RESUMO
Drug-resistant epilepsy seems like a different disease compared with easy to control epilepsy, and new strategies are needed to help these patients. Vagus nerve stimulation (VNS) therapy is the most frequently used neurostimulation modality for patients with drug-resistant epilepsy who are not eligible for seizure surgery. In this study, we aimed to evaluate the efficacy and adverse effects of VNS in patients with drug-resistant epilepsy in an open-label, prospective, long-term study in Iran. We selected 48 patients with partial-onset drug-resistant epilepsy. Implantations were performed in the neurosurgery department of Loghman Hospital, Tehran, Iran. Follow-up visits were done on monthly bases for 5 years. Forty-four patients completed the study. Mean age of patients was 24.4 years. Mean years of epilepsy history was 14 years. The mean number of anti-epileptic drugs did not significantly change over five years (p = 0.15). There was no exacerbation of epilepsy; however, one patient discontinued his therapy due to unsatisfactory results. Five patient had more than 50 %, and 26 patients (59 %) had 25-49 % reduction in the frequency of monthly seizures persistently. Overall mean frequency of monthly seizures decreased by 57.8, 59.6, 65, 65.9, and 67 %, in 1st, 2nd, 3rd, 4th, and 5th years of follow-up, respectively. Most common side effects were as follows: hoarseness (25 %) and throat discomfort (10 %). We found VNS as a safe and effective therapy for drug-resistant epilepsy, with an approximate long-term decrease in mean seizure frequency of 57.8-67 %. Thus, VNS is recommended for suitable patients in developing countries.
Assuntos
Epilepsia Resistente a Medicamentos/terapia , Epilepsias Parciais/terapia , Estimulação do Nervo Vago/métodos , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Irã (Geográfico) , Masculino , Avaliação de Resultados em Cuidados de Saúde , Estimulação do Nervo Vago/efeitos adversos , Adulto JovemRESUMO
Pilocytic astrocytoma (PA) is the most common pediatric central nervous system glial neoplasm and the most common pediatric cerebellar tumor. The spontaneous regression that occurs after partial/subtotal resection is multifactorial, depending on multiple factors, as for the case of humoral and cell-mediated immune responses of the host to the implanted tumor. A 7-year-old boy was referred to a neurosurgery clinic with headache. Further imaging workup revealed hypothalamic PA. Partial resection of the lesions was performed with right-side pterional approach. The patient developed a severe panmucositis [Stevens-Johnson syndrome (SJS)] and respiratory failure plus conjunctivitis, due to phenytoin allergy. During the patient's 6-month follow-up, postoperative magnetic resonance imaging (MRI) revealed a residual tumor, and about 9 months later (at 15 months postoperatively), the MRI showed total regression of the tumor. Clinically, symptomatic PA may undergo spontaneous regression after partial resection. We report a well-documented case of spontaneous regression hypothalamic PA after partial resection that complicated with SJS. Immune system reaction in SJS may have a role in tumor behavior and spontaneous regression. Multiple studies confirmed spontaneous regression in PA after partial/subtotal resection. This phenomenon occurs due to humoral and cell-mediated host immune responses to the implanted tumor. The immune system reaction in SJS may have a role in tumor behavior and spontaneous regression.
Assuntos
Astrocitoma/cirurgia , Neoplasias Cerebelares/cirurgia , Síndrome de Stevens-Johnson/cirurgia , Astrocitoma/diagnóstico , Astrocitoma/patologia , Neoplasias Cerebelares/diagnóstico , Neoplasias Cerebelares/patologia , Criança , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Neoplasia Residual/cirurgia , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/patologia , Resultado do TratamentoRESUMO
The authors report an unusual case of intradural epidermoid tumour in a 19-year-old girl presenting with refractory complex partial seizures including auditory hallucinations, and memory dysfunction. A complete resection was carried out sparing the hippocampus resulting in seizure freedom.
Assuntos
Neoplasias Encefálicas/cirurgia , Epilepsia do Lobo Temporal/cirurgia , Alucinações/cirurgia , Hipocampo , Lobo Temporal , Adulto , Neoplasias Encefálicas/complicações , Constrição Patológica/complicações , Constrição Patológica/cirurgia , Eletroencefalografia , Epilepsia do Lobo Temporal/etiologia , Feminino , Alucinações/etiologia , Humanos , Monitorização Intraoperatória , Resultado do TratamentoRESUMO
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.
