Microsurgical treatment of ophthalmic artery aneurysm, a case series of 55 patients with long-term follow-up.

BACKGROUND: Ophthalmic artery aneurysm (OAA) can be secured in endovascular or microsurgical approaches. Still there are controversies in technique selection and their long term outcomes. METHODS: All the patients with OAA were treated microsurgically and followed. Demographic data, neurological status, physical examination findings, angiographic data, operation details, and intraoperative and postoperative events were recorded and analyzed. P < 0.05 was considered significant. RESULTS: Among 55 patients, 38 were females (69.1%). Median preoperative glasgow coma scale (GCS), Fisher Grade, and Hunt and Hess(HH) scores were 15, 1 and 1, respectively. The most common neurologic manifestation was visual problems (n = 15). The most common anatomical projection was medial (43.6%) oriented lesions. 85.5% of them only had 1 ophthalmic aneurysm while multiple aneurysms were reported in 14.6%. In 52 patients temporary clip was used. in 21 patients (38.2%) intraoperative aneurysm rupture occurred. Larger aneurysm size and preoperative hydrocephalus were associated with higher rates of aneurysm rupture (P = 0.003 and 0.031). 28.5% of the patients with visual problems had clinical improvement in the postoperative period. The mean follow-up period was 5 years. Follow-up angiography showed a 100% obliteration rate with a 0.0% recurrence rate. Median values for follow-up glasgow outcome scale and modified Rankin scale were 5 and 0, respectively. favorable neurological outcomes were associated with better primary GCS and HH scores. CONCLUSION: OAA microsurgery is an effective and safe procedure with significant improvement in both visual and neurological status. Low recurrence rate and excellent clinical recovery are the most important advantages of microsurgery in OAA treatment.

Clinical Outcome of Pedicle-Sparing Transfacet Diskectomy and Fusion with Segmental Instrumentation for Thoracic Disc Herniation.

BACKGROUND: Thoracic disk herniations (TDHs) are relatively rare compared with their cervical and lumbar counterparts. Posterior approaches allow for a simpler and less invasive surgery than anterior and lateral approaches. A pedicle-sparing transfacet approach was initially described in 1995, and modified in 2010. A few clinical series have reported the outcome of this procedure in patients with TDH. This study aimed to evaluate the outcomes and complications of pedicle-sparing transfacet diskectomy with interbody fusion and segmental instrumentation in patients with TDH. METHODS: Twenty-one consecutive patients with symptomatic TDH referred to our tertiary care center were included in this retrospective study. All patients underwent a pedicle-sparing transfacet diskectomy with polyetheretherketone (PEEK) cage interbody fusion and short segmental instrumentation. Distribution of TDH, operative duration, blood loss, Visual Analog Scale (VAS) pain scores, Nurick grades, modified Japanese Orthopaedic Association (mJOA) scores, and fusion rate were assessed. RESULTS: All patients had single-level herniations. The most common location was T12-L1 (38.1%), followed by T11-T12 (33.3%). All patients were successfully operated on with no cerebrospinal fluid (CSF) leaks or wrong-level surgery. The VAS scores significantly diminished from 4.9 (preoperatively) to 2 (18 months after surgery). The average mJOA score increased from 4.6 to 8.5, and the average Nurick grade decreased from 3.1 to 1.6. All patients reported significant improvement in quality of life relative to their preoperative status. CONCLUSION: A modified pedicle-sparing transfacet diskectomy combined with PEEK cage interbody fusion and segmental instrumentation offers a safe and less invasive approach for the treatment of TDHs.

Spontaneous idiopathic spinal subdural hemorrhage in a 16-year-old boy: A rare case in pediatrics and review of literature.

Idiopathic spinal subdural hematoma (SSDH) is a rare phenomenon. Here, we present a 16-year-old-boy who presented with acute sudden onset weakness and brown squared syndrome; the cervical MRI findings showed acute subdural hematoma from C2 to C6. Emergent surgical intervention was performed, and significant improvement was seen in follow-ups.

