16 minute read
Neuronavigation in the surgical management of
Neuronavigation in the surgical management of brain tumors:
Future trend now available at Almoosa Specialist Hospital
Our Neuroscience Center, led by Dr. Mohammad Kassab, a consultant neurosurgeon, managed to treat a grade 2 brain tumor that causes recurrent epileptic seizures, using a combination of modern technologies and a Neuronavigation device.
Dr. Kassab states that the patient came to the emergency department in a critical condition after sufering from severe seizures, leading to loss of consciousness while at home. BASED ON THE EXAMINATION & THE INVESTIGATION, THE DOCTOR DECIDED TO TRANSFER PATIENT FAISAL TO THE NEUROSCIENCE CENTER.
Dr. Hasan Salama, a consultant neurologist, received the case, a head CT scan was requested, it pointed to changes in the left side of the frontal lobe. To confrm the diagnosis, Dr. Salama ordered an MRI scan, which showed an infltrated tumor spread locally in the left frontal lobe.
Based on the examination and the investigation, the doctor decided to transfer patient Faisal to the Neuroscience Center, where a specialized medical team was formed to treat Fais-
al's case. After full discussion with the patient's family, the surgical team decided to remove the tumor and discover its histological nature.
Dr. Kassab adds that we have faced several challenges in treating Faisal's case, the most prominent of which is that the tumor is widespread adjacent to the motor area and partially infltrating into it. The excision process may lead to paralysis on the right side of the body, in addition to the possibility of afecting the speech control area (pronunciation) located on the left side of the brain.
The medical team decided to remove the tumor under local anesthesia and keep the patient in a state of wakefulness so that the team can perform repeated movement and speech tests during surgery to ensure that the movement and verbal area adjacent to the tumor area is not breached or damaged during the surgical excision. Accurate localization of the tumor was another challenge. To face this challenge, a Neuronavigation technology was used to help identify the brain's diferent sensitive functional areas and accurately determine the tumor's location to avoid making a wide opening to the skull, thus avoiding further complications. The operation took around three hours, and the tumor's nature was confrmed by histological examination of the sample and biopsy taken during surgery. The operation went successfully and smoothly. Praise be to God. The patient is currently in good health and did not have any complications or any new defcit, and was discharged from the hospital 48 hours after the surgery.
It is worth noting that such cases' success requires accurate diagnosis, wise decision-making, excellent surgical and anesthesia expertise, and the availability of modern high-tech surgical equipment available in the hospital.
Case: grade 2 brain tumor that causes recurrent epileptic seizures
Diagnosis: infltrated tumor spread locally in the left frontal lobe.
Challenges: the tumor is widespread adjacent to the motor area and partially infltrating into it. The excision process may lead to paralysis on the right side of the body, in addition to the possibility of afecting the speech control area (pronunciation) located on the left side of the brain.
Techniques used: Neuro-navigation technology was used to help identify the brain's different sensitive functional areas and accurately determine the tumor's location to avoid making a wide opening to the skull, thus avoiding further complications.
Medical team:
• Dr. Mohamed kassab, consultant neurosurgeon • Dr. Hassan Salama, consultant neurologist • Team of anesthesiologists THE OPERATION WENT SUCCESSFULLY AND SMOOTHLY. PRAISE BE TO GOD. THE PATIENT IS CURRENTLY IN GOOD HEALTH AND DID NOT HAVE ANY COMPLICATIONS OR ANY NEW DEFICIT, AND WAS DISCHARGED FROM THE HOSPITAL 48 HOURS AFTER THE SURGERY.
Dr. Mohamed kassab, consultant neurosurgeon
Dr. Hisham Abu Al-Saud
NMC Royal Hospital provides all necessary tests to diagnose and follow up on endocrine disease, in addition to diagnostic radiology, such as X-rays and MRI, depending on the need of each case. The hospital also provides a team of medical staf with the highest level of expertise in the feld of endocrinology, as well as an integrated team of dieticians and nurses to raise health awareness among patients. The endocrinologist at NMC Royal Hospital - Khalifa City, Dr. Hisham Abu Al-Saud, spoke to the "Hospitals" Magazine about the most prominent medical services provided by the medical team at the hospital.
