Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
2423-6829
6
4
2020
10
1
Spinal Manifestations of Neurofibromatosis: An Update
169
180
EN
Kaveh
Haddadi
Orthopedic Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
kh568hd@yahoo.com
Y
oooo-ooo2-7349-2574
Saeed
Kargar Soleiman Abad
Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
saeed1376.mu@gmail.com
N
0000-0001-5602-3816
Seiied Mohammad
Hashemie Amir
Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
mohhas1394@gmail.com
N
0000-0001-7062-0461
Mehdi
Pooladi
Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
mehdi_pooladi1197@yahoo.com
N
0000-0001-9391-8416
10.32598/irjns.6.4.1
Background and Aim: Neurofibromatosis-1 (NF1) is a common genetic condition in children. It is becoming increasingly recognized that in neurofibromatosis, there might be anomalous development of bone with or without any local anomaly of neuroectodermal basis. This review was conducted to highlight the different features of spinal disorders in this congenital disease.
Methods and Materials: Different search engines were used in this research. After going through the results and discarding the repeated ones, 2 reviewers began to inspect the studies independent of one another. In case of any disagreements between the reviewers over the inclusion of certain research material into the study, the final decision was made by the senior author. In the end, accepted research materials were used as needed in categorizing different types of spinal injuries.
Results: Skeletal defects are among the most effective complications on the quality of life of patients. Bone deformities, osteoporosis, osteopenia, reduction of bone mass density, and spinal osteopathy such as scoliosis among such defects. Although the relative prevalence of spinal defects in neurofibromatosis type 1 is not clear, scoliosis can be considered the most common type of spinal deformity in this illness to the point it is present in 10 to 71% of cases. Thus, spine surgeons may face numerous common challenging conditions in NF1 patients like scoliosis, spondylolisthesis, and dural ectasia.
Conclusion: As NF1 distresses several organ systems, radiologic spine screening is important in patients with NF1 and patients are likely to profit most from a multidisciplinary treatment policy.
Spine, Manifestations, Neurofibromatosis
http://irjns.org/article-1-238-en.html
http://irjns.org/article-1-238-en.pdf
Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
2423-6829
6
4
2020
10
1
Tips and Pearls in Chronic Subdural Hematoma
181
194
EN
Abdolkarim
Rahmanian
Department of Neurosurgery, Namazi Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
kazemimd@msn.com
N
0000-0001-5223-7083
Mohammad
Samadian
Department of Neurosurgery, Skull Base Research Center, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
kazemimd@msn.com
N
0000-0002-4212-1738
Guive
Sharifi
Department of Neurosurgery, Skull Base Research Center, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
N
0000-0001-5691-2509
Navid
Kalani
Department of Anesthesiology, Critical Care and Pain Management Research Center, Jahrom University of Medical Sciences, Jahrom, Iran.
navidkalani@ymail.com
N
0000-0003-1900-4215
Ali
Kazeminezhad
Department of Neurosurgery, Peymanieh Hospital, Jahrom University of Medical Sciences, Jahrom, Iran.
kazemimd@msn.com
Y
0000-0000-0000-0000
10.32598/irjns.6.4.2
Background and Aim: One of the most prevalent neurosurgery conditions is Chronic Subdural Hematoma (CSDH). Among neurosurgeons, there are various CSDH treatment approaches.
Methods and Materials/Patients: This is a narrative review examining the various aspects of the CSDH. To provide up-to-date information on CSDH, we concisely reviewed the related articles. All of the relevant articles retrieved from Google Scholar, PubMed, and Medline were reviewed and critically analyzed. We searched for keywords including chronic subdural hematoma, burr hole craniotomy versus craniostomy, middle meningeal artery embolization, conservative therapy versus surgical therapy in CSDH, and recurrence of CSDH in published articles from 1960-2020.
