Papers by Kriengsak Limpastan
Asian Journal of Neurosurgery
Objective Consistency of meningiomas is one of the most important factors affecting the completen... more Objective Consistency of meningiomas is one of the most important factors affecting the completeness of removal and major risks of meningioma surgery. This study used preoperative magnetic resonance imaging (MRI) sequences in single and in combination to predict meningioma consistency. Methods The prospective study included 287 intracranial meningiomas operated on by five attending neurosurgeons at Chiang Mai University Hospital from July 2012 through June 2020. The intraoperative consistency was categorized in four grades according to the method of surgical removal and intensity of ultrasonic aspirator, then correlated with preoperative tumor signal intensity pattern on MRI including T1-weighted image, T2-weighted image (T2WI), fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted image (DWI), which were described as hypointensity, isointensity, and hyperintensity signals which were blindly interpreted by one neuroradiologist. Results Among 287 patients, 29 were male ...
Journal of Craniofacial Surgery
Meningeal hemangiopericytoma (HPC) is a rare tumor in the central nervous system. It is often rep... more Meningeal hemangiopericytoma (HPC) is a rare tumor in the central nervous system. It is often reported as “Meningioma”. Unlike meningiomas, HPC has a high rate of local recurrence and distant metastasis, which may occur several years after initial treatment [1]. The purpose of this article is to report a case of parasagittal hemangiopericytoma with delayed multiple extracranial metastases and local recurrence.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2013
OBJECTIVE Evaluate the result of intracranial aneurysm surgery in Maharaj Nakorn Chiang Mai Hospi... more OBJECTIVE Evaluate the result of intracranial aneurysm surgery in Maharaj Nakorn Chiang Mai Hospital. MATERIAL AND METHOD A retrospective study ofpatients who underwent surgery for intracranial aneurysms between 2003 and 2007. The patients'age, gender, signs and symptoms, CT brain findings, Subarachnoid hemorrhage (SAH), World Federation of Neurosurgical Society grading (WFNS), and aneurysm location were studied and correlated with outcome after surgery. RESULTS Two hundred twenty five patients ofintracranial aneurysm were operated on between 2003 and 2007. Two hundred nine patients (92%) had anterior circulation aneurysms and 18 (8%) had posterior circulation aneurysms. The outcome, as evaluated by Glasgow Outcome Scale (GOS), showed good recovery and moderate disability patients (142, 62.9%) were classified as favorable outcome group whereas patients with severe disability, vegetative state, and dead (83, 36.9%) were classified as unfavorable outcome. According to WFNS grading...
PLoS ONE, 2020
Background The majority of clinical decision rules for prediction of intracranial injury in patie... more Background The majority of clinical decision rules for prediction of intracranial injury in patients with mild traumatic brain injury (TBI) were developed from high-income countries. The application of these rules in low or middle-income countries, where the primary mechanism of injury was traffic accidents, is questionable. Methods We developed two practical decision rules from a secondary analysis of a multicenter, prospective cohort of 1,164 patients with mild TBI who visited the emergency departments from 2013 to 2016. The clinical endpoints were the presence of any intracranial injury on CT scans and the requirement of neurosurgical interventions within seven days of onset. Results Thirteen predictors were included in both models, which were age ≥60 years, dangerous mechanism of injury, diffuse headache, vomiting >2 episodes, loss of consciousness, posttraumatic amnesia, posttraumatic seizure, history of anticoagulant use, presence of neurological deficits, significant wound...
Most traumatic intracranial extradural hematomas become rapidly symptomatic and over one half of ... more Most traumatic intracranial extradural hematomas become rapidly symptomatic and over one half of casea may be rendered unconsciousness from the moment of impact.papillary changes and hemiparesis commonly occur in patients with a large extradural hematoma,which typically resulting in ipsilateral pupil dilatation.here we present an unusual case of a large traumatic extradural hematoma with delayed presentation of double vision without symporopa without neurological deficit. Chiang Mai Med Bull 1998;37(3-4):81-83.
Pituitary abscess is a potentially life-threatening and rare condition. This report presents the ... more Pituitary abscess is a potentially life-threatening and rare condition. This report presents the case of a young male who was investigated for progressive headache. Magnetic Resonance Imaging (MRI) showed a cystic sellar lesion with ring enhancement that was diagnosed fi rstly as cystic pituitary adenoma. The patient was operated on with a sublabial transphenoidal approach to the pituitary gland. After dural opening, yellowish purulent material was obtained, with no tumor tissue detected. Pus examination showed many white blood cells (WBC) and gram positive diplococci. Culture was negative. After surgery, the patient was given antibiotics for 6 weeks and he made a good recovery.
