AIM:This study was done to study the three dimensional anatomy of internal capsule's white fibers completely by cadaveric dissection and its relation to basal ganglia and other related anatomical structures. MATERIAL and METHODS: Eight formalin fixed cerebral hemispheres were dissected for internal capsule under operating microscope. Klingler's technique of fiber dissection was adopted. The internal capsule was dissected from superiolateral, inferior and medial surface of cerebral hemisphere. During and after dissection its relation with basal ganglia and other related structures were studied.
RESULTS:The internal capsule was demonstrated by dissecting fibers of all its parts. Fibers that forms the internal capsule originate from different parts of cerebral cortex and pass through corona radiata that lies in lateral periventricular area and lateral to the caudate nucleus above the upper border of lentiform nucleus. The internal capsule is situated medial to lentiform nucleus and lateral to caudate nucleus and thalamus. Caudally it continues in the midbrain as cerebral peduncle. It has an anterior limb, genu, posterior limb, retrolentiform and sublentiform part. The relation of different parts of internal capsule with surrounding structures were also shown. CONCLUSION: Knowledge of the microsurgical anatomy of the internal capsule and other white fibers tracts is essential for neurosurgeons and other neuroscientists.
In suboccipital craniectomy where the bone is not repositioned, there may be a significant cosmetic defect due to lack of skull bone in the suboccipital region. It may accompanied by sensory symptoms, including pain. To prevent any cosmetic defect and sensory symptoms we repositioned the bone chips at the craniectomy site in 42 suboccipital craniectomies before the closure of the scalp. At a mean follow-up of 22 months (range: 5-44 months), two patients complained of mild discomfort in the healed wound or of occasional local pain. One patient complained of mild itching at the site. In two patients, bone chips were accumulated at the lower part of the suboccipital craniectomy and failed to form a uniform bone cover at the operated site. In one patient, all bone chips were reabsorbed and there was no bone at the operated site. There was pseudomeningocele formation in one patient. In the rest of the cases there was satisfactory bone coverage at the operated site, both clinically and radiologically. The wound sites were aesthetically acceptable in 40 cases. Our study suggests that in the majority of cases where suboccipital craniotomy is not possible or not done, repositioning of the bone chips at the craniectomy site is associated with satisfactory aesthetic and functional outcome and formation of bone coverage at the operated site.
Transsphenoidal approach to sella is not a new approach. In the last 100 years it has gone numerous changing refinements from using headlight to microscope and more recently the sensitive endoscope. In this prospective study, all patients with pituitary tumor who underwent endonasal transsphenoidal pituitary surgery during the period of January 2006 to July 2009 in the department of neurosurgery, Dhaka Medical College Hospital and Islami Bank Central Hospital, Dhaka, Bangladesh were included. Among the 55 patients 36 cases were operated by combined endoscopic and microscopic techniques and 19 cases were operated by endoscope only. Total 73 procedures were done in 55 patients. Age range was 17 years to 70 years. Follow up period was 03 months to 42 months (mean 14.2 months) .Male: female was almost 1:1. Clinical features were pituitary apoplexy, pituitary apoplexy with 3rd/+6th cranial nerve palsy, headache, amenorrhea, loss of libido, galactorrhoea, gynecomastia, weight gain and psychosis. Visual impairment was in 35 cases. Functioning adenoma was 21 and non functioning adenoma was 34 cases. Among the functioning adenoma acromegaly was seen in 12 cases, gigantism in 01 case, prolactinoma in 05 cases, Cushing's disease 03 cases. Purely sellar tumor was 15, sellar & suprasellar 35 and sellar & parasellar 11 cases. Microscopic plus endoscopic techniques used in 54 procedures. Purely endoscopic procedures were 19. Complete removal of tumor in single stage was done in 33 cases. Complete removal with more than one stage surgery in 13 cases. In our initial cases of the series, we exposed the sella endonasally with endoscope then we used microscope for the rest of the surgery. In the later part of the series we gained experience and confidence for removal of pituitary tumor with an endoscope completely. The rate of diabetes insipidus occurred in 11(20%) cases and all are transient. Postoperative CSF leak was noted in 10(18%) cases. Patient with ocular palsy improved post operatively within 6 weeks. Among non functioning adenoma that were removed completely (30 cases) recurrence occurred in three cases. Eleven patients were stable in vision as preoperative. Other showed visual improvement to variable extents. Key words: Pituitary surgery; Endonasal; Transsphenoidal; Microsurgery; Endoscopic surgery. DOI: 10.3329/bjo.v15i2.5056 Bangladesh J Otorhinolaryngol 2009; 15(2): 45-49
Keywords: brain biopsy; frame-based biopsy; stereotacticDOI: 10.3329/jcmcta.v20i2.5622Journal of Chittagong Medical College Teachers' Association 2009: 20(2):24-28
Key words: neurological examination; compressive myelopathy; MRI; myelomere; myelomelaciadoi: 10.3329/jcmcta.v19i2.3864Journal of Chittagong Medical College Teachers' Association 2008: 19(2):12-15
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