Youssef Fahde, D. Mpando, M. Laghmari, Houssine Ghannane, S. Aitbenali
Background and Importance: Transorbitocranial assaults with sharp objects like a knife are rare neuro-ophthalmologic emergencies. However, they can have dramatic functional and life-threatening consequences. Our presentation aims to report the importance of an urgent multidisciplinary approach and to raise awareness among the general population on the importance of preventing violent behavior. Case Presentation: A 33-year-old man was a victim of a knife attack without obvious brain or ophthalmological lesions. The knife entered the medial part of the orbit. Neurological examination was normal, and Computed Tomography (CT) scan showed intracranial trajectory through the orbit to the frontal horn of the lateral ventricle. The knife was extracted without complications. The patient reported spectacular improvement in visual acuity without neurological or oculomotor deficit at long-term follow-up. In this case report, we will discuss the radiological diagnosis and surgical management of transorbital and orbitocranial injuries by foreign body penetration. Conclusion: Urgent multidisciplinary management in orbitocranial trauma by stabbing is mandatory to avoid life-threatening complications and irreversible damages.
{"title":"Penetrating Orbitocranial Injury With a Good Aesthetic and Functional Outcome: A Case Report","authors":"Youssef Fahde, D. Mpando, M. Laghmari, Houssine Ghannane, S. Aitbenali","doi":"10.32598/irjns.7.1.8","DOIUrl":"https://doi.org/10.32598/irjns.7.1.8","url":null,"abstract":"Background and Importance: Transorbitocranial assaults with sharp objects like a knife are rare neuro-ophthalmologic emergencies. However, they can have dramatic functional and life-threatening consequences. Our presentation aims to report the importance of an urgent multidisciplinary approach and to raise awareness among the general population on the importance of preventing violent behavior. Case Presentation: A 33-year-old man was a victim of a knife attack without obvious brain or ophthalmological lesions. The knife entered the medial part of the orbit. Neurological examination was normal, and Computed Tomography (CT) scan showed intracranial trajectory through the orbit to the frontal horn of the lateral ventricle. The knife was extracted without complications. The patient reported spectacular improvement in visual acuity without neurological or oculomotor deficit at long-term follow-up. In this case report, we will discuss the radiological diagnosis and surgical management of transorbital and orbitocranial injuries by foreign body penetration. Conclusion: Urgent multidisciplinary management in orbitocranial trauma by stabbing is mandatory to avoid life-threatening complications and irreversible damages.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44236647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Luiz A. Vieira Netto, Luís Felipe Araújo Peres, Nayara Matos Pereira, Alice Jardim Zaccariotti1, Vladimir Arruda Zaccariotti, Rômulo Alberto Silva Marques, João Batista Arruda, Edesio Martins, Rodrigo Alves de Carvalho Cavalcante
Background and Aim: Gynecological cancer is one of the most common types of cancer worldwide. Nonetheless, spinal metastasis from gynecological cancer is scarcely reported in the literature. In cases of spinal cord compression, the standard treatment is a decompressive surgery followed by radiotherapy treatment for selected patients. This study aimed to report the overall survival and surgical results in patients presenting with gynecological spinal metastases who underwent spinal cord/nerve root decompression and stabilization. Methods and Materials/Patients: A total of 18 patients were included in this study. The surgical procedures were performed from 2012 to 2019. The evaluation of neurological status, spinal stability, and pain were performed using the American Spinal Injury Association Impairment Scale (ASIA), Spinal Instability Neoplastic Score (SINS), and Visual Analogue Scale (VAS), respectively. Results: The lumbar spine was the most affected location (n=30; 50.0%). Regarding the preoperative neurological deficits, 16 cases (n=16; 88.9%) presented ASIA graded A–D before the surgery, being reduced to five (n=5; 27.8%) after the procedures. The pain level means (pre-and postoperative) were 9.39±0.79 and 2.28±1.44. The overall median survival was 6.1 months (95% Confidence Interval [CI] of 1.10–11.13 months). The mean survival of ambulatory and non-ambulatory patients before the surgery was 7.36 months and 3.2 months, respectively (P=0.007 – Log-rank Mantel–Cox). Conclusion: Decompressive surgery and stabilization promote mechanical pain relief, spinal stability, an improvement of neurological function, and indirectly improving quality of life, despite a dismal overall survival of patients who present with metastatic spinal compression disease.
