Archives of Neuroscience
Volume:7 Issue: 1, Jan 2020

 Lumbar spine operations can be safely performed under general or neuroaxial anesthesia, but there are controversies as to the clinical outcomes and cost benefits of each method. The goal of this systematic review and meta-analysis was to determine the advantages of each technique (i.e., regional or general anesthesia) for lumbar spine surgery with regards to cost, duration of surgery, duration of post anesthesia care unit, and duration of hospital stay.
Data Sources: We conducted a systematic search for articles comparing regional anesthesia (RA) versus general anesthesia (GA) for lumbar spine surgery using three major databases (i.e., PubMed, EMBASE, and Google Scholar), without limitation for date and language of publication. We also manually double checked the references of all the related articles to detect missed articles by electronic searching. The last search was performed before September 2018; the quality of the included articles was assessed by different checklists according to the type of the article. STATA software (V. 10) was used for performing meta-analysis.

Twenty-eight articles were included in this meta-analysis. Cost data were presented in seven studies and reported a significant decrease in the cost of treatment in RA patients compared with GA patients. The standard mean difference (SMD) (95% CI) for cost was 1.64 (1.53 to 1.75); z = 29.17; P < 0.001; I2 = 98.9. Surgical time data were presented in 25 studies, which reported significant reduction in the surgery time in RA patients compared with GA patients, the SMD (95% CI) for surgery time was 0.77 (0.71 to -0.84); z = 23.9; P < 0.001; I2 = 97.9. Post anesthesia care unit (PACU) stay data were presented in 16 studies and reported significant increase in PACU stay in RA patients compared with GA patients. The SMD (95% CI) for PACU stay time was -0.4 (-0.49 to -0.31); z = 8.65; P < 0.001; I2 = 99.2. Hospital stay data were presented in 18 studies and reported significant decrease in hospital stay time in RA patients compared with GA patients. The SMD (95% CI) for hospital stay time was 0.76 (0.68 to 0.84); z = 18.81.; P < 0.001; I2 = 98.3. Egger and Begg’s tests showed no significant publication bias.

This comprehensive systematic review showed that RA has several advantages over GA with respect to cost, surgery time, and duration of hospital stay in patients undergoing lumbar spine surgery, while increase in PACU stay time was observed in RA patients.

Neuroplasticity is defined as adaptive changes in the sub-structures of synapses. Neuroplasticity is an important capability of the brain to respond to new stress. Stress can range from environmental changes to organic damages. Neurogenesis defined as the generation of new neurons in some parts of brain regions, especially the dentate gyrus of the hippocampus and sub-ventricular zone, can be considered as neuroplasticity. Neurogenesis facilitates the brain’s adaptive response to new stress by integrating new neurons into related areas. In this review, we recall some aspects of neurogenesis that may be considered as neuroplasticity.

Nanotechnology is a rapidly developing field with numerous applications spread in different fields, especially medicine. It plays a role in tissue engineering, tissue regeneration, drug delivery, and regenerative medicine. The present brief review summarizes the role of nanotechnology in tissue engineering and tissue regeneration. The CRISPR/Cas9 system in tissue engineering is playing an important role, as CRISPR is a revolutionary genome-editing technology that is being used for tissue engineering where it emphasizes to address tissue architecture formation, immune response circumvention, cell differentiation, and disease model development. Moreover, the development and research expenses for tissue engineering and regenerative medicine are too high and there is a need for making these systems cost-effective. Thus, the advanced approach of applications of nanotechnology to regenerative medicine and CRISPR will definitely revolutionize the basis of treatment, prevention, and diagnosis of various diseases.

 The major aim of tissue engineering is inducing of the body’s mechanisms to regenerate damaged tissues to original condition and task. Scaffolds are 3D porous constructs which provide a cellular microenvironment needed for tissue engineering. Choosing a biomaterial with proper biological, physical, and mechanical properties is of great importance in tooth tissue engineering. Thus, the current study reviews the properties of different polymers and ceramics for use as scaffolds in tooth dental regeneration.

The current study searched databases such as Elsevier, Wiley, Google Scholar, and PubMed in English from 1972 to 2018. After going through the required process, 29 articles were eventually confirmed and enrolled in this review paper.

The results of this work confirmed that thanks to having the ability to provide suitable amounts of interconnected porosities, high ratio of surface area to volume, proper mechanical strength, and different geometries required for tissue engineering, polymers are a good option for regeneration of tooth tissues. Although bioceramics such as calcium phosphate and glasses have good biocompatibility and bioactivity, their poor mechanical properties and low degradation rate limit their extensive use in tooth tissue regeneration.

