Diffuse subarachnoid and intraventricular hemorrhage as the presenting sign of a conus medullaris arteriovenous malformation: Case report

Spinal arteriovenous malformations (AVMs) are rare vascular lesions that usually present with progressive myelopathy or less frequently, with acute neurological deficit due to hematomyelia or spinal subarachnoid hemorrhage (SAH). There are few reports of concomitant cerebral SAH and intraventricular hemorrhage (IVH) following rupture of a spinal AVM. Herein, we present a rare case of conus medullaris arteriovenous malformation, out-breaking with loss of consciousness due to SAH and IVH

Nondysraphic Huge Cervical Intramedullary Lipoma: a Case Report and a Review of Literature

We report the case of a 14-year-old girl with huge cervical intramedullary lipoma, who presented with spastic quadriparesis. Her MRI revealed an intramedullary lipoma extending from the craniovertebral junction to the sixth cervical vertebra. There was no spinal dysraphism. Subtotal excision of tumor with primary dural closure and laminoplasty was performed from C3 to C6, which produced an improvement in the patient’s function

The correlation between the duration of sciatica and clinical outcome after lumbar discectomy

Background: Sciatic pain in association with lumbar disc herniation may require surgical intervention in the form of lumbar discectomy. Yet, the optimal time for this operation has not been specified in medical literature. Methods: In a Cross-sectional study, 147 patients (100 men and 47 women) with radiological and clinical signs of L4-L5 or L5-S1 disc herniation were entered to our registry prior to March 2009. They were all examined, diagnosed and operated on (lumbar discectomy) in Ghaem General Hospital, Mashhad, Iran. Patients were all subsequently followed for one year. The follow-up continued in a number of 126 cases, whose satisfaction was rated via phone interview for an extra year. The patients’ assessments were implemented employing three scaling systems, both before and following lumbar discectomy, to name the Modified Oswestry Disability Index (MODI), Visual Analogue Scale (VAS) and Prolo Functional Economic Outcome Rating Scale (PORS). The former two were used for pre-operative and post-operative assessments whereas the latter was applied during the first year of follow-up. The focus of the investigation during second year was on patients’ satisfaction. Results: Mean age of our cases were 34±7.4 years. According to the duration of the sciatica, patients were divided into 4 groups. <3 months, 3 to <6 month, 6 to 12 months. Statistical analysis revealed a significant difference between patients having undergone lumber discectomy with a history of sciatica for less and more than three month before the operation in terms of pre-and post-operative visual Analogue Scale (P= 0.022). However, there could be found no such disparity in other clinical scores (P= 0.63 for MODI, P= 0.85 for Prolo scale and P= 0.73 for satisfaction). Conclusion: Patients with less than three months of sciatica may seem to enjoy a better clinical outcome after one year, there could be found no correlation between the duration of sciatica and the satisfaction after two years

Anterior Cervical Incision and Thoracotomy for Cervico-thoracic, Thoracic, and Thoracolumbar Spine Surgery: A Clinical Series

Introduction:Surgical treatment of diseases in cervicothoracic, thoracic and thoracolumbar regions can be a challenging issue. Cooperation of the thoracic surgeons and spine surgeons can improve the outcomes and decrease the complications of patients who underwent these approaches.Materials & Methods: The participants of this study consisted of seventeenpatients suffering from different types of vertebral lesions such as spinal TB, primary tumor, metastasis, and scoliosis. These patients were operated through anterior lower cervical incision (without sternotomy), standard thoracotomy, and lower thoracotomy during 2001-2016. For five patients, exposure of cervicothoracic region was achieved through anterior cervical incision with extension to anterior chest wall (without sternotomy). Through performing posterolateral thoracotomy (left or right) on nine patients, spine surgeons had a better access to the vertebral pathologies. In three cases, a perfect access to the thoracoabdominal spine was obtained by performing lower thoracotomy with removal of the twelfth rib and release of diaphragm from the chest wall.Results: In total, seventeen patients [eleven males (65%) and 6 (35%) females] with the mean age of 33.6 ± 19.4 were operated. 6 (35%) patients suffered from cervicothoracic lesions, 8 (47%)cases had lesions in middle and lower thoracic spine, and 3 (18%) patients had lesion in the thoracolumbar vertebra. Postoperatively, no mortality was observed in the patients and complications were reported to be minimal.Conclusion: According to the findings, the joint corporation of thoracic and spine surgeons can improve exposure of cervicothoracic, thoracic, and thoracolumbar regions. Furthermore, this approach can decrease the complications of these complex surgeries

