Iranian Journal of Neurosurgery
Volume:8 Issue: 3, Summer 2022

Traumatic brain injury (TBI) is one of the critical causes of death in trauma patients. In this study, the effect of nanocurcumin on the outcome of severe TBI was investigated for the first time in humans.

Methods and Materials/Patients:

 This randomized, double-blind, and paralleled controlled study included 128 patients aged from 18 to 70 years with severe brain trauma. Patients were randomly assigned to control group (standard care treatment+placebo) and intervention group (standard care treatment+oral nanocurcumin). Changes in the level of consciousness, cerebral edema, kidney function, liver enzymes, sodium and potassium electrolytes, and brain function were followed up and compared until 6 months after discharge.

The Mean±SD in the intervention (14.44±31.86 years) and control patients (14.86±33.34 years) had no significant difference (P=0.543). Both groups were similar in terms of gender (P=0.669). The average level of consciousness in the intervention group increased by about 3 units (P=0.004) and more than 2 units (P=0.002) at discharge compared with the control group. By comparing the optimal performance of patients in the first (P=0.389) trimester and second (P=0.309) trimester after discharge, no significant difference was observed between the intervention and control groups. The amount of brain edema caused by severe brain trauma on the seventh day of treatment in the intervention group was lower than that in the control group (P=0.038).

Administrating oral nanocurcumin supplement in patients with severe brain trauma along with their routine treatment is effective in improving brain edema and their level of consciousness without causing coagulation, and liver and kidney complications. These findings are not only statistically significant but also clinically vital.

Optic pathway glioma (OPG) is a chronic condition that needs a multidisciplinary management strategy. Most of these tumors are observed in the pediatric population and the tumor tends to stabilize after the child’s growth. This benign course can be observed mostly in neurofibromatosis 1 (NF1) patients, which are about half of the pediatric patients.

Methods and Materials/Patients:

 The current literature in PubMed and Scopus databases was searched. The recent data regarding OPG and treatment options were reviewed to design this narrative mini-review.

The brief data extracted from 17 articles, cited in the reference list, were included in the study.

Chemotherapy is the first and best treatment modality for patients with OPG. It is more useful at younger ages because it has lower rates of complications and cancer in the future compared with radiotherapy, the treatment of choice in previous decades for these patients. However, in recent practice, it has been substituted by chemotherapy because of its serious adverse effects on the pediatric population. Neurosurgical treatments for OPG are used for three main purposes, third ventricle obstruction-related hydrocephalus, biopsy, and tissue diagnosis for cases with an uncertain diagnosis, and tumor decompression due to mass effect on vital structures. Surgical decompression is not considered the first-line treatment in OPG. It can be used for patients with progressive exophthalmos with ipsilateral blindness or patients with refractory pain after adjuvant treatment. This short review discusses the main aspects of OPG treatment modalities.

Telemedicine can be considered a primary modality of patient care for non-emergent conditions in the COVID-19 era. The usage and expansion of telemedicine are important and inevitable issues. We decided to investigate the neurosurgeons’ perspective on telemedicine in the treatment and follow-up of neurosurgical patients during the COVID-19 period.

Methods and Materials/Patients: 

This cross-sectional study was carried out in the Department of Neurosurgery, Tehran, from June 2021 to July 2021. An internet-based questionnaire was distributed among all postgraduate and assistant neurosurgeons at the Tehran University of Medical Sciences. Statistical analysis was performed using SPPS (IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp; 2016).

This study was performed among 74 neurosurgeons who were mainly male (89.2%). Their mean age was 33.16±5.69 years (ranging from 27 to 62 years), and telemedicine has not been used previously in 37 precipitants (50%). Most precipitants preferred telemedicine for follow-up (93.24%). The common reasons for unimplemented telemedicine were determined by insurance and repayment obstacles (58.11%). Most of the participants believed that telemedicine should first be adapted to working condition and local setting, then it can be applied more in the future. Eventually, the effectiveness of telemedicine was controversial, according to most neurosurgeons’ replies.

This study indicated neurosurgeons’ preference for telemedicine. They considered it a comfortable alternative. However, the effectiveness of telemedicine is controversial as it should be adapted first and then used extensively for future purposes. It is also suggested that future studies compare the results of this research with those of studies performed after the COVID-19 outbreak.

Background and Importance: 

Capillary hemangiomas are benign tumors found on the skin and soft tissues. They rarely present as an intradural spinal tumor. Common differential diagnosis methods are schwannoma, hemangioblastoma, metastasis, and paragangliomas.

We report a case of a 38-year-old female with complaints of lower backache with radiation to lower limbs, in which the magnetic resonance imaging revealed an intradural tumor compressing the cauda equina nerve roots, arising from the L3 level. The patient underwent L2-L3 laminectomy with tumor excision with the preservation of nerve roots.

