Iranian Journal of Neurosurgery
Volume:1 Issue: 1, Winter 2015

Traumatic brain injury is one of the main causes of death and disability. The aim of this study is to systematically review the articles which assessed some serum factors of traumatic brain injury patients in relation to their outcomes.Methods & Materials: Patients: Databases were searched for relevant publications from 2005 to 2014. Selection criteria were:Studies which evaluate the factors affecting the outcome after TBI, TBI defined as “acute changes in brain function resulting in a strong external force to the head”.Resultswere measured by Glasgow Outcome Score or a comparable measure.Factors were measured in first month after injury and the prognosis was addressed. All papers were checked and approved by a specialist and expert in that field. A systematic review was performed for prognostic factors. Sixty-three studies were included. Most studies used Glasgow Outcome Score at 6 months post-injury as outcome measure, sometimes in combination with other outcome measures. Strong evidence for predicting outcome was found for serum concentration of S100 protein, NSE, MBP, NF-H, GFAP, UCH-L1, blood glucose levels, serum levels of LDH, sodium level, prothrombin time, partial thromboplastin time, platelet count, D.dimer, HSP 70, serum levels of IL-8, number of circulating EPCs, and DNA levels in serum. Moderate evidence for predicting outcome was found for high serum MMP9. Strong evidence of no association was found for WBC count and serum cortisol levels. Moderate evidence of no association was found for serum total cholesterol for other determinants, inconclusive or no evidence or limited evidence was found. S100 protein, NSE, MBP, NF-H, GFAP, UCH-L1, blood glucose levels, serum levels of LDH, sodium level, prothrombin time, Partial thromboplastin time, platelet count, D.dimer, HSP 70, serum levels of IL-8, number of circulating EPCs, and DNA levels in serum predicted outcome after traumatic brain injury. WBC count, serum cortisol levels, total cholesterol and MMP9 did not have predictive value.

To assess functionality status and surgical outcome of fenestration versus laminotomy technique based on Core Outcome Measures Index (COMI) in patients with lumbar disc hernia (LDH).Methods & Materials: Patients: A cross-sectional study was performed between January 2007 and April 2012. A total of 108 patients with a single-level disc herniation were asked to respond to the Oswestry Disabiltiy Index (ODI) and COMI at two points in time: pre- and post-operative assessments. The ODI and COMI were assessed comparing patients’ pre- and postoperative scores to determine the functionality status and surgical outcome. The mean age of patients was 52.4 (SD=10.1) years who underwent fenestration (n=45) or laminotomy discectomy (n=63). The mean clinical follow-up was 27.8 (SD=3.6) months (range 24 - 37 months). Regarding COMI scores, all subgroup values showed statistical significance pre- and postoperative indicating improvements on the outcomes and functionality. The change in the ODI after surgery was strongly correlated with change in the COMI, (r=0.79; P<0.001). The ODI score also was found to be statistically different between the groups in pre-and postoperative (P<0.001) assessment. However, the functionality status rate was similar in both groups. The findings suggest that fenestration or laminotomy discectomy is an efficacious procedure for treatment of LDH. However, both methods are equally effective in surgical outcome.

Although most patients experience severe pain after major spinal fixation surgery, little attention has been paid to control it with a multi-modal approach. The aim of this study is to select appropriate method of pain management after spinal surgery.Methods & Materials: Patients: This study was a randomized clinically controlled trial in candidates of spondylolisthesis and spinal fixation surgery under general anesthesia. 90 patients were divided into three groups, as follows: 1) Intervention group of epidural fentanyl (F): patient-controlled analgesia (PCA) pump infused 100 µg of fentanyl and 98cc of normal saline at the rate of 3-5 ml/h in the epidural space via an epidural catheter placed by surgeon 2) Intervention group of epidural fentanyl-bupivacaine (FB): PCA pump infused 100 µg of fentanyl and bupivacaine 0.125% at the rate of 3-5 ml/h in the epidural space. 3) IV morphine group (M): No medication was received epidurally. In case of visual analog scale (VAS) score more than four, one mg of IV morphine bolus was administered to patient. The blood pressure, heart rate, respiratory rate and pain severity were recorded at the moment of patient’s transfer from recovery room to the ward and compared in three groups every six hours for 24 hours. The results of this study were analyzed by statistical tests including repeated measures ANOVA, Kruskal-Wallis, Fisher’s exact test and SPSS software 16. P values less than 0.05 were considered statistically significant. The results of the study showed that VAS score in fentanyl-bupivacaine group was significantly lower than that in the two other groups during the first 18 hours. However, VAS score in all groups decreased at 24th hour postoperatively (less than three) suggesting that there was no statistically significant difference between the three groups. In this study, no serious and severe complications were observed except for a few cases of nausea in the control group. Epidural analgesia with fentanyl-bupivacaine is a safe and effective way to postoperative pain management in listhesis and spinal surgeries.

