Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
6
1
2020
1
1
COVID-19 Pandemic and Neurological Presentations: Body of Evidence
1
2
EN
Payman
Vahedi
Assistant Professor of Neurosurgery, Department of Neurosurgery, School of Medicine, Tehran Medical Sciences Branch, Islamic Azad University of Medical Sciences, Tehran, Iran.
N/A
Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
6
1
2020
1
1
Low Lumbar Fractures: Unique Biomechanics and Treatment Options
3
12
EN
Kaveh
Haddadi
Associate Professor of Neurosurgery, Spine Fellowship, Orthopedic Research Center, Mazandaran University Of Medical Sciences, Sari, Iran.
Saeed
Ehteshami
Associate Professor of Neurosurgery, Spine Fellowship, Orthopedic Research Center, Mazandaran University Of Medical Sciences, Sari, Iran.
Background and Aim: Acute lower lumbar spinal fractures (L4 and L5) can cause major neurologic damage and mechanical instability. The ultimate surgical method for the management of unstable lower lumbar spine fractures
Methods and Materials/Patients: Online search databases including Google scholar databases, PubMed and Ovid was performed using the keywords: Low lumbar, fractures, spine trauma, biomechanics, classification, anatomy, spinopelvic alignment, non-operative and surgical treatment options. Finally, about 47 related studies were identified and reviewed.
Results: The L4 and L5 vertebra and related discs contribute to 50% of the lordosis in the lumbar area. Fracture of the trapezoidal body of the fifth vertebra can considerably decrease this and change the L4-L5 and L5-S1 biomechanics. The lower lumbar spine, in contrast to the thoracolumbar
junction, is secure by the pelvis and the robust musculature. There is great controversy about the treatment of lumbar burst fractures without neurologic deficit. The surgical indication and optimal procedure may be influenced by numerous aspects such as the severity of signs and symptoms, the amount of loss of vertebral body height and the involvement of the spinal canal, and finally, the stability of the posterior spinal components.
Conclusion: There is no consensus on what establishes the paramount treatment for low lumbar burst fractures. Conservative care has been related to acceptable outcomes for patients with a burst fracture which are neurologically intact. In more severe injuries, spinal decompression and stabilization via a posterior or anterior approach are based on the surgeon’s preference. For lower lumbar burst fractures or fracture-dislocations of the lumbosacral junction with neurologic injury, posterior decompression and stabilization, and a period of rest and bracing for the preservation of lumbar lordosis are appropriate.
Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
6
1
2020
1
1
Post-operative Morbidity and Mortality of Lumbar Spinal Stenosis at one Teaching Hospital in North-eastern Benin.
13
20
EN
Holden
Olatoundji Fatigba
Department of Neurosurgery, Medicine School of Parakou University, Borgou, Benin, Africa
Luphin
Hode
Department of Trauma and Orthopedic Surgery, Medicine School of Abomey-Calavi University, Benin, Africa
Kisito
Quenum
Department of Neurosurgery, Medicine School of Parakou University, Borgou, Benin, Africa
Thierry
Alihonou
Department of Trauma and Orthopedic Surgery, Medicine School of Abomey-Calavi University, Benin, Africa
Kofi-Mensa
Savi de Tove
Department of Radiodiagnosis and Medical Imaging, Medicine School of Parakou University, Borgou, Benin, Africa
Alexandre
S. Allodé
Department General Surgery, Medicine School of Parakou University, Borgou, Benin, Africa
Background and Aim: Surgical management of Lumbar Spinal Stenosis (LSS) is a common practice. This study aimed to report the morbidities and mortalities observed during surgical treatment of LSS and the outcome of these patients after management over an 8-year study period.
Methods and Materials/Patients: It was a retrospective, descriptive, and transversal study performed at the Departmental Teaching Hospital of Borgou in the Republic of Benin (West Africa) from January 2010 to December 2018. This study included the patients who underwent surgical management for LSS. Type of complication, its management, and the patient’s outcomes was registered.
Results: During the study period and based on the selection criteria, 239 patients were selected. These patients were divided into 135 men (56.5%) and 104 women (43.5%). The mean age of the patients was 52.3±10.9 years. Laminectomy was performed on one, two, and three lumbar spinal segments in 17.6%, 55.6% and 26.8% of cases, respectively. Laminectomy was associated with discectomy in 6.3% of the cases. No arthrodesis with spinal fixation was performed. Ninety percent of patients had no post-operative complications. Functional post-operative results were considered excellent, good, acceptable and poor in 32.1%, 52.1%, 10.9% and 4.9% of cases, respectively. Five types of complications were observed in 22 patients (9.2%). A reoperation was performed in 1.6% of cases. These different complications included dural tear (4.6%), wound infection (3.3%), stroke (0.8%), cauda equina syndrome (0.4%) and pseudomeningocele (0.4%). The mortality rate was 0.8% (n=2).
Conclusion: Lumbar canal stenosis surgery is not without complications. Careful selection of patients, consideration of risk factors, and selection of an appropriate surgical strategy can reduce or avoid these complications.
Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
6
1
2020
1
1
Revisiting the Urge to Operate: One-year Neurophysiological Follow-up in Severe CTS
21
28
EN
Alireza
Ashraf
MD., Professor, Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran.
Zahra
Hooshanginezhad
MD., Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
Attiyeh
Vasaghi
MD., Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran.
