Surgical Outcome of Pediatric Posterior Fossa Tumors in Shiraz, Southern Iran: A Brief Report.

Posterior fossa tumors (PFTs) are prevalent in children, and about half of all childhood brain tumors arise from the structures of the posterior fossa. Studies on PFTs in Iranian children have mainly focused on epidemiological characteristics. This study aimed to evaluate surgical outcomes and predictive factors for survival in children with PFTs in Shiraz, Iran. A prospective cohort study was conducted from March 2014 to September 2019 in Namazi Hospital affiliated with Shiraz University of Medical Sciences (Shiraz, Iran). A total of 87 pediatric patients under the age of 16 who were diagnosed with PFT and had undergone surgery were recruited. The children were followed up for postoperative outcomes such as mortality and neurological complications. Data were analyzed using SPSS software (version 20.0) and R software (version 3.3.1). P<0.05 was considered statistically significant. The mean age of the patients was 6.49±4.14 years and 64.4% were male. Sixteen patients were lost to follow-up, 31 died after surgery, and 40 were in remission during phone calls. The median survival time of the patients was four years. The most common type of PFT was medulloblastoma (n=46, 53%). The result of the multivariate Cox proportional hazards model showed that age (P=0.034) was correlated with postoperative survival, hazard ratio 0.90 (95% confidence interval 0.82 to 0.99). Among various predictive factors, lower age was associated with poor outcomes in pediatric children with PFTs.

Traumatic Cervical Vertical Translational Injury: A Case Report.

Traumatic cervical translational injury is a notably rare and highly unstable subtype of type C sub-axial cervical spine injury with high morbidity and mortality rates. Hereby, we report a 41-years-old man who was a case of multiple trauma due to car rollover. He was completely conscious, complaining of cervical pain, with a GCS score of 15/15. His neurological examination was unremarkable. The cervical CT scan revealed a vertical translation at the C6-C7 level (roughly 11 mm) and bilateral facet joint diastases which are highly unstable injuries. A two-stage combined anterior and posterior fixation operation was performed. First, an anterior cervical discectomy and fusion with autologous graft and plate fixation, and then a posterior approach with lateral mass screw fixation was performed. Disruption of the anterior longitudinal ligament, annulus fibrosis, facet capsules, and severe strain of ligamentum flavum was noted intraoperatively. He had no early and late complications within 2 years of follow-up.

Multiple Brain Abscesses by an Air Gun Shot: A Case Report

Introduction Low-velocity penetrating brain injury is not prevalent. In some conditions such as childhood, and with the penetration of a pellet in weak spots of skull, low-velocity penetrating brain injury is expected; however, high-velocity projectiles have also been reported as the cause of severe brain injuries. One of the complications of penetrating brain injury is infection, in which different types ofmicroorganisms play a role. The Streptococcus genus is the leading cause of abscess formation in nontraumatic patients. Multiple brain abscesses are not common. Case Presentation A 10-year-old boy with penetrating brain injury caused by an air gun pellet, who developed signs and symptoms of high intracranial pressure 18 days after the trauma. After the imaging scans and the detection of multiple brain abscesses and severe brain edema, prompt surgical intervention was performed for all three lesions in a single operation. The culture of a pus specimen was positive for Streptococcus species, and, with adequate antibiotic therapy, the patient was discharged from the hospital in good condition. Conclusion Brain injurywith air gun shot is not prevalent. The penetration of a low-velocity air gun pellet in weak points of the skull (such as the orbit, the squamous portion of the temporal bone, and the cranial suture), specially in children, can cause significant brain injuries.

An Unusual Dermoid Cyst of the Pineal Region: Case Report in a Child

Introduction The pineal gland is a common location for intracranial germ cells, but dermoids are not commonly observed in this area. In the present paper, we discuss the clinical and radiological features as well as the treatment and outcome of this cyst in a 6-year- old child with a pineal dermoid cyst. Case Presentation The patient presented with chronic headache 6 months before admission in 2018. On the first admission, an enhanced lesion with a small cyst was detected in brain imaging. Magnetic resonance imaging (MRI) of the brain at follow-up (2 months after the first presentation) showed enlargement of the cyst size with compression on the adjacent structures. Radical excision of the tumor was performed after the endoscopic biopsy due to pressure exerted on the adjacent structures. Conclusion Dermoid cyst should be considered as a differential diagnosis for enhanced lesions of the pineal region.

Surgical Management of Adult Traumatic Atlantoaxial Rotatory Subluxation with Unilateral Locked Facet; Case Report and Literature Review.

Atlantoaxial rotatory subluxation (AARS) is rarely occurred in adults with trauma as the most common cause. In type A and B it is usually managed with close reduction and external brace; however, in nonresponsive cases, surgical interventions might be needed. Our patient is a 21-year-old man with neck pain and torticollis after a car turn- over. There was C1-C2 rotatory subluxation with left side locked facet and C1 rotation about 40 degrees relative to C2 on computed tomography without evident of ligamentous injury in magnetic resonance imaging (MRI). However, during the first 48 hours, two tries of close reduction using Gardner cervical traction under fluoroscopy were failed. Thus, the patient underwent open reduction of the subluxation and atlantoaxial fixation (Harm's technique) with subsequent relief of pain and torticollis. This a rare case of traumatic AARS type A with unilateral locked facet joint in an adult patient which needed surgical manipulation for reduction. The management of the AARS in adults should be individualized in each patient.

Dumbbell-Shape Hydatid Cyst of Meckel Cave Extending to Cerebellopontine Angle and Middle Fossa; Surgical Technique and Outcome of Rare Case.

BACKGROUND: Cerebral hydatid cyst is among the rare presentations of echinococcosis. Almost all the reported cases of intracranial hydatid cysts are in the cortical regions (parietal lobe in the territory of the middle cerebral artery), and all have been removed surgically using the water jet dissection technique. However, in locations in which there are several neuronal structures, such as the cerebellopontine angle, this method might not be applicable. CASE DESCRIPTION: A 62-year-old lady presented to our outpatient clinic with left-sided facial deviation, inability to close the eyes, and diplopia since a month before. She was diagnosed with having a dumbbell-shape lesion in the Meckel cave extending to the left cerebellopontine angle and middle fossa just lateral to the cavernous sinus. As it was adherent to the surrounding structures, we evacuated the contents using a fine needle and then dissected the cyst totally. The patient's symptoms alleviated after the surgery, and there was no residue. After the 2-year follow-up, our patient does not have recurrence. CONCLUSIONS: The Meckel cave and cerebellopontine angle are rare locations for hydatid cysts, and the surgical technique is different due to adhesion of the cyst to several neuronal structures (lower cranial nerve, brainstem, and cerebellum). Needle aspiration along with dissection of the cyst microsurgically is recommended in similar cases.