Iranian Journal of Neurosurgery最新文献

{"title":"The Extra-axial Cerebellopontine Angle Medulloblastoma in an Adult Patient: A Case Report and Review of Literature","authors":"K. Ebrahimzadeh, Mohammad Mirahmadi Eraghi, Hesameddin Hoseini Tavassol, Mohammad Hallajnejad, Omidvar Rezaei mirghaed, Seyed Sina Naghibi Irvani, F. Jahanshahi","doi":"10.32598/irjns.8.32","DOIUrl":"https://doi.org/10.32598/irjns.8.32","url":null,"abstract":"Background and Importance: Medulloblastoma (MB) is regarded as a scarce primary brain neoplasm in adulthood, originating from the fourth ventricle or the cerebellum, and cerebellopontine angle (CPA)-MB has been described less often in the literature. Few cases of CPA MB have been reported in the English-written literature, most of which are intra-axial, mainly in children; adults' extra-axial CPAMB is even scarcer. To the best of the authors’ knowledge, 12 cases of extra-axial CPA MBs have been reported in the English-written literature. Case Presentation: A 23-year-old man presented to our center complaining of a generalized pulsatile headache, imbalance, swallowing impairment, and right-sided hearing loss for the past 20 days. Computed tomography (CT) scan of the brain showed a hyper-dense extra-axial mass lesion (41*37mm) in the right CPA with a significant compression effect on the fourth ventricle, causing a three ventricular obstructive hydrocephalus. Magnetic resonance imaging (MRI) showed a well-defined heterogeneous extra-axial, lobulated, dural-based mass lesion in the right CPA, hypointense on the T1 sequence, and hyperintense on the T2 sequence compared with the adjacent parenchyma, which has a bright heterogeneous enhancement during gadolinium injection. A significant mass effect was observed on the adjacent parenchyma, brain stem, and fourth ventricle without evidence of parenchymal edema. The patient underwent emergent surgery the next day regarding the mass effect and hydrocephalus. On the postoperative examination in the intensive care unit, no new neurological deficit was detected, and the swallowing and gag reflex significantly improved. Conclusion: Though rare, clinical considerations, along with early supportive radiologic measures, should be considered in subjects with suspected MB. A total tumor excision approach followed by aggregative chemotherapy/radiotherapy is designed to hinder tumor relapse.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42576388","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":"Effect of Granulocyte Colony-Stimulating Factor (G-CSF) on Improving Impairment Scale After Acute Spinal Cord Injury: An Individual Participant Data Meta-Analysis","authors":"Seyyed Amir Yasin Ahmadi, Mohammad Javad Nourmohammadi, Ahmed Sayahi, B. Alijani, S. Yousefzadeh-Chabok, J. Rezaian","doi":"10.32598/irjns.8.15","DOIUrl":"https://doi.org/10.32598/irjns.8.15","url":null,"abstract":"Background and Aim: The present study was conducted to investigate the effects of granulocyte colony-stimulating factor (G-CSF) after acute spinal cord injury on increasing a grade of improvement entitled American spinal cord injury association impairment scale (AIS) as an individual participant data (IPD) meta-regression analysis of clinical trials. Methods and Materials/Patients: According to our search strategy, four studies were selected. Multilevel ordered logistic regression modeling was used to predict AIS grade with G-CSF administration and time variable (first day and a 3-month follow-up). The IDs of the studies as well as the time series variable were imported to the random part of the model. Odds ratio (OR) and 95% confidence interval (CI) were reported. Results: A total of 277 samples were studied. A fixed effect model was performed at first. Accordingly, using G-CSF was associated with increased AIS grade (lower impairment) (OR=1.503, 95% CI=1.110-2.035) adjusted with time series (OR=1.868, 95% CI=1.378-2.532). In the mixed effect model, G-CSF was again associated with increased AIS grade (OR=1.780, 95% CI=1.301- 2.436) adjusted with time series (OR=2.152, 95% CI=1.406-3.294). Conclusion: The present meta-analysis showed the protective effect of GCS-F observed as an improvement in AIS grade. This protecting effect was further after adjusting the random effects of time series and individual studies. Although multilevel modeling could reduce our limitations, it should be regarded that the number of trials was not enough to establish strong conclusions.