Histopathology suggested capillary hemangioma and the patient improved symptomatically and no recurrence has been reported to date.

 The cause of most strokes is associated with the pathology of the carotid arteries. Many modern researchers suggest preventive surgery in the presence of arterial deformity to prevent strokes. The hemodynamic significance of carotid deformities is determined by morphological and functional disorders at the level of tortuosity, the reaction of cerebral blood flow is not often considered. Here, we assume that cerebral autoregulation in tortuosity can be different.

Methods and Materials/Patients:

 A total of 64 patients (31-75 years old) with 110 carotid deformities were analyzed. Duplex color mapping, computed tomography angiography of carotid arteries, and computed tomography perfusion were performed by estimating the absolute and average values of cerebral blood flow (mL/100 g/min), cerebral blood volume (mL/100 g), Mean transit time (MTT) (s) in similar areas of the cortex. In 6 patients, the acetazolamide challenge test was used to evaluate the autoregulatory disturbances.

According to computed tomography angiography and duplex color mapping, 18(28.1%) patients had unilateral tortuosity, and 46(71.9%) patients had bilateral tortuo s ity. Hemodynamically significant deformities were detected in 33 cases (30% of tortuosity). In 54 cases (49% of tortuosity), the deformities were accompanied by carotid stenosis. Perfusion disorders were detected in 23 of 64 patients (35.9%). In the majority of cases (75% of all perfusion disorders), hypoperfusion was diagnosed on the side corresponding to the maximum degree of stenosis, regardless of the location of the tortuosity.Neurologically significant hypoperfusion, compensated by collateral blood flow revealed only in 7.8% of cases of hemodynamic significant internal carotid artery deformity without concomitant atherosclerosis.

The decision on surgical correction of carotid artery tortuosity should be made while considering both local changes in hemodynamics and proven violations of autoregulation of cerebral blood flow, especially in patients with concomitant carotid stenosis.

Chronic pain is an emotional experience with unpleasant psychological consequences for individuals and society. This research aims to systematically review the psychological interventions implemented in people suffering from chronic pain.

Methods and Materials/Patients:

 In this systematic review, the following keywords were searched in PubMed, Scopus, and Google Scholar databases: Chronic pain, psychological interventions, psychotherapy, psychology, clinical trials, and randomized clinical trials. The time span for the search was from January 2018 to December 2022. From a total of 2785 articles, 20 articles by 2078 contributors were selected for this review.

Cognitive behavioral therapy ranks first among psychological interventions for people with chronic pain. Also, to improve the quality of life and psychological health of these individuals from other psychological interventions, such as acceptance and commitment therapy, the mindfulness.method has been used. This treatment has been effective in relieving pain, controlling pain, reducing stress and depression, and improving the quality of life. Using a randomized controlled trial design and follow-up were the strengths of these studies.

The findings suggest that psychological interventions had the greatest impact on pain relief, quality of life, depression, and stress, respectively. Accordingly, it is proposed to use psychological interventions in addition to medical treatment.

Background and importance: 

Cervical laminectomy and fixation (PCF) is a surgery used in the treatment of symptomatic patients who are resistant to medical therapy, though it can have serious complications affecting patient outcomes.

This case report describes a rare occurrence of a solitary fibrous tumor (SFT) at the site of a previous cervical laminectomy in a 45-year-old female patient. Following non-surgical treatment for paresthesia and weakness in the upper limbs due to cervical stenosis, the patient underwent cervical laminectomy from C3-6 without instrumentation.

One year after surgery, the patient presented with severe pain and swelling at the surgical site, and radiological evaluation revealed a large mass in the para-vertebral muscular layer. The mass was removed, and microscopic evaluation revealed a typical SFT. The patient underwent an extension of laminectomy and fusion with lateral mass screw, and follow-up at six months showed no recurrence of the tumor.

This study aims to evaluate the frequency of adjacent segment disease (ASD) and its risk factors following posterior decompression and fusion in lumbar degenerative disorders.

Methods and Materials/Patients: 

This retrospective cohort study was performed by reviewing the records of patients with spinal degeneration disorders who underwent lumbar fusion surgery and needed reoperation from 2013 to 2019. The participants were divided into two groups, including patients with ASD and non-ASD patients, and were compared in terms of age, sex, BMI, smoking, fusion level, surgical indications, follow-up times, laminectomy, cross-link device usage, imaging findings, fusion terminating in L1, L5 and S1, and reoperation.

