arash fattahi

Traumatic sacral spondylosis is a sporadic injury pattern, and frequently, it is accompanied by injury to the cauda equina with perineal numbness, paralysis of sphincters, and sacral root weakness.

A 35-year-old male complained of low back pain, left-sided dropped foot, and sphincter dysfunction after 9 meters fall. On imaging, he had S1-S2 spondylosis. We operated on the patient with a single posterior approach. The L3-S3 instrumented fusion after stepwise distraction to reduce deformity concomitant with L5-S2 laminectomy and foraminotomy. After two years of follow-up, the sphincter disturbance was relieved, but the limb deficit had no change. On follow-up images, the fusion between S1 and S2 was confirmed.

We recommend surgical treatment of this injury to allow some neurological improvement and stabilize the spine on the pelvis. Also, the operation must be delayed for days to rule out any intra-pelvic life-threatening, primarily vascular injury. A stepwise intraoperative distraction on not curved rods could be helpful in the reduction of this deformity.

People with cardiovascular problems have poor sleep quality and quality of life. These problems exacerbate the process of their disease.

The purpose of this study was to investigate the effectiveness of acceptance and commitment-based therapy on improving quality of life and sleep quality of cardiovascular patients.

This research has been executed in context of a clinical trial plan with pre-test, post-test and two-month and six-month follow up period. Among the patients with cardiovascular disease of Kermanshah city who had referred in hospitals of this city in year 2020-2021, 40 people were purposefully selected and were randomly assigned to experimental (n=20) and control (n=20) groups. Tools of this research included: Pittsburgh sleep quality index (PSQI) and The Short form health survey (SF-36). The experimental group received eight sessions of 90-minute acceptance and commitment therapy. SPSS-24 software and repeated measures analysis of variance were used to analyze the data.

The results of this research indicated that acceptance and commitment therapy leads to a significant improvement in sleep quality and quality of life in the experimental group (P<0.01). The effect size for quality of life and quality of sleep were 0.63 and 0.62, respectively (P<0.01).

The findings of this study showed that acceptance and commitment therapy leads to improved quality of life and quality of sleep in patients with cardiovascular problems. Based on these findings, this treatment can be used to improve sleep quality and quality of life problems that play an exacerbating role in the process of disease in patients with cardiovascular problems.

The purpose of this study was determination of the prevalence of post-traumatic hydrocephalus (PTH) in patients who had traumatic brain injury (TBI) worldwide.

Four electronic databases including Scopus, PubMed, Embase, and Web of Science were searched in this meta-analysis. The random-effects model was appliedfor the pooled effect size of I2> 50%. Subgroup analysis was done to evaluate the heterogeneity, and the Egger’s test was used to test the asymmetry of the funnel plots in order to assess the publication bias.

A total of 48 studies with 11624 patients were evaluated. The pooled prevalence of PTH was 13% [95% confidence interval (CI): 11.0-15.0] and according to decompressive craniectomy (DC) surgery was 22.0% (95% CI: 18.0-26.0). This result among patients with severe TBI (sTBI) was 16.0% (95% CI: 13.0-19.0) and it was higher in the developed countries. The prevalence of PTH was generally higher in studies with a sample size lower than 100 (21.0%) and was generally lower in studies conducted between 1990 to1999 (4.0%). These results were not toodifferent according to the study design.

It is recommended to design a prospective clinical study in order to explain the true dynamics and circulation of the cerebrospinal fluid (CSF) after DC. Moreover, there is a need to evaluate the cost-effectiveness of DC in reducing the intracranial pressure in comparison with other available options. In fact, performing the clinical studies with higher quality in less developed countries could provide more reliable related results to achieve a true global conclusion.

Clival fracture is a rare traumatic injury that usually occurs in patients with high-energy trauma to the head and neck. Here, we present and discuss our experience with a patient with a transverse clival fracture associated with a significant vertical displacement.A 52 years-old comatose patient was admitted to our emergency department after a high-energy motor vehicle accident. The physical examination demonstrated a Glasgow coma scale (GCS) of 6 (with the motor scale of 4) associated with a left-sided six cranial nerve palsy, a left-sided fixed and dilated pupil; and quadriparesis that was more severe on the right side. The imaging tests revealed the brain contusions, pneumocephalus, and generalized brain edema without local mass effect and midline shift. Also, it showed TCF with a significant vertical displacement and a signal change within the medulla oblongata. The clival fracture was managed in a mild head flexion position without bracing, a routine ICU exchange body positioning program, and the minimum time of supine positioning. The follow-up imaging three months later showed complete bone fusion without any displacement. After 18 months of follow-up, he ambulated, and cranial nerve deficits improved except for mild diplopia due to a remnant of 6 nerve paresis.Transverse clival fracture, as most of the authors reported, does not need surgical treatment. Bracing can be used in conscious ambulated patients. A mild head-on-neck flexion position associated with suppurative care for bedsores can be a good option for unconscious patients.