Results: CSDH may present with various clinical presentations. Medical symptoms range from general and moderate symptoms (such as headache, tiredness) to severe symptoms (e.g. hemiparesis, coma). A definite trauma history may be obtained in most cases. Contrast-enhanced CT or MRI may help diagnosis. The treatment choice for uncomplicated CSDH is Burr-Hole Craniotomy (BHC). The use of drainage to decrease recurrence rates has been shown to have limited outcomes in most recent studies. Craniotomy is also used for treatment. Only asymptomatic or high-risk operative patients are subjected to non-surgical management.
Conclusion: Management of CSDH is still contentious. It is widely agreed that if neurological signs and radiological observations are present, CSDH should be evacuated. Burr-hole craniotomy appears to be the preferred surgical technique because, in most patients, it gives the best treatment outcomes. Several issues are still uncertain, including the proper surgical technique [Burr-hole craniotomy versus Twist Drill Craniostomy (TDC) and craniotomy], the advantage of 2 perforated holes over one, the location of drainage, the impact of irrigation of the hematoma, and the duration of post-operative immobilization.
Chronic subdural hematoma, Surgical operation, Craniotomy
http://irjns.org/article-1-247-en.html
http://irjns.org/article-1-247-en.pdf
Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
2423-6829
6
4
2020
10
1
Effects of Temporary Clips on Somatosensory Evoked Potentials in Anterior Circulation of Brain Aneurysm Surgery Among Rasul Akram Hospital Patients During 2017-2018
195
202
EN
Alireza
Tabibkhooei
Neurosurgery Research Center, Rasul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
tabibkhooei.a@iums.ac.ir
N
0000-0002-4510-4511
Maziar
Azar
Neurosurgery Research Center, Rasul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
maziarazar@yahoo.com
N
0000-0003-3538-1512
Siamak
Alizadeh
Neurosurgery Research Center, Rasul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
siamakalizadehmd@gmail.com
N
0000-0002-1937-6708
Asghar
Aslaninia
Neurosurgery Research Center, Rasul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
dr.aslaninia@gmail.com
Y
0000-0002-2405-237x
10.32598/irjns.6.4.3
Background and Aim: Cerebrovascular brain incidents especially brain aneurysm ruptures are a major cause of death and disability. Monitoring Somatosensory Evoked Potential (SSEP) and corresponding changes are used for identifying cerebral ischemia and predicting neuronal injuries during using temporary clips in brain aneurysm surgeries. This approach limits integrated performance evaluation for somatosensory and cortex paths.
Methods and Materials/Patients: This clinical trial study was conducted on the patients who were candidate for anterior cerebral circulation aneurysm surgery during 2017-2018 in Rasul Akram Hospital. SSEP monitoring was performed related to the median nerve in the contralateral wrist to examine the Middle Cerebral Artery (MCA) and posterior tibialis nerve in the contralateral ankle to examine Anterior Cerebral Artery (ACA) during the surgery procedure. Incentive parameters with a power of 5 to 25 milliampere and corresponding duration of 0.2 milliseconds and waves with a frequency of 3.3 Hertz were registered. Before locating temporary clips, SSEP was extracted as a baseline from every patient and then recorded.
Results: Totally 9 patients (9 aneurysms) were studied. Three of them were men and 6 patients women. The age of patients ranged 39-78 years. The clinical status of patients was assessed using the Hunt-Hess scale. Five cases were classified as grade 1, 2 cases as grade 2, and 2 cases as grade 3. Among 9 aneurysms, 7 cases were about A.com artery and 2 cases were in connection with MCA artery, having the size of 5 to 11 millimeters. Friedman test was applied to explore average latency change percentage and amplitude change percentage in 1st, 2nd, and 3rd minutes for the 1st, 2nd, and 3rd clips where the results were significantly different (P=0.050).
Conclusion: Neuromonitoring can be used as an index for examining tissue perfusion level of the brain and help to prevent accidental ischemic injuries of the brain followed by temporary clipping.
