Iranian Journal of Neurosurgery
Volume:7 Issue: 3, Summer 2021

Since its introduction in 1959 by Perry and Nickel, the halo fixation device has become the most common means used to immobilize the unstable cervical spine. The majority of the reviews in the literature concerning the halo have concentrated on its ease of application, the tolerance of the device by the patient, the degree of immobilization obtained, and its success in maintaining reduction and achieving healing after a fracture or arthrodesis. Although other authors have reported complications in their patients, no prior review has concentrated specifically and concisely on the complications that may be associated with use of the halo fixation device. The purpose of this study is to evaluate the problems associated with halo orthosis.

To provide up-to-date information on complications of halo, we concisely reviewed the halo complications. Using the keyword halo vest orthosis, unstable cervical spine fracture, halo vest complications, halo vest immobilization ,pin site related complications, vest related complications all the relevant articles were retrieved from Google Scholar, Medline, PubMed, and etc. reviewed, and critically analyzed.

Halo vest was initially designed to be used after surgery on patients paralyzed by poliomyelitis, its current use is primarily related to spinal trauma or reconstructive procedures on the cervical spine.  Compared with conventional orthoses, the halo vest or halo body jacket offers more rigid immobilization of the cervical spine, the ability to more precisely position the neck to obtain or maintain cervical alignment, and less interference with mandibular motion and eating.  However, we have found the overall complication rate to be relatively high but no permanent serious sequelae from these complications reported despite the documentation of problem areas. Though rare, penetrating injuries after cranial pin insertion can occur. Halo devices must be applied by, or under close supervision of, experienced personnel to avoid such complications, and halo vests should be reviewed frequently to detect such incidents early.

Our review is the initial step in an evaluation of the halo, and it does delineate areas in need of further investigation. Loosening and infection are particularly common and imply that further basic research in halo-pin design and application is needed. To date, only changes in the superstructure of the halo have been made since its first description by Perry and Nickel in 1959.

Traumatic Brain Injury (TBI) is an essential cause of morbidity and mortality worldwide. TBI patients frequently encounter lung complications, such as Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS), which is associated with poor clinical outcome because hypoxia causes additional injury to the brain. This study aimed to evaluate the frequency of ALI in patients with TBI and its consequences.

In this descriptive cross-sectional study, data from all records of patients admitted to Poursina Hospital's ICU (emergency and neurosurgery ICU) in 20 18-2019 were used. The evaluated data included age, gender, type of head trauma mechanism, kind of brain injury based on CT scan findings, the severity of brain injury based on Glasgow Coma Scale (GCS), underlying diseases, mean head AIS score, the number of pack cell units injected, as well as bilateral pulmonary infiltration in favor of ALI and brain injury.

Only 81 of the 557 TBI cases met the inclusion criteria of the present study. The highest frequency of ALI following TBI was observed on the first day of hospitalization, in men (0.41%) in the age group of 40-50 years (7%) with severe brain damage (6%) and subdural hematoma (12%), following a motorcycle accident, cars, as well as on the third day of hospitalization were seen in men (43.8%) with the age group of 20-30 years (55%) with severe brain damage (42%) and intra-parenchymal bleeding (57%), following a motorcycle accident. In addition, no significant correlation was detected between the incidence of ALI and mortality, the duration of hospitalization, GCS, mean head AIS score, or the extent of received blood units in our study.

According to the obtained findings, men aged between 20 and 30 years with severe cerebral injury, epidural hematoma and a motorcycle accident presented the highest rate of progression toward ALI in the first to third days of hospitalization.

During lumbar discectomy, the surgical knife might be broken and embedded deeply in the disc space. In some cases, it may be impossible to remove the broken blade during the initial surgery despite allocating several hours for this purpose, thus require a subsequent surgical session. However, the eventual retrieval of the broken scalpel during a second surgical encounter can be a very daunting challenge.

L4-L5 discectomy in a young boy was complicated with intradiscal retained broken surgical knife blade. The broken blade was successfully retrieved in another session via extended extraforaminal approach.

The occurrence of intradiscal retained broken scalpel has been rarely discussed within the medical literature. There exist a wide variety of different approaches used for such a needed retrieval. The extended extraforaminal corridor has yet to be described within the context of medical journalism.

Oligodendroglioma (ODG) constitutes 0.9- 4% of all brain tumours and are relatively rare tumours in pediatric age group constituting 6.5% cases with mean age 12 +/- 6 years . They are most common in frontal and temporal lobes however rare cases of Intraventricular ODG are reported. Most commonly they arises from anterior part of lateral ventricles.  Third ventricle ODG is extremely rare and only few cases of lateral and third ventricle anaplastic ODG are reported. ODG infiltrate locally to meninges and rarely have leptomeningeal spread. Anaplastic ODG constitutes 24% of all pediatric ODG. Thus ODG forms an differential diagnosis of pediatric intraventricular tumour and unlike other intraventricular tumours have low propensity for spinal metastasis.

Here we present a case of 15 months old  male child with obstructive hydrocephalus who presented with features of raised intracranial pressure. Patient was detected to be COVID-19 RT -PCR positive in preoperative evaluation. He underwent emergency Right sided Ventriculo peritoneal shunt and later his contrast MRI Brain was done which showed a 50X24X39 mm heterogenously enhancing mass epicentred at third ventricle and extending to lateral and fourth ventricle with spinal drop metastasis. Pre operative differntial diagnosis of Ependymoma was made and  definitive surgery was done once child recovered from COVID-19. However his biopsy and Immunohistochemistry was suggestive of oligodendoglioma and child responded well to chemotherapy.

Although extremely rare intraventricular oligodendroglioma should be kept as a differntial in pediatric intraventricular space occupying lesion as they have low chances of leptomeningeal spread and better response to adjuvant chemotherapy.

Ependymomas are a rare malignant neoplasm. Multifocal intradural extramedullary anaplastic ependymomas are even more of a rare entity with much of the current knowledge derived from case reports. We presented a case of a multifocal intradural extramedullary anaplastic ependymoma with intracranial involvement at presentation.

A 53-year-old male presented with urinary symptoms. Magnetic resonance imaging revealed two lesions along the spinal cord and two lesions, intracranially. Histopathological examination was consistent with the World Health Organization grade III anaplastic ependymoma. The patient was treated with the gross total resections of spinal cord lesions, followed by radiation therapy to the resection cavities and intracranial lesions. At the 10-month follow-up visit, he reported almost complete resolution of symptoms, and magnetic resonance imaging revealed no recurrence.

Despite their rarity, ependymomas should be considered as the differential diagnosis when evaluating spinal tumors. Gross total resection followed by targeted radiotherapy appears to be an effective treatment modality for high-grade lesions.

Traumatic cervical spondyloptosis is a rare and severe situation, i.e., associated with disabling neurological deficits.

We described an unusual clinical presentation of cervical spondyloptosis in a 49-year-old man without neurological impairment and severe neck pain. Moreover, C6-C7 spondyloptosis was assessed two days after the trauma. X-rays, Computed Tomography (CT) scans and Magnetic Resonance Imaging (MRI) demonstrated a C6 bi-pedicular fracture, C6-C7 facet dislocation with complete ptosis of C6 vertebral body over C7 and without spinal cord injury. The patient was managed with an intra-operative 4 Kg traction and underwent a posterior decompression, with reduced fracture/dislocation by bilateral completed facetectomies at C6, and fusion from C4 to T3.

This case report emphasized that sometimes cervical spondyloptosis may occur without neurological deficit symptoms. Prompt clinical recognition and surgical removal are essential to prevent serious complications in this respect.