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Ambulatory Endoscopic Lumbar Foraminotomy for Spinal Stenosis During COVID-19 Pandemic: A 27-Patient Case Series of Transpedicular Approach Under Sedation
Carlos Sajama,
Gustavo Zomosa,
Gonzalo Suarez,
Mario Castillo,
Gino La Rosa,
Pedro Vergara
Issue:
Volume 6, Issue 2, December 2022
Pages:
32-37
Received:
1 June 2022
Accepted:
30 June 2022
Published:
20 July 2022
DOI:
10.11648/j.ijn.20220602.11
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Abstract: Background: To demonstrate the safety of the endoscopic lumbar foraminotomy for spinal stenosis and to study clinical outcomes. During the COVID-19 Pandemic there was a lack of beds for elective surgeries that we solved starting to develop ambulatory endoscopic lumbar foraminotomy for foraminostenosis under sedation. Methods: Retrospectively we study 27 patients with foraminostenosis who were operated endoscopically under sedation since October 2020 to October 2021 in our hospital, by a single senior neurosurgeon. Demographics variables and hospital stay times were reviewed. Each patient’s functioning was assessed using the Oswestry Disability Index (ODI) and the visual analog scale (VAS) score for leg pain. Postoperatively, patients were evaluated at 1 month and 1 year. Results: In twenty-seven patients we performed endoscopic foraminotomies under sedation. Eleven were females (40,7%). The average hospital stay time was 6 hours, there was a statistically significant reduction of the preop, post op and final VAS and preop, post op and final ODI. Like the PREOVAS data, POSTOVAS and FVAS do not have normal distribution, a non-parametric ANOVA is performed, obtaining KW = 73.26, p < 0.0001, then, there are statistically significant differences between these three variables. For the variables PREODI, POSTODI and FODI, since they are not normal, a non-parametric ANOVA is performed, obtaining KW = 59.03, p < 0.0001, then, there are statistically significant differences between these three variables. To make comparisons between the VAS and ODI variables, use the Mann Whitney non-parametric method to compare if there is a difference between the medians of the different groups and there is a statistically significant difference between the variables compared with p < 0.0001 in all cases. A Cluster analysis was also made and for elderly patients the reduction of ODI was bigger than the young ones. Conclusions: The authors recommended ambulatory endoscopic lumbar foraminotomy for electives patients when there is a lack of beds in hospital for prolonged stays. There were statistically significant reductions of VAS and ODI score preoperative to post operative with a maximum of 8 hours between the admission to the discharge.
Abstract: Background: To demonstrate the safety of the endoscopic lumbar foraminotomy for spinal stenosis and to study clinical outcomes. During the COVID-19 Pandemic there was a lack of beds for elective surgeries that we solved starting to develop ambulatory endoscopic lumbar foraminotomy for foraminostenosis under sedation. Methods: Retrospectively we stu...
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Brain Metastasis of Ovarian Cancer: Report four Cases and Review the Literature
Pawendtaoré Esdras Zongo,
Tarik Chekrine,
Asmaa El Kebir,
Mouna Bourhafour,
Zineb Bouchbika,
Nadia Benchakroun,
Hassan Jouhadi,
Mehdi Karkouri,
Abdelhakim Lakhdar,
Abdelatif Benider,
Souha Sahraoui,
Nezha Tawfiq
Issue:
Volume 6, Issue 2, December 2022
Pages:
38-43
Received:
18 July 2022
Accepted:
4 August 2022
Published:
10 August 2022
DOI:
10.11648/j.ijn.20220602.12
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Abstract: Objective: The objective of this manuscript is to present different cases of brain metastasis of ovarian cancer. These cases were managed by a multimodal treatment. Materials and methods: To present the clinical characteristics, the imaging, the anatomopathological and immunohistochemical data, and the multimodal treatment (surgery, chemotherapy, in toto brain radiotherapy, and stereotactic radiotherapy) of brain metastases of ovarian cancers. Results: Patients aged 48, 49, 57, and 62 years followed since 2018 and 2019 for clear cell carcinoma of the ovary, high-grade serous adenocarcinoma diagnosed by anatomy pathology and immunohistochemistry examination. They were treated with Paclitaxel carboplatin chemotherapy with the clinical, biological, and radiological response (evaluated according to RECIST criteria); then total surgery. Fifteen, thirty-seven, and nine months after the totalization surgery, the patients presented a confirmed cerebral metastatic relapse. This cerebral relapse was treated by surgical removal of the metastases and by either total brain radiotherapy or stereotactic radiotherapy followed by chemotherapy. Post-radiotherapy chemotherapy was performed with anti-VEGF (bevacizumab) at 14, 29, 31, and 17 months after the radiotherapy sessions. Conclusion: Brain metastases from ovarian cancer are rare. Of late onset, the management requires a multimodal treatment, with chemotherapy, surgery, and radiotherapy either total brain or by stereotaxis.
