فهرست مطالب

Neurosurgery - Volume:2 Issue: 3, Summer 2016

Iranian Journal of Neurosurgery
Volume:2 Issue: 3, Summer 2016

  • تاریخ انتشار: 1395/09/23
  • تعداد عناوین: 7
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  • Pages 6-7
    G20 World Brain Mapping Initiative (Neuroscience/N-20) is Putting Brain Mapping on the top of Global Economic Issues.
    The Society for Brain Mapping, Therapeutics, and Brain Mapping Foundation are propelling therapeutic advances in nanoneurosurgery, NanaoBioElectronics, Artificial Intelligence, Neuro-Supercomputing and ‘cross-pollination’ among the bio-medical sciences and engineering worldwide. “Think of Brain Mapping as a google map, the snapshot of earth being equivalent of the MRI. Now zoom down to the cities, which represents a Functional MRI, then zoom on the roads, which represent brain connectomics. If you zoom down further you will see the cars, which represent brain cells and people in the car represent brain genomics and nanoscale structures” explains Dr. Babak Kateb, Founding Chairman of the Board of SBMT, Scientific Director of California Neurosurgical Institute.
  • Parviz Samadi, Motlagh*, Mohammad Shimia, Moslem Shakeri, Azad Mohammadzadeh, Firooz Salehpour, Atta Mahdkhah, Farhad Mirzaiee Pages 8-10
    Introduction
    Traumatic brain injury is considered as the major cause of mortality and hospitalization of about ten million people across the globe. Most of these patients are young and active people suffering disabilities. Tranexamic acid (TXA) therapy is commonly used to reduce blood loss and need for blood transfusions in surgical cases. This study aimed at investigating the effect of tranexamic acid drug in patients with epidural hematoma.
    Methods & Materials/Patients: In a clinical trial study, 100 patients with acute epidural hematoma diagnosed with traumatic brain injury were enrolled. The patients in both groups were matched for age and sex groups. Fifty patients treated with the tranexamic acid drug were compared with 50 patients in the control group. Hematoma size variations (diameter and volume) between the two groups were studied.
    Results
    A hundred patients with traumatic brain injury with a mean age of 34.2 ± 7.9 were studied. There were 69% male and 31% female patients. Place of hematoma was 33% in parietal, 39% in the frontal and 28% in temporal region. Hematoma diameter was 3.71 ± 1.8 mm after treatment with tranexamic acid, and 4.03 ± 1.6 mm in the control group. There was no statistically significant difference between the two groups. The volume of hematoma was 8.04 ± 3.2 cc in patients treated with tranexamic acid, and 10.4 ± 3.7 cc in the control group. There was statistically significant difference between the two groups.
    Conclusion
    According to our study, tranexamic acid drug can be effective on bleeding control in patients with acute epidural hematoma. The role of these drugs in elective surgeries has been proven. In cases of brain trauma they can be useful and improve the prognosis of patients.
    Keywords: Tranexamic acid, Acute Epidural Hematoma, Brain Trauma, Cerebral Hemorrhage
  • Association of Obesity and Overweight with Disc Height and Disc Herniation in Lumbar Spine
    Sima Falah Arzpeyma, Gholamreza Mahfoozi, Parisa Sedighi Moghadam Pour* Pages 11-14
    Background and Aim
    Low back pain is the most debilitating condition, and can lead to decreased physical function, compromised quality of life, and psychological distress. Several studies has conducted to recognize the risk factors of LBP, but despite of strong relationship between obesity and LBP, the underlying mechanisms are unclear. The aim of this study was to evaluate the relationship between obesity and overweight with disc height and disc bulging at each level and total levels in lumbar vertebra, considering occupational risk factor as a cofounder variable.
    Methods & Materials/Patients: This is a cross-sectional study on 102 patients with LBP referring to MRI department in Poursina hospital in Rasht. BMI (kg/m2) categories modified for Asian populations based on World Health Organization guidelines were used. Disc height and disc herniation were evaluated in sagittal T1, sagittal T2 and axial T2 MRI images. We used four risk factors agreed by US-NIOSH (USA-National Institute for Occupational Safety and Health), to evaluate the occupational risk factors. Regression test was used for statistical analysis.
    Results
    Of the 102 patients, 36.3% were men and 63.7% were women. The range of age was 15 to 75 years. Results showed that 26.5% of patients had normal BMI, 39.2% were overweight and 34.3% were obese. Distribution of levels of occupational risk factor included 36.3% low, 17.6% moderate and 46.1% high. Analysis with regression test showed that the relationship between obesity and overweight and disc height was negative at total levels and all levels, unless L5-S1. At L5-S1 level there was no association. There was a positive relationship between obesity and total score of disc herniation at L1-S1. There was no association between overweight and total score at this level. At L1-L2, L2-L3 and L5-S1 there were no association between obesity and overweight and disc herniation and at L3-L4 and L4-L5 there was a negative relationship between obesity and disc herniation.
    Conclusion
