The proverbial "walking while chewing gum" statement has been once again proven by our colleagues in PGH. Being able to publish quality research articles amidst the challenges brought about by the turn of events, is testament to not only the grit that we have developed in its wards but also to the commitment in pursuing new knowledge. Prior to the pandemic, PGH has shown a continuous trend of increasing annual publication. From 8% in 2015, it has steadily risen to 42%. The investment in focused attention guided by a clear agenda, extensive funding and protected time for research obviously is paying off handsomely. It is my fervent hope that we will be able to bring our research output to the next level which is health policy formulation based on the knowledge that we have generated.

The epidemiologic features of 652 histologically confirmed intracranial tumors were reviewed. 600 were primary tumors and 52 were metastatic. 17.4% of all tumors were gliomas and 23.2% were meningiomas. 73% of adult tumors were supratentorial, most commonly meningiomas, while 10% of pediatric tumors (age14) were infratentorial, predominantly medulloblastomas. There was an equal distribution of the tumors in the first decades of life. The medulloblastomas and astrocytoma I-II, peaked in early childhood whereas meningiomas, neurilemmomas and metastatic tumors increased in frequency with advancing age. The overall risk for intracranial tumors was the same for both sexes. However, women had greater susceptibility for meningiomas, pituitary adenomas and merilemmomas. The features of intracranial tumors in Filipinos mirrored those seen in Blacks and other Asians, and differed from most Western profiles. It is possible that racial difference play a role in the development of intracranial tumors.

Human ; Male ; Female ; Middle Aged ; Adult ; Adolescent

Terson's syndrome has been implicated by previous studies as a strong predictor of poor outcome of patients with subarachnoid hemorrhage. There was even a recommendation to place patients with the syndrome in the next less favorable category. Hence this study was designed to provide a general profile of patients with Terson's syndrome and investigate whether the syndrome correlates with poor outcome. This study was done using a prospective cohort of patients seen at the Philippine General Hospital pay and charity wards from July 1, 1999 to June 30, 2000 diagnosed to have aneurysmal subarachnoid hemorrhage. Detailed ophthalmological examination was done and data were collected using a standard database. Patients were then followed up at 2 weeks, 1 month and 3 months to determine outcome (using Glasgow Outcome Score). Data collected were subjected to univariate analysis using chi square and/or Fisher test to determine significant correlation of variables with Terson's syndrome and to determine significance of Terson's syndrome as a predictor of poor outcome. A total of 52 patients were included in the study. The general demographic profile of patients with Terson's syndrome was comparable to that of the study population. The frequency of Terson's syndrome was 13.4 percent. There were no statistically significant differences in outcomes among patients with and without Terson's syndrome. However, positive correlation between laterality of Terson's syndrome with the side of aneurysm was shown. Although results were not significant, funduscopic examination remains to be warranted as an important part of diagnostic work-up of aneurysmal subarachnoid hemorrhage patients. When present, the laterality of Terson's syndrome may give a clue to the presence and side of the aneurysm.

Human ; Subarachnoid Hemorrhage ; Charities ; Vitreous Hemorrhage ; Ophthalmoscopes ; Ophthalmoscopy ; Aneurysm

This is a descriptive study of Tersons syndrome among patients with aneurysmal subarachnoid hemorrhage at the Philippine General Hospital. The incidence of Tersons syndrome was 13.4 percent. There were no statistically significant differences in outcomes among patients with and without Tersons syndrome. (Author)
Human ; EYE DISEASES ; EYE HEMORRHAGE ; RETINAL HEMORRHAGE ; VITREOUS HEMORRHAGE ; VITREOUS HEMORRHAGE/ETIOLOGY ; PROGNOSIS ; ANEURYSM ; SUBARACHNOID HEMORRHAGE

OBJECTIVE: Endoscopic third ventriculostomy (ETV) has been shown to be a sufficient alternative in the surgical treatment of hydrocephalus. Our goal in this retrospective study is to analyze our results with the use of ETV in our first 30 cases that it may provide us with selection criteria as to who among our patients will benefit most from this procedure.
METHODOLOGY: Thirty ETVs were performed in 30 patients. Their ages ranged from 2-155 months. Hydrocephalus was caused by aqueductal stenosis in 17 patients, tumors in 7, post-infectious in 3, Dandy-Walker malformation in 2 and arachnoid cyst in 1 patient. The outcome of ETV was evaluated in 26 of the cases that were available for follow-up
RESULTS: The overall success rate was 69.2 percent. Patients with non-communicating hydrocephalus from post-infectious causes, tumors and aqueductal stenosis had high success rates. Patients less than 6 months of age had a poor outcome. Complications included ventriculitis in 1 patient
CONCLUSION: ETV is a viable treatment option for non-communicating hydrocephalus secondary to post-infectious cause, aqueductal stenosis and tumors. A successful outcome is more likely if ETV is done in patients more than 6 months of age Patients who have previously undergone shunting and who have non-communicating hydrocephalus should undergo ETV at the time of shunt failure. These patients showed good outcome.