{"title":"Outcomes of Surgical Decompression for Spinal Metastases From Gynecological Cancers: A Retrospective Cohort Study","authors":"Luiz A. Vieira Netto, Luís Felipe Araújo Peres, Nayara Matos Pereira, Alice Jardim Zaccariotti1, Vladimir Arruda Zaccariotti, Rômulo Alberto Silva Marques, João Batista Arruda, Edesio Martins, Rodrigo Alves de Carvalho Cavalcante","doi":"10.32598/irjns.7.1.5","DOIUrl":"https://doi.org/10.32598/irjns.7.1.5","url":null,"abstract":"Background and Aim: Gynecological cancer is one of the most common types of cancer worldwide. Nonetheless, spinal metastasis from gynecological cancer is scarcely reported in the literature. In cases of spinal cord compression, the standard treatment is a decompressive surgery followed by radiotherapy treatment for selected patients. This study aimed to report the overall survival and surgical results in patients presenting with gynecological spinal metastases who underwent spinal cord/nerve root decompression and stabilization. Methods and Materials/Patients: A total of 18 patients were included in this study. The surgical procedures were performed from 2012 to 2019. The evaluation of neurological status, spinal stability, and pain were performed using the American Spinal Injury Association Impairment Scale (ASIA), Spinal Instability Neoplastic Score (SINS), and Visual Analogue Scale (VAS), respectively. Results: The lumbar spine was the most affected location (n=30; 50.0%). Regarding the preoperative neurological deficits, 16 cases (n=16; 88.9%) presented ASIA graded A–D before the surgery, being reduced to five (n=5; 27.8%) after the procedures. The pain level means (pre-and postoperative) were 9.39±0.79 and 2.28±1.44. The overall median survival was 6.1 months (95% Confidence Interval [CI] of 1.10–11.13 months). The mean survival of ambulatory and non-ambulatory patients before the surgery was 7.36 months and 3.2 months, respectively (P=0.007 – Log-rank Mantel–Cox). Conclusion: Decompressive surgery and stabilization promote mechanical pain relief, spinal stability, an improvement of neurological function, and indirectly improving quality of life, despite a dismal overall survival of patients who present with metastatic spinal compression disease.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42908971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Hosseininezhad, A. Ghayeghran, Paria Nasiri, S. Saadat, Katayoun Esmaili, Enayatollah Homaei Rad, Zahra Gholipour Soleimani
Background and Aim: The present study aimed to use the median nerve Compound Muscle Action Potential (CMAP) amplitude by stimulation at the palm instead of Abductor Pollicis Brevis (APB) needle Electromyography (EMG) for determining axonal loss in patients with Carpal Tunnel Syndrome (CTS). Methods and Materials/Patients: This study was performed on 180 patients with CTS referred to the Electrodiagnostic (EDX) Center, Poursina Hospital, Guilan Province, Iran, in 2018-19. In this study, the APB needle EMG diagnostic test was used as the gold standard, and median nerve CMAP amplitude with stimulation at the palm and wrist were used to compare the two nerve stimulation tests. Results: All of the cases with abnormal amplitude loss detected by median nerve stimulation at the palm also had an axonal loss in the needle EMG of APB. So this test could be a good indicator of axonal loss if there is an abnormality (sensitivity: 73%, specificity: 100%). The results with wrist stimulation were not as accurate as of the palm stimulation, and some cases with decreased CMAP amplitude of median nerve had normal needle EMG of APB muscle (sensitivity: 86.6%, specificity: 94.9%). Conclusion: In cases with CTS, the abnormally decreased amplitude of the median nerve detected by stimulation at the palm could be a good indicator of axonal loss.
{"title":"Estimation of Median Nerve Axonal Degeneration without Needle Electromyography","authors":"M. Hosseininezhad, A. Ghayeghran, Paria Nasiri, S. Saadat, Katayoun Esmaili, Enayatollah Homaei Rad, Zahra Gholipour Soleimani","doi":"10.32598/irjns.7.1.4","DOIUrl":"https://doi.org/10.32598/irjns.7.1.4","url":null,"abstract":"Background and Aim: The present study aimed to use the median nerve Compound Muscle Action Potential (CMAP) amplitude by stimulation at the palm instead of Abductor Pollicis Brevis (APB) needle Electromyography (EMG) for determining axonal loss in patients with Carpal Tunnel Syndrome (CTS). Methods and Materials/Patients: This study was performed on 180 patients with CTS referred to the Electrodiagnostic (EDX) Center, Poursina Hospital, Guilan Province, Iran, in 2018-19. In this study, the APB needle EMG diagnostic test was used as the gold standard, and median nerve CMAP amplitude with stimulation at the palm and wrist were used to compare the two nerve stimulation tests. Results: All of the cases with abnormal amplitude loss detected by median nerve stimulation at the palm also had an axonal loss in the needle EMG of APB. So this test could be a good indicator of axonal loss if there is an abnormality (sensitivity: 73%, specificity: 100%). The results with wrist stimulation were not as accurate as of the palm stimulation, and some cases with decreased CMAP amplitude of median nerve had normal needle EMG of APB muscle (sensitivity: 86.6%, specificity: 94.9%). Conclusion: In cases with CTS, the abnormally decreased amplitude of the median nerve detected by stimulation at the palm could be a good indicator of axonal loss.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46493560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Aim: Indocyanine Green (ICG) angiography has become the standard of practice in many centers managing cerebrovascular diseases. Though 3D stereoscopic recording of the surgeries has received widespread attention, there is a need for a technology to display and record real-time 3D ICG angiographies. In this study, we designed and constructed an ICG angiography camera to display the real-time 3D ICG angiographies. Methods and Materials/Patients: Our project had three phases. In phase I, a handmade ICG camera was designed and constructed in our laboratory. The second phase included creating a 3D camera to display real-time images in 3D anaglyph format. In the last phase, we developed a 3D ICG camera to demonstrate 3D ICG angiographies in real-time. Results: We successfully completed all three phases of the project and could display real-time 3D ICG angiography of a mouse mesenteric arteries, recorded it, and took pictures. Conclusion: We proposed a method and proved its feasibility for producing a 3D ICG angiography camera to be mounted on the next generation of neurosurgical microscopes.
