Recurrent delayed-onset cerebral vasospasm following ruptured ICA aneurysm: case report.

We report a unique case of late-onsetcerebral vasospasm at 21 and again at 30 days following aneurismal subarachnoid hemorrhage.

Unique case of successful surgical treatment of recurrent spinal epidural hematoma after lumbar disc surgery in a Glanzmann thrombasthenia patient.

We report a case of recurrent postoperative spinal hemorrhage after lumbar disc surgery in a Glanzmann thrombasthenia patient.

Management of chronic subdural hematoma: A study from Jordan.

Objectives: Chronic subdural hematoma (CSDH) is a common condition encountered in neurosurgical practice. Few studies have reported the characteristics of CSDH patients in the Middle Eastern population. We describe the clinical presentation, surgical management, radiological findings, and post-operative outcomes in our hospital. Methods: We performed a retrospective cohort study in King Abdullah University Hospital, Northern Jordan, between 2009 and 2019. Data were extracted from patients' medical records and analyzed in patients treated with burr hole drainage (BHD). Univariate analysis was performed to identify correlations with age, laterality, and recurrence. Results: A total of 172 CSDH patients were identified, of whom 128 (74.4%) were treated surgically. The mean age of patients treated with BHD (n = 108) was 60.9 years with a male-to-female ratio of 2.38:1. Headache was the most common presenting symptom (64.81%) and was significant in patients aged 41-64 years (p = 0.004), whereas muscle weakness and unsteady gait were significant in patients ≥ 65 years (p = 0.004 and p = 0.033, respectively). A higher pre-operative maximum thickness was associated with bilateral presentation (p = 0.001), whereas a higher pre-operative midline shift was associated with unilateral presentation (p = 0.027). Regarding CSDH recurrence, only a preoperative midline shift was significant (p = 0.021). Conclusion: Clinical presentation was affected by age, as patients < 65 years commonly presented with headaches, whereas those ≥ 65 years presented with limb weakness, speech impairment, unsteady gait, and altered consciousness. BHD was the most utilized surgical option with low mortality and complication rates. Recurrence was only associated with a pre-operative midline shift.

Isolated tectal cavernomas: A comprehensive literature review with a case presentation.

Intracranial cavernous angiomas or cavernomas (ICCs) are abnormal blood-filled vasculatures made of mono-endothelial layer and characterized by their bubble-like caverns. Brainstem cavernomas (BSCs) is a critical form of ICCs since slight changes in the lesion can result in devastating or life-threatening outcomes. We hereby present a rare case of BSC developed in the mesencephalic tectum with intraventricular bleeding and Parinaud's Syndrome. Our patient was managed by complete surgical resection of the lesion through an infra-tentorial supracerebellar approach. Additionally, we reviewed and analyzed the hitherto reported cases of isolated tectal cavernomas (TCs) in the literature, including our case, to elucidate the main factors associated with the management outcomes of TCs. There have been 25 cases of isolated TC reported until now. Most of the patients were adults between 18-77 y of age, except for two children (7 and 13 y). There was no sex predominance. Symptomatic patients presented with headache 56%, altered level of consciousness 24%, and/or double vision 20%. Most cases (64%) had hemorrhagic lesions at presentation, and 60% of all cases experienced recurrent hemorrhages. Parinaud's Syndrome was recorded in five cases, including the current one. All cases affected with Parinaud's were males. Lesion size was a determinant of the outcome as larger lesions were more likely to result in persistent deficits. Surgical resection of the lesion was an effective management modality with ∼79% (15/19) of patients who underwent surgery ended up with complete recovery.

Cervical decompressive laminectomy and lateral mass screw-rod arthrodesis: surgical experience and analytical review of 4120 consecutive screws.