Abstract: Objective: The objective of this manuscript is to present different cases of brain metastasis of ovarian cancer. These cases were managed by a multimodal treatment. Materials and methods: To present the clinical characteristics, the imaging, the anatomopathological and immunohistochemical data, and the multimodal treatment (surgery, chemotherapy, i...
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Surgical Treatment of Endometriosis in the Lumbar Spine
Rodrigues Jr José Carlos,
Bortholin da Silva Vithor Ely,
Batista de Sousa Aldimar,
Aguillar Condori Luís Alberto
Issue:
Volume 6, Issue 2, December 2022
Pages:
44-47
Received:
16 July 2022
Accepted:
11 August 2022
Published:
24 August 2022
DOI:
10.11648/j.ijn.20220602.13
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Abstract: Introduction: Endometriosis consists of the presence of endometrial tissue outside the uterus most often in the pelvic peritoneum, ovaries, and rectovaginal septum. It can present with low back pain and radiculopathy, being its presentation within the spinal canal very rare. This paper reports the case of a patient with endometriosis within the spinal canal who presented with chronic low back pain that evolves to sciatica, showing its rarity and relevance as a differential diagnosis of low back pain. Case Report: A 32 years old, female patient, search attendance complaining of low back pain that started 1 year ago. Her pain was in the left S1 territory and had worsening in a cyclical manner. Magnetic resonance [MR] of the lumbosacral region demonstrated small nodular epidural lesion at the S1 level, with well-defined limits, located along the posterior contour of the vertebral body of S1, determining discrete local bone remodeling and bone marrow edema in this topography. With these features, patient was submitted to surgical treatment. The capsule of the cyst was removed and send to pathology examination. Pathology examination revealed endometriosis with focal stroma in fibroconnective tissue with old hemorrhage. With all of this in mind, we can affirm that the case we present is very rare, with few similar publications, and that’s highlight its originality. Conclusion: As illustrated by our case, spine surgeons must be aware of this pathology. Treatment options depend on the patient's symptoms and planning for pregnancy, with total removal of endometrial tissue being the ideal treatment targeted by the neurosurgeon.
Abstract: Introduction: Endometriosis consists of the presence of endometrial tissue outside the uterus most often in the pelvic peritoneum, ovaries, and rectovaginal septum. It can present with low back pain and radiculopathy, being its presentation within the spinal canal very rare. This paper reports the case of a patient with endometriosis within the spi...