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49085878","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 Effects of Underlying Comorbidities on Surgical Outcome in Patients With Spondylolisthesis Undergoing Surgical Treatment","authors":"Zohair Reihanian, H. Behzadnia, B. Alijani, S. Jafari, S. Yousefzadeh-Chabok, Mostafa Ramezani-Shamami","doi":"10.32598/irjns.8.11","DOIUrl":"https://doi.org/10.32598/irjns.8.11","url":null,"abstract":"Background and Aim: In patients with spondylolisthesis, both conservative and surgical approaches are considered based on the stage of the disease. However, in addition to the technical characteristics of the surgery and the stage of the disease, the underlying characteristics of the patients may also affect the therapeutic prognosis. In this regard, some studies have indicated that the surgical prognosis is worse in diabetic and hypertensive patients and also preoperative medical treatments, such as anticoagulants may be effective in the prognosis of the disease. The aim of this study was to evaluate the role of underlying risk factors, such as diabetes mellitus, hypertension, and anticoagulant conditions (such as aspirin) in worsening outcomes after surgery in patients with spondylolisthesis. Methods and Materials/Patients: This cross-sectional study was conducted on 130 patients suffering from spondylolisthesis and scheduled for surgery. According to baseline characteristics, 65 patients with a history of diabetes mellitus, hypertension, and receiving aspirin were categorized as the case group, and 65 sex- and age matched individuals without such comorbidities as the control group. Preoperative and postoperative radicular pain intensity, wound healing, and discharge from the surgical site were considered the study outcomes. Results: The two groups with and without comorbidities were matched for gender, mean age, mean body mass index, and time of operation. Preoperative pain intensity was similar in the groups, but those with comorbidities experienced higher radicular pain severity postoperatively. We showed no difference in the rate of surgical site discharging, but the lack of wound healing was significantly higher in those with comorbidities. Conclusion: In patients with spondylolisthesis and candidates for surgical treatment, a history of diabetes mellitus, hypertension, and aspirin can be associated with a worse prognosis, including no improvement in pain and lack of wound healing.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43642758","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":"Retained Lumbar Intradiscal Surgical Knife Blade Retrieved Via Extended Extraforaminal Approach: Case Report and Review","authors":"A. Rahimizadeh, Zahed Malekmohammadi, Mahan Amirzadeh, Shaghayegh Rahimizadeh","doi":"10.32598/irjns.7.3.5","DOIUrl":"https://doi.org/10.32598/irjns.7.3.5","url":null,"abstract":"Background and Importance: During a lumbar discectomy, the surgical knife might be broken and embedded deeply within the disc space. In some cases, it may be impossible to remove the broken blade during the initial surgery despite allocating several hours for this purpose. This fact may justify a subsequent surgical session. However, the eventual retrieval of the broken scalpel during a second surgical encounter can likewise be a very daunting challenge. Case Presantation: An L4-L5 discectomy in a young boy was complicated by the presence of an intradiscal broken surgical knife blade. The broken blade was successfully retrieved in a subsequent surgical session via the extended extraforaminal approach. Conclusion: The occurrence of an intradiscal retained broken scalpel has been rarely discussed within medical literature. There exist a wide variety of different approaches used for such a needed retrieval. The extended extraforaminal corridor has yet to be described within the context of medical journalism.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42355697","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":"Third Ventricle Anaplastic Oligodendroglioma: A Case Report","authors":"Tamajyoti Ghosh, S. Dey","doi":"10.32598/irjns.7.3.6","DOIUrl":"https://doi.org/10.32598/irjns.7.3.6","url":null,"abstract":"Background and Importance: Anaplastic Oligodendroglioma (ODG) constitutes 24% of all pediatric ODG. The mean age of presentation of ODG is 12±6 years. They are most common in frontal and temporal lobes; however, rare cases of intraventricular ODGs are reported. Most commonly they arise from the anterior part of lateral ventricles. Third ventricle ODG is extremely rare and only a few cases of lateral and third ventricle anaplastic ODG are reported. ODGs infiltrate locally to meninges and rarely have leptomeningeal spread. Thus, ODG forms a differential diagnosis of pediatric intraventricular tumor. Case Presentation: Here we present a case of a 