IntroductionA cerebral aneurysm has been surgically treated since the early twentieth century. Since then, numerous new surgical methods and technologies have been developed in neurosurgical practice to improve outcome of the neurosurgical treatments. In fall of 1980, the very first aneurysm surgery was successfully performed in Mongolia. Until 2011, the bitemporal and pterional approaches had been used as the main treatment option for anterior circulation aneurysms in Mongolian neurosurgicalpractice. The keyhole approach, cultivated by German neurosurgeon A.Perneczky, was introduced to Mongolian neurosurgical practice in 2011 as another threatment option for the anterior circulation aneurysmGoalThis study aimed to design new key hole surgical techniques with four small burr holes, based on the method of German neurosurgeon A. Perneczky for treatment of anterior circulation aneurysms and decrease the rate of surgically related complications.Materials and MethodsBetween January 2011 and March 2012, in the neurosurgical department of Third State Central Hospital 259 patients were treated with anterior circulation aneurysms. 103 of them treated with key hole approaches (as the study groupe), while 55 were treated with pterional approaches. We choose 103 patients reports (as the control groupe), who were treated with traditional approaches and studied the results retrospectively, which were compared with the results of the new techniquesof surgical treatment. We compared the outcomes of the new keyhole surgical approach with the outcomes of traditional approaches based on the severity of after surgery complications, focal neurological deficits, postoperative mental changes and functional impairments, and duration of hospital stay (recovery period). The skin incision begins laterally from the supraorbital incisura and is made within the eyebrow. Posterior to the temporal line at the level just above the zygomatic arch we drilled two small (0.5 cm) burr holes, and two more burr holes above the orbital rim. Quadrangle shaped bone flap is cut with the angle 45o, and removed, after which drill of the inner edge of the bone above the orbital rim. Inner edge of the other side is not drilled off. After intradural procedure, we fixed bone flap using the inner edge, which was not drilled off.ResultsFrom Jan, 2011 to Dec, 2012, 235 patients received surgical treatment (78 women and 79 men, median age, 46.3±2.3 yo). The lesions included 9 anterior cerebral artery aneurysms, 6 in posterior communicating artery, 35 in middle cerebral artery, 34 in anterior communicating artery, 1 in ophthalmic artery, and 18 in internal carotid artery aneurysms. The ratio of men and women with aneurysmal SAH was 1:1, which demonstrated different results comparing with the countries such as Japan, Austria and Canada. Two patients died after operation due to cerebral vasospasm, who were admitted to our hospital with the WFNS grade III-IV after SAH. The postoperative hemiparesis accounts 4.8% (5 cases). After short-term observations (3 months) 4 of these patients showed a good recovery of paralyzed extremities. One patient missed out of follow up. Surgically related complications like mental change, temporal muscle atrophy were about 4%-8%. (The difference between two methods is P<0,009). The average duration of hospital stay was 8.2 ±2. ConclusionsSubtemporal, subfrontal, and paranasal key hole with pterional approaches have several advantages over the traditional craniotomies, including minor tissue damage, less brain retraction, a superior cosmetic results, and shorter duration of surgery and hospital stay. The operative field becomes wider in the deep area, providing sufficient space for microscope-assisted surgeries without need of highly specialized instruments.

Goal: The purpose of this study is to identify issues of current situation of the health information system in the health care facilities of Mongolia.Materials and Methods: A total 362 users as hospital directors, physicians, nurses, statisticians and IT workers of 105 health care facilities at primary, secondary and tertiary level participated in this study. Data collection methods were generated using a combination of questionnaires and in-depth interview of the users. The statistical analysis was carried out using the SPSS. Outcome measures were calculated with 95% confidence intervals (CI).Results: The survey results were shown that a vertical health information flow regulates in the health sector, internal networks set up and H-info 2.0 software as routine data processing and insurance claims are used in the hospitals of Mongolia. Regarding of e-health software as Computerized Physician Order Entry (CPOE), Drug Information System (DIS), Laboratory Information System (LIS) and Radiology Information System (RIS), 82.6% of the health care facilities used only CPOE. There 50% of the existed e-health software is not integrated in the health care facilities. In the data management, 27.0% of the health care facilities that used e-health applications had no backup solution. 45.5% of total users said that the information technology human resource is insufficient. 70.0% of users responded as there did not any continues training program in health information technology. The study was determined lack of functions and difficulty of using the existed software and inadequate software operation and not user-friendliness are the causes of the most of dissatisfactions. Conclusions: A vertical health information flow, internal networks, routine statistic processing set up and mainly CPOE used in the health care facilities. However there is no integration of e-health software and lack of its capacity. It is required modern integrated health information system in the health sector of Mongolia.

