IRANIAN JOURNAL OF NEUROSURGERY
Year:2019 | Volume:5 | Issue:1 (16)|Papers Count:6

Background and Aim: A comparative study of the effectiveness and safety of Traditional Pterional Surgery (TPS) and Endoscopic Endonasal Transsphenoidal Surgery (EETS) for the resection of Tuberculum Sellae Meningioma (TSM) using visual resection and Gross Total Resection (GTR) as the outcome measures. Methods and Materials/Patients: A PUBMED and MEDLINE (2002-2014) search was performed to identify case series for TSM resected by TPS and EETS. The visual outcome, extent of resection and surgical complications were analyzed to evaluate the efficacy of the procedures. Statistical analyses were performed for the categorical and continuous variables using the Chi-square test, t-test and Fisher’ s exact test, as befitting. Results: The literature review revealed 21 studies, which had examined 507 patients overall. A total of 334 patients had undergone TPS and 173 EETS. EETS had achieved a higher rate of visual improvement (P=0. 0106) and lower rate of visual worsening (P<0. 0001) and a lower rate of GTR (P=0. 0080). Even if Cerebrospinal Fluid (CSF) leak was higher in EETS, there were no significant differences with TPS (25% vs. 6%, P=0. 6038). Surgical complications were reported more frequently in TPS, even though there were no significant differences between the two procedures, except in terms of the mortality rate (6% vs. 2%, P=0. 0486). Conclusion: The literature review showed that EETS for the resection of TSM results in a higher rate of visual improvement, lower rate of visual worsening and lower rate of GTR as well as a higher rate of CSF leak despite the lack of significant differences compared to TPS. EETS appears to be safe and effective for TSM resection compared to pterional surgery.

Background and Aim: Spinal Cord Injury (SCI) is one of the main causes of severe disability and mortality following trauma. Complications and outcomes of patients with spine trauma, especially those who undergo surgery, are a less divulged topic in Iran. Therefore, we designed the present study to evaluate complications and outcomes of patients with traumatic spine in Poursina Hospital of Rasht. Methods and Materials/Patients: In the present cross-sectional study, we referred to registry of spinal cord injuries of Poursina Hospital, which is a referral center for trauma in Rasht in the north of Iran. We investigated records of all the patients with traumatic spine confirmed by Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) during 2016-2018. Demographic data, types of SCI, types of surgical interventions, time from injury to surgery, number of fixed and fused vertebrae, complications, and outcome (based on Glasgow Outcome Scale (GOS) criteria) of the patients were evaluated upon discharge. Results: In total, records of 274 patients with spine trauma were reviewed. The Mean± SD of age of the patients was 42. 27± 16. 83 years. There were 76 women (27. 7%) and 198 males (72. 3%). Surgical interventions were done for 148 patients (54%). The median of time of surgical interventions for displacement of the vertebrae and the median of time for removal of pressure from spinal cord in the patients were 5 hours (range =82 hours). Median of duration of hospital stay was 2 days (range =167 days). 2. 2% of the patients experienced complications. 85% of the patients showed good recovery according to GOS. Conclusion: The evidence from the present study indicates that approximately half of the patients with spine trauma underwent operation. Good recovery was seen in roughly four fifth of all of the patients with spine trauma. Most of the patients had no complications during their stay in the hospital.

Background and Aim: Hydrocephalus is a common complication of intraventricular brain tumors. The present study was conducted to determine demographic and clinical features and type of hydrocephalus in patients with intraventricular brain tumors before and after surgical interventions. Methods and Materials/Patients: The present cross-sectional study was conducted on 102 patients with intraventricular brain tumors as candidates for tumor surgeries. The presence of hydrocephalus before and after the surgery, External Ventricular Drainage (EVD) insertion and other characteristics such as the tumorlocation, location, pathology, demographic characteristics of the patients, and the management of hydrocephalus were analyzed. Results: Hydrocephalus was observed in 81 (79. 4%) out of the 102 patients before undergoing the surgery and in 41 (59. 8%) after the surgery. No significant differences were observed among the patients in terms of the tumor pathology location and demographic characteristics. Although hydrocephalus was not significantly different among the patients by individual characteristics, the tumor location and pathology, the incidence of hydrocephalus was significantly different between before and after the surgery based on features such as colloid cyst, medulloblastoma and ependymoma as well as the tumor location. Conclusion: The present findings suggested features such as the tumor pathology and location affected the subsequent hydrocephalic survival both before and after the operation. In case these findings are confirmed, they can help predict the therapeutic measures required for preventing and treating postoperative hydrocephalus, including ventriculoperitoneal shunt and EVD insertion.