Somatosensory evoked potentials, Somatosensory, Brain aneurysmm
http://irjns.org/article-1-239-en.html
http://irjns.org/article-1-239-en.pdf
Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
2423-6829
6
4
2020
10
1
Cosmetic Outcomes of Scalp in Standard Reverse Question Mark Incision and L.G. Kempe Incision in Large Craniotomies
203
210
EN
Hossein
Safari
Department of Neurological Surgery, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Hossein.safary88@yahoo.com
N
0000-0002-3159-3757
Shahram
Bagheri
Department of Pathology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Bagheri.s@ajums.ac.ir
N
0000-0003-5462-4435
Behnia
Ahmadi Halili
Department of Neurological Surgery, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Behnia.1994@gmail.com
Y
0000-0012-0004-5555
10.32598/irjns.6.4.4
Background and Aim: Craniotomy is a surgery in which a flap of the skull is opened to access the affected area in the brain. Since paying attention to the aesthetic aspects of the patient’s head after surgery is very important for the patient’s mental health and social life, surgeons should try to adopt a method that minimizes damage to the scalp and follicles.
Methods and Materials/Patients: In this clinical trial study, patients who were candidates for frontotemporoparietal craniotomy surgery were selected. Twenty-three selected patients were randomly divided into 2 groups consisting of a 12-member intervention group (L.G. Kempe) and an 11-member control group (Standard Reverse Question mark). Patients underwent a pre-operative biopsy of the scalp and a follow-up biopsy 6 months post-operatively. In the evaluation of aesthetic aspects, the created scar was scored using the Stony Brook Scar Evaluation Scale (SBSES). Patients were also directly asked about their satisfaction with the operation and the scar created.
Results: In 23 patients, the results showed that patients who underwent LG Kempe incision craniotomy received significantly higher scores in SBSES scoring evaluations (P=0.005). There was no significant difference in subjective evaluations by asking patients about their satisfaction with the scar site and the operation area (P=0.75). In the analysis of post-operative hair follicle density between the 2 groups (P=0.910), general changes in pre-operative and post-operative follicle density in all samples (P= 0.657) as well as comparing the changes between 2 groups, no significant difference was found between follicular density changes between the intervention and control groups (P=0.137).
Conclusion: Patients treated with L.G. Kempe incision had significantly higher SBSES scores, which can be considered an aesthetically superior method that could prevent the formation of undesirable scar.
Craniotomy, Aesthetics, Hair follicle, Scar
http://irjns.org/article-1-251-en.html
http://irjns.org/article-1-251-en.pdf
Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
2423-6829
6
4
2020
10
1
Purely Neuro-endoscopic Transventricular Approach for Cystic Craniopharyngiomas
211
218
EN
Sagar
Diop
Department of Neurosurgery, Principal Hospital of Dakar, Dakar, Senegal.
sagardiop19@hotmail.fr
Y
0000-0002-6138-9342
El Hadji Cheikh Ndiaye
SY
Department of Neurosurgery, National University Hospital of Fann, Dakar, Senegal.
N
, 0000-0002-6222-2309
Mbaye
Thioub
Department of Neurosurgery, National University Hospital of Fann, Dakar, Senegal.
N
0000-0003-0171-5115
Maguette
Mbaye
Department of Neurosurgery, National University Hospital of Fann, Dakar, Senegal.
N
0000-0001-7372-1448
Alioune Badara
Thiam
Department of Neurosurgery, National University Hospital of Fann, Dakar, Senegal.
N
0000-0002-4994-1800
Mouhamed Abdoulaye
Cisse
Department of Neurosurgery, National University Hospital of Fann, Dakar, Senegal.
N
0000-0003-1992-4601
Momar Codé
BA
Department of Neurosurgery, National University Hospital of Fann, Dakar, Senegal.
N
0000-0001-6514-330x
Seydou Boubakar
Badiane
Department of Neurosurgery, National University Hospital of Fann, Dakar, Senegal.
