The Iranian Journal of Neurosurgery最新文献

{"title":"Analysis of Nonvestibular Cranial Nerve Schwannomas","authors":"Binoy Damodar Thavara, Rajeev Mandaka Parambil, Pavithran Vadakkam Muriyil, Vishal Mangla, Byjo Valiyaveetil Jose, Prem kumar Sasi","doi":"10.32598/irjns.9.16","DOIUrl":"https://doi.org/10.32598/irjns.9.16","url":null,"abstract":"Background and Aim: Cranial nerve (CN) schwannomas other than the eighth nerve schwannoma are called nonvestibular cranial nerve schwannomas (NVCNS). This study aims to analyze the clinical profile, distribution, and surgical outcome of the NVCNS. Methods and Materials/Patients: This is a retrospective study analyzing the NVCNS conducted between January 2007 and December 2021. VIIIth cranial nerve schwannomas and conservatively managed NVCNS were excluded from the study. Results: This study included 25 patients with NVCNS. Ten patients (40%) had trigeminal schwannomas, 3(12%) facial nerve schwannomas, 9 (36%) lower cranial nerve (LCN) schwannomas, 1 (4%) vagal schwannoma in neck and 2(8%) hypoglossal schwannomas. Eight patients (32%) were male and 17(68%) were female. The age of the patients ranges from 13 to 62 years (mean 39 years +/- 14 SD). Findings of cerebellar involvement, VIIIth CN involvement, and headache are the most common clinical features. The posterior cranial fossa is the most common location of the tumors. Thirteen patients (52%) underwent gross total resection (GTR), 7(28%) underwent neartotal resection (NTR) and 5(20%) underwent subtotal resection (STR). All the patients improved in the postoperative period. Facial nerve palsy is the most common cranial nerve palsy occurring in the postoperative period. Conclusion: Trigeminal and lower cranial nerve (LCN) schwannomas are the most common NVCNS. The retrosigmoid suboccipital approach is the most commonly used surgical approach for tumors located in the posterior cranial fossa. Since NVCNS are benign lesions, postoperative clinical improvement along with decreased complications should be the goal of the surgery. Hence, gross total resection is the most commonly achieved extent of resection, near-total or subtotal resection can be done wherever gross total resection (GTR) is not possible in NVCNS.","PeriodicalId":143032,"journal":{"name":"The Iranian Journal of Neurosurgery","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125570871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microlumbar Discectomy vs Minimally Invasive Tubular Microdiscectomy: A Prospective Comparative Analysis","authors":"R. Chandran, Arun Sathyababu, Sharmad Mohammed Haneefa, R. Prabhakar","doi":"10.32598/irjns.9.18","DOIUrl":"https://doi.org/10.32598/irjns.9.18","url":null,"abstract":"Background and Aim: Lumbar disc prolapse is a common cause of backache and radicular symptoms in lower limbs. Different surgical options have been described to compare the functional outcome, complications, and recurrence following surgery for lumbar disc prolapse by classical microlumbar discectomy (MLD) and minimally invasive tubular microdiscectomy. The advantages of one procedure over the other were also analyzed. Methods and Materials/Patients: A prospective, observational study conducted over a period of 1 year in the Department of Neurosurgery, Government Medical College Thiruvananthapuram, among patients who underwent surgical treatment for lumbar disc herniation by either microlumbar discectomy or minimally invasive surgery using a tubular retractor system. Ninety-nine patients who satisfied the inclusion and exclusion criteria were analyzed and tabulated for the outcome. Results: The two groups did not show a statistical difference in terms of functional outcome, complications, or recurrence rate. However, the need for post-operative analgesics, blood loss, and hence hospitalization was less in the tubular discectomy group. Conclusion: Both procedures are equally effective in terms of surgical results. However, the advantages and the subtle tendency of the patients to adopt “keyhole” make the tube an attractive option.","PeriodicalId":143032,"journal":{"name":"The Iranian Journal of Neurosurgery","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121968652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gigantic Exteriorized Frontal Meningioma: An Exceptional Clinical Entity","authors":"D. S. Zabsonre, Inoussa Zoungrana, Julie Marie Adeline Wendlamita Kyelem, A. Sanou, Yakouba Haro, Souleymane Ouattara, A. Traore, A. Kabre","doi":"10.32598/irjns.9.11","DOIUrl":"https://doi.org/10.32598/irjns.9.11","url":null,"abstract":"Background and Importance: Meningiomas are usually benign tumors. Depending on their location and size, dealing with them can be problematic. We report an exceptional case of gigantic frontal meningioma. Its diagnosis was misleading and the excision laborious. Case Presentation: A 29-year-old patient who presented gradually over 5 years, developed behavioral disorders then swelling of the vertex at the frontal level and decreased visual acuity. Physical examination on admission revealed a median frontal swelling slightly lateralized to the left axis of approximately 10 cm, hard, covered with the healthy, severe frontal syndrome, and decreased visual acuity. Computerized tomography (CT) scan showed a voluminous medial frontal lesion