Introduction: A brain abscess is a serious disease of the central nerve system. We conducted this study to summarize the clinical manifestations and outcomes of brain abscesses. Materials and Methods: A retrospective chart review of pediatric patients diagnosed with brain abscesses from November 2000 to Jаn 2016 was performed at Shastin Medical Hospital neurosurgery department. Results: Twenty-five patients were included in this study. On average, 1.67 cases per year were identified and the median age was 4.3 years. The common presenting clinical manifestations were fever (18/25, 72%), seizure (12/25, 48%), altered mental status (11/25, 44%), and signs of increased intracranial pressure (9/25, 36%). A total of 14 (56%) patients had underlying illnesses, with congenital heart disease (8/25, 32%) as the most common cause. Predisposing factors were identified in 15 patients (60%). The common predisposing factors were otogenic infection (3/25, 12%) and penetrating head trauma (3/25, 12%). Causative organisms were identified in 64% of patients (16/25). The causative agents were S. intermedius (n=3), S. aureus (n=3), S. pneumoniae (n=1), Group B streptococcus (n=2), E. coli (n=1), P. aeruginosa (n=1), and suspected fungal infection (n=5). Seven patients received medical treatment only while the other 18 patients also required surgical intervention. The overall fatality rate was 16% and 20% of patients had neurologic sequelae. There was no statistical association between outcomes and the factors studied. Conclusion: Although uncommon, a brain abscess is a serious disease. A high level of suspicion is very important for early diagnosis and to prevent serious consequences.

BackgroundDandy described first, about intervertebral disc hernia (1929). Mixter W.J and Barr J.S (1934) investigated that correlation of sciatica and lumbar disc hernia. Discectomy is most confirming surgery among all spine surgery. Asymptomatic lumbar disc hernia revealed in 70% of adult, by MRI. Spine disorder is first cause of disability of workers below 45 yrs, in European countries. International research for predisposing, risk factors of intervertebral disc hernia is widely confirmed, but diagnostic and treatment aspects are not completed.Materials and MethodsWe did computer aided search using key words “disc degeneration, risk factor, discectomy, lumbar disc hernia, spinal instrumentation” in online library: MEDLINE, E pub, PUBMED, HINARI, Mongolmed, years 1970-2011, also domestic research works from Central library of HSUM, Mongolia. We included article, case-control study, systematic review, case study.ConclusionIncidence and disability caused by lumbar disc hernia, requiring surgical treatment is common problem in world. By anatomical region, lumbar disc hernia is the highest. Research work revealed that patients who took surgical treatment different by gender (male:female=2:1), geographical region (US 160/100000, Switzerland 62/100000). At last 20 yrs, dramatically changed theory about predisposing factor of disc hernia. It is changed from mechanical load to genetic role. Disc degeneration disease is basis of disc hernia. Nucleus pulposus, annulus fibrosus losing own structure, containing moleculs, and water under degeneration. The risk factors are frequent heavy lifting, frequent twisting and bending, vibration, sedentary work, driving and overweight. The golden standard surgery of herniated disc of cervical area is anterior cervical discectomy and fusion (ACDF). Posterior screw fixation of lumbar vertebrae is most frequently confirming surgery among the world.

Introduction: A brain abscess is aserious disease of the central nerve system.We conducted this study to summarize theclinical manifestations and outcomes ofbrain abscesses.Materials and Methods: A retrospectivechart review of pediatric patients diagnosedwith brain abscesses from November 2000 toJаn 2016 was performed at Shastin MedicalHospital neurosurgery department.Results: Twenty-five patients wereincluded in this study. On average, 1.67cases per year were identified and themedian age was 4.3 years. The commonpresenting clinical manifestations were fever(18/25, 72%), seizure (12/25, 48%), alteredmental status (11/25, 44%), and signs ofincreased intracranial pressure (9/25, 36%).A total of 14 (56%) patients had underlyingillnesses, with congenital heart disease(8/25, 32%) as the most common cause.Predisposing factors were identified in 15patients (60%). The common predisposingfactors were otogenic infection (3/25, 12%)and penetrating head trauma (3/25, 12%).Causative organisms were identified in 64%of patients (16/25). The causative agentswere S. intermedius (n=3), S. aureus (n=3),S. pneumoniae (n=1), Group B streptococcus(n=2), E. coli (n=1), P. aeruginosa (n=1),and suspected fungal infection (n=5). Sevenpatients received medical treatment onlywhile the other 18 patients also requiredsurgical intervention. The overall fatality ratewas 16% and 20% of patients had neurologicsequelae. There was no statistical associationbetween outcomes and the factors studied.Conclusion: Although uncommon, a brainabscess is a serious disease. A high level ofsuspicion is very important for early diagnosisand to prevent serious consequences.