{"title":"Three-dimensional Anaglyph Indocyanine Green Video Angiography: A New Technology for Cerebrovascular Surgeries","authors":"M. Nouri, A. Azarhomayoun","doi":"10.32598/irjns.7.1.3","DOIUrl":"https://doi.org/10.32598/irjns.7.1.3","url":null,"abstract":"Background and Aim: Indocyanine Green (ICG) angiography has become the standard of practice in many centers managing cerebrovascular diseases. Though 3D stereoscopic recording of the surgeries has received widespread attention, there is a need for a technology to display and record real-time 3D ICG angiographies. In this study, we designed and constructed an ICG angiography camera to display the real-time 3D ICG angiographies. Methods and Materials/Patients: Our project had three phases. In phase I, a handmade ICG camera was designed and constructed in our laboratory. The second phase included creating a 3D camera to display real-time images in 3D anaglyph format. In the last phase, we developed a 3D ICG camera to demonstrate 3D ICG angiographies in real-time. Results: We successfully completed all three phases of the project and could display real-time 3D ICG angiography of a mouse mesenteric arteries, recorded it, and took pictures. Conclusion: We proposed a method and proved its feasibility for producing a 3D ICG angiography camera to be mounted on the next generation of neurosurgical microscopes.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44499886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Aim: The insertion of Ventriculoperitoneal (VP) or Ventriculoatrial (VA) shunt is the first line of treatment in patients with hydrocephalus and normal-pressure hydrocephalus. The provision of a safety profile for shunting in the treatment of hydrocephalus patients is very important. This study aimed to determine the success rates and complications of VP and VA shunting in patients with hydrocephalus. Methods and Materials/Patients: This systematic review investigated the complication rates of VP and VA shunting in managing patients with hydrocephalus. All the published studies were searched in three electronic databases of Web of Science, PubMed and Google Scholar from March 20 to April 10, 2020, using the keywords of “Ventriculoperitoneal” and “Ventriculoatrial” in combination with “Hydrocephalus”. Results: In total, nine articles met the eligibility criteria for being included in this review. Some studies showed a higher rate of shunt obstruction in patients undergoing VA shunting; however, other studies demonstrated no difference in terms of shunt obstruction. The rates of primary revision shunt were various within the ranges of 5.4%-48% and 9.1%-58% for VA and VP shunting, respectively. A higher rate of revision shunt was reported among the patients undergoing VP shunting, compared to that reported for VA shunting. The different mortality rates in various studies were estimated within the range of 0%-10% and at 13.9% for VA and VP shunting, respectively. Conclusion: In general, no difference was reported between VA and VP shunting regarding the rates of complications and mortality. Due to the ease of placement and revision, VP shunting could be considered the first-line treatment of hydrocephalus. However, this approach has been preferred in newborns, and there have been insufficient data on adults in this regard.