BACKGROUND: Cervical decompressive laminectomy with lateral mass arthrodesis is a common neurosurgical procedure used to address a variety of cervical spine pathologies. PURPOSE: This study aimed to determine the safety and efficacy of this neurosurgical procedure using the Anderson-Sekhon technique for screw trajectory. METHODS: The study retrospectively reviewed all clinical and radiological indicators for patients who underwent lateral mass arthrodesis between December 2005 and December 2017. All patients underwent polyaxial screw-rod implants using the Anderson-Sekhon technique for screw trajectory. It additionally reported all intra- and post-operative complications, along with short- and long-term outcomes for these patients. The follow-up period ranged from 2 months to 10 years. RESULTS: The study evaluated 695 patients who received a total of 4120 lateral mass screws. This is considered the largest reported case series up to date. No patients had neuro-vascular injuries. The main complications included 51 (7.3%) cases of screw malposition, as when the screw had breached either of foramen transversarium, neural foramen, or the facet joint; 39 (5.6%) cases of lateral mass breakdown; 29 (4.2%) cases of C5 root pain which has subsided overtime; 22 (3.2%) of incidental durotomy; and 18 (2.6%) cases of postoperative wound infection. There were only 3 cases of screw pullout leading to a stability rate of 99.5%. Most cases demonstrated very good to excellent outcomes on both short- and long-term follow-up. CONCLUSIONS: Cervical decompressive laminectomy with lateral mass arthrodesis is a safe and effective technique for the management of different cervical spine pathologies, which results in favourable short- and long-term outcomes.

Morphometric Analysis of the Corpus Callosum According to Age and Sex in Middle Eastern Arabs: Racial Comparisons and Clinical Correlations to Autism Spectrum Disorder.

This study sought to examine the influence of age and sex on morphometric measurements of the corpus callosum (CC) within Middle Eastern Arab population, in order to obtain reference data and conduct racial comparisons with previously reported measurements from other ethnicities. Furthermore, it aimed to investigate CC variations that may occur in children with autism. To this end, magnetic resonance images of normal brains were acquired from three different age groups, consisting of children, younger adults, and older adults. Brain images were also acquired from boys with autism spectrum disorder (ASD). The CC length, area, and thickness were measured. The CC length was smaller in children than in the other age groups, but no difference in CC length was found between younger and older adults. The CC area and thickness were greater in younger adults than in children and older adults, and greater in older adults than in children. With regard to sexual dimorphism, the CC area and forebrain volume were larger in male children than in female children. No sex-related differences in CC area or thickness were found in adults. However, the ratio of CC area to the forebrain volume was greater in adult females than in males, owing to the smaller forebrain volume in females. The absolute length of the CC was greater in older adult males than in their female counterparts. In addition, significant differences in CC measurements were found in comparison to measurements obtained from other ethnicities. Lastly, significant reductions in CC area and thickness were found in boys with ASD compared to their neurotypical peers. In conclusion, age and sex significantly influence morphometric measurements of CC in Middle Eastern Arab population. This study points to the presence of racial differences in CC size. Finally, it reveals that children with ASD display a distinct reduction in CC size compared to neurotypical children of the same ethnicity.

Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus patients.

Distal catheter migration of a ventriculoperitoneal shunt (VPS) is a rare but serious complication. It is usually asymptomatic. However, it can be further complicated by the presence of co-infections, interruption of the shunt, and/or disturbances in penetrated organ function. In this report, we presented a case of spontaneous complete extrusion of the distal end of a VPS catheter through the intact abdominal wall in a 5-year-old boy with hydrocephalus. We also reviewed and analyzed the literature for similar cases of complete extrusion of the distal end of a VPS catheter, through an intact or a potential weakness in the body wall, in the last 20 years. From the reviewed literature, we did not observe any difference (p>0.05) in the incidence of this complication between cases with an intact or a potential weakness in the body wall.

Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus: A Comprehensive Analytical Review from an Anatomical Perspective.

