Reasons for delayed spinal cord decompression in individuals with traumatic spinal cord injuries in Iran: A qualitative study from the perspective of neurosurgeons / 中华创伤杂志(英文版)

PURPOSE@#The median time from the event leading to the spinal cord injury (SCI) to the time of decompressive surgery is estimated to be 6.9 days in Iran, which is much longer than the proposed ideal time (less than 24 h) in published guidelines. The current qualitative study aimed to determine the reasons for the observed decompression surgery delay in Iran from the perspective of neurosurgeons.@*METHODS@#This qualitative study is designed to perform content analysis on the gathered data from face-to-face semi-structured interviews with 12 Iranian neurosurgeons.@*RESULTS@#The findings of the current study suggest that patient-related factors constitute more than half of the codes extracted from the interviews. Overall, the type of injury, presence of polytrauma, and surgeons' wrong attitude are the main factors causing delayed spinal cord decompression in Iranian patients from the perspective of neurosurgeons. Other notable factors include delay in transferring patients to the trauma center, delay in availability of necessary equipment, and scarce medical personnel.@*CONCLUSION@#In the perspective of neurosurgeons, the type of injury, presence of polytrauma, and surgeons' wrong attitude are the leading reasons for delayed decompressive surgery of individuals with SCI in Iran.

Effects of neurofeedback on the short-term memory and continuous attention of patients with moderate traumatic brain injury: A preliminary randomized controlled clinical trial / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>There are some studies which showed neurofeedback therapy (NFT) can be effective in clients with traumatic brain injury (TBI) history. However, randomized controlled clinical trials are still needed for evaluation of this treatment as a standard option. This preliminary study was aimed to evaluate the effect of NFT on continuous attention (CA) and short-term memory (STM) of clients with moderate TBI using a randomized controlled clinical trial (RCT).</p><p><b>METHODS</b>In this preliminary RCT, seventeen eligible patients with moderate TBI were randomly allocated in two intervention and control groups. All the patients were evaluated for CA and STM using the visual continuous attention test and Wechsler memory scale-4th edition (WMS-IV) test, respectively, both at the time of inclusion to the project and four weeks later. The intervention group participated in 20 sessions of NFT through the first four weeks. Conversely, the control group participated in the same NF sessions from the fifth week to eighth week of the project.</p><p><b>RESULTS</b>Eight subjects in the intervention group and five subjects in the control group completed the study. The mean and standard deviation of participants' age were (26.75 ± 15.16) years and (27.60 ± 8.17) years in experiment and control groups, respectively. All of the subjects were male. No significant improvement was observed in any variables of the visual continuous attention test and WMS-IV test between two groups (p ≥ 0.05).</p><p><b>CONCLUSION</b>Based on our literature review, it seems that our study is the only study performed on the effect of NFT on TBI patients with control group. NFT has no effect on CA and STM in patients with moderate TBI. More RCTs with large sample sizes, more sessions of treatment, longer time of follow-up and different protocols are recommended.</p>

Pial Arteriovenous Fistula with Giant Varices: Report of Two Cases with Good Surgical Outcome

Pial arteriovenous fistulas (pAVF) are rare vascular lesions consisting of one or more arterial connections to a single venous channel without any intervening nidus of vessels or capillaries. Case 1: A 65-year-old woman with a complaint of headache and left hand paresthesia was referred to us. Magnetic resonance imaging showed a large saccular lesion with signal void in the posterior part of the right sylvian fissure and catheter angiography showed a giant venous aneurysm fed by one branch of the middle cerebral artery (MCA) and draining into the vein of Trolard. Case 2: A 12-year-old boy was transferred to our hospital with a history of sudden loss of consciousness and hemiplegia. Brain computed tomography revealed a massive hemorrhagic mass in the right hemisphere and cerebral angiography showed a pAVF with a large aneurysmal varix, which was fed by multiple branches of the right MCA and draining into the superior sagittal sinus. Both patients underwent craniotomy and after ligation of vascular connections, aneurysmal varices were removed completely. Surgical resection can be a safe method for treatment of pAVFs, particularly in those with large varices.

overview of therapeutic approaches to brain tumor stem cells

Primary and secondary malignant central nervous system [CNS] tumors are devastating invasive tumors able to give rise to many kinds of differentiated tumor cells. Glioblastoma multiform [GBM], is the most malignant brain tumor, in which its growth and persistence depend on cancer stem cells with enhanced DNA damage repair program that also induces recurrence and resists current chemo- and radiotherapies. Unlike non-tumor stem cells, tumor stem cells lack the normal mechanisms that regulate proliferation and differentiation, resulting in uncontrolled production and incomplete differentiation of tumor cells. In current paper recent developments and new researches in the field of brain tumor stem cells have been reviewed

[Endoscopic third ventriculostomy in Dandy Waker syndrome: case report and review of literature]

