Papers by Associate Professor John R Ouma
Surgical Neurology International
Background: Keyhole neurosurgery is the notion of safely removing brain and skull base lesions th... more Background: Keyhole neurosurgery is the notion of safely removing brain and skull base lesions through smaller and more precise openings that lessen collateral damage to the surrounding scalp, brain, blood vessels, and nerves. The traditional frontal and pterional approaches require large craniotomies and this predisposes patients to significant and avoidable morbidity. With the growing expectation for minimally invasive surgery, we present our experience with the supraorbital keyhole craniotomy for surgical lesions in the anterior cranial fossa and parasellar regions. Methods: We retrospectively analyzed and evaluated all cases of neoplastic, vascular, trauma, and infective pathologies of the anterior fossa and parasellar regions treated using a keyhole approach, the supraorbital eyebrow (SOE) approach from January 2018 to June 2022. Treatment outcomes were evaluated based on pathology. Results: A total of 50 patients underwent a SOE craniotomy during the study period (28 females a...
Trauma Case Reports, 2022
Superficial temporal artery (STA) pseudoaneurysm is a very rare occurrence that usually presents ... more Superficial temporal artery (STA) pseudoaneurysm is a very rare occurrence that usually presents as a pulsatile mass along the STA distribution following trauma or an iatrogenic cause. We report a case of STA pseudoaneurysm that developed in a 32 year old male following blunt trauma. Unfortunately, the pseudoaneurysm was missed and led to multiple hospital presentations that culminated in an acute bleeding episode. Surgical resection of the pseudoaneurysm was performed and the STA was reconstructed with an STA-STA anastomosis. To our knowledge, this is the second reported case of an STA pseudoaneurysm treated with an STA-STA anastomosis. This case report aims to bring awareness. Although extremely rare, the importance of treating the presence of a pulsatile mass along the STA distribution following a history of trauma or recent cranial surgery with a high level of suspicion is imperative.
African health sciences, 2013
Worldwide there are varying reports on the prevalence of meningiomas among intracranial neoplasms... more Worldwide there are varying reports on the prevalence of meningiomas among intracranial neoplasms. Different reports state intracranial meningiomas, gliomas or metastatic tumours as the most common tumour among intracranial neoplasms. We present our institutions' experience of patients with intracranial neoplasms and a comparison of our findings with those from the literature. To determine the relative frequency of intracranial meningiomas among intracranial neoplasms in our environment. Consecutive patients (151) seen at the CMJAH and CHBAH, Johannesburg, with histologically proven intracranial neoplasms over a 12 month period were analyzed. The commonest histological types were meningiomas, gliomas and pituitary tumours. Forty eight (31.8%) patients had histologically confirmed intracranial meningiomas during the study period, 35 (23.2%) had pituitary adenomas and 32 (21.2%) had gliomas. The mean age of the patients was 43 years with a female-to-male ratio of 1.3:1. The peak a...
Journal of Neurosurgery: Pediatrics
OBJECTIVE Early suturectomy with a rigid endoscope followed by orthotic cranial helmet therapy is... more OBJECTIVE Early suturectomy with a rigid endoscope followed by orthotic cranial helmet therapy is an accepted treatment option for single-suture craniosynostosis. To the authors’ knowledge, flexible endoscope–assisted suture release (FEASR) has not been previously described. Presented herein is their experience with FEASR for the treatment of isolated sagittal craniosynostosis. METHODS A retrospective analysis of the health records of patients who had undergone FEASR between March 2018 and December 2020 was performed. Patients under the age of 6 months who had been diagnosed with isolated sagittal synostosis were considered eligible for FEASR. Exclusion criteria included syndromic synostosis or multiple-suture synostosis. The cephalic index, the primary measure of the cosmetic endpoint, was calculated at prespecified intervals: immediately preoperatively and 6 weeks and 12 months postoperatively. Parental satisfaction with the cosmetic outcome was determined throughout the clinical ...
Wits Journal of Clinical Medicine, 2021
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2003
Archives in Cancer Research, 2018
Neurofibromatosis is a condition that can occur in a number of forms, the commonest of which are ... more Neurofibromatosis is a condition that can occur in a number of forms, the commonest of which are types 1 and 2. As a group, they fall under the phacomatoses family of conditions, otherwise known as neurocutaneous syndromes, owing to the fact that they concurrently have disorders of the nervous system and the integument, which organs share a common ectodermal origin. Other examples include Schwannomatosis and Von Hippel Lindau syndromes. We describe a case of a young girl who presented with features of NF2 and was discovered to have a cerebellar hemangioblastoma at the same time. We are not aware of this association being described in the literature.
