فهرست مطالب
Iranian Journal of Neurosurgery
Volume:4 Issue: 1, Winter 2018
- تاریخ انتشار: 1396/12/15
- تعداد عناوین: 8
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Pages 5-12Background and AimSurgical site infection is an important complication after spinal surgery. Prevention and treatment of this complication requires more and reliable information. In this article, we investigated the epidemiology, pathogenesis, diagnosis and treatment of post-operative infection in spine procedures by reviewing previous related studies. Methods and Materials/Patients: In this paper, original articles available in PubMed and Scopus published between 1991 and 2017 were reviewed and studied.ResultsOrganisms resistant to antibiotics have increased and made treatment harder, especially in patients with instrumentation of spine. The frequency of surgical site infection depends on surgical technique, anatomical location, and duration of surgery.ConclusionPrevention is the best way to reduce the frequency of post-spinal surgical infection. Excessive use of antibiotics increases the risk of infection with bacteria resistant to treatment.Keywords: Spine, Surgery, Postoperative, Wound infection
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Pages 13-18Background and AimVascular imaging during surgical procedures is very important and has many applications. There are several methods for intraoperative vascular assessment such as intraoperative angiography, Doppler, and fluorescence-based techniques. The latter group and specially the Indocyanine Green (ICG) Video Angiography (VA) is commonly used for vascular surgery and sentinel node biopsy. However, the cost of these microscope mounted cameras limit their availability in the developing countries. Considering this limitation, we designed and constructed a simplified low-cost camera for real-time ICG angiography. In this article, we describe the device structure and give a preliminary report on its usage in an animal model. Methods and Materials/ Patients: ICG-VA camera was designed and constructed in our laboratory. The device consists of optic filters, light sources, and cameras.ResultsAfter inducing anesthesia and exposing mesenteric vessels in a mouse, ICG-VA of these vessels were taken and recorded.ConclusionConsidering the very low cost of the device and its acceptable image quality, it can be utilized in operation theatres and or laboratories for research purposes.Keywords: Indocyanine green, Angiography, Fluorescence
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Pages 19-24Background and AimAlthough operation is the most appropriate treatment for Cauda Equina Syndrome, the effectiveness of operation on clinical symptoms is still under discussion. This study aimed to determine the prognosis of Cauda Equina Syndrome in patients with lumbar disk surgery in Al-Zahra Hospital of Isfahan City, Iran, from 2013 to 2015. Methods and Materials/ Patients: In This prospective study, patients diagnosed with Cauda Equina Syndrome who underwent operation in Al-Zahra Hospital of Isfahan from 2013 to 2015 were followed up for two years and the effect of the surgery on the improvement of their clinical symptoms was investigated.ResultsIn this study, 33 patients with Cauda Equina Syndrome were evaluated. About 24-month follow-up of patients showed muscle weakness improvement in 26(78.8%) of them. Of all 19 patients with urinary dysfunction, 18(94.7%) recovered. Six (33.3%) cases improved the day after surgery, 6(33.3%) cases in one month, 4(22.2%) cases in six months, and 2(11.1%) cases within 24 months after the surgery. All 4(100%) patients with bowl disorder also recovered during the study. One (25%) of them improved the day after operation, 1(25%) one month after the operation and 2(50%) within 24 months following the operation.ConclusionAccording to the results of this study, operation of the lumbar disks leads to improvement of Cauda Equina Syndrome, including recovery of sphincter disorders and muscle weakness, but considering the limitations of our investigation (including a small sample size), further studies are recommended in this area.Keywords: Cauda Equina Syndrome, Lumbar vertebrae, Hernia, Prognosis