Endovascular treatment of an unruptured anterior communicating artery aneurysm presenting with acute altitudinal visual field defect: A case report

Purpose: To describe a case of endovascular occlusion of an unruptured anterior communicating artery aneurysm presenting with acute altitudinal visual field defect is presented here. Methods: A 52-year-old man was evaluated and treated for altitudinal visual field defect in the right eye. Results: In ophthalmic and neuro-imaging, an accompanying anterior communication artery aneurysm was detected as a cause of visual field defect. He underwent endovascular procedure, yielding excellent outcome as full recovery of visual field defect was observed one month following the procedure and sustained when followed at month 24. Conclusions: Visual dysfunction is a rare presentation of unruptured anterior communication artery aneurysm. Endovascular procedure may be a safe treatment in these cases. Keywords: Intracranial aneurysm, Anterior communicating artery, Visual field, Endovascular procedur

Acute Epidural Hematoma after Ventriculoperitoneal Shunt Insertion: a Case Report

Background & Importance: Acute epidural hematoma is a very rare complication of ventriculoperitoneal shunt insertion. The insertion of a ventriculoperitoneal shunt can cause sudden decompression of the brain, subsequent to which epidural hematoma occurs due to CSF drainage. To our knowledge, there are only a few cases of acute epidural hematoma in the literature which required acute evacuation. Case Presentation: In this report, we present a case of epidural hematoma close to ventriculoperitoneral shunt insertion site in a 30-year-old man after failure of endoscopic surgery for opening of the wall of a suprasellar arachnoid cyst. Secondary to communication between cyst and ventricles and clinical symptoms and sings, the patient underwent the shunt insertion. The patient became comatose two hours following the insertion of the shunt, developing a voluminous right temporo-parietal epidural hematoma that had to be evacuated immediately. Here, we intend to discuss both the pathophysiology and treatment. Conclusion: Development of epidural hematoma after ventriculoperitoneal shunt surgery is a devastating complication. Dehisensce formation between the skull and dura matter, which may be facilitated by lax adhesion between the two, is a common underlying pathology. We recommend a close post-surgical observation for immediate diagnosis and reoperation of this event

Non syndromic primary diffuse leptomeningeal melanomatosis in a child: a case report

Abstract In this study, a case of primary diffuse leptomeningeal melanomatosis (PDLM), without neurocutaneous melanosis syndrome, is presented. A female patient (age, 14 years) presented with headache, nausea, vomiting, vertigo, diplopia, and lower limb weakness. Definitive histological examination showed a densely cellular tumor, characterized by irregular clusters of large pleomorphic cells and melanin in tumor cells. Adjuvant therapy was refused by the parents, and the patient died within 6 months. &nbsp;PDLM is recognized as an uncommon and malignant melanoma affecting the central nervous system. In case comorbidities are not diagnosed in patients with unusual symptoms of meningitis, diagnostic methods such as cerebrospinal fluid analysis and CNS biopsy can be helpful in identifying other underlying conditions

Problems in Diagnosis and Treatment of Retrorectal Tumors: Our Experience in 50 Patients

Retrorectal tumors are rare lesions in adults, which remains a difficult diagnostic and management problem. The purpose of this study was to evaluate the results of surgical management of retrorectal tumors in our institution. In a retrospective study, a consecutive series of patients who underwent surgical excision of a retrorectal tumor were identified from a database. Medical records, radiology, pathology reports and surgical approach were checked retrospectively. The data was analyzed using SPSS statistical software (version 18). From 50 patients, 24 were male, and 26 were female with the mean age of 41.7 years. The origin of mass was congenital in 46% (23 cases) and neurogenic in 14% (7 patients), bone origin in 12% (6 cases) and miscellaneous in 24% (12 cases). In total, 56.7% (21 cases) were malignant. Surgical approaches included laparotomy in 11 cases, the sacral approach in 17 cases, the anterior-posterior approach in 14 cases and one case through abdomino-sacral approach. The mean follow-up was 56.7 (10-277) month. Ten patients died due to extensive metastases with a mean survival of 46.6 (1-158) months. Primary urethrorectal tumors are very rare. Successful treatment of these tumors requires careful clinical evaluation and expertise in pelvic surgery