lateralized to the left, with irregular limits, superior sagittal sinus invasion, brain engagement under the scythe, heterogeneous contrast taking, and significant osteolysis first evoking tumor metastasis. Magnetic resonance imaging (MRI) suggested a meningioma. The resection was macroscopically complete. Dural and cranial plasty was performed. The postoperative follow-up was simple. Histology concluded that the meningioma was grade 1 based on the world health organization (WHO) classification. Conclusion: Late-diagnosis meningiomas can take on very large proportions and pose management problems while seriously engaging the patient functional and vital prognosis.","PeriodicalId":143032,"journal":{"name":"The Iranian Journal of Neurosurgery","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128163429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Hydroalcoholic Extract of Salep on Pentylenetetrazole-Induced Seizure in Adult Male Rats","authors":"Hossein Kargar Jahromi, Arman Khorram, Shekofeh Atashpoor, Maryam Jalali, Zahra Kargar Jahromi, F. Mohammadi, Mohammad Amin Serpoosh, N. Sadeghi","doi":"10.32598/irjns.9.1","DOIUrl":"https://doi.org/10.32598/irjns.9.1","url":null,"abstract":"Background and Aim: Epilepsy as a neurological disorder is characterized by unpredictable and periodic seizures. In the present study, the anticonvulsant effect of different doses of salep hydroalcoholic extract on pentylenetetrazole (PTZ) induced seizures was investigated. Methods and Materials/Patients: The animal model of seizure was established by the intraperitoneal injection of pentylenetetrazole (PTZ- 85 mg/kg). Hydroalcoholic extract of salep was administered to the animals in 3 doses (80, 160, and 320 mg/kg). The parameters of the onset and duration of tonic-clonic seizure, total seizure time, balance (falling), and jumping during seizure mortality rate were measured. The results were analyzed by ANOVA test at a significant level of p≤0.05. Results: The results of the current study indicated that salep extract increased the delay in the onset of seizure in the PTZ + extract group in comparison with the PTZ group. The duration of tonic-clonic seizure and the number of falling, jumping, and total seizure times were significantly decreased by salep extract compared to the PTZ group. In the seizure + salep extract, the number and percentage of 24-hour mortality among animals decreased with increasing dosage. All changes were dose-dependent and 320 mg/kg showed the most effect. Conclusion: Extract of salep can probably have anticonvulsant properties, however, further studies are needed to clarify the exact mechanisms.","PeriodicalId":143032,"journal":{"name":"The Iranian Journal of Neurosurgery","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132837688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Launching the DCER (Distraction, Compression, Extension, and Reduction) Technique in Basilar Invagination and Atlantoaxial Dislocation: A Preliminary Report of Two Cases in Iran","authors":"S. M. Mousavi, Alireza Liaghat, Mohammadhadi Amir Shahpari Motlagh, M. Pishjoo, Amir Tarokh, M. Farrokhi","doi":"10.32598/irjns.9.2","DOIUrl":"https://doi.org/10.32598/irjns.9.2","url":null,"abstract":"Background and Importance: Developmental craniovertebral junction (CVJ) anomalies are often comprised of irreducible atlantoaxial dislocation (AAD) and basilar invagination (BI) associated with the fusion of the C1 arch. BI is described as a congenital upward displacement of mostly the odontoid process into the foramen magnum, which AAD can accompany. The DCER (Distraction, Compression, Extension, and Reduction) consists of decompression of craniocervical junction, BI reduction followed by occipitocervical fusion in anatomic lordotic curvature –performing extension and compression. This technique has recently been applied in patients with BI and AAD, demonstrating satisfactory results. Case Presentation: Herein, we report two cases of BI with AAD who underwent surgery with the DCER technique for the first time in our center. Conclusion: BI has been managed with combined approach (anterior odontoid resection followed by posterior craniocervical fusion). Since last decade, single posterior approaches has been utilized to reduce and stabilize BI and AAD. DCER approach is the most recent and successful procedure.","PeriodicalId":143032,"journal":{"name":"The Iranian Journal of Neurosurgery","volume":"272 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115901981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Principles of Neuronavigation","authors":"A. Seddighi, A. Seddighi, Mahsa Ghadirian, A. Zali, D. Ommi, Seyed Mahmoud Tabatabaei Far, Hamidreza Azizi Faresani, Nooshin Masoudian","doi":"10.32598/irjns.specialissue.3","DOIUrl":"https://doi.org/10.32598/irjns.specialissue.3","url":null,"abstract":"Background and Aim: Numerous efforts have been made over the past century. Various innovation techniques are increasingly gaining attention and gradually establishing the foundation of recent significant developments in the world of neurosurgery, among which varied stereotactic neuro-navigation designs and other novel emerging systems are being developed every day. This narrative review aims to describe basic concepts in frameless stereotaxy and summarize the