Project Brings smile to cancer kid

 

“I am very lucky to get the operation free of cost,” she said, her eyes sparkling. Wei said she would like to go to school as soon as possible. Wei also added that she would like to become a doctor to take care of patients and reduce their pain.

One of the volunteer-doctors said the cost for acoustic neuroma removal surgery was HK$600,000. He said there were about 100 new cases of acoustic neuroma in Hong Kong each year. However, there are a few cases of giant tumor of more than four centimeters.

The majority of patients in Hong Kong were middle-aged men, he noted, and young patients like Wei were rare. Explaining acoustic neuroma, he said if the disease was found at a young age, the tumor would grow rather fast. He also said patients in Hong Kong with tumor less than two centimeters could opt for a follow-up therapy instead of surgery.

Dr. Joseph Lam Ming-kuen, specialist in neurosurgery who also took part in the free surgery, said the incidence of acoustic neuroma in Hong Kong had been increasing in recent years.

A higher incidence rate could be related to the fact that MRI scanning had become more common for people with loss of hearing on one side. Chief hospital manager of The Hong Kong Hospital, said: “Healing Heart Initiative” would provide free surgery to 10 poor patients in Hong Kong and mainland. Wei was the third person to have received the service, he added.

Reference: www.scmp.com.

The information provided aims to provide educational purpose, if you have the described conditions as above, please consult your neurosurgeon.

Hong Kong Project Brings hope to cancer kid

 

Seventeen years old Wei Qunqun from a poor farmer family in rural Shangdong Province, had acoustic neuroma (hearing-nerve cancer). But, thanks to the humanitarian efforts by “Healing Heart Initiative” Charity Program, she could undergo the surgery free of charge in Hong Kong.

A Hong Kong Hospital charity project “Healing Heart Initiative” and charity group Hear Talk Foundation paid Wei’s medical bills.

Since she was 13, acoustic neuroma badly affected Wei’s learning ability and left her almost crippled. Her hearing ability and sense of balance worsened two years ago. She always felt dizzy and could hardly walk.

The disease could have been fatal if the five-centimeter tumor continued to grow.

However, except for a tiny part that is close to her facial nerve, the tumor had been successfully removed last week by a team of volunteer doctors from Hear Talk Foundation. Wei is able to eat, think and walk and is currently undergoing physiotherapy. She will be released from hospital next week.

Reference: http://www.surgery.cuhk.edu.hk/neuro/default.htm

The information provided aims to provide educational purpose, if you have the described conditions as above, please consult your neurosurgeon.

Neuropathic Pain Syndromes

Postherpetic neuralgia

      - occurs following an acute attack of herpes zoster (shingles). It is defined as pain persisting for more than 3 months after the active herpes zoster lesions have healed, and involves constant aching, burning or itching with intermittent, severe, lancinating pain. Allodynia and hyperalgesia may also occur.

Peripheral or painful diabetic neuropathy

      - a peripheral, autonomic or cranial nerve disorder associated with diabetes mellitus. These conditions usually result from diabetic microvascular injury involving small blood vessels that supply nerves. It is estimated that over 50% of diabetic patients may experience a neuropathy during their lifetime, although not all neuropathies are painful. Painful neuropathy is generally described as superficial and affects the feet and hands. Burning, tingling and allodynia are typically reported.

Trigeminal neuralgia

-          affects any of the 3 trigeminal nerves that supply either side of the face, and can sometimes affect 2 branches at once. The 1-sided pain of trigeminal neuralgia may extend through the cheek, mouth, nose and/or jaw muscles. This condition is characterized by a lancinating, shooting, electric-like sensation that can last from a few seconds to several minutes. Pain may be initiated by stimulating trigger points on the face, lips or gums, or by facial muscle movement, such as chewing.

Reference: http://www.neuropainhk.org

The information provided aims to provide educational purpose, if you have the described conditions as above, please consult a neurosurgeon.

Are there any screening tools to help diagnose neuropathic pain?

Various screening tools are available to help physicians diagnose neuropathic pain. The European Federation of Neurological Societies (EFNS) has recently published updated guidelines that provide an overview of, and recommendations on, the key screening tools. These tools are: the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS)2; Neuropathic Pain Questionnaire (NPQ)3; Douler Neuropathique en 4 questions (DN4)4; PainDETECT5; ID Pain6; and the standardized evaluation of pain (StEP)7. All these screening tools have been validated in various neuropathic pain populations; the LANSS, DN4 and StEP utilize interview questions and physical examination, while the NPQ, PainDETECT and ID Pain use only interview questions. Of relevance to the Hong Kong population, one of the screening tools – the ID Pain – has been translated to and validated. The validity of the 6-item patient-completed questionnaire was assessed in 92 patients with either neuropathic or nociceptive pain. At a score of 3 or more, the questionnaire correctly classified 71% of cases. While screening tools are useful for identifying patients with possible neuropathic pain, particularly by non-specialist physicians, they do have limitations. As noted in the EFNS guidelines, these tools fail to identify 10–20% of patients with physician-diagnosed neuropathic pain; hence, they should be used together with a thorough patient history and physical examination.

