Iranian Journal of Neurosurgery
Volume:5 Issue: 4, Summer-Autumn 2019

Sexual function and orientation is a complex platform of human personality which is being modulated by several brain circuities which is less understood currently. Recently, several studies have demonstrated interesting results regarding the role of several brain locations in sexual behaviors and orientation. Sexual arousal in homosexual men are associated with activation of the left angular gyrus, left caudate nucleus, Ventrolateral Preoptic Nucleus of Hypothalamus (VLPO) and right pallidum; while it is associated with bilateral lingual gyrus, right hippocampus, and right parahippocampal gyrus in heterosexual men. We postulate that sexual-orientation behaviors are being mediated by several circuits in the brain in the center of which the VLPO is playing an indistinguishable role. We hypothesize that the different aspects of the sexual dysfunction could be associated with innate or acquired lesions of VLPO. Accordingly, the electrical stimulation of the nucleus in those with sexual dysfunction would be a treatment option. Thus the VLPO could be considered a target for deep brain stimulation (DBS) in individuals with impaired sexual function.

Early and sufficient nutritional support is vital to improve outcomes in patients with traumatic brain injury. This study aims to determine the effects of dietitian involvementin the nutritional and clinical outcomes inpatients with traumatic brain injuries admitted tothe neurosurgical ICU.

Forty-eight male patients with traumatic brain injuries admitted to Poursina Hospital neurosurgical ICU were studied, retrospectively. Patients were divided to either receive dietitian intervention or without any nutritional recommendation(control). Demographic information, Glasgow Coma Scale and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, the timing of initial enteral feeding, the amount of energy and protein intakeon day 4, the duration of mechanical ventilation and ICU length of stay were recorded.

Patients under the dietitian recommendation had significantly lower timing of initial enteral nutrition compared to the other cases (P=0.02). The average energy or protein intake and the percentage of target energy or protein intake on day4 appeared to be significantly lower in the subjects in the control group than in those with nutritional intervention(P≤0.001). There was no statistically significant difference in the duration of mechanical ventilation and ICU length of staybetween different groups of patients.

Instead of occasional consultations for exclusive cases, the daily attendance of dietitians during multidisciplinary rounds of ICU is required to assess the nutritional needs of patients.

Postoperative C5 motor palsy is known as a common complication, not only after cervical laminectomy but also after anterior discectomy. There is no consensus on any of the proposed mechanisms of C5 palsy following posterior cervical decompression. It was found that C5 palsy is more common in patients with smaller C5 root foramen area. The purpose of this study was to define a cut-off value for C4-C5 foraminal area on preoperative computed tomography images to predict post-laminectomy C5 palsy.

Methods and Materials/Patients:

 In this prospective clinical study, C4-C5 foraminal area of 119 patients with cervical spondylotic myelopathy calculated on reformatted pure sagittal computed tomography images value was defined by measuring maximal height and transverse diameter of foramina and a cut-off in which with lesser amounts, post-laminectomy C5 palsy was more common.

Of 119 patients with spondylotic myelopathy undergoing cervical laminectomy,23 ones experienced postoperative C5 palsy with mean C4-C5 foraminal area of 44.54±0.72 mm2.Mean C5 root exit foraminal area in patients with intact post-operative root function was calculated 56.78±5.48 mm2 and the difference between these two groups was statistically significant (P<0.05). No patient with C5 exit foraminal area more than 46 mm2had C5 palsy after laminectomy.

The incidence of post-laminectomy C5 palsy is significantly higher in patients with C5 exit foraminal area less than 46 mm2. Prophylactic C4-C5 foraminotomy in this group may significantly reduce the risk of postoperative C5 nerve motor palsy, although the effect of this procedure is still debatable.

The risk factors of the neural tube defects (NTD) have been previously described but there are ethnic and geographical variations. Data from the Iranian population is still scarce. The aim of the current study was to determine the NTDs risk Factors in a large sample of Iranian patients admitted to a single center.

This case-controlled study was conducted during a 5-year period from 2012 to 2017 in Namazi hospital of Shiraz, a tertiary healthcare referral center for all the neonatal anomalies in southern Iran. We included a total number of 100 newborns with NTDs as the case group and 200 healthy newborns as the control group. We recorded the baseline characteristics including the maternal variables (age, weight, height, previous pregnancy and gravid, gestational age), newborn information (birth weight, clinical diagnosis, clinical finding in examination, clinical finding in radiologic test) and medical history of the perinatal period.

The baseline characteristics of the mothers were matched in the two study groups. NTDs were associated with lower folic acid intake during pregnancy (66% vs. 78%; p=0.030; OR95% CI=1.82) and before pregnancy (p=0.002; OR95% CI= 2.36). The prevalence of neural tube defects was significantly higher in patients who lived in hot climates (p=0.001).

Taking adequate folic acid supplement before and during pregnancy can reduce the risk of NTDs in Iranian population. Hot climate zones were associated with increased risk of NTDs in Iran.

Atlanto-occipital non-segmentation failure of segmentation between the fourth occipital sclerotome and the first cervical sclerotome results in atlanto-occipital non-segmentation/ assimilation, also known as occipitalization of the atlas.1The incidence of occipitalisation has been reported to be between 0.08% to 3% of the general population, affecting males and females equally.2 A cartilaginous cleft and an open synchondrosis between the osseous posterior arches of the atlas is a normal finding in children up to four years of age; therefore, a true defect in the posterior arch was diagnosed only in patients who were more than four years old.3 Atlanto-occipital fusion reduces the foramen magnum dimension leading to neurological complications due to compression of spinal cord.4 The slow development of the fibrosis was the source of gradual spinal-cord compression with increasing symptoms.5 Fusion of atlanto-occipital joints can also result in restricted neck movement.6 Basilar invagination is an abnormality at the craniocervical junction (CVJ) either congenital or degenerative, where the odontoid tip is inside the foramen magnum with or without neurological symptoms.7

Spinal stenosis in tandem (SST) can be defined as simultaneous stenosis of two distinct spinal (cervical, thoracic and lumbar) areas. Characterized by an association of the spinal, radicular and medullary signs of the limbs, the planning of his surgery remains controversial. We report the one that was set up on the cases observed at the CHU-B.