Lumbar spinal stenosis (LSS) is a common condition. This congenital or acquired stenosis has multiple etiologies. The goal of this study was to describe intraoperative pathoanatomic findings of lumbar spinal stenosis observed within a black African population.Methods & Materials: Patients: It was a retrospective and descriptive study performed at Departmental Teaching Hospital of Borgou in Republic of Benin (West Africa) from January 2008 to June 2014. All black African patients who underwent surgery for LSS were included. Intra operative aetiologies were recorded. Patients with extruded lumbar discopathy were excluded. During study period, 199 patients were selected. It was 109 men (54.8%) and 90 women (42.2%). Patients mean age was 53.2 years ± 10.96, mean weight 77.11kg ± 14.37 and mean height 171 cm ± 8.64cm. The LSS was acquired in 157 patients (78.9%), congenital in 29 (14.6%) and in 13 cases (6.5%) it was mixed origin. A hypertrophyof ligamentum flavum was observed in 101 patients (50.8%), zygapophyseal joint hypertrophy in 15 cases (7.2%) and in 74 cases (37.2%) the two factors were associated. A disc bulge were observed in 9 cases (4.5%) The ligamentum flavum hypertrophy is the main cause of LSS in black Africans. Studies to determine the mechanism of hypertrophy will be useful in order to initiate preventive treatment.

Patients with spinal cord injury (SCI) impose a heavy burden on health care system. Awareness on prevalence and incidence of SCI is important because this would show the necessity of prevention. This study aimed to investigate the epidemiology and types of traumatic spinal cord injuries in a trauma referral center in Guilan. Methods & Materials: Patients: This is a descriptive study which was conducted on patients with spinal cord trauma using a questionnaire during one year. The questionnaire included demographic information, injured spinal cord area, mechanism of injury, and type of neural damage based on ASIA scale. The data were analyzed using SPSS18 and descriptive statistics. Out of 76 study patients, 68 (88.2%) were men with mean age of 35.2 ± 1.45 years. The most common cause of SCI was motor vehicle accidents (MVA) (48.7%). 34 patients (44.7%) had cervical spine injury and in 23 patients (30.3%), thoraco-lumbar injuries caused SCI. 29.7% of patients suffered from paraplegia and 10.8% quadriplegia. 25 patients (38.5%) had complete SCI. 7 patients with SCI (9.2%) died during hospitalization. In this study, increased age was identified as a risk factor for death. In 4 of these patients (57.1%) cervical SCI was the underlying cause of death. Young men were the group at highest risk and the most mechanism leading to SCI was motor vehicle accidents. Many of these accidents are preventable; thus, more attention should be devoted to safety policies based on needs of the vulnerable groups. Besides, comprehensive education program with clear and practical goals should be developed.

Background and Importance:The coexistence of pituitary adenoma and another type of brain tumor is a very rare clinical scenario. Even though such a presentation can be an incidental event but the possible pathogenesis of coexistence of different lesions in the sella and suprasellar region has not yet been elucidated. Two cases of concomitant sellar and suprasellar region tumors are reported. A 37-year-old lady with Prolactinoma and a suprasellar meningioma and a 42-year-old Acromegalic man with suprasellar meningioma and a pituitary adenoma (PA). Both meningiomas were removed transcranially while the Prolactinoma could be managed medically and the growth hormone (GH) secreting adenoma was removed trans-sphenoidally. The visual problems and hormonal imbalances of both patients improved postoperatively and there has been no sign of recurrence of the lesions after a mean of five years follow up. The literature is reviewed on this topic and the possible pathogenesis and management protocol of similar lesions are discussed.

Background and Importance: Our learning curve during two decades of neurosurgical practice has been changed from an abstractive to a more meaningful and conductive state. In cases of fifth nerve neurinoma, pre-operative anatomopathologic diagnosis could lead us to a pre-planned program during and after the surgery to get the safe surgical result. Representation of two complex fifth nerve neurinoma cases, untoward happenings and the way to manage patient safety. Review of literature to find a wise approach for maximum benefit is included here. Both of our patients have developed iatrogenic unilateral corneal anesthesia, one of them warned of it and the second one not. We have had more problems in the way of preservation of the cornea in the warned case. We have reviewed the factors influencing safe corneal preservation after the operation of fifth nerve neurinoma which are included following items: surgical approach, Anatomopathologic location of the tumor (pre-ganglionic, ganglionic or post-ganglionic), simultaneous damage of V and VII nerve including vidian nerve, preserved corneal sensation, any combination of injury to physiologic and mechanical protectors. The cornerstones to have a safe cornea following such surgeries are pre-operative exam of fifth and 7th nerve in all aspects and also early post-operative evaluation of them including the state of the tear secretion. We encounter corneal anesthesia and epithelial defect. Iatrogenic damage of vidian nerve depending to approach selected seems to be considerable. Simultaneous damage of V and VII nerve during the surgery of large neurinoma are expected and noteworthy.

Background & Importance: Primary hemifacial spasm is usually caused by microvascular compression of the facial nerve at its root exit zone at brainstem without any space-occupying pathology. Secondary or so-called symptomatic hemifacial spasm has an additional underlying pathology e.g. tumors leading to the microvascular compression. We review and discuss the pathophysiology and the literature of secondary hemifacial spasm. We report on a 23 year-old man with a secondary right-sided hemifacial spasm in association with an ipsilateral epidermoid tumor of the cerbello-pontine angle. Intraoperatively, no offending vessel was observed near the root exit zone of the facial nerve. Microsurgical tumor removal relieved the patient also from his hemifacial spasm.