Assuntos
Plexo Braquial/lesões , Procedimentos Neurocirúrgicos/métodos , Guerra , Ferimentos por Arma de Fogo/cirurgia , Adolescente , Adulto , Plexo Braquial/cirurgia , Humanos , Irã (Geográfico) , Iraque , Masculino , Medicina Militar , Recuperação de Função Fisiológica , Resultado do Tratamento , Adulto JovemRESUMO
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.
Assuntos
Endoscopia/métodos , Hidrocefalia/terapia , Terceiro Ventrículo/cirurgia , Ventriculostomia/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-IdadeRESUMO
Acquired non-traumatic transethmoidal encephaloceles are very infrequent lesions that are generally caused by a tumor or hydrocephalus. As far as we know, there is no reported case of encephalocele after CSF diversion in the literature. We present a 25-year-old woman with hydrocephalus due to aquiductal stenosis who was treated with endoscopic third ventriculostomy. Nine months later, she had developed rhinorrhea and on imaging she had a transethmoidal encephalocele. She underwent endonasal endoscopic repair of the defect and removal of herniated parenchyma. CSF diversion to parasellar cisterns is not a known iatrogenic cause of basal encephalocele and is not noted elsewhere as a complication of third ventriculostomy. However, as third ventriculostomy is performed usually for intracranial hypertension treatment and intracranial hypertension itself is a known but rare cause of lacunar skull defect and encephalocele, this co-incidence may occur.
Assuntos
Aqueduto do Mesencéfalo/patologia , Encefalocele/etiologia , Seio Etmoidal/patologia , Hipertensão Intracraniana/complicações , Hipertensão Intracraniana/cirurgia , Complicações Pós-Operatórias/etiologia , Adulto , Vazamento de Líquido Cefalorraquidiano , Rinorreia de Líquido Cefalorraquidiano/etiologia , Constrição Patológica , Feminino , Humanos , Hidrocefalia/cirurgia , Terceiro Ventrículo/cirurgia , Resultado do Tratamento , VentriculostomiaRESUMO
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.
Assuntos
Rinorreia de Líquido Cefalorraquidiano/cirurgia , Fossa Craniana Média/cirurgia , Encefalocele/cirurgia , Meningocele/cirurgia , Procedimentos Neurocirúrgicos/métodos , Rinorreia de Líquido Cefalorraquidiano/etiologia , Encefalocele/complicações , Feminino , Humanos , Meningocele/complicações , Seio Esfenoidal/cirurgia , Adulto JovemRESUMO
Angiosarcoma is a rare tumor of bone that uncommonly involves the skull. Primary neoplasms of the skull represent 2.6% of primary neoplasms of bone. We wish to report a case of angiosarcoma of he skull in an 18-year-old pregnant woman who presented with a rapidly growing left frontotemporal mass. Neuroimaging revealed a left frontotemporal mass with destruction of diploic space and both tables and with extension to the subgaleal and epidural spaces. The patient underwent surgery and the tumor was removed totally. Histological features of angiosarcoma were seen in the pathology study. She received adjuvant chemotherapy and radiation therapy. She has remained well during 6 years of follow-up with no evidence of recurrence. Angiosarcoma is a rare malignant bone tumor of vascular origin. Our case is the only female patient with skull angiosarcoma that has been reported so far.
Assuntos
Hemangiossarcoma/patologia , Hemangiossarcoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Complicações Neoplásicas na Gravidez/patologia , Neoplasias Cranianas/patologia , Neoplasias Cranianas/cirurgia , Adolescente , Feminino , Humanos , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Gravidez , Complicações Neoplásicas na Gravidez/cirurgia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: Localization of superior sagittal sinus before craniotomy is very crucial to prevent the complications of surgery. The goal of this study was to verify the anatomical relationship between the sagittal suture and the superior sagittal sinus (SSS). METHODS: Fifty adult cadavers were included in this descriptive analytic study. The length of sagittal suture and the width of sagittal suture and SSS were measured in three points: (bregma), (lambda) and midpoint of sagittal suture. Anatomical relationship between SSS and sagittal suture was analyzed. RESULTS: Superior sagittal sinus was deviated to the right side of the sagittal suture in 54% of cases at bregma and 64% of cases at the midpoint of sagittal suture and lambda. SSS was located at the right side of sagittal suture about 3.5mm at bregma, 4.5mm at midpoint of sagittal suture and 5.7 mm at lambda. The right transverse sinus was dominant in 76% of cases. No gender-associated difference was noticed. CONCLUSION: Our study demonstrates that SSS is deviated to the right side of sagittal suture in the majority of cases. Maximum deviation of SSS to the right side is about 10mm. Neurosurgeons are advised to be aware of this anatomical relation while operating around SSS.