Pretrigeminal Neuralgia: An Overlap Between Neurosurgery and Dentistry

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Complications of Halo Vest Orthosis: A Narrative Study

Background and Aim: Perry and Nickel introduced the halo vest in 1959. It is the most common immobilization device for the unstable cervical spine. In the literature review, most articles review the beneficial effects of the halo vest, and a few report its complications. This study aims to evaluate the complications associated with halo orthosis. Methods and Materials/Patients: This is a narrative study about halo vest complications. To provide up-to-date information, we reviewed the articles written about halo complications. All relevant articles were retrieved from Google Scholar, Medline, PubMed, etc., using the keywords of “halo vest orthosis”, “unstable cervical spine fracture”, “halo vest complications”, “halo vest immobilization”, “pin-site-related complications”, and “vest-related complications”. Afterward, we reviewed and critically analyzed the articles. Results: At first, the halo vest was used for postoperative paralyzed poliomyelitis patients, and later, it was also used for traumatic injury of the cervical spine or postoperatively in cervical spine reconstructive surgery. Compared to other orthoses, the halo vest provides a more effective external fixation and maintains normal anatomic alignment of the cervical spine without impacting jaw motion and resulting in eating problems. However, it has many temporary complications. To prevent halo vest complications, experienced people should apply it, and the patients should be regularly followed up for early detection and treatment of complications. Conclusion: Our review is the starting point for the evaluation and investigation of halo vest complications. Because of the high incidence of pin loosening and infection, it is better to evaluate the design and application of halo pin. Since the initial design of the halo vest, only its superstructure has been redesigned without any significant change in other parts of it.

Incidence and Outcomes of Acute Lung Injury in Patients With Isolated Traumatic Brain Injury

Background and Aim: Traumatic Brain Injury (TBI) is an essential cause of morbidity and mortality worldwide. TBI patients frequently encounter lung complications, such as Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS), which is associated with poor clinical outcome because hypoxia causes additional injury to the brain. This study aimed to evaluate the frequency of ALI in patients with TBI and its consequences. Methods and Materials/Patients: In this descriptive cross-sectional study, data from all records of patients admitted to Poursina Hospital’s ICU (emergency and neurosurgery ICU) in 20 18-2019 were used. The evaluated data included age, gender, type of head trauma mechanism, kind of brain injury based on CT scan findings, the severity of brain injury based on Glasgow Coma Scale (GCS), underlying diseases, mean head AIS score, the number of pack cell units injected, as well as bilateral pulmonary infiltration in favor of ALI and brain injury. Results: Only 81 of the 557 TBI cases met the inclusion criteria of the present study. The highest frequency of ALI following TBI was observed on the first day of hospitalization, in men (0.41%) in the age group of 40-50 years (7%) with severe brain damage (6%) and subdural hematoma (12%), following a motorcycle accident, cars, as well as on the third day of hospitalization were seen in men (43.8%) with the age group of 20-30 years (55%) with severe brain damage (42%) and intra-parenchymal bleeding (57%), following a motorcycle accident. In addition, no significant correlation was detected between the incidence of ALI and mortality, the duration of hospitalization, GCS, mean head AIS score, or the extent of received blood units in our study. Conclusion: According to the obtained findings, men aged between 20 and 30 years with severe cerebral injury, epidural hematoma and a motorcycle accident presented the highest rate of progression toward ALI in the first to third days of hospitalization.