There have been many reports on migration of the distal catheter of the ventriculoperitoneal shunt (VPS) since this phenomenon was recognized 50 years ago. However, there have been no attempts to analyze its different patterns or to assess these patterns in terms of potential risk to patients. We comprehensively reviewed all reports of distal VPS catheter migration indexed in PubMed and identified three different anatomical patterns of migration based on catheter extension and organs involved: (1) internal, when the catheter invades any viscus inside the thoracic, abdominal, or pelvic cavity; (2) external, when the catheter penetrates through the body wall either incompletely (subcutaneously) or completely (outside the body); and (3) compound, when the catheter penetrates a hollow viscus and protrudes through a pre-existing anatomical orifice. We also analyzed the association between each migration type and several key factors. External migration occurred mostly in infants. In contrast, internal migration occurred mostly in adults. A body wall weakness was not a risk factor for catheter protrusion. Shunt duration was a critical factor in the migration pattern, as most newly-replaced shunts tended to migrate externally. Clinicians must pay close attention to cases of large bowel perforation, since they were most often associated with intracranial infections. The organ involved in compound migration could determine the route of extrusion, as the bowel was involved in all trans-anal migrations and the stomach in most trans-oral cases. Clin. Anat. 30:821-830, 2017. © 2017Wiley Periodicals, Inc.

Glioblastoma and ABO blood groups: further evidence of an association between the distribution of blood group antigens and brain tumours.

BACKGROUND: Glioblastoma is a highly malignant brain tumour that usually leads to death. Several studies have reported a link between the distribution of ABO blood group antigens and a risk of developing specific types of cancer, although no consensus has been reached. This study aims to investigate the relationship between the distribution of ABO blood group antigens and the incidence of glioblastoma. MATERIALS AND METHODS: The study cohort consisted of 115 glioblastoma patients who were diagnosed at King Abdullah University Hospital, Jordan, between 2004 and 2015. Three different patient populations made up three control groups and these were selected from among patients at the same institution between 2014 and 2015 as follows: 3,847 healthy blood donors, 654 accidental trauma patients admitted to the Departments of Neurosurgery and Orthopaedics, and 230 age- and sex-matched control subjects recruited blindly from the Departments of Paediatrics and Internal Medicine. RESULTS: There was a significant association between the distribution of ABO blood group antigens and the incidence of glioblastoma. Post hoc residual analysis revealed that individuals with group A had a higher than expected chance of developing glioblastoma, while individuals with group O had a lower than expected chance. Furthermore, individuals with group A were found to be at a 1.62- to 2.28-fold increased risk of developing glioblastoma compared to individuals with group O. DISCUSSION: In the present study, we demonstrate that, in Jordan, individuals with group A have an increased risk of developing glioblastoma, while individuals with group O have a reduced risk. These findings suggest that the distribution of ABO blood group antigens is associated with a risk of brain tumours and may play an important role in their development. However, further clinical and experimental investigations are required to confirm this association.

Successful Management of a Unique Condition of Isolated Intracranial Mucormycosis in an Immunocompetent Child.

This report describes a unique case of isolated intracranial mucormycosis of a slowly progressive nature in a healthy immunocompetent child. A 4-year-old girl with a clear medical and surgical history presented with complaints of right side facial asymmetry and unsteady gait for a period of 10 months. Clinical and radiographic investigations revealed right-sided lower motor neuron facial palsy caused by an infiltrative lesion on the right cerebellopontine angle. Initial surgical debulking was performed, a biopsy was sent for histopathological examination, and a course of prophylactic antibiotic and antifungal drugs was prescribed. The pathological report confirmed the mucormycosis fungal infection, and intravenous amphotericin B was administered for 3 weeks. One month after admission, the patient left the hospital with complete recovery. Follow-ups after 4, 8 and 12 weeks revealed no sensory or motor neurological deficits. In conclusion, this is a unique case of mucormycosis with regard to the nature and location of the infection, along with the host being a healthy child. Initial surgical exploration is a very critical step in the early diagnosis and treatment of such rare conditions.

Cervical lateral mass screw-rod fixation: Surgical experience with 2500 consecutive screws, an analytical review, and long-term outcomes.