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Thoracic Spinal Arachnoid Cyst Causing Neuropathic Arthropathy of the Elbow
Adam Alayli,
Jonah Gordon,
Khaled Abdelghany,
Gavin Lockard,
Anthony Urbisci,
Gautam Rao,
Nam Tran
Issue:
Volume 6, Issue 2, December 2022
Pages:
48-51
Received:
19 August 2022
Accepted:
13 September 2022
Published:
27 September 2022
DOI:
10.11648/j.ijn.20220602.14
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Abstract: Neuropathic arthropathy (NA), or Charcot arthropathy, involves rapid degeneration and instability of a joint caused by hypesthesia. This condition is commonly caused by diabetes, while syringomyelia and arachnoid granulations are rare causes of NA. We report a 50-year old male who presents with progressive numbness to his arms, weakness to his right hand and mass to the right elbow. A diagnosis of neuropathic arthropathy of the elbow was made after MRI of the cervical and thoracic spine revealed a compressive thoracic arachnoid granulation causing cervical syringomyelia. We highlight the importance of a thorough workup including key imaging characteristics that resulted in the diagnosis. Thoracic surgical decompression successfully restored CSF flow and reduced the cervical syringomyelia. The patient remained neurologically stable at the most recent follow-up, although no known treatment halts disease progression once NA has developed.
Abstract: Neuropathic arthropathy (NA), or Charcot arthropathy, involves rapid degeneration and instability of a joint caused by hypesthesia. This condition is commonly caused by diabetes, while syringomyelia and arachnoid granulations are rare causes of NA. We report a 50-year old male who presents with progressive numbness to his arms, weakness to his righ...
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Lumber Disc Herniation - An Unusual Aetiology of Acute Painless Synchronous Foot Drop
Mohamed Awad Mohamed Hassan,
Majed Saleh Alanazi,
Amjad Abdulkader Ahmad Darwish,
Abdulhafeez Osman Eltoum Mohamed,
Salah Hani Sharif,
Saggaf Alawi Assaggaf
Issue:
Volume 6, Issue 2, December 2022
Pages:
52-55
Received:
11 September 2022
Accepted:
22 September 2022
Published:
29 September 2022
DOI:
10.11648/j.ijn.20220602.15
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Abstract: Background and importance: Acute bilateral painless foot drop is a common symptom of various diagnoses and consider a red flag sign for a serious pathology in the central or peripheral nervous system including cerebral, spinal, and peripheral causes. Therefore, medical history and careful clinical examination are often used in the neurotopographic classification. Acute painless bilateral Foot drop (FD) is an uncommon initial manifestation of nerve root compression secondary to acute lumbar disc herniation not associated with low back pain and radiculopathy. In most patients with lumber disc herniation, FD is unilateral and is associated with low back pain and leg pain. Few cases have been described as bilateral FD, occurring simultaneously. Chronic bilateral foot drop as a sequela of systemic illnesses has been well-studied; however, acute painless bilateral foot drops not associated with radiculopathy or back pain in a healthy person should be immediately investigated, cauda equina syndrome is not necessarily to be associated with acute bilateral foot drop as shown in our case here. This study highlights the unusual presentation of lumber disc prolapse and illustrates the importance of palsy duration, early diagnosis, and time to surgery as predicting factors for improvement. The author presents bilateral acute foot drop case associated with lumbar discopathy without back pain, radiculopathy, or cauda equina symptoms as an unusual initial manifestation of lumbar discopathy. The current study aimed to provide insight on the lumbar acute painless etiology of bilateral FD in a patient without radiculopathy and back pain to prevent functional loss. Moreover, it emphasized the rare initial manifestations of lumbar disc prolapse and the importance of predictive factors of improvement such as palsy duration, early diagnosis, and time to surgery. To illustrate work-up for bilateral foot drop in acute setting presentation. A systematic review was conducted using PubMed and google scholar. Demographic and radiological data were obtained from a painless acute bilateral foot drop presented to our neurosurgery unit. We reviewed the patient demographics, clinical presentation, radiological parameters, surgical parameters, and time from presentation to surgery. In addition, preoperative, early postoperative, and most recent follow-up neurological examinations were compared. Our patient improved gradually after the surgery, on the first postoperative day, we obtained an MMT (Manual Muscle Test) Scoring < 3 on admission, and third day postoperative MMT Scoring of 3. After six weeks, the last follow-up had an MMT Score of 5 for both ankles.