Dandy walker syndrome is a kind of congenital anomaly consisting of absence of cerbellar vermis, cystic fourth ventricle and large posterior fossa. It can be associated with hydrocephaly. Generally it is treated with shunting but endoscopic third ventriculostomy can also be used. Our patient is a known case of dandy walker syndrome. She has been shunted due to hydrocephaly when she was 5 months old. She was presented with signs of raised intracranial pressure and endoscopic third ventriculostomy [ETV] was considered for the patient. As ETV didn't resolve the symptoms ventriculoperitoneal shunting was done. Patient discharged with good general condition. ETV is a novel procedure for hydrocephaly, but it should be considered that there are many factors that determine the success rate of it. Correct patient selection can increase success rate of this procedure

Distribution of age and location of chordoma in 39 cases and review of treatment options

Skull base chordomas are rare neoplasms arising from the notochord. Although histologically benign, these tumors are locally aggressive and present significant management challenges. There are some studies on chordoma cases but there was no study about Iranian cases. In this study we evaluated the location, age and gender of the patients with Chordoma in two referral centers in Tehran. A database of patients with chordoma tumors referred to two centers [Shariati and Imam Hospitals, Tehran] from 2001 to 2011 was retrospectively reviewed. In our subjects tumors affect men nearly twice as frequently as women, and they are most commonly diagnosed in middle-aged [mean age was 50.6]. Tumors typically occur in the axial skeleton and have a tendency for the spheno-occipital region of the skull base and sacral region. In adults 33.3% of chordomas involve the sacrococcygeal region, 53% occured at the base of the skull near the spheno-occipital area, and near 14% were found in the vertebral column. The cranial nerves mostly affected were abducens, oculomotor and trochlear, with some overlaps. All patients were treated with surgery and some cases referred for gamma-knife radiosurgery [GKS]. Findings of this study showed more involvement of males compare to females; that is different from other studies, however, few studies reported more male to female ratio. Despite the progress in current surgical techniques and some encouraging results with the use of targeted therapy, disease control and long-term prognosis of patients are still poor

[Tectal lipoma: a case report and review of literature]

Intracranial lipomas are rare benign neoplasms that comprise 1% of all primary brain tumors. Generally, occur in midline structure and usually identified incidentally on CT scans or in autopsies. The incidence of intracranial lipomas is about 0.08 to 0.46% on autopsies. These benign lesions are slow-growing, usually asymptomatic and rarely require surgery. We report a 20 years old male who complained of headache since two years ago. On CT examination, a quadrigeminal cistern lipoma without any pressure effect on neural structures demonstrated. His headache remitted with conservative measures. Here, we have a review on the literature and explain CT scan and MRI findings. According to the literature and present case, it seems that direct surgical excision of tumor is not justified in the majority of cases and symptoms of patients greatly respond to conservative measures and, at most, in cases of hydrocephalus, CSF shunting relieves their symptoms

[Vertebrobasilar dolichoectasia: a case report]

Vertebrobasilar dolichoectasia is defined as a prominent elongation, dilatation and tortuosity of the vertebral and basilar arteries. Ectatic basilar arteries may cause different neurological symptoms by several mechanisms including compressive effects and embolic or ischemic events. In this report we present a 58-year old female patient who was admitted in Dr. Shariati General Hospital in Tehran, Iran with complaints of dysarthria, vertigo, ataxia and nausea. Neuro-imaging procedures [brain CT scan, CT angiography, and an MRI study of the blood vessels or MRA] were performed. Dilation and elongation, as well as tortuosity of the vertebral and basilar arteries revealed the diagnosis of vertebrobasilar dolichoectasia. The patient was discharged from the hospital following the control of underlying diseases and neurological symptoms related to dolichoectasia without undergoing any invasive procedures. Paying attention to any minor or major neurological symptoms, as well as underlying medical conditions along with the conservative control of symptoms can be most helpful. Invasive interventions in a chronically ill patient can be very risky, therefore, medical management including control of associated or underlying diseases is recommended as the first line of treatment

Lumbar vertebral hemangioma with extradural extension, causing neurogenic claudication: a case report

The authors present a rare case of lumbar vertebral hemangioma extending to the epidural space with a bisected appearance and impinging on thecal sac. This 52-year-old lady presented with one year history of low back pain and bilateral leg radiation. Plain radiography showed vertical linear streaks at L2 vertebral body and axial computed tomography [CT] scan revealed small "polka dot" appearance within the vertebral body. Magnetic resonance imaging [MRI] showed low signal intensity on T1-weighted images in L2 vertebral body which was not characteristic for hemangioma. The patient underwent an L2 laminectomy, spinal canal decompression and posterior spinal instrumentation. This study indicates that lumbar vertebral hemangioma can extend to the epidural space and cause neurologic symptoms. Magnetic resonance imaging may not show diagnostic features, especially in active lesions and plain radiography and CT scan may be helpful

overview of pharmacological approaches for management and repair of spinal cord injuries

Spinal cord injury [SCI] leads to loss of nervous tissue and consequently to catastrophic neurological deficits. Up to now there is no definite treatment available that restores the loss of function to a degree that an independent life can be guaranteed. This justifies the cost of research into the new modalities for a treatment of SCIs. In current paper, recent developments and new approaches in pharmacological therapy have been reviewed