فهرست مطالب

Neurosurgery - Volume:2 Issue: 1, Winter 2016

Iranian Journal of Neurosurgery
Volume:2 Issue: 1, Winter 2016

  • تاریخ انتشار: 1395/03/18
  • تعداد عناوین: 6
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  • A Rare Association between Meningioma and Two Intracranial Vascular Lesions: Case Report & Review of Literature
    Andrea Boschi, Giovanni Barbagli, Ashraf Noubari Bahman, Edvardo Cipolleschi, Salvatore Mangiafico, Franco Ammannati Page 5
    Background & Importance: Our study was performed based on the first case, reported in English, of a patient with three contemporary lesions, an extra-axial malformation and two vascular ones.
    Case Presentation
    A 62-year-old man who came to our clinic due to right hand tremor associated to a slowing of idea-forming function and movements. The neuroradiological evidence showed a right fronto-temporal meningioma with the contemporary presence of an arteriovenous malformation (AVM) and of an aneurysm. The neuroradiological finding showed, also, a presumably “flow-related” right carotid-ophtalmic aneurysm with two mm in size. We performed the meningioma excision by the usage of Cavitron ultrasonic surgical aspirator (CUSA), after the isolation of the sylvian fissure with the microdoppler and the removal of the AVM by the Hashimoto technique. According to the very small size of the aneurysm, we decided to leave it in site.
    Conclusion
    The post-operative examination showed a complete removal of the lesions, meningioma and AVM. We performed an exhaustive review of the current literature and the result encompassed only another case, written in Japanese, about the contemporary presence of these three lesions.
    Keywords: Meningioma, Brain arteriovenous Malformation, Brain aneurysm, Association, Literature
  • Rostam Poormousa, Kaveh Haddadi, Misagh Shafizad, Sajjad Shafiee Page 6
    Background And Aim
    : Pituitary adenomas are part of a dissimilar group of benign neoplasms. The development of endoscopic techniques for surgery of paranasal sinuses has increased the opportunity for an endoscopic approach with regard to the pituitary gland. Minimally invasive endoscopic pituitary surgery, in turn, permits a more thorough tumor resection and fewer associated surgical complications. This study aimed to determine the descriptive outcomes and the complication rates for endoscopic transsphenoidal hypophysectomies.
    Methods & Materials/Patients: A prospective study was conducted from November 2012 to March 2015. 28 patients with proven symptoms of pituitary adenomas were included in this study, and regularly attended follow-up sessions.
    Results
    In our study, we have operated on 28 patients with hypophysis adenoma with the help of an endoscopic setting. The male to female ratio was 1:2.5, with average age range of 35 to 45 years. Growth hormone (GH) adenoma appeared in 36% (10 patients), prolactinoma in 21% (6 patients), Cushing’s disease in 18% (5 patients) and non-functional adenoma in 18% (5 patients). Gonadotroph adenomas were the least common at about 7%. The most common symptoms in our series were headache and visual defects. 5 patients including 2 with prolactinoma and 3 with GH adenoma presented apoplexy signs and symptoms.
    Conclusions
    Our series demonstrated that the endoscopic approach not only allows well anatomical visualization, and therefore facilitates the full oncological resection of tumors, but also reduces the incidence of pre operative complications.
    Keywords: Endoscopic, Surgery, Transnasal, Hypophyseal, Pituitary Adenoma
  • Shahrokh Yousefzadeh, Chabok, Babak Alijani, Mohammadreza Emamhadi, Hamid Behzadnia, Siavash Dehghani, Alireza Razzaghi, Shabnam Golmohammadi Page 11
    Background and Aim
    Spinal cord injury (SCI) is one of the worst kinds of traumatic injuries with remarkable social and economic effects on communities.
    Methods & Materials/Patients: In this prospective randomized clinical trial, 122 patients with traumatic spinal cord injury were admitted to Poursina hospital within 48 h of injury to compare G-CSF and high-dose methylprednisolone as neuroprotective therapy.
    Results
    In this study, 122 patients were studied out of which 62 patients were included in the granulociote colony-stimulating factor (G-CSF) group with a mean age of 40.4, and 60 patients in the methylprednisolone group with an average age of 40.10 years. 55 patients (45%) out of 122 patients were completely paralyzed (Grade AIS: A) and 67 (55%) were with incomplete spinal injury (Grade AIS: B, C, D). The average ASIA sensory scores in the two groups were similarly compared in the same time intervals, and p values were 0.7, 0.3, 0.2, and 0.1, respectively . They were not statistically significant.