Abstract: Background and importance: Acute bilateral painless foot drop is a common symptom of various diagnoses and consider a red flag sign for a serious pathology in the central or peripheral nervous system including cerebral, spinal, and peripheral causes. Therefore, medical history and careful clinical examination are often used in the neurotopographic ...
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The Roof of the Labyrinthine Facial Nerve Canal and the Geniculate Ganglion Fossa on High-Resolution Computed Tomography: Dehiscence, Thickness and Pneumatization
Fondjo Teu’Mbou Sa’Deu,
Zunon-Kipre Yvan Jacques-Olivier Toualy,
Kakou Konan Medard,
Veillon Francis,
Nchufor Roland,
Motah Mathieu
Issue:
Volume 6, Issue 2, December 2022
Pages:
56-66
Received:
23 August 2022
Accepted:
5 September 2022
Published:
11 October 2022
DOI:
10.11648/j.ijn.20220602.16
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Abstract: The labyrinthine segment of facial nerve canal and the geniculate ganglion fossa are two important landmarks in the middle cranial approach for acoustic neuromas removal. Their roof is drilled during this approach. The aim of the study was to appreciate the roof of these two structures on high-resolution computed tomography. To achieve this purpose, we used computed tomography examinations of 194 healthy adult petrous bones, selected within a period of one year. They represented 97 subjects with a mean age of 49.3 years. The computed tomography machines were Siemens® "SOMATOM Definition AS + Fast Care", 128 slices. The appreciated variable were t he presence or absence of a dehiscence, the thickness of the bone (mm), and the pneumatization of the bone (presence of aerated cells in the bone) or not (dense bone with total absence of aerated cells). We determined for each of these variables, the mean (mm), the standard deviation, the ranges (minimum, maximum). The paired Student’s t-test was used to compare the means of the variables according to gender (male-female), and side (right-left). We obtained the following results for the roof of the labyrinthine facial canal: all the canals (100%) were covered, 104 cases (53.6%) were pneumatized. The mean thickness of the bone was 3.86 mm ± 2.06, ranges 0.22 - 9.95 mm. Without male-female difference (p = 0.99 and p = 0.30), nor right-left difference (p = 0.07). For the geniculate ganglion fossa, 62 cases (31.96%) were dehiscent. One hundred and eight cases (81.81%) of the 132 covered cases were pneumatized. The mean thickness of the bone was 3.01 mm ± 1.87, ranges 0.36 - 9.12 mm. There was no male-female (p = 0.68 and p = 0.94) or left-right difference (p = 0.49). Our results therefore lead us to conclude that osseous covering of the geniculate ganglion is more prone to dehiscence and pneumatization than that of the labyrinthine facial canal, and thus presents more risks during surgery because of its fragility. So, we think that the bony covering should be studied for every patient in the event of middle fossa approach.
Abstract: The labyrinthine segment of facial nerve canal and the geniculate ganglion fossa are two important landmarks in the middle cranial approach for acoustic neuromas removal. Their roof is drilled during this approach. The aim of the study was to appreciate the roof of these two structures on high-resolution computed tomography. To achieve this purpose...