Out of a total of 277 candidates, 181 met the inclusion criteria. In terms of gender distribution, 43.3% of the participants were male and 56.7% were female. The median age was 54 years in the ASD group and 48 years in the non-ASD group. The median follow-up of the patients was six years in the ASD group and five years in the non-ASD group. Forty patients (22.1%) developed ASD during this period. The final analysis showed a significant relationship between age, sex, indication for reoperation, repeated surgery, laminectomy, cross-link device use, imaging findings, and fusion terminating in L1.

High body mass index, aging, lumbar spinal canal stenosis, reoperation, laminectomy at the upper fusion unit, cross-link device use, lumbar canal stenosis in imaging, and fusion to L1 vertebrae are considered risk factors for ASD.

Epilepsy as a neurological disorder is characterized by unpredictable and periodic seizures. In the present study, the anticonvulsant effect of different doses of salep hydroalcoholic extract on pentylenetetrazole (PTZ) induced seizures was investigated.

Methods and Materials/Patients: 

The animal model of seizure was established by the intraperitoneal injection of pentylenetetrazole (PTZ- 85 mg/kg). Hydroalcoholic extract of salep was administered to the animals in 3 doses (80, 160, and 320 mg/kg). The parameters of the onset and duration of tonic-clonic seizure, total seizure time, balance (falling), and jumping during seizure mortality rate were measured. The results were analyzed by ANOVA test at a significant level of p≤0.05.

The results of the current study indicated that salep extract increased the delay in the onset of seizure in the PTZ + extract group in comparison with the PTZ group. The duration of tonic-clonic seizure and the number of falling, jumping, and total seizure times were significantly decreased by salep extract compared to the PTZ group. In the seizure + salep extract, the number and percentage of 24-hour mortality among animals decreased with increasing dosage. All changes were dose-dependent and 320 mg/kg showed the most effect.

  Extract of salep can probably have anticonvulsant properties, however, further studies are needed to clarify the exact mechanisms.

Background and Importance: 

 Developmental craniovertebral junction (CVJ) anomalies are often comprised of irreducible atlantoaxial dislocation (AAD) and basilar invagination (BI) associated with the fusion of the C1 arch. BI is described as a congenital upward displacement of mostly the odontoid process into the foramen magnum, which AAD can accompany. The DCER (Distraction, Compression, Extension, and Reduction) consists of decompression of craniocervical junction, BI reduction followed by occipitocervical fusion in anatomic lordotic curvature –performing extension and compression. This technique has recently been applied in patients with BI and AAD, demonstrating satisfactory results.

Herein, we report two cases of BI with AAD who underwent surgery with the DCER technique for the first time in our center.

BI has been managed with combined approach (anterior odontoid resection followed by posterior craniocervical fusion). Since last decade, single posterior approaches has been utilized to reduce and stabilize BI and AAD. DCER approach is the most recent and successful procedure.

Background and Importance: 

Meningiomas are usually benign tumors. Depending on their location and size, dealing with them can be problematic. We report an exceptional case of gigantic frontal meningioma. Its diagnosis was misleading and the excision laborious. 

A 29-year-old patient who presented gradually over 5 years, developed behavioral disorders then swelling of the vertex at the frontal level and decreased visual acuity. Physical examination on admission revealed a median frontal swelling slightly lateralized to the left axis of approximately 10 cm, hard, covered with the healthy, severe frontal syndrome, and decreased visual acuity. Computerized tomography (CT) scan showed a voluminous medial frontal lesion lateralized to the left, with irregular limits, superior sagittal sinus invasion, brain engagement under the scythe, heterogeneous contrast taking, and significant osteolysis first evoking tumor metastasis. Magnetic resonance imaging (MRI) suggested a meningioma. The resection was macroscopically complete. Dural and cranial plasty was performed. The postoperative follow-up was simple. Histology concluded that the meningioma was grade 1 based on the world health organization (WHO) classification.

Late-diagnosis meningiomas can take on very large proportions and pose management problems while seriously engaging the patient functional and vital prognosis.

Adjacent segment disease (ASD), radiological and clinical, is observed in many of the patients who undergo cervical inter-body fusion with/without graft, and with/without plating. This study aims to evaluate the proportion of ASD among patients who underwent cervical spine fusion surgery, to study the severity of degenerative radiographic findings at adjacent levels, and to determine sites and patterns of ASD.

Methods and Materials/Patients: 

A descriptive study was performed on patients who underwent a previous cervical arthrodesis procedure in the last 2-5 years and continued follow-up as neurosurgery outpatients. A total of 59 patients who qualified for the inclusion criteria were included in the study.

