Biomedical subjects

Iman Feiz-Erfan

Publications and source records attributed to Iman Feiz-Erfan.

At least 19 recordsLinked to original sources

PubMed2006

Hemorrhage of cavernous malformations during pregnancy and in the peripartum period: causal or coincidence? Case report and review of the literature.

There is growing evidence to suggest that pregnancy may increase the risk of hemorrhage from cavernous malformations (CMs). In the present case, a 21-year-old primigravida was admitted to the authors' neurosurgical service after a cesarean section. Three weeks before admission she had experienced rapidly progressive bilateral lower-extremity paresthesias. Spinal magnetic resonance (MR) imaging revealed the presence of an intramedullary thoracic lesion. On T2-weighted MR images, heterogeneous signal intensity with a rim of decreased intensity was demonstrated in the spine. The mass was successfully resected, and 1 year later the patient's symptoms had resolved completely. This is the fourth reported case of a spinal intramedullary CM that became symptomatic during pregnancy. The pathogenesis and management of this entity are reviewed.

Adult↗

PubMed2006

Endoscopic surgery for hypothalamic hamartomas causing medically refractory gelastic epilepsy.

INTRODUCTION: There is increasing evidence that removal or disconnection of hypothalamic hamartomas can lead to seizure control and improvement in behavior. The purpose of this study is to report our experiences with endoscopic removal of these hamartomas. METHODS: This is a prospective review of the early outcome of 44 patients undergoing endoscopic resection utilizing frameless stereotaxis and a micromanipulator. RESULTS: All patients had normal-sized ventricles. Complete removal was possible in 14 patients, 13 of whom were seizure free at follow-up. Four patients suffered complications that have persisted for more than 3 months: One had significant hemiparesis and three had persistent difficulties with short-term memory. Postoperatively, no patient suffered a permanent hormonal deficiency. In one patient who had undergone a previous attempt at transcallosal resection, the procedure was abandoned because of the lack of internal anatomic landmarks. In a second patient, insufficient mass could be removed due to the size of the lesion and the distorted anatomy. Consequently, 1 week later, the patient underwent a transcallosal approach. CONCLUSION: In appropriately selected patients, sessile hypothalamic hamartomas can be removed completely or they can be completely disconnected from the hypothalamus with an acceptable risk. At least a year after surgery is needed to evaluate the efficacy of the procedure in terms of control of seizures and improvements in behavior and emotional ability.

Adolescent↗

PubMed2006

Bedside twist drill craniostomy for chronic subdural hematoma: a comparative study.

BACKGROUND: Although the bedside twist drill craniostomy is used to treat chronic subdural hematomas, the efficacy of this technique has not been compared with that of standard treatments (operative bur hole or craniotomy). METHODS: Twist drill craniostomy was compared with operative bur hole or craniotomy in a prospective nonrandomized trial. The inclusion criteria were computed tomographic evidence of chronic subdural hematoma (isodense or hypodense compared with brain) and symptoms indicating the need for drainage. Selection of the procedure depended on the on-call surgeon's preference. Clinical success of the procedure, recurrence, length of hospitalization, complications, and neurologic outcome were compared. RESULTS: Between August 2001 and October 2002, 79 consecutive patients with 91 chronic subdural hematomas were treated (67 unilateral and 12 bilateral) at our institution. Fifty-five patients were treated with twist drill craniostomy and 24 with bur hole or craniotomy. There were no differences in the mean age of presentation, thickness of hematoma, length of hospitalization, reoperation rate, mortality rates, or ability to be discharged to home between the 2 groups. There was no difference in the neurologic outcomes in the 57 of the 79 patients available for follow-up. CONCLUSIONS: Twist drill craniostomy performed at the bedside is just as effective in treating chronic subdural hematomas as bur holes or craniotomy in the operating room. This procedure can most often be the first line of treatment in patients with symptomatic chronic subdural hematomas.