背景与目的：脑室-腹腔（VP）或脑室-心房（VA）分流术是治疗脑积水和常压脑积水的第一道防线。在脑积水患者的治疗中，提供分流的安全性是非常重要的。本研究旨在确定脑积水患者VP和VA分流的成功率和并发症。方法和材料/患者：本系统综述研究了VP和VA分流治疗脑积水患者的并发症发生率。2020年3月20日至4月10日，所有已发表的研究都在Web of Science、PubMed和Google Scholar的三个电子数据库中进行了搜索，关键词分别为“脑室腹膜”和“脑室心房”，并结合“脑积水”。结果：总共有9篇文章符合纳入本次审查的资格标准。一些研究表明，在接受VA分流的患者中，分流阻塞的发生率更高；然而，其他研究表明分流梗阻方面没有差异。VA和VP分流的初次翻修分流率不同，分别在5.4%-48%和9.1%-58%的范围内。据报道，与VA分流相比，接受VP分流的患者的翻修分流率更高。在各种研究中，VA和VP分流的不同死亡率估计分别在0%-10%和13.9%之间。结论：总的来说，VA和VP分流在并发症发生率和死亡率方面没有差异。由于放置和翻修方便，VP分流可被认为是脑积水的一线治疗方法。然而，这种方法在新生儿中更受欢迎，在这方面，关于成年人的数据不足。
{"title":"Success Rates and Complications of Ventriculoperitoneal and Ventriculoatrial Shunting: A Systematic Review","authors":"H. Rezaee, Amin Tavallaii, E. Keykhosravi","doi":"10.32598/irjns.7.1.1","DOIUrl":"https://doi.org/10.32598/irjns.7.1.1","url":null,"abstract":"Background and Aim: The insertion of Ventriculoperitoneal (VP) or Ventriculoatrial (VA) shunt is the first line of treatment in patients with hydrocephalus and normal-pressure hydrocephalus. The provision of a safety profile for shunting in the treatment of hydrocephalus patients is very important. This study aimed to determine the success rates and complications of VP and VA shunting in patients with hydrocephalus. Methods and Materials/Patients: This systematic review investigated the complication rates of VP and VA shunting in managing patients with hydrocephalus. All the published studies were searched in three electronic databases of Web of Science, PubMed and Google Scholar from March 20 to April 10, 2020, using the keywords of “Ventriculoperitoneal” and “Ventriculoatrial” in combination with “Hydrocephalus”. Results: In total, nine articles met the eligibility criteria for being included in this review. Some studies showed a higher rate of shunt obstruction in patients undergoing VA shunting; however, other studies demonstrated no difference in terms of shunt obstruction. The rates of primary revision shunt were various within the ranges of 5.4%-48% and 9.1%-58% for VA and VP shunting, respectively. A higher rate of revision shunt was reported among the patients undergoing VP shunting, compared to that reported for VA shunting. The different mortality rates in various studies were estimated within the range of 0%-10% and at 13.9% for VA and VP shunting, respectively. Conclusion: In general, no difference was reported between VA and VP shunting regarding the rates of complications and mortality. Due to the ease of placement and revision, VP shunting could be considered the first-line treatment of hydrocephalus. However, this approach has been preferred in newborns, and there have been insufficient data on adults in this regard.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46801314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sundus Ali, Fauzia Sajjad, A. Shabbir, Akmal Azeemi
Background and Aim: Most good grade (WFNS I and II) patients who undergo microsurgical clipping achieve a favorable outcome. However, some independent patients before surgery face unfavorable outcomes after the operation, signifying the impact of microsurgical clipping. This study aimed to identify the risk of developing dependency in patients without previous neurological deficits. Methods and Materials/Patients: We reviewed 50 consecutive good grade patients with ruptured anterior circulation aneurysms who underwent microsurgical clipping between May 2017 and May 2020 in the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan. The clinical outcome at discharge and three months follow-up was assessed using the Glasgow Outcome Scale (GOS). Results: In this study, seven patients (14%) became dependent (GOS II and III) following clipping. Of whom, five patients (10%) suffered surgical insult in the form of intraoperative rupture (4%), post-op infarct (4%), and direct brain damage (2%). Conclusion: Patients without neurologic deficit pre-operatively still suffer unfavorable outcomes mainly due to operative complications. Vascular injuries remain the main cause of morbidity-producing dependency. Therefore, all surgical techniques must minimize the risk to vessels, both during dissection and at clip placement.