BACKGROUND: Posterior lateral mass screw-rod fixation is a common procedure in patients who undergo multilevel cervical spine laminectomy. It has been widely used in the last decade due to its ease of application and better biomechanical stability when compared with other techniques. However, the main risk remains the possibility of violating the spinal nerve root, vertebral artery, and/or facet joint. PURPOSE: This study reviews the short- and long-term outcomes of patients who underwent posterior cervical screw-rod stabilisation using the Anderson-Sekhon technique. It investigates the safety and reliability of this technique in one of the largest reported case series. METHODS: Both clinical and radiological indicators were retrospectively assessed in lateral mass fixation patients who were treated with the Anderson-Sekhon technique for screw insertion and trajectory. The sample included 430 patients with different cervical spine disorders who were treated with a total of 2500 lateral mass polyaxial screws from December 2005 until January 2014. Follow-up period ranged from 4 months to 8 years. No neural or vascular injury occurred. Twelve patients had wound infection, of whom 6 had deep infection. Twenty patients had C5 radicular pain that subsided over time; 2 required C5 screw modification; and another 3 required screw repositioning at different levels. Two patients had asymptomatic screw pull-out evident only on radiographs and required no treatment. Iatrogenic dural tear occurred in 12 patients with severe spondylosis, while CSF leakage from the tear was observed in 3 patients. Symptomatic adjacent segment disease was noted in 4 patients within the follow-up period and was treated with surveillance. CONCLUSION: Lateral mass screw-rod stabilisation using the Anderson-Sekhon technique can be applied safely and effectively for various cervical spine diseases, resulting in a low complication rate and favourable short- and long-term outcomes.

Utilization of multidisciplinary surgical techniques to successfully manage 20 brain abscesses in a child.

PURPOSE: This study describes a case of multiple brain abscesses in a four-year-old boy who presented with a history of fever and disorientation. METHODS: Medical investigations revealed severe leukocytosis and the presence of 20 hypodense lesions in the boy's cerebrum. Initial medical treatment included intravenous antibiotics, antiepileptics, and dexamethasone. The boy underwent five surgical interventions within a period of 5 weeks that included frameless stereotactic craniotomies for aspiration and resection of the abscesses. RESULTS: At the 3-month follow-up, the boy displayed no neurological deficits and no lesions were detected in his brain. CONCLUSIONS: This study reveals the importance of instituting a standardized protocol to determine the urgency of surgical intervention in cases of brain abscess so that surgical treatment can be applied in the appropriate time period. This case also shows that rewarding results can be obtained in treating brain abscesses in children when the proper treatment method is initiated in the appropriate amount of time.

Fresh onion juice enhanced copulatory behavior in male rats with and without paroxetine-induced sexual dysfunction.

Onion (Allium cepa) is one of the most commonly cultivated species of the family Liliaceae, and has long been used in dietary and therapeutic applications. Treatment with fresh onion juice has been reported to promote testosterone production in male rats. Testosterone is the male sex hormone responsible for enhancing sexual libido and potency. This study aimed to investigate the effects of onion juice on copulatory behavior of sexually potent male rats and in male rats with paroxetine-induced sexual dysfunction. Sexually experienced male rats were divided into seven groups: a control group, three onion juice-treated groups, a paroxetine-treated group, and two groups treated with paroxetine plus different doses of onion juice. At the end of the treatments, sexual behavior parameters and testosterone levels were measured and compared among the groups. Administration of onion juice significantly reduced mount frequency and latency and increased the copulatory efficacy of potent male rats. In addition, administration of onion juice attenuated the prolonged ejaculatory latency period induced by paroxetine and increased the percentage of ejaculating rats. Serum testosterone levels increased significantly by onion juice administration. However, a significant reduction in testosterone because of paroxetine therapy was observed. This reduction was restored to normal levels by administration of onion juice. This study conclusively demonstrates that fresh onion juice improves copulatory behavior in sexually potent male rats and in those with paroxetine-induced sexual dysfunction by increasing serum testosterone levels.