Iranian Journal of Neurosurgery
Volume:4 Issue: 3, Summer 2018

We aimed to determine the prognostic imaging and clinical markers of chronic Post-Traumatic Sleep-Wake Disorders (PTSWDs) with a special focus on the early cognitive and executive dysfunctions following Traumatic Brain Injury (TBI). The prevalence rate of Post-Traumatic Psychiatric Disorders (PTPDs) in various sleep disorders was also investigated.  Methods and Materials/Patients: In the present longitudinal study, 165 qualified patients with closed TBI were studied. Demographic, imaging and clinical characteristics of the subjects were recorded. The presence of acute post-traumatic cognitive deficits, anxiety, depression, and headache were measured by standard scales at discharge. Executive functioning was scored by the verbal fluency test. Several subjective questionnaires were applied to screen the chronic PTSWDs at 6 months after the onset of TBI. All variables were compared between the patients as well as those with and without PTSWDs using appropriate statistical tests.  Of 146 patients remaining in the follow-up study, 35% manifested PTSWDs, with insomnia and Excessive Daytime Sleepiness (EDS) as the most prevalent types. A poor executive functioning was observed in all PTSWDs patients, compared to those without PTSWDs, with only insomnia and hypersomnia patients demonstrating acute depression. Hypersomnia was also significantly related to bilateral brain contusion. The insomnia mostly comorbid with fatigue was predicted by mild injury, cortical lesions in the frontal lobe and acute severe headache. However, the patients who experienced the brain stem and diffusion lesions of right hemisphere were prone to EDS that was mainly accompanied by aggression.  The predictive role of acute executive dysfunction has been clarified in this study. It is suggested that early neurorehabilitative interventions targeting the impaired neural circuits of executive functioning and mood processing may accelerate and facilitate the optimal neurofunctional recovery leading to minimizing the persistent sleep disturbances.

Thoracolumbar Junction (TLJ) is a transitional zone between the rigid thoracic spine and the flexible lumbar spine. Diagnosis and treatment of herniated discs pertaining to this spinal region is difficult owing to its unique anatomy has challenges to spine and orthopedic surgeons and neurosurgeon. There is not definite approach to TLJ surgeries, with different controversies surrounding each. Therefore, the outcomes and complications associated with different approaches were examined in this study. Methods and Materials/Patients: After being approved by ethics committee of Tabriz university of medical sciences Forty-nine patients undergoing TLJ disc surgeries during 2012-2016 were studied in three Iranian hospitals, i.e. Imam Reza and Shohada hospitals in Tabriz, and Azarbaijan Hospital in Urmia. Patients were examined in terms of gender, age, BMI, surgical level, number of surgical surfaces, lower extremity pain, back pain, paresthesia of limbs and perineum, weakness of lower limbs, sphincter disorder, surgery types including laminectomy+festectomy+discectomy with or without Fusion and with or without Fixation. From Forty-nine patients, 22 patients were male and 27 were female. The mean age was 46.75±6.83. Nine patients had severe lower extremity pain (VAS≥6) and 40 patients had mild pain (VAS<6), which corresponded to postoperative limb pain: 24 patients reported severe pain and 25 mild pain, which lasted over 6 months. There was no significant relationship between fusion and lower extremity pain. Based on the results of this study, which examined the factors affecting prognosis and severity of pain after thoracolumbar discs, spinal cord manipulation should be avoided due to limited circulation of the spinal area.

Cervical trauma is a major injury and although using cervical collar is the standard measure in trauma patients, it is not usually applied properly. This study aimed to examine the effect of education on the knowledge of paramedic staff regarding cervical collar use in patients with head and neck injuries. Methods and Materials/Patients: In this quasi-experimental study, 100 paramedic staff of Rasht Emergency Medical Services (EMS) participated through census sampling method. First, the knowledge of paramedics about utilizing cervical collar was examined using a researcher-made questionnaire. Then, those with low or intermediate knowledge were trained by the resident of emergency medicine. Instructional CDs, including materials on using the cervical collar were distributed among paramedics, too. After two weeks, their knowledge was tested by written and practical tests. By comparing the scores before and after the education, the effectiveness of the intervention was assessed. All samples were male. Their Mean±SD age and work experience were 38.8±7.5 and 12.6±6.5 years, respectively. The results of pre-education knowledge survey showed that the 71 (69.6%) subjects had a moderate knowledge and 27 (26.47%) individuals had poor knowledge, and only 4 (3.9%) individuals had sufficient knowledge about using the cervical collar. Knowledge survey assessment after education in poor and moderate groups (n=98, 96.1%) showed that 73 (74.5%) subjects had good knowledge and 25 (25.5%) subjects had moderate knowledge. Nobody had weak knowledge. The paramedic staff knowledge of using cervical collar increased after holding an appropriate educational course. Therefore, the staff with low to intermediate knowledge should be trained at least once a year.