Since the number of prognostic and predictive neuro-oncologic genetic markers is steadily increasing, a comprehensive analysis of the molecular techniques used to examine neuro-oncology samples is vastly required. Molecular analysis and profiling of brain malignancies result in improved diagnostic accuracy, target identification, and predictive prognosis. Application of high-throughput molecular approaches, such as next generation sequencing (NGS), to analyze brain tumors has provided a large amount of molecular information. In the clinical practice, the application of NGS has been increased, which has consequently improved the treatment option for brain cancer as well as other types of malignancies. Target therapy has recently become one of the most promising treatment options for various tumors, especially brain tumors. In this review, we provided and summarized high-throughput genomic studies, such as NGS technique, that could independently identify the integrated management and diagnosis of primary human brain tumors across a variety of entities with pathognomonic genetic alterations.

Hyperglycemia has been tried to explain by different mechanisms, but glucose-sensing tongue taste buds-geniculate ganglia-facial nerve-vagal nerve-pancreas web relation has not been adequately investigated.

We aimed to investigate if there is any relationship between the described taste buds network degeneration and blood glucose levels following subarachnoid hemorrhage (SAH).

This study was conducted on 32 rabbits. Blood glucose levels were measured at the beginning, mid-phase, and the end of the experiment. Animals were divided into the groups of control (n = 5), physiologic serum saline (SHAM; n = 5), and subarachnoid hemorrhage with 0.5 cc homolog blood injection into cisterna magna (study; n = 22) three times a week and were sacrificed under general anesthesia after two weeks. The blood glucose level of 113 ± 20 mg/dL was accepted as normal (G-I; n = 11), lower than 80 mg/dl as hypoglycemic (G-II; n = 6), and higher than 149 mg/dl as hyperglycemic (G-III; n = 5). Their neuron densities of geniculate ganglia were examined by stereological methods. The statistical analysis was done between glucose levels/degenerated taste bud/neurons using Kruskal-Wallis and Mann-Whitney U tests. We accepted P > 0.005 as non-significance.

The mean normal blood glucose level was 115 ± 9 mg/dl before surgery. The pre-sacrificed glucose level was 113 ± 8 mg/dL and the neuron density of the geniculate ganglia was 7.421 ± 530/mm3. The degenerated neuron density of geniculate ganglia was 13 ± 4/mm3 in controls 21 ± 7/mm3 in SHAM, 27 ± 7/mm3 in G-I, 21 ± 5/mm3 in G-II, and 112 ± 18/mm3 in G-III groups. The P values of glucose levels-degenerated neuron density of geniculate ganglia between control/G-III was: P < 0.00001; SHAM/G-III: P < 0.0005; GI/GII: P < 0.005.

Glucose sensing tongue taste buds-geniculate ganglia-facial nerve-vagal nerve-pancreas circuitry should be an unexplained web for the regulation of blood glucose level.

Spinal cord injury (SCI) is a catastrophic event that influences all aspects of the life of the patients and their families. It may have many acute or chronic complications. One of the most common complications is shoulder pain, which particularly occurs in wheelchair users.

This study aimed to estimate the prevalence of shoulder pain in paraplegic spinal cord injury patients who were referred to our clinic.

We included 70 spinal cord injury patients in our study according to inclusion criteria. Demographic data and SCI-related factors were recorded. The disabilities of the arm, shoulder, and hand (DASH) questionnaire was used to assess shoulder pain in our patients.

Mean score of pain was 51 in cervical, 23 in thoracic and 12 in lumbar spinal cord injury according to the DASH questionnaire. The pain was more prevalent and severe in the cervical group.

According to our study, it seems that shoulder pain has a relatively high prevalence and is more severe in cervical quadriplegic SCI patients that may be due to muscle imbalance around the shoulder. Therefore, this problem should be noted in the course of managing these patients.

The lateral skull base lesions are one of the most challenging parts of the head and neck. Surgical approaches for this area are complex and difficult. Although endoscopic approaches in skull base surgeries have progressed dramatically in recent years, there are few studies concerning these approaches.

This study aimed to describe the endoscopic transcanal transcochlear approach (ETTA) to reach the internal auditory canal (IAC) in the cadaveric temporal bone specimen.

First, pre- and post-operative high resolution computed tomography (HRCT) images of the transcanal transcochlear pathway were obtained and 3D segmentation was performed using 3D Slicer software. The anatomic landmarks were identified using the endoscopic approach with and without navigation guide. Surgeries were done and the feasibility and challenges were evaluated.