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Outcomes of Surgical Decompression Approaches in Patients with Lumbar Spinal Stenosis: Conventional VS Minimal Invasive VS Addition of Fixation
Ahmed Nagaty,
Hesham Radwan,
Mohamed Helmy Abd Elshafouk,
Ahmad Elsabaa
Issue:
Volume 6, Issue 2, December 2022
Pages:
67-76
Received:
7 September 2022
Accepted:
26 September 2022
Published:
11 October 2022
DOI:
10.11648/j.ijn.20220602.17
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Abstract: Background: Lumbar spinal stenosis is one of the commonest causes of patients’ disability due to degenerative disorders. Surgery have been found to be a more effective in relieve of patients’ symptoms and improvement of physical disability after failure of conservative management for 6 months. A variety of surgical techniques are available for management of this condition. We present our experience with conventional laminectomy, decompressive laminectomy with fixation and microscopic laminotomy via unilateral approach as 3 different surgical options regarding patients’ outcomes and complications. Methods: This is a retrospective study of patients with lumbar spinal stenosis operated in our institute in the period from January 2018 to December 2019. We included 69 adult patients and were subdivided into 3 groups according to the intervention done, either Lumbar decompression and fixation (group A) or conventional laminectomy (group B) or microscopic decompression (group C). Postoperative Disability changes via ODI, Back pain and leg pain via VAS were compared in the three groups. Results: Patient’s pain and disability significantly improved in all patients of the 3 groups. There was no significant difference in patients’ leg pain improvement compared in the 3 groups. Patients in the fixation group had significant back pain improvement (median improvement of 6) in comparison to both other groups (median improvement of 3 and 3). Patients in fixation groups had more amount of blood loss (median of 200 ml) and longer operative time (median of 180 minutes) compared to both other groups however this was not statistically significant. Conclusion: Conventional decompressive laminectomy with or without fixation and microscopic decompression would provide sufficient pain and disability improvement for patients with lumbar spinal stenosis. Further research is recommended to conclude evidence in favor of specific surgical technique. We suggest a significant improvement in postoperative back pain for patients with lumbar spinal stenosis receiving decompression and fixation in comparison to those who receive conventional laminectomy or microscopic decompressive laminotomy.
Abstract: Background: Lumbar spinal stenosis is one of the commonest causes of patients’ disability due to degenerative disorders. Surgery have been found to be a more effective in relieve of patients’ symptoms and improvement of physical disability after failure of conservative management for 6 months. A variety of surgical techniques are available for mana...
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Efficacy of Posterior Cervical Laminectomy and Fixation Technique Using High Speed Drill in Cervical Myelopathy
Ahmed Nagaty,
Ahmad Elsabaa,
Mohamed Helmy Abd Elshafouk
Issue:
Volume 6, Issue 2, December 2022
Pages:
77-83
Received:
7 September 2022
Accepted:
26 September 2022
Published:
11 October 2022
DOI:
10.11648/j.ijn.20220602.18
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Abstract: This study aims to assess the efficacy and accuracy of a technique for posterior cervical decompression and fixation using high speed drill for posterior laminectomy and anatomical lateral mass screws placement. Background: Posterior cervical decompression through laminectomy is a well-known approach for surgical management of multiple levels cervical spondylosis with myelopathy, and ossification of the posterior longitudinal ligament (OPLL). Posterior decompression with lateral mass fixation helps to improve the clinical symptoms of those patients, in addition to improvement of their cervical curvature and range of motion. Methods: This is a retrospective study conducted from February 2019 to January 2021 included 30 patients with cervical myelopathy that underwent multiple levels posterior cervical laminectomy and lateral mass fixation using high speed drill. The primary outcomes measured in our study were Visual Analog Score (VAS) of neck pain and upper limbs pain, Japanese Orthopedic Association (JOA) score for assessment of cervical myelopathy for all those patients with comparison of preoperative and postoperative values up to 12 months after surgery. Secondary parameters assessed were perioperative complications, duration of surgical procedures, operative blood loss and hospital stay. Results: The included 30 patients in our study were 18 males (60%) and 12 females (40%), with mean age of 65.77 ± 5.056 years. Laminectomy and anatomical lateral mass screws placement using high speed drill approach showed average operative time of 119.83 ± 13.676 minutes, and minimal blood loss with mean 95.83 ± 14.389 ml. As regards VAS, our results showed marked improvement of postoperative VAS of neck pain 2.53 ± 0.73 and postoperative VAS of upper limbs 1.73 ± 0.828 at 12 months follow up in comparison to preoperative VAS values of neck pain 6.17 ± 1.51 and upper limbs 9.03 ± 0.85 with highly significant statistical difference value (P 0.001). In addition, there was significant improvement of Postoperative JOA score 15.06 ± 1.36 in comparison to preoperative values 9.56 ± 1.43, also with highly significant statistical difference (P 0.001). Conclusion: Posterior cervical decompression and fixation using high speed drill for Laminectomy and Anatomical lateral mass screws placement is an effective method for management of cases of cervical myelopathy with Favorable outcomes observed at 12 month follow up, with optimum operative time and minimal blood loss. However, a multicenter comparative study with long term follow-up is highly recommended.