ID pain

1 Did the pain feel like pins and needles? 您的痛楚是否好像被針刺般疼痛？

2 Did the pain feel hot/burning? 您的痛楚是否灼熱或好像被火燒一樣？

3 Did the pain feel numb? 您的痛楚是否帶有麻痺？

4 Did the pain feel like electrical shocks? 您的痛楚是否好像觸電一樣？

5 Is the pain made worse with the touch of clothing or bedsheets? 您的痛楚是否因觸碰衣服或床單而加劇？

6 Is the pain limited to your joints? 您的痛楚是否只限於關節部位？

Reference: http://www.neuropainhk.org

The information provided aims to provide educational purpose, if you have the described conditions as above, please consult your doctor immediately.

Back Pain and Degenerative Disc Disease: Are Artificial Discs the Solution?

There has been considerable excitement among surgeons as well as patients following the recent FDA (Food and Drug Administration) release. The excitement among patients with degenerative disc disease stems from the impression that there is now a safe way to eliminate pain from degenerative discs while at the same time maintaining normal motion. Many of these patients have heard about others with similar problems undergoing fusion procedures in the past, who still continue with persistent pain or had more than one attempt at fusion without success or have developed additional levels of disc degeneration requiring an additional fusion procedure. They have also heard of the successful results following disc arthroplasty in Europe which has been highly publicized by the media in the United States. 

Early Detection and Lumbar Fusions
This is definitely an exciting new addition to our armamentarium for the treatment of degenerative disc disease. When we look at how the evaluation and treatment for degenerative disc disease has developed over the past few years an almost unbelievable amount of progress has been made. We now are better able to identify disc disease early on with MRI and pain generators with discography and facet blocks. Where only a decade ago, lumbar fusions were being performed through large posterior incisions, now they can be performed percutaneously through incisions that are barely visible either anteriorly through the abdomen or through the back. With the use of presently available instrumentation, success rates for one level fusions approach 90-95%. Unfortunately, not every patient who has degenerative disc disease and has a successful fusion has a successful clinical result. There is still a group of patients for whom fusion does not effectively alleviate pain.

Disc Replacement: Risks
Disc replacement arthroplasty has the potential for the treatment of many of the spinal motion segment disorders that are currently being treated both successfully and not so successfully by one of the many fusion techniques. At this relatively early stage of disc replacement development, we do not know all of the problems that may be encountered following these procedures. Because the surgical approach is through the abdomen either retroperitoneal or transperitoneal (around/through the stomach), there are some predictable complications including vascular injury, thrombophlebitis (vein inflammation accompanied by blood clot formation), nerve root injuries, injury to the ureter, and retrograde ejaculation in males.

We also know that a number of disc replacements have failed and have been converted to a fusion with variable clinical outcomes. The removal of artificial discs, especially at the L4-5 level, is fraught with a significant risk of vascular injury because of scarring around the prosthesis. We do not know at the present time how long these prostheses will last and how well they will function. Will they provide enough motion to prevent adjacent segment degeneration, and will the patient with multilevel disease be a candidate for this procedure? Certainly we know that artificial joints produce wear debris and an inflammatory response which escalates over time where this is obviously not a problem with fusion. 

Optimism and Early Results
Spine surgeons in general are very optimistic and excited about total disc arthroplasty and appropriately so. There also will be a learning curve by both the spine surgeon as well as the access surgeons who provide the exposure. Appropriate training via courses and cadaveric labs will help to minimize the learning curve and potential complications. There will no doubt be many improvements and modifications in the prosthetic designs.

Early results are certainly encouraging in the hands of the investigational surgeons but are fraught with the many problems common to the development of a new procedure. Total disc arthroplasty is likely to be a better solution than fusion for many degenerative disorders of the lumbar spine as design improvements continue to be made and as further experience defines the indications for its use.

Reference source: http://www.spineuniverse.com/treatments/emerging/artificial-discs/back-pain-degenerative-disc-disease-artificial

The above information is for educations only, if you have any related disease, plese consult your neurosurgeon for more information.