Human ; Male ; Female ; Infant ; Ventriculostomy ; Dandy-walker Syndrome ; Arachnoid Cysts ; Hydrocephalus, X-linked ; Hydrocephalus ; Cerebral Aqueduct ; Genetic Diseases, X-linked

Awake craniotomy is a neurosurgical technique that involves an awake neurological testing during the resection of an intracranial lesion in eloquent cerebral cortical areas representing motor, language, and speech. This technique is highlighted by an intra-operative cortical mapping that requires active participation by the patient and poses unique challenges to the anesthesiologist. The surgical and anesthetic techniques have evolved significantly over time, as the neurosurgeon and the anesthesiologist learn new steps in making this technique safe to achieve reasonable patient satisfaction. A thorough understanding of this surgical technique's rationale will guide the anesthesiologist in planning the anesthetic management depending on the surgery and neurologic testing. Constant communication between the neurosurgeon, anesthesiologist, and the patient will define this surgical technique's success. It is already a well-established procedure; however, factors that contribute to failures in awake craniotomy procedures have not been well characterized in the literature. Failure is defined as the inability to conduct awake neurologic testing during the awake craniotomy procedure because of various factors which will be described. This paper aims to review the challenges in the performance of three (3) cases of awake craniotomies performed in the Philippine General Hospital. The challenges described in these three (3) cases reveal that this can be experienced by the neurosurgeon, neuroanesthesiologist, and most especially the patient in an acute critical condition. Identification of the procedures' failure and the steps taken to manage such situations with the patient's safety in mind are discussed.
Anesthesia, Intravenous ; Anesthesia, General

Objective: Neurosurgical boot camps allow trainees to hone practical skills in a risk-free environment, but the models and simulators used are relatively costly. In developing countries like the Philippines, low-cost alternatives have to be devised. The authors aimed to demonstrate the feasibility of using local, readily available, and inexpensive tropical fruits as surrogate models for basic neurosurgical skills training during a neurosurgical boot camp. Methods: Locally available tropical fruits were used to teach basic neurosurgical skills to trainees. Coconut, pomelo, and watermelon were used as models for head clamp application, scalp and dural suturing, and ventriculostomy, respectively. Feedback was obtained from the participants after the boot camp. Results: All eight residents thought that the boot camp was useful in learning new skills, and that the fruit models served their purpose. The trainees favored the fruit models that catered to the skill sets required according to level of training. The use of tropical fruits in the boot camp also provided an informal atmosphere that was conducive to learning. Conclusion The novel use of tropical fruits as surrogate models in basic neurosurgical skills training was a feasible and affordable alternative in resource-limited settings, although the activity was perceived to be more useful to junior than to senior residents. The informal atmosphere generated by the use of the fruits contributed to an improved learning experience for the trainee.
Teaching ; Simulation Training ;

Objectives: To identify factors that predict the occurrence of seizures in patients with aneurysmal subarachnoid hemorrhage (SAH) and to evaluate the efficacy of antiepileptic drugs (AEDs) in preventing in-hospital seizures among patients who undergo clip occlusion of ruptured intracranial aneurysms. Methods: In this retrospective study, the medical charts of 205 patients admitted for aneurysmal SAH in Philippine General Hospital (PGH) and who underwent craniotomy and clipping of aneurysm from January 2011 to June 2014 were reviewed. Demographic, radiologic, and clinical factors were converted into categorical variables and their association with the occurrence of seizures analyzed. The incidence of seizures among patients who received an AED (AED cohort) and those who did not receive an AED (No AED cohort) were compared. Secondarily, the effects of seizures and AED use on early postoperative outcomes were determined using the Glasgow Outcome Scale (GOS) on the day of discharge. Results: Among 205 patients with aneurysmal SAH, 31 (15.1%) developed seizures. 21 (10.2%) had seizures at onset of SAH and only seven (3.4%) had in-hospital seizures. Aneurysm re-rupture (OR 5.26, p-value 0.045) and the presence of a parenchymal clot (OR 2.90, p-value 0.043) were independent predictors for seizure occurrence. There was no significant difference in the incidence of seizures in the AED cohort and in the No AED cohort (4/100, 4% vs. 3/99, 3%, p-value 0.714). AED use was associated with a higher proportion of patients with a discharge GOS score of 3 or less (28.0% vs 12.1%, p-value 0.005). Conclusion The results of the study do not support the routine use of AEDs in patients with aneurysmal SAH.
Seizures ; Aneurysm ; Subarachnoid Hemorrhage ; Craniotomy ; Phenytoin ; Levetiracetam ; Anticonvulsants