal seizures. This is the preoperative MRI, such as our section shows a couple of normal deep 2D.
27:01
right, presenteral gyrus. And this is also a preoperative MRA. It shows the relation between the cover norm and the cerebral vasculature. So the
27:13
intracellular dissection was done with the age of the intracellular of ultrace and not gripping our navigation to detect the exact location of the lesion. So they can start the
27:24
intracellular kind of dissection, the intracellular dissection. And also the motor cortical mapping was done with the age of the
27:34
functional mapping and the intracellular physiological monitoring. As you can see here, this is
27:40
the bipolar mode, because most of these area was a facial motor area. So they use the bipolar mode to detect a lesser facial activity so they can start the intracellular dissection without causing
27:52
any damages. That was integral part of this surgery,
27:59
the pre-central jazz cover number is one of the most challenging operations because of the bleeding and the severe defects, but the outcome of this case was very successful and the team submitted a
28:16
case report about it a few weeks ago I'm very excited about it and I hope it will be published soon.
28:23
So my second favorite case was the Vibromoscalar dysplasia was a 53-year-old near referred to the hospital to the history of
28:34
frequent transatlantic attacks with the upper left cilantro nucleus. This is the pre-operative angiography. For those who are not very familiar with the Vibromoscalar dysplasia, it's a rare
28:44
vascular disease that causes a regular cellular reproduction and causes, this goes
28:51
This is a regular deformed of the arterial wall, as you can see here. This is the right extracranial ICA with multiple synopses. The treatment of choice for this case was the extracranial
29:01
intracranial bypass to improve the
29:06
blood flow and to prevent any further strokes. This is the pre-operative T1 MRI.
29:16
It shows the CSF blood cleft extended from the frontal horn of the lateral ventricle to the sodium fission. This is also pre-operative T2 weighted MRI.
29:27
It shows the CSF blood cleft from a frontal region. So
29:33
the last one is the recurrent glioblastoma. This one is my favorite for so many reasons. One of them is I actually assist in the operation. This is me with the normal saline and this is with the
29:49
bonaflep at the end. So attend the operations is at different feelings and be in this close and be in part of the team as I use different feelings. I think it was outstanding experience. And also I
30:02
was very stressed because you know, you don't want to touch the surgeon and you don't want to touch the microscope. You don't want to do any damages, but it was outstanding experience.
30:14
So that was a bright description of what I have learned from the anatomy and brain imaging. I learned also some life skills, for example, the teamwork skills. So when you attend the operations,
30:27
you see there are four surgeons working on the same case and there are also residents and students all working on the same case. And also not just that. And their papers and their books, everything
30:39
is a teamwork effort. I think this is a unique part of this mentorship.
30:46
everything is a teamwork efforts and also I have learned many other skills like leadership, communication skills, networking, and so many other skills.
30:57
So I'll tell you that was a brief again description of the mentorship. I'll tell you a little bit about myself. My
31:11
name
31:35
is Fanny Asala. I have graduated from the biology department, college of science. I am the only non-medical students in this mentorship And I think I am the only one who attended the surgeries in
31:35
my country. I think mainly my interests came during my teenage years. I was fascinating and very inspired by Dr. David Eagleman ideas and Dr. Sergio Canaderas. The human machine interactions,
31:37
the idea of making a human more than humans. I think that was fascinating. It's It shows that there is no limit of what we can achieve and there is no limit to what we can be as a human. I think
31:50
that what's got me hooked up with neuroscience. And I said, I want to become a neuroscientist. But unfortunately, I live in a country where we do not have a neuroscience departments. We do not
32:02
have a facilities to study the brain. But also, I was lucky enough to live in a country where we have someone like Dr. Summer with his unconditional support and his limitless opportunities. I'm
32:16
forever thankful for this opportunity, Dr. Summer.
32:20
So one thing I have learned about this mentorship is that I wanted to - I was mainly interested in science just because I was curious, and I wanted to know why and how things works. But attending
32:33
the operations and seeing the patients and their families, it's very emotional experience, I must say. So basically, we're not doing research because we're curious, we're doing research to help
32:45
people less suffer. This is all to create a better life. Currently, I am working to apply on a post-graduate school and I want to establish a neuroscience department here in Iraq. Dr. The current
33:00
situation with the market and the job, it's not a very wise decision, but I want to establish a clinical neuroscience research center because we have so many neurological conditions and this will be
33:15
very helpful to learn about these cases and maybe help them in the future.
33:22
Again, thank you, Dr. Summer and the team for this outstanding experience. I can thank you and I'll forward. Thank you.
33:33
Thank you, Hanin. Actually, the thanks is for you and what actually did nothing except just
33:41
support you and you're really not enough. Let's
33:48
take a comment just I want to say that, yeah honey, it's different from US, US, the student before they go to medical school they go to biology two years maybe then they go to medical school and
34:02
Iraq it's different either you go to medical school directly from high school or it's not there so that's why her experience is different she's from biology college by the way she's one of the first
34:15
on her college as around people but has a specific interest that obligates us we cannot say anything except okay come on come on and try this is for medical student but why not let's involve you and
34:30
it was a nice experience to have you actually hanging and I we are pretty sure that you will excel in the future I will be happy to have any comment from the panel? Well, I'm really very, very
34:47
impressed. Most impressed with Hanin and her courage and her dedication and her interest in neurosciences.
34:57
And thank you, Sam, again, for your mentorship and for guidance for such wonderful young scientists and doctors Hanin, there is in Moustesh for Jirahat, Jirahat Hospital,
35:13
a good scientist who is doing neurophysiology and he is really deep down to earth with his science and the ability I would like you to meet with him, his name's Abden Nasser, is in the
35:27
neurophysiology department, which is part of the neurosciences or neurosurgical department at Jirahat. It would
35:35
be - Thank you, Professor. I would love to meet him Yeah, if we communicate. give me your email and I speak with him and I'm sure you'll find him very helpful and very inspiring too.
35:48
So thank you so much for your presentation. Thank you Professor. Do you have a comment Dr. Osman?
35:56
No I think I'm very happy she's I'm very happy and Nina's happy and this has been satisfied I think that's that's that's to go. Yeah yeah. Actually from my side I should say that they are they are
36:14
efficient enough that make you think okay let's support them they they have the courage and they have the will that's that's the most important and I'm thinking all the other students are there they
36:27
are showing themselves and act them and honey and I think they will do even better in the future thank you that's that's the end of President's and the student speech
36:41
We hope you enjoyed these presentations. Please fill out your evaluation of this video to receive CMA credit.
36:52
This program in series was supported by the James I. and Carolyn Arosman Educational Foundation,
36:59
which are the owners of SI and SI Digital and associated with the Waymaster Corporation Producers of the Leading Gen Television Series, Silent Majority Speaks, and Role Models, and the Founder of
37:15
the Medical News Network.
37:19
This recorded session is available free on SI Digitalorg, or
37:25
if you have questions or comments, please send them to osmondsidigitalorg.
37:34
We want to thank you for attending this meeting and listening to these lectures
View Transcript
Listen to Podcast