Multilevel anterior cervical fusion with standalone cage or cage-and-plate after cervical discectomy: Benefits and drawbacks.

PURPOSE: Multilevel anterior cervical discectomy and fusion (ACDF), especially two-level ACDF, has been usually performed in the cervical degenerative disease, and the incidence rate of complications is controversial. This study aimed to compare the outcomes of ACDF approach with cage alone and with plate fixation in multilevel discectomy. METHODS: Patients who had undergone multilevel ACDF by the Smith-Robinson methods were included from 2018 to 2020. Data were collected using a questionnaire containing demographic characteristics, surgical complications, and outcome. All the patients were followed for 18 months post-surgery. Visual Analogue Scale (VAS), Neck Disability Index (NDI) and Nurick Grading scale were used to measure the pain degree, neck pain effect, and myelopathy grade, respectively. Bone fusion rate, subsidence and instrument failure were checked through radiography. Data were analyzed using SPSS, and the significant level was considered 0.05. RESULTS: 24 patients were included. There was no significant difference between the mean blood losses in the two groups. The rate of subsidence was much higher in group B after 18 months (60% vs 14.3%). As to the VAS score, NDI, and Nurick scale, trend change overtime was significantly improved in each group, but there was no significant difference between the groups. There was no significant difference between the two groups regarding bony fusion rate. DISCUSSION: ACDF with plate leads to a more prolonged surgery with no significant benefits. Stand-alone cage approach could be suggested as the gold standard for anterior cervical discectomy.

Simultaneous Increase in Serum Levels of IL-37 and IL-18 Binding Protein In Low-Grade and High-Grade Brain Tumors.

BACKGROUND: IL-18binding protein (IL-18BP) might play a role in tumor escape from immune surveillance through interacting with IL-37. Such interactions modulate the antitumor activity of IL-18 and affect regulatory T cell (Treg) function. However, the biological roles of IL-37 and IL-18BP have not yet been explored in brain tumors. This study aimed to investigate serum levels of IL-37 and IL-18BP in high-grade and low-grade brain tumors and determine their associations with pathological characteristics of the patients. SUBJECTS AND METHODS: This case-control study consisted of 60 patients with brain tumors (40 low-grade and 20 high-grade) and 30 healthy controls. Enzyme-linked immunosorbent assay (ELISA) kits were used to measure the levels of IL-37 and IL-18BP in serum. RESULTS: Our results indicated that serum levels of IL-37 and IL-18BP were significantly higher in patients with brain tumors (109.02, 426.37 pg/mL), high-grade (104.44, 428.87 pg/mL), and low-grade (113.88, 426.37 pg/mL) tumors in compared to healthy controls (35.03, 362.00 pg/mL), (P<0.05). Interestingly, our results revealed a significant positive correlation between IL-37 and IL-18BP serum levels in brain tumors (n=60, R=0.42, P=0.001). Our study also showed that serum levels of IL-37 and IL-18BP in glioblastoma grade IV were approximately similar to those in astrocytoma grade II, meningioma type I, and pituitary adenoma. Furthermore, no significant differences were found in serum levels of IL-37 and IL-18BP between patients with low-grade and high-grade tumors (P=0.24 and P=0.61, respectively). CONCLUSION: The simultaneous increase in IL-37 and IL-18BP serum levels and their positive correlation may facilitate disease progression in low-grade and high-grade brain tumors by inhibiting antitumor immune responses.

Evaluation of Serum Interleukin-1ß (IL-1ß) Levels in Patients with Intracranial Aneurysms Compared to a Control Group.