15-month-old male child with raised intracranial pressure due to obstructive hydrocephalus. The patient was detected to be COVID-19 RT–PCR (Reverse Transcriptase Polymerase Chain Reaction) positive in the preoperative period and underwent emergency Right-sided Ventriculo Peritoneal (VP) shunt. His contrast MRI (Magnetic Resonance Imaging) Brain showed a 50×24×39 mm heterogeneously enhancing mass epicenter at third ventricle and extending to lateral and fourth ventricle with spinal drop metastasis. Preoperative differential diagnosis of Ependymoma was made and definitive surgery was done once the child recovered from COVID-19. However, his biopsy specimen pathology and Immunohistochemistry (IHC) were suggestive of anaplastic oligodendrogliomas and the child responded well to chemotherapy. Conclusion: Intraventricular ODG is an extremely rare pediatric tumor. Patients usually present with obstructive hydrocephalus. Contrast MRI findings are nonspecific and help in detecting leptomeningeal spread to the spine. IHC and chromosomal analysis are important diagnostic and treatment prognostication tools. These tumors have a high recurrence and poor prognosis despite gross total resection.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44320920","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":"Incidence and Outcomes of Acute Lung Injury in Patients With Isolated Traumatic Brain Injury","authors":"S. Rimaz, Seyyed Mahdi Zia Ziabari, Neshat Jabbari, Z. Pourmohammadi, Parrisa Bagheri, Sheyda Rimaz","doi":"10.32598/irjns.7.3.3","DOIUrl":"https://doi.org/10.32598/irjns.7.3.3","url":null,"abstract":"Background and Aim: Traumatic Brain Injury (TBI) is an essential cause of morbidity and mortality worldwide. TBI patients frequently encounter lung complications, such as Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS), which is associated with poor clinical outcome because hypoxia causes additional injury to the brain. This study aimed to evaluate the frequency of ALI in patients with TBI and its consequences. Methods and Materials/Patients: In this descriptive cross-sectional study, data from all records of patients admitted to Poursina Hospital’s ICU (emergency and neurosurgery ICU) in 20 18-2019 were used. The evaluated data included age, gender, type of head trauma mechanism, kind of brain injury based on CT scan findings, the severity of brain injury based on Glasgow Coma Scale (GCS), underlying diseases, mean head AIS score, the number of pack cell units injected, as well as bilateral pulmonary infiltration in favor of ALI and brain injury. Results: Only 81 of the 557 TBI cases met the inclusion criteria of the present study. The highest frequency of ALI following TBI was observed on the first day of hospitalization, in men (0.41%) in the age group of 40-50 years (7%) with severe brain damage (6%) and subdural hematoma (12%), following a motorcycle accident, cars, as well as on the third day of hospitalization were seen in men (43.8%) with the age group of 20-30 years (55%) with severe brain damage (42%) and intra-parenchymal bleeding (57%), following a motorcycle accident. In addition, no significant correlation was detected between the incidence of ALI and mortality, the duration of hospitalization, GCS, mean head AIS score, or the extent of received blood units in our study. Conclusion: According to the obtained findings, men aged between 20 and 30 years with severe cerebral injury, epidural hematoma and a motorcycle accident presented the highest rate of progression toward ALI in the first to third days of hospitalization.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42013235","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":"Post-traumatic Cervical Spondyloptosis Without Neurological Deficits: A Case Report","authors":"H. Rezaee, Mohammad Ali Abouie-Mehriz, S. Mohazzab-Torabi, E. Keykhosravi","doi":"10.32598/irjns.7.3.8","DOIUrl":"https://doi.org/10.32598/irjns.7.3.8","url":null,"abstract":"Background and Importance: Traumatic cervical spondyloptosis is a rare and severe situation, i.e., associated with disabling neurological deficits. Case Presentation: We described an unusual clinical presentation of cervical spondyloptosis in a 49-year-old man without neurological impairment and severe neck pain. Moreover, C6-C7 spondyloptosis was assessed two days after the trauma. X-rays, Computed Tomography (CT) scans and Magnetic Resonance Imaging (MRI) demonstrated a C6 bi-pedicular fracture, C6-C7 facet dislocation with complete ptosis of C6 vertebral body over C7 and without spinal cord injury. The patient was managed with an intra-operative 4 Kg traction and underwent a posterior decompression, with reduced fracture/dislocation by bilateral completed facetectomies at C6, and fusion from C4 to T3. Conclusion: This case report emphasized that sometimes cervical spondyloptosis may occur without neurological deficit symptoms. Prompt clinical recognition and surgical removal are essential to prevent serious complications in this respect.