STEREOTAXIS BRAIN & SPINE HOSPITAL
 
 
 
art
STEREOTACTIC SURGERY-
What is Stereotactic surgery?  It is a method of doing a procedure in brain with very great accuracy(with 0.5mm accuracy) without damaging the brain. Either biopsy, aspiration or lesioning is done. Biopsy of deep seated unoperable brain tumours is done. Aspiration of cystic tumour or haemorrahge is done. Lesioning is done with  radiofrequency lesion generator or even radiation etc.; which is useful in functional neurosurgery. Various functions of brain can be altered by making lesion in appropiate site(target). Target is selected on CTScan or MRI of the patient.
Procedure : In this procedure, with the help of CT scan or MRI , the centre is located, calculated by computer and target is reached there with the help of Stereotactic frame. So it is called CT / MRI guided computer assisted functional stereotactic neurosurgery.
This operation is done with the help of CT scan or MRI of patient’s brain with precision upto 0.5 mm.It is not necessary to open the Skull. So there neither  any risk of anaesthesia , infection ,nor any problem arises like paralysis, speech disturbances or damage to any other brain centres. Before starting operation , target is checked on phantom model and if it is correct , then operation is done on patient. Operation can be done with the help of radio frequency machine and the latest frame within 2 to 3 hours, without risk  and successfully and with 1 to 3 days hospital stay . Without frame such operation will be 6 to 8 hours, along with risks and a week’s hospital stay.
The mental diseases which are not cured by medicine, surgery is an option and it is called psychosurgery. Such operations normalize brain function, so they are called Functional Neurosurgery .Generally psychiatric patients are treated by medicine, psycho-therapy, Electro convulsive therapy  etc. But if the patient is not cured by these, then neurosurgeon tries to control the disease by operating on their causative centres.
                       
Indications : Stereotactic surgery is useful in biopsy of brain tumour , to remove brain haemorrhage, abscess, aspirate cyst etc. It is also useful in chronic mental disorders like schizophrenia, aggressive behaviour, wandering tendency , obsessive compulsion ,    Depression, anxiety, addiction of drug, alcohol, tobacco etc, as well as in movement disorders such as parkinsonism, tremors, cerebral Palsy, spasticity or unusal movements of limbs, body. The unbearable pain of cancer or chronic pain, uncontrolled epilepsy can be controlled by this surgery.

 
            Brain tumour : If surgery is not possible due to tumour’s location in the centre or vital area of brain, its biopsy can be taken precisely through this machine. So the doctor can decide whether to operate  further or to give radiation. The type of tumour can be decided by biopsy and doctor can predict the outcome ( prognosis ). Cystic brain tumour or abscess can be aspirated by stereotaxis and the major surgery is avoided, if there is brain haemorrhage due to head injury or high blood pressure, and the patient becomes unconscious or victim of paralysis, then surgery becomes essential. Haemorrhage can be aspirated from eloquent areas by frame and the patient starts to improve and it is non risky. The patient regains consciousness faster and can be relieved from paralysis faster.
             
         Mental Disorders : 
           Schizophrenia : In this disorder the patient becomes mischievous fights with others. He may be  violent, destructive. If such patients are uncontrollable, then they are admitted to mental hospital. Sometimes medicine, injection or electric current therapy may not be effective for such patients, and they are kept in mental hospital. When such cases are operated by Stereotaxis ( Targets : Amygdala, Basofrontal,  Cingulotomy ) it gives good results. Schizophrenic patient becomes calm and controllable.
  • Wandering tendency : Patients with wandering tendency, hyperkinetic children who are restless & cannot concentrate on work; are operated by stereotaxis(Amygdalotomy) to calm down or slow down the patients.
  • Obsession (OCD): Such patients either thinks repeatedly or does any activity repeatedly  eg: washing hands, continuous eating, sweeping or rearranging drawers or other items. He is not satisfied by what he does. Such patients cannot progress in any work. If there is no relief by medicine, psychotherapy or ECT, then stereotaxis surgery(Cingulotomy) can be done. So repeated thinking stops. Whatever he is told, he accepts or understands. He is satisfied with his thoughts and work. It gives better results and success is upto 95%.

       Addiction : Addiction of any thing, especially alcohol is an evil to family & society. It damages patient, his family and society. Person addicted of alcohol, cigarette, tobacco, narcotic drugs (morphine, pethidine etc.),  suffers from      physical, mental and economical problems. If patient gets operated by stereotaxis ( cingulotomy ), then his addiction is removed, it gives better and long lasting results.
 