    Our study noted the positive and significant effect of obesity and overweight on disc degenerative changes in lumbar spine. Since there is abundant evidence in the literature demonstrating the strong association of disc degeneration on MRI with low back pain, Prevention and treatment of being overweight or obese must be a public health priority. If successful, such outcomes may lead to the prevention or minimization of the extent and severity of disc degeneration, which in turn may also decrease the risk of developing low back pain and the subsequent need for medical management.
    Keywords: Body Mass Index, Intervertebral Disc, Spine
  • Hojjat Hossein Pourfeizi, Ali Sadighi, Alireza Sadeghpour, Bahamin Attar*, Zahra Azizian Pages 15-18
    Background & Importance: Spinal deformity is one of the most common disorders among the vertebral diseases that results from unnatural curvatures of spine, such as scoliosis and kyphosis. Spinal fusion surgery used most commonly to treat certain types of spinal deformity. Here in, we report the efficacy of posterior spinal fusion accompanied by instrumentation in patients with the limitations of the anterior approach.
    Case Presentation
    Spinal deformity is one of the most common disorders among the vertebral diseases that results from unnatural curvatures of spine, such as scoliosis and kyphosis. Spinal fusion surgery used most commonly to treat certain types of spinal deformity. Here in, we report the efficacy of posterior spinal fusion accompanied by instrumentation in patients with the limitations of the anterior approach.
    Conclusion
    The outcomes of posterior spinal fusion surgery were found to be satisfactory in patients with the limitations of the anterior approach.
    Keywords: Spinal Deformity, Spinal Fusion, Anterior Approach
  • Souad Bakhti Bakhti*, Nabila Tighilt Tighilt, Wahiba Khoudir Khoudir, Mohamed Djennas Djennas Pages 19-21
    Background & Importance: Iniencephaly is a rare cranio-cervical deformity. It belongs to neural tube defects. This disorder is characterized by a retro flexion of the head, a very short neck, varying degrees of incomplete posterior closure of vertebrae and cervical and thoracic spinal synostosis. This malformation is associated with central nervous system and systemic malformations. Most of patients are dead born and others die after few hours of life. There are only few long term survivors reported in literature.
    Case Presentation
    A 7-year-old girl with iniencephaly signs who has been managed conservatively and still alive after 6 years of followup.
    Conclusion
    Iniencephaly is a rare complexe disorder with a dismal prognosis but not uniformly fatal.
    Keywords: Iniencephaly, Neural tube defect, Spine
  • Hossein Ghalaenovi, Maziar Azar, Hessam Rahatlou*, Shahrzad Astaraki Pages 22-25
    Background and Importance: Lumboperitoneal shunts are commonly used to treat several conditions, but their use can result in significant complications. We discuss a complication of these shunts that has not been reported in the literature to date.
    Case Presentation
    An obese, 41-year-old woman admitted to Rasool Akram Hospital complaining of a severe headache and blurred vision. The physical examination indicated that she had papilledema, and a lumbar puncture demonstrated cerebrospinal fluid opening pressure of 33 cm of H2O. Pseudotumor Cerebri was diagnosed, and the patient underwent surgery to insert a lumboperitoneal (LP) shunt. She suffered from severe headaches and nausea during the post-operative period. The post-operative syndrome was misdiagnosed as shunt-induced cerebellar tonsillar ptosis; however, further evaluation indicated that intracranial chronic subdural hematoma, a very rare complication subsequent to lumboperitoneal shunting, was the cause of the post-operative syndrome. Subdural hematoma was evacuated and her symptoms disappeared thereafter.
    Conclusion
    Persistent symptoms, such as headache, nausea, and vomiting, after placement of a lumboperitoneal shunt should be taken serious, and imaging, such as a CT of the brain, should be done to rule out subdural hematoma.
    Keywords: Benign intracranial hypertention, Chronic subdural hematoma, Lumboperitoneal shunt
  • Guive Sharifi, Ehsan Alimohammadi*, Kaveh Ebrahimzadeh, Karim Moradian, Omidvar Rezaei Pages 26-28
    Background and Importance: Disk sequestration can be defined as a herniated disk with perforation of the fibrous ring (or outermost annulus fibrosus) and posterior longitudinal ligament with migration of the disk fragment to the epidural space. Even after the introduction of high-resolution magnetic resonance imaging (MRI), it is still frequently misinterpreted as neoplastic masses. Unfortunately, no particular symptoms or signs are also known to allow differentiation between atypical hernias and spinal tumors.
    Case Presentation
    This study describes a rare case of a huge herniated and sequestrated disc, which is misinterpreted as a spinal tumor on the radiological report.
    Conclusion
    MRI findings are useful in the preoperative diagnosis of disc herniation. The differential diagnosis includes not only metastatic lesions but also some other benign epidural lesions such as synovial cysts, hematomas, and abscesses.
    Keywords: Disk Sequestration, Spinal Tumor, Herniated Disk