AIM: To examine the screening value of the serum level of interleukin-1ß (IL-1ß) in aneurysmal subarachnoid hemorrhage (SAH), and to evaluate its association with the severity of initial bleeding. MATERIAL AND METHODS: This case-control study was performed in Namazi Hospital, affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. The study population included patients referred to Namazi Hospital with a diagnosis of SAH, whose symptoms had emerged within less than 48 hours. The case group consisted of patients with cerebral aneurysms, who were divided into two groups of raptured and un-raptured brain aneurysms. This study examined the relationship between the serum IL-1ß levels and brain aneurysms. The number of samples was 43 per group and 86 in total. Forty-eight hours before the onset of symptoms and before surgery, a blood sample was collected to measure the IL-1Β antibody (anti-IL-1ß) level; in less than three hours, the serum was isolated and placed in a -80ºC freezer. RESULTS: In patients with unruptured aneurysms, the Fisher's grade was 0, while most ruptured aneurysms were grade 3. The middle cerebral artery (MCA) (n=10, 23%) was the most common site of aneurysm, followed by the anterior communicating artery (ACom) (n=9, 20%). There was a significant correlation between ruptured aneurysms and the Glasgow Comma Scale (GCS) score (p=0.01) and also Fisher's classification (p=0.04). Patients with ruptured and unruptured aneurysms showed no significant differences regarding the serum IL-1ß levels. A significant difference was found in the serum level of IL-1ß between the case and control groups (p=0.04). CONCLUSION: Generally, knowledge of the association between aneurysm development and inflammatory response can have significant clinical implications in the future. The present findings suggested a significant correlation between the IL-1ß levels and the outcomes of aneurysmal SAH, independent of initial hemorrhage.

Undetected pituitary adenoma in a patient with retinitis pigmentosa.

BACKGROUND: Retinitis pigmentosa (RP) is one of the most severe hereditary retinal disorders with a worldwide prevalence reaching 1 in every 3000-5000 people and a total of almost one million affected individuals. RP is heterogeneous in its clinical presentations but typically presents as progressive visual dysfunction, including nyctalopia in adolescence, restricted peripheral vision (tunnel vision) in young adults, and loss of central vision at an advanced age. CASE DESCRIPTION: Herein, we want to report a case of RP who presented with gradual worsening of vision and headache, and further evaluation revealed a concomitant non-functional pituitary macroadenoma. Ophthalmologic evaluation revealed a little chance for him to regain his vision, so the patient refused to undergo endoscopic surgical resection. However, he is still under clinic-radiologic follow-up, to be evaluated for progression in tumor size and obstructive hydrocephalus. CONCLUSION: Presenting with similar symptoms of tunnel vision, the simultaneous occurrence of these two diseases in a patient may delay the diagnosis of the latter, leading to its progression.

Sphenoid Aspergilloma with Headache and Acute Vision Loss.

BACKGROUND: Fungal infection is a rare pathology in the sphenoid sinus, and extension into the pituitary fossa with visual loss has only been described in a few reports in the literature. Following publication of a recent report of pituitary abscess by Candida glabrata, we describe our own experience with a similar pathology. CASE DESCRIPTION: In the present report, we overview a diabetic patient who sustained aspergilloma in his sphenoid sinus with extension to the pituitary fossa. Clinical presentations are discussed along with an emphasis on the role of endoscopic endonasal drainage of the abscess as the mainstay of treatment. Following administration of intravenous amphotericin B for 6 days, endoscopic drainage of the aspergillus abscess was done. Visual acuity improved immediately after the operation. At the 12-month follow-up visit, the improvement in visual acuity was maintained and magnetic resonance imaging showed no recurrence. CONCLUSION: Correction of the underlying immune deficiencies, administration of intravenous antifungal agents perioperatively, endoscopic endonasal drainage of abscess, and a meticulous debridement of necrotic material, followed by a course of oral antifungal medication, comprises the standard treatment protocol for a fungus ball (aspergilloma) of the sphenoid sinus.

Orbital Hydatid Cyst Causing Papilledema and Proptosis in an Adult.

Hydatid cyst is an infectious disease caused by Echinococcus granulosus, primarily involving the liver and lungs. The orbit is an extremely rare site for involvement with hydatid cyst. We present a 36-year-old man with unilateral visual loss, proptosis, and papilledema caused by an orbital hydatid cyst.