World Neurosurgery: X
BACKGROUND: Neurosurgical task shifting and task sharing (TS/S), delegating clinical care to non-... more BACKGROUND: Neurosurgical task shifting and task sharing (TS/S), delegating clinical care to non-neurosurgeons, is ongoing in many hospital systems in which neurosurgeons are scarce. Although TS/S can increase access to treatment, it remains highly controversial. This survey investigated perceptions of neurosurgical TS/S to elucidate whether it is a permissible temporary solution to the global workforce deficit.-METHODS: The survey was distributed to a convenience sample of individuals providing neurosurgical care. A digital survey link was distributed through electronic mailing lists of continental neurosurgical societies and various collectives, conference announcements, and social media platforms (July 2018eJanuary 2019). Data were analyzed by descriptive statistics and univariate regression of Likert Scale scores.-RESULTS: Survey respondents represented 105 of 194 World Health Organization member countries (54.1%; 391 respondents, 162 from high-income countries and 229 from low-and middle-income countries [LMICs]). The most agreed on statement was that task sharing is preferred to task shifting. There was broad consensus that both task shifting and task sharing should require competency-based evaluation, standardized training endorsed by governing organizations, and maintenance of certification. When perspectives were stratified by income class, LMICs were significantly more likely to agree that task shifting is professionally disruptive to traditional training, task sharing should be a priority where human resources are scarce, and to call for additional TS/S regulation, such as certification and formal consultation with a neurosurgeon (in person or electronic/telemedicine).-CONCLUSIONS: Both LMIC and high-income countries agreed that task sharing should be prioritized over task shifting and that additional recommendations and regulations could enhance care. These data invite future discussions on policy and training programs.
World Neurosurgery: X
Working Group-BACKGROUND: Because nearly 23,000 more neurosurgeons are needed globally to address... more Working Group-BACKGROUND: Because nearly 23,000 more neurosurgeons are needed globally to address 5 million essential neurosurgical cases that go untreated each year, there is an increasing interest in task-shifting and task-sharing (TS/ S), delegating neurosurgical tasks to nonspecialists, particularly in low-and middle-income countries (LMICs). This global survey aimed to provide a cross-sectional understanding of the prevalence and structure of current neurosurgical TS/S practices in LMICs.-METHODS: The survey was distributed to a convenience sample of individuals providing neurosurgical care in LMICs with a Web-based survey link via electronic mailing lists of continental societies and various neurosurgical groups, conference announcements, e-mailing lists, and social media platforms. Country-level data were analyzed by descriptive statistics.-RESULTS: The survey yielded 127 responses from 47 LMICs; 20 countries (42.6%) reported ongoing TS/S. Most TS/S procedures involved emergency interventions, the top 3 being burr holes, craniotomy for hematoma evacuation, and external ventricular drain. Most (65.0%) believed that their Ministry of Health does not endorse TS/S (24.0% unsure), and only 11% believed that TS/S training was structured. There were few opportunities for TS/S providers to continue medical education (11.6%) or maintenance of certification (9.4%, or receive remuneration (4.2%).-CONCLUSIONS: TS/S is ongoing in many LMICs without substantial structure or oversight, which is concerning for patient safety. These data invite future clinical outcomes studies to assess effectiveness and discussions on policy recommendations such as standardized curricula, certification protocols, specialist oversight, and referral networks to increase the level of TS/S care and to continue to increase the specialist workforce.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2013
OBJECTIVE To evaluate risk factors that influences the outcome of decompressive craniectomy (DC) ... more OBJECTIVE To evaluate risk factors that influences the outcome of decompressive craniectomy (DC) in severe traumatic brain injury patients. MATERIAL AND METHOD The authors' retrospective review of data collected from 826 severe traumatic brain injury patients admitted to the Chiang Mai University Hospital between January 1, 2006 and December 31, 2008. During this period, 159 of 826 patients (19.25%) underwent DC and the craniectomy size was not smaller than a fronto-temporo-parietal or a bifrontal bone flap. Data collected included demographics, pre- and post-operative Glasgow coma scores (GCS), timing of surgery, complications, and Glasgow outcome score (GOS) at discharge and six months after surgery. At our institution, patients are managed using the Brain Trauma Foundation guidelines. RESULTS One hundred fifty nine patients were identified, 130 (81.76%) male and 29 (18.23%) female. One hundred twenty two patients were operated within the first 24 hours after admission. Overal...
Surgical Neurology International
Background: Mild traumatic brain injury (MTBI), accounting for 80% of traumatic brain injury, is ... more Background: Mild traumatic brain injury (MTBI), accounting for 80% of traumatic brain injury, is one of the most common conditions seen in emergency departments. Clinical parameters to predict intracranial lesions vary among guidelines. This study intended to find clinical parameters that can predict traumatic intracranial lesions in the setting of a middle-income country. Methods: Data from mild head injury patients admitted to the emergency department from two large hospitals in Chiang Mai, Thailand, were prospectively collected from 2013 to 2014. The primary outcome was identifying clinically-important traumatic brain injury (ciTBI), and the secondary outcome was the neurosurgical procedure performed. Ten clinical findings and six predicting factors were analyzed using univariable and multivariable analysis. Results: Among 1164 patients, ciTBI was identified in 244 cases (21.0%). The neurosurgical operation was performed in 57 cases (4.9%). Multivariable analysis showed factors f...
