- Volume:3 Issue: 3, Summer 2017
- تاریخ انتشار: 1396/10/30
- تعداد عناوین: 7
Treatment of 44 Cases With Lumbar Spine Stenosis and Degenerative Instability: Outcomes of Surgical InterventionPages 79-88Background And AimDegenerative lumbar spine disease can lead to lumbar spine instability. The patients can present with Low Back Pain (LBP), radicular pain, and motor and sensory dysfunction. Age >50, female sex and pregnancies are among prevalent risk factors. The degeneration process usually starts from the intervertebral discs progressing to involve facet joints, ligaments, and vertebral bodies leading to spinal instability and deformity. This study aims to evaluate the effect of lumbar decompression and Posterolateral Fusion (PLF) on the short- and long-term outcomes of these patients.
Methods and Materials/Patients: This prospective study assessed the effect of lumbar decompression and PLF in patients with lumbar instability referred to the Neurosurgery Clinic of Chamran hospital between March 2011 and March 2013. Forty-four patients with degenerative lumbar spine instability and stenosis were eligible for participation to undergo lumbar decompression and PLF. Its clinical effect was evaluated using Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI). The change in sagittal and coronal planes was also assessed according to pre- and post-operative findings at 2-year follow-up. The statistical method of assessment was repeated using paired t-test. PResultsThe mean preoperative VAS score decreased significantly at 2 years after the surgery (6.87±1.07 vs. 2.20±1.15; PConclusionLumbar decompression and PLF is a safe and effective method for patients suffering from degenerative lumbar instability.Keywords: Lumbar spine stenosis, Degenerative instability, Posterior lumbar fusion, Visual Analogue Scale, Oswestry Disability Index
The Effect of Applying Topical Vancomycin Powder on Prevention of Surgical Site Infection in Patients Undergoing Spinal Surgery Using ImplantsPages 89-94Background And AimSurgical Site Infection (SSI) is one of the most important complications after spine surgeries. Different methods have been proposed to prevent this type of infection. The present study was performed to evaluate the effect of applying topical vancomycin powder on prevention of SSI in patients undergoing spinal surgery using implants in Al-Zahra Hospital, Isfahan, Iran from February 2015 to June 2016.
Methods and Materials/Patients: In this clinical trial, 100 patients candidate for spinal surgery with implants were divided into two groups using randomization technique including 50 patients in each group. Vancomycin powder solved in 20cc N/S serum was flushed over all layers of the surgical wound in the case group and in the control group sterile normal saline solution was used. Patients were examined at discharge and three months after surgery for ruling out surgical site infection. SSIs following spine surgery can be superficial, characterized by obvious wound drainage and erythema or it can be deep infections disseminating under the fascia which may lead to discitis, epidural abscess, and spondylitis.ResultsOne case of SSI was observed in the control group who was 83 years old. The mean age of all patients was 51.9±14.5 years old. The duration of surgery in this patient was 5 hours. The mean duration of surgery was 3.41±0.73 hours. The length of implant, BMI, sex, underlying diseases and other risk factors (diabetes and hypertension) did not affect the rate of infection.ConclusionEven though topical antibiotics seem to be effective on controlling SSI but our finding did not support this hypothesis. The authors would like to suggest that keeping routine strict sterility strategies during spine operations is effective enough in preventing surgical site infection.Keywords: Surgical, Site, Wound, Infection, Spinal surgery, Vancomycin
Cerebral Angiographic Findings in Non-Traumatic Intracranial Hemorrhage: A Single Center Experience in the West of IranPages 95-102Background And AimThis study aimed at analyzing the demographic characteristics of the patients with non-traumatic intracranial hemorrhage, their angiographic results and the correlation between computed tomography (CT) scan and angiography findings.
Methods and Materials/Patients: In a descriptive study, we retrospectively reviewed the records of the patients with non-traumatic intracranial hemorrhage based on their brain CT or lumbar puncture findings from 2011 to 2017. For all patients, four vessel catheter angiography via the femoral approach was performed in the Medical Imaging Center of Kermanshah University of Medical Sciences, Iran.ResultsWe investigated 143 cases with non-traumatic intracranial hemorrhage which was indicated in CT findings (91.61%) or lumbar puncture (8.39%). Of 143 patients, 64 (44.8%) were men and 79 (55.2%) women (mean age 53.7±12.1 years old). Moreover, 104(72.7%) patients had Subarachnoid Hemorrhage (SAH), 19(13.3%) of them had Intracranial Hemorrhage (ICH), 8(5.6%) ones had Intraventricular Hemorrhage (IVH) and 12(8.4%) patients had normal brain CT. There were 100 cases of aneurysm (69.93%), 13 cases of Arteriovenous Malformations (AVM) (9.09%), 28 cases with negative angiograms (19.58%), and 2 cases with other pathologies (1.4%). Seven (4.89%) cases of multiple aneurysms were also recorded. Of 13 patients with AVM, 8(61.5%) patients had AVM in parieto-occipital region, 2(15.4%) in temporal, 1(7.7%) in frontal region and 2(15.4%) had deep AVM. Two (1.4%) patients with SAH had dural AVF. Twenty-eight (19.6%) patients had negative angiogram, 22 cases of them had second angiography after one to two weeks. The most common positive finding in the second angiogram was Acom aneurysm (18.18%).ConclusionAneurysms and AVMs are the most common causes of non-traumatic intracranial hemorrhage. The most common site of intracranial aneurysms is the circle of Willis. A second angiogram after one to two weeks is necessary in most patients with negative results in first angiography after non-traumatic intracranial hemorrhage.Keywords: Cerebral, Angiography, Intracranial, Hemorrhage, Arteriovenous, Malformation
Pages 103-108Background And AimHydrocephalus can cause ventricular expansion, which if not treated promptly, can result in brain damage. The hydrocephalus-induced damage is not fully improved, even by means of surgical procedures, leading to permanent damages to the brain.
