Iranian Journal of Neurosurgery
Volume:4 Issue: 4, Autumn 2018

Traumatic brain injury (TBI) in all degrees of injury severity mainly induces   deviant cognitive, emotional and behavioral alterations that lead to their respective disorders. This brief overview strives to define the variables that determine the risk of occurrence of these disorders and to describe the common patterns of these disorders and their relevant neuropathogenetic mechanism(s).  In addition, post-traumatic deficits can interact  and exacerbate the probability, , persistence and severity of each variable relative to  one another. Since, neural substrates and pathways further complicate these TBI sequels, identifying the neuropathogenetic basis of these deficits using human brain mapping techniques has been a milestone in the investigations of the TBI field.    It has been found that TBI-induced functional disturbance of one or more specific neural networks may cause a distinct disorder. However, this matter is a topic of discussion in TBI research. Evidently, prevalent, unpleasant TBI consequences such as motivational deficits, antisocial behaviors, aggression, disability of inhibitory control and executive function are mostly associated with the disruption of neural circuits originated from separate parts of the prefrontal cortex connected to thalamic nuclei and basal ganglia. Evidence strictly emphasizes the abnormality of the default mode network (DMN) either within the network or between it and other neural networks for a majority of cognitive, emotional and sleep disorders after TBI. Therefore, imbalanced neural circuits due to TBI may serve as diagnostic and prognostic biomarkers for post-traumatic neuropsychological and neuropsychiatric disorders as well as a guide for circuit-based neurotherapy.

Traumatic spinal cord injury (SCI) is one of the most traumatic events threatening patients’ well-being and places a financial burden on health care system. The first step in determination of the exact impact of SCI is to estimate the pattern of traumatic injuries in a population and also the type of frequently occurred co-injuries. Hence, this study was conducted to assess the frequency of anatomy, type of spine injuries, and associated co-injuries in patients with trauma in Poursina Hospital of Guilan province in Iran.

A descriptive cross-sectional study was carried out on traumatic spine patients admitted to the Poursina hospital of Rasht, a referral therapeutic center for trauma in north of Iran, in Rasht during 2015 to 2019. Data were extracted from the SCI registry of Poursina Hospital, Rasht, Guilan, Iran.

A total of 274 records were reviewed. Seventy-six patients were females and 198 patients were males. Mean±SD of age of the patients was 42.27±16.83 years. Based on this survey, most of the patients (43.8%) had SCI in lumbar region. Locked facet was seen in 12 patients. Fifty-seven patients (20.8%) complained about having pain. The median of VAS score was 6 (range=6). Co-existence of associated injuries (e.g. limb fractures, TBI, Internal bleeding, etc.) was found in 27.4% of the patients. According to ASIA (The American Spinal Injury Association) impairment scale, three patients (2.9%) had score A, and 100 patients (97.1%) had score E neurological defects.

The most telling reiteration to be drawn is that men mostly suffered from spine trauma. Lumbar region was the most susceptible location of SCI. Moreover, most of the patients experienced score E (normal neurological charcteristics) according to ASIA.

Treatment of parasagittal meningioma (PSM) is always a challenge, especially if the tumor is spread enough to invade critical structures like venous sinuses. This study aims to evaluate the outcomes of gamma knife radiosurgery in patients with parasagittal meningioma.

In this descriptive retrospective study, medical records of 61 patients with PSM who had undergone GKRS from 2003 to 2013 were reviewed. The demographic characteristics, medical history and radiotherapy history, tumor's volume and the characteristics of radiosurgery were assessed.  Radiological tumor control following treatment were evaluated during follow-up period.

