1.Hemodynamic effects resulting from a common carotid to middle cerebral bypass with varying degrees of proximal internal carotid stenosis
Sheau Fung Sia ; Yu Zhang ; Yi Qian ; Khairul Azmi Abd Kadir ; Hazman Mohd Nor ; Michael Kerin Morgan
Neurology Asia 2014;19(3):241-247
Objective: To investigate the degree of stenosis of the internal carotid artery required for continuous blood flow in an interposition vein bypass to the middle cerebral artery. Methods: Computational fluid dynamics techniques were used to investigate a case of common carotid to middle cerebral artery brain bypass with varying degrees of internal carotid artery stenosis. Blood flow patterns across the patient-specific brain bypass were evaluated. Results: Simulation found that for cross section stenosis of less than 60%, no flow occurred in the bypass graft. Further narrowing of the internal carotid artery increased flow linearly within the bypass graft. There was significant energy loss and pressure gradient difference between the proximal and distal anastomosis sites of the bypass. Conclusion: Computational fluid dynamics helps us to quantify the flow distribution, wall shear stress and pressure gradient in brain bypass surgery. The angle of the distal anastomosis had no effect on hemodynamic indices, allowing this consideration to be ignored in modeling. This modeling technique is useful to estimate the required degree of stenosis in the artery that is to be occluded to ensure sustained flow in the bypass. This will be of importance where there is staged surgery with a time interval between the bypass and the definitive internal carotid artery occlusion.
2.Multicompartmental congenital intracranial immature teratoma
Dharmendra Ganesan ; Sheau Fung Sia ; Vairavan Narayanan ; Gnana Kumar ; Lucy Lum ; Lucy Chan ; KS Mun ; Vicknes Waran
Neurology Asia 2013;18(1):117-121
Congenital intracranial tumors are rare and account for 0.5 to 1.5% of all childhood tumours. We report
a case of a 3 week old baby presenting with multi compartmental congenital intracranial immature
teratoma, fi rst of its kind in the literature. The child had gross total excision in two stages with aid of
neuronavigation. The short term outcome was good. The four years of follow-up with serial imaging
showed no tumour recurrence with a stable hydrocephalus after shunting. However, there is global
developmental delay with full time dependence of care giver
3.Vasospasm and delayed cerebral ischaemia in patients with spontaneous subarachnoid haemorrhage (aneurysmal and pretruncal non-aneurysmal): a centre’s perspective
Narendra Balasekaran ; Shahrul Aiman Soelar ; Lalita Anbarasen ; Chun Yoong Cham ; Retnagowri Rajandram ; Sheau Fung Sia
The Medical Journal of Malaysia 2021;76(1):17-23
Spontaneous subarachnoid haemorrhage (SAH) is a
significant cause of stroke and may lead to severe
neurological deficit or death. It is also associated with high
morbidity and mortality for patients despite optimal medical
and surgical treatment. Based on the World Health
Organization the annual incidence of spontaneous SAH
varies in different regions of the world between
2.0-22.5 per 100,000 populations with Finland and
Japan having the highest incidence and South and
Central America with lowest incidence.1