en
jalali
1396
9
1
gregorian
2017
12
1
3
3
online
1
fulltext
en
Treatment of 44 Cases With Lumbar Spine Stenosis and Degenerative Instability: Outcomes of Surgical Intervention
Background and Aim: Degenerative lumbar spine disease can lead to lumbar spine instability. The patients can present with Low Back Pain (LBP), radicular pain, and motor and sensory dysfunction. Age >50, female sex and pregnancies are among prevalent risk factors. The degeneration process usually starts from the intervertebral discs progressing to involve facet joints, ligaments, and vertebral bodies leading to spinal instability and deformity. This study aims to evaluate the effect of lumbar decompression and Posterolateral Fusion (PLF) on the short- and long-term outcomes of these patients.
Methods and Materials/Patients: This prospective study assessed the effect of lumbar decompression and PLF in patients with lumbar instability referred to the Neurosurgery Clinic of Chamran hospital between March 2011 and March 2013. Forty-four patients with degenerative lumbar spine instability and stenosis were eligible for participation to undergo lumbar decompression and PLF. Its clinical effect was evaluated using Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI). The change in sagittal and coronal planes was also assessed according to pre- and post-operative findings at 2-year follow-up. The statistical method of assessment was repeated using paired t-test. P<0.05 was considered statistically significant.
Results: The mean preoperative VAS score decreased significantly at 2 years after the surgery (6.87±1.07 vs. 2.20±1.15; P<0.001). The comparison between preoperative ODI and its 6-month, 1 and 2-year counterparts showed a significant improvement (P<0.001). Moreover, 82.7% of the patients showed a good fusion rate. The sagittal and coronal angles were reduced significantly after the surgery (P<0.05). Short vs. long segment fusion and inclusion of sacral body did not significantly affect the VAS, ODI scores and the deformity angles.
Conclusion: Lumbar decompression and PLF is a safe and effective method for patients suffering from degenerative lumbar instability.
Lumbar spine stenosis, Degenerative instability, Posterior lumbar fusion, Visual Analogue Scale, Oswestry Disability Index
79
88
http://irjns.org/browse.php?a_code=A-10-185-1&slc_lang=en&sid=1
2017/06/15
1396/3/25
2017/09/3
1396/6/12
Majid Reza
Farrokhi
Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran & Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
farrokhimr@yahoo.com
0031947532846002273
0031947532846002273
Yes
Golnaz
Yadollahikhales
Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran & Department of Neurology, University of Illinois at Chicago, Chicago, Illinois, United States
0031947532846002274
0031947532846002274
No
Mehrnaz
Gholami
Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
0031947532846002275
0031947532846002275
No
en
The Effect of Applying Topical Vancomycin Powder on Prevention of Surgical Site Infection in Patients Undergoing Spinal Surgery Using Implants
Background and Aim: Surgical Site Infection (SSI) is one of the most important complications after spine surgeries. Different methods have been proposed to prevent this type of infection. The present study was performed to evaluate the effect of applying topical vancomycin powder on prevention of SSI in patients undergoing spinal surgery using implants in Al-Zahra Hospital, Isfahan, Iran from February 2015 to June 2016.
Methods and Materials/Patients: In this clinical trial, 100 patients candidate for spinal surgery with implants were divided into two groups using randomization technique including 50 patients in each group. Vancomycin powder solved in 20cc N/S serum was flushed over all layers of the surgical wound in the case group and in the control group sterile normal saline solution was used. Patients were examined at discharge and three months after surgery for ruling out surgical site infection. SSIs following spine surgery can be superficial, characterized by obvious wound drainage and erythema or it can be deep infections disseminating under the fascia which may lead to discitis, epidural abscess, and spondylitis.
Results: One case of SSI was observed in the control group who was 83 years old. The mean age of all patients was 51.9±14.5 years old. The duration of surgery in this patient was 5 hours. The mean duration of surgery was 3.41±0.73 hours. The length of implant, BMI, sex, underlying diseases and other risk factors (diabetes and hypertension) did not affect the rate of infection.
Conclusion: Even though topical antibiotics seem to be effective on controlling SSI but our finding did not support this hypothesis. The authors would like to suggest that keeping routine strict sterility strategies during spine operations is effective enough in preventing surgical site infection.