Hong Kong Pain review – Visceral pain and neuropathic pain

Visceral Pain

Visceral pain is caused by obstruction, infiltration or compression of visceral structures and supporting

connective tissues.3 Lung, liver and kidney parenchyma are insensitive to pain, but tumours associated with these organs may cause pain when the capsule or adjacent structures are affected.4 Visceral pain is often diffuse and sometimes referred to other nonvisceral structures, making the source of pain difficult to localize.

Neuropathic Pain

Studies indicate approximately 30% to 55% of cancer patients have neuropathic pain, which is due to involvement of neural structures (eg, nerves, plexi or roots), usually by tumour infiltration or compression. Sympathetic activity also plays a role in spontaneous neuropathic pain. This type of pain is characterized as aching, burning, stabbing or lancinating.3,4 It may also present as paraesthesia, dysaesthesia, hyperalgesia or allodynia. Relative to somatic and visceral pain, neuropathic pain responds poorly to systemic opioids, hence other treatments are often utilized. Most post-treatment pain syndromes (eg, postsurgical, postradiotherapy or postchemotherapy pain) are neuropathic.3 Injury to the intercostobrachial nerve during mastectomy causes a tight, burning sensation in the axilla, the medial aspect of the upper arm and the upper aspect of the anterior chest wall. Radiation-induced fibrosis can cause peripheral nerve injury. Vincristine, cisplatin and paclitaxel are neurotoxic and can cause dysaesthesia, paraesthesia, cramps and restless legs associated with weakness, sensory loss or autonomic dysfunction. This set of recommendations aims to provide a logical approach to

effectively manage cancer pain, with a particular focus on neuropathic pain. Patients may have several cancer pain syndromes that respond differently to pharmacological and nonpharmacological interventions. Therefore, a pain management programme should be devised on an individual basis depending upon patient characteristics and responses. Multiple medications may be used, with each agent adjusted according to the specific pain syndrome for which it is used.7 Pain management should be guided by a detailed patient assessment.

Reference source: http://www.neuroPAINhk.org, www.brain-spine.com.hk

The above information is for educations only, if you have any related disease, please consult your neurosurgeon for more information.

Prevalence, Pathophysiology and Symptoms of Neuropathic Cancer PAIN – Hong Kong review

PAIN can be a persistent and incapacitating symptom of cancer. Although reports indicate only 15% of patients with nonmetastatic disease experience tumour-associated PAIN at the time of diagnosis, PAIN becomes more pervasive as disease progresses.1 In patients with recurrent or metastatic cancer, 67% complain of PAIN and 41% experience PAIN directly attributable to the disease. PAIN may be

chronic or acute, and patients with chronic PAIN commonly experience acute flares of PAIN. One half to two thirds of patients with well-controlled chronic PAIN experience transitory ‘breakthrough’ PAIN. Cancer-associated PAIN may be secondary to antineoplastic therapy or an unrelated comorbid condition, but is commonly due to direct tumor involvement (ie, infiltration or compression of adjacent local structures, such as bone, soft tissue, nerves or the gastrointestinal tract).1,4 Hence, cancer PAIN syndromes can be somatic, visceral or neuropathic in origin.3 Understanding and recognizing these

syndromes can help identify PAIN etiology and the need for additional evaluation, and target therapy

more appropriately.

Reference source: http://www.neuroPAINhk.org, www.brain-spine.com.hk

The above information is for educations only, if you have any related disease, please consult your neurosurgeon for more information.

Spinal neuropathic pain conditions treated with minimally invasive spine surgery by neurosurgeron

If you have back pain and non-surgical treatments aren't working for you, then you may be a candidate for minimally invasive spine surgery.

Minimally invasive spine surgery is different from standard open spine surgery because it combines technology with innovative techniques so you can have smaller incisions, and a shorter hospital stay. In fact, minimally invasive spine surgery can often be performed on an outpatient basis.

Although minimally invasive spine surgery accomplishes what traditional open spine surgery accomplishes, it's an attractive option if you need spine surgery for a certain spine conditions because there are fewer risks involved than in open spine surgery.

Numerous spine conditions can be treated using minimally invasive spine surgery like degenerative disc disease, Herniated discs, Sciatica, Spinal stenosis, Scoliosis or other spinal deformities, Spondylolisthesis, Spinal fractures, Spinal infections Spinal tumors. 

It's important to note that not all spine conditions can be treated using minimally invasive surgery. In rare cases, if you have a certain spinal infection, sometimes it cannot be treated minimally invasively.

If minimally invasive spine surgery is an option for you, your neurosurgeon will explain the types of surgery he or she recommends. In most cases, minimally invasive spine surgery can effectively and safely treat your pain.