Cancers seldom happen in childhood age and awareness of accurate cancer incidence is essential in order to preventive programs. This study aimed to estimate the childhood cancer incidence in Iran using the three-source capture -recapture method.

Total new cases of childhood cancer reported by three national data sources of MAHAK charity database, pathology reports and clinical records in Iran were enrolled in this study. The common cases among three sources were determined using data linkage method. The childhood incidence rate per 1 million popula-tions was estimated based on three-source capture-recapture method. We used BIC, G2 and AIC statistics to select the best-fit model. Arch GIS was used to determine geographic distribution.

Overall, 2567 childhood cancer was included by three sources of registries. The total estimated num-ber of childhood cancer was 5388 (95% CI: 4742.15-6228,14). The higher estimated incidence rate was Leuke-mia, Lymphoma by 94.91 and 24.80 per 1 million populations and the lower incidence was liver and retinoblas-toma with 2.35 and 7.01 per 1 million populations. Provinces of Ardabil and Kohgiluyeh with an incidence rate of 420.01 and 404.61per 1 million populations had a higher incidence rate and Mazandaran and Ilam with an incidence rate of 60.87 and 66.88 per 1 million populations had the lowest incidence. The overall completeness of the childhood cancer registry based on three-source was48%.

The low-quality childhood cancer registration system highlights the needs for urgent screening programs for early detection in the high prevalent area in Iran

Idiopathic intracranial hypertension (IIH) is defined as increased cerebrospinal fluid (CSF) opening pressure and abnormal fundoscopy, when other causes of increased intracranial pressure are ruled out.

We present a patient with primary diagnosis of IIH who had undergone lumboperitoneal shunt. Later she was treated with shunt revision, anti-tuberculosis drugs and intravenous immunoglobulin. Acute lymphoblastic leukemia (ALL) was diagnosed after bone marrow biopsy. Initial response to chemotherapy was promising.

Careful history taking, avoidance of unnecessary repetition of diagnostic procedures, avoidance of a tunneled vision and a strong clinical suspicion is important to see the hidden causes underlying a difficult case of pseudotumor cerebri.

Acute lymphoblastic leukemia and carcinomatous meningitis should be sought in IIH patient with abnormal presentation and unusual response to the known treatments.

Hemangioblastoma (HB) in the supratentorial region of the brain is rare and only a few cases are reported on intraventricular HB. HB of the lateral ventricles is even rarer. We present a case of a 30-year-old man with generalized tonic clonic seizures. The brain computed tomography showed a 5.5 cm heterogeneous mass extending into both lateral ventricles with partial enhancement. Based on the size and imaging features, we present the fourth documented case of a large solitary intraventricular HB. Our approach to this unique case and some treatment complexities are also described.Considering the rarity of the case and the patient’s imaging features, the present study provides a better understanding of HB and recommends HB to be considered in the differential diagnosis of masses in the lateral ventricles. In addition, some preventable pitfalls in the treatment of such complex cases are described.

Brain tumors are rare and yet a significant cause of mortality and morbidity in adults. Surgical resection has been treatment of choice for brain tumors. Despite its effectiveness, surgical resection may cause various post-operatives complications such as infections, neurological deficits, and vascular damages that can lead to decrease in quality of life and survival rate and can impose great medical expenses. This study was aimed to assess related factors of medical and surgical complications after surgical brain tumors resection.

This was a descriptive and retrospective study performed on patients that underwent brain surgical tumor resection at Rasoul Akram Hospital of Iran University of medical science in Tehran, 2016. Age, sex, extent of resection, pathology of tumor, post-operative symptoms and complications, duration of surgery, blood loss volume during surgery, and duration of admission were collected, and analyzed with SPSS.

Of 179 patients, 47.5% (85) were male, and 52.5% (94) were female. Mean patient age was 45.8 years old, and mean admission duration was 4.6 day before and 9.7 day after surgery. The most common surgical complications were hydrocephalus (13.4%) and ICH (9.5%). The most common medical complication was electrolyte disorder (13.4%). Mean surgery duration was 1 hour 40 min and mean blood loss during surgery was 542 ml.

Based on our study, extent of brain resection was correlated with surgical and medical complications. Older age, longer duration of admission, and longer duration of surgery were correlated with medical complications, but it was not correlated with surgical complications. Older age was correlated with higher mortality rate. Blood loss volume during surgery had no correlation with surgical or medical complications.