Aged↗

PubMed2006

Retroperitoneal approach for lumbar interbody fusion with anterolateral instrumentation for treatment of spondylolisthesis and degenerative foraminal stenosis.

BACKGROUND: An alternative approach for the treatment of the degenerative or unstable lumbar spine using retroperitoneal lateral LIF with anterolateral screw-plate or screw-rod fixation is introduced. Special attention is given to application of this procedure in patients who have undergone prior lumbar surgery. METHODS: Between 1998 and 2001, 14 patients underwent lateral LIF with anterolateral instrumentation to treat degenerative foraminal stenosis or spondylolisthesis. Eleven patients (79%) had undergone prior posterior lumbar surgery, 7 of whom were also fused at that time. All patients first presented with mechanical back pain, radicular pain, or both. The mean follow-up was 21 months (range, 8 to 36 months). RESULTS: Radicular pain and mechanical back pain significantly improved in 71% and 54% of patients, respectively. Of the 9 patients with preoperative neurological deficits, 7 were intact or had improved at their follow-up examination. One patient developed postoperative radiculopathy contralateral to his original symptoms. Radiography confirmed good positioning of the hardware and evidence of fusion in all 14 patients. No major complications occurred. CONCLUSIONS: Retroperitoneal lateral LIF with anterolateral instrumentation is an attractive alternative for the treatment of the degenerative or unstable lumbar spine in the absence of significant spinal stenosis. This approach is particularly useful for treating spondylolisthesis or degenerative foraminal stenosis in the postoperative lumbar spine.

Aged↗

PubMed2006

Transcallosal resection of hypothalamic hamartoma for intractable epilepsy.

PURPOSE: To present the results of transcallosal surgical resection of hypothalamic hamartoma (HH) in 26 patients with refractory epilepsy in a prospective outcome study. METHODS: Patients with refractory epilepsy symptomatic to HH were referred for surgical resection of their HH (mean age, 10.0 years; range, 2.1-24.2 years). A transcallosal, interforniceal approach was used to remove and/or disconnect the hamartoma. Volumetry was obtained on pre- and postoperative brain MRI scans to determine percentage of resection. Outcome assessment included determination of postoperative seizure frequencies in comparison to baseline and the incidence of postoperative complications. Postoperative changes in cognitive and behavioral functioning, in comparison to baseline, were elicited by parental report. RESULTS: The average postoperative follow-up interval was 20.3 months (range, 13-28 months). Fourteen (54%) patients were completely seizure free, and nine (35%) had at least a 90% improvement in total seizure frequency. Parents reported postoperative improvement in behavior in 23 (88%) patients and in cognition in 17 (65%) patients. Transient postoperative memory disturbance was seen in 15 (58%) patients, but persisted in only two (8%). Two (8%) patients had persisting endocrine disturbance requiring hormone replacement therapy (diabetes insipidus and hypothyroidism in one each). With univariate analysis, the likelihood of a seizure-free outcome correlated with younger age, shorter lifetime duration of epilepsy, smaller preoperative HH volume, and 100% HH resection. CONCLUSIONS: Refractory epilepsy associated with HH can be safely and effectively treated with surgical resection by a transcallosal, interforniceal approach. Short-term memory deficits appear to be transient for most patients, and family perception of the impact of surgery on cognitive and behavioral domains is favorable. Complete resection yields the best result.

Adolescent↗

PubMed2006

Endoscopic resection of hypothalamic hamartoma using a novel variable aspiration tissue resector.