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Pages 25-34Background and AimPain is an experience often caused by tissue damage and is proportional to the severity of the injury. The role of underlying factors in severity of the pain such as prehospital factors have been discussed in some investigations. The current study aimed to assess the effect of different parameters on pain severity in patients with trauma. Methods and Materials/Patients: The current descriptive, cross-sectional study was conducted fully conscious 270 fully patients with trauma admitted to Poursina Hospital in Rast, Guilan, Iran, in 2016. They were assessed in terms of demographic and pre-hospital factors as well as mechanism and severity of trauma based on verbal rating scale.ResultsLinear regression analysis demonstrated that among various factors like age, sex, level of education, opium dependence, vehicle type, ventilation, blood pressure, pulse rate, mechanism of trauma, and type of trauma, the highest severity of pain was pertaining to the type of trauma such as multiple trauma and large bone fracture with mean scores of 9.26 and 9.13, respectively. It also revealed that among these parameters, mechanism of trauma, type of trauma, transfer time, type of vehicle, and pulse rate were significantly associated with the severity of the pain.ConclusionThe current study showed that increasing the quality of vehicle, decreasing the transfer time, and paying more attention to hemodynamic factors such as pulse rate, blood pressure, use of analgesic agents, and immobilization of damaged tissue can diminish the severity of pain in patients with trauma.Keywords: Severity, Pain, Trauma, Prehospital
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Pages 35-40Background and AimEndovascular neurosurgery is widely accepted as a useful modality for the management of neurovascular disorders. This retrospective study aimed to evaluate the causes of diagnostic and therapeutic neuroendovascular procedures, as well as the prevalence, type, location and management of vascular pathologies observed in Firoozgar Hospital, Tehran City, Iran. Methods and Materials/ Patients: In this study, we analyzed the causes and outcomes of the neuroendovascular procedures during 18 months from February 2013 to September 2014 in Firoozgar Hospital, Tehran, Iran.ResultsIn total, 724 diagnostics and therapeutic neuroendovascular procedures were performed on 561 patients. The mean (SD) age of the patients was 44.83(18.73) years and 598(50.27%) of them were females. The most prevalent cause of these procedures was cryptogenic intracranial hemorrhages (24.58%), followed by ruling out vascular lesions due to suspicious MRI without neurological defects (14.91%), and suspicious MRI with focal neurologic defects (11.74%).ConclusionEndovascular neurosurgery plays a key role in diagnosis and treatment of the most prevalent neurovascular disorders in our referral center.Keywords: Neurosurgery, Angiography, Brain
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Pages 41-44Background and Importance: Symptomatic Rathke’s cleft cyst is a rare lesion that often presents without any symptoms.Case PresentationWe report a 40-year-old female with symptomatic Rathke’s cleft cyst located in the sellar and suprasellar region. She presented with visual disturbance, headache, weight gain, hypothyroidism and amenorrhea. The patient underwent surgery and the pathological examination confirmed Rathke’s cleft cyst.ConclusionAlthough the symptomatic Rathke’s cleft cyst is rare, the differential diagnosis must be done with intrasellar and suprasellar lesions.Keywords: Rathke’s cleft cyst, Suprasellar lesions, Decreased visual acuit
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Pages 45-50Spontaneous Spinal Epidural Hematoma (SSEH) is a rare spinal condition. Early surgical intervention is generally indicated to prevent serious permanent neurological deficits. We encountered a case of spontaneous spinal epidural hematomas associated with motor weakness that was treated successfully by surgical evacuation.Keywords: Spinal epidural hematoma, Laminectomy, Prosthetic valve, Spinal cord injury
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Pages 51-55Background and Importance: A 60-year-old diabetic man with simultaneous diffuse idiopathic hyperostosis, massive ossification of the posterior longitudinal ligament and cervical and higher part of thoracic ligamentum flavum is reported in this article. Such comorbidity rarely occurs.Case PresentationThe patient’s chief complaint was sensation abnormalities without gait disturbance or severe cord compression symptoms despite the advanced stage of the disease. Computed tomography scan and magnetic resonance imaging confirmed multi-level involvement of cervicothoracic spine.ConclusionAfter surgical treatment, his symptoms resolved completely with no complication.Keywords: Diffuse idiopathic skeletal hyperostosis, Ossification of the posterior longitudinal ligament, Ligamentum flavum, Diabetes mellitus