Methods and Materials/Patients: The aim of this study was to evaluate the demographic characteristics as well as hydrocephalus in patients with head trauma in Poursina Hospital, Rasht. The information including age, sex, Glasgow Coma Scale (GCS), trauma mechanism and accompanying brain injuries on admission were recorded. Patients with hydrocephalus diagnosed by CT scan underwent further investigation and therapeutic approaches. The treatment-related results were collected based on the GOS scale. Finally, the data were entered into SPSS version 18, and the results were analyzed by Fishers exact test, and Independent t-test.ResultsOf the 548 patients, hydrocephalus was observed in 14 patients (2.6%). The mean age of the patients was 44.07±24.48 years old. 31.1% of men (14 cases) had hydrocephalus, while none of women suffered from this complication. Car accidents (12 people) and fall (2 people) were identified as causes of incident in hydrocephalus patients. Head injury severity in most patients with hydrocephalus was mild (n=7, GCS=13-15) and moderate (n=6, GCS=9-12), and severe (n=1, GCS=3-8). Subarachnoid hemorrhage (n=5) and then epidural hematoma (n=4) and intracerebral hemorrhage (n=4) had the most severe damage to the skull. Most patients (n=11) were treated by surgery. Three patients recovered completely. Moderate disability, severe disability, vegetative state, and death occurred in 3, 2, 1, and 5 Patients, respectively. According to independent t-test, there is a statistically significant relationship between Glasgow Coma Scale and hydrocephalus (P=0.03). Fishers exact test also showed a statistically significant relationship between intracerebral hemorrhage (P=0.045) and intraventricular hemorrhage (P=0.013) on admission with hydrocephalic incidence.ConclusionThis complication was mostly observed in young traumatic patients (younger than 40 years of age) and in patients with mild head injury. Therefore, it is necessary to pay attention to these people in order to detect hydrocephalus, if any, as soon as possible, and these patients be treated appropriately.Keywords: Hydrocephalus, Head Injury, Trauma
Pages 109-114Background And AimVentriculoperitoneal shunt (VPS) is the most commonly used procedure for treatment of hydrocephalus in children. Abdominal cerebrospinal fluid pseudocyst is a rare complication but potentially fatal. The pathogenesis of this complication remains unclear. This complication should be considered during differential diagnosis of an abdominal mass. Our aim is to report how large and giant an abdominal cerebrospinal fluid pseudocyst can develop, and how severe the neurological damage can be.Case PresentationA 6 year-old girl known to have a ventriculoperitoneal shunt presented with abdominal distension and signs of increased Intracranial Pressure (ICP). Ultrasonography revealed a hypoechoic intraperitoneal fluid containing cyst with a well-defined margin and septations. Abdominal computerized tomography revealed a huge cyst in the abdomen and the distal part of the peritoneal shunt tube located within the cyst. Laparotomy revealed a huge cyst extending from the upper right side of the abdomen to the pelvis. The whole cyst was excised and the catheter repositioned.ConclusionEarly diagnosis of abdominal Cerebrospinal Fluid (CSF) pseudocyst is only possible through close and periodic examination of patients after the procedure.Keywords: Ventriculoperitoneal shunt, Abdominal, Pseudocyst, Cerebrospinal fluid, Hydrocephalus, Encephalocele
Pages 115-118Background and Importance: Arachnoid cysts are benign nontumoral lesions that are usually found incidentally in brain imaging. Suprasellar Arachnoid Cysts (SSACs) are rare. They can cause hydrocephalus and increased intracranial pressure, lower cranial nerve impairment and endocrine disorder. Sometimes arachnoid cysts become complicated by subdural hematoma/hygroma.Case PresentationWe describe a patient with a suprasellar arachnoid cyst that was complicated with symptomatic subdural effusion and increased intracranial pressure after minor trauma.ConclusionAlthough these cysts are rarely complicated with subdural hematoma/hygroma, and intracystic hemorrhage, the probability of subsequent subdural hygroma and increased intracranial pressure should not be underestimated.Keywords: Subdural effusion, Suprasellar arachnoid cyst
Pages 119-123Cerebral angiography through transfemoral approach is preferred in most of the situation though in cardiovascular surgery transradial angiography is accounted as the superior standard. The present study aimed at presenting our early experience of transradial approach to cerebral angiography and intervention of a patient with basilar tip aneurysm that had inappropriate vasculature to perform routine transfemoral approach. The patient was a 65 year-old man with a large basilar tip aneurysm that was candidate for endosacular coiling through transfemoral route. But due to very tortuous iliac artery, aortic arch and its branches, navigation transfemorraly via both vertebral arteries was impossible. Therefore we decided to do the procedure through right transarterial route. The procedure was started by doing Allen`s test to confirm good perfusion of right hand by collateral arteries. After that cerebral angiography and neurointervention was done transradially without any complication. As a result, although a transradial approach is not a routine way for cerebral angiography and intervention, it can be used safely as an alternative way in specific cases.Keywords: Transradial, Angiography, Cerebral, Aneurysm