IRANIAN JOURNAL OF NEUROSURGERY
Year:2020 | Volume:6 | Issue:4 (23)|Papers Count:8

Background and Aim: Neurofibromatosis-1(NF-1) is a common genetic condition in children. It is becoming increasingly recognized that in neurofibromatosis, there might be anomalous development of bone with or without any local anomaly of neuro-ectodermal basis. This review was conducted to highlight the different features of spinal disorders in this congenital disease. Methods and Materials: Different search engines were used in this research. After going through the results and discarding the repeated ones, 2 reviewers began to inspect the studies independent of one another. Should any disagreements take place over the inclusion of certain research material into the study, the final decision would belong to the senior writer. In the end, accepted research materials were used as needed in categorizing different types of spinal injuries. Results: Skeletal defects are among the most impactful complications on the quality of life of patients. Bone deformities, osteoporosis, osteopenia, a reduction of bone mass density, and spinal osteopathy such as scoliosis count among such defects. Although the relative prevalence of spinal defects in neurofibromatosis type 1 is not clear, scoliosis can be considered the most common type of spinal deformity in this illness to the point it is present in 10 to 71% of cases. So, spine surgeons may involve numerous public challenging conditions in NF-1 patients like scoliosis, spondylolisthesis, and dural ectasia. Conclusion: Thus, Because NF-1 distresses several organ systems, radiologic spine screening is important in patients with NF-1 and patients are likely to profit most from a multidisciplinary treatment policy.

Background and Importance: The rare intracranial neoplasms are Choroid Plexus Papillomas (CPPs), especially in the cerebellopontine angle. The main location of Choroid Plexus Papillomas in adults and children are 4th ventricle and lateral ventricles, respectively. Case Presentation: We report on a little girl with a cerebellopontine angle CPP who presented with symptoms of torticollis. Assessment of Magnetic Resonance Imaging showed a mass in the right cerebellopontine angle, just next to the brain stem. The tumor was completely resected using the right retrosigmoid approach method. Conclusion: A pathological examination determine a typical CPP that this being should be considered an extremely rare cause of a lesion in the posterior fossa.

Background and Aim: One of the most prevalent neurosurgery conditions is chronic subdural hematoma (CSDH). Among neurosurgeons, there are various CSDH treatment approaches. Methods and Materials: This narrative review was performed on various aspects of the CSDH using related articles extracted from different databases. Results: CSDH may present with various clinical presentations. Medical symptoms range from general and moderate symptoms (such as headache, tiredness) to severe symptoms (eg. hemiparesis, coma). A definite trauma history may be obtained in most cases. Contrast-enhanced CT or MRI may help diagnosis. The treatment choice for uncomplicated CSDH is Burr-hole therapy. The use of drainage to decrease recurrence rates has been shown to have limited outcomes in most recent studies. Craniotomy is also used for treatment. Only asymptomatic or high operative risk patients are subjected to non-surgical management. Conclusion: Management of CSDH is still contentious. It is widely agreed that if neurological signs and radiological observations are present CSDH should be evacuated. Burr-hole craniotomy appears to be the preferred surgical technique because, in most patients, it gives the best treatment outcomes. Several issues are still uncertain, including the proper surgical technique (Burr-hole craniotomy (BHC) versus Twist drill craniostomy (TDC) and craniotomy), the advantage of two perforated holes over one, the location of drainage, the impact of irrigation of the hematoma, and the duration of postoperative immobilization.

Background and Importance: Subdural empyema is a rare complication of ventriculoperitoneal shunts. The ventriculoperitoneal shunt is a common technique used in the treatment of hydrocephalus. It is often plagued with multiple complications, especially infectious ones. However, the appearance of infectious complications related to ventriculoperitoneal shunt remotely from surgery is rather unusual. Case Presentation: Through this observation, we are reporting an unusual case of chronic bilateral calcified subdural empyema which occurred 8 years after ventriculoperitoneal shunt surgery. The child underwent a bilateral craniotomy in order to evacuate the empyema and meanwhile remove the valve. One month later, the empyema relapsed along with active hydrocephalus. Consequently, the implementation of an external ventricular shunt was performed and the child benefited from adapted antibiotic therapy. After the infection was treated, a second ventriculoperitoneal shunt valve was implemented. Afterwards, the evolution was favorable, the child retained a discrete left hemiparesis as a sequel. Conclusion: This observation is reporting the existence of late morbidity due to the insertion of a ventriculoperitoneal valve; which shows that a regular and prolonged follow-up is necessary in children with a ventriculoperitoneal shunt valve.

Background and Importance: Craniopharyngiomas are tumors made up of mixed components which can present intraventricular cystic portion. This study aimed at evaluating the outcome of the endoscopic marsupialization as a surgical approach. Methods and Materials/Patients: We report 11 cases presenting craniopharyngioma with intraventricular cystic portion inducing hydrocephalus managed at Neurosurgery Unit of Fann Hospital between June 2013 and June 2017. Endoscopic marsupialization was realized for all patients with a rigid neuroendoscope Karl Storz. Results: The mean age of cases was 30. 18 years with a range of 07 to 69 years. There was a male predominance with a sex ratio of 1. 75. All patients were suffering from an intracranial pressure syndrome. Lowering visual acuate including two (02) blindness cases was found in patients under 15 years. Frontal lobe syndrome was found in all patients of more than 50 years. A cerebral CT scan was realized for 9 patients and an MRI for 4 patients. A cystic marsupialization with biopsy was realized by precoronal approach. Fluid looked like « waste oil » for 9 patients. Ventriculocisternostomy of the 3rd ventricle was realized in 2 cases. Progress was favorable with intracranial pressure signs disappearance in 8 cases. We noticed 3 failures with cyst persistence at control CT-Scan. Three patients had a recurrence, requiring revised marsupialization complicated by death in 1 case. Conclusion: Endoscopic marsupialization represents a seductive technique which is easy and reproducible of the therapeutic for intraventricular cystic craniopharyngioma.

Background and Aim: Cerebrovascular brain incidents especially brain aneurysm ruptures are a major cause of death and disability. Monitoring somatosensory evoked potential and corresponding changes is used for identifying cerebral ischemia and helps to predict neuronal injuries during using temporary clips in brain aneurysm surgeries. This approach limits integrated performance evaluation for somatosensory and cortex paths. Methods and Materials: This study was conducted as a clinical trial for candidate patients of anterior cerebral circulation aneurysm surgery during 2017-2018 in Rasul Akram Hospital. Somatosensory evoked potential (SSEP) monitoring was performed related to the median nerve in the contralateral wrist to examine the middle cerebral artery (MCA) and posterior tibialis nerve in the contralateral ankle to examine anterior cerebral artery (ACA) during the surgery procedure. Incentive parameters with a power of 5 to 25 milliampere and corresponding duration of 0. 2 milliseconds and waves with a frequency of 3. 3 Hertz were registered. Before locating temporary clips, SSEP was extracted as a baseline from every patient and then recorded. Results: Totally 9 patients (9 aneurysms) were studied. Three of them were men and 6 patients women. The age of patients ranged from 39 to 78 years old. The clinical status of patients was assessed using the Hunt-HESS scale. Five cases were grade 1, 2 cases classified as grade 2, and 2 cases in grade 3. Among 9 aneurysms, 7 cases were about A. com artery and 2 cases were in connection with MCA artery, having the size of 5 to 11 millimeters. Friedman test was applied to explore average latency change percentage and amplitude change percentage in 1st, 2nd, and 3rd minutes for the first, second, and third clips where results suggested that, was significantly different (P=0. 050). Conclusion: Neuromonitoring can be used as an index for examining tissue perfusion level of the brain and help to prevent accidental ischemic injuries of the brain followed by temporary clipping.

Introduction: Craniotomy is a surgery in which a flap of the skull is opened to access the problem area in the brain. Since paying attention to the aesthetic aspects of the patient's head after surgery is very important for the patient's mental health and social life, surgeons should try to adopt a method that minimizes damage to the scalp and follicles. Methods: In this clinical trial study, patients who were candidates for frontotemporaneopranital craniotomy surgery were selected. 23 selected patients were randomly divided into two groups consisting of a 12-member intervention group (LG Kempe) and an 11-member control group (Standard Reverse Question mark). Patients underwent a preoperative biopsy of the scalp and a follow-up biopsy six months postoperatively. In the evaluation of aesthetic aspects, the created scar was scored using SBSES scoring system. Patients were also directly asked about their satisfaction with the operation and the scar created. Results: In 23 patients, the results showed that patients who underwent LG Kempe incision craniotomy received significantly higher scores in SBSES scoring evaluations (P value = 0. 005, p <0. 05). There was no significant difference in subjective evaluations by asking patients about their satisfaction with the scar site and the operation area (P value = 0. 75, p> 0. 05). In the analysis of post-operative hair follicle density between the two groups (P value = 0. 910, p> 0. 05) general changes in pre-operative and post-operative follicle density in all samples (P value = 0. 657. P> 0. 05) as well as comparing the changes between two groups, no significant difference was found between follicular density changes between the intervention and control groups (P value = 0. 137. p> 0. 05). Conclusion: Patients treated with LG Kempe incision had significantly higher SBSES scores, which can be considered an aesthetically superior method that could prevent the formation of undesirable scar.

Background and Importance: Sacrococcygeal teratoma (SCT) with medular invasion is rare. Case Presentation: We report a case of an 11-months male infant, with no prenatal history of any abnormality, presenting since birth, a mass in the buttock extended to retrorectum associated with a right side hypotonic limb and monoplegia. Medullar and abdominal pelvic magnetic resonance imaging (MRI) showed a sacrococcygeal tissue mass and intradural lombosacral invasion with a high level of alpha-fetoprotein. Surgical performed was done successfully with an uneventful follow-up. Conclusion: Although the intradural invasion, those SCT are in major cases mature and present low risk of malignancy or recurrence.