There is no consensus over the relationship between lipid profiles and atherosclerosis risk factors with lumbar disc degeneration. This study aims to investigate the lipid profile and some risk factors of cardiovascular diseases in patients undergoing surgery for lumbar disc degeneration. Methods and Materials/Patients: A correlational cross-sectional study was carried out on all candidates for lumbar disc degenerative diseases surgery at Poursina Hospital in Rasht City, Iran from July to December 2017 (130 adult patients aged 20-77 years). The obtained data were collected from the patients’ medical file or asking them after obtaining written informed consent. The collected data were analyzed in SPSS V. 16 by performing the Chi-square and Fisher’s exact tests to examine the relationship between the study variables. The significance level was set at P≤0.05 for all tests. 60.8% of subjects had comorbid diseases, mostly hyperlipidemia, and hypertension. Their mean low-density lipoprotein and triglyceride levels were higher than normal and their mean total cholesterol was at borderline. Also, 74.6% and 84.6% of the patients had Body Mass Index and abdominal circumference higher than the normal range. Physical activity in 88.5% of subjects was below the desired level and 79.2% of the patients did not report a history of smoking. Inferential findings indicated a significant relationship between dyslipidemia and various types of lumbar disc degenerative diseases (P<0.05). The study showed dyslipidemia and some other risk factors of cardiovascular diseases, including obesity and inactivity in patients with lumbar disc degenerative disease. More research is needed to assess other atherosclerosis risk factors and types of lipids with respect to disc degenerative diseases.

Tethered spinal cord is the most common anatomic deformity which is usually diagnosed in childhood. This study aimed to describe the different anatomo-radiological patterns of the tethered spinal cord with lipoma. Methods and Materials/Patients: We conducted a retrospective and descriptive study in Neurosurgery Department of General Grand Yoff Hospital and the Neurosurgical Clinic at Fann University Hospital of Dakar, Senegal. Eight patients with spinal cord lipoma underwent surgery in these medical centers from July 2007 to January 2011. Anatomo-radiological and clinical data of the patients were collected and analyzed. The mean age of the patients was 4 years ranging from 45 days to 30 years. Male to female ratio was 0.6. The symptomatic triad of median cutaneous signs, orthopedic, and sphincter disorders was found in 2 (25%) patients. Neuroimaging, mainly MRI, showed conus medullaris lipoma in 7 (87.5%) cases, and a filum terminalis lipoma in 1 (12.5%) case. All patients had a tethered spinal cord with a low-lying conus medullaris. The dehiscence of posterior lumbosacral and sacral vertebral arches was noted in 7 (87.5%) cases and scoliosis and scalloping each in 1 case. All patients were operated and the outcome was good for 5 (62.5%) patients. No death has been reported. According to surgical findings, the patients were grouped in the modified Chapman’s classification. In comparison to myelomeningocele, tethered spinal cord with lipoma is a rare condition. Health practitioners should be aware of this condition when facing a child or a young adult patient bearing a median lumbar sacral cutaneous stigmata associated with or without lower limb orthopedic abnormalities and or sphincter disorders. Ultrasound and MRI are good diagnostic tools for the newborn allowing to make good surgical planning. However, MRI is reportedly more sensitive and the surgical option for asymptomatic cases has remained controversial. To our experience, the surgical findings can provide comprehensive information on the interface between the lipoma and the neural structure.

Secondary complications management of Subarachnoid Hemorrhage (SAH) is one of the therapeutic challenging issues during Intensive Care Unite (ICU) admission. The complications of patients with SAH admitted to the ICU of Imam Khomeini Hospital of Urumia were investigated in this study. Methods and Materials/Patients: In this descriptive study, the clinical complications of the patients with SAH admitted to ICU including anemia, fever, hyperglycemia, hypertension, electrolyte imbalance, and cardiac arrhythmia were collected from their medical records within a 7-year period. The collected data were analyzed using Chi-squared test and t-test by SPSS.  In total, 483 records of patients with SAH were explored. Moreover, 183 (37.9%) samples had anemia, 174 (36%) suffered from fever, 204 (42.2%) patients were diagnosed with hypertension. A total of 111 (23%) patients had hyperglycemia, 54 (11.2%) individuals suffered from sodium disorders. Additionally, 131 (27.1%) individuals had cardiac arrhythmias. The obtained results suggested that the most prevalent complications following SAH are hypertension, anemia and fever. Furthermore, there was a significant correlation between cardiac arrhythmias, as well as sodium and hyperglycemia disorders, and the treatment outcome of patients. Patients admitted to ICU should be under intensive care to reduce the mortality rate associated with SAH.

Conus medullaris dermoid cysts are benign lesions, usually observed in the lumbosacral region of the spinal canal. Such lesions are often associated with congenital dermal sinus tracts and spinal dysraphism.  We reported a 37-year-old man with progressive paralysis distal part of the left lower limb presented to our clinic. The MRI of the lumbar spine, as a modality of choice, has revealed a well-defined sausage-shaped lesion, a multilobular cyst, and the heterogeneous contrast enhancement of an intra- and extra-medullary lesion in the conus medullaris region.  Subtotal microsurgical resection was performed on the lesion. The result of histopathological examination confirmed the dermoid cyst, as well. After conducting the subtotal resection, an appropriate clinical result was achieved in the patient.