Neurological Research, 2016
Current chemotherapy treatments available for treating high-grade brain tumors, Temozolomide (TMZ... more Current chemotherapy treatments available for treating high-grade brain tumors, Temozolomide (TMZ) or Bevacizumab (BEV), not only have specific anti-tumor mechanisms, but also have an effect on mitochondria. However, effects of both drugs on mitochondria isolated from human brain tumors have not been thoroughly investigated. This study determined the direct effects of TMZ and BEV as well as the neurotoxic condition (calcium overload), on the function of mitochondria and compared these effects on mitochondria isolated from low- and high-grade human brain tumors. Mitochondria were isolated from either low- or high-grade human primary brain tumors. Calcium overload conditions (100 or 200 μM), TMZ (300 μM), and BEV (2 mg/mL) were applied to isolated mitochondria from low- and high-grade brain tumors. Following the treatment, mitochondrial function, including reactive oxygen species production, membrane potential changes, and swelling, were determined. The mitochondrial morphology was also examined. In calcium overload conditions, mitochondrial dysfunction was only found to have occurred in low-grade tumors. In TMZ and BEV treatment, BEV, rather than TMZ, caused greater membrane depolarization and mitochondrial swelling in both grades of brain tumors. TMZ and BEV can directly cause the dysfunction of mitochondria isolated from human brain tumors. However, BEV has a greater ability to disturb mitochondrial function in mitochondria isolated from human brain tumors than either TMZ or calcium overload conditions.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2013
Evaluate the result of intracranial aneurysm surgery in Maharaj Nakorn Chiang Mai Hospital. A ret... more Evaluate the result of intracranial aneurysm surgery in Maharaj Nakorn Chiang Mai Hospital. A retrospective study ofpatients who underwent surgery for intracranial aneurysms between 2003 and 2007. The patients'age, gender, signs and symptoms, CT brain findings, Subarachnoid hemorrhage (SAH), World Federation of Neurosurgical Society grading (WFNS), and aneurysm location were studied and correlated with outcome after surgery. Two hundred twenty five patients ofintracranial aneurysm were operated on between 2003 and 2007. Two hundred nine patients (92%) had anterior circulation aneurysms and 18 (8%) had posterior circulation aneurysms. The outcome, as evaluated by Glasgow Outcome Scale (GOS), showed good recovery and moderate disability patients (142, 62.9%) were classified as favorable outcome group whereas patients with severe disability, vegetative state, and dead (83, 36.9%) were classified as unfavorable outcome. According to WFNS grading, the patients with unruptured aneurys...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2013
To evaluate risk factors that influences the outcome of decompressive craniectomy (DC) in severe ... more To evaluate risk factors that influences the outcome of decompressive craniectomy (DC) in severe traumatic brain injury patients. The authors' retrospective review of data collected from 826 severe traumatic brain injury patients admitted to the Chiang Mai University Hospital between January 1, 2006 and December 31, 2008. During this period, 159 of 826 patients (19.25%) underwent DC and the craniectomy size was not smaller than a fronto-temporo-parietal or a bifrontal bone flap. Data collected included demographics, pre- and post-operative Glasgow coma scores (GCS), timing of surgery, complications, and Glasgow outcome score (GOS) at discharge and six months after surgery. At our institution, patients are managed using the Brain Trauma Foundation guidelines. One hundred fifty nine patients were identified, 130 (81.76%) male and 29 (18.23%) female. One hundred twenty two patients were operated within the first 24 hours after admission. Overall mortality rate was 44.65%. The survi...
Asian journal of neurosurgery, 2013
Most reports of cadaveric specimen preparation for neurosurgical dissection describe methods usin... more Most reports of cadaveric specimen preparation for neurosurgical dissection describe methods using fresh cadavers. Our cultural limitations prevent us from obtaining fresh cadaveric heads. To study and report on an alternative method of preparation of head specimens for neurosurgical dissection using defrosted cadavers. Twenty-four head specimens were procured through the Department of Anatomy, received by donation three to seven days after funeral activity. The specimens were sectioned through the neck, and preserved by refrigeration at a temperature of -10°C for a period of one week to three months prior to preparation. The process began with defrosting the frozen head specimens for 48 hours in a refrigerator, in which the temperature was controlled within the range of -2° to -8°C. The great vessels were identified and cannulated. These were then irrigated with tap water until clear, following which colored silicone was injected. The specimens were preserved in 95% ethyl alcohol, ...
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Papers by Kriengsak Limpastan