Third Ventricle Anaplastic Oligodendroglioma: A Case Report

Background and Importance: Anaplastic Oligodendroglioma (ODG) constitutes 24% of all pediatric ODG. The mean age of presentation of ODG is 12±6 years. They are most common in frontal and temporal lobes; however, rare cases of intraventricular ODGs are reported. Most commonly they arise from the anterior part of lateral ventricles. Third ventricle ODG is extremely rare and only a few cases of lateral and third ventricle anaplastic ODG are reported. ODGs infiltrate locally to meninges and rarely have leptomeningeal spread. Thus, ODG forms a differential diagnosis of pediatric intraventricular tumor. Case Presentation: Here we present a case of a 15-month-old male child with raised intracranial pressure due to obstructive hydrocephalus. The patient was detected to be COVID-19 RT–PCR (Reverse Transcriptase Polymerase Chain Reaction) positive in the preoperative period and underwent emergency Right-sided Ventriculo Peritoneal (VP) shunt. His contrast MRI (Magnetic Resonance Imaging) Brain showed a 50×24×39 mm heterogeneously enhancing mass epicenter at third ventricle and extending to lateral and fourth ventricle with spinal drop metastasis. Preoperative differential diagnosis of Ependymoma was made and definitive surgery was done once the child recovered from COVID-19. However, his biopsy specimen pathology and Immunohistochemistry (IHC) were suggestive of anaplastic oligodendrogliomas and the child responded well to chemotherapy. Conclusion: Intraventricular ODG is an extremely rare pediatric tumor. Patients usually present with obstructive hydrocephalus. Contrast MRI findings are nonspecific and help in detecting leptomeningeal spread to the spine. IHC and chromosomal analysis are important diagnostic and treatment prognostication tools. These tumors have a high recurrence and poor prognosis despite gross total resection.

Retained Lumbar Intradiscal Surgical Knife Blade Retrieved Via Extended Extraforaminal Approach: Case Report and Review

Background and Importance: During a lumbar discectomy, the surgical knife might be broken and embedded deeply within the disc space. In some cases, it may be impossible to remove the broken blade during the initial surgery despite allocating several hours for this purpose. This fact may justify a subsequent surgical session. However, the eventual retrieval of the broken scalpel during a second surgical encounter can likewise be a very daunting challenge. Case Presantation: An L4-L5 discectomy in a young boy was complicated by the presence of an intradiscal broken surgical knife blade. The broken blade was successfully retrieved in a subsequent surgical session via the extended extraforaminal approach. Conclusion: The occurrence of an intradiscal retained broken scalpel has been rarely discussed within medical literature. There exist a wide variety of different approaches used for such a needed retrieval. The extended extraforaminal corridor has yet to be described within the context of medical journalism.

Post-traumatic Cervical Spondyloptosis Without Neurological Deficits: A Case Report

Background and Importance: Traumatic cervical spondyloptosis is a rare and severe situation, i.e., associated with disabling neurological deficits. Case Presentation: We described an unusual clinical presentation of cervical spondyloptosis in a 49-year-old man without neurological impairment and severe neck pain. Moreover, C6-C7 spondyloptosis was assessed two days after the trauma. X-rays, Computed Tomography (CT) scans and Magnetic Resonance Imaging (MRI) demonstrated a C6 bi-pedicular fracture, C6-C7 facet dislocation with complete ptosis of C6 vertebral body over C7 and without spinal cord injury. The patient was managed with an intra-operative 4 Kg traction and underwent a posterior decompression, with reduced fracture/dislocation by bilateral completed facetectomies at C6, and fusion from C4 to T3. Conclusion: This case report emphasized that sometimes cervical spondyloptosis may occur without neurological deficit symptoms. Prompt clinical recognition and surgical removal are essential to prevent serious complications in this respect.

Multifocal Intradural Extramedullary Anaplastic Ependymoma With Intracranial Involvement at Presentation: A Case Report

Background and Importance: Ependymomas are a rare malignant neoplasm. Multifocal intradural extramedullary anaplastic ependymomas are even more of a rare entity with much of the current knowledge derived from case reports. We presented a case of a multifocal intradural extramedullary anaplastic ependymoma with intracranial involvement at presentation. Case Presentation: A 53-year-old male presented with urinary symptoms. Magnetic resonance imaging revealed two lesions along the spinal cord and two lesions, intracranially. Histopathological examination was consistent with the World Health Organization grade III anaplastic ependymoma. The patient was treated with the gross total resections of spinal cord lesions, followed by radiation therapy to the resection cavities and intracranial lesions. At the 10-month follow-up visit, he reported almost complete resolution of symptoms, and magnetic resonance imaging revealed no recurrence. Conclusion: Despite their rarity, ependymomas should be considered as the differential diagnosis when evaluating spinal tumors. Gross total resection followed by targeted radiotherapy appears to be an effective treatment modality for high-grade lesions.