Nima
Derakhshan
Assistant Professor, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
Background and Aim: Several approaches have been proposed for the treatment of Carpal Tunnel Syndrome (CTS) based on its severity. The aim of this study is to determine the optimal management for severe CTS.
Methods and Materials/Patients: This cross-sectional study was conducted for 22 months from August 2017 to June 2019 in a referral rehabilitation clinic in southern Iran. A total of 117 hands diagnosed with severe CTS were included in 78 patients according to Electrodiagnostic Study (EDX) reports (considering Sensory Proximal Latency (SPL) >3.6 msec, Sensory Distal Latency (SDL) >5.3 msec, Sensory Nerve Conduction Velocity (SNCV) <30 m/sec, Distal Motor Latency (DML) >6.5 msec as being severe) who refused to undergo surgery. Boston questionnaire was filled out and conventional EDX was carried out at the first and the 1-year follow-up visits.
Results: In patients with a detectable Sensory Nerve Action Potential (SNAP), motor amplitude (P<0.002) and latency (P<0.01), SPL (P<0.003) and SNCV (P<0.006), and Boston parameters improved significantly in the one-year follow-up visit compared with the results at the first visit. However, improvement in patients with absent or low amplitude SNAP at the first visit was only observed in proximal sensory latency (P<0.005) and amplitude (P<0.003).
Conclusion: There is a considerable chance for non-surgical improvement of patients with severe CTS in terms of symptom relief, hand function, and EDX parameters in those with detectable SNAP at the first visit; however, patients with undetectable SNAP have little, if any, the chance for improvement with
conservative measures.
Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
6
1
2020
1
1
Attenuation of Motor Evoked Potentials Following Prone PositioningPositioning
29
34
EN
Sotirios
Apostolakis
Department of Neurosurgery, KAT General Hospital of Attica, Kifisia, Greece
Aikaterini
Karagianni
Department of Neurosurgery, KAT General Hospital of Attica, Athens 145 61, Greece
Eirini
Chiotaki
Intraoperative Monitoring Service, GE Scientific, G. Vasios & Co, Ioannina, Greece
Konstantinos
Vlachos
Department of Neurosurgery, KAT General Hospital of Attica, Kifisia, Greece
Background and Importance: Of utmost importance for successful neurosurgical operations is proper patient positioning. This is particularly the case for operations conducted in the prone position, which is associated with several potential complications.
Case Presentation: Here we report the case of a 52-year-old male patient who underwent endoscopic discectomy for L5-S1 herniated disc. Following placement in the prone position, Motor Evoked Potentials (MEP) were significantly asymmetric, with those from the left side being disproportionately low considering his clinical presentation. MEP recordings were ameliorated when the patient was placed in the supine position. Considering the nervous and vascular anatomy of the area, a peripheral insult is highly unlikely to be the cause of the neurophysiological profile of this patient. Instead, compression of the dural sac due to biomechanical alterations of the contents
of the spinal canal is the most possible pathogenetic mechanism.
Conclusion: Proper patient positioning is of paramount importance for the success of a neurosurgical operation. Still, even if all precautions are taken, it is possible that insults to neuronal structures can be due to biomechanical alterations of the contents of the spinal canal, secondary to prone positioning.
Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
6
1
2020
1
1
Can C2 Vertebroplasty Restore Alignment in Pathologic Odontoid Fracture?Odontoid Fracture?
35
40
EN
Majid Reza
Farrokhi
Professor of Neurosurgery, Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran And Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
Amir
Tarokh
Neurosurgeon, Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran And Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
Javad
Safaei
Neurosurgeon, Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran And Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
Background and Importance: Plasmacytoma is more likely to involve the spine with up to 50%, most commonly in the thoracic spine.
Case Presentation: This study examined a patient with solitary plasmacytoma with neck pain and abnormal C1-C2 range of motion, which happened to have an osteolytic C2 lesion on CT scanning. The patient underwent a fluoroscopically guided anterior percutaneous C2 vertebroplasty without posterior fusion, leading to management of pain, maintenance of normal motions, and restoration of cervical alignment.
Conclusion: This case represents fluoroscopically guided anterior percutaneous C2 vertebroplasty as an effective treatment for C2 osteolytic lesions with an abnormal range of motion, which can be considered in selected cases as an alternative approach for demanding open surgical approaches to this challenging region.
Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
6
1
2020
1
1
A Case Report of Primary Brain Hydatid Cyst in a Child
41
48
EN
Deepak
Garg
MCH Neurosurgery, Senior Resident, SMS Medical College, Jaipur, India
Gaurav
Jain
DNB Neurosurgery, Assistant Professor, SMS Medical College, Jaipur, India
Virendra
Sinha
MCH Neurosurgery, Senior Professor, SMS Medical College, Jaipur, India
Background and Importance: Hydatid cyst is endemic in India, with different clinical presentations according to the site of involvement in the body. However, its occurrence in the brain without the involvement of other body parts is rare.
Case Presentation: An eight-year-old female child presented with right-sided limb weakness and slurring of speech. The diagnosis of primary brain hydatid cyst was made with Magnetic Resonance Imaging (MRI) of the brain. The cyst was removed completely, resulting in improved post-operative slurring of speech and limb weakness.
Conclusion: In countries where hydatid disease is endemic, brain hydatidosis should on top of the differential diagnoses for intracerebral cystic lesions and managed as per hydatid protocol until proved otherwise. This approach is critical to prevent rupture and dissemination.