Review Article

Functional neurosurgery And Neuro-cognitive Rehabilitation

Afsaneh Zarghi

International Clinical Neuroscience Journal, Vol. 1 No. 2 (2014), 25 November 2014, Page 43-47

Cognitive rehabilitation is a group of designed techniques that is for the promotion of cognitive domains in people with disease or disability. Cognitive rehabilitation therapy (CRT) is the science of restoring cognitive processing and learning compensatory strategies and it affects the molecular and cellular recovery rehabilitation by integration of behavioral and cognitive changes. The promotion of rehabilitation science of cognitive neuroscience has made it a priority by the help of full range of effected interventional procedures. It has been able to achieve the desired goals in the chain of theoretical and experimental science on the basis of behavioral interventions which is made of neuroscience, cognitive neuroscience, psychology, physiology, pharmacology, medical imaging, and other medical disciplines and achieved some success in compensatory and medical strategies after surgery. Cognitive impairment after brain surgery is huge health challenges beyond the common disorders associated with diseases. Our approach to CRT is on the assumption that treatment would be the most effective way when focusing on the cognitive sub-systems after neurosurgery and these are also affected by other aspects of life as a patient emotions, nutrition, health, stress, and social performance. Intervention in the passive skills can lead to neuro-cognitive rehabilitation that includes designed experience on the basis of nerve and brain function and structure. A failure of cognitive or brain processing during or after surgery is an abnormal result and these impairments are treated better with CRT. This method is on the basis of neuroplastisity, reorganization of damaged cortical through morphological and physiological responses of nerve reconstruction ways by techniques in neuro-cognitive disorders due to illness, injury or disability, even in healthy individuals which are affected by environment, the complexity of stimulation, repeated tasks and motivation.

Original / Research Article

Surgery outcomes and functionality in patients with cervical spondylotic myelopathy

Parisa Azimi, Sohrab Shahzadi, Hassan Reza Mohammadi, Pooyan Alizadeh, Andia Shahzadi

International Clinical Neuroscience Journal, Vol. 1 No. 2 (2014), 25 November 2014, Page 48-50

Purpose: This study investigated functionality statues and surgical outcome of patients with cervical spondylotic myelopathy (CSM) contains cervical herniated disc (CHD) and cervical spinal stenosis (CSS) based on the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ).

Methods: This was a prospective clinical study a sample of cases with CSM. Patient’s functionality statues and surgical outcome were evaluated based on JOACMEQ scores at two points in time: pre- and postoperative assessments.

Results: In all 87 patients were completed the JOACMEQ measure. The mean age of patients was 50.3 (SD=10.2) years. The mean clinical follow-up was 12 months (range 7-37 months). Statistically difference between was observed pre- and postoperative indicating improvements on the outcomes and functionality in all subscales (P < 0.001). However, there was no significant difference between patients with CSM and CHD.

Conclusion: The findings suggest that surgery is an efficacious procedure for the treatment of CSM and the functionality statues as measured by the JOACMEQ are higher than prior to surgery.

The CT-Based Patient Specific Hip Joint 3D-Modeling; Potential to Correct the Alignment

Amirhossein Saveh, Ali Reza Zali, Hamidreza Haghighatkhah, Morteza Sanei Taheri, Seyed Morteza Kazemi, Mahmoud Chizari, Kazuyoshi Gammada

International Clinical Neuroscience Journal, Vol. 1 No. 2 (2014), 25 November 2014, Page 51-54

Background: The salvage proximal femoral osteotomy is performed in mild or moderate osteoarthritis when the articulating surfaces are normal and relieves the subject’s pain. Because the importance of angular mal-alignment of the femur bone at the hip junction accurate pre-op planning based on patient specific anatomy is required to prevent any lower limb misalignment and joint problem pre-operative.

Methods: In this study a CT-Based modeling technique was used to generate a 3D model of the patient’s hip and proximal femur. The registration stage using angio-fluoroscopy was performed to calculate the proximal femur kinematic and input it into a finite element model to achieve the stress distribution pattern of femuroacetabular joint.

Results:From finite element model the stress distribution on the articulating surface at the contact zone was analyzed. The result was showing the maximum stress of 1.1 MPa at the contact surface where femur contact the acetabulum. The maximum stress is found in line with mechanical loading of the lower limb.

Conclusion: Use of a non-invasive 3D modeling method will remediate the surgical approach in pre-op stage. The in-vivo modeling and assessment of the patient femoroacetabular contact has performed. It has been shown that the accuracy of the proposed model is comparable with the existing surgical pre-op planning.

Purpose: This study was conducted to assess cognitive impairments, depression, anxiety and quality of life among patients with brain tumor and healthy adults, comparatively.

Methods: A cross-sectional study was administrated on 84 brain tumor patients and 84 healthy adults measured by the mini mental state examination, Beck, Hamilton and SF36 questionnaires before and after 10 days of surgery.

