Evaluation of the results of cervical spine and spinal Cord trauma in children

Major differences exist in the anatomy and biomechanics of the growing spine that causes failure patterns different from those in adults. Spinal injury in the pediatric patient is a main concern because timely diagnosis and appropriate treatment can prevent further neurologic damage and deformity and potentiate recovery. We conducted a retrospective clinical study of 137 cases [93 boys, 44 girls] of pediatric cervical spine injuries, managed over fifteen years, to present data from a large series of pediatric patients with cervical spine injuries from a single regional trauma center. The aim was to assess and analyze complications, etiology, pathogenesis, site of injuries and age difference of cervical spine and spinal cord injury in a pediatric age group and compare the findings with current literature. One hundred and thirty seven children with cervical spine injuries, seen over twelve years, were divided into two age groups: 54 patients were in group one [0-9 years] and 83 patients were in group two [10-17 years]. We managed them according to status at presentation and type of injury. Forty seven patients were managed surgically and ninety nonsurgically [52 wore a halo brace and 38 wore different hard collars and braces]. T-test and Chi squares were used to analyze differences between groups. The most common cause of injury was motor vehicle accidents [MVA]. Our younger patients [Group 1] had sustained more neurological injuries than the older ones [Group 2], 77% vs. 48%; upper cervical spine was the most common site involved in 76%, while 43% suffered head injuries. In group two, 88% of children two sustained fractures or fracture/ subluxations; also in this group, subluxation, and fracture/ subluxation was present in 10 and 25% of children respectively. The most common radiological findings were vertebral fracutes [38%]. Solid fusions were demonstrated in all patients at late follow-up review [mean 6 years]. None of the children developed neurological deterioration; however 18% mortality was documented. Various fusion techniques were used and neurological and fusion outcomes improved as compared with the previous reports. Outcomes of cervical spine injuries in children are more positive than in adults, particularly in patients with incomplete injuries. The prognosis for children with complete spinal cord injuries, however, is still discouraging. Upper cervical spine injuries are more common between birth and 9 years of age; however fractures and fracture/subluxation are rare in this group. Surgical intervention with appropriate instrumentation and fusion are very effective in children with cervical spine instability

[Intracranial arachnoid cyst [review of 20 cases]]

The purpose of this study is to evaluate the distribution, clinical features, and treatment modalities of arachnoid cyst in our department. The study was carried out between April 1, 1996 and October 1, 2006 in the neurosurgery department, Ghaem hospital, Mashhad University of Medical Sciences. Twenty patients with arachnoid cyst underwent surgery between April 1, 1996 until October 1, 2006, consisting of 12 males and 8 females aged 5 to 68 years [mean age 32.4 years]. Twelve patients underwent surgery and one patient underwent endoscopic fenestration, and cystoperitoneal shunting [medium pressure] was performed in 7 patients. All patients were followed for minimum of 6 months after surgery. During the study period, 20 patients were investigated. The cysts location was the middle cranial fossa in 12 patients [60%], suprasellar region in 1 patient [5%], the cerebral convexity in 1 patient [5%], posterior cranial fossa in 2 patients [10%], cerebellopontine angle in 3 patients [15%], and quadrigeminal cisterns in 1 patient [5%]. All cysts had clearly unilateral distribution, 12 [60%] were located on the left side and 8 [40%] on the right side. The most common symptoms on presentation were epileptic seizures [46%], increased intracranial pressure [34%], visual impairment [5%], headache [10%], and cerebellar signs [5%]. Arachnoid cysts have a strong predilection for the middle cranial fossa which may be explained by a meningeal mal-development theory. We also conclude that the major indication for surgery in patients with arachnoid cyst is the presence of intractable seizures, increased intracranial pressure, and compression of nervous tissues. Headache is not a surgical indication on its own

[Giant pituitary adenoma: a cases report of 22]

