Iranian Journal of Neurosurgery
Volume:4 Issue: 2, Spring 2018

Intracranial Arachnoid Cysts (IAC) are suitable choices for endoscopic procedure to avoid craniotomy or shunt placement. Our main objective is to study the outcome of endoscopic procedure in IAC treatment. Methods and Materials/Patients: In this descriptive and retrospective study, we report our experience of 27 symptomatic patients with IAC who underwent endoscopic surgery at National Institute of Neurosciences Hospital and Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2009 to December 2016. The recorded data of patients’ management including operations, outcomes, and follow up were studied retrospectively. The diagnosis was confirmed by neuroimaging, surgery and histopathological examination. Patients were postoperatively followed up on regular basis. Size of the IAC decreased (significant to minimal) in all cases. Even where size reduction was minimal, patients’ symptoms improved significantly. No IAC increased in size after endoscopic procedure. There was no recurrence of symptoms in the follow up period. There was no postoperative mortality or major morbidity related to the surgery. Based on our results, most of symptomatic IAC cases can be managed by endoscopic procedure which seems to be a safe and effective method.

This study aimed to present the results of early and delayed operation on patients with ruptured brain aneurysms. In addition to comparing the results and rates of morbidity and mortality in the surgical procedure and identifying the effective factors, this study aimed to provide methods to improve the treatment of brain aneurysm. Methods and Materials/Patients: This was a retrospective study on 60 patients with a definitive diagnosis of brain aneurysm admitted to Neurosurgery Ward of Poursina Hospital, Rasht, Iran from 2009 to 2013. 7(11.7%) patients on the first 3 days and 37(61.7%) patients on the days 4-14 and 16(26.7%) after 2 weeks and selectively underwent surgery. In total, 11.7% of patients died and 15% developed severe complications. In the group underwent surgery on the first 3 days, 2(28.5%) patients died and 2 experienced severe complications. In the second group (in 4-14 days), 4(10.8%) patients died and 5(13.5%) suffered from severe complications, and in the group (16 patients) with delayed surgeries, 1(6.2%) patient died and 2(12.5%) suffered from severe complications. Neurological grading and operation time were important factors in complications and mortality of patients. This study showed that Hunt and Hess neurological grading score has a direct relationship with increased morbidity and mortality rates, while delayed operation is associated with a reduction in morbidity and mortality. Given the complications of early aneurysm surgery (during the first 3 days) compared with delayed surgery, and also most of these patients die due to vasospasm or recurrent hemorrhage before the onset of a delayed phase, performing early surgery in these patients requires further evaluation. According to this study, the reduction of each episode of occlusion with temporary clipping will result in fewer complications.

Lumbar disc degeneration is one of the most frequent causes of pain in the lower back, and lack of physical activity, overweight and obesity have been regarded as the most significant factors in its occurrence. The present study was conducted with the aim of evaluation of body mass index, abdominal obesity and physical activity level in patients registered for elective lumbar disc degeneration surgery. Methods and Materials/Patients: This descriptive-analytical study was conducted on adult patients (20 to 77 years old) candidates for surgery admitted to the Poursina Hospital in Rasht City, Iran in 2016 due to degenerative lumbar vertebrae diseases. After obtaining the patients' consent, their abdominal circumference, weight, and height were measured by the researcher. The Rapid Assessment of Physical Activity (RAPA) questionnaire was used to assess the level of physical activity of the subjects and questions about professional sports were asked by the researchers. SPSS 16 was used to analyze the study findings. The Chi-square test and Fisher exact test were applied to examine the relationship between qualitative data. The mean±SD BMI values in males and females were 26.63±4.47 and 28.96±4.45 kg/m2, respectively. Also, the mean±SD values of abdominal circumference in men and women were 99.8±13.35 cm and 107.44±17.58 cm, respectively. The majority of the people (88.5%), including 71.7% of men and 97.6% of women had suboptimal physical activity, and a small percentage of samples (10.8%) reported previous professional exercises The present study results indicate the lack of activity level, high BMI and abdominal fat in our patients. Further study is required to investigate the significant relationship between BMI and degenerative disease types