Results: This study showed that cognitive impairment, depression and anxiety increased in brain tumor patients after surgery but quality of life did not changed.

Conclusion: Findings of current study show the necessity of cognitive and mental assessments before and after surgery and emphasizes on the need for rehabilitation and treatment.


Accuracy and complications of pedicle screw insertion for lumbar and thoracolumbar fractures

Parisa Azimi, Sohrab Shahzadi, Andia Shahzadi

International Clinical Neuroscience Journal, Vol. 1 No. 2 (2014), 25 November 2014, Page 61-64


Background: The accuracy of pedicle screw placement is essential for lumbar and thoracolumbar spine fracture fixation.

Purpose: The aim of the present study was to assess the accuracy of the pedicle screw placement with conventional C-arm fuoroscopy-guided in these patients.

Methods: A retrospective review identified patients who underwent operative management with thoracolumbar instruments at our hospital between June 2012 and August 2013. Clinical data were acquired from medical records and final screw positions were graded based on a classification of Gertzbein and Robbins.

Results: A total of 216 pedicle screws in 52 patients (34 males, mean age 32.6±5.8 years) were evaluated. They were instrumented with transpedicular posterior fixation technique within 72 hours. The follow-up time was 6.1 months (ranging from 1 to 14 months). The screws were graded A (n=43 [19.9%]), B (n=89 [41.2%]), C (n=62 [28.7%]), D (n=21 [9.7%]), and E (n=1 [0.5%]). One of the screws was revised on the second day after surgery due to screw malposition.

Conclusion: Based on existing facilities, the findings showed that the pedicle instrumentation screws with transpedicular posterior fixation technique in patients with lumbar and thoracolumbar fractures can be done with acceptable complication rate. However, more advanced equipment as CT navigation (O-arm) is recommended for higher accuracy.

Case Report

Cervical Neurinoma Encasing Vertebral Artery

Afsoun Seddighi, Amir Saied Seddighi, Maryam SadeghAzar, Amir Hossein Zohreh Vand

International Clinical Neuroscience Journal, Vol. 1 No. 2 (2014), 25 November 2014, Page 65-68

Our case was a 48-year-old man with cervical pain radiatingto the upper limbs. Imaging showed an intradural tumor with extradural component encasing the vertebral artery.Thetumor diagnosed asa neurinomaand had been removed surgically.The post operationmagnetic resonance imagingshowed that the tumor was completely removed andthe vertebral arterywas intact at theentire length.The goal of surgery of neurinoma is a total removal of the tumor,however if the vertebral artery is completely encasing by the tumor, it is advisable to remove the tumor to the level that the vertebral intactness issaved.

Unilateral cortical thickening and hyper-intensity due to mitochondrial encephalopathy, lactic acidosis, and stroke like episodes (MELAS)

Hamid Reza Hatamian, Babak Bakhshayesh, Nazanin Rahman-A

International Clinical Neuroscience Journal, Vol. 1 No. 2 (2014), 25 November 2014, Page 69-72

Patients with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) present with recurrent and partially reversible neurological deficits. Lesions of MELAS classically cause a signal change in both the grey and white matter, predominantly in the occipital and parietal lobes. These lesions mimic infarction. Here, we reported a case of MELAS with rare neuroimaging finding of hemispheric cortical thickening on T2/FLAIR images with intracortical nodular gadolinium enhancement; then we discussed the clinical and radiological differential diagnoses of it.

Imaging based learning points

Endoscopic Surgery for Third Ventricular Colloid Cysts in the Absence of Hydrocephalus- a feasibility study

Guive Sharifi, Mehrdad Hosseinzadeh Bakhtevari, Mohammad Samadian, Reza Jabbari, Omidvar Rezaei

International Clinical Neuroscience Journal, Vol. 1 No. 2 (2014), 25 November 2014, Page 73-77

Purpose: The aim of this study was to investigate the feasibility and effectiveness of endoscopic neurosurgery for patients with third ventricular colloid cysts without ventriculomegaly.

Methods: Seventy-one patients with third ventricular colloid cysts were identified and recruited to this study. Eighteen of these patients did not have concomitant hydrocephalus and underwent primary endoscopic surgery for cyst resection. The surgical technique, the success rate, and patients’ outcome were assessed and compared with 53 hydrocephalic patients who underwent similar procedures.

Results: The ventricular compartments were successfully cannulated and gross total resectin of the colloid cysts was achieved in all patients. There were no operative complications related to the endoscopic procedure. Two patients required subsequent intervention for hydrocephalus. The success rate for endoscopic surgery in non-hydrocephalic patients was similar to its value in patients with hydrocephalus.

Conclusion: Endoscopic resection of third ventricular colloid cyst in patients without hydrocephalus seems to be feasible, effective and not contraindicated.