Spine fixation was commonly performed at a single level mostly with sample size (54.2%, n=32) then at two levels (42.4%, n=25) and three levels (3.4%, n=2). Adjacent segment degeneration was present in the spine fixation level subgroup at a single level of 9 cases (28.12%), two levels of 9 cases (36%), and three-level fixations of 2 cases (100%). Six patients (10.2%) out of 59 patients developed radiculopathy. Among twenty-two cases (37.3%) with new changes at adjacent levels, reduced disc height was the most common one (18.6%, n=11). Anterior and posterior osteophytes with reduced disc height were found in 2 cases. Therefore, actual new changes were present in 20 cases only. The most common level of C4-C5 was observed for the development of ASD (13.6%, n=8). ASD developed at cranial to fusion in 13 cases (22%), caudal to fusion in 5 cases (8.5%), and at both levels in 2 patients.

Adjacent segment disease was observed in a significant number of patients who underwent cervical spine surgery as evident from the results but only 6 out of 20 cases with radiological evidence of ASD were symptomatic. Changes were observed commonly at the C4/C5 level.

Sciatic nerve injury is a common condition that can lead to significant functional deficits. Although current treatments are effective in reducing symptoms, more effective and safer treatments are still required. In this research, the effect of trans-anethole (TA) was investigated on improving the sciatic nerve function in a rat model.

Methods and Materials/Patients: 

Twenty-eight adult male Wistar rats were divided into four groups. Animals were subjected to deep anesthesia. Then, to create a model of the sciatic nerve, the right leg of the rats was compressed above the location of the trifurcation of the nerve. The control and negative groups received saline. Trans-anethole 125 mg/kg and 250 mg/kg were injected intraperitoneally into two groups of the sciatica model. Finally, muscle histological
changes were evaluated.

The results indicated that the injection of TA improved motor recovery in rats. The highest recovery rate was related to the dose of 250 mg/kg. The morphometric analysis suggested that the number of fibers and the thickness of the myelin sheath were significantly higher in the group treated with TA compared with the control group. An increase in muscle mass and a decrease in muscle atrophy were observed in the groups treated with TA compared with the negative control group.

These data showed that TA improves nerve damage and can be used as an option to improve inflammation-induced sciatica.

Background and Importance: 

Diffuse idiopathic skeletal hyperostosis (DISH) can compress the trachea and esophagus when located in the cervical spine. In this report, we investigated whether it is preferable to perform the early surgical intervention in symptomatic patients or to wait and administer supportive care and perform late surgical intervention regardless of whether symptoms progress or not.

We present the case of a 70-year-old patient with diffuse idiopathic skeletal hyperostosis (DISH) causing significant dysphagia and unilateral vocal cord paresis, resulting in dyspnea and stridor. Imaging diagnostics revealed large osteophytes anterior to the cervical spine from C3 to C6 compressing the cervical spine. Significant clinical improvement was observed following the anterior resection of the patient's osteophytes.

In order to achieve higher success and less recurrence, it is preferable to perform surgical intervention earlier in the disease's progression. However, more studies are necessary to confirm this because most of the present results are from case report articles and have less evidence.

Smoking has been extensively investigated in oncology, and controversial associations with brain tumor incidence have been reported. Caspase-3 and matrix metalloproteinases (MMPs) belong to an important cascade in tumor vasculogenesis. We aim to study the smoking impact on these signaling molecules in nontumoral rat brain tissue.

Methods and Materials/Patients: 

A total of 60 Wistar rats were divided into two groups: treatment (cigarette smoke/electronic cigarette) and control groups with subgroups of male and female rats. After general anesthesia and decapitation, their brains were collected, and 3-μm thick coronal sections were prepared. Following immunohistochemical staining with rabbit anti-MMP-2 and anti-caspase-3 antigens, protein expressions were analyzed by selecting two fields at 400x magnification.

Our data suggest that the expression of MMP-2 was not significantly different between the studied groups. However, the significant inductive activity of cigarette smoking was observed on caspase-3.

Cigarette smoking indicates pro-tumoral signaling impact in normal tissue with activation of caspase-3 in rat brain tissue.

Cranial nerve (CN) schwannomas other than the eighth nerve schwannoma are called nonvestibular cranial nerve schwannomas (NVCNS). This study aims to analyze the clinical profile, distribution, and surgical outcome of the NVCNS.

Methods and Materials/Patients:

 This is a retrospective study analyzing the NVCNS conducted between January 2007 and December 2021. VIIIth cranial nerve schwannomas and conservatively managed NVCNS were excluded from the study.

This study included 25 patients with NVCNS. Ten patients (40%) had trigeminal schwannomas, 3(12%) facial nerve schwannomas, 9 (36%) lower cranial nerve (LCN) schwannomas, 1 (4%) vagal schwannoma in neck and 2(8%) hypoglossal schwannomas.Eight patients (32%) were male and 17(68%) were female. The age of the patients ranges from 13 to 62 years (mean 39 years +/- 14 SD). Findings of cerebellar involvement, VIIIth CN involvement, and headache are the most common clinical features. The posterior cranial fossa is the most common location of the tumors. Thirteen patients (52%) underwent gross total resection (GTR), 7(28%) underwent neartotal resection (NTR) and 5(20%) underwent subtotal resection (STR). All the patients improved in the postoperative period. Facial nerve palsy is the most common cranial nerve palsy occurring in the postoperative period.