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47324438","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":"Complications of Halo Vest Orthosis: A Narrative Study","authors":"A. Babashahi, M. Rezvani, M. Vatankhah, N. Kalani, A. Kazeminezhad","doi":"10.32598/irjns.7.3.2","DOIUrl":"https://doi.org/10.32598/irjns.7.3.2","url":null,"abstract":"Background and Aim: Perry and Nickel introduced the halo vest in 1959. It is the most common immobilization device for the unstable cervical spine. In the literature review, most articles review the beneficial effects of the halo vest, and a few report its complications. This study aims to evaluate the complications associated with halo orthosis. Methods and Materials/Patients: This is a narrative study about halo vest complications. To provide up-to-date information, we reviewed the articles written about halo complications. All relevant articles were retrieved from Google Scholar, Medline, PubMed, etc., using the keywords of “halo vest orthosis”, “unstable cervical spine fracture”, “halo vest complications”, “halo vest immobilization”, “pin-site-related complications”, and “vest-related complications”. Afterward, we reviewed and critically analyzed the articles. Results: At first, the halo vest was used for postoperative paralyzed poliomyelitis patients, and later, it was also used for traumatic injury of the cervical spine or postoperatively in cervical spine reconstructive surgery. Compared to other orthoses, the halo vest provides a more effective external fixation and maintains normal anatomic alignment of the cervical spine without impacting jaw motion and resulting in eating problems. However, it has many temporary complications. To prevent halo vest complications, experienced people should apply it, and the patients should be regularly followed up for early detection and treatment of complications. Conclusion: Our review is the starting point for the evaluation and investigation of halo vest complications. Because of the high incidence of pin loosening and infection, it is better to evaluate the design and application of halo pin. Since the initial design of the halo vest, only its superstructure has been redesigned without any significant change in other parts of it.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47620236","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":"Pretrigeminal Neuralgia: An Overlap Between Neurosurgery and Dentistry","authors":"Z. Vahedi, Payman Vahedi","doi":"10.32598/irjns.7.3.1","DOIUrl":"https://doi.org/10.32598/irjns.7.3.1","url":null,"abstract":"<jats:p>NA</jats:p>","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43231149","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":"Multifocal Intradural Extramedullary Anaplastic Ependymoma With Intracranial Involvement at Presentation: A Case Report","authors":"K. Mozaffari, M. Stellon, E. Chalif, Michael K. Rosner","doi":"10.32598/irjns.7.3.7","DOIUrl":"https://doi.org/10.32598/irjns.7.3.7","url":null,"abstract":"Background and Importance: Ependymomas are a rare malignant neoplasm. Multifocal intradural extramedullary anaplastic ependymomas are even more of a rare entity with much of the current knowledge derived from case reports. We presented a case of a multifocal intradural extramedullary anaplastic ependymoma with intracranial involvement at presentation. Case Presentation: A 53-year-old male presented with urinary symptoms. Magnetic resonance imaging revealed two lesions along the spinal cord and two lesions, intracranially. Histopathological examination was consistent with the World Health Organization grade III anaplastic ependymoma. The patient was treated with the gross total resections of spinal cord lesions, followed by radiation therapy to the resection cavities and intracranial lesions. At the 10-month follow-up visit, he reported almost complete resolution of symptoms, and magnetic resonance imaging revealed no recurrence. Conclusion: Despite their rarity, ependymomas should be considered as the differential diagnosis when evaluating spinal tumors. Gross total resection followed by targeted radiotherapy appears to be an effective treatment modality for high-grade lesions.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49630406","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}