{"title":"Risk of Dependency Following Microsurgical Clipping in Good Grade Patients With Ruptured Anterior Circulation Aneurysms","authors":"Sundus Ali, Fauzia Sajjad, A. Shabbir, Akmal Azeemi","doi":"10.32598/irjns.7.1.6","DOIUrl":"https://doi.org/10.32598/irjns.7.1.6","url":null,"abstract":"Background and Aim: Most good grade (WFNS I and II) patients who undergo microsurgical clipping achieve a favorable outcome. However, some independent patients before surgery face unfavorable outcomes after the operation, signifying the impact of microsurgical clipping. This study aimed to identify the risk of developing dependency in patients without previous neurological deficits. Methods and Materials/Patients: We reviewed 50 consecutive good grade patients with ruptured anterior circulation aneurysms who underwent microsurgical clipping between May 2017 and May 2020 in the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan. The clinical outcome at discharge and three months follow-up was assessed using the Glasgow Outcome Scale (GOS). Results: In this study, seven patients (14%) became dependent (GOS II and III) following clipping. Of whom, five patients (10%) suffered surgical insult in the form of intraoperative rupture (4%), post-op infarct (4%), and direct brain damage (2%). Conclusion: Patients without neurologic deficit pre-operatively still suffer unfavorable outcomes mainly due to operative complications. Vascular injuries remain the main cause of morbidity-producing dependency. Therefore, all surgical techniques must minimize the risk to vessels, both during dissection and at clip placement.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43906893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Yousefzadeh-Chabok, G. Sharifi, M. Ghorbani, M. Samadian, N. Kalani, A. Kazeminezhad
Background and Aim: EETA (Endoscopic Endonasal Transsphenoidal Approach) is a preferred choice for pituitary tumors. EETA offers minimal invasiveness, fewer complications, and better outcomes than the sublabial or transseptal microscopic approach. EETA has three approaches: mononostril endoscopic transsphenoidal approach, binostril endoscopic transsphenoidal approach, and one and a half nostril approach. This study aims to compare three different EETAs and compare between microscopic transsphenoidal approach, transcranial approach and EETA. Methods and Materials/Patients: To provide up-to-date information, we concisely reviewed these three EETAs. Using the keywords of “neuroendoscopy”, “META” (Mononostril Endoscopic Transsphenoidal Approach), “OETA” (One and a half nostril Approach), “BETA” (Binostril Endoscopic Transsphenoidal Approach), “pituitary adenoma”, “EETA”, “endoscopy”, “transsphenoidal approach”, “transcranial approach for pituitary adenoma” and “microscopic transsphenoidal approach”. We retrieved all the relevant articles from Google Scholar, PubMed, and Medline. Then, we reviewed them and critically analyzed them. Results: In BETA there is free and easy movement of surgical instruments in the surgical field and a broader view of the sphenoid sinus and it is an excellent approach to resect large tumors. The META is suitable in tumors with limited involvement of the intra-sellar and supra-sellar area. The mononostril approach is not suitable and has some limitations for the following situations: a crowded narrow nasal cavity, a harder tumor with the invasive appearance or significant suprasellar extension, and lesions other than pituitary adenomas. The OETA provides a sufficient surgical corridor for a 2-surgeon/4 or 3-hands technique with a minimal injury of the nose and good operative results, free and easy movement of surgical instruments in the surgical field, low post-operative morbidity, and good post-operative quality of life. Conclusion: In EETA, knowing the size and consistency of tumor, general versus invasive pituitary adenoma, and the extent of parasellar and suprasellar extension, is essential. If we cannot reach a pituitary macroadenoma with a trans-sphenoidal approach, then we can use a transcranial approach for the removal of the tumor. The microscopic transsphenoidal approach is suitable for pediatric pituitary adenoma
{"title":"Comparing Mononostril, Binostril, and One and a Half Nostril Endoscopic Transsphenoidal Approach for Treating Pituitary AdenomaPituitary Adenoma","authors":"S. Yousefzadeh-Chabok, G. Sharifi, M. Ghorbani, M. Samadian, N. Kalani, A. Kazeminezhad","doi":"10.32598/irjns.7.1.2","DOIUrl":"https://doi.org/10.32598/irjns.7.1.2","url":null,"abstract":"Background and Aim: EETA (Endoscopic Endonasal Transsphenoidal Approach) is a preferred choice for pituitary tumors. EETA offers minimal invasiveness, fewer complications, and better outcomes than the sublabial or transseptal microscopic approach. EETA has three approaches: mononostril endoscopic transsphenoidal approach, binostril endoscopic transsphenoidal approach, and one and a half nostril approach. This study aims to compare three different EETAs and compare between microscopic transsphenoidal approach, transcranial approach and EETA. Methods and Materials/Patients: To provide up-to-date information, we concisely reviewed these three EETAs. Using the keywords of “neuroendoscopy”, “META” (Mononostril Endoscopic Transsphenoidal Approach), “OETA” (One and a half nostril Approach), “BETA” (Binostril Endoscopic Transsphenoidal Approach), “pituitary adenoma”, “EETA”, “endoscopy”, “transsphenoidal