The endocrinology team treats patients over the age of 16 who require diagnosis and ongoing management of medical conditions afecting the endocrine system, including: • Type 1 and type 2 diabetes • Adrenal gland disorders • Pituitary hormone disorders • Endocrine disorders, including hypothyroidism and hyperthyroidism • Thyroid cancer • Osteoporosis (a condition in which the quality and density of the bones is reduced) • Vitamin D defciency • Hypercalcemia (high calcium levels in the blood) • Hypocalcemia (low calcium levels in the blood) • Paget's disease (a disease that causes fragile and misshapen bones) • Osteomalacia • Osteoporosis associated with organ transplants The team of endocrinologists also treats obesity, in addition to running tests and managing diseases related to it, such as: • Polycystic ovary syndrome • Hyperlipidemia (high cholesterol) • Hypertension
Endocrine Disease Diagnostic Tests
The endocrinology team adopts a multidisciplinary approach to diagnose and treat endocrine diseases. On the frst visit, the patient is required to provide a detailed medical history and undergo a physical examination. Depending on the symptoms experienced by the patient, the doctor requests a specifc set of laboratory tests and radiographic examinations. These tests may include the following: • Blood and urine tests: These tests use blood or urine samples to measure certain hormone levels. • Radiographic examinations: They provide images of a specifc organ or area in the body and include: X-ray scans, CT scans, DEPENDING ON THE SYMPTOMS EXPERIENCED BY THE PATIENT, THE DOCTOR REQUESTS A SPECIFIC SET OF LABORATORY TESTS AND RADIOGRAPHIC EXAMINATIONS.
MRI, thyroid and parathyroid imaging, and radiography to measure bone density (also known as dual-energy X-ray absorptiometry that assesses bone mineral density). • Glandular function tests: Two or more samples of blood are taken at specifc times, as some pituitary and adrenal gland disorders require this type of test.
Treatment of Endocrine Disease
The treatment provided to the patient depends on the diagnosis, which is often with medication. Radioiodine therapy is used in cases of thyroid cancer and thyroid disorders. However, surgery may still be required, and in this case, endocrinologists cooperate with surgeons at the hospital.
Certain health conditions, such as diabetes, lipid disorder, and obesity, require a consultation with a dietician and patient counselor, who both constitute a part of the endocrinology team. Follow-up visits are determined according to the health condition of each patient. Doctors may ask patients to rerun laboratory tests and radiographic examinations during the follow-up period, if necessary.
All members of the endocrinology team have extensive experience in endocrinology and metabolism. The team includes: • Endocrinologists • Pathologists • Radiologists • Psychiatrists • Surgeons • Nursing staf • Dieticians RADIOIODINE THERAPY IS USED IN CASES OF THYROID CANCER AND THYROID DISORDERS.
NMC Royal Hospital Khalifa City is considered to be the fagship hospital within the NMC Group with 500 beds, the NMC fagship hospital Royal Khalifa City is a tertiary referral center treating not only Covid-19 cases, but also its patient base, which relies on its pediatric ICU, neonatal services, cancer program, and international collaborative research initiatives. It’s the only hospital that holds a tripe 9 rating in the emirate of Abu Dhabi, meaning it can receive emergency cases on behalf of Government hospitals. Strategically located between Abu Dhabi and Al Ain, the facility is extremely accessible for immediate medical care, as well as hospital transfers.
Dr. Ahmed Kaabneh
NMC Royal Hospital, Khalifa City has recently launched a non-surgical thyroid cyst treatment program, which is one of the comprehensive programs within the Thyroid Disorder Clinic. Dr. Ahmed Kaabneh, Consultant Interventional Radiology - NMC Royal Hospital, Khalifa City, talks about this program in the following interview.
When is this procedure necessary?
Thyroid cysts are benign fuid-flled cysts inside the thyroid gland. Depending on their size, they cause neck pain, difculty swallowing, and swelling at the bottom of the neck. Non-surgical treatment is usually necessary in a patient with these symptoms.
What are the conditions that require non-surgical treatment?
This treatment is available to all patients because it obviates the need for surgical intervention. There are no medical conditions that would prevent the patient from receiving this treatment.
What are the advantages of this treatment in terms of safety and accuracy? In this context, to what extent does the doctor’s skill contribute to the success of the treatment?
This treatment or non-surgical intervention is entirely performed in the clinic by a specialist doctor using an ultrasound device, which allows the doctor to locate the thyroid cysts with high accuracy in order to treat them. Studies and scientifc research that focused on this treatment have proven that it is very safe and has rare complications.