N
, 0000-0003-3111-1654
10.32598/irjns.6.4.5
Background and Importance: Craniopharyngiomas are tumors made up of mixed components which can present intraventricular cystic portion. The aim of our work is to evaluate the outcome of the endoscopic marsupialization as a surgical approach.
Methods and Materials/Patients: We report 11 cases presenting craniopharyngioma with intraventricular cystic portion inducing hydrocephalus managed at Neurosurgery Unit of Fann Hospital between June 2013 and June 2017. Endoscopic marsupialization was realized for all patients with a rigid neuroendoscope Karl Storz.
Results: The mean age of cases was 30.18 years with a ranged 07-69. There was a male predominance with a sex ratio of 1.75. All patients were suffering from an intracranial pressure syndrome. Lowering visual acuity including two (02) blindness cases was found in patients under 15 years. Frontal lobe syndrome was found in all patients of more than 50 years. A cerebral CT scan was realized for 9 patients and an MRI for 4 patients. A cystic marsupialization with biopsy was realized by precoronal approach. Fluid looked like “waste oil” for 9 patients. Ventriculocisternostomy of the 3rd ventricle was realized in 2 cases. Progress was favorable with intracranial pressure signs disappearance in 8 cases. We noticed 3 failures with cyst persistence at control CT Scan. Three patients had a recurrence, requiring revised marsupialization complicated by death in 1 case.
Conclusion: Endoscopic marsupialization represents a seductive technique which is an easy and reproducible treatment for intraventricular cystic craniopharyngioma.
Craniopharyngioma, Endoscopic marsupialization, Intraventricular cyst, Cyst, 3rd ventricle
http://irjns.org/article-1-231-en.html
http://irjns.org/article-1-231-en.pdf
Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
2423-6829
6
4
2020
10
1
Torticollis as a Rare Presentation of Cerebellopontine Angle Choroid Plexus Papilloma in Children
219
224
EN
Mohammad
Faraji-Rad
Department of Neurosurgery, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
farajirad@yahoo.com
N
0000-0003-3681-2548
Einollah
Alipour
Department of Neurosurgery, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Alipourainollah@gmail.com
Y
0000-0002-3339-2472
Elnaz
Farajirad
Department of Medical Imaging, LHSC Victoria Hospital, Western University, London, Ontario, Canada.
elnazfaraji@yahoo.com
N
0000-0003-3317-8326
10.32598/irjns.6.4.6
Background and Importance: The rare intracranial neoplasms are Choroid Plexus Papillomas (CPPs), especially in the cerebellopontine angle. The main location of choroid plexus papillomas in adults and children are 4th ventricle and lateral ventricles, respectively.
Case Presentation: We report on a little girl with a cerebellopontine angle CPP who presented with symptoms of torticollis. Assessment of Magnetic Resonance Imaging showed a mass in the right cerebellopontine angle, next to the brain stem. The tumor was completely resected using the right retrosigmoid approach method. A pathological examination determine a typical CPP that this being should be considered an extremely rare cause of a lesion in the posterior fossa.
Conclusion: CPP is usually presented in the atrium of the lateral ventricle in children; however, we reported a rare case in the cerebellopontine angle.
Choroid plexus papilloma, Torticollis, Cerebellopontine angle, Brain stem
http://irjns.org/article-1-213-en.html
http://irjns.org/article-1-213-en.pdf
Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
2423-6829
6
4
2020
10
1
Chronic Bilateral Calcified Subdural Empyema: An Unusual Complication of a Ventriculoperitoneal Shunt
225
228
EN
Abdoulaye
Diop
Department of Neurosurgery, Regional Hospital of Thies, Thies, Senegal.
a.diop@univ-zig.sn
Y
0000-0003-3550-4906
Mohameth
Faye
Department of Neurosurgery, Fann Teaching Hospital, University Cheikh Anta Diop, Dakar, Senegal.