OBJECTIVE: We present a novel variable aspiration tissue resector for use with neuroendoscopy. METHODS: Two patients, 4 and 14 years old, respectively, presented with intractable gelastic seizures refractory to maximal medical therapies. Magnetic resonance imaging showed mass lesions of the third ventricle consistent with hypothalamic hamartoma. RESULTS: The patients underwent magnetic resonance imaging wand-guided endoscopic resection of the tumor with the Suros novel variable aspiration tissue resector. There were no device-associated complications or adverse events. The hamartoma was disconnected in one patient, and gross total resection was achieved in the other. CONCLUSION: Endoscopy for tumor resection is still frustrated by the lack of surgical tools, such as ultrasonic aspirators, comparable with those available for use during open procedures. The variable-aspiration tissue resector reported here can be used to resect tumor tissue safely. These two cases demonstrate that gross total resection of small hypothalamic hamartomas is feasible with minimal morbidity through an endoscopic approach.

Adolescent↗

PubMed2006

Complications of halo fixation in the elderly.

OBJECT: The risk factors of halo fixation in elderly patients have never been analyzed. The authors therefore retrospectively reviewed data obtained in the treatment of such cases. METHODS: A discharge database was searched for patients 70 years of age or older who had undergone placement of a halo device. In a search of cases managed between April 1999 and February 2005, data pertaining to 53 patients (mean age 79.9 years [range 70-97 years]) met these criteria. Forty-one patients were treated for traumatic injuries. Ten patients had deficits ranging from radiculopathy to quadriparesis, and 43 had no neurological deficit. Adequate follow-up material was available in 42 patients (mean treatment duration 91 days). Halo immobilization was the only treatment in 21 patients, and adjunctive surgical fixation was undertaken in the other 21 patients. There were 31 complications in 22 patients: respiratory distress in four patients, dysphagia in six, and pin-related complications in 10. Eight patients died; in two of these cases, the cause of death was clearly unrelated to the halo brace. The other six patients died of respiratory failure and cardiovascular collapse (perioperative mortality rate 14%). Three patients who died had sustained acute trauma and three had undergone surgical stabilization. CONCLUSIONS: External halo fixation can be used safely to treat cervical instability in elderly patients. The high complication rate in this population may reflect the significant incidence of underlying disease processes.

Age Factors↗

PubMed2006

Multiple myeloma of the cervical spine: treatment strategies for pain and spinal instability.

OBJECT: Metastases of multiple myeloma often occur in the cervical spine. These metastases may cause pain and associated spinal instability. The authors report the results of radiotherapy and surgical treatment for myeloma involving the cervical spine. The results of radiation therapy for multiple myeloma metastases to the cervical spine that cause clinical or radiographically documented instability have not been reported previously. METHODS: A retrospective chart review of patients with multiple myeloma metastases to the cervical spine was undertaken. Between 1993 and 2005, 35 patients were treated with external-beam radiation and/or surgical stabilization at the University of Texas M. D. Anderson Cancer Center in Houston, Texas. Nineteen of 20 patients with sufficient follow-up data experienced resolution of their pain when treated with radiation without surgical intervention. Twenty-three patients had evidence of spinal instability on radiographic images; 15 of these were treated with radiation alone. Of these, 10 had sufficient follow-up data, and none showed any clinical progression of instability. Radiographic follow-up images demonstrated an arrest of further progression of instability and, in some cases, healing of pathological fractures by means of radiation alone. CONCLUSIONS: The results of this series suggest that, in selected cases, external-beam radiation for multiple myeloma metastases to the cervical spine is an effective palliative treatment, even in cases involving clinical or radiographically documented instability.

Adult↗

PubMed2006

Percutaneous vertebroplasty of a myelomatous compression fracture in the presence of previous posterior instrumentation. Report of two cases.