Chondrosarcoma of Cranial Vault: Case Report and Review of Literature

Background and Importance: Chondrosarcoma is a rare malignant cartilage forming tumor, usually arising from long bones and rarely observed in the cranium. In the cranium, it commonly arises from the skull base with the skull vault being a highly unusual site. Case Presentation: We present the case of a 30-year female presenting with complaints of headache for 6 months. The patient was found to have large chondrosarcoma in the right frontoparietal region, which is an extremely rare location. The final diagnosis was based on histological examination, suggestive of well-differentiated chondrosarcoma [the World Health Organization (WHO); grade I]. Conclusion: Cranial vault chondrosarcoma is an uncommon histological diagnosis with surgery as the primary treatment option; however, adjuvant radiotherapy plays a definitive role, especially in aggressive or incomplete removed cases.

Spontaneous Intracranial Hypotension – Not Always Benign

Background and Aim: Spontaneous Intracranial Hypotension (SIH) is a rare cause of headaches. It commonly presents with newly-developed persistent postural headaches and resolves with conservative treatment but rarely becomes a life-threatening disease. We retrospectively reviewed all cases of SIH patients treated in our institution for over ten years. Their clinical and radiological findings and the treatment given were analyzed. Their outcomes were assessed at a minimum of one year of follow-up. Materials and Methods: We retrospectively reviewed all cases of SIH patients treated in our institution over ten years. Clinicoradiological aspects, as well as the treatment given, were analyzed. The outcome was assessed at a minimum of one year of follow-up. Results: Six cases of SIH were studied. The Mean±SD age of the study population was 41.6±2.87 years. Four cases (66%) were female. The most common symptom was orthostatic headache which was present in all of them. The Mean±SD duration of symptoms before the diagnosis of SIH was 3±1.78 months. Four cases were managed conservatively, while one patient was managed with surgery and the other with epidural patch repair. The exact site of the leak could be delineated in 2 cases (33%). Two patients who were managed invasively for Cerebrospinal Fluid (CSF) the leak had a subdural hematoma. All patients had a favorable outcome at one year of follow-up. Conclusion: Prompt and early identification of changes in symptom pattern and the onset of subdural hematoma are essential markers of shifting to definitive management rather than continuing conservative measures. Subdural hematoma, secondary to SIH, warrants evacuation if it causes clinical deterioration.

Psychological Interventions in Chronic Low Back Pain: A Systematic Review

Background and Aim: Chronic low Back Pain (CLBP) is one of the most common musculoskeletal disorders with possible psychological consequences for the patients. This study aimed to review all evidence on the effectiveness of psychological interventions in improving the mental status of people with CLBP and providing recommendations for future therapeutic interventions. Methods and Materials/Patients: This systematic review was conducted on the articles published from January 2010 to December 2020. The keywords included “psychology”, “intervention”, “low back pain”, “chronic disease”, “quality of life”, “empowerment”, “psychotherapy”, “psychological interventions”, “clinical trials”, and “randomized clinical trials” in the indexing databases of Magiran, PubMed, Scopus, and Google Scholar. Of the total 1740 articles found, 14 articles were selected for review. Results: The results showed that Cognitive-Behavioral Therapy (CBT) and its combination therapies with mindfulness techniques played an influential role in improving psychological status and quality of life, and reducing pain perception in CLBP patients. The lack of RCT (randomized controlled trial) research and follow-up to assess long-term outcomes are the main limitations of the studies conducted in Iran. Conclusion: It is recommended that psychological interventions be considered alongside medical therapies to improve CLBP patients’ adjustment to chronic condition and their quality of life. Researchers and therapists should consider treatment programs based on RCT plans and long-term follow-up.