seyed mojtaba miri

Nowadays, the endoscopic transsphenoidal approach is the initial option for resection of all pituitary adenomas. The current study reported the experience with endoscopic transsphenoidal surgery remission rates using the 2010 consensus criteria, predictors of remission, and the associated complications.
A prospectively collected database of 49 patients with acromegaly who underwent endoscopic endonasal transsphenoidal surgery was analyzed. Tumors were classified according to size, as well as the Knosp and the Hardy-Wilson classifications. Endocrinological remission was defined as normal insulin-like growth factor (IGF)-I level and either a suppressed growth hormone (GH) level Biochemical remission was achieved in 7 of 9 (77.8%) microadenoma and 28 of 40 (70%) macroadenoma. The total remission rate was 71.4% and gross total resection was achieved in 45 of 49 (91.8%) patients. Tumor size, age, gender, history of prior surgery, suprasellar extension, and sphenoid sinus invasion were not associated with remission rate. Preoperative variables predictive of remission included the Knosp score (P = 0.041) and GH levels (P = 0.047). Two patients (4.1%) experienced postoperative pan hypopituitarism, and permanent DI was observed in 3 (6.1%) patients. One patient (2%) had cerebrospinal fluid (CSF) leaks treated with serial lumbar punctures. The median follow-up period was 25.45 months; ranged from 3 to 49.
Endoscopic transsphenoidal adenoma resection leads to a high rate of endocrinological remission in patients with low acromegaly complication. Patients with high preoperative GH levels and the Knosp scores are less likely to achieve remission.

Low back pain is one of the most important causes of disability among people around the world. Although only 2-5% of low back pain disorders resulting from herniation of lumbar intervertebral discs but surgery for lumbar disc herniation is a common procedure. The aim of this study was to determine the relation between some bio-psycho-social variables and treatment outcomes in patients who undergo first time single-level lumbar discectomy.
This is a prospective observational analytic study comprised 100 patients (age range 18-73 years) underwent single-level lumbar disc surgery. The patients who met our inclusion criteria and were willing to participate in the study were recruited from the neurosurgery ward of Logman and Imam Khomaini hospitals in Tehran, Iran, between October 2015 and March 2016. The patient completed SF-36 quality of life Questionnaires before, one and two months after surgery.
In comparison to standard values, before the surgery patients had significantly lower baseline SF-36 (36-Item Short Form Survey) Questionnaire value in all 8 domains. The role limitations due to physical health had greatest impact on quality of life. At the eight weeks’ follow-up SF-36 scores showed significant improvement in both physical and mental scales. Age had no significant impact on mental scales of weeks’ Questionnaire but in age less than 30 years there was a positive relation between the patient’s age at surgery and physical aspects of quality of life. Although there was no significant difference in physical aspects of SF-36 Questionnaire between males and females but males had a significantly higher mean mental health score than females after surgery. Smokers had lower value of mental scales of SF-36 Questionnaire than in nonsmokers.
The result of this study showed that surgery for lumbar disc herniation had a great impact on both physical and mental scales of SF-36 Questionnaire two months after surgery. Factors such as age, sex, smoking and psychological factors can play the role of predictor for patient’s outcomes after lumbar disc surgery.

Neurological emergencies are common causes of emergency department visits. The need for emergency medicine (EM) physicians and/or specialists worldwide is growing to meet this requirement. Delivery of time-sensitive interventions and lifesaving care requires training.. The aim of this study was to evaluate the level of knowledge of EM residents in neurosurgical emergencies before and after holding an education course.. In this cross-sectional study, 28 EM residents during their first and second years of training were evaluated. A multiple choice questionnaire containing 60 questions about neurosurgical emergencies (radiology, cranial, spinal and spinal cord, and pediatrics) was designed by 3 neurosurgeons. Without any prior notification, pre-training exam was taken. A short-term course of education via didactic lectures in 8 sessions was held after the first exam. At the end of the course, participants were tested again in the similar conditions as the pre-training test. Scores were analyzed using paired t-tests.. Performance of residents was significantly improved from pre-training test with mean scores from 35.7 to 42.03 on post-training test (P < 0.001). Scores between males and females in the two exams were not significantly different (P = 0.063). The second-year residents had a significantly better performance compared to the one-year residents (P < 0.001).. At present, there is no standard education program that provides the optimum needs for EM residency training. To deal with the need of improving EM residency education in neurosurgical emergencies, teaching by neurosurgeons either through formal lectures and clinical rotations or other similar educational methods could be advantageous..