Background and Aim: The aim of this study was to assess the pre-hospital emergency services, non-surgical interventions, and clinical outcomes in patients with traumatic spine referred to Poursina hospital in Guilan. Methods and Materials/Patients: Spine trauma registry of Poursina hospital of Rasht were used. Records of patients with traumatic spine were reviewed for pre-hospital emergency services, nonsurgical interventions, and clinical outcomes during 2015 to 2019. Results: 197 patients with traumatic spine were reviewed. 80. 2% of the patients were transferred by ambulance. Pre-hospital fixation was performed in 59. 4% of the patients (n=117). Pre-hospital intubation was required in 1% of patients (n=2). 4. 6% of the patients had Glasgow Comma Scale (GCS) <9; 3% of them (n=6) had 9< GCS<12; and 92. 4% had GCS≥ 13. 11. 7% of the patients experienced SCI. 6. 1%, 1%, 3%, 0. 5%, and 1% of the patients suffered from paraplegia, paraparesis, quadriplegia, quadriparesis, hemiparesis, respectively. Surgery was performed in 89. 8% of the patients. Traction was performed for 3. 6% of the patients. Good recovery, moderate disabilities, severe disabilities, persistent vegetative state, and death were found in 85. 8%, 2%, 5. 1%, 1. 5%, and 2. 5% of the patients, respectively, according to Glasgow Outcome Scale. Conclusion: Most of the patients were transferred to the hospital by ambulance. Pre-hospital fixation was required in more than half of the patients. Most of the patients showed GCS≥ 13 and a good recovery outcome, according to GCS.

Background and Importance: Hangman’ s fracture concomitant with atlantoaxial subluxation is a rare phenomenon. Herein, we reported the victim of a motor vehicle crash with traumatic spondylolisthesis of the axis and atlantoaxial rotary dislocation. Case Presentation: The patient was a 32-year-old female with the chief complaint of severe neck pain. Her neurologic examination was normal, but did reveal mild torticollis. Imaging revealed anterolisthesis of the C2 over C3 with angulation of C1/ C2 and rupture of the C2/ C3 disc, while the integrity of the transverse ligament was preserved. The patient first underwent a partial close reduction for the dislocation followed by the operation focusing on the Hangman’ s fracture using a 360-degree approach. An anterior discectomy of C2/ C3 with cage and plate insertion was followed by posterior fixation using C1, C3 and C4 lateral mass screws. The one-year follow-up radiography depicted proper fusion and alignment. Conclusion: Paucity of evidence regarding simultaneous atlantoaxial dislocation and Hangman’ s fracture made its management challenging. The mechanism of injury is probably hyperextension and rotation. Based on our presented case, anteroposterior fixation resulted in a satisfactory longterm outcome, both clinically and radiologically.

Background and Importance: Primary Central Nervous System Lymphoma (PCNSL) is a rare cancer confined to the brain, spinal cord, leptomeninges, and eyes. The origin of this type of lymphoma is often type B lymphocytes, and because the Central Nervous System (CNS) has no lymph nodes or lymphatic vessels, the cause of PCNSL is still unclear. But its source appears to be from lymphocytes located in the CNS. This type of lymphoma has been reported in the context of congenital or acquired immune deficiency such as Wiskott Aldrich syndrome, kidney transplantation, and, in particular, AIDS. Frontal lobes are the most common sites of involvement in CNS. Case Presentation: The patient was a 55-year-old man who had been referred to the Emergency Department of Al-Zahra Hospital, Isfahan, Iran due to recurrent headaches, nausea, and vomiting since 6 months ago. Conclusion: Meningiomas are often benign and slowly growing tumors that originate from the arachnoid cap cell of meninges. Due to the rarity of concomitance of primary cerebral lymphoma and meningioma, there is no possibility of epidemiological studies in these patients.