Abstract: This study aims to assess the efficacy and accuracy of a technique for posterior cervical decompression and fixation using high speed drill for posterior laminectomy and anatomical lateral mass screws placement. Background: Posterior cervical decompression through laminectomy is a well-known approach for surgical management of multiple levels cervi...
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Pituitary Metastases Experience in a Neurosurgical Oncology Cohort
Sebastian Rubino,
Katherine Kunigelis,
John Lynes,
Solmaz Sahebjam,
Krupal Patel,
Andre Beer-Furlan,
James Liu,
Michael Vogelbaum,
Arnold Etame,
John Arrington,
Nam Tran
Issue:
Volume 6, Issue 2, December 2022
Pages:
84-89
Received:
19 August 2022
Accepted:
4 October 2022
Published:
21 October 2022
DOI:
10.11648/j.ijn.20220602.19
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Abstract: Previously reported prevalence of pituitary metastases ranges from 0.4-5%. This study’s primary objective is to determine the incidence of pituitary metastases among patients presenting for neurosurgical evaluation with abnormal pituitary imaging findings, and secondarily to report our outcomes. We conducted a single-center, retrospective chart review of patients undergoing neurosurgical evaluation for sellar/suprasellar masses from 2008-2020. Demographic data, presenting symptoms, radiographic features, interventions, and outcomes were analyzed. 78 charts were reviewed; 21 patients (26.9%) had history of prior cancer, and 12 patients (15.4%) were diagnosed with pituitary metastases using pathologic and/or MRI criteria. Of the 21 patients with prior cancer diagnosis, 52.4% were diagnosed with pituitary metastases: 28.6% using MRI criteria and 23.8% using pathologic criteria. Average age of patients with metastases was 61.8 years. Tumor pathology consisted of 33.3% breast, 33.3% lung, 8.3% esophageal, 8.3% renal, 8.3% neuroendocrine and 8.3% melanoma. Pituitary metastasis diagnosis led to one patient’s initial cancer diagnosis. Symptoms at diagnosis included 33.3% headaches, 41.7% endocrinopathies, and 25% visual deficits. Treatment included surgical intervention plus radiation in 41.7%, surgery alone in 8.3%, radiation alone in 25%, and observation alone in 25%. Median follow-up, progression-free-survival, and overall survival was 8.8 months, 4.5 months, and 11.5 months, respectively. Incidence of pituitary metastases in our cohort is higher than previously reported in the general population. Given these findings, there may be a role for early excisional biopsy or resection of sellar/suprasellar lesions in cancer patients, as confirmation of CNS metastatic disease may require targeted brain radiation and/or alteration of systemic therapy.
Abstract: Previously reported prevalence of pituitary metastases ranges from 0.4-5%. This study’s primary objective is to determine the incidence of pituitary metastases among patients presenting for neurosurgical evaluation with abnormal pituitary imaging findings, and secondarily to report our outcomes. We conducted a single-center, retrospective chart rev...