·         Parkinsonism : Tremors or stiffness of upper  limbs or slowness is       seen in parkinsonism. So the patient cannot eat, drink, write or do  any work . If patient is operated on one side disease progression on other side is slowed down. Operation is done if medicines are not tolerated. By stereotaxis the centre of brain (Thalamus, Globus pallidum or Substantia nigra ) for this disorder is operated and the patients are relieved of their symptoms. DBS (Deep Brain Stimulator) stimulate centres of brain and can also control patient’s symptoms. DBS operation is complicated & difficult to handle post-operatively.

·         Cerebral Palsy : Children suffering from this disorder have stiff limbs, so they cannot sit or move or do work. But if they undergo this    surgery, limbs are loose and they can walk or sit and work independently. Bilateral lumbar spine nerve are treated  with RFLG , for Selective rhizotomy under IITV guidance. This will relieve only spasticity of lower limbs and upper limbs. Postoperative physiotherapy and electric stimulation greatly helps in regaining normal power of limbs and activity. Spasticity due to any cause like cerebral palsy, post stroke, post trauma ( head injury, spine injury ),   degenerative ( brain, spine ) demyelination or infection, is relieved with unilateral or bilateral selective lumbar spinal rhizotomy with RFTC.


Thus in disorders like brain tumour, haemorrhage, abscess, or movement disorders like parkinsonism, chorea etc. Stereotaxis surgery gives better results. Epilepsy, cancer or any chronic pain can be relieved. Chronic, uncontrollable psychiatric disorder like Schizophrenia, anxiety, depression, obsession, drug addiction etc if not cured by medicine, this surgery is beneficial. So psychosurgery and functional surgery are useful in intractable diseases. It is less risky and effective solution. Due to this , a useful person  rehabilitates in society and family.


     Trigeminal Neuralgia : In this disease there is acute pain of nerve on one side of face. This pain is due to trigeminal nerve. When trigeminal nerve comes in contact with blood vessel, which presses on it, then pain occurs. There is intolerable pain in one or more area of one side of face either forehead, cheek or chin. So there is short circuit of sensory nerve, it aches like an electric current. It occurs after the age of 50, but sometimes it occurs at younger age. There are trigger points of this pain, where a simple touch or pressure gives similar recurrence of pain.  It occurs with any activity like washing face, eating or drinking any type of food, shaving, brushing or with blow of wind. Hence the patient becomes helpless to do all this activities. Such patients have unshaven face, foul odor from mouth, unable to speak and weak body. The medicine i.e. carbamezapine, is effective. Dosage of this medicine can start from 1 or 2 tablets of 100 mg and increase or reduce as per necessity. If pain is controlled then it is confirmed as trigeminal neuralgia. But gradually the dose increases. Sometime pain may be completely relieved, then medicine can be withdrawn. If the dose reaches to 1600 to2000 mg, pain is not relieved, patient feels giddiness, lethargy or skin reaction, then it is better to change
the medicine. Trials of 2 or 3 medicine can be taken, and if not cured then patient consults neurosurgeon.

·         Radio Frequency Thermocoagulation  ( RFTC ):     With the help of X-Ray or IITV and stimulation, nerve is localized by electrode (needle) the patient is given anaesthesia for 5 to 10 minutes, nerve is lesioned by Radio Frequency Lesion Generator machine (RFLG). 80 %  patients can get relief  for 8 years, 10% patients get relief for 10 years, more or life long from pain by this therapy. The face is not numbed, medicines are withdrawn and is non risky. Patient can be discharged within 6 hours. This surgery can be done at any age ( 20 to 95 years ) gives best results and cost is half to one third of other procedures. Dr Sheth has operated 180 such cases and all are relieved from medicine and pain totally(98%). So in trigeminal neuralgia after medicine, treatment like RFLG gives relief to patient from pain and medicine and one can eat, drink and live happily.

Routine Neurosurgical Operations-

Brain - Congenital- Hydrocephalus, Encephalocoele, Craniostenosis etc.

Traumatic- Head Injuries (all types- including medicolegal, accident ).

Inflammatory  - Tuberculoma, Cysticercosis etc.

Neoplastic - Brain Tumours.

Vascular - Aneurysms, AVM, Brain haemorrhages, Infarct etc.

Spine - Congenital - Meningocoele, all types of spinal dysraphism.

Traumatic - Spinal injury - Cervical, Dorsal, Lumbar.

Inflammatory - TB(Koch's Spine) etc.

Neoplastic - Spinal Tumours (Spinal, ED, ID, SD, IM).

Vascular - Spinal AVM etc. 

·here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.
·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.·         ·         ·         ·         ere.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.
Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.

Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.

Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.Content will come here.