Surgical, Site, Wound, Infection, Spinal surgery, Vancomycin
89
94
http://irjns.org/browse.php?a_code=A-10-184-1&slc_lang=en&sid=1
2017/06/152017/08/26
1396/6/4
2017/09/32017/09/19
1396/6/28
Homayoun
Tabesh
Department of Neurosurgery, School of Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
homtabesh@yahoo.com
0031947532846001533
0031947532846001533
No
Mohammad
Kamangar
Department of Neurosurgery, School of Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
dr_mkamangar@yahoo.com
0031947532846001534
0031947532846001534
Yes
Aryan
Tabesh
Department of Biochemistry, University of Washington, Seattle, Washington, United States
0031947532846001535
0031947532846001535
No
Amin
Rastgoo
Department of Neurosurgery, School of Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
0031947532846001536
0031947532846001536
No
Ehsan
Mohammadhosseini
Department of Neurosurgery, School of Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
0031947532846001537
0031947532846001537
No
Mehrnaz
Raeissi-dehkordi
Department of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
0031947532846001538
0031947532846001538
No
en
Cerebral Angiographic Findings in Non-Traumatic Intracranial Hemorrhage: A Single Center Experience in the West of Iran
Background and Aim: This study aimed at analyzing the demographic characteristics of the patients with non-traumatic intracranial hemorrhage, their angiographic results and the correlation between computed tomography (CT) scan and angiography findings.
Methods and Materials/Patients: In a descriptive study, we retrospectively reviewed the records of the patients with non-traumatic intracranial hemorrhage based on their brain CT or lumbar puncture findings from 2011 to 2017. For all patients, four vessel catheter angiography via the femoral approach was performed in the Medical Imaging Center of Kermanshah University of Medical Sciences, Iran.
Results: We investigated 143 cases with non-traumatic intracranial hemorrhage which was indicated in CT findings (91.61%) or lumbar puncture (8.39%). Of 143 patients, 64 (44.8%) were men and 79 (55.2%) women (mean age 53.7±12.1 years old). Moreover, 104(72.7%) patients had Subarachnoid Hemorrhage (SAH), 19(13.3%) of them had Intracranial Hemorrhage (ICH), 8(5.6%) ones had Intraventricular Hemorrhage (IVH) and 12(8.4%) patients had normal brain CT. There were 100 cases of aneurysm (69.93%), 13 cases of Arteriovenous Malformations (AVM) (9.09%), 28 cases with negative angiograms (19.58%), and 2 cases with other pathologies (1.4%). Seven (4.89%) cases of multiple aneurysms were also recorded. Of 13 patients with AVM, 8(61.5%) patients had AVM in parieto-occipital region, 2(15.4%) in temporal, 1(7.7%) in frontal region and 2(15.4%) had deep AVM. Two (1.4%) patients with SAH had dural AVF. Twenty-eight (19.6%) patients had negative angiogram, 22 cases of them had second angiography after one to two weeks. The most common positive finding in the second angiogram was Acom aneurysm (18.18%).
Conclusion: Aneurysms and AVMs are the most common causes of non-traumatic intracranial hemorrhage. The most common site of intracranial aneurysms is the circle of Willis. A second angiogram after one to two weeks is necessary in most patients with negative results in first angiography after non-traumatic intracranial hemorrhage.
Cerebral, Angiography, Intracranial, Hemorrhage, Arteriovenous, Malformation
95
102
http://irjns.org/browse.php?a_code=A-10-44-3&slc_lang=en&sid=1
2017/06/152017/08/262017/06/12
1396/3/22
2017/09/32017/09/192017/09/6
1396/6/15
Mohammad
Gharib-Salehi
Department of Radiology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
salehi@gmail.com
0031947532846001539
0031947532846001539
No
Ehsan
Alimohammadi
Department of Neurosurgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
hafez125@gmail.com
0031947532846001540
0031947532846001540
Yes
Seyed-Reza
Bagheri
Department of Neurosurgery, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
hafez125@gmail.com
0031947532846001541
0031947532846001541
No
Hamidreza
Saeidi-Brojeni
Department of Neurosurgery, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
hafez125@gmail.com
0031947532846001542
0031947532846001542
No
Alireza
Abdi
Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
hafez125@gmail.com
0031947532846001543
0031947532846001543
No
Meisam
Akbary
Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
hafez125@gmail.com
0031947532846001544
0031947532846001544
No
Mozhgan
Nargesi
Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
hafez125@gmail.com
0031947532846001545
0031947532846001545
No
Zahra
Abbasi
Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
hafez125@gmail.com
0031947532846001546
0031947532846001546
No
Ameneh
Khani
Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
hafez125@gmail.com
0031947532846001547
0031947532846001547
No
Akram
Amiri
Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
hafez125@gmail.com
0031947532846001548
0031947532846001548
No
fa
Hydrocephalus in Patients With Head Trauma: A Series of 14 Patients
Background and Aim: Hydrocephalus can cause ventricular expansion, which if not treated promptly, can result in brain damage. The hydrocephalus-induced damage is not fully improved, even by means of surgical procedures, leading to permanent damages to the brain.