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Dermoid Cyst of the Anterior Fontanelle: A Case Report and Literature Review
Sanou Abdoulaye,
Ouattara Ousmane,
Comboigo Somnéré Louis Junior,
Sabourin Justo Luis Delis,
Haro Yakouba,
Zoungrana Inoussa,
Zabsonre Denléwendé Sylvain,
Kabre Abel
Issue:
Volume 6, Issue 2, December 2022
Pages:
90-93
Received:
23 September 2022
Accepted:
11 October 2022
Published:
21 October 2022
DOI:
10.11648/j.ijn.20220602.20
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Abstract: Background: Dermoid cysts are benign congenital lesions that usually appear on the surface of the skull mainly at the anterior fontanelle. They develop from abnormal sequestration and inclusion of the surface ectoderm along the lines of skin fusion during embryologic development. They are rare lesions and characterized by the presence of hair follicles, sweat glands, and sebaceous glands. It is described predominantly in children. Besides physical evaluation, diagnostic imaging such as ultrasonography, computer tomography or magnetic resonance imaging are necessary to correctly analyse these lesions. Here, we report a case about dermoid cyst of the anterior fontanelle which was managed successfully by surgery. Case information: We describe a case of a 7-years-old male, who was admitted to the neurosurgery department of Yalgado Ouedraogo teaching Hospital for a scalp swelling evolving since birth. The swelling increased in size progressively but was not painful. Computed tomography of the head revealed extracranial cystic lesion over the bregma with no intracranial extension. Cyst was excised completely with no postoperative complications. On histopathology, it was dermoid cyst. Conclusion: Few cases of bregmatic dermoid cysts of the scalp have been reported in the literature. The present paper analyses a case of dermoid cyst of the anterior fontanelle in a child and reviews the available literature. It is important to remember that theses lesions must be diagnosed and treated early by neurosurgeons in the view of varied differential diagnosis and to avoid more extensive surgeries.
Abstract: Background: Dermoid cysts are benign congenital lesions that usually appear on the surface of the skull mainly at the anterior fontanelle. They develop from abnormal sequestration and inclusion of the surface ectoderm along the lines of skin fusion during embryologic development. They are rare lesions and characterized by the presence of hair folli...
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Surgical Outcome of Expansile Duraplasty VS Multiple Dural Slits in Patients with Traumatic Acute Sub-Dural Hematoma in Terms of Glasgow Outcome Scale (GOS)
Nafees Ahmad Khan,
Syed Arif Hussain,
Umer Sajjad,
Ghayur Abbas,
Sajid Nazeer Bhatti
Issue:
Volume 6, Issue 2, December 2022
Pages:
94-98
Received:
8 August 2022
Accepted:
12 October 2022
Published:
29 October 2022
DOI:
10.11648/j.ijn.20220602.21
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Abstract: Objective: To compare the post-operative Glasgow Outcome Scale (GOS) of expansile duraplasty vs multiple dural slits in patients with traumatic Acute Sub Dural Hematoma. Duration: 20.11.2019 to 19.05.2002 (6months). Setting: Department of Neurosurgery, PIMS, Islamabad. Subject and Methods: The study design was a randomized control trial. A total of 70 patients presented to our department with traumatic brain injury (acute subdural hematoma) divided into two groups through the lottery method and meeting our inclusion criteria were enrolled through the nonprobability consecutive sampling technique. Results: Out of 70 patients, Group A (wide dural wide flap and duraplasty) was found in 15 (42.86%) patients, while Group B (multiple dural slits) was found in 04 (11.43%) patients (p-value=0.003).Conclusion: This study concluded that favorable outcome is better in such cases who underwent expansile duraplasty in patients with traumatic acute sub dural hematoma as compared to patients who underwent multiple dural slits in traumatic acute sub dural hematoma. Therefore, we recommend that expansile duraplasty should be used as a prime technique in patients with traumatic acute sub dural hematoma for favorable outcome in terms of Glasgow Outcome and to reduce the overall morbidity and mortality of our general population presented with traumatic brain injury (traumatic acute sub dural hematoma).
Abstract: Objective: To compare the post-operative Glasgow Outcome Scale (GOS) of expansile duraplasty vs multiple dural slits in patients with traumatic Acute Sub Dural Hematoma. Duration: 20.11.2019 to 19.05.2002 (6months). Setting: Department of Neurosurgery, PIMS, Islamabad. Subject and Methods: The study design was a randomized control trial. A total of...