Background: Spine disorder is the first cause of disability of workers below 45 years and economicalburden costs 20-50 billion us.dol, in European countries. Lumbar disc hernia estimates 40% of 30-50aged population in U.S and in Japan 26/10000. In last 5 years, spine surgeries increased in 4-5 timesdue intervertebral disc hernia, at Shastin State Third Central hospital of Mongolia.Goal: To populate new methods of surgical treatment for compressive lesions of spinal cord, spinalnerve root of cervix, thorax and lumbar spineMaterials and Methods: We did clinical research involving patients who had spine surgery at ourdepartment due “compressive lesion of spinal nerve root and spinal cord”. From, total 217 patients,excluded 9. Excluded cases are: declined from surgery 3, Arnold-Chiari malformation 5, and epiduralabscess 1. We collected data with permission of patient and did statistical analysis by IBM SPSS 17.Results: The surgery for intervertebral disc hernia takes 84.6% (176) of total surgery and 94.9% (167)of lumbar disease. Tumor of spinal cord estimates 9.1% (19) of total case, dominates in lumbar area(57.9%). We used posterior approach mostly, because it is frequently used in lumbar spine. The surgerycontinued 36-750 min (204.6, SD 128.5) ten patients (4.8%) had complications. In this project weused 5 surgical methods totally in solitary or combined. Spondilodesis is the most combined methodamong them. We used Oswestry disability index in Mongolia at first, to count treatment effect. Currentindex evaluated pre and post surgery period. Patient complaint and difficulty of daily life progressivelydecreased after surgery and almost disappeared at third month (p<0.00).Conclusion:1. It is possible to develop international standard surgical treatment of compressive lesions of spinalnerve root, spinal cord of cervix, thorax and lumbar spine in Mongolia.2. We used Oswestry disability index in Mongolia at first, so this questionnaire is simpler and accuratemethod for spine, spinal cord induced disability.3. Twenty seven point nine percent of patients who had surgical treatment has minimal to moderatedisability by Oswestry disability index, so it means we have to process standard of spine surgeryand increase non surgical treatment efficiency.4. Working ability recovers faster when spine surgery has been done.5. These new methods of spine surgery are cost effective than same surgery which will be doneabroad.

Background. Low back pain is a frequently encountered symptom. Although 70-80% of the entirepopulation have low back pain complaints in their lives, only 2-4% of them require surgical intervention.’Department of Neurosurgery, Shastin 3rd Central Hospital about 200 patients who undergo back surgery,while 90% of patients who have prolapsed lumbar disc surgery from 2010 to 2012. There are variousstudies indicating that exercise improves pain and disability in chronic low back pain and in those whohave had surgery. The main objectives of the postoperative rehabilitation programmes are to accelerateand maximize function recovery as much as possible, and to prevent further injury by restricting theprogression of degenerative changes. We evaluated the effectiveness of rehabilitation treatments thatare used in our department which is the first time in our country.Goal. To evaluate the effectiveness of rehabilitation after lumbar discectomy.Materials and Method. We examined 83 patients were included the Shastin central hospital, Departmentof neurosurgery and rehabilitation after lumbar discectomy at a single level and operated in the periodfrom May 15, 2013 to September 15, 2014. All patients were evaluated at the beginning and at theend of treatment by Oswestry Disability Index which is a specific functional questionnaire for back pain.Pretreatment values are one month after surgery and posttreatment values three months after surgery.All patients received the intensity specific exercise and back school education programme 3 days aweek for eight weeks.Results. All patients pain intensity are reduced after treatment evaluated by VAS (p<0.000). Functionalability had significantly increased after treatment which is evaluated by Oswestry Disability Index in allpatients (p<0.000). 46 from all patients had minimal disability before treatment and this number wasincreased in to 79 after treatment. The number of moderate and severe disabled patients ability wasincreased after treatment.Conclusion: Back school education and specific exercise programme should be one of the parts oftreatment after lumbar discectomy. After treatment was increased functional ability and early painrelief.