Trigeminal and lower cranial nerve (LCN) schwannomas are the most common NVCNS. The retrosigmoid suboccipital approach is the most commonly used surgical approach for tumors located in the posterior cranial fossa. Since NVCNS are benign lesions, postoperative clinical improvement along with decreased complications should be the goal of the surgery. Hence, gross total resection is the most commonly achieved extent of resection, near-total or subtotal resection can be done wherever gross total resection (GTR) is not possible in NVCNS.

Background and Importance: 

Ossification of the ligamentum flavum (OLF) is a pathological condition that affects the yellow ligaments, mostly in adult males between the ages of 45 to 70. Ossification is more common in the thoracolumbar region with an accompanying progressive neurological deficit, and its occurrence within the cervical spine is quite rare. Ossification of the yellow ligament is so common in East Asian countries that it is regarded as a frequently occurring aging pathology in the people of this region. Its existence in other ethnic groups is significantly lower.

A 68-year-old Iranian woman with progressive quadriparesis is presented. Cervical computerized tomography and MRI scans revealed two-level, bilateral, posteriorly located, ossified masses occurring at the C4-C5 and C5-C6 levels, which coincided with the ossification of the yellow ligament. Cervical laminectomy and excision of both masses were undertaken and the patient gradually recovered from his resultant neurological symptoms.

Symptomatic cervical OLF is a markedly rare pathological finding and is typically illustrated as a medical case report. In a careful review of the literature including the presented patient, we could uncover only 77 cases involving a documented symptomatic cervical OLF.

Lumbar disc prolapse is a common cause of backache and radicular symptoms in lower limbs. Different surgical options have been described to compare the functional outcome, complications, and recurrence following surgery for lumbar disc prolapse by classical microlumbar discectomy (MLD) and minimally invasive tubular microdiscectomy. The advantages of one procedure over the other were also analyzed.

Methods and Materials/Patients:

 A prospective, observational study conducted over a period of 1 year in the Department of Neurosurgery, Government Medical College Thiruvananthapuram, among patients who underwent surgical treatment for lumbar disc herniation by either microlumbar discectomy or minimally invasive surgery using a tubular retractor system. Ninety-nine patients who satisfied the inclusion and exclusion criteria were analyzed and tabulated for the outcome.

The two groups did not show a statistical difference in terms of functional outcome, complications, or recurrence rate. However, the need for post-operative analgesics, blood loss, and hence hospitalization was less in the tubular discectomy group.

Both procedures are equally effective in terms of surgical results. However, the advantages and the subtle tendency of the patients to adopt “keyhole” make the tube an attractive option.

This study aims to provide information about the common complications of adult spinal deformity (ASD) surgery that requires revision surgery and proximal junctional kyphosis (PJK) as the most common complication. We emphasized crucial protective factors that reduce the risk of post-operative PJK, especially the careful selection of the upper instrumented vertebra (UIV) and gradual transitional zone on the proximal end of the construct.

Methods and Materials/Patients: 

This study is a retrospective review of the adult population with spinal deformity who underwent posterior instrumentation surgery and requires revision surgery due to post-operative complications, such as disc herniation, screw loosening, rod breakage, distal junctional failure, and symptomatic PJK. Fifteen ASD patients requiring revision surgery were included. We evaluated the ratio of age, gender, the prevalence of postoperative complications, and the most common complication of PJK based on Cobb angle and patient symptoms.

This study included 15 patients with ASD who underwent posterior spinal instrumentation surgery and experienced post-operative complications requiring revision surgery. As a result, 6 patients out of 15 (40%) had PJK, four patients (26.6%) had disc herniation and canal stenosis, two patients (13.3%) had screw loosening, one patient (6.6%) had rod breakage and two patients (13.3%) had distal junctional failure required revision surgery.

In our study, PJK is at the top of the complications and two risk factors have a great impact on predisposing ASD surgery to the post-operative PJK, that is, the UIV level, and gradual transitional zone at the proximal end of the construct, therefore the risk of this unfortunate outcome can be significantly minimized by carefully selecting UIV and hooks using a smooth gradual transitional zone along with other protective factors.