Because of rapid advances in technology, many spine disorders now can be treated with minimally invasive surgery, so talk to your doctor about any questions or concerns you have regarding MISS

Reference source: spineuniverse.com

The above information is for educations only, if you have any related disease, plese consult your neurosurgeon for more information.

What is neurosurgery? And what is the neurosurgeon do?

Neurosurgery is a specialty of surgery which provides the critical care, prevention, diagnosis, evaluation, treatment, and rehabilitation of neurological disorders. This includes the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify the function or activity of the nervous system, including the hypophysis and the operation and non-operative treatment of pain. As such, neurosurgery encompasses treatment of adult and pediatric patients with disorders of the nervous system: disorders of the brain, meninges, and the skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland, disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution.

What is neurosurgeon?

Neurosurgeon is a surgical doctor specialized in neurological disorders.

Central Nervous System (CNS) disorders - Stroke, Parkinsonism disease, Dementia, Brain tumors, Acoustic neuroma, Arteriole-venous malformation (AVM), etc...

Peripheral Nervous System (PNS) disorders – like Back pain, Scoliosis, Sciatica, Low back pain, Neck pain, Neuropathic pain, etc…  .

Reference information: www.brain-spine.com.hk, http://www.surgery.cuhk.edu.hk/neuro/default.htm

The information above is used for educational purpose only, for any enquiries, please consult your neurosurgeon for medical advices.

Neuropathic Pain Syndromes in Hong Kong (Sciatica, cancer pain, post-stroke pain, trigeminal neuralgia, etc..)

Trigeminal neuralgia

It impacts any of the 3 trigeminal nerves that supply either side of the face, and can sometimes affect 2 branches at once. The 1-sided pain of trigeminal neuralgia may extend through the cheek, mouth, nose and/or jaw muscles. This condition is characterized by a lancinating, shooting, electric-like sensation that can last from a few seconds to several minutes. Pain may be initiated by stimulating trigger points on the face, lips or gums, or by facial muscle movement, such as chewing.

Sciatica

It is characterized by pain radiating from the back into the buttock and into the leg. The pain may travel below the knee and may also involve the foot. Lower leg muscles may become numb or weak. Sciatica is most commonly caused by prolapse of the intervertebral disc. This term is also used to describe pain anywhere along the sciatic nerve.

Cancer pain

It can be nociceptive, neuropathic or mixed in nature. Neuropathic pain in cancer patients can occur via various mechanisms, such as by nerve compression or injury caused directly by the tumour, or by cancer treatments, such as chemotherapy. Common symptoms include spontaneous burning pain, intermittent sharp or stabbing pain, hyperalgesia and allodynia.

Post-stroke pain

It is characterized by pain in body areas that have lost sensory innervation due to disruption of the spinothalamic tract as a direct result of the stroke.

Postherpetic neuralgia

It is a neuropathic pain syndrome that occurs following an acute attack of herpes zoster (shingles). It is defined as pain persisting for more than 3 months after the active herpes zoster lesions have healed, and involves constant aching, burning or itching with intermittent, severe, lancinating pain. Allodynia and hyperalgesia may also occur.

Peripheral or painful diabetic neuropathy

It is a peripheral, autonomic or cranial nerve disorder associated with diabetes mellitus. These conditions usually result from diabetic microvascular injury involving small blood vessels that supply nerves. It is estimated that over 50% of diabetic patients may experience a neuropathy during their lifetime, although not all neuropathies are painful. Painful neuropathy is generally described as superficial and affects the feet and hands. Burning, tingling and allodynia are typically reported.

Painful upper limb

It describes a range of painful syndromes affecting the upper limbs, such as carpal tunnel syndrome and tennis elbow. Carpal tunnel syndrome is caused by compression of the median nerve in the hand as it passes through the carpal tunnel, a narrow passage in the wrist comprised of bone and the transverse carpal ligament. Overuse, injury, friction, fractures, fluid retention and forceful movements are common causes. One of the first symptoms of carpal tunnel syndrome is numbness in the hand, thumb, index finger and middle finger, soon followed by pain in the same area.

Complex regional pain syndrome

It describes a variety of syndromes that may follow injury, commonly to an extremity. Patients describe their pain as constant, burning, aching and throbbing, and this may be combined with autonomic and tissue changes at the injury site. The pain usually begins days to weeks after the injury, and persists beyond the time normally expected for the injury to heal. The pain tends to radiate to an entire anatomic region, such as the distal leg and foot.

Reference information: www.spineuniverse.com, www.brainspine.com.hk, www.back.com.

The information above is used for educational purpose only, for any enquiries, please consult your neurosurgeon for medical advices.