South African Journal of Surgery, 2019
Professor Victor Farrell was born in Johannesburg in 1933, a third generation South African of En... more Professor Victor Farrell was born in Johannesburg in 1933, a third generation South African of English and Irish descent. He attended Rosebank Primary School and Parktown Boys High and then Dale College, King Williamstown. He excelled academically and at sport, particularly at tennis which he enjoyed all his life.
Open Access Journal of Clinical Surgery, 2020
29th Annual Meeting North American Skull Base Society, 2019
British Journal of Neurosurgery, 2017
Acalvaria is a rare condition indeed, defined as the absence of the flat bones of the skull, as w... more Acalvaria is a rare condition indeed, defined as the absence of the flat bones of the skull, as well as the associated muscles and dura, with, in some cases, normal skull base bones and normal brain structures. It has been reported as a fatal congenital condition, because of the failure of afflicted children to survive for extended periods. There have, however, been reports of extended survival. The first report of this condition was in 1996, involving an 11-year-old child who had severe mental retardation. Since then, there have been few further reports of this condition, generally in infants.
Journal of Neurological Surgery Part B: Skull Base, 2016
ANZ Journal of Surgery, 2010
Background: Acute compartment syndrome is a serious and not uncommon complication of limb trauma... more Background: Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency, and is associated with significant morbidity if not managed appropriately. There is variation in management of acute limb compartment syndrome in Australia.
South African Journal of Surgery, 2019
Surgical Neurology International, 2020
Background: Empty sella syndrome (ESS) is a condition in which there is loss of volume of the pit... more Background: Empty sella syndrome (ESS) is a condition in which there is loss of volume of the pituitary gland, which is the normal constituent of the sella turcica. There may be visual and endocrine deficits associated with this condition, and radiologically, there may be downward prolapse of the optic chiasm. It occurs in a primary ESS, poorly understood form, as well as a secondary ESS form that follows medical or surgical treatment of a pituitary macroadenoma, or else spontaneous hemorrhage into such a tumor. Case Description: A 56-year-old man presenting with deficits of both visual acuity and visual fields in the setting of radiological ESS without associated optic chiasm prolapse is discussed. He underwent endoscopic endonasal chiasmapexy with gradual improvement of his visual function over the following 6 months. Conclusion: ESS is a potentially potent cause of visual deterioration that lends itself to reversal through a relatively simple neurosurgical technique. This case il...
South African Journal of Surgery, 2019
Background: Intradural extramedullary (IDEM) spinal masses are common lesions with varying histol... more Background: Intradural extramedullary (IDEM) spinal masses are common lesions with varying histological diagnoses often associated with significant neurological deficits. This study aimed to describe the epidemiology, management and perioperative outcome of IDEM tumours seen at the teaching hospitals of the University of the Witwatersrand, Johannesburg, between 2014 and2017. Results: 92 patients were included in the study. The ages ranged from 21 to 87 years, sex ratio was M:F 1:1.4, and duration of symptoms prior to diagnosis ranged between 3 days to 18 months. Local and radicular type pain as well as motor weakness were the commonest symptoms. 67% had severe neurological deficit McCormick Grade III and IV. Schwannoma (26) Neurofibromas (21) and Meningiomas (16) and were the most frequent tumour types. Meningiomas predominantly occurred at the cranio-cervical and thoracic levels. Nerve sheath tumours were mostly found at the cervical and lumbar levels while filum terminale ependymomas occurred at the thoracolumbar area. Laminectomy was the commonest surgical approach employed, and the extent of resection varied, with total excision in half the cases. Neurological function was regained in 3 patients, deteriorated in two and was unchanged in the remainder. Conclusions: IDEM tumours are an important subset of spinal cord compressive lesions Presentation with severe neurological deficit is common and though resection is feasible neurological deficit remains in the vast majority. Earlier detection should improve the results of surgery.
Panamerican Journal of Trauma, Critical Care & Emergency Surgery
The World Health Organization (WHO) defines nutrition as the intake of food in relation to the bo... more The World Health Organization (WHO) defines nutrition as the intake of food in relation to the body's dietary needs: however, if the body's nutritional needs are not met, either overnourishment or undernourishment/malnutrition develops. 6 Malnutrition is defined as a body mass index (BMI) of <18.5 kg/m 2 , or unintentional weight loss (mandatory) with an associated reduction in BMI or a low-fat free mass index (FFMI). Weight loss can be defined as either >10% of habitual weight loss over an indefinite period or >5% over 3 months. 7 An all-encompassing IntroductIon While treating patients with traumatic brain injury (TBI), we often face excessive muscle wasting and severe malnutrition, despite adequate caloric supplementation. This malnutrition negatively affects outcomes, yet we do not fully understand its pathophysiology and the factors influencing it.
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Papers by Associate Professor John R Ouma