SARS-COV-2 can present with pulmonary, renal, gastrointestinal, hematological, and neurological manifestations. Neurological manifestations may occur after or before COVID-19 symptoms and signs. Spine and spinal cord complications are documented as neurological complications of COVID-19. Spinal cord pathology following COVID-19 showed inflammatory myelopathy and suspected cord ischemia. The most frequent presentation of COVID-19 myelitis is non-enhancing central expansile cord T2 signal changes, but it can present with lateral and dorsal column-specific disease and in some cases with negative magnetic resonance imaging (MRI). There is no known documented mechanism for spinal cord involvement in COVID-19 infection, but it seems as a post-infectious immunological and post-inflammatory disorder and reaction. Viral infection of SARS-CoV-2 can cause demyelination of the brain and spinal cord and also can exacerbate the known primary demyelinating disorders.

Methods and Materials/Patients:

 This is a narrative study about the spinal cord complications of COVID-19. To provide up-to-date information, we precisely reviewed COVID-19 articles on spine and spinal cord complications. Based on the keywords COVID-19, SARS-CoV-2, spine, and spinal cord, all the related articles were taken from Google Scholar, PubMed, and Medline and were precisely studied.

There are reported cases of COVID-19 spine and spinal cord involvement. There is no documented mechanism for these involvements but the possible mechanisms are direct invasion, cytokine storm, coagulopathy, and an autoimmune response. The routine therapy of such complications is the treatment of these complications with other primary causes with a poor and unsatisfactory response of myelopathy to treatment; however, early diagnosis and vigilance of such involvement improve outcome.

COVID-19 can cause spine and spinal cord complications in some patients without a known incidence rate of such complications. The pathogenesis is not completely known; therefore, more conclusive studies are obligatory to improve our information on COVID-19 spinal cord and spine complications.

Background and Importance:

 Idiopathic spinal cord herniation (ISCH), or spontaneous spinal cord herniation, is a rare but serious condition that can cause progressive myelopathy and irreversible neurological deficits if left untreated. The condition is marked by the gradual herniation of the spinal cord through a ventral defect in the dura, leading to compromised blood flow and neurological deficits. Common symptoms include Brown-Séquard syndrome or asymmetrical paraparesis. Treatment options typically focus on reducing the strangulated spinal cord and closing the dural defect with a synthetic patch.

We present the case of an adult woman with progressive asymmetrical weakness of the lower limbs compatible with spastic paraparesis. Thoracic magnetic resonance imaging (MRI) revealed characteristic features of ISCH at the T3-T4 level. Intraoperative neurophysiological monitoring was used during the surgical intervention, which involved a 3-level laminectomy, dura opening, excision of the dentate ligament, and reduction of the cord across the dural defect. The defect was then filled with an autogenous piece of muscle, followed by the closure of the defect with an artificial dural patch and dural closure. At the 6-month follow-up, the patient showed favorable improvement.

Patients with slowly progressive paraparesis or Brown-Séquard syndrome should consider the possibility of ISCH as a potential cause, despite its rarity. In symptomatic cases, the preferred treatment option often involves reducing the incarcerated spinal cord followed by covering the dural defect.

Craniopharyngiomas (CP) are histologically benign tumors of the sellarsuprasellar region and are associated with significant morbidity. Due to the lack of knowledge of the factors responsible for the recurrence of CP and the challenges in surgeries for recurrent CP studies, it is necessary to determine the predictive factors for CP patients for preoperative prognosis and also for proper planning of surgery for a better functional outcome. Using”primum non nocere” or “do no harm” rule, our study tries to find out the optimum surgical strategy to have a better functional outcome as well as to reduce recurrence.

Methods and Materials/Patients: 

This study is a 5-year retrospective analysis of the institutes of neuropathology database and clinical and radiological data with 12 months of follow-up in such patients.

Out of 72 patients, 33 were men and 39 were women with a mean age of 17.34 years. A total of 11 patients underwent gross total resection (GTR) and the rest 61 patients were operated by subtotal resection (STR) followed by radiotherapy (RT). The recurrence rate in GTR and STR+radiotherapy (RT)was 1% and 24%, respectively. Eighteen cases had a poor postoperative outcome with a mortality rate of 6.98. Postoperative visual loss, obesity, neurological deficit, and diabetes insipidus (DI) were more common in the GTR group, while postoperative endocrinal dysfunction was more common in the STR+RT group. Also, older age, preoperative vision loss, hypothalamus invasion, and GTR were associated with poor postoperative outcomes.

Patient-tailored resection should be performed for better functional outcomes with acceptable recurrence rates. Preoperative risk factor analysis helps to make proper surgical decisions regarding the extent of resection.

Spinal cord trauma is a public health problem. The subaxial cervical spine is the most frequent seat of such injuries. This study aims to describe the treatment of subaxial cervical spine injuries at the University Hospital Center of Brazzaville, the Republic of Congo.

