Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
2
1
2016
6
1
Endoscopic Endonasal Transsphenoidal Approach for Pituitary Adenomas: a Prospective Review of Our Early Experience
6
10
FA
Rostam
Poormousa
MD, Assistant Professor of Otorhinolaryngology, Bo'ali Hospital, Mazandaran University of Medical Sciences, Sari, Iran
Kaveh
Haddadi
MD, Associate Professor of Neurosurgery, Orthopedic Research Center, Neurosurgery Department, Imam Hospital, Mazandaran University of Medical Sciences, Sari, Iran
Misagh
Shafizad
MD, Assistant Professor, Neurosurgery Department, Imam Hospital, Mazandaran University of Medical Sciences, Sari, Iran
Sajjad
Shafiee
MD, Assistant Professor, Neurosurgery Department, Imam Hospital, Mazandaran University of Medical Sciences, Sari, Iran
Background & Aim: Pituitary adenomas are a part of a dissimilar group of benign neoplasms. The development of endoscopic techniques for surgery of paranasal sinuses has increased the opportunity for an endoscopic approach with regard to the pituitary gland. Minimally invasive endoscopic pituitary surgery, in turn, permits a more thorough tumor resection and fewer associated surgical complications. This study aimed to determine the descriptive outcomes and the complication rates for endoscopic transsphenoidal hypophysectomies.
Methods & Materials/Patients: A prospective study was conducted from November 2012 to March 2015. 28 patients with proven symptoms of pituitary adenomas were included in this study, and regularly attended follow-up sessions.
Results: In our study, we operated on 28 patients with hypophysis adenoma with the help of an endoscopic setting. The male to female ratio was 1:2.5, with average age range of 35 to 45 years. Growth hormone (GH) adenoma appeared in 36% (10 patients), prolactinoma in 21% (six patients), Cushing’s disease in 18% (five patients) and non-functional adenoma in 18% (five patients). Gonadotroph adenomas were the least common at about seven percent. The most common symptoms in our series were headache and visual defects. Five patients including two with prolactinoma and three with GH adenoma presented apoplexy signs and symptoms.
Conclusion: Our series demonstrated that the endoscopic approach not only allows well anatomical visualization, and therefore facilitates the full oncological resection of tumors, but also reduces the incidence of pre-operative complications.
Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
2
1
2016
6
1
A Comparison between Therapeutic Effect of Granulocyte Colony-stimulating Factor and Methylprednisolone in Treatment of Patients with Acute Traumatic Spinal Cord Injury
11
14
EN
Shahrokh
Yousefzadeh-Chabok
MD, Professor of Neurosurgery, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran
Babak
Alijani
MD, Associate Professor of Neurosurgery,Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran
Mohammadreza
Emamhadi
MD, Associate Professor of Neurosurgery,Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran
Hamid
Behzadnia
MD, Assistant Professor of Neurosurgery, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran
Siavash
Dehghani
MD, Senior Resident of Neurosurgery, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran
Alireza
Razzaghi
MSc in Epidemiology, Guilan Road Trauma Research Center, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran
Shabnam
Golmohammadi
MD, Senior Resident of Neurosurgery, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran
Background & Aim: Spinal cord injury (SCI) is one of the worst kinds of traumatic injuries with remarkable social and economic effects on communities.
Methods & Materials/Patients: In this prospective randomized clinical trial, 122 patients with traumatic spinal cord injury were admitted to Poursina hospital within 48 hours of injury to compare granulocyte colony stimulating factor (G-CSF) and high-dose methylprednisolone as neuroprotective therapy.
Results: In this research, 122 patients were studied out of whom 62 patients were included in the granulociote colony-stimulating factor (G-CSF) group with a mean age of 40.4, and 60 patients in the methylprednisolone group with an average age of 40.10 years. 55 out of 122 patients (45%) were completely paralyzed (Grade AIS:A) and 67 (55%) were with incomplete spinal injury (Grade AIS:B,C,D). The average American spinal injury association (ASIA) sensory scores in the two groups were similarly compared in the same four time intervals, and p values were 0.7, 0.3, 0.2, and 0.1. They were not statistically significant.
Conclusion: According to the results, the G-CSF was shown to be beneficial in average ASIA motor and sensory scores in the two groups of male patients at six months of onset of G-CSF treatment (p value=0.04), and average ASIA motor scores improvement in the falls subgroup patients also differed significantly within six months of onset of G-CSF treatment (p value=0.03). A multicentre prospective randomized clinical trial to compare the placebo effect with G-CSF protocol's treatment, and also assessment of the cost benefits of the common medical treatment versus G-CSF are needed.
Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
2
1
2016
6
1
Post-operative Pseudomeningocele after Spine Surgery: Rare Cause of Failed Back Syndrome
15
18
EN
Rakesh
Gupta
MD, Professor, Department of Neurosurgery, Sri Aurobindo Medical College and PG Institute, Indore, India
Sharadendu
Narayan
MD, MCh Resident, Department of Neurosurgery, Sri Aurobindo Medical College and PG Institute, Indore, India
Background and Importance: Pseudomeningocele is a rare complication of spine surgery, and it is the collection of cerebrospinal fluid in paraspinal tissues. Giant pseudomeningoceles are still rare, and very few cases have been reported in literature. It is usually occult in presentation, and patients do not have any symptoms ascribable to it.
Case Presentation: We came across two symptomatic patients with post laminectomy pseudomeningoceles in past one year at our institution. The patients were managed with surgical closure of the dural defect. Both patients were asymptomatic post-operatively and doing well on follow up.