primary principles of neuronavigation and clarify basic characteristics, such as the accuracy of this technique (frameless navigation), and emphasize the importance of designing phantom. Methods and Materials/Patients: The application of brain images to steer the surgeon to a target in the brain by utilizing the stereotactic principle of co-registration of the patient with an imaging study that permits brain surgery to be fulfilled with greater safety and smaller incisions by providing precise surgical guidance of the location of intracranial pathology is highly noticeable. General uses of frameless stereotaxy are explained and common benefits are highlighted. It is genuinely inevitable to estimate the accuracy of these systems and discover sources of error. Results: The findings have provided considerable insight into recent findings on principles of frameless stereotactic surgery and novel developments for image-guidance systems. Conclusion: The unprecedented development of image guidance has been much discussed. As a concluding note, several determinants, including updated imaging/registration, ease of use, robotic instruments, automated registration of increased accuracy, and the program’s potential for expansion to other disciplines, are all under development for image guidance.","PeriodicalId":143032,"journal":{"name":"The Iranian Journal of Neurosurgery","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128772611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of 5-ALA Fluorescence-guided Resection in Patients Suffering From High-grade Gliomas: A Report of 30 Consecutive Cases and a Literature Review","authors":"Mohammad Mirahmadi Eraghi, S. Javadi, Martin Mortazavi, Seyed Morsal Mosallami Aghili, Seyed Khalil Pestei","doi":"10.32598/irjns.specialissue.6","DOIUrl":"https://doi.org/10.32598/irjns.specialissue.6","url":null,"abstract":"Background and Aim: The extent of resection seems a solid prognostic factor in patients with high-grade gliomas (HGGs). When administered orally, 5-aminolevulinic acid (5-ALA) is exclusively converted into protoporphyrin IX (PPIX) by malignant cells and detects, identifying contrast-enhancing glial lesions under 400 nm blue light. The authors thoroughly assess the efficacy, accuracy, and safety profile of 5-ALA-guided surgery toward the maximal resection of cranial HGGs. Case Presentation: Thirty consecutive patients with HGG adjacent to the corticospinal tract (CST) met our inclusion criteria in a single-arm retrospective study. Bilateral diffusion tensor imaging (DTI)-derived corticospinal tract (CST) tractography was employed using a 1.5 Tesla magnetic resonance imaging (MRI). Oral 5-ALA was ingested with a dose of 20 mg/kg 4 hours prior to operation and was applied to qualify the margins of the local resection cavity. The clinical and volumetric assessments were postoperatively conducted. The mean preoperative tumor volume on T1 contrast-enhanced MRI and fluid-attenuated inversion recovery (FLAIR) images was 16.8 cm3 and 47.6 cm3, respectively. Complete resection of contrast-enhanced lesions was yielded in 27 of 30 patients (90%). All patients improved postoperatively regarding motor deficits and or seizures. No new permanent neurological deficits were detected in the 3-month follow-up. Conclusion: Fluorescence image-guided surgery (FIGS) using 5-ALA increases the extent of resection (EOR) with further surgical risks in eloquent regions when combined with multimodality visualization- functional mapping. It also provides pathological insights to visualize cranial HGGs and identify infiltration of functional fiber tracts.","PeriodicalId":143032,"journal":{"name":"The Iranian Journal of Neurosurgery","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117354760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Benefits and Implementation of Diffusion Tensor Imaging and Neural Fiber Tractography in Brain Surgery","authors":"A. Seddighi, A. Seddighi, Mahsa Ghadirian, A. Zali, D. Ommi, Seyed Mahmoud Tabatabaei Far, Hamidreza Azizi Faresani, Nooshin Masoudian","doi":"10.32598/irjns.specialissue.5","DOIUrl":"https://doi.org/10.32598/irjns.specialissue.5","url":null,"abstract":"Background and Aim: The methods to detect brain activation with functional MRI (fMRI), and MRI provide a way to measure the anatomical connections which enable lightning-fast communication among neurons that specialize in different kinds of brain functions. Diffusion tensor imaging (DTI) can measure the direction of bundles of the axonal fibers which are all aligned. Besides mapping white matter fiber tracts, these methods can enable us to detect and characterize white matter disorders in diseases. The objective of this narrative review is to overview current knowledge concerning DTI as one of the prominent popular MRI techniques that provide a planned tool for comprehensive, noninvasive, functional anatomy mapping of the human brain in both research and practical field. This review summarizes the DTI development in recent years concerning the specificity and utility of this technique in brain surgery. Methods and Materials/Patients: The significance of mapping the structure of white matter tracts, constructively the brain’s wiring by visualization and characterization of white matter fasciculi in two and three