fayeneurochir92@gmail.com
N
Roger Ilunga
Mulumba
Department of Neurosurgery, Regional Hospital of Thies, Thies, Senegal.
rogermulumba2004@gmail.com
N
0000-0002-7565-4733
Momar Codé
Ba
Department of Neurosurgery, Fann Teaching Hospital, University Cheikh Anta Diop, Dakar, Senegal.
bamcode@hotmail.com
N
0000-0001-6514-330X
Seydou Boubacar
Badiane
Department of Neurosurgery, Fann Teaching Hospital, University Cheikh Anta Diop, Dakar, Senegal.
seybadiane@gmail.com
N
0000-0003-3111-1654
10.32598/irjns.6.4.7
Background and Importance: Subdural empyema is a rare complication of ventriculoperitoneal shunts. The ventriculoperitoneal shunt is a common technique used in the treatment of hydrocephalus. It is often plagued with multiple complications, especially infectious ones. However, the appearance of infectious complications related to ventriculoperitoneal shunt remotely from surgery is rather unusual.
Case Presentation: Through this observation, we are reporting an unusual case of chronic bilateral calcified subdural empyema which occurred 8 years after ventriculoperitoneal shunt surgery. The child underwent a bilateral craniotomy in order to evacuate the empyema and meanwhile remove the valve. One month later, the empyema relapsed along with active hydrocephalus. Consequently, the implementation of an external ventricular shunt was performed and the child benefited from adapted antibiotic therapy. After the infection was treated, a second ventriculoperitoneal shunt valve was implemented. Afterwards, the evolution was favorable, the child retained a discrete left hemiparesis as a sequel.
Conclusion: This observation is reporting the existence of late morbidity due to the insertion of a ventriculoperitoneal valve; which shows that a regular and prolonged follow-up is necessary in children with a ventriculoperitoneal shunt valve.
Complication, Ventriculoperitoneal shunt, Subdural empyema, Bilateral, Calcified
http://irjns.org/article-1-218-en.html
http://irjns.org/article-1-218-en.pdf
Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
2423-6829
6
4
2020
10
1
A Rare Case of Sacrococcygeal Teratoma With Medullar Invasion
229
232
EN
Najoua
Aballa
Department of Pediatric Surgery, School of Medicine, Mother and Child Hospital, Mohammed VI Teaching Hospital, University Cadi Ayyad, Marrakesh, Morocco.
N
0000-0003-0473-9438
Houssine
Ghannane
Department of Pediatric Surgery, School of Medicine, Mother and Child Hospital, Mohammed VI Teaching Hospital, University Cadi Ayyad, Marrakesh, Morocco.
N
0000-0001-6856-4898
Mohamed
Oulad Saiad
Department of Pediatric Surgery, School of Medicine, Mother and Child Hospital, Mohammed VI Teaching Hospital, University Cadi Ayyad, Marrakesh, Morocco.
mouladsaiad@gmail.com
Y
0000-0001-6845-3936
10.32598/irjns.6.4.8
Background and Importance: Sacrococcygeal Teratoma (SCT) with medular invasion is rare.
Case Presentation: We report a case of an 11-month male infant, with no prenatal history of any abnormality, presenting since birth, a mass in the buttock extended to retrorectum associated with a right side hypotonic limb and monoplegia. Medullar and abdominal pelvic Magnetic Resonance Imaging (MRI) showed a sacrococcygeal tissue mass and intradural lumbosacral invasion with a high level of alpha-fetoprotein. Surgical excision was done successfully with an uneventful follow-up.
Conclusion: Despite of the intradural invasion, those SCT are in major cases mature and present low risk of malignancy or recurrence.
Sacrococcygeal teratoma, Medular invasion, Neurological deficit, Alpha-fetoprotein, Malignancy
http://irjns.org/article-1-214-en.html
http://irjns.org/article-1-214-en.pdf