The aim of this study was to determine predictive factors of blood transfusion and the length of hospital stay in patients who underwent spinal surgery that required discectomy or decompression with laminectomy, without segmental instrumentation. The purpose of this multi-center, prospective cross-sectional survey study was to determine predictive factors of blood transfusion and the length of hospital stay in 252 adults’ patients who underwent spinal surgery that required discectomy or decompression with laminectomy, without segmental instrumentation. Descriptive analysis, univariate and multivariate analysis were used to describe the predictive factors of blood transfusion requirement and the length of hospital stay (LOS). According to our statistical analysis the length of operation (R2: 0.65 and p< 0.001) and the volume of intra-operative blood loss (R2: 0.66 and p=0.033) significantly predict the postoperative LOS in patients who had had the lumbar discectomy. Additionally major predictors for intra-operative blood loss were the length of operation (R2:0.30 and p<0.001) and much more comorbid conditions (R2:0.34 and p=0.002).The considerable predictors for postoperative LOS in patients who had had laminectomy without instrumentation were the length of the operation (R2: 0.34 and p<0.001), perioperative blood loss (R2: 0.44 and p=0.042) and also age >50 (R2: 0.42 and p<0.001). As well, the length of operation (R2: 0.27 and p<0.001), mean of perioperative systolic blood pressure (R2: 0.31 and p<0.001) and the co-morbidities (R2: 0.42 and p<0.001) were the significant predictors for perioperative blood loss. In order to our study, in discectomy and laminectomy without instrumentation, length of operation and the volume of perioperative blood loss seem to be the significant predictors for length of hospital stay.

Blood loss during spinal decompression and fusion is high as much or more than the patient’s total estimated blood. It is possible that increased blood loss increased the risks of morbidity and eventually length of hospital stay (LOS). The aim of this study was Identification the predictors of blood transfusion in major spine surgery. This multi-center study was a cross-sectional survey study of predicting factors of LOS and intraoperative blood transfusion in patients undergoing posterior lumbar spinal surgeries between April 2012 and June 2013. In this study, 298 patients who needed spinal surgery upon for spinal stenosis, for spondylolishtesis and for fracture were enrolled. Revision surgeries were not included. The number of level fused (mainly more than three segments) had significant correlation with intraoperative blood loss (IBL). Intraoperative mean SBP was the second momentous variable subsequent to the number of level fused. It appears diminishing intraoperative mean SBP could directly proportional to decreased IBL, need of red cell transfusion, short operation time and eventually decreased LOS. Length of operation was important as intraoperative SBP in predicting IBL and eventually LOS. In this study, we observed that number of instruments (especially more than six screws) had significant correlation with IBL though in logistic analysis it was not useful predictor for IBL. Factors included: increasing age, length of surgery, increased intraoperative mean SBP, more level of laminectomy and furthermore the number of instruments could positively predict IBL. Operation length, level of fused, intraoperative mean SBP and preoperative Hb value could be useful predictor for blood transfusion. Also, age>50y, the volume of IBL (especially more than 500cc), operation length (particularly more than 180 minute), increased level of fused (mainly more than 3 levels) and the number of comorbid conditions could predict increasing LOS. This multi-center study was a cross-sectional survey study of predicting factors of LOS and intraoperative blood transfusion in patients undergoing posterior lumbar spinal surgeries between April 2012 and June 2013. In this study, 298 patients who needed spinal surgery upon for spinal stenosis, for spondylolishtesis and for fracture were enrolled. Revision surgeries were not included.

Although fungal brain infections are not uncommon, intracranial granulomas due to fungi are rare. Immunodeficiency is considered to be the main predisposing factor. We have presented the case of a 21-year-old lady admitted to the emergency ward with the clinical picture of impending brain herniation. She was a known case of chronic mucocutaneous candidiasis (CMCC) since childhood and had been under oral topical nystatin treatment which she had arbitrarily discontinued for the past ten years. The patient underwent emergent craniotomy and resection of the lesion. Pathologic exam revealed its fungal granulomatous nature. Cultures documented Candida albicans as the offending pathogen. The history of immunodeficiency was a useful clue in this case. To the best of our knowledge, this was the first case of fungal granuloma of the brain in the setting of chronic mucocutaneous candidiasis.

Chondroma is a benign tumor which mostly occurs in extremities but also sometimes in brain. Most intracranial chondromas arise from skull base, but chondroma of falx origin is a rare circumstance. Indeed, the intracranial chondromas rise from falx is mostly in relation with syndromic disorders such as Mafucci''s syndrome or Ollier''s syndrome. Here, we reported a rare case of falxian intracranial chondroma in a young man who has normal physical examination and no signs of any syndromic disorder. The goal of this paper was to raise awareness about chondromas and suggest that chondroma be ruled out in any patient with masses arising from falx.

Topically applied tranexamic acid has been shown to decrease the amount of blood loss associated with major spinal surgical procedures. The aim of this study was to evaluate the effects of locally applied tranexamic acid in epidural space on post-laminectomy blood loss. One hundred patients who were scheduled to undergo laminectomy in Imam Khomeini Hospital in Tehran, Iran were enrolled in a clinical trial

Meningiomas are among the most common tumors of the brain. Skull base meningiomas comprise s major part of brain meningiomas. They are difficult to treat because of proximity to major vital neuro-vascular structures which makes their surgical resection hazardous and fraught with a high rate of complications. Radiosurgery is considered as an alternative efficient way to treat them, which targets the tumor and its supplying vasculature. The standard treatment consists of tumor eradication and its supplying vessels through homogeneous dose of 201 rays of cobalt 60 source