The authors report the use of percutaneous transpedicular vertebroplasty performed using polymethylmethacrylate (PMMA) in two patients. These men (53 and 57 years old) had previously undergone open surgery and posterior instrumentation to treat myelomatous compression fractures. Both patients presented with acute back pain that manifested after minor activities. Kyphotic wedge fractures were diagnosed at T-1 in one case and at L-1 in the other. Both patients were treated at other hospitals with laminectomy and instrumented fusion; multiple myeloma was diagnosed after surgery. The patients experienced severe, recalcitrant, and progressive pain; on referral, they were found to have persistent kyphosis. Multiple myelomatous lesions of the spine were seen in one case and in the other the L-1 fracture represented the only site of disease. Percutaneous vertebroplasty was performed by injecting PMMA into the anterior third of the compressed vertebral body. Both patients experienced a 50% reduction in pain immediately after treatment; 3 months later both were walking and reported minimal back pain while undergoing treatment for multiple myeloma. Three years after surgery one patient reported no back pain and no progressive instability of the spine. Four years after surgery the other patient remains pain free, ambulatory, and with overall disease remission. Percutaneous vertebroplasty provided effective analgesia in these two patients with progressive back pain despite posterior stabilization. In both cases, the anterior column was effectively stabilized. A much larger operative intervention with its attendant risks of morbidity was avoided. In addition, subsequent aggressive medical treatment was well tolerated.

Adult↗

PubMed2006

Spinal cord compression from traumatic anterior cervical pseudomeningoceles. Report of three cases.

Pseudomeningoceles rarely develop after cervical trauma; in all reported cases the lesions have extended outside the spinal canal. The authors report the first known cases of anterior cervical pseudomeningoceles contained entirely within the spinal canal and causing cord compression and neurological injury. The authors retrospectively reviewed the cases of three patients with traumatic cervical spine injuries and concomitant compressive anterior pseudomeningoceles. The lesion was recognized in the first case when the patient's neurological status declined after he sustained a severe atlantoaxial injury; the pseudomeningocele was identified intraoperatively and decompressed. After the decompressive surgery, the patient's severe tetraparesis partially resolved. In the other two patients diagnoses of similar pseudomeningoceles were established by magnetic resonance imaging. Both patients were treated conservatively, and their mild to moderate hemiparesis due to the pseudomeningocele-induced compression abated. The high incidence of anterior cervical pseudomeningoceles seen at the authors' institution within a relatively brief period suggests that this lesion is not rare. The authors believe that it is important to recognize the compressive nature of these lesions and their potential to cause devastating neurological injury.

Adult↗

PubMed2006

Dynamic retraction of the psoas muscle to expose the lumbar spine using the retroperitoneal approach. Technical note.

The retroperitoneal surgical approach has gained acceptance as a way to access the ventral aspect of the lumbar spine. Visualization is often limited, however, by the psoas muscle, which lies along the posterolateral aspect of the spine. Improved visualization is often attempted by retracting the muscle from the wound, which generally pulls the muscle laterally from the spine but not posteriorly, which is desirable for a better exposure of the spine, particularly the neural elements. In this paper, the authors describe a simple, atraumatic technique for retraction of the psoas muscle that allows excellent visualization of the spine.

Humans↗

PubMed2005

Indications for surgical fusion of the cervical and lumbar motion segment.

STUDY DESIGN: A literature review and the authors' clinical experience for the indication of fusion in the degenerative lumbar and cervical spine is provided. OBJECTIVE: To establish absolute and relative criteria for the indication for fusion in the degenerative cervical and lumbar spine. SUMMARY OF BACKGROUND DATA: Fusion in the cervical and lumbar degenerative spine is indicated under certain strict criteria. However, fusion in circumstances not meeting these criteria is controversial. METHOD: A review of the literature and the authors' experience concerning indication and criteria of fusion in degenerative, lumbar, and cervical spine is provided. RESULTS: Fusion for the unstable spine related to trauma, infection, and tumors is relatively accepted. However, indications for fusion for degenerative, cervical, and lumbar spine are more controversial. CONCLUSION: Lumbar and cervical fusion in the degenerative spine is frequently performed. Certain criteria have been established when a fusion should be considered. However, even these are not universally accepted. Strict prospective studies are needed to determine when a fusion of the degenerative, cervical, and lumbar spine is indicated. Patients with severe radicular pain may be considered for surgery after a comprehensive trial of conservative management. Fusion is usually necessary after a cervical discectomy, especially when spondylosis or osteophytic compression is present. Lumbar fusion is rarely indicated for routine discectomy. In patients with mechanical back or neck pain, surgery should only be considered after conservative measures have been exhausted and a radiographic abnormality is present at the symptomatic level, perhaps with pain concordant with discographic findings. Careful patient selection is the key to obtaining favorable surgical outcomes. In many cases, the goal may be a return to functionality rather than achieving a completely asymptomatic state.

