A Multidisciplinary Technique Using Endonasal Endoscopic Approach with Intrathecal Fluorescin Under Neuronavigation Guidance in Patients with Cerebrospinal Fluid Leak

Background: Cerebrospinal fluid (CSF) is contained in an anatomic space, including cerebral ventricles and subarachnoid spaces and cisterns of brain and spine. Distraction of normal anatomy of any containing parts of this system will result in CSF leakage which could be associated with morbidity and mortality with variable degrees. In this study, we aimed to present 3 patients with history of blunt head trauma, who presented with delayed CSF leak and underwent endonasal endoscopic approach under image guided surgery using neuronavigation system with fluorescein illumination.Case Presentation: Three patients were referred to neurosurgery department of Shohada Tajrish Hospital with previous history of blunt head trauma, complained from CSF rhinorrhea. They underwent thin slice Computed Tomography scan and received intrathecal fluorescein for better visualization of leakage source under live endonasal endoscopic approach, using image guided neuronavigation technology. Autologous fat tissue and fascia was used to seal the leakage site. Clinical and imaging follow up at post-operative state as well as 1st, 2nd, 4th and 8th week revealed no post-operative complications and repeated CSF leakage.Conclusion: CSF rhinorrhea indicates abnormality in bony structure of skull base and is a major threat for ascending microbial infections and subsequent meningitis. Thus, identification of leakage site(s) and accurate surgical repair is necessary. We experienced a multidisciplinary approach which showed excellent results and no post-operative complications. Multidisciplinary approach with combination of endonasal endoscopic view under neuronavigation system improves accuracy and will minimize post-operative complications.

Coincidence of Anterior Communicating Artery Aneurysm in a Patient With Carotid Body Tumor: A Case Report

Background: Intracranial aneurysms (IAs) are focal pathologic dilation of cerebral vasculature, which mostly affect the anterior circulation of brain. Carotid body tumors (CBTs) are the most common head and neck parasympathetic paragangliomas. These slow growing neoplasms may cause hypertension along with catecholamine release symptoms, mostly in patients in their fourth decade. This is the second reported case of simultaneous presentation of CBT and IA in a male patient.Case Presentation: A 54-year-old male with positive history of hypertension presented with isolated acute weakness of right upper extremity. Bilateral Doppler ultrasound of carotid arteries showed a mass at left carotid bifurcation, which was confirmed by vessels computed tomography (CT) – angiography. CT scan also demonstrated anterior communicating artery (A-Com) aneurysm. Digital subtraction angiography (DSA) confirmed a right sided A-com artery aneurysm. Aneurismal repair was performed prior to CBT removal.Conclusion: Although multifactorial etiologies, such as hypertension, atherosclerosis and congenital predisposition with vascular abnormalities exists; this case raises the possibility of etiologic relationship between hypertension and hypertensive crises due to catecholamine release and aneurismal development and rupture. Avoidance of possible life threatening complications of aneurismal rupture necessitates preoperative evaluation for CBT in patients with established diagnosis of IA

Effect of Local Steroid Injection on Prevertebral Soft Tissue Swelling Following Anterior Cervical Discectomy and Fusion

Background: Prevertebral soft tissue swelling (PSTS) following anterior cervical surgery, may proceed to airway compromise which is potentially lethal. We plan to evaluate the effect of local steroid injection to reduce PSTS after anterior cervical discectomy and fusion (ACDF).Methods: In a randomized clinical trial 66 patients who underwent ACDF involving one to three segments due to radiculopathy or myelopathy were enrolled and randomly divided to two groups of 38 with local injection of 80 mg methylprednisolone in operation site, and control. Prevertebral soft tissue thickness to mid anteroposterior vertebral body diameter (S/V) ratio was defined to assess PSTS. In addition, dysphagia and pain at surgery site was evaluated using Bazaz dysphagia scale and Visual Analogue Scale (VAS) respectively, at 1st, 5th and 10th post-operative days.Results: We have observed significantly lower S/V ratio in all studied vertebrae, except C6 on second postoperative day in case group. At the end of the 6th month, there was no significant difference for S/V ratio in any level in two groups. Severity of dysphagia was significantly lower in 1st, 5th and 10th post-operative day in patients in case group. (P value<0.05) Also, patients in case group experienced significantly less severe odynophagia at 1st, 5th and 10th post-operative day, which was assessed by VAS. (P value<0.05)Conclusions: The use of local methyl prednisolone in prevertebral space is a simple and effective method to reduce PSTS and severity of dysphagia and odynophagia. Furthermore, this method was not associated with any adverse effects.

Comparison of the homodynamic effects of Nesdonal and Propofol in patients under electroconvulsive therapy

Background: General anesthesia is a safe method for induction of electroconvulsive therapy (ECT) in patients suffering from psychiatric disorders. We aimed to compare the hemodynamic effects of Nesdonal and propofol as induction agents for ECT.Methods: This semi-experimental study was performed on 84 patients with confirmed diagnosis of psychiatric disorders, who underwent ECT at Shohada Tajrish hospital in 2016. After randomization, each patient either received Nesdonal or propofol for induction of anesthesia. Hemodynamic changes of mentioned anesthetic agents were recorded and evaluated during ECT, including systolic and diastolic blood pressure, heart rate, seizure duration related to the procedure and recovery from sleep. Statistical analysis was performed using Student t test and Friedman test.Results: There were 50 men and 34 women among included patients. The mean and standard deviation (SD) of age of patients in Nesdonal group in female and male were 40.5 ± 13.4 years and 30.2 ± 13.5 years, respectively. Data for propofol group was 36.5 ± 20.9 years and 25.7 ± 7.7 years for female and male patients, respectively. Nesdonal offered a superior hemodynamic stability during the procedure, and seizure duration has decreased with Nesdonal compared with propofol. However, patients who underwent propofol for their anesthesia recover faster from sleep, while systolic and diastolic blood pressure of this group were higher than Nesdonal group (P < 0.0001).Conclusion: Considering better hemodynamic stability, it seems that Nesdonal is better than propofol for induction in ECT