The experience of the treating physician, like any medical intervention, plays an important role in the success of this treatment, especially in terms of helping to determine the appropriate amount of the substance used in the injection of these cysts to eradicate them.
What types of non-surgical treatments are adopted in the Thyroid Disorder Clinic?
There are currently two types of non-surgical treatments adopted for the treatment of thyroid nodules or lumps. The frst treatment is used to remove the thyroid cysts, where the fuids are withdrawn from these cysts and then injected with a special substance to ensure that they do not return. The second treatment is available for non-fuid small and benign nodules, as these nodules are cauterized with a special device to eliminate them. THYROID CYSTS ARE BENIGN FLUIDFILLED CYSTS INSIDE THE THYROID GLAND. DEPENDING ON THEIR SIZE, THEY CAUSE NECK PAIN, DIFFICULTY SWALLOWING, AND SWELLING AT THE BOTTOM OF THE NECK.
Dr. Gilbert Ayoub
Chairman, HOD & Consultant General Surgeon
1. Nodular Goiter causing local Symptoms, Compression of the Trachea and difculty swallowing. 2. Visible or sightly Mass. 3. Nodule which might be Thyroid Cancer. 4. Thyroid Cancer
There are many specifc faced Challenges during the Thyroid Surgery because the Area of Interest is a high-Risk area since it contains the Vessels going to and from the Brain which can lead to severe Bleeding and even Brain Damage in extreme Cases, adding to Identifcation of the Parathyroids to the Damage Trachea, Esophagus or the vocal Cords Damage etc..
For all these Challenges we are using the Best available Machines and Methods in the Word including The Vocal Cord Neuromonitoring, and the State-of-the-Art Microscope for delicat Dissection. Last and not Least the Huge Experience of our Thyroid Surgeons.
The Type of Surgery is individually decided for each Patient which varies from partial Removal/Lobectomy to complete Thyroidectomy with or without Lymph nodes Neck Dissection in Cancer Cases. We use usually a minimal invasive access with 2-2,5 cm Incision length. We are currently working on Our new know how, the Scarless transoral Thyroidectomy Approach known to be the only Approach with invisible Incision Scar. We have the State-of-theArt Techniques and Instruments including the Vocal Cord Neuromonitoring System, the newest Dissection Microscope for Thyroid and Neck Dissection Surgeries and the Latest Laboratory Frozen Section technique to get the Tissue histopathology Results even during the Surgery. Adding to this we established a unique “One Step Thyroid Clinic” where the Patient gets all the Workout done in one day, starting by getting checked by an endocrinologist, referred to interventional radiologist for diagnostic (US, Uptake Scan, and Fine Needle Biopsy if needed), fnishing by discussing the Treatment Plan with the Surgeon. This Time Management gives the Patient the best and pleasant Hospital Experience, quick Service and best Outcome. Our Thyroid Surgeon is one of the few accredited and renominated Surgeons by the DOH for Complex Thyroid Surgeries and especially Redo Cases for recurrence and complicated Cancer Cases with a Vast Experience of several Thousands of done thyroid Cases in one of the Biggest and best Endocrinology centers in Germany.
Dr. Sokiyna Al Ameer
Consultant Surgeon and breast surgery specialist at NMC Royal Hospital, Khalifa City
We created the “One Stop Breast Clinic” to spread awareness and prevent cancer
The One Stop Breast Clinic provides all comprehensive care services for patients in one location, and these services are divided into non-surgical or surgical interventions. Non-surgical interventions include running tests and diagnosing the patient's condition, as many breast fbroids are benign and breast fat may need to be monitored for a certain period of time to monitor their development and growth. If these tumors change over time or if these are complex or giant breast masses, then they are surgically removed.
Breast cysts are also a common breast condition that are monitored periodically and do not need surgical treatment; if they are large in size and painful, they are emptied with a needle without surgical treatment.
Breast abscess is treated most of the time with antibiotics, and it may need to be drained without surgical intervention, but sometimes we resort to opening it surgically if the abscess is large in size and has not been completely emptied by aspiration.
Dilation of the mammary ducts, which affects women over age 50, only needs follow-up without surgical intervention. It can be treated with antibiotics if it is accompanied by nipple discharge, redness and pain in the nipple and surrounding tissues. In some cases, a biopsy is needed to rule out breast cancer. As for breast cancers, the breast clinic ofers treatment options by experienced personnel in providing this type of care by preparing the best treatment plans depending on the type of cancer, its size, location, disease severity, laboratory test results and the patient’s general health.
Breast problems are not always cancer, but there are many benign tumors that are not dangerous, but in one way or another they cause fear and anxiety in women.
The patient’s medical history is taken, clinically examined, and then the appropriate X-rays are determined for her condition. • Mammogram • Breast Ultrasound • MRI Mammography The results of the required tests are taken on the same day, with the possibility of conducting a biopsy for cases that require this directly.
Medical conditions that require surgical treatment: • Breast cancer and precancerous stage DCIS (Ductal carcinoma in situ) • Phyllodes tumor and precancerous tumors due to the presence of an atypical tissue • Complex or giant fbroadenoma • Intraductal papilloma that grows in the milk duct
To relieve this anxiety, we have created the One Stop Breast Clinic. The clinic seeks to spread awareness about breast health and cancer prevention, as well as providing early detection, diagnosis and treatment services for malignant and benign breast tumors. The patient is received in the clinic by breast health and surgery specialists.
• Breast abscess that does not respond to antibiotic therapy and aspiration • Large fatty cysts and lipomas associated with chronic pain
Breast cancer surgery is a key factor in breast cancer treatment, and it involves removing the cancer through surgery. Breast cancer surgery may be used alone or in combination with other treatments such as chemotherapy, hormone therapy, targeted therapy and radiation therapy. NMC Royal Hospital has highly experienced breast surgeons, and is working with other specialists to develop an individualized treatment approach and provide the patient with the comprehensive care she needs.
The care team includes breast cancer surgeons, oncologists, pathologists, plastic surgeons to perform the necessary breast reconstruction, physiotherapists, nurses and radiologists. The patient’s appointments are coordinated with the diferent specialties and often within days. If surgery is chosen frst, the operation will be carried out quickly to avoid long waiting times.
State-of-the-art equipment and technologies
Diagnostic services in the clinic include: • Mammography: An X-ray imaging method that allows the radiologist to enlarge and adjust the size, brightness and contrast to easily detect any abnormalities. • 3D mammogram: An imaging test that combines multiple breast X-rays to create a three-dimensional picture of the breast. A 3D mammogram is used to look for breast cancer in people who have no signs or symptoms. • Magnetic Resonance Imaging (MRI): A contrast material is used in this imaging technique to distinguish between diferent tissue structures in the breast. Breast MRI uses radio waves and strong magnets to make detailed pictures of the breast tissue. • Ultrasound: This technique uses an ultrasound device on the surface of
the body. The device emits sound waves that bounce of the tissues of the body to be converted into digital images that are useful for detecting any abnormalities. • Computer-assisted breast exam: It is used in conjunction with a traditional or digital mammogram. The image is analyzed by a computer to provide the radiologist with an image of suspicious areas that require further study. • Minimally invasive diagnostic breast biopsy: It is usually performed by a surgeon or radiologist using computer imaging to guide him in taking small tissue samples with a sterile needle. • Vacuum-assisted stereotactic breast biopsy: A minimally invasive diagnostic technique in which a radiologist uses a suction probe inserted through a small incision to take small samples of breast tissue under the guidance of the mammogram images. • Ultrasound-guided vacuum-assisted breast biopsy: A minimally invasive diagnostic technique in which a radiologist uses a suction probe inserted through a small incision to take small samples of breast tissue guided by the ultrasound images.
Surgery Techniques
Women with early stage breast cancer may undergo breast-conserving surgery (lumpectomy), in which only the tumor is removed from the breast while preserving the breast. The choice between mastectomy and lumpectomy can be difcult. Both measures are equally efective in preventing recurrence of breast cancer. However, lumpectomy is not an option for all breast cancer patients, and mastectomy is preferred by others. We have mastectomy techniques that preserve breast skin and allow for a more natural breast appearance following the procedure. This is also called a skin-sparing mastectomy. Nipple sparing and areola sparing mastectomy where only breast tissue is removed while preserving the skin, nipple and areola. BREAST PROBLEMS ARE NOT ALWAYS CANCER, BUT THERE ARE MANY BENIGN TUMORS THAT ARE NOT DANGEROUS, BUT IN ONE WAY OR ANOTHER THEY CAUSE FEAR AND ANXIETY IN WOMEN.