In-hospital rebleeding and early aneurysm rupture are major causes of mortality and morbidity in aneurysmal subarachnoid hemorrhage. Rebleeding may occur at the referring hospital, during transfer or at the referral neurovascular center prior to surgical or endovascular treatment. However, there has been no report regarding the rate of in-hospital rebleeding and early aneurysm rupture at the referral centers. This study aims to clarify the incidence, significance, management, and outcome of individuals who suffer in-hospital aneurysmal rebleeding and early aneurysm rupture at the referral hospital due to anterior circulation cerebral aneurysm to the time when its neck is visualized for clipping. Methods and Materials/Patients: Among 617 patients with anterior circulation cerebral aneurysms who underwent operation between September 2010 and September 2017 at Neurovascular Unit of Namazi Hospital (main referral neurovascular center in southern Iran), 22 suffered rebleeding since the time of neuroradiologic diagnosis of aneurysm to intraoperative visualization of aneurysm for neck dissection. A surgical technique for fast access and securing the aneurysm is described in this article, too. The patients’ demographics were collected via hospital records in a retrospective fashion. Six-month functional outcome was obtained via OPD records as well as phone calls. Utilizing Independent t test, 1-way ANOVA, Kruskal-Wallis and Mann-Whitney tests in SPSS22, the effect of each study variable was evaluated during 6 months follow-up period. Rebleeding occurred at different venues from CT angiography to frontal lobe retraction. Anterior communicating artery was the most common aneurysm to suffer in-hospital rebleeding and male gender was found as a risk factor. These patients have significantly higher bleeding amount and longer operative time (P<0.001), but still have a 68.2% chance of surviving with good functional recovery. Earlier in-hospital rebleedings are used to have worse outcomes (P=0.036 for GOS and 0.028 for mRS, respectively). Patients with in-hospital rebleeding and early aneurysm rupture at the referral hospitals will have a considerable chance for favorable outcome if they undergo aggressive surgical management emergently.

Several surgical techniques have been so far used for treating Cerebrospinal Fluid (CSF) leakage (rhinorrhea) such as using abdominal fat or fascia lata, but these methods have complications such as the presence of several surgeons in variable fields in the operating room or cosmetic complications for donors such as the surgical scar. This study aimed to investigate using buccal fat pad for management of traumatic CSF leakage. Methods and Materials/Patients: In this clinical trial, 46 patients with traumatic CSF leakage were enrolled according to inclusion criteria and randomly divided into intervention and control groups. Buccal fat pad for the intervention and abdominal fat for the control were inserted in the defect of the anterior cranial cavity by applying endoscopic sinus surgery. The patients were followed up for 1 year postoperatively. All patients were improved with no recorded report of CSF leakage relapse. In the intervention group, temporary complications such as edema (18.2%), numbness (9.1%) and facial asymmetry (9.1%) were observed in resected buccal fat pad areas. Also the control group all developed abdominal scar. The duration of surgery in the intervention group was significantly shorter than control (P=0.02). Using buccal fat pad for management of CSF leakage is a highly effective and reliable method which requires simple procedure with low cosmetic complication and short duration of surgery compared with other methods such as an abdominal fat graft. In addition, using buccal fat pad has better cosmetic results, so we suggest this surgical method for patients with CSF leakage

This is a retrospective epidemiological study, based on ICD-10 system, using statistical data from the Cyprus Statistical Service official archives. To estimate the spinal cord injury incidence and its characteristics like gender preference and hospitalization, in Cyprus people, over a 10-year period of time. The study investigated cases that have occurred within the territory of the Republic of Cyprus. Methods and Materials/Patients: The data from the Cyprus Statistical Service official archives were reviewed based upon the ICD-10 searching, using annual reports, from 2005 to 2014. The extracted information included the number of hospitalized patients, using ICD-10 codes S14, S24 and S34, sex and days of hospitalization. In order to report the incidence rates, we used the Cyprus Statistical Service official demographic data. The Mean Spinal Cord and the related Nerves Injury (SCI and NI) incidence was calculated to be 0.24%. The Mean SCI & NI male incidence was 0.158 %. The Mean SCI and NI female incidence was 0.076 %. There were 2.8 days of hospitalization per every SCI and NI patient per year. Based on the study results, it seems advisable to have a National Spine and Spinal Cord Injury registry, in order that different parameters be correlated in a more effective way. The study highlights the need for a well-organized trauma and rehabilitation center which would be of great benefit for the health system of the country. Furthermore, this information can be useful in future health economic studies related to the SCI and NI.

Selective Dorsal Rhizotomy (SDR) is a neurosurgical procedure currently used as a surgical treatment of children with spasticity in their legs. In SDR, the dorsal roots from L2 to S1 or S2 is partially sectioned. The primary goal of SDR is to reduce spasticity and improve the range of movement with preservation of muscle strength. The dorsal roots involved in spasticity are identified on the basis of intraoperative electrophysiological stimulation. Currently, SDR is most commonly performed for the treatment of spastic cerebral palsy in children. We report an 8-year-old child with spastic cerebral palsy who underwent intraoperative neurophysiology monitoring during SDR for treating his spasticity. Before the operation, patient’s examination revealed more spasticity at the lower extremities, mild spasticity at the upper extremities, and occurrence of fixed contracture of his both ankle joints. Intraoperative neuromonitoring (consisting of motor evoked als, direct nerve root stimulation, and free run electromyography) was performed during the operation. Electrophysiological monitoring was initially used to help differentiate between the ventral and dorsal roots and cutting the abnormal sensory rootlets. After the operation, his motor power of the lower extremities in the proximal and distal muscles was 4 out of 5, his saddle sensation became normal, and there was no urinary and stool incontinency. Four weeks after the surgery, he could walk about 10 m without help. His examination at 2 and 4 weeks after the operation showed was no sign of sensory deficits, urinary, or stool incontinency. Two months after the operation, the patient could walk independently without help while before the operation, he could not.