Endoscopic Surgery for Third Ventricular Colloid Cysts in the Absence of Hydrocephalus- a feasibility study

Purpose: The aim of this study was to investigate the feasibility and effectiveness of endoscopic neurosurgery for patients with third ventricular colloid cysts without ventriculomegaly.Methods: Seventy-one patients with third ventricular colloid cysts were identified and recruited to this study. Eighteen of these patients did not have concomitant hydrocephalus and underwent primary endoscopic surgery for cyst resection. The surgical technique, the success rate, and patients’ outcome were assessed and compared with 53 hydrocephalic patients who underwent similar procedures.Results: The ventricular compartments were successfully cannulated and gross total resectin of the colloid cysts was achieved in all patients. There were no operative complications related to the endoscopic procedure. Two patients required subsequent intervention for hydrocephalus. The success rate for endoscopic surgery in non-hydrocephalic patients was similar to its value in patients with hydrocephalus.Conclusion: Endoscopic resection of third ventricular colloid cyst in patients without hydrocephalus seems to be feasible, effective and not contraindicated

The Relationship between Platelet Volume Indices (PVIs) and Epileptic Seizure

Background: Platelet volume indices (PVIs) are low on price and easily accessible criteria in today’s medicine. However, the impact of PVIs on seizure characteristics in epileptic patients is not clear.Aim: To assess the level of PVIs in seizure affected patients and to see if there is a relationship between these results and the clinical status of patients.Methods: The current study enrolled patients with the epileptic seizure (ES) to evaluate the PVIs for investigating whether a relationship exists between PVIs levels with duration, frequency and type of seizure. In this survey, the platelet indices including mean platelet volume (MPV), platelet distribution width (PDW), and platelet count (PLT) were calculated for the patient.Results: A total of 199 patients were included in the study period, for which 59 attacks were focal seizures and 149 attacks were generalized convulsive seizures. The platelet counts and PCT were significantly higher in focal seizure than in generalized convulsion seizure. In generalized onset, MPV was significantly higher as compared to the focal onset.Conclusion: The acquired data indicated that the high level of MPV and low level of PLT and PCT in generalized seizures might substantially contribute to the clinical signs of epileptic patients

Emerging role of non-coding RNAs in regulation of t-lymphocyte function

T-lymphocytes (T cells) play a major role in adaptive immunity and current immune checkpoint inhibitor-based cancer treatments. The regulation of their function is complex, and in addition to cytokines, receptors and transcription factors, several non-coding RNAs (ncRNAs) have been shown to affect differentiation and function of T cells. Among these non-coding RNAs, certain small microRNAs (miRNAs) including miR-15a/16-1, miR-125b-5p, miR-99a-5p, miR-128-3p, let-7 family, miR-210, miR-182-5p, miR-181, miR-155 and miR-10a have been well recognized. Meanwhile, IFNG-AS1, lnc-ITSN1-2, lncRNA-CD160, NEAT1, MEG3, GAS5, NKILA, lnc-EGFR and PVT1 are among long non-coding RNAs (lncRNAs) that efficiently influence the function of T cells. Recent studies have underscored the effects of a number of circular RNAs, namely circ_0001806, hsa_circ_0045272, hsa_circ_0012919, hsa_circ_0005519 and circHIPK3 in the modulation of T-cell apoptosis, differentiation and secretion of cytokines. This review summarizes the latest news and regulatory roles of these ncRNAs on the function of T cells, with widespread implications on the pathophysiology of autoimmune disorders and cancer

The Therapeutic Effect of Endoscopic Tumor Resection on Acromegalic Cardiomegaly in Patients With Pituitary Adenoma