Although most pituitary neoplasms are benign, but some of them spreads to extrasellar structures. Definition of these giant pituitary adenoma is not clear. In order to clarify this question, we studied all pituitary adenomas with diameter of 30 mm or more and attempting to identify their typical and clinical features, complications and their prognosis. In our prospective study since 1996 to 2006, 235 patients had been admitted and operated in neurosurgical centers, were determind. We evaluated the clinical and paraclinical signs and symptoms and surgical results of these tumors and Rate of recurrence, morbidity and mortality was determind. Then we compared these results with other studies. The processing of the results was achieved by SPSS [11.5] and statistical analysis with descriptive methods. From 235 patients with pituitary adenoma in our study, 131 patients were male and 104 cases were female. The age of patients were 18 to 75 years with the average of 50.5%. 22 patients from 234 cases had giant pituitary adenoma. The diameter of their tumors were equal or more than 30 mm.The most common clinical findings in our patients with giant pituitary adenoma were visual impairement [95.4%], headache [81.8%], gait disturbance [13.6%], decreasing of libido [18.1%] and papilledema [27.2%]. In our study, the most common giant pituitary adenomas were non-functional adenomas and prolactinomas respectively. Mortality and post operative complications of giant pituitary adenomas is more than other adenomas. The giant pituitary adenoma is about 10.6% of total pituitary adenomas. Although these lesions are not special and typical tumors but in order to more invading and more spreading to adjacent structures, they are different of other adenomas. They are characterized by a higher clinical signs and symptoms, higher frequency of neuro-ophthalmological symptoms and hormonal deficits and poorer response to surgical treatments. The rate of recurrence, morbidity and mortality is more than other adenomas too

[Primary results of neuroendoscopy in neurosurgery department]

Endoscopic third ventriculostomy [ETV] is currently being performed for patients with obstructive hydrocephalus, who also have preservation of communication between the subarachnoid space and the venous system, and in whom the basilar cisterns are still open. Despite the shunt complications, most children are shunt dependent permenantly or for many years. Recently, neuroendoscope is used to treat some of brain tumors, arachnoid cysts, some of congenital disorders and medullary diseases. The aime of this study was to evaluate primary results of neuroendoscopy in neurosurgery department. In this prospective study, all of the patients who were operated by neuroendoscope in neurosurgical department of Ghaem Hospital for 24 months were reviewed. Age, sex, underlying diseases, clinical findings, complications, CT or MRI findings before and after neuroendoscopy were studied. Data was collected in questionnaire and the processing of the results was achieved by SPSS [11.5] and statistical analysis with descriptive methods. From 30 patients in our study, 26 had obstructive hydrocephalus [two of them had intraventricular tumors and four cases had parenchymal tumors], 3 had arachnoid cysts, and one patient had loculated hydrocephalus. All of them have been operated by neuroendoscopy. From 26 patients with obstructive hydrocephalus, 4 had been operated by VP shunt before. From 26 patients undergoing neuroendoscopy for obstructive hydrocephalus, 14 cases within one week and 10 cases whitin one month after neuroedoscopic third ventriculostomy had normal size ventricules. The results were excellent in treatment of arachnoid cysts, intraventricular tumors, and loculated hydrocephalus too. With respect to excellent results of neuroendoscopy in treatment of obstructive hydrocephalus, arachnoid cysts, and shunt malfunction; and in regard to many complications and severe dependency in shunt surgery, neuroendoscope is recommended as the first step of treatment of these diseases

[Surgical ttreatment of chest wall tumours]

Chest wall tumor is an uncommon malignancy; and incomplete diagnosis and resection and inability to reconstruction of expanded chest wall defect after resection, Causes mortality and morbidity in patients. Academic surgery provides the best choice for the patients, and surgery technique should be based on the individual characteristics. This study was done to evaluate the surgery results of chest wall tumors and to report the operated cases. The descriptive research was performed in Tehran Valiasr Hospital and Ghaem Hospital [Mashhad University of Medical Sciences] from 1995 to 2003 [9 years] and 61 patients have been evaluated in retrospective study. Individual, clinical, laboratory, treatment and complication data were gathered in a questionnaire and analyzed by descriptive statistics. 28 [45.9%] patients had primary chest wall malignancy, 4 [6.55%] patients had metastatic tumors, 10 [16.39%] patients had benign tumors, 16 [26.22%] patients had inflammatory disease and 3 [4.9%] had undiagnosed pattern. Results of our study and also review of other articles recommended that wide enblock exiscion of chest wall tumors with appropriate reconstruction is the best method of treatment

[Role of fibrin/fibrinogen degradation products in prognosis of patients with head trauma]