Methods and Materials/Patients: The aim of this study was to evaluate the demographic characteristics as well as hydrocephalus in patients with head trauma in Poursina Hospital, Rasht. The information including age, sex, Glasgow Coma Scale (GCS), trauma mechanism and accompanying brain injuries on admission were recorded. Patients with hydrocephalus diagnosed by CT scan underwent further investigation and therapeutic approaches. The treatment-related results were collected based on the GOS scale. Finally, the data were entered into SPSS version 18, and the results were analyzed by Fisher’s exact test, and Independent t-test.
Results: Of the 548 patients, hydrocephalus was observed in 14 patients (2.6%). The mean age of the patients was 44.07±24.48 years old. 31.1% of men (14 cases) had hydrocephalus, while none of women suffered from this complication. Car accidents (12 people) and fall (2 people) were identified as causes of incident in hydrocephalus patients. Head injury severity in most patients with hydrocephalus was mild (n=7, GCS=13-15) and moderate (n=6, GCS=9-12), and severe (n=1, GCS=3-8). Subarachnoid hemorrhage (n=5) and then epidural hematoma (n=4) and intracerebral hemorrhage (n=4) had the most severe damage to the skull. Most patients (n=11) were treated by surgery. Three patients recovered completely. Moderate disability, severe disability, vegetative state, and death occurred in 3, 2, 1, and 5 Patients, respectively. According to independent t-test, there is a statistically significant relationship between Glasgow Coma Scale and hydrocephalus (P=0.03). Fisher’s exact test also showed a statistically significant relationship between intracerebral hemorrhage (P=0.045) and intraventricular hemorrhage (P=0.013) on admission with hydrocephalic incidence.
Conclusion: This complication was mostly observed in young traumatic patients (younger than 40 years of age) and in patients with mild head injury. Therefore, it is necessary to pay attention to these people in order to detect hydrocephalus, if any, as soon as possible, and these patients be treated appropriately.
Hydrocephalus, Head Injury, Trauma
103
108
http://irjns.org/browse.php?a_code=A-10-44-6&slc_lang=en&sid=1
2017/06/152017/08/262017/06/122017/04/30
1396/2/10
2017/09/32017/09/192017/09/62017/09/3
1396/6/12
Shahrokh
Yousefzadeh-Chabok
1 Neuroscience Research Center, Guilan University of Medical Sciences, Rasht, Iran. 2 Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran.
0031947532846002795
0031947532846002795
No
Ehsan
Kazemnejad-Leili
Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran.
0031947532846002796
0031947532846002796
No
Leila
Kouchakinejad-Eramsadati
2
0031947532846002797
0031947532846002797
No
Maria
Moghtader
Department of Nursing, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
0031947532846002798
0031947532846002798
No
Nasim
Abolfathi
Department of Nursing, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
0031947532846002799
0031947532846002799
No
Zoheir
Reihanian
Department of Neurosurgery, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
0031947532846002800
0031947532846002800
No
Marieh
Hosseinpour
2 Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran.
m_hosseinpour88@yahoo.com
0031947532846002801
0031947532846002801
Yes
en
A Giant Abdominal Cerebrospinal Fluid Pseudocyst
Background and Aim: Ventriculoperitoneal shunt (VPS) is the most commonly used procedure for treatment of hydrocephalus in children. Abdominal cerebrospinal fluid pseudocyst is a rare complication but potentially fatal. The pathogenesis of this complication remains unclear. This complication should be considered during differential diagnosis of an abdominal mass. Our aim is to report how large and giant an abdominal cerebrospinal fluid pseudocyst can develop, and how severe the neurological damage can be.
Case Presentation: A 6 year-old girl known to have a ventriculoperitoneal shunt presented with abdominal distension and signs of increased Intracranial Pressure (ICP). Ultrasonography revealed a hypoechoic intraperitoneal fluid containing cyst with a well-defined margin and septations. Abdominal computerized tomography revealed a huge cyst in the abdomen and the distal part of the peritoneal shunt tube located within the cyst. Laparotomy revealed a huge cyst extending from the upper right side of the abdomen to the pelvis. The whole cyst was excised and the catheter repositioned.
Conclusion: Early diagnosis of abdominal Cerebrospinal Fluid (CSF) pseudocyst is only possible through close and periodic examination of patients after the procedure.