approach”, “transcranial approach for pituitary adenoma” and “microscopic transsphenoidal approach”. We retrieved all the relevant articles from Google Scholar, PubMed, and Medline. Then, we reviewed them and critically analyzed them. Results: In BETA there is free and easy movement of surgical instruments in the surgical field and a broader view of the sphenoid sinus and it is an excellent approach to resect large tumors. The META is suitable in tumors with limited involvement of the intra-sellar and supra-sellar area. The mononostril approach is not suitable and has some limitations for the following situations: a crowded narrow nasal cavity, a harder tumor with the invasive appearance or significant suprasellar extension, and lesions other than pituitary adenomas. The OETA provides a sufficient surgical corridor for a 2-surgeon/4 or 3-hands technique with a minimal injury of the nose and good operative results, free and easy movement of surgical instruments in the surgical field, low post-operative morbidity, and good post-operative quality of life. Conclusion: In EETA, knowing the size and consistency of tumor, general versus invasive pituitary adenoma, and the extent of parasellar and suprasellar extension, is essential. If we cannot reach a pituitary macroadenoma with a trans-sphenoidal approach, then we can use a transcranial approach for the removal of the tumor. The microscopic transsphenoidal approach is suitable for pediatric pituitary adenoma","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48623241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Masoudi, N. Hadi, F. Ghaffarpasand, M. Askarpour, Faeze Ershadi, Tayebeh Sadeghpour
Background and Aim: 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 objective of the current study was to investigate the NTDs risk factors in a large sample of Iranian patients admitted to a single center. Methods and Materials/Patients: This case-control study was performed within five years from 2012 to 2017 in Namazi Hospital of Shiraz, a tertiary referral center for neonatal anomalies in the south of Iran. One hundred newborns with NTDs were included in the study 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 gravidity, gestational age), newborn information (birth weight, clinical diagnosis, clinical findings in the examination, and clinical findings in radiologic test) and medical history of the perinatal period. Results: The baseline characteristics of the mothers were matched in both groups. NTDs were associated with lower folic acid intake during pregnancy (66% vs. 78%; P=0.030; OR 95% CI=1.82) and before pregnancy (P=0.002; OR95% CI=2.36). The prevalence of NTD was significantly higher in patients who lived in hot climates (P=0.001). Conclusion: Taking adequate folic acid supplements before and during pregnancy can reduce the risk of NTDs in the Iranian population. Hot climate zones were associated with an increased risk of NTDs in Iran.
背景与目的:神经管缺陷(NTD)的危险因素已被描述，但存在种族和地理差异。来自伊朗人口的数据仍然很少。本研究的目的是调查单一中心收治的大量伊朗患者中被忽视的热带病的危险因素。方法和材料/患者:本病例对照研究于2012年至2017年的五年内在设拉子的Namazi医院进行，该医院是伊朗南部新生儿异常的三级转诊中心。本研究以100名新生儿为病例组，200名健康新生儿为对照组。我们记录了基线特征，包括母亲变量(年龄、体重、身高、既往妊娠和妊娠、胎龄)、新生儿信息(出生体重、临床诊断、检查临床表现、放射学检查临床表现)和围产期病史。结果:两组母亲的基线特征相符。NTDs与怀孕期间叶酸摄入量较低相关(66%对78%;P = 0.030;OR 95% CI=1.82)和妊娠前(P=0.002;OR95% CI = 2.36)。居住在炎热气候地区的患者NTD患病率明显更高(P=0.001)。结论:在怀孕前和怀孕期间服用足够的叶酸补充剂可以降低伊朗人群患NTDs的风险。在伊朗，炎热气候区与被忽视热带病的风险增加有关。
{"title":"Risk Factors of Neural Tube Defects in a Sample of Iranian Population From Southern Iran: A Hospital-based Investigation","authors":"M. Masoudi, N. Hadi, F. Ghaffarpasand, M. Askarpour, Faeze Ershadi, Tayebeh Sadeghpour","doi":"10.32598/irjns.5.3.4","DOIUrl":"https://doi.org/10.32598/irjns.5.3.4","url":null,"abstract":"Background and Aim: 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 objective of the current study was to investigate the NTDs risk factors in a large sample of Iranian patients admitted to a single center. Methods and Materials/Patients: This case-control study was performed within five years from 2012 to 2017 in Namazi Hospital of Shiraz, a tertiary referral center for neonatal anomalies in the south of Iran. One hundred newborns with NTDs were included in the study 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 gravidity, gestational age), newborn information (birth weight, clinical diagnosis, clinical findings in the examination, and clinical findings in radiologic test) and medical history of the perinatal period. Results: The baseline characteristics of the mothers were matched in both groups. NTDs were associated with lower folic acid intake during pregnancy (66% vs. 78%; P=0.030; OR 95% CI=1.82) and before pregnancy (P=0.002; OR95% CI=2.36). The prevalence of NTD was significantly higher in patients who lived in hot climates (P=0.001). Conclusion: Taking adequate folic acid supplements before and during pregnancy can reduce the risk of NTDs in the Iranian population. Hot climate zones were associated with an increased risk of NTDs in Iran.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41663652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Andalib, Z. Mohtasham-Amiri, S. Yousefzadeh-Chabok, A. Saberi, M. Emamhadi, L. Kouchakinejad-Eramsadati, Zohreh Norouzi, Hadiseh Shokat, Sara Sayad-Fathi, Samaneh Ghorbani-Shirkouhi
