Iranian Journal of Neurosurgery
Volume:7 Issue: 4, Autumn 2021

Multiple Sclerosis (MS) is considered as one of the most prevalent chronic and progressive neurological diseases that has high simultaneity with some psychological disorders such as depression and anxiety; we examined depression and anxiety in people suffering from MS in this review study.

We conducted this study using a systematic review method relying on the search from January 2010 to December 2020 and also searched keywords of multiple sclerosis, MS, psychiatric issues, psychological disorders, psychological problems, anxiety, mental health, quality of life and depression in four online databases (PsycNET, PubMed and Scopus, Magiran). Ultimately, we selected 14 comprehensive papers that examined psychiatric disorders in patients with MS quantitatively and qualitatively to analyze them in order to achieved the wanted results.

A total of 14 studies was analyzed that included 27,106 patients with MS. The results achieved by the analytical studies explained that depression and anxiety are significantly higher in patients with MS compared to healthy people. The prevalence of depression and anxiety in MS patients has been reported to be heterogeneous.

Data related to a large number of patients with MS show a high prevalence of depression and anxiety in them, but it is possible that not separating the symptoms from the disorder be misleading. Consequently, it is recommended to conduct further research in order to precisely assess the prevalence of depression and anxiety as a disorder in these patients. It is required that future studies consider more the use of clinical interviews instead of self-reported questionnaires, sample selection methods, and providing a complete report of patients' demographic and clinical information.

Nowadays, surgical educations face new problems. Legal issues and patients' rights are a matter of concern in educational hospitals. On the other hand, the high cost of modern technology-based surgical education has made it more difficult for residents to train. Therefore, it seems that new approaches in the training of surgeons are necessary. One of the strategies is considered for this purpose is the establishment of clinical skill labs.

In this study, 4 clinical skill labs were designed that could increase the resident's clinical skills in a very low-cost setting. For this purpose, 13 residents registered in this study. The workshops subgroups were categorized as craniotomy, working with the microscope, tissue resection, and microsurgical dissection. After the workshop, residents and their attending physicians were surveyed by filling the questionnaires about the benefits of the workshop.

After the end of skill labs, residents and professors were asked about the enhancement of their skills and the efficacy of these skill labs. Both residents and their attending physicians believe that this enhancement of skills was significant.

It seems that adding clinical skill labs into the residency curriculum can improve the quality of their training and avoid the stressful environment of the real operating room and the legal problems that may be involved. Also, residents can learn more in a limited time and have better self-esteem for training in neurosurgery.

Tumor Necrose Factor-alpha (TNF-α) changes by REM sleep deprivation. Some believe that TNF-α is a biomarker in the deprivation of REM sleep. The patients with insomnia could be better after using Anti TNF-α or Infliximab (IFX), on the other hand, IFX effects on Patient Tolerance Threshold (PTT). Trying to manage the hospital inpatients’ pain is one of the common aims specially for intensive care unit patients.

 An experimental study with 72 male Wistar rats in 9 groups that each of groups include 8 rats and approved according to the ethics code in ethics committee of Tehran medical sciences university (CNS.Protocol-ICSS-940816). IFX was administered and it showed the time of the latency changed as PTT.

A significant difference between saline and IFX 0.2 mg/kg (F2 = 8.363, (P = <0.001)) in the time of latency observed.

REM sleep deprivation effects on TNF-α and IFX change the PTT in a Wistar rat model. So, these findings could be considered complex for patients and must to manage.

Neurovascular lesions may cause death or disability. Some of them are operable, but surgical approaches to these lesions are complicated and proper access is crucial. A few numbers of these surgeries occur in every resident education period and their experience for operating these lesions may be quite inadequate. Using new technologies like 3D-restructure of vascular lesion images may lead to better education and improving concepts of residents for these operations.

Four senior neurosurgery residents enrolled in this study. They have been taught to use a 3D image rebuilding program (3D-Slicer). They should rebuild a 3D image of every patient lesion and practice different surgical views and review anatomical structures around the lesion before surgery.

All residents mentioned that their concept of surgical approaches improved and they could learn more from each operation. Two of them commented better self-trust during surgeries can lead to more effective education. Also, their ability of surgical planning was enhanced. Attending physicians of these residents believe that this practice improved the residents' abilities and educational quality.

New technologies can develop residency educational programs. It seems that working on 3D images of lesions before surgery can promote residents' educational attributes.

The incidence of obesity has risen steadily to epidemic proportions in many regions of the world. Surgeons often encounter problems in surgeries on the obese patients.  In this study, we evaluated the effect of Body Mass Index (BMI) on outcome of patients undergoing lumbar microdiscectomy.

  This was primarily a case series retrospective study of patients who underwent single level lumbar microdiscectomy at our institution between January 2014 and April 2018. BMI was used to categorize our patients. Outcome measures were Oswestry Disability Index (ODI), and Visual Analogue Scale (VAS). The Patients were also analyzed according to the operative time, average blood loss during surgery, hematoma formation, wound infection, CSF leak, deep vein thrombosis, length of stay after surgery, recurrent disc herniation and neurologic deficit. ANOVA and regression analysis were used to assess differences between variables.

Five_ hundred Patients (225 male and 275 female) with a mean age of 40.3 ± 5.2 years old (ranged 19_70) who underwent single-level lumbar microdiscectomy were enrolled for the study. All patients were followed up for 24 months after surgery. The VAS and ODI were significantly improved in all patients. There was no significant difference between groups with respect to the operative time, average blood loss during surgery, hematoma formation, wound infection, CSF leak, deep vein thrombosis, length of stay after surgery, recurrent disc herniation and neurologic deficit.

The findings from this study showed that BMI does not have negative impact on outcome of patients undergoing lumbar microdiscectomy.

 The development of C5 root palsy is a well-known potential complication of cervical spine surgeries for the correction of cervical spondylotic myelopathy. It typically occurs unilaterally but on extremely rare occasions it might occur as a bilateral anomaly. The value of intraoperative neurophysiologic monitoring in detection of iatrogenic acute versus delayed onset C5 palsy, the rarity of bilateral C5 palsy and its optimal management requires further

Case Description: A 49-year-old woman with quadriparesis due to cervical spondylotic myelopathy is presented. She underwent circumferential 360’ degree cervical spine surgery. This operation was subsequently complicated by a delayed bilateral C5 palsy, despite normal transcranial motor evoked potentials (MEPs). With the utilization of conservative treatment options, the complete resolution of this complication took roughly eight months.

Bilateral C5 palsy is an extremely rare consequence of a multilevel cervical spine surgeries. Although, intraoperative monitoring of transcranial electrical stimulation–induced motor evoked potentials (MEPs) have high sensitivity and specificity in foreseeing acute onset C5 palsy, it cannot predict delayed onset palsy. With consideration of the current case, only 7 previously reported cases within all of medical literature. Further, conservative management in adherence to rigorous physical therapy may be an acceptable treatment

The novel SARS COV-2 virus has had an undeniable widespread effect on the world in different aspects. Although cerebrovascular disease and especially SAH has been reported earlier in COVID patients, there is confusion on different types and patterns of SAH.

A 63-year-old female presented in the emergency department with a headache. Her headaches were severe (Hunt&Hess 2). She was diagnosed with COVID by a positive nasopharyngeal swab PCR test. Her CT revealed a peri mesencephalic, thick SAH without any signs of hydrocephalus or intra-ventricular hemorrhage.

Reviewing the different associations of SAH and COVID, the peri mesencephalic hemorrhage in our case is a novel type which although is not uncommon among non-infected populations, its relation to COVID patients has not been reported before and needs further investigation.