Ventriculoperitoneal shunt, Abdominal, Pseudocyst, Cerebrospinal fluid, Hydrocephalus, Encephalocele
109
114
http://irjns.org/browse.php?a_code=A-10-179-1&slc_lang=en&sid=1
2017/06/152017/08/262017/06/122017/04/302017/06/18
1396/3/28
2017/09/32017/09/192017/09/62017/09/32017/09/13
1396/6/22
Mohamed
Ouladsaiad
Department of General Pediatric Surgery, School of Medicine, Cadi Ayyad University, Marrakesh, Morocco. & Mother and Child Unit, Mohammed VI University Hospital, Marrakesh, Morocco
mouladsaiad@gmail.com
0031947532846001556
0031947532846001556
Yes
Hamza
Hokoumi
Department of General Pediatric Surgery, School of Medicine, Cadi Ayyad University, Marrakesh, Morocco. & Mother and Child Unit, Mohammed VI University Hospital, Marrakesh, Morocco
arthorius_@hotmail.com
0031947532846001557
0031947532846001557
No
Najoua
Aballa
Department of General Pediatric Surgery, School of Medicine, Cadi Ayyad University, Marrakesh, Morocco. & Mother and Child Unit, Mohammed VI University Hospital, Marrakesh, Morocco
naj.aballa@gmail.com
0031947532846001558
0031947532846001558
No
en
Symptomatic Unilateral Subdural Effusion as the First Presentation of Suprasellar Arachnoid Cyst
Background and Importance: Arachnoid cysts are benign nontumoral lesions that are usually found incidentally in brain imaging. Suprasellar Arachnoid Cysts (SSACs) are rare. They can cause hydrocephalus and increased intracranial pressure, lower cranial nerve impairment and endocrine disorder. Sometimes arachnoid cysts become complicated by subdural hematoma/hygroma.
Case Presentation: We describe a patient with a suprasellar arachnoid cyst that was complicated with symptomatic subdural effusion and increased intracranial pressure after minor trauma.
Conclusion: Although these cysts are rarely complicated with subdural hematoma/hygroma, and intracystic hemorrhage, the probability of subsequent subdural hygroma and increased intracranial pressure should not be underestimated.
Subdural effusion, Suprasellar arachnoid cyst
115
118
http://irjns.org/browse.php?a_code=A-10-189-1&slc_lang=en&sid=1
2017/06/152017/08/262017/06/122017/04/302017/06/182017/06/3
1396/3/13
2017/09/32017/09/192017/09/62017/09/32017/09/132017/08/27
1396/6/5
Omidvar
Rezaei
Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
rozgarnana@gmail.com
0031947532846002267
0031947532846002267
No
Karim
Moradian-Kokhdan
Department of Neurosurgery, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
srazme82@gmail.com
0031947532846002268
0031947532846002268
Yes
Saeed
Razmeh
Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
norodiasht@gmail.com
0031947532846002269
0031947532846002269
No
Kaveh
Ebrahimzadeh
Department of Neurology, Faculty of Medicine, Yasuj University of Medical Sciences, Kohgiluyeh and Boyer-Ahmad, Iran
kavehebrahimzadeh@gmail.com
0031947532846002270
0031947532846002270
No
Guive
Sharifi
Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
narenjijome@gmail.com
0031947532846002271
0031947532846002271
No
Mohammad
Samadian
Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
mdsamadian@hotmail.com
0031947532846002272
0031947532846002272
No
fa
Transradial Neurointerventional Approach to Basilar Tip Aneurysm: Case Report and Technical Note
Cerebral angiography through transfemoral approach is preferred in most of the situation though in cardiovascular surgery transradial angiography is accounted as the superior standard. The present study aimed at presenting our early experience of transradial approach to cerebral angiography and intervention of a patient with basilar tip aneurysm that had inappropriate vasculature to perform routine transfemoral approach. The patient was a 65 year-old man with a large basilar tip aneurysm that was candidate for endosacular coiling through transfemoral route. But due to very tortuous iliac artery, aortic arch and its branches, navigation transfemorraly via both vertebral arteries was impossible. Therefore we decided to do the procedure through right transarterial route. The procedure was started by doing Allen`s test to confirm good perfusion of right hand by collateral arteries. After that cerebral angiography and neurointervention was done transradially without any complication. As a result, although a transradial approach is not a routine way for cerebral angiography and intervention, it can be used safely as an alternative way in specific cases.
Transradial, Angiography, Cerebral, Aneurysm
119
123
http://irjns.org/browse.php?a_code=A-10-189-3&slc_lang=en&sid=1
2017/06/152017/08/262017/06/122017/04/302017/06/182017/06/32017/08/2
1396/5/11
2017/09/32017/09/192017/09/62017/09/32017/09/132017/08/272017/09/3
1396/6/12
Mohammad
Ghorbani
Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
0031947532846002265
0031947532846002265
No
Ebrahim
Hejazian
Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
sehbums@yahoo.com
0031947532846002266
0031947532846002266
Yes