Background: Spine trauma is an important health problem. Traumatic spinal cord injury (SCI) due to motor vehicle accident (MVA) might have a different epidemiologic pattern in Guilan province of Iran owing to its geographical characteristics. Therefore, the present study was conducted to the study epidemiology of SCI injuries due to road accidents in a trauma referral center in Guilan. Methods: In this cross-sectional study, we used data SCI registry of Poursina Hospital. All the patients with spine trauma, due to MVA, hospitalized in the trauma center of Poursina Hospital, Rasht, Guilan, Iran between March 2015 and March 2018 were studied. Results: A total of 127 patients with spine trauma due to MVA were reviewed. The mean±SD age of patients was 38.27±16.22 years. We observed that 93.7%, 1.6%, and 4.7% of the patients had initial Glasgow Comma Scale (GCS≥13, 9≤GCS≤12, and GCS<9, respectively). SCIs were found several anatomical regions including cervical (n=54, 42.5%), lumbar (n=39, 30.7%), thoracic (n=23, 18.1%), thoracic and lumbar (n=7, 5.5%), thoracic and cervical (n=3, 2.4%), and lumbar and cervical (n=1, 0.8%) regions. Evaluated by Glasgow Outcome Scale (GOS), good recovery, moderate disability, severe disability, vegetative state, and death were found in 114 (91.2%), 4 (3.1%), 4 (3.1%), 1 (0.8%), 2 (1.6%) of the patients, respectively. Two patients were discharged by their personal contest. Conclusion: Spine trauma due to MVA is mostly seen in the young. SCI due to such trauma is mostly found in the cervical region. Good recovery was seen in most of the subjects.
{"title":"Traumatic Spinal Cord Injuries Due to Motor Vehicle Accidents","authors":"S. Andalib, Z. Mohtasham-Amiri, S. Yousefzadeh-Chabok, A. Saberi, M. Emamhadi, L. Kouchakinejad-Eramsadati, Zohreh Norouzi, Hadiseh Shokat, Sara Sayad-Fathi, Samaneh Ghorbani-Shirkouhi","doi":"10.32598/irjns.4.4.195","DOIUrl":"https://doi.org/10.32598/irjns.4.4.195","url":null,"abstract":"Background: Spine trauma is an important health problem. Traumatic spinal cord injury (SCI) due to motor vehicle accident (MVA) might have a different epidemiologic pattern in Guilan province of Iran owing to its geographical characteristics. Therefore, the present study was conducted to the study epidemiology of SCI injuries due to road accidents in a trauma referral center in Guilan. Methods: In this cross-sectional study, we used data SCI registry of Poursina Hospital. All the patients with spine trauma, due to MVA, hospitalized in the trauma center of Poursina Hospital, Rasht, Guilan, Iran between March 2015 and March 2018 were studied. Results: A total of 127 patients with spine trauma due to MVA were reviewed. The mean±SD age of patients was 38.27±16.22 years. We observed that 93.7%, 1.6%, and 4.7% of the patients had initial Glasgow Comma Scale (GCS≥13, 9≤GCS≤12, and GCS<9, respectively). SCIs were found several anatomical regions including cervical (n=54, 42.5%), lumbar (n=39, 30.7%), thoracic (n=23, 18.1%), thoracic and lumbar (n=7, 5.5%), thoracic and cervical (n=3, 2.4%), and lumbar and cervical (n=1, 0.8%) regions. Evaluated by Glasgow Outcome Scale (GOS), good recovery, moderate disability, severe disability, vegetative state, and death were found in 114 (91.2%), 4 (3.1%), 4 (3.1%), 1 (0.8%), 2 (1.6%) of the patients, respectively. Two patients were discharged by their personal contest. Conclusion: Spine trauma due to MVA is mostly seen in the young. SCI due to such trauma is mostly found in the cervical region. Good recovery was seen in most of the subjects.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45873398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Andalib, Z. Mohtasham-Amiri, S. Yousefzadeh-Chabok, A. Saberi, Z. Reihanian, Leila Kouchakinejad-Eramsadat, Sara Sayad-Fathi, Hadiseh Shokat, Bahador Hasanzadeh, Samaneh Ghorbani-Shirkouhi
Background: Traumatic spinal cord injury (SCI) is one of the most traumatic events threatening patients’ wellbeing and places a financial burden on health care system. The first step in determination of the exact impact of SCI is to estimate the pattern of traumatic injuries in a population and also the type of frequently occurred co-injuries. Hence, this study was conducted to assess the frequency of anatomy, type of spine injuries, and associated coinjuries in patients with trauma in Poursina Hospital of Guilan province in Iran. Methods: A descriptive cross-sectional study was carried out on traumatic spine patients admitted to the Poursina hospital of Rasht, a referral therapeutic center for trauma in north of Iran, in Rasht during 2015 to 2019. Data were extracted from the SCI registry of Poursina Hospital, Rasht, Guilan, Iran. Results: A total of 274 records were reviewed. Seventy-six patients were females and 198 patients were males. Mean±SD of age of the patients was 42.27±16.83 years. Based on this survey, most of the patients (43.8%) had SCI in lumbar region. Locked facet was seen in 12 patients. Fifty-seven patients (20.8%) complained about having pain. The median of VAS score was 6 (range=6). Co-existence of associated injuries (e.g. limb fractures, TBI, Internal bleeding, etc.) was found in 27.4% of the patients. According to ASIA (The American Spinal Injury Association) impairment scale, three patients (2.9%) had score A, and 100 patients (97.1%) had score E neurological defects. Conclusion: The most telling reiteration to be drawn is that men mostly suffered from spine trauma. Lumbar region was the most susceptible location of SCI. Moreover, most of the patients experienced score E (normal neurological charcteristics) according to ASIA.
