Iranian Journal of Neurosurgery
Volume:7 Issue: 1, Winter 2021

The insertion of ventriculoperitoneal (VP) and ventriculoatrial (VA) shunts is the first-line treatment of patients with hydrocephalus and normal-pressure hydrocephalus. The provision of a safety profile for shunting in the treatment of hydrocephalus patients is very important. This study aimed to determine the success rates and complications of VP and VA shunting in patients with hydrocephalus.

This systematic review investigated the complication rates of VP and VA shunting in the management of patients with hydrocephalus. All the published studies were searched in three electronic databases, including Google Scholar, PubMed, and Web of Science, within March 20th to April 10th in 2020 using the keywords, namely “Ventriculoperitoneal” and “Ventriculoatrial” in combination with “Hydrocephalus”.

Nine articles met the eligibility criteria for being included in this review. Some studies showed a higher rate of shunt obstruction in patients undergoing VA shunting; however, other studies demonstrated no difference in terms of shunt obstruction. The rates of primary revision shunt were various within the ranges of 5.4-48% and 9.1-58% for VA and VP shunting, respectively. A higher rate of revision shunt was reported among the patients undergoing VP shunting in comparison to that reported for those with VA shunting. The different rates of mortality in various studies were estimated within the range of 0-10% and at 13.9% for VA and VP shunting, respectively.

In general, no difference was reported in the rates of complications and mortality between VA and VP shunting. Due to the ease of placement and revision, VP shunting could be considered the first-line treatment of hydrocephalus. However, this approach has been preferred in newborns, and there have been insufficient data on adults in this regard

Over the past 2 decades, endoscopy has become an integral part of the surgical repertoire for pituitary procedures and over the past several decades, the endoscopic endonasal trans sphenoidal approach (EETA) has gradually become an accepted option for pituitary tumors with intra-,supra-,and para-sellar location and extension, because of its minimal invasiveness and high efficiency. Over the past several decades EETA offers improved illumination and superior panoramic visualization of the sella and the surrounding structures. Compared with traditional sub labial or trans septal microscopic approach, EETA offers minimal invasiveness, fewer complications, and overall improved outcomes. However, some EETA operations are performed through one nostril (mononostril endoscopic Trans sphenoidal approach [META]), while other EETA operations are performed through both nostrils (binostril endoscopic Tranchr(chr('39')39chr('39'))s sphenoidal approach [BETA]) and recently through one and a half nostril approach [OETA]. Both of these three approaches have some pros and cons.The real aim of this study is to compare between 3different EETAs from pros and cons viewpoint of these three approaches and some comparison between traditional microsurgery (microscopic trans sphenoidal approach) and transcranial approach and EETA in pituitary adenoma.

To provide up-to-date information on these three approaches, we concisely reviewed these three approaches and their pros and cons. Using the keywords, neuroendoscopy, META ,OETA , BETA ,pituitary adenoma,EETA,endoscopy, pituitary surgery, trans sphenoidal approach, binostril, mononostril, one and a half nostril, transcranial approach for pituitary adenoma, microscopic trans sphenoidal approach all the relevant articles were retrieved from Google Scholar,PubMed,and Medline reviewed, and critically analyzed.

Because of maneuverability of instruments and a wider view in the sphenoid sinus, the binostril technique is superior for resection of large tumors with parasellar and suprasellar extension and tumors requiring extended approaches. The mononostril technique is preferable for tumors with limited extension in the intra- and suprasellar area. Limitations to the mononostril approach may be as following: a crowded narrow nasal cavity, a harder tumor with invasive appearance or significant suprasellar extension, and lesions other than pituitary adenomas. The mononostril surgery may then be simply turned into a binostril, wider and more dynamic approach to allow for better dissection of such larger, harder, and more extensive tumors. However, we believe that these limitations resolve with changing in the lens of endoscope and some maneuver in creation of visual field in nasal cavity and transsphenoidal rout. The one-and-a-half nostril endoscopic trans sphenoidal approach is a simple and reliable technique. It provides not only a sufficient surgical corridor for a 2-surgeon/4 or 3-hands technique, but also ensures minimal invasion of the nasal canal.Its clinical results with respect to surgical outcome, maneuverability of instruments, postoperative morbidity, and postoperative quality of life support the theory that this is a highly efficient technique.

Based on the results of this study for selecting suitable EETA as META or BETA or OETA, the size and consistency of tumor,general versus invasive pituitary adenoma, and the extent of parasellar and suprasellar extension are important and transcranial approach is effective when resection becomes necessary for a portion or all of a pituitary macroadenoma that is judged to be inaccessible from the transsphenoidal route and looks like microscopic transsphenoidal approach is suitable for pediatrics pituitary adenoma, but for more reliable conclusion further studies are needed to prove this more conclusively.

The present study aimed to use the median nerve compound muscle action potential (CMAP) amplitude by stimulation at the palm instead of abductor pollicis brevis (APB) needle electromyography (EMG) for determining a sign of axonal loss in patients with carpal tunnel syndrome (CTS).

Methods and Materials/Patients:

 This study was performed on 180 patients with CTS referred to Poursina Hospital at the Electrodiagnosis (EDX) Center in 2018-19. In this study, the APB needle EMG diagnostic test was used as the gold standard, and median nerve CMAP AMP with stimulation at the palm and wrist were used to compare the two nerve stimulation tests. 