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Epidemiology of Pituitary Adenomas Operated at the University Hospital Center Yalgado Ouedraogo
Yameogo Wendlasida Serge Pacome Arnauld,
Zabsonre Denlewende Sylvain,
Biogo Wend Toin Joseph,
Kabre Abel
Issue:
Volume 6, Issue 2, December 2022
Pages:
99-103
Received:
11 October 2022
Accepted:
29 October 2022
Published:
10 November 2022
DOI:
10.11648/j.ijn.20220602.22
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Abstract: Background: Pituitary adenomas are benign tumors whose incidence and/or prevalence are difficult to assess in the general population. Our objective was to determine the epidemiological data of pituitary adenomas from hospital data. Methods: A cross-sectional study (01 January 2006-31 December 2018) was carried out in the department of neurosurgery of the university hospital center-Yalgado OUEDRAOGO. Patients operated for a pituitary adenoma and having a medical record and anatomopathological confirmation were included in the study. Data were entered and processed using EXCEL 2013 software and Stata13 software. Fischer's exact test was used. A P-value <0.05 was considered a statistically significant difference. Results: The average annual number of patients was 3.92. The average age was 44.55 years. It was found a female and male predominance respectively before and after the age of 40 years. The pituitary adenoma was non-functional in 34 patients including 24 men. The pituitary adenoma was functional in 17 cases including 14 women. Immunostaining was positive at 1, 2 and 3 hormonal axis (es) in 17 cases, 4 cases and 1 case respectively. It was negative in 3 cases. Conclusions: The frequency of pituitary adenomas increases with age in men and vice versa in women. Nonfunctional and functional pituitary adenomas are common in men and women, respectively.
Abstract: Background: Pituitary adenomas are benign tumors whose incidence and/or prevalence are difficult to assess in the general population. Our objective was to determine the epidemiological data of pituitary adenomas from hospital data. Methods: A cross-sectional study (01 January 2006-31 December 2018) was carried out in the department of neurosurgery ...
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Transforaminal Endoscopic L5–S1 Discectomy Case Series One Year Experience
Mohammed Helmy,
Mohamed Nossier,
Ahmed Hassan Abou-Zeid,
Mahmoud Massoud,
Ahmed Maamoun Ashour
Issue:
Volume 6, Issue 2, December 2022
Pages:
104-109
Received:
2 November 2022
Accepted:
16 November 2022
Published:
29 November 2022
DOI:
10.11648/j.ijn.20220602.23
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Abstract: With recent advances in minimally invasive surgery, full endoscopic discectomy has been more involved, not only the interlaminar approach but also the transforaminal. Transforaminal endoscopic surgery (TFES) can decompress the nerve root with less insult to surrounding soft tissues compared to interlaminar or open approaches, resulting in less postoperative pain, reduced length of stay, and early return to work. We reviewed retrospectively the clinical presentation of 20 patients with symptomatic L5-S1 disc prolapse with unilateral radicular pain whom underwent Transforaminal endoscopic surgery (TFES). Clinical and satisfactory outcomes were assessed using the visual pain analogue scale (VAS), Oswestry disability index (ODI) at follow up period 6 months postoperative. This study included 20 patients 14 males (70%) and 6 females (30%) Male to female ratio was 2.3: 1 with a mean age of 42.38 years ± 13.1 (range 25- 58 years). The preoperative mean VAS scores for radicular pain significantly decreased from 8.1± 14 to 2.8± 1.1 at 6 months follow-up (p = 0.0034). There was significant difference in VAS scores for back pain (5.7± 2.1) preoperatively to 1.9± 2 (p=0.02). ODI decreased from 57±2.5 to 11±10.5. Average length of stay was 1-3 days (1±0.5). TFES can be done for herniated L5-S1 discs bypassing the iliac crest barrier, by using an appropriate suprailiac trajectory and tailoring the entry point based on the patient’s body mass index guided by fluoroscopy.
Abstract: With recent advances in minimally invasive surgery, full endoscopic discectomy has been more involved, not only the interlaminar approach but also the transforaminal. Transforaminal endoscopic surgery (TFES) can decompress the nerve root with less insult to surrounding soft tissues compared to interlaminar or open approaches, resulting in less post...
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