Methods and Materials/Patients: 

This descriptive study was conducted for 7 years, from 2015 to 2021 in the Department of Multipurpose Surgery at the University Hospital Center of Brazzaville, Congo. The research included all patients hospitalized for subaxial cervical spine injury. The surgery was performed on 32 cases (53.3%).

A total of 90 cases with subaxial cervical spine injuries were reported with a frequency of 3.2% and included 60 cases. The median age was 37 years and the sex ratio (male/female) of 3.6. The trauma was because of a road accident in 68.3% of the cases. The affected vertebral level was C5-C6 in 18 cases (30%). It was a luxation in 30% and fracture luxation in 26.7% of the subjects. Surgery was indicated in 51 patients and 32(53.3%) were operated. The median time between admission and surgery was 288 hours. A total of 31(96.9%) cases were operated by the anterior approach alone. Anterior osteosynthesis was performed in all cases. Meanwhile, 18(56.3%) cases had a favorable evolution, 7(21.9%) had a worsening of the deficit, 5(15.6%) experienced a postoperative infection, 5(15.6%) showed deep pressure ulcers, and 7(22%) cases died. In both univariate and multivariate analysis, an unfavorable American Spine Injury Association score (between A and B) was associated with the occurrence of complications with a significant statistical difference (P<0.05).

Therapeutic care is delayed due to insufficient financial means for patients who lack health insurance. The surgery consists of neural decompression, arthrodesis then osteosynthesis, particularly by an anterior approach.

Emotion dysregulation (ED) after traumatic brain injury (TBI) can exacerbate a wide range of symptoms, including problems in restraining emotions and behaviors, executive function disorders, and diminished emotional awareness and expression. This study aims to systematically review these studies on emotion dysregulation (ED) in people with TBI.

Methods and Materials/Patients: 

PubMed, Web of Science, Scopus, as well as Google Scholar, were systematically searched for required articles published between 1997 and 2023. The eligibility of identified literature was determined by screening the titles and abstracts by two autonomous researchers, denoted as the first author and the second author. Only those studies that reported either emotional regulation or expressive suppression in their findings of TBI adults were included in this review. The abstract and full text of search results were screened by Rayyan QCRI (Qatar Computing Research Institute) intelligent systematic review. Subsequently, the two researchers independently assessed the full-text versions of the residual articles to determine their admissibility. Disputes at each stage were amicably resolved through discourse and consultation.

Of the 773 articles identified, 361 studies remained after removing duplicate studies. A final 58 studies were retrieved for full-text screening based on inclusion criteria. So that after the renewed screening, 34 studies were included in this review, which indicated the existence of emotional problems in patients with TBI in all severities.

Even though numerous effective factors either physical or psychological aspects made brain injuries more complicated, long-term outcomes associated with post-injury emotional and mental distress and dysregulation have rarely been analyzed in terms of TBI treatment. Hence, by considering medical and clinical psychology care, a more comprehensive approach can be adopted to treat people with TBI and improve their quality of life.

We assessed surgical cases with giant epidural hemorrhages that have a significant influence on therapeutic as well as clinical prognosis.

Methods and Materials/Patients:

 A total of 112 cases underwent surgery for epidural hemorrhage in an Emergency Neurosurgical Department of the Uttar Pradesh University of Medical Sciences, Saifai, Etawah, India (a rural hospital), between January 1, 2022, and March 31, 2023. We defined giant epidural hemorrhage as a quantity of more than 80 cc. The therapeutic and prognostic features of 15 people with giant epidural hemorrhage with a hematoma volume of 80 cc were studied further.

The most prevalent age group was between 20 and 40 years (53.33%). M2 response (60%) represented the most frequent motor movement among giant epidural hemorrhage victims who underwent surgery. The majority of them (86.66%) suffered from serious brain damage. The Glasgow Coma Scale (GCS) score on admission, pupil alterations, and motor movement were all associated with the prognosis of giant epidural hemorrhage surgery.

Giant epidural hemorrhage > 80 cc performs badly. The GCS on admission, pupil alterations, and motor movement are all markers of the operative prognosis of a large epidural hemorrhage.

This study aims to determine the histological evolution of the relationship between the dura mater and the walls of the arteries with the encephalic destination in fetuses of different ages.

Methods and Materials/Patients: 

We conducted a prospective descriptive study over 4 months. It included eight fetuses aged between 24 and 34 weeks of amenorrhea obtained after informed consent from the parents. Four fetuses were less than 30 weeks old and four were more than 30 weeks old. After the previously formalized anatomical dissection of the fetal skull base, partial pairs of the internal carotid and vertebral arteries were removed at the level of the dural crossing. Samples were fixed with 10% formalin and embedded in paraffin before routine histochemical (hematoxylin-eosin) and immunohistochemical (matrix metalloproteinase 7 [MMP7]) staining.

