amir mahabadi

In the present manuscript, an 87-year-old man, who was a candidate for knee joint replacement surgery due to severe osteoarthritis of the right knee, was case reported. He underwent neuroaxial anesthesia. Following spinal anesthesia with bupivacaine 0.5% in the fourth and fifth lumbar vertebra, the patient developed myoclonic seizures in the lower limbs and abdomen that lasted during the surgery, as well. Due to the continuation of the seizures, the necessary examinations were performed and an extra-axial tumor in the left parasagittal was detected in the patient’s brain imaging.

Craniopharyngioma is a group of primary sellar and suprasellar neoplasms that are usually observed in two separate age groups. It begins in childhood from 5 to 15 years old and in adulthood from 45 to 60 years old and can manifest with various neurological, visual and endocrine symptoms. The present study was conducted with the aim of determining the frequency of visual disturbances and headache in patients with craniopharyngioma tumor after surgery.

The present study is a cross-sectional descriptive study that was conducted in 1402. In this study, the files of all patients with craniopharyngioma tumor who were referred to teaching hospitals in Isfahan between 1392 and 1401 were examined. The sampling method was census and included 41 patients.

During the post-operative follow-up, after the surgery, one of the children had diplopia and three children had decreased visual acuity. In adults, one person had diplopia and 5 people had decreased visual acuity. Also, three people were identified with defects in the field of vision. Classical headache (early morning) was not observed in the patients and most of the headaches were in the evening. Tension headaches were observed in three children and four adults. In fact, surgery can significantly reduce headaches in these patients.

In the end, this study intends to emphasize the role of post-operative follow-up in reducing or ideally eliminating headache, vision disorders and tumor recurrence, leading to a better prognosis in patients.

Vestibular schwannoma tumor in advanced levels can cause a wide range of disorders, the aim of this study was to determine the frequency of balance disorders in patients with vestibular schwannoma tumor after surgery in Isfahan city.

The present study is a cross-sectional descriptive study that was conducted in 1402. In this study, the files of all patients with Vestibular schwannoma tumor who were referred to the teaching hospitals of Isfahan, including Kashani, Al-Zahra, Seyyed al-Shohada and Imam Hossein (AS) between 1392 and 1401, were examined. The sampling method was census and included 55 patients.

The average age of the patients was about 46 years and ranged from 10 to 78 years. 61.8% were men, 87.3% were married and only 1.8% had a family history of tumor. 15 patients (27.3%) had balance disorder after surgery, and muscle strength was lower in patients with balance disorder. Three of the patients had also died.

Based on the obtained results, following up the condition of patients, especially balance disorders, can be fruitful for improving the quality of life of patients.

Sodium disorders are one of the most important electrolyte disorders among brain trauma patients.
The purpose of this study was to determine the frequency of hyponatremia in patients with moderate and severe brain trauma and its relationship with disease prognosis.
This descriptive-cross-sectional and prospective study was conducted on brain trauma patients visiting Kashani Hospital in Isfahan city in 2023. The obtained data was analyzed by SPSS 24.
Out of the 54 examined (23 severe TBI and 31 moderate TBI) patients, hypernatremia was observed in seven cases (13%), and hyponatremia was observed in 23 cases (42.7%). Hyponatremia on the first day had a significant relationship with the bad prognosis of the disease. In addition, a significant relationship was observed between the type of imaging findings and GOS, so that people who had ICH imaging findings were associated with a poorer prognosis p <0.05.
On the first day, hyponatremia had a significant prevalence in moderate and severe brain trauma patients, which was associated with a bad prognosis of the disease, and this relationship is not dependent on factors such as age, gender, and cause of trauma.

The novel severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has had drastic effects on global healthcare. This study aimed to ascertain changes in the volume of neurosurgical procedures carried out before, during, and after the COVID-19 pandemic in Isfahan city hospitals, Iran.

This retrospective cohort study was conducted at the three Hospitals of Isfahan. Data of the neurosurgical patients (both urgent and nonurgent) treated from the February in 2017 to 2022 were collected. Two groups were thus created (COVID-19 (2020-2022), pre-COVID-19 (2017-2X019) and Post-COVID (2022-2023).