dimensions enables us to profound how different brain regions are connected and how diseases affect white matter and cause neurological problems. And we noted that while DTI proposes a potent tool to study and visualize white matter, it suffers from inherent artifacts and limitations. Additionally, some materials about the origin of the DTI signal and unique information on white matter and 3D visualization of neuronal tracts have been raised. Results: This article focuses on DTI modality and its computational techniques, and investigates significant considerations in this regard. Moreover, an inspection of the white matter structure and integrity of normal and diseased brains (e.g. multiple sclerosis, stroke, aging, dementia, schizophrenia, etc.) have been raised as a clinical application of tractography. Conclusion: The utilization of advances in diffusion-tensor (DT) imaging techniques considerably enables us to map the white matter tractography (WMT) in the normal brain. These techniques impress the operative decision in a surgical operation, especially concerning cerebral neoplasms. Also, it is possible to judge with the assistance of DTI in each subject.","PeriodicalId":143032,"journal":{"name":"The Iranian Journal of Neurosurgery","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116238264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Deployment of Web Application Using Machine Learning for Predicting Intraoperative Transfusions in Neurosurgical Operations","authors":"Thara Tunthanathip, Sakchai Sae-heng, T. Oearsakul, Anukoon Kaewborisutsakul, Chin Taweesomboonyat","doi":"10.32598/irjns.8.24","DOIUrl":"https://doi.org/10.32598/irjns.8.24","url":null,"abstract":"Background and Aim: Preoperative blood product preparation is a common practice in neurosurgical patients. However, over-requesting of blood is common and leads to the wastage of blood bank resources. Machine learning (ML) is currently one of the novel computational data analysis methods for assisting neurosurgeons in their decision-making process. The objective of the present study was to use machine learning to predict intraoperative packed red cell transfusion. Additionally, a secondary objective focused on estimating the effectiveness of blood utilization in neurosurgical operations. Methods and Materials/Patients: This was a retrospective cohort study of 3,021 patients who had previously undergone neurosurgical operations. Data from the total cohort were randomly divided into a training dataset (N=2115) and a testing dataset (N=906). The supervised ML models of various algorithms were trained and tested with test data using both classification and regression algorithms. Results: Almost all neurosurgical conditions had a cross-match to transfusion ratio of more than 2.5. Support vector machine (SVM) with linear kernel, SVM radial kernel, and random forest (RF) classification had a performance with good AUC of 0.83,0.82, and 0.82, respectively, while RF regression had the lowest root mean squared error and mean absolute error. Conclusion: In almost all neurosurgical surgeries, preoperative overpreparation of blood products was detected. The ML algorithm was proposed as a high-performance method for optimizing blood preparation and intraoperative consumption. Furthermore, ML has the potential to be incorporated into clinical practice as a calculator for the optimal cross-match to transfusion ratio.","PeriodicalId":143032,"journal":{"name":"The Iranian Journal of Neurosurgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130423585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decompressive Cranioplasty Using Titanium Mesh in a Patient with Osteopetrosis: Case-based Reviews","authors":"C. Demirel, V. Köksal","doi":"10.32598/irjns.8.23","DOIUrl":"https://doi.org/10.32598/irjns.8.23","url":null,"abstract":"Background and Importance: Osteopetrosis is an inherited disease that causes the thickening of the cranial bone. The need for both cerebral decompression and intracranial volume-enlarging cranioplasty in the same surgical session in a patient suffering from rising intracranial pressure is critical and a very rare decision in neurosurgical practice. The only indication that can lead to this surgery is osteopetrosis. Case Presentation: A 24-year-old female patient with osteopetrosis was admitted with the complaint of severe headache that did not respond to medical treatment, and surgery was decided. After decompressive craniectomy was performed with difficulties, cranioplasty with titanium mesh was performed in the same session to protect the cerebral tissue, close the defect area, and give more space to the cerebral tissue. It was observed that the complaints of increased intracranial pressure were completely resolved in the early postoperative period and the one-year clinical follow-up. The surgical intervention technique and the radiological findings obtained during the follow-up are presented. Conclusion: Performing cranioplasty with titanium mesh, which is used to protect and save cerebral tissue in patients with osteopetrosis, seems the most appropriate choice.","PeriodicalId":143032,"journal":{"name":"The Iranian Journal of Neurosurgery","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130940583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}