Accident is the third common cause of mortality in population .Traumatic head injury is the most common cause of mortality among these events. In different studies, coagulation disorder is one of the most important factors for determination of severity of injury. The present study was designed to evaluate post traumatic fibrinolysis in adults after head injury. In this descriptive cross sectional study, ninety six patients [22 patients with mild head injury and 74 patients with severe or moderate head injury], who admitted in Mashhad Shahid Kamyab Hospital for six months, were chosen randomly. All of them had only head injury and admitted in hospital in less than 6 hours after trauma. The clinical and paraclinical findings including FDP were evaluated. Data was gathered in a questionnaire and analyzed by descriptive statistics and frequency distributes tables. Most cases of delayed hematoma happened within 14 hours of trauma. FDP value was correlated with severity of head injury and there was a meaningful correlation between FDP value and GCS. Higher FDP was seen with lower BMR, and vise versa. The most common cases with delayed hematoma were intracerebral hematoma. FDP may be a valuable predictive factor in traumatic head injury and changes in coagulation cascade may improve the outcome of patients with traumatic head injury

Intraventricular hemorrhage in blunt head trauma

Before the CT scan was widely used for imaging, intraventricular hemorrhage [IVH] was a rare diagnosis and in most cases proved fatal. Currently, thanks to the CT scan IVH. is easily diagnosed. Prognosis of IVH is very poor and almost always is accompanied with other intracranial traumatic lesions and pure traumatic IVH is very rare. This descriptive study done on 28 patients with IVH. During a year 742 patients were admitted to the Neurosurgical Intensive Care Unit of Shahid Kamyab Hospital. In 28 cases the leading cause of admittance was motor vehicle accidents, Most of the patients were between the age of 21-30., Out of 28 cases had IVH, 5 patients [18%] had pure IVH and the remaining others had intera cranial legions like, parenchymal hemorrhage, sub-arachnoid hemorrhage, brain contusions, subdural hemorrhage and acute hydrocephalus in one patient [3.6%]. 82% of patients had a very low-conscious level at admittance, which measured by the Glasgow Coma Scale, lower than 8. Mortality was higher than 61%. Four patients had surgical treatment and all died. Eight cases did not have any surgical procedure. Traumatic IVH is very rare in severe blunt head injuries and is associated with other brain lesions and had a poor prognosis. Mortality rate is different and depends on other accompanying intracranial lesions. Surgical intervention does not have a significant effect for a successful out come

Surgical evaluation of patients with cauda equina syndrome

Cauda equina syndrome is one of the neurosurgical disorders and it must be handled urgently and seriously. The aim of this study is to evaluate surgical results and the relationship between timing of surgery and outcome in 87 patients. This is a descriptive retrospective study since 1 987 to 2004. 87 patients with cauda equina syndrome were admitted in Qaem hospital. The evaluation of clinical and paraclinical signs and symptoms and surgical results were done. to assessment of outcome, the patients were divided to four grades: excellent, good, moderate and without change From 87 patients, 67 patients were male and 26 were female. the age of patients were 26 to 64 years, the more common level of disc hemiation was L4- L5 [%39],less common L2- L3 [%9/1]. The surgical result was excellent in%37/9 and without changed in%8/l. Cauda equina syndrome is one of the emergent problems in neurosurgery and if operated in 48 hour of beginning of clinical symptoms, especially in patients with incomplete clinical findings, the surgical results are excellent

[Evaluation of epidemiologic and angiographic findings of 100 patients with brain AVM in imam Reza and Shahid Kamyab hospitals]

Determining of epidemiologic and angiographic findings in 100 patients with brain AVM. 100 patients with clinical and neurological symptoms and CT and MRI findings which had brain AVM after four vessel angiography, was selected. The peak incidence of clinical symptoms presentation was second decade and there was mild predominancyof male sex [59%]. Clinical findings in order of prevalence were brain hemorrhage, headache, seizure and motor deficit. In brain CT scan the most common finding was heterogeneous density mass and mass with intracranial hemorrhage. In angiography, most AVMs were grade IV that most of them had one feeding artery and two draining veins. In 10% of cases there was only superficial draining vein. In 6%, AVMs was coexistent with aneurysm. In most cases, there were patent anterior and posterior communicating arteries. Location of AVMs in eloquent and non - eloquent area of brain was equal. The most common location was parietal lobe. ICH is more than IVH or SAH. Parietal lobe is the most common site for these AVMs in our study. Most of them are in grade IV Spetzler and Martin

[Brain abscess in children]