Recent Progresses in Brain Gene Therapy

Gene therapy consists of the introduction of genetic material into cells for a therapeutic purpose. The understanding of the basics of the molecular and cellular mechanisms in disease treatments has resulted in the development of high-tech gene transfer materials with improved therapeutic efficacy. Based on the results of more than 2000 clinical trials to date, gene therapy is going to be included in standard treatment approaches in some specific diseases. Also, gene therapy has been highly improved in central and peripheral nervous system diseases. This review tried to focus on techniques and approaches in brain tumors and nervous system’s gene therapy strategies and will discuss about associated problems and potential future in management of inherited or acquired neurological disorders

Extradural Thoracic Arachnoid Cyst En-Bloc Resection and Follow-Up: A Case Report

Background: Arachnoid cysts are cerebrospinal fluid (CSF) fluid-filled sacs that are located between the brain and spinal cord. Spinal column arachnoid cysts are rare and mostly asymptomatic, being mostly located in intradural regions. We reported a patient who presented with neurological deficits and mid-thoracic extradural arachnoid cyst treated with en-bloc resection.Case Presentation: Patient was a 34-year-old female who presented with progressive back pain, lower extremity weakness and paresthesia in her lower limbs. Magnetic resonance imaging (MRI) study revealed an extradural hyperintense signal lesion in T2-weighted, extending from T7 to T9, which did not enhance on T1-weighted post-contrast MRI. Patient underwent T6-T10 laminectomy and en-bloc resection of the lesion which was compatible with arachnoid cyst after histopathological examination. Patient did not experience worsening of neurological symptoms and lesion recurrence in clinical and imaging evaluation during 2-year follow-up.Conclusion: Clinical and neuroimaging evaluation of every patient with progressive neurological deficits should be carried out in detail. This report suggests that rare spinal lesion, as extradural spinal arachnoid cyst in this case, may cause neurologic deficits and en-bloc resection of the lesion is feasible and may prevent local recurrence

Peripheral Nerve Injury: A Review Article

Traumatic peripheral nerve injuries are among most important cause of physical disability among young adults. Most partial injuries and some complete injuries recover without operative intervention, with early return of function appearing to be the most significant prognostic factor in these cases. Return of function over time depends to a great extent on the underlying neuropathologic condition of the nerve. Although some nerve injuries recover spontaneously, in some cases surgery is the only therapeutic option for the improvement of neurological deficits or control of neuropathic pain. We aimed to review the classification and management of peripheral nerve injury, with emphasize on clinical aspect

Development and Validation of HPLC Method for Determination of Crocetin, a constituent of Saffron, in Human Serum Samples

Objective(s):The present study reports the development and validation of a sensitive and rapid extraction method beside high performance liquid chromatographic method for the determination of crocetin in human serum. Materials and Methods:The HPLC method was carried out by using a C18 reversed-phase column and a mobile phase composed of methanol/water/acetic acid (85:14.5:0.5 v/v/v) at the flow rate of 0.8 ml/min. The UV detector was set at 423 nm and 13-cis retinoic acid was used as the internal standard. Serum samples were pretreated with solid-phase extraction using Bond Elut C18 (200mg) cartridges or with direct precipitation using acetonitrile. Results:The calibration curves were linear over the range of 0.05-1.25 µg/ml for direct precipitation method and 0.5-5 µg/ml for solid-phase extraction. The mean recoveries of crocetin over a concentration range of 0.05-5 µg/ml serum for direct precipitation method and 0.5-5 µg/ml for solid-phase extraction were above 70 % and 60 %, respectively. The intraday coefficients of variation were 0.37- 2.6% for direct precipitation method and 0.64 - 5.43% for solid-phase extraction. The inter day coefficients of variation were 1.69 – 6.03% for direct precipitation method and 5.13-12.74% for solid-phase extraction, respectively. The lower limit of quantification for crocetin was 0.05 µg/ml for direct precipitation method and 0.5 µg/ml for solid-phase extraction. Conclusion: The validated direct precipitation method for HPLC satisfied all of the criteria that were necessary for a bioanalytical method and could reliably quantitate crocetin in human serum for future clinical pharmacokinetic stud

Neurocysticercosis: Manifestations, Diagnosis and Treatment

Neurocysticercosis, is the infection caused by the larval form of the tapeworm Taenia solium. It is considered as the most common parasitic disease of the central nervous system and the most common cause of acquired epilepsy. This has primarily been a disease that remains endemic in countries with poor economy , but because of increased migration neurocysticercosis is being diagnosed more frequently worldwide. During the past decades improved diagnostics, imaging, and treatment have led to more accurate diagnosis and improved prognosis for patients. This article is a review about the current data about neurocysticercosis, including recent diagnostics and treatment developments