Conclusion: Reappearance of neurological symptoms in a patient undergoing spine surgery previously needs careful evaluation. Rarely the symptoms of failed back surgery are seen to be arising due to a pseudomeningocele.
Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
2
1
2016
6
1
Outcome of Transphenoid Surgery for Corticotroph Pituitary Tumors
19
21
EN
Masoud
Mehrazin
MD, Neurosurgeon, Professor of Neurosurgery, TUMS, Shariati Hospital, Tehran, Iran.
Reza
Mirfallah
MD, Neurosurgeon, Arad Hospital, Tehran, Iran
Hossein
Bokaei
MD, ENT Surgeon, Arad Hospital, Tehran, Iran
Mousa
Sadr-Hosseini
MD, ENT Surgeon, Associate Professor of ENT Surgery, TUMS, Imam Khomeini Hospital, Tehran, Iran
Background & Importance: The aim of this study was to demonstrate the result of transsphenoid microsurgery for Cushing disease in our center and comparing the results in details with other articles, to achieve the best decision for patients management in future.
Case Presentation: Between 1991 to 2015, 50 patients suffering from Cushing disease were operated. Before operation, endocrine tests and neuroimaging examinations were done for all patients and all of them were operated via transsphenoid approach. They were followed up in clinic with endocrine tests and imaging in regular intervals. During this study, 50 Cushing cases including 47 primary and three secondary tumors were operated. Thirty four (68%) tumors were microadenoma and 16 (32%) macroadenoma. A patient died due to postoperative fulminant meningitis (mortality=2%). Mean of follow-up was five years. Overall, 40 (80%) patients had remission after operation and 9 (18%) patients achieved no remission, three of them had macroadenoma and six microadenoma. During follow-up period, three (6%) patients had recurrence which needed second operation. In secondary tumor and in macroadenoma with cavernous sinus involvement, the
result was not good (33% and 0% remission, respectively).
Conclusion: Transsphenoid surgery is a safe and effective first choice method to manage Cushing disease compared to other treatment modalities. In recurrent or resistant cases, other modalities could help to manage patients.
Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
2
1
2016
6
1
A Rare Association between Meningioma and Two Intracranial Vascular Lesions: Case Report and Review of Literature
22
24
EN
Andrea
Boschi
MD, Resident in Neurosurgery, University of Florence, Florence, Italy
Giovanni
Barbagli
MD, Resident in Neurosurgery, University of Florence, Florence, Italy
Bahman
Ashraf-Noubari
MD, Consultant in Neurosurgery, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
Edvardo
Cipolleschi
MD, Neurosurgery Clinic, University of Florence, Italy
Salvatore
Mangiafico
MD, Director of Interventional Neuroradiology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
Franco
Ammannati
MD, Consultant in Neurosurgery, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
Background & Importance: Our study was performed based on the first case, reported in English, of a patient with three contemporary lesions, an extra-axial malformation and two vascular ones.
Case Presentation: A 62-year-old man referred to our clinic due to right hand tremor associated to a slowing of idea-forming function and movements. The neuroradiological evidence showed a right fronto-temporal meningioma with the contemporary presence of an arteriovenous malformation (AVM) and of an aneurysm. The neuroradiological finding showed, also, a presumably “flow-related” right carotid-ophthalmic aneurysm with two millimeters in size. We performed the meningioma excision by the usage of cavitron ultrasonic surgical aspirator (CUSA), after the isolation of the sylvian fissure with the microdoppler and the removal of the AVM by the Hashimoto technique. Considering the very small size of the aneurysm, we decided to leave it in site.
Conclusion: The post-operative examination showed a complete removal of the lesions, meningioma and AVM. We performed an exhaustive review of the current literature, and the result encompassed only another case, written in Japanese, about the contemporary presence of these three lesions.
Neurolosurgical Society of Iran
Iranian Journal of Neurosurgery
2423-6497
2
1
2016
6
1
Delayed Bilateral Symptomatic Vasospasm after Resection of a Skull Base Meningioma: Report on a New Case and Literature Review
25
30
EN
Matteo
Capozza
MD, Consultant in Neurosurgery, University of Florence, Florence, Italy
Giovanni
Barbagli
MD, Resident in Neurosurgery, University of Florence, Florence, Italy
Andrea
Boschi
MD, Resident in Neurosurgery, University of Florence, Florence, Italy
Bahman
Ashraf-Noubari
MD, Consultant in Neurosurgery, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
Sergio
Nappini
MD, Consultant in Interventional Neuroradiology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
Nicola
Limbucci
MD, Consultant in Interventional Neuroradiology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
Arturo
Consoli
MD, Consultant in Interventional Neuroradiology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
Leonardo
Lenieri
MD, Resident in Interventional Neuroradiology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
Andrea
Rosi
MD, Resident in Interventional Neuroradiology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
Salvatore
Mangiafico
MD, Director of Interventional Neuroradiology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
Background and Importance: Symptomatic vasospasm is a well-known pathology associated with ruptured aneurysms. Nevertheless, this condition is rarely found as a result of skull base tumor removal.
Case Presentation: We reported a new case of 40-year-old woman previously treated for a tuberculum and diaphragma sellae meningioma showing symptomatic vasospasm after twelve post-operative days without previously documented sub-arachnoid hemorrhage (SAH). A digital subtraction angiography (DSA) was performed, and a bilateral vasospasm was detected. After subsequent endovascular treatments by intra-arterial infusion of nimodipine, the patient experienced a full recovery. Conclusion: Symptomatic vasospasm after meningioma removal is a challenging and life-threatening condition. Early diagnosis is the key for successful treatment.