Background: Acromegaly defines as chronic elevations of insulin-like growth factor-1 (IGF-1) and growth hormone (GH), which results in enlargement of organs and soft tissues. Cardiovascular complications of acromegaly such as cardiomegaly, hypertension contributing to a high risk of cardiovascular events. This study aimed to identify the determinants of the prevalence of cardiomegaly as cardiovascular comorbidity of acromegaly and the potential effect of the curative intervention.Methods: A total of 160 patients with acromegaly due to pituitary adenoma participated in this study. Acromegaly diagnosed was based on clinical manifestations, age-adjusted plasma IGF-I, and elevated plasma GH levels, not suppressible during an oral glucose tolerance test (75 g). Electrocardiogram and chest X-ray obtained in all patients. Treatment approaches included transsphenoidal surgery and hormonal evaluation performed before and six months after surgery.Results: The GH serum level was elevated in all patients before surgery, with a mean of 33.7 ng/mL that reached 5.7 ng/mL after surgery. Mean IGF-1 was 794.1 ng/mL that reached 395.6 ng/mL postoperatively. The prevalence of cardiomegaly was 15% that improved in 5% of patients after trans sphenoidal surgery.Conclusion: Appropriate surgical intervention in acromegaly that complicated by cardiomegaly may result in significant improvement of the cardiac structure

Quality of Life in Acromegaly Disease Among Iranian Population:One Longitudinal Before-After Study

Background: The current study aimed to determine the quality of life (QoL) scores before and after treatment in patients with acromegaly.Methods: In this longitudinal before-after study, the acromegaly quality of life (AcroQoL) questionnaire was used to assess the QoL. Demographics, clinical manifestations and co-morbidity data, pituitary axis involvement, biochemical and hormonal component tests, and health-related quality of life (HRQoL) before and after treatment (endoscopic transsphenoidal surgery, medication, radiotherapy) were evaluated in patients over 18 years of age. To compare the mean of continuous data, the independent t and Mann–Whitney tests were used. To compare the mean QOL score before and after the study, the paired-t and Wilcoxon tests were performed. The significance level was set at p<0.05.Results: Among 80 patients with acromegaly who underwent trans-sphenoid surgery with or without radiotherapy or medication therapy with somatostatin analogs, 52 (65%) entered the remission phase within 6 months. Associations were found between the remission phase and female gender (p=0.004) and lower growth hormone (GH) (p=0.04) but not between remission and lower insulin-like growth factor-I (IGF1) after surgery (p=0.02) or gonadal axis disorder after treatment (p<0.001) statistically. Moreover, a significant association was found between not being in the remission phase and gonadal axis disorder before treatment (p=0.04). The QoL score in all dimensions of the AcroQoL questionnaire increased 6 months after treatment (p<0.001). Total AcroQoL score was higher after treatment in the remission group (p=0.03). The psychological scale had a significantly higher score both on the total scale (p<0.001) and on the two subscales of appearance (p<0.001) and personal relationship (p=0.003).Conclusion: Because of the importance of QoL in acromegaly patients, further studies in this field are recommended

Prevalence of Cerebrospinal Fluid Rhinorrhea Following Trans-Sphenoidal Surgery for Pituitary Adenoma in Patients Referred to Loghman Hakim Hospital from 2016 to 2020

Background: Endoscopic endonasal transsphenoidal surgery is commonly used to remove pituitary adenomas. However, it can lead to cerebrospinal fluid (CSF) leakage, with an incidence of around 5% in sphenoid transnasal procedures and up to 20% in extended endonasal approaches. A retrospective study was conducted on 160 pituitary adenoma patients admitted to Loghman Hakim Hospital from 2016 to 2020 to evaluate the factors influencing CSF leak. Aim: The aim of this study was evaluating the occurrence of cerebrospinal fluid leakage and analyzing the factors involved. Methods: This is a retrospective analysis of patients diagnosed with pituitary adenoma at Loghman-Hakim hospital over a four-year period. Demographic information, tumor characteristics, surgical procedures, and complications were collected. All patients gave their consent, and the study was approved by the ethics committee. Surgical procedures were conducted using a direct endonasal trans-sphenoidal approach under general anesthesia, and antibiotics were given. Statistical analysis was conducted using SPSS to evaluate the relation between measured variables and the occurrence of CSF leak. Results: The study found that 19.4% of the patients developed CSF leak during their hospital stay. Age and body mass index (BMI) of patients with CSF leak significantly differed from those without. The size of the tumor did not differ significantly between patients with and without CSF leak. The only variable associated with CSF leak was sphenoid sinus anatomy. Conclusion: The study concluded that older patients with a lower BMI and a larger defect size are more prone to CSF leak, but no significant difference was found in tumor size between the groups with and without CSF leak. Sphenoid sinus anatomy correlated with CSF leak, while other factors did not show any correlation with the incidence of CSF leak