We treated 30456 admissions under neurosurgery during the COVID-19 (2020-2022) compared with 42300 admissions in pre-COVID-19 (2017-2019). Pre-COVID-19, the median number of referrals was 46 per 24 hour. During COVID-19, this decreased to 33 per day. During the post-COVID era, there was an admission of 17,341 patients, which escalated to 37 cases within a 24-hour timeframe during the post-COVID period. A noteworthy disparity was evident in the overall count of admitted patients, the aggregate of surgical procedures executed, and the elective surgical procedures performed during the post-COVID phase when juxtaposed with the pre-COVID and the COVID-19 pandemic periods (P<0.05). Additionally, there was a marked contrast in spinal column issues between the post-COVID period and the pandemic period (P<0.05).

The capacity to safely treat patients requiring urgent or emergency neurosurgical care was maintained at COVID-19 pandemic. Moreover, following the conclusion of the pandemic, there was a decline in the number of surgical procedures in contrast to the pre-pandemic period.

Background and importance: 

Cervical laminectomy and fixation (PCF) is a surgery used in the treatment of symptomatic patients who are resistant to medical therapy, though it can have serious complications affecting patient outcomes.

This case report describes a rare occurrence of a solitary fibrous tumor (SFT) at the site of a previous cervical laminectomy in a 45-year-old female patient. Following non-surgical treatment for paresthesia and weakness in the upper limbs due to cervical stenosis, the patient underwent cervical laminectomy from C3-6 without instrumentation.

One year after surgery, the patient presented with severe pain and swelling at the surgical site, and radiological evaluation revealed a large mass in the para-vertebral muscular layer. The mass was removed, and microscopic evaluation revealed a typical SFT. The patient underwent an extension of laminectomy and fusion with lateral mass screw, and follow-up at six months showed no recurrence of the tumor.

In this paper, we will present a case of a 63‑year‑old female with bifrontal epidermoid tumor who has gone under bilateral craniotomy. In a case report study, a 63‑year‑old female with a chief complaint of progressive headache that has been admitted to Department of Neurosurgery was studied. Magnetic resonance imaging was performed for better evaluation. After detection of bifrontal epidermoid cyst, the patient underwent surgery, and following the surgery, a cut of the tumor has been excised, sent for pathology sampling and reviewed for detection of cyst. Microscopic review of the resected part reported normal brain tissue along with sections containing parts of cyst wall covered by squamous epithelium and huge amount of irregularly stratified keratin within its lumen, which clearly emphasizes on diagnosis of a typical epidermoid tumor. Bifrontal epidermoid cyst is rare, and according to our study, the clinical symptoms and patients imaging were consistent with other studies.

As marcaine is administered to a great extent due to minor complications and reasonable expenses and as discectomy is prevalently used in Iran, this study makes a comparison between effect of marcaine alone, lidocaine alone, and marcaine plus lidocaine on pain relief of patients undergoing lumbar disc open surgery.

In a clinical trial study, 192 patients were selected and randomly divided into four groups. Patients in Groups 1–4 received 0.5 ml marcaine during surgery, 5 ml lidocaine 2% before incision, 5 ml lidocaine 2% before incision plus 5 ml marcaine during surgey and normal saline, respectively. After patients gained knowledge of visual analog scale (VAS) criteria, their severity of pain was measured and was recorded in their profiles, along with demographic details and history of diseases. After surgery and their transfer to their rooms, their severity of pain was measured and recorded again by using VAS criteria. Finally, difference between the four groups was compared by SPSS software.

The mean (±standard deviation) of postoperative pain in marcaine + lidocaine, marcaine, lidocaine, and normal saline was 3.5 ± 1.3, 3.5 ± 1.6, 36.1.9, and 4.2 ± 1.8, respectively, and we did not observe any significant difference in severity of pain after surgery in these groups (P = 0.15). The highest and lowest degree of satisfaction occurred in marcaine-lidocaine group and control group, respectively, (40 patients [83.3%] vs. 25 patients [52.1%]).

Lidocaine-marcaine treatment reduces the need to opiates in cases of postoperative pain relief of discectomy and provides patients with great satisfaction.

Cerebral aneurysms are a kind of cardiovascular diseases which are accompanied with high morbidity and mortality due to rupturing and causing subarachnoid hemorrhages. The current study aimed to determine epidemiologic and demographic features and prognosis of patients with cerebral aneurysms.

In this cross‑sectional study, 465 patients with cerebral aneurysms hospitalized in Al‑Zahra Hospital were studied. The required information including demographic, epidemiologic, and clinical features of the disease were extracted from their records. The obtained data were analyzed using SPSS software and the factors associated with the prognosis of the disease were determined.