Post-traumatic intradiploic leptomeningeal cyst (IDPTLC) manifests as an internal table disruption of the skull concomitant with a dural defect and intact external table after a previous skull fracture. It is very rare, especially in adults. We present a 30-year-old male with right occipital IDPTLC treated with duraplasty with allograft and cranioplasty with autograft ribs. Seventeen cases of IDPTLC in adulthood since 1978 were found in the literature; to the best of our knowledge, ours is the eighteenth case. Considering the possible etiology at the time of the first trauma, torn dura matter was not healed and retracted overtime. Also due to intracranial CSF pulsation, the disrupted inner table was widened and continuous force on the diploe caused a thinned swollen external table. We recommended performing overlying cranioplasty with autologous bone (rib or normal external table) with the edge of the duraplasty and the cranioplasty placed at different sites.

Meningioma is the second most common brain tumor. The extent of peritumoral brain edema (PTBE) is one of the important prognostic factors in patients with meningioma.A 55-year-old female patient suffering from a progressive severe headache and mild left hemiparesis was referred to the Department of Neurosurgery, Rasool Akram Hospital (Tehran, Iran). The preoperative imaging revealed a 2×2 cm solid extra-axial mass with bright enhancement at the outer third of the right sphenoid wing. In addition, there was a disproportionately extensive peritumoral brain edema in the right cerebral hemisphere that even involved the right internal capsule. The patient was operated through the right pterional approach and the mass was totally resected. Twenty-one days after surgery, the brain CT scan surprisingly showed only mild frontal edema and the patient was asymptomatic 1 year after the surgical treatment. According to the literature, the size and extension of the PTBE are correlated with the prognosis of meningioma. A larger edema is associated with a larger tumor, higher grade, and a more invasive meningioma with a higher recurrence rate. Our patient had a very large hemispheric PTBE which was disproportionate to the small size of the meningioma and the tumor had not directly invaded the adjacent brain tissue. We believe that the visible compression of the tumor on major veins of the Sylvian fissure was the reason for the PTBE in our patient. The presence of a large PTBE concomitant with a meningioma does not necessarily indicate a poor prognosis. Hence, we recommend a preoperative venogram to be performed in such patients.

Lymphangiomas are benign lesions consisting of abnormal proliferations of lymphatic vessels. Lymphangiomas associated with bone involvement, particularly in vertebral bodies, accompanied by cord compression, are extremely rare, and our literature review yielded only a few relevant reports. We describe a 61-year-old man presenting with progressive paraparesis and sphincter disturbance of 5 months’ duration. Magnetic resonance imaging (MRI) revealed an enhancing T8 vertebral body involvement as well as a homogeneously enhancing posterior epidural mass at the T7–T8 level, with severe cord compression and cerebrospinal fluid (CSF) blockade. The patient underwent surgery via T7–T8 laminectomy, and after the removal of the epidural mass, the surgical procedure was stopped due to severe bleeding. Histopathologic examination reported a lymphangioma. After 10 days, the patient was able to walk. In the sixth postoperative month, MRI showed complete relief of the mass effect. The wide spectrum of the preoperative differential diagnosis of lymphangiomas renders a definite preoperative diagnosis impossible; therefore, histopathologic examination is the sole definite route for their diagnosis. In case of the solitary lymphangiomas of the spine with epidural compression, preoperative angiography and embolization should be considered to reduce intraoperative bleeding and enhance the chance of total resection and total surgical resection should be performed to decrease the likelihood of recurrence.

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.

Neurofibromatosis type 1, or Von Recklinghausen disease, is the most common of the neurocutaneous syndromes, occurring in approximately 1 in 3000 people. Cutaneous, Systemic and Neurological features are the main items that the patients suffering from them. Their management is palliative, either cosmetic or function preservation. We present a 3.5 years old female with unilateral cranio-orbito-facial enlarging and infiltrating mass, involving forehead, orbit and its contents. There is also right Hemicraniocerebral Hypertrophy and right sided large single ventricle. She had no neurologic deficit, except inability to open right eye (mass infiltration). She underwent right orbital roof decompression for the management of right exophthalmous, at the 6 month of age, as the earliest presentation of the patient. We have done right sided orbital excentration, further advancement of orbital rim and reconstructive cranioplasty in accompany with right occuloplastic orbital prosthesis. In NF-1, the definite diagnosis is by finding of Lisch Nodule, which is age dependent, but the management is palliative and controversial. Right orbital roof decompression as the management of early exophthalmous (at 6 month of age), seems to be inappropriate. Are reconstructive Palliative and cosmetic surgery (above mentioned ones) appropriate, sufficient and efficacious? What should we do about Hemicraniocerebral Hypertrophy and ventriculomegaly?