Normal Pressure Hydrocephalus Presentation with a Large Pseudomeningocele

Background and Importance: This interesting case is about the presence of normal pressure hydrocephalus and a large pseudomeningocele at the same time after 13 months of posterior fossa surgery. Although the occurrence of a pseudomeningocele following posterior fossa surgery is not so rare, such a late large pseudomeningocele development with signs and symptoms of NPH after 13 months of surgery is rather peculiar.   Case Presentation: A 59-year-old man referred to our clinic for a cerebellopontine angle tumor. The patient presented with right hearing loss and mild facial palsy. We operated the patient with retrosigmoid approach, and we discharged him after five days. After about 13 months, the patient referred to our center again with complaint of progressive bulging of previous surgical region and gait apraxia, urinary incontinence and dementia. A large pseudomeningocele in the site of previous surgery was seen. Conclusion: The authors presented a case report on late development (13 months) of a huge pseudomeningocele following vestibular schwannoma surgery with signs and symptoms of normal pressure hydrocephalus. Such a late big pseudomeningocele presentation with signs and symptoms of normal pressure hydrocephalus after posterior fossa surgery is peculiar

Isolated trochlear nerve schwannoma presenting with diplopia: A case report and literature review

Background: Trochlear nerve schwannoma is a very rare tumor encountered especially in patients without type 2 neurofibromatosis (NF2). Most of the time, this tumor is diagnosed intraoperatively. We describe a rare case of trochlear nerve schwannoma. Clinical Presentation: A 63-year-old male presented with generalized headache from 8 months earlier, without nausea and vomiting. The headache had worsened during the last months. Clinically, he suffered from transient diplopia. Magnetic resonance imaging (MRI) demonstrated a mass in the left ambient and interpeduncular cisterns that was compressing the midbrain and upper pons. The preoperative impression was of trigeminal schwannoma. However, intraoperatively, the tumor originated in the trochlear nerve. The mass was removed entirely via left suboccipital retrosigmoid approach. The histopathology diagnosis confirmed schwannoma. The patient's diplopia did not improve postoperatively. Conclusion: Trochlear nerve schwannoma is a rare type of schwannoma and in almost all of the cases is diagnosed intraoperatively. There are three types of trochlear nerve schwannoma according to the classification proposed for trigeminal schwannoma: cisternal type—confined to the precavernous segment of the trochlear nerve; cistocavernous type—invading the cavernous sinus and the retroclival and retropetrosal cistern; cavernous type—located in the middle cranial fossa on the cavernous or paracavernous segment of the fourth cranial nerves, with or without cavernous sinus invasion. The cisternal type was the most common type encountered in previous studies. The clinical signs and symptoms of trochlear nerve schwannoma are similar to the trigeminal schwannoma and should be considered in the differential diagnosis of trigeminal schwannoma

The Role of Anxiety and Cortisol in Outcomes of Patients With Covid-19

Introduction: The outbreak due to Coronavirus Disease 2019 (COVID-19) is n global public health emergency and challenges psychological resilience. The central nervous system, endocrine system, and immune system are complex interacting systems. Cortisol has been implicated as the cause of a wide range of mental and physical health disorders; however, the impact of cortisol on outcomes in patients with COVID-19 is not clear. Methods: The current study enrolled patients with COVID-19 (onset of disease within 7 days of the first symptom) to evaluate the serum concentration of cortisol and levels of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) to investigate a possible relationship between cortisol, depression, and anxiety levels and outcomes of patients with COVID-19.  Results: A total of 30 patients with COVID-19 were studied. The levels of cortisol and HADS score in patients who died of Covid-19 were significantly higher in comparison with surviving patients (P<0.017 and P<0.001 respectively). We also found that the HADS score was positively correlated with serum cortisol levels (r= 0.842, P=0.004).  Conclusion: Our findings showed that stress and anxiety are associated with patients’ outcomes. Psychological interventions can improve the mental health of vulnerable groups during the COVID-19 epidemic