Brain abscess is one of the most important diseases among the neurosurgical infectious diseases which is accompanied by considerable mortality and morbidity. The aim of this research is contemplation of brain abscess in children [5-12 years] to ascertain the incidence, effectual underlying factors, clinical and laboratory findings and mortality and morbidity rates in Ghaem hospital in Mashad since 10 years ago.This is a descriptive and analytic study in children with brain abscess in Ghaem hospital achieved retrospectively. We considered age, sex, underlying factors, clinical and laboratory findings, location of abscess, methods of treatment [medical or surgical], the duration of staying in hospital, and mortality and morbidity of the disease. Statistical analysis was achieved with Odds Ratio and Chi[2] test.The age of children with brain abscess was 5-7 years. Male to female ratio was 1.6 to l.The most common underlying factors for brain abscesses were acute and chronic diseases of ear, mastoiditis, and chronic cyanotic heart disease [CCHD]. The patients had fever [55.5%], headache [46.6%], focal neurological findings [64.6%] and altered consciousness in 46.7%. The most common sites of involvement were: temporo-parietal [20%] and parietal lobe [18.2%]. Pus culturing was positive in 34% of cases. In 73.3% of cases one organism and in 26.6% several organisms were found in the culture. We achieved aspirated type operation in 93.3% of cases. The incidence of mortality and morbidity was 17.7% totally. The mortality and morbidity rates in patients with CCHD and otogenic brain abscess were 11.1% and 22.2% respectively. There was no meaningful correlation between mortality and morbidity with the number of abscesses or patient's age.Attention to hygiene of mouth and teeth in pediatric patients with cyanotic heart disease is very important in prevention of infectious brain diseases. We must also consider attention to ear-nose-throat diseases of children. It is very important that the patients are examined again after treatment because of finding and treatment of unknown otitis and chronic sinusitis

Delayed intracranial hematoma after head injury

Introduction: Delayed intracranial hematoma after head trauma is an important complication that must be considered much more in our neurosiirgical departments. These hematomas may be intra. or extraaxial. The purpose of this study is to determine the incidence, Complications and mortality rates of delayed intracranial hemorrhages and describe there, pathophysiology, clinical and radiological presentations

Material and Methods: Prospectively from March 2000 to February 2002, 1806 patients with posttraumatic intracranial hemorrhages were admitted at neurosurgical department of Shahid Kamyab Hospital . Many of them underwent operation

Results:1308 cases of the 1806 patients underwent craniotomy and hematoma removal. Among these cases 247 patients [about 13.6% of cases] had delayed intracranial hematoma [EDH, SDK orlCH]. Delayed intracranial hematoma after head injury is a frequent and potentially devastating problem

Conclusion: Few clinical studies showed the effects of vascular disorders and blood dyscrasias in higher incidence of delayed intracranial hematomas. Identification of patients at aricular risk for delayed intracranial hematoma, use of ICP monitoring in selected patients and prompt application of CTScan all can improve the early recognition of this complication of head injury. Early recognition and prompt treatment are both essential for optimal Management

Rehabilitation of severe traumatic head injured patients [deep coma] by tactile, thermal, visual and auditory stimulation

Introduction: The following research intends to determine the effects of a sensory stimulation program and the level of consciousness in patients with sever head injuries. The main hypothesis is these sensory stimulation programs will reduce the level of consciousness and duration of hospitalization in comparison with those without

Material and methods: this study was conducted in two patient groups [each group consisted of 22 patients] during a 6 month period in the ICU ward of Kamiab Hospital, Mashhad, Iran

Results: there was no statistically significant difference between levels of consciousness in the two groups; however there was a significant difference in the average duration of hospitalization

Plasmocytoma in cerebellopontie Angle [Case report]

Objective and Importance: The authors reported a case of plasmocytoma involving the Cerebellopontine plasmocytoma. Clinical presentation: The patient was a 55-years-old woman who complained of vertigo and tinnitus for one year before admission, Neurologial examination showed impairement of cerebellar test. CT scan revealed a large mass lesion in the left CPA region. Intervention: The patient underwent a left retromastoid craniectomy and resection of the tumor. Histopathological studies of biopsy revealed plasmocytoma. Other studies, including bone isotope scan and bone marrow aspiration, did not show involvement of other parts of the body. Within 6 months of follow up there was no sign of progression of the tumor in CT scan. There are few reports of CPA solitary plasmocytoma. There is a potential risk for error in diagnosis in imaging and pathology. The current treatment is subtotal or radical resection combined with radiotherapy