A retrospective study of 16 patients operated for SST, from June 2009 to May 2019, was conducted. We analyzed the demographic, clinical, paraclinical, therapeutic and evolutionary data of these patients.

In ten years, 16 patients (9 men and 7 women) with SST had been received. They were on average 57 years (41 and 72 years). The signs evolved for 17.6 months (13 and 30 months) and were made of radicular and / or medullary compression syndrome of cervical, thoracic and / or lumbar localization. Medical imaging made it possible to objectify the cervico-thoracic (1 case), thoraco-lumbar (2 cases) and cervico-lumbar lesions (13 cases). The surgery was performed in one stage in two cases and in two stages in 14 cases. These were laminectomies for lumbar and thoracic disorders, discectomy or somatotomy in the cervical segment. The order of surgical management was cranio-caudal.Signs improved in 13 patients and stabilized in 3 patients.

The combination of lumbo-radicular and medullary signs should search for SST. The surgery indicated after an MRI examination, is performed in one or two stages, following a cranio-caudal order or not. It allows, when it is performed early, a clinical improvement of these patients.

Background  Liponeurocytoma is a rare tumor of the central nervous system(CNS) characterized by low neuronal proliferation with foci of lipomatous differentiation. to the best of the authors` knowledge, 70 cases of brain liponeurocytoma have been reported which most of them are located in the cerebellar hemisphere but only 7 case of   primary cerebellopontine angle liponeurocytoma have been reported till now. Herein we presented a 27 -year-old woman presented to our clinic with a 6-month history of progressive headaches, dizziness.  More recently, he developed progressive hearing loss and   ataxia. Pre-operative Magnetic resonance imaging (MRI) of the brain demonstrated a heterogeneous solid extra-axial lesion, in the right cerebellopontine angle with hydrocephalus. The operation was performed via a right  retro sigmoid approach. The final histopathological diagnosis was confirmed as liponeurocytoma. Radiation therapy was not done and close observation was maintained during the follow-up for the subsequent 2 years; no signs of recurrence were found.

Lumbar intervertebral discs (IVDs) are complex anatomical structures that are essential for the mobility of intervertebral joints. It appears that there are no clear standard clinical or investigation criteria for the diagnosis and selection of patients with lumbar disc herniation for surgery. This study investigates whether Neurophysiological Studies can be used to identify the subgroup with better postoperative outcome.

The current study was conducted on 60 patients with Clinically and neuroimaging diagnosed cases of Lumbar disc herniation. Preoperative radiological assessment involved the flexion and extension lateral radiographs and MRI of the lumbar spine. Preoperative clinical assessment was done by Oswestry Low Back Pain Disability Questionnaire and Visual Analog Scale (VAS). The patients underwent surgery within 1 month of neurophysiologic testing. Surgery was performed at the level suggested by neuroradiology. In all patients we found an abnormal disc, which was removed along with any loose disc material. The patients were followed up for 1 year with interval of 3 months for post-operative assessment.

Statistically significant difference in postoperative percentage fall in visual analogue scale score (95.59%/73.69%) and Oswestry disability score (76.2%/ 65.3%) were observed in patients with normal  preoperative electrodiagnostic studies as compared to abnormal electrodiagnostic studies  at 12 months postoperative period (p=0.993 to 0.002 and p= 0.200 to 0.037 respectively) were observed.

Neurophysiological studies have an important role in predicting the outcome of lumbar spine surgery that can be helpful in better selection of patients and to reduce the incidence of Failed back syndrome.

Background & Importance:

 Spondylodiscitis is an inflammatory disease of the body of one or more vertebrae and intervertebral disc. The fungal etiology of this disease is rare particularly in patients whit out immune dysfunction. Delay in diagnosis and treatment of this disease can lead to complications and even death.

 A 63-year-old female patient, who had a history of spinal surgery and complaining of radicular lumber pain in both lower limbs with probable diagnosis of Spondylodisties, underwent L1 and complete L3 and L4 partial correctomy. As a result of pathology from tissue biopsy specimen, Aspergillus fungi was observed.

 There was no evidence of immunosuppresive status in the patient. The patient was treated with Itraconazol 100mg twice a day for two months. Pain, neurological and laboratory symptoms improved.

Background and Importance: 

Alkaptonuria is a rare genetic disorder due to deficiency of the enzyme homogentisic acid Oxidase which results in the accumulation of homogentisic acid in various body tissues; it produces a multisystemic disorder with a characteristic bluish-black discoloration of the skin and cartilage, termed ochronosis.

Herein, we reported A 45-year-old female patient presented to our outpatient clinic with chronic low back and left leg radiated pain that aggravated gradually in the previous six months. She also suffered from progressive muscle weakness in her left lower extremity. The patient was operated for prolapsed disc herniation. Macroscopically, no abnormality of the skin, muscles or ligaments was observed during surgery. After the annulus was incised, surprisingly it was seen that the nucleus pulposus removed from the L3-L4 disc space was black. The alkaptonuria was diagnosed after histopathological examination of the black disc material and also was confirmed by urinalysis.

The postoperative course was uneventful and the patient was free from low back and leg pain after surgery. In patients with no other signs of alkaptonuria or ochronosis such as our case, early detection of this rare disease is important to asses and treat the involvement of other systems (e.g., cardiovascular and urinary).