    Conclusion
    According to the results, the G-CSF was shown to be beneficial in average ASIA motor and sensory scores in the two groups of male patients at six months of onset of G-CSF treatment (p value=0.04) and average ASIA motor scores improvement in the falls subgroup patients also differed significantly within six months of onset of G-CSF treatment (p value=0.03). A multicentre prospective randomized clinical trial to compare the placebo effect with G-CSF protocol's treatment, and also assessment of the cost benefits of the common medical treatment versus G-CSF are n eeded.
    Keywords: Granulocyte, Colony, stimulating, Methylprednisolone, Treatment
  • Rakesh Gupta, Sharadendu Narayan Page 15
    Background and Importance: Pseudomeningocele is a rare complication of spine surgery, and it is the collection of cerebrospinal fluid in paraspinal tissues. Giant pseudomeningoceles are still rare, and very few cases have been reported in literature. It is usually occult in presentation, and patients do not have any symptoms ascribable to it.
    Case Presentation
    We came across two patients of symptomatic post laminectomy pseudomeningoceles in past one year at our institution.
    The patients were managed with surgical closure of the dural defect. Both patients were asymptomatic post operatively and doing well on follow-up.
    Conclusion
    The reappearance of neurological symptoms in a previously operated patient of spine surgery needs careful evaluation. Rarely the symptoms of failed back surgery are seen to be arising due to a pseudomeningocele.
    Keywords: Pseudomeningocele, Incidental Durotomy, Laminectomy, Failed Back Syndrome
  • Masoud Mehrazin, Reza Mirfallah, Hosein Bokaei, Mohammad Sadre Hoseini Page 22
    Background & Importance: The aim of this study was to demonstrate the result of transsphenoid microsurgery for Cushing disease in
    our center and comparing the results in detail with other article, to achieve the best decision to manage patients in future.
    Case Presentation
    Between 1991 to 2015, 50 patients suffering from Cushing disease were operated. Before operation, endocrine tests and neuroimaging studies were done for all patients and all the patient were operated via transsphenoid approach. They were followed up in clinic with endocrine tests and imaging in regular intervals. During this study, 50 Cushing disease including 47 primaries and 3 secondary tumors were operated. Thirty-four (68%) of tumors were microadenoma and 16 (32%) patients had macroadenoma. A patient died due to post-operative fulminant meningitis (mortality= 2%). Mean of follow up was 5 years. Overall, 40 (80%) of patients had remission after operation and 9 (18%) patients achieved no remission, 3 of them had macroadenoma and 6 tumors were microadenoma. During follow-up period 3 (6%) patients had recurrence which need second operation. In secondary tumor and in macroadenoma with cavernous sinus involvement the result was not good (33% & 0% remission respectively).
    Conclusion
    Transsphenoid surgery is a safe and effective first choice method to manage Cushing disease comparing to other treatment modality. In recurrent or resistant cases other modality could help to manage patients.
    Keywords: Cushing Disease, Microadenoma, Cavernous Sinus, Transsphenoid Surgery
  • Matteo Capozza, Giovanni Barbagli, Andrea Boschi, Bahman Ashraf Noubari, Sergio Nappini, Nicola Limbucci, Arturo Consoli, Leonardo Renieri, Andrea Rosi, Salvatore Mangiafico, Franco Ammannati Page 25
    Background & Importance: Symptomatic vasospasm is a well-known pathology associated with ruptured aneurysms. Nevertheless this condition could be rarely found as a result of skull base tumor removal.
    Case Presentation
    We reported on a new case of a 40 year old woman previously treated for a tuberculum and diaphragma sellae meningioma showing symptomatic vasospasm after twelve post-operative days without previously documented sub-arachnoid hemorrhage. A digital subtraction angiography (DSA) was performed, and a bilateral vasospasm was detected. After subsequent endovascular treatments by intra-arterial infusion of nimodipine, patient experienced a full recovery.
    Conclusion
    Symptomatic vasospasm after meningioma removal is a challenging and life-threatening condition. Early diagnosis is
    the key for successful treatment.
    Keywords: Cerebral Vasospasm, Tumor Resection, Tuberculum Sellae, Diaphragma Sellae, Nimodipine, Meningioma