Four hundred and sixty‑five cases with cerebral aneurysm undergoing surgery were investigated. The mean age of the patients was 48 ± 14 years whereas 216 cases (46.5%) were male and 249 (53.5%) were female. Two hundred and thirty‑seven patients (51%) remitted completely while the disease caused moderate disability in 84 cases (18.1%), severe disability in 24 ones (5.2%) and vegetative state in 9 cases (1.9%) and mortality in 57 ones while it was unknown in 54 cases (11.6%). In terms of the age of patient, WFNS index, anatomical position of aneurysm, type of aneurysm lesion, the incidence season of the disease, type of postoperative complications, family history and operative approach, the disease outcome had a significant difference while gender, ethnicity, and risk factors had no significant effect on the disease outcome.

According to the type of aneurysm, the incidence position of the aneurysm and other epidemiologic, demographic, and clinical features, providing the prevention and treatment strategies is necessary

Intervertebral disc herniation is a major cause of low back pain. Several treatment methods are available for lumbar disc herniation including Chemonucleolysis, open surgery, nucleoplasty, laser disc decompression, and intradiscal electrothermal therapy. The high prevalence of lumbar disc herniation necessitates a minimally invasive yet effective treatment method. In this study, we compared the outcomes of open surgery and nucleoplasty method in patients with single lumbar disc herniation. This study was a noninferiority randomized clinical trial conducted in one of the University Hospitals of Isfahan Medical University; The Alzahra Hospital. About 200 patients with the diagnosis of lumbar disc herniation were recruited and were assigned to either the treatment or control groups using block randomization. One group received open surgery and the other group received nucleoplasty as the method of treatment. Patients were revisited at 14 days, 1, 2, 3 months, and 1-year after surgery and were assessed for the following variables: Lower back pain, lower limb pain, common complications of surgery (e.g., discitis, infection and hematoma) and recurrence of herniation. The mean (standard deviation) severity of low back pain was reduced from 6.92 (2.5) to 3.43 (2.3) in the nucleoplasty group (P = 0.04) and from 7.5 (2.2) to 3.04 (1.61) in the discectomy group (P = 0.73). Between group difference was not statistically significant (P = 0.44), however, time and treatment interaction was significant (P = 0.001). The level of radicular pain evaluated 1 year after treatment was reduced from 8.1 (1.2) to 2.9 (1.2) (P = 0.004) and from 7.89 (2.1) to 3.6 (2.5) (P =0.04) in the discectomy and the nucleoplasty groups respectively, significant interaction between time and treatment options was observed (P < 0.001) while there was no significant difference between two treatment groups (P = 0.82). Our results show that while nucleoplasty is as effective as open discectomy in the treatment of lumbar disc herniation, it is also less invasive with higher patient compliance. Taking factor such as decreased cost and duration of the surgery, as well as faster recovery in patients into account; we suggest considering nucleoplasty as an effective method of treatment in patients with single-level disc herniation.

After single disk herniation operation, about 5-20% recurrences may occur. Different etiology may affect the prevalence of recurrence. Disk degeneration according to Modic and Los Angles scales could affect recurrence rate. This study wants to show the relationship between disk space degeneration according to these scales on severity, time, and prevalence of disk herniation recurrence.

Thirty-four patients presented with radicular pain (with or without back pain) and history of lumbar disk surgery was included in this prospective study. Pre- and postoperative T2-weighted sagittal magnetic resonance imaging (MRI) compared for Modic and Los Angeles disk degeneration grading, then, data analysis on SPSS (version 20) software, paired t-test, and others.

The result of study shows for first operation that grade (II) Los Angeles is the most common, but, for second procedure grade (IV) was less common and the mostly decreased (from 14.7 to 9.2%). In addition, Wilcoxon test shows no change of Los Angeles grading for both first and second surgery (P = 0.06). Whereas; based on Modic criteria grading was different from first operation, in other words, grade (I) (41.2%) in first operation was changed to 20.6% in second operation (P = 0.007).

Our study showed that the Los Angeles criterion is more practical and useful for prediction of recurrence and in the patients with Los Angles grade III and IV and grade II and III on Modic scale, the chance of recurrence is less than patients with lower grades.

