Browsing by Author "Labuschagne, Jason"

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    Intra‑operative monitoring as an adjuvant to standard vagus nerve stimulation implantation
    (Child's Nervous System, 2021-07-23) Labuschagne, Jason; Mutyaba,Denis; Casieri, Claudia
    The treatment of refractory epilepsy by vagus nerve stimulation (VNS) is a well-established therapy. Complications following VNS insertion may be procedure-related or stimulation-related. Herein, we describe our technique of intra-operative neuro-monitoring (IONM) in an attempt to diminish these adverse events. This retrospective study describes 66 consecutive patients between the ages of 3 and 12 years who had undergone primary VNS implantation. The study population consisted of two cohorts, one in which the VNS device was implanted according to the standard described technique and a second group in which IONM was used as an adjuvant during the VNS device placement. Prior to VNS insertion, a Pediatric Voice Handicap Index (PVHI) was performed to assess voice-related quality of life, and this was repeated at 3 months following VNS insertion. Sixty-six patients underwent the VNS implantation. Forty-three patients had a “standard” VNS insertion technique performed, whereas 23 had IONM performed during the VNS implantation. There were significant changes in the PVHI scores across both cohorts at 3-month follow-up. There were no statistically significant differences in PVHI scores between the monitored group and non-monitored group at 3-month follow up. IONM can be used during VNS insertions to ensure correct placement of the leads on CNX. IONM may minimise vocal cord stimulation by placing the lead coils on the area of nerve eliciting the least amount of vocal cord EMG response. IONM however does not appear to improve voice outcomes at early follow up.
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    Intrinsic Brainstem Epidermoid: Case Report and Literature Review
    (Wits Journal of Clinical Medicine, 2020-11-09) Labuschagne, Jason; Mutyaba, Denis; Koranteng, Promise
    Epidermoid cysts are rare lesions of the central nervous system, representing 1-2% of all intracranial tumours. These mass lesions are typically found in the parasellar region or cerebellopontine angle. As far as we are aware only 15 cases of an intrinsic brainstem epidermoid have been reported in the pediatric population to date. We report a case in which an 8-yearold male patient with an intrinsic brainstem epidermoid was misdiagnosed and treated as a diffuse intrinsic pontine glioma (DIPG). The child was subsequently referred to our unit failing response to treatment at the index hospital. Magnetic resonance imaging (MRI) revealed a well-defined lesion, with clearly distinct borders, that was hypointense on T1WI, hyperintense on T2WI, had minimal contrast enhancement and had restricted diffusion on the DWI/ADC map. With the aid of intra-operative neurophysiological monitoring he underwent surgical resection of the lesion. Histopathology revealed abundant nucleated and anucleated squamous cells, in keeping with an epidermoid tumor. Clinical follow up at 3 months post-surgery showed significant improvement in the child’s pre-surgical neurological function. Follow up MRI at 3 months and a year post surgery revealed that the lesion is stable following near total resection. The objective of this case report is to highlight this unusual condition which may otherwise be misdiagnosed and to encourage a more universal acceptance of the need for either brainstem biopsies in atypical brainstem lesions or formal resection of lesions amenable to safe surgical resection.