背景:外伤性脊髓损伤(SCI)是威胁患者健康的最严重的创伤性事件之一，给医疗保健系统带来了巨大的经济负担。确定脊髓损伤确切影响的第一步是估计人群中创伤性损伤的模式以及经常发生的共同损伤的类型。因此，本研究旨在评估伊朗桂兰省Poursina医院创伤患者的解剖频率、脊柱损伤类型和相关共伤。方法:对2015 - 2019年伊朗北部创伤转诊治疗中心Rasht Poursina医院收治的创伤性脊柱患者进行描述性横断面研究。数据摘自伊朗Rasht Poursina医院的SCI登记处。结果:共审阅274份病历。女性76例，男性198例。患者平均±SD年龄为42.27±16.83岁。调查结果显示，大部分患者(43.8%)发生腰椎区脊髓损伤。12例患者出现关节突锁定。57例(20.8%)患者抱怨疼痛。VAS评分中位数为6(范围=6)。并发损伤(肢体骨折、脑外伤、内出血等)占27.4%。根据ASIA (The American Spinal Injury Association)损伤量表，3例(2.9%)为A分，100例(97.1%)为E分神经缺损。结论:最能说明问题的是男性脊柱损伤最多。腰椎是最容易发生脊髓损伤的部位。此外，大多数患者根据ASIA评分为E分(正常神经特征)。
{"title":"Epidemiology of Spine Trauma and Spinal Cord Injuries in the North of Iran","authors":"S. Andalib, Z. Mohtasham-Amiri, S. Yousefzadeh-Chabok, A. Saberi, Z. Reihanian, Leila Kouchakinejad-Eramsadat, Sara Sayad-Fathi, Hadiseh Shokat, Bahador Hasanzadeh, Samaneh Ghorbani-Shirkouhi","doi":"10.32598/IRJNS.4.4.180","DOIUrl":"https://doi.org/10.32598/IRJNS.4.4.180","url":null,"abstract":"Background: Traumatic spinal cord injury (SCI) is one of the most traumatic events threatening patients’ wellbeing and places a financial burden on health care system. The first step in determination of the exact impact of SCI is to estimate the pattern of traumatic injuries in a population and also the type of frequently occurred co-injuries. Hence, this study was conducted to assess the frequency of anatomy, type of spine injuries, and associated coinjuries in patients with trauma in Poursina Hospital of Guilan province in Iran. Methods: A descriptive cross-sectional study was carried out on traumatic spine patients admitted to the Poursina hospital of Rasht, a referral therapeutic center for trauma in north of Iran, in Rasht during 2015 to 2019. Data were extracted from the SCI registry of Poursina Hospital, Rasht, Guilan, Iran. Results: A total of 274 records were reviewed. Seventy-six patients were females and 198 patients were males. Mean±SD of age of the patients was 42.27±16.83 years. Based on this survey, most of the patients (43.8%) had SCI in lumbar region. Locked facet was seen in 12 patients. Fifty-seven patients (20.8%) complained about having pain. The median of VAS score was 6 (range=6). Co-existence of associated injuries (e.g. limb fractures, TBI, Internal bleeding, etc.) was found in 27.4% of the patients. According to ASIA (The American Spinal Injury Association) impairment scale, three patients (2.9%) had score A, and 100 patients (97.1%) had score E neurological defects. Conclusion: The most telling reiteration to be drawn is that men mostly suffered from spine trauma. Lumbar region was the most susceptible location of SCI. Moreover, most of the patients experienced score E (normal neurological charcteristics) according to ASIA.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44950021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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