In this study, 32 patients (52.5%) were men and 29 (47.5%) were women. Of 61 patients, 45 had a history of surgery or/and radiotherapy. The mean tumor volume was 11.35±9.20 ml (1-37.9 ml). The mean follow-up time was 30.28±27.48 months. Five patients died. Radiologic tumor control was achieved in 91.8% of the patients, in whom the tumor volume decreased to 30 (49.2%) and remained unchanged in 26 (42.6%) ones. The tumor volume increased in 5 patients (8.2%). Overall, the progression-free survival of the patients was 98.6% during 12 and 67.04±13.4% during 60 months. Edema occurrence rate was 18%. There was no significant difference in GKRS characteristics, tumor volume, and history of surgery and radiotherapy between patients whose tumors were controlled and patients who experienced an increase in the tumor volume.

Our study suggest that GKRS can be the first or second treatment to control PSM[NM1] . There was no association between the treatment outcome, tumor characteristics, and radiosurgery parameters AS radiosurgery management in PSMs encounter limitations , a long-term follow-up to diagnose life-threatening complications including brain edema is needed.




 [NM1]It is not a conclusion statement, but it can be suggest.

Spine trauma is an important health problem. Traumatic spinal cord injury (SCI) due to motor vehicle accident (MVA) might have a different epidemiologic pattern in Guilan province of Iran owing to its geographical characteristics. Therefore, the present study was conducted to the study epidemiology of SCI injuries due to road accidents in a trauma referral center in Guilan.

In this cross-sectional study, we used data SCI registry of Poursina Hospital. All the patients with spine trauma, due to MVA, hospitalized in the trauma center of Poursina Hospital, Rasht, Guilan, Iran between March 2015 and March 2018 were studied.

A total of 127 patients with spine trauma due to MVA were reviewed. The mean±SD age of patients was 38.27±16.22 years. We observed that 93.7%, 1.6%, and 4.7% of the patients had initial Glasgow Comma Scale (GCS≥13, 9≤GCS≤12, and GCS<9, respectively). SCIs were found several anatomical regions including cervical (n=54, 42.5%), lumbar (n=39, 30.7%), thoracic (n=23, 18.1%), thoracic and lumbar (n=7, 5.5%), thoracic and cervical (n=3, 2.4%), and lumbar and cervical (n=1, 0.8%) regions. Evaluated by Glasgow Outcome Scale (GOS), good recovery, moderate disability, severe disability, vegetative state, and death were found in 114 (91.2%), 4 (3.1%), 4 (3.1%), 1 (0.8%), 2 (1.6%) of the patients, respectively. Two patients were discharged by their personal contest.

Spine trauma due to MVA is mostly seen in the young. SCI due to such trauma is mostly found in the cervical region. Good recovery was seen in most of the subjects.

Post-neurosurgical meningitis can lead to severe complications and high mortality rates. The incidence varies in different conditions. The aim of this retrospective study is to determine the risk factors, occurrence, and microbiological spectrum of meningitis in patients with non-emergency craniotomy.

The patients who underwent non-emergency craniotomy at Poursina Hospital from September 23, 2016 to September 22, 2017 were selected. Exclusion criteria included traumatic surgery, only burr holing, only stereotactic surgery, and only trans-sphenoidal surgery. The medical records of each patient were reviewed, information on risk factors was extracted, and then the patients were evaluated for meningitis.

Out of 140 patients in the study, 7 cases were identified as meningitides, with an occurrence rate of 5%. The risk of meningitis increased with the presence of preoperative hydrocephalus (p=0.001), the use of an EVD (external ventricular drain) (P=0.001), perioperative antibiotics (p=0.001) and a GCS (Glasgow Coma Scale) <12 (P=0.001). Three out of 7 patients with meningitis had positive cultures. The only isolated microorganism was Acinetobacter spp.

Even after non-emergency craniotomy, meningitis can be a major source of morbidity and mortality. Low levels of consciousness (GCS<12), perioperative antibiotics, the use of an EVD, and hydrocephalus carry significantly high risks of infection.  Therefore, early identification of the risk factors will help physicians possibly prevent meningitis after non-emergency craniotomy in their patients.

Neuroblastoma is a nervous system malignancy. The extension of intra-abdominal neuroblastoma to the spinal canal is a rare condition. In this case report, we present a patient with monoplegia and a huge intra-abdominal mass with intra spinal extension and cord compression.