Cervical Vertebrae↗

PubMed2005

Sinonasal leiomyosarcoma: review of literature and case report.

OBJECTIVES/HYPOTHESIS: To determine prognosis of primary sinonasal leiomyosarcomas after treatment. STUDY DESIGN: Literature review and case report. METHODS: Review of English literature from MEDLINE and independent sources with the addition of our case. RESULTS: Including our case, 63 cases have been reported. Primary treatment includes resection with or without radiation. Chemotherapy has not been reported to be effective. In our case, however, chemotherapy, consisting of etoposide and high-dose ifosfamide, caused the tumor to shrink significantly. On the basis of a review of all reported cases, the overall survival rate at a mean follow-up of 38.24 month is 66%. The minimal overall survival rates at 5 and 10 years are 20% and 6%, respectively. CONCLUSION: The prognosis for primary sinonasal leiomyosarcomas is poor. However, a 10-year survival has been reported in a few patients. Chemotherapy may be a useful adjunct when managing extensive lesions unamenable to curative resection.

Adult↗

PubMed2005

Exposure of midline cranial base without a facial incision through a combined craniofacial-transfacial procedure.

OBJECTIVE: A single-stage combined craniofacial-transfacial approach that exposes the midline cranial base without visible facial incisions is described. METHODS: Between 1992 and 1998, eight patients underwent surgery for five different anterior cranial base pathological findings: four angiofibromas, one mesenchymal chondrosarcoma, one esthesioneuroblastoma, one odontogenic myxoma, and one encephalocele. In all cases, the surgical exposure consisted of a bicoronal scalp incision with a bifrontal craniotomy and fronto-orbitonasal osteotomy, and then a sublabial incision for transmaxillary exposure. RESULTS: Gross total resection was achieved in five cases. The encephalocele was resected with complete reconstruction of the bony defect. Seven patients developed complications, primarily wound infections, cerebrospinal fluid leaks, and anemia. Postoperative Karnofsky Performance Scale scores ranged between 80 and 100 (mean, 92.5). Long-term follow-up information (mean, 56 mo; median, 59.5 mo; range, 5-108 mo) was available for all patients. CONCLUSION: Large anterior cranial base lesions can be resected and excellent cosmetic outcomes can be achieved with a single-stage combined transfacial-craniofacial approach that exposes the entire midline cranial base and requires no facial incisions.

Adolescent↗

PubMed2005

Microsurgical anatomy of the transcallosal anterior interforniceal approach to the third ventricle.

OBJECTIVE: We explored relevant regional microanatomy as it relates to the challenging anterior interforniceal (AIF) approach for removing hypothalamic hamartomas. METHODS: Five silicone-injected cadaveric heads were dissected by use of frameless stereotactic navigation to reveal microanatomy and extent of exposure through the transcallosal AIF approach. Distances between trajectories to the coronal suture and the genu of the corpus callosum (CC) and between the posterior border of the anterior commissure to the lower end of the rostrum of the CC and posterior border of the foramen of Monro were measured. RESULTS: The AIF approach provided adequate access to the anterior third ventricle and related structures (i.e., hypothalamus, infundibular recess, and mamillary bodies) through the corridor bounded by the anterior commissure anteriorly and the choroid plexus at the foramen of Monro posteriorly. The mean distances from the posterior trajectory to the coronal suture and the genu of the CC were 44.8 mm (range, 43.8-46.2 mm) and 14.88 mm (14.1-15.7 mm), respectively. The mean distance from the anterior trajectory posterior to the coronal suture was 4.66 mm (0-8.9 mm), and 32.6 mm (30.5-33.9 mm) to the genu of the CC. The mean length of callosotomy was 17.52 mm (16.2-19.1 mm). The mean distance between the posterior border of the anterior commissure and the lower end of the rostrum of the CC was 5.22 mm (4.6-5.6 mm), and 10.52 mm (9.7-11.5 mm) to the posterior border of the foramen of Monro. CONCLUSION: The technically safe AIF approach permitted limited interforniceal splitting, no major deep vein manipulation, and adequate visualization of the hypothalamus, infundibular recess, and mamillary bodies.