The internal auditory canal (IAC) was accessed via the ETTA. Anatomic landmarks were looked and a surgical corridor was identified with HRCT segmentations and images obtained during surgery.

We tried to increase our learning curve and extend surgical experience in lateral skull base surgery via minimally invasive ETTA. The increased endoscopic skills and the use of auxiliary tools such as a navigation guide may be helpful for successful access to the lateral skull base.

Studies indicate that balance disorder, motor development problems, and weak postural control are likely to occur in children with severe to profound hearing deficits. Children with hearing deficits also indicate behavioral problems related to impulse control, distraction, and disability to maintain attention in the visual modality.

The present study, therefore, aimed to investigate the effect of balance exercises on balance performance, motor coordination, and attention in children with hearing deficits.

In this experimental study, 36 children aged 7 to 12 years with severe to profound hearing deficits were randomly divided into two control and experimental groups using permuted block randomization. The experimental group performed a 12-session balance and vestibular sensory, motor exercise program. Assessments were performed as pretest and posttest by four subtests of the Bruininks-Oseretsky test of Motor Proficiency and Continuous Performance test. Then, the mean scores were compared between the pretest and posttest phases and between control and experimental groups by the paired t-test, Wilcoxon signed-rank test, two-sample t-test, and Mann-Whitney U test.

The results indicated a significant difference between the control and experimental groups in the pretest and posttest scores of balance (P = 0.000), upper limb coordination (P = 0.000), bilateral coordination (P = 0.004), and visual-motor control (P = 0.023) subtests of Bruininks-Oseretsky test and Continuous Performance test (P = 0.017) in children with hearing deficits.

Balance training including vestibular sensory and motor exercise program can simultaneously affect balance performance, motor coordination, and attention in children with hearing deficits.

This study aimed to determine the accuracy of the Face-Arm-Speech-Time (FAST) screening tool used by emergency medical dispatchers (EMDs) and emergency medical technicians (EMTs) for the diagnosis of acute stroke and its effect on the patient’s transfer time from the scene to the hospital.

This study was conducted retrospectively during a one-year period. Via census sampling, we recruited all patients over 18-years-old diagnosed with acute stroke whether by EMDs or by EMTs. Pre-hospital operation forms and hospital records were used for data gathering. Final diagnoses were finally determined according to the patients’ brain magnetic resonance imaging (MRI).

Totally, 1,280 patients with a mean age of 64.1 ± 17.8 years were studied, of whom, 730 were men (57%). Accordingly, 1,016 probable cases of stroke (79.4%) were reported by EMDs, while only 543 cases (42.4%) were reported as suspected cases of stroke by EMTs at the scene of the incident. Ultimately, stroke was confirmed in 519 (40.5%) cases. Accordingly, the Area under the curves (AUCs) for EMDs and EMTs were 0.50 (0.48 to 0.53) and 0.74 (0.71 to 0.76), respectively. Transport time (TT) was shorter if the initial diagnosis of stroke was made by EMTs. The TT was marginally significant and patients with stroke diagnoses were transported to the hospital faster than others (17.3 ± 11.5 vs. 18.5 ± 11.9 min; P = 0.065).

The use of FAST by EMTs for detecting probable acute stroke has acceptable sensitivity and specificity; but when it is used by EMDs, it has higher sensitivity and very low specificity. The diagnosis of stroke by EMTs may lead to faster transport to the hospital.

In the current study, we reported a successfully managed case of giant cerebral hydatid cyst in a 59-year-old male. Cerebral hydatid disease is a rare manifestation of echinococcosis representing 1% - 2% of all cases with hydatid disease. The mainstay of its treatment is surgical excision of entire intracranial cystic lesion, avoiding intra-operative rupture, which can result in subsequent recurrence or anaphylactic reaction. The surgery can be associated with intraoperative complications (including anaphylaxis, bleeding, neurological deficits, development of subdural effusion, epidural hematoma, and pneumocephalus), especially in the cases where the cyst is infected. All of these complications are of significant concern for the anesthesiologists. Thus, it is of paramount importance for anesthesiologists to consider the intra-operative challenges and possible required actions preoperatively.

Tension pneumocephalus is a neurosurgical emergency that occurs when subdural air causes a mass-effect over the underlying brain parenchyma. It is often termed the Mount Fuji sign due to an anticipated similarity with an iconic mountain peak in Japan.

We describe an 83-year-old woman with loss of consciousness, severe dizziness, nausea, and vomiting symptoms 20 days after a craniotomy.

In this case report we discuss imaging and management of tension pneumocephalus.