All of the cases with abnormal amplitude loss detected by median nerve stimulation at the palm had also axonal loss in the needle EMG of APB, and this test could be a good indicator of AL if there is an abnormality (sensitivity: 73%, specificity: 100%). The results with wrist stimulation were not as accurate as the palm stimulation, and some cases with decreased CMAP amplitude of median nerve, had normal limits needle EMG of APB muscle (sensitivity: 86.6%, specificity: 94.9%). 

It was found that in cases with CTS, abnormally decreased amplitude of median nerve detected by stimulation at the palm could be a good indicator of axonal loss.

Object: 

Indocyanine green (ICG) angiography has become the standard of practice in many centers managing cerebrovascular diseases. Though, 3D stereoscopic recording of the surgeries has received widespread attention, there is need for a technology to display and record real time 3D ICG angiographies. In this study, we designed and constructed an ICG angiography camera to display real time 3D ICG angiographies.

Our project had three phases. In phase I, a handmade ICG camera was designed and constructed in our laboratory. Second phase included creating a 3D camera to display real time images in 3D anaglyph format. In the last phase, we developed a 3D ICG camera to demonstrate 3D ICG angiographies in real time.

We successfully completed all three phases of the project and could display real time 3D ICG angiography of a mouse mesenteric arteries, record it, and take pictures.

We proposed a method and proved its feasibility for producing a 3D ICG angiography camera to be mounted on the next generation of neurosurgical microscopes.

Gynecological cancer is one of the most common types of cancer worldwide. Nonetheless, spinal metastasis from gynecological cancer is scarcely reported in the literature. In cases of spinal cord compression, the standard treatment is a decompressive surgery followed by radiotherapy treatment for selected patients. This study aimed to report the overall survival and surgical results in patients presenting with gynecological spinal metastases who underwent spinal cord/ nerve root decompression and stabilization.

METHODS & PATIENTS:

 A total of 18 patients were include in this study. The surgical procedures were performed from 2012 to 2019. The evaluation of neurological status, spinal stability, and pain were performed using the American Spinal Injury Association Impairment Scale (ASIA), Spinal Instability Neoplastic Score (SINS), and Visual Analogue Scale (VAS), respectively.

The lumbar spine was the most affected location (n = 30; 50.0%). Regarding the preoperative neurological deficits, 16 cases (n = 16; 88.9%) presented ASIA graded A–D before the surgery, being reduced to five (n = 5; 27.8%) after the procedures. The pain level means (pre-and postoperative) were 9.39 and 2.28 (SD ±0.79 and ±1.44). The overall median survival was 6.1 months (95% confidence interval [CI] of 1.10–11.13 months). The mean survival of ambulatory and non-ambulatory patients before the surgery was 7.36 months and 3.2 months, respectively. (ρ = 0.007 – Log-rank Mantel–Cox).

Decompressive surgery and stabilization promote mechanical pain relief, spinal stability, an improvement of neurological function, and indirectly improving quality of life, despite a dismal overall survival of patients who present with metastatic spinal compression disease.

It is well known that the majority of good grade (WFNS I and II) patients who undergo microsurgical clipping achieve a favorable outcome, but still a number of patients who are independent before surgery face unfavorable outcomes signifying the impact of microsurgical clipping. The aim of this study was to quantify the risk of dependency in patients who had no previous neurological deficit.

We reviewed 50 consecutive good grade patients with ruptured anterior circulation aneurysms who underwent microsurgical clipping between May 2017 and May 2020 in the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore. The clinical outcome at discharge and at 3 months follow-up was assessed using the Glasgow Outcome Scale (GOS).

In this study, seven patients (14%) were dependent (GOS II and III) following clipping. Out of this, five patients (10%) suffered surgical insult in the form of intraoperative rupture (4%), postop infarct (4%), and direct brain damage (2%).

Patients without neuro deficit preoperatively still suffer unfavorable outcome mainly due to operative insults. Vascular injuries remain the main cause of morbidity producing dependency. Therefore, it is essential to reiterate that all surgical techniques must be directed at minimizing the risk to vessels, both during dissection and at clip placement.

Background and Importance:

Coronavirus 19 is caused by the SARS-COV-2 virus. The primary target of the virus is the respiratory system, but it can also affect other systems of the body, such as the cardiovascular system and the Central Nervous System (CNS).

In this study, we introduce an 83-year-old man who referred due to reduced level of consciousness and hemiparesis in left part of his body and had no symptoms such as fever, cough, muscle aches and fatigue. In High-resolution computed tomography (HRCT) of lung, the Ground-glass opacification/opacity(GGO) view indicated Covid-19 disease, and in computerized tomography (CT) scans of the brain, hemorrhage was evident in the right thalamus, lateral ventricles, and right ventricle. The Polymerase chain reaction (PCR) test performed on the upper part of nose was also positive. This is a case report of intracranial and intraventricular hemorrhage in an aged man with asymptomatic COVID-19.

Low of consciousness in the elderly can be a sign of infection with SARS-COV 2 virus and cause adverse effects in these people.
Key Word:COVID-19, Intracranial hemorrhage, Aged

A 33-year-old man victim of a knife attack without obvious brain or ophthalmological lesions. The knife entered the medial aspect of the orbit. Neurological examination was normal and computed tomographys (CT) scan showed intracranial trajectory through the orbit to the frontal horn of the lateral ventricle. The knife was extracted without complications and  spectacular improvement in visual acuity and no neurological or occulomotor deficit at long term evolution. In this case report, we discuss the radiologic diagnosis and surgical management of transorbital orbitocranial injury by foreign body penetration.