Traumatic brain injury is one of the most common causes of mortality and morbidity among the young and middle aged. This study was conducted to evaluate the factors that affect the outcome of the patients with moderate to severe traumatic brain injury. This descriptive analysis study enrolled 460 patients with moderate to severe traumatic brain injury, according to Glasgow Coma Scale (GCS) score, who were admitted in Shahid Bahonar Hospital of city of Kerman during one year (October 2009 to October 2010). Data collection tool was a checklist that includes level of conciseness, age, gender, type of trauma, level of arterial oxygen and arterial blood pressure. Level of conciseness was evaluated according to GCS score at the time of admission at emergency room and six and 12 hour after that. Age of patients was 10 ± 28.3 years (mean ± SD). Duration of admission was 15.4 ± 8.3 (mean ± SD) that had significant relationship with GOS (P= 0.0001). Sixty percents of patients had good outcome. GCS at the time of admission and 6 and 12 hour after that had significant relationship with GOS (P=0.005) but logistic regression analysis showed that only GCS of patients 12 hour after arrival had significant relationship with GOS (P=0.004). GCS of the patients 12 hour after arrival is the most important prognostic factor in traumatic brain injury so data about GCS should be recorded meticulously to assess the outcome.

Continuous intracranial pressure (ICP) monitoring is now an accepted part of neurosurgical practice, but in Iran, where has a high rate of the road traffic accidents, ICP monitoring does not use routinely. We are reporting the primary results of applying ICP monitoring in the patients with traumatic head injury in Bahonar Hospital in 2011. During one year, all patients with traumatic head injury who underwent ICP monitoring because of traumatic brain injury were evaluated considering the primary neurological status and the treatments they had received based on their ICP. We also evaluated the outcome 6 months after the injury. During this time, 18 patients underwent ICP monitoring. The mean age was 33±9.6 years and the mean GCS was 6±1.3. ICP monitoring showed high ICP in 13 out of 18 patients. Seven patients received barbiturate coma and 8 operations were performed on 6 patients with refractory high ICP. ICP was controlled in 10 patients. All three patients with uncontrollable ICP died during hospital admission. Outcome was related to the primary GCS, controllable ICP, and the pupil reaction. It seems that ICP monitoring is a safe and effective modality in the patients with traumatic brain injury. However it is necessary to conduct studies with large samples number to evaluate the role of ICP monitoring on long term outcome and functional recovery of the patients with traumatic brain injury.

Intracranial aneurysms are among the most common vascular malformations of the brain being associated with high morbidity and mortality. The epidemiology and clinical pattern of the disease will assist the physicians to encounter the disease more precautiously. The pattern and characteristics of intracranial aneurysms has not been previously described in Iranian population. Thus the aim of the current study is to determine the characteristics of the disease in an Iranian population. This was a retrospective cross-sectional study being performed in Al-Zahra and Kashani healthcare centers affiliated with Isfahan University of Medical Sciences during a 10-year period from 2003 to 2013. We included all the patients who presented to our centers with acute subarachnoid hemorrhage and were further diagnosed to have intracranial aneurysms. The patients’ medical charts were reviewed for demographic information, risk factors, the treatment options and the patients’ outcome. Overall we included 447 patients with mean age of 48.1 ± 14.1 (range 13 to 82) years out of whom 210 (47%) were men and 237 (53%) were women. Among the patients, there were 31 (6.9%) Armenian. Spring with 141 (31.5%) patients was the most common season of presentation. Family history of vascular anomalies was reported in 26 (5.9%) patients. Of the patients, 143 (32%) had more than one aneurysms. After the city of Isfahan, the most common place of residence was western parts of the province. World Federation of Neurosurgeons Scale (WFNS) was calculated to be 1 in 169 (37.8%) and 2 in 131 (29.3%) patients. The most common site of the aneurysms was middle cerebral artery in 166 (37.1%) followed by anterior communicating artery in 96 (21.5%). Saccular aneurysms were found to be the most common type of the aneurysm with a frequency of 296 (66.2%). Overall, 412 (92.2%) patients underwent surgical clipping while 37 (8.9%) were expired during the hospital stay. 35 (7.8%) patients died before operation. Infarction was the most common complication of the surgery being reported in 54 (13.1%) followed by neurological deficit in 24 (5.8%). Hypertension was the most common risk factor being recorded in 93 (20.8%). During the hospital stay, 46 (10.3%) developed vasospasm and 22 (4.9%) rebleeding. The clinical pattern as well as outcome of the patients with intracranial aneurysms in Iran is similar to that being previously reported in the international literature. As the mortality rates of these aneurysms is extremely high, screening work-ups especially in those with family history of vascular anomalies is recommended. Keywords: