Prepontine arachnoid cyst presenting with headache and diplopia: A case report study

Background:

Arachnoid cysts are found everywhere in cerebrospinal axis, most often in the middle cranial fossa. They are very rare in prepontine location.

Case Description:

In this study, we report a 26-year-old female presenting with a 3-month history of headache and diplopia. On physical examination, she had clinical manifestations of sixth cranial nerve palsy. Magnetic resonance imaging revealed a prepontine arachnoid cyst with extension into interpeduncular and suprasellar cisterns. Computed tomography scan demonstrated no evidence of hydrocephalus. The patient was treated surgically by endoscopic fenestration of the cyst with endonasal transsphenoidal approach. The cyst was opened to prepontine, interpeduncular, and suprasellar cisterns.

Conclusion:

Endoscopic endonasal fenestration of the cyst to adjacent cistern may be safe in prepontine arachnoid cysts with sellar and suprasellar extension; it may be effective and less invasive compare to transcranial approach.

Transplantation of adult monkey neural stem cells into a contusion spinal cord injury model in rhesus macaque monkeys

OBJECTIVE

Currently, cellular transplantation for spinal cord injuries (SCI) is the subject of numerous preclinical studies. Among the many cell types in the adult brain, there is a unique subpopulation of neural stem cells (NSC) that can self-renew and differentiate into neurons. The study aims, therefore, to explore the efficacy of adult monkey NSC (mNSC) in a primate SCI model.

MATERIALS AND METHODS

In this experimental study, isolated mNSCs were analyzed by flow cytometry, immunocytochemistry, and RT-PCR. Next, BrdU-labeled cells were transplanted into a SCI model. The SCI animal model was confirmed by magnetic resonance imaging (MRI) and histological analysis. Animals were clinically observed for 6 months.

RESULTS

Analysis confirmed homing of mNSCs into the injury site. Transplanted cells expressed neuronal markers (TubIII). Hind limb performance improved in trans- planted animals based on Tarlov's scale and our established behavioral tests for monkeys.

CONCLUSION

Our findings have indicated that mNSCs can facilitate recovery in contusion SCI models in rhesus macaque monkeys. Additional studies are necessary to determine the im- provement mechanisms after cell transplantation.

Surgical outcome of anterior decompression in cervical spondylotic myelopathy in patients with less cord derangement

AIM

CSM patients caused by osteophytic ridge or intervertebral disc herniation underwent anterior decompression and fusion were prospectively enrolled. The purpose was to elucidate the effects of decompression (anterior cervical discectomy and fusion) on myelopathic cord in milder cases, younger patients, and in short duration of the disease.

METHODS

Forty-three patients with CSM were examined comprising Cooper and mJOA scale before and after surgery and followed for 12 months.

RESULTS

Patients included in the study were 30 males and 13 females. The mean age of men was 50.9±13.2, and that of women was 46.8±11.8. The mean interval from symptoms onset to hospital presentation was 10.78±7.3 months. In lower limbs, among 31 with preoperative functional impairment, 25 remained unchanged, three improved and three worsened, which is not significant, and of 39 patients with preoperative upper limb functional impairments using Cooper's scale, 20 improved, 15 remained unchanged and 4 became worse (P=0.001). Recovery rate for mJOA score was 24.5±17.7%, for Cooper lower extremity score was 32.2±40.56% and for Cooper upper extremity score was 7.8±16.8%. The mean gain in mJOA was 0.84 (±0.57).

CONCLUSION

Patients with short duration of symptom onset respond remarkably to decompression surgery. In patients with good condition that myelopathy has not established yet, perhaps mJOA is not a perfect and powerful scale for pre and postoperative assessment of patient.

Transcranial approach for spontaneous CSF rhinorrhea due to Sternberg's canal intrasphenoidal meningoencephalocele: case report and review of the literature

One type of congenital intrasphenoidal meningoencephalocele is remnant of lateral craniopharyngeal (Sternberg's) canal. We present a case of a 23-year girl with 10-month history of right side CSF rhinorrhea. CT scan, MRI revealed congenital meningoencephalocele and CSF leak from middle fossa to right side of sphenoid sinus, and there were bony defects at the floor of the anterior aspect of the right middle fossa. Transcranial repair was performed with right side pterional craniotomy. Careful preoperative evaluation and localization of the sphenoid defect are essential for selection of the best possible surgical approach and skull base reconstruction for repair of sphenoid sinus CSF leaks and meningoencephaloceles. In this case, an endoscopic technique was not successful so, transcranial repair was performed with right side pterional craniotomy.

Neuroendoscopic foraminoplasty for bilateral idiopathic occlusion of foramina of Monro

We report the safety and efficacy of bilateral foraminoplasty of Monro in a patient with partial occlusion of right Monro and complete occlusion of the left one. A 38-year-old man who underwent a ventriculoperitoneal shunt three years ago, and shunt revision surgery twice, presented with hydrocephalus, and was referred to us because of continuing complaints of headaches, nausea and vomiting. The primary surgical treatment of the patient was bilateral endoscopic Monro foraminoplasty. Then, the patient did not need a ventriculoperitoneal shunt, and hydrocephalus was resolved. Bilateral monroplasty in a single-session surgery can be the treatment of choice, instead of microsurgically open reconstruction of the foramen of Monro. The procedure can be less invasive, and it avoids ventriculoperitoneal shunting.

Extension of echinococcal spinal infestation extra- and intradurally after a decade of extinction

Simultaneous intradural, extradural, vertebral and paravetebral invasion of hydatid cyst, pathologic fracture, and multiple vertebral involvement are all rare encountered conditions in echinococcal infestation. A 48-year-old man who had experienced a falling down trauma, 10 years ago, and at that time, because of L1 burst fracture, undergone on Harrington rod placement, admitted in our ward for newly started urinary retention and mild paresis of lower extremities. With imaging analysis and during surgery, we discovered the extension of echinococcal spinal infestation extra- and intradurally after a decade of extinction. We performed a double stage circumferential reconstruction and adjuvant long term chemotherapy. We closely monitor our patient neurologically and radiologically and believe that aggressive surgical treatment and sustained cyclical albendazole therapy can increase the quality of life and life expectancy.

Gunshot injuries to the brachial plexus during wartime

Gunshot injuries of the brachial plexus are a challenging issue among peripheral nerve lesions. Surgical reconstruction of such injuries is difficult and the clinical outcome depends on several factors. The aim of this study was to present the outcome of surgical management of gunshot injuries of the brachial plexus that occurred following Iran-Iraq war. Twenty patients with 55 injured elements of the brachial plexus underwent surgery in Loghman-Hakim Hospital during 1982 and 1992. Reconstructive procedures included neurolysis in 30 injured elements, nerve grafting in 17 and a combination of these two methods in 8 cases. Surgical procedure was selected based on the microscopic findings during the operation. Final recovery outcome was assessed at least 3 years after surgery on the basis of motor and sensory recoveries. Final outcome was defined as poor, intermediate, and good. Both good and intermediate outcomes were considered as useful recovery. An acceptable recovery was obtained in 28 of 30 (94%) injured elements undergone neurolysis, 15 of 17 (89%) elements in nerve graft group, and 7 of 8 (87.5%) elements reconstructed with neurolysis in combination with nerve graft. In neurolysis, good recovery was more frequent and obtained in 23 of 30 (77.5%) lesions. Best treatment outcome was observed in lesions of lateral cord to musculocutaneous nerve which all injured elements showed good recovery. Impairment in none of the lesions in the level of posterior cord and lower trunk or C8-T1 led to good recovery. In surgical reconstruction of gunshot injuries of the brachial plexus the most favorable results were observed in the neurolysis reconstruction of the lesions in the lateral cord to musculocutaneous nerve. In the absence of spontaneous improvement of neurologic deficit, surgical procedures should be done as soon as possible according to the type and location of injury.

Endoscopic third ventriculostomy for treatment of obstructive hydrocephalus

BACKGROUND

Endoscopic third ventriculostomy has become the preferred treatment for obstructive hydrocephalus. The purpose of this paper is to present our experience with ventriculostomy at our center.

METHODS

Twenty-four patients underwent ventriculostomy for the treatment of obstructive hydrocephalus between May 2000 and May 2006. The follow-up period lasted between one and 51 (median: four) months. The mean age of the patients was 31 (range: 0.5 - 67) years. It was determined that the obstructive hydrocephalus was caused by space-occupying lesions in nine patients (eight tumors and one with calcified arteriovenous malformation), aqueductal stenosis in 14 patients, and shunt infection and entrapped fourth ventricle in one patient. Kaplan-Meier survival analysis showed that the proportion of functioning ventriculostomies became stable at rates of 80% to 90% after the third postoperative month.

RESULTS

There was no statistically significant difference in the aqueductal stenosis and tumor subgroups (P=0.716). A high rate of functioning ventriculostomies was found in both subgroups: 12 of 14 in the aqueductal stenosis subgroup and eight of nine in the tumor subgroup. In cases of intraventricular tumors, in addition to ventriculostomy, biopsy was performed that successfully helped the patient management. In the present study, the procedure failed in three patients (13%). Ventriculostomy failures occurred within three months after the operation. The cases of treatment failure were one with aqueductal stenosis, one with Chiari I, and one with pineocytoma. There was no permanent morbidity after ventriculostomy in our patients.

CONCLUSION

The results indicated that ventriculostomy is an effective treatment in cases of obstructive hydrocephalus that is caused by aqueductal stenosis and space-occupying lesions. This procedure is worthy for controlling hydrocephalus without shunt and its complications. Early clinical picture after the operation plays an important role in predicting patient's outcome after endoscopic third ventriculostomy.