We observed a "separation zone" between the dura mater and the arterial wall that is complete in fetuses between 24 and 29 weeks gestation. This cleavage zone disappeared in fetuses of 30 weeks gestation and more. This dural-arterial contact, observed from this age onwards, bears witness to a progressive arterial "invasion" by the dura mater, to reach the aspect observed in adults, characterized by the penetration of dural fibers into the arterial wall. 

The duro-arterial relationship at the intersection level is a dynamic phenomenon that has been going on since the antenatal period.

Lumbar spine posterior stabilization surgery is based on the formation of bone structures around the device placement. However, if these bone structures are not formed well, the conditions for pseudoarthrodesis are provided. In recent years, the use of platelet-rich plasma (PRP) as an induction of bone formation after spinal stabilization has received attention, but its results have been different and sometimes controversial. This study was conducted to accurately evaluate the effect of this method on arthrodesis after lumbar spine posterior stabilization surgery.

Methods and Materials/Patients:

 Twenty patients under the age of 70 years who were candidates for posterior spinal stabilization surgery were selected, and on the day of surgery, PRP was prepared from their venous blood, and at the end of the surgery, a combination of PRP and allograft bone was used on one side of the spine, and a combination of normal saline and allograft bone was used on the other side for arthrodesis. Then, the arthrodesis in the patients was evaluated with a computerized tomography (CT) scan in the third, sixth, and twelfth months after the operation by two radiologists based on the Hounsfield index.

In all 20 patients, the arthrodesis was significant during the third, sixth, and twelfth months in the intervention side and in the control side and had a decreasing trend (P<0.001). In the comparison of the arthrodesis rate in the third and twelfth months after the operation, no significant difference was observed between the intervention and control groups (P=0.120 and P=0.405, respectively). In the sixth month, the rate of arthrodesis between the intervention and control groups was borderline statistically significant (P=0.061).

The use of PRP in the stabilization of the lumbar spine does not affect the increasing rate of spinal arthrodesis, and it may only accelerate the rate of arthrodesis in the sixth month.

Background and importance:

 Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the United States. CLL invasion to the central nervous system (CNS) is a scarce complication followed by diverse outcomes. Moreover, symptomatic CNS lesion as the primary clinical presentation of undiagnosed CLL is extremely rare. In CNS involvements, it usually invades leptomeningeal, and less commonly causes parenchymal lesions.

We introduce 71 years 71-year-old man with a history of CLL referred to our center with headache and lower extremities weakness CNS involvement. After the initial evaluation, the MRI findings revealed a “ring or target sign” both in the temporal lobe and intramedullary spinal cord according to T9-T10. Surgical resection of the temporal lesion was done and CLL was confirmed with histological findings.

Finally, the primary presentation of CLL with CNS involvement is an uncommon occurrence. It doesn't show a preference for age, gender, or ethnicity and can occur at any stage of CLL. Therefore, it is important to be aware of this possibility when patients with a history of CLL present with neurological symptoms

Background and Importance:

 Acute spinal cord injury without an apparent spinal fracture/dislocation in an asymptomatic subject with silent thoracic ossification of the ligamentum flavum (TOLF) is an extremely rare with only seven fully documented example with this specific scenario in the literature.

A previously healthy middle-aged woman with a history of MRI documented silent TOLF who developed sever weakness of the lower limbs immediately after a minor fall is presented.  Repeat MRI revealed appearance of a myelopathy at the site of the preexisting silent T10-T11 OLF. Laminectomy and excision of the O LF result in complete recovery within 6 months.

We believe that our asymptomatic patient should had undergone prophylactic surgical intervention before this catastrophic event. In a survey of medical literature, we found that the presented case is the first example with MRI documented TOLF in its silence period.

In the context of academic medical education, mentorship has been known to play an undeniable role in academic and personal development of junior mentees, as well as guiding them through their carrier, research, and education. Here in, we enumerated the qualities and characteristics of a good mentor, through introducing an exemplary mentor in neurosurgery: Professor Abbas Amirjamshidi. He had been an exemplary mentor with professional mentorship characteristics including altruistic and understanding, accessible and punctual, knowledgeable and experienced, able to assist mentees in defining and reaching goals, senior and well-respected in the field, sincerely dedicated to developing an important relationship with the mentee. Professor Amirjamshidi had been a role model as a mentor steering his mentees in changing their professional life by directing them in the right direction. To achieve this coveted goal, Professor Amirjamshidi would invest time and energy to ascertain that his mentees achieve the loftiest goals in their professional career. He has been present both at the national and international forums as an invited speaker, and has served as a member of the editorial boards of reputed journals. Besides, he has innumerable publications to his credit in peer-reviewed journals.