Cadaver↗

PubMed2005

Preserving olfactory function in anterior craniofacial surgery through cribriform plate osteotomy applied in selected patients.

OBJECTIVE: Olfaction is often sacrificed to gain access to the cranial base in anterior craniofacial surgery. We describe the long-term results of olfactory function in patients who underwent anterior craniofacial surgery and a cribriform plate osteotomy to preserve olfaction. METHODS: Between 1992 and 2004, 28 patients underwent 29 cribriform plate osteotomies in an attempt to preserve olfaction during anterior craniofacial surgery performed through modified extended transbasal approaches. Patients' charts and office notes were reviewed retrospectively. Formal olfactory testing was available in 5 patients, but most data were based on patients' subjective reports of olfaction. Olfactory preservation was defined by the subjective ability to detect fumes such as coffee, chocolate, roses, and orange juice regardless of the intensity of the sensation. Follow-up was based on phone calls to patients. RESULTS: Four patients were lost to follow-up and excluded. Therefore, follow-up was available in 24 patients after 25 procedures. On the basis of patients' subjective reports, olfaction was spared in 22 patients after 23 procedures (92%) and was confirmed objectively in the five patients formally tested. After surgery, only two patients were anosmic. CONCLUSION: Olfaction can be preserved in selected patients undergoing anterior craniofacial surgery. At least 1 cm of nasal mucosa should remain attached to the cribriform plate, which can be achieved by including the nasal bone in the osteotomy of the orbital bar. A medial orbital canthopexy is therefore necessary after these procedures.

Adolescent↗

PubMed2005

Avulsion fracture of the foramen magnum treated with occiput-to-c1 fusion: technical case report.

OBJECTIVE AND IMPORTANCE: A 31-year-old woman presented with an avulsion fracture of the foramen magnum via bilateral occipital condyles with extension through the inferior aspect of the clivus. CLINICAL PRESENTATION: The patient had no neurological deficits and was initially immobilized in a halo brace. INTERVENTION: To preserve rotational motion at C1-C2, we performed an occiput-to-C1 fusion with bilateral C1 lateral mass screws attached with rods to occipital keel screws. Postoperatively, the patient remained neurologically intact. Three-month follow-up imaging revealed no abnormal motion. Follow-up computed tomographic scan showed an intact construct and bony fusion. CONCLUSION: This rare injury, a bony variant of occipitoatlantal dislocation, was successfully treated with a unique occiput-to-C1 fusion.

Adult↗

PubMed2005

The radical transbasal approach for resection of anterior and midline skull base lesions.

OBJECT: Craniofacial surgery can be performed to treat midline and anterior skull base lesions by creating a bicoronal scalp incision without the need for an additional transfacial procedure. Originally described as the transbasal approach, several modifications for further exposure of the skull base have been described. The authors present data on the application and outcomes of a modified transbasal approach. The radical transbasal approach consists of a bifrontal craniotomy and a frontoorbitonasal osteotomy. METHODS: Between 1992 and 2002, 41 patients (28 male and 13 female patients with a mean age of 38.3 years [range 7-77 years]) underwent 44 radical transbasal procedures. Twenty-three malignant and 18 benign lesions involving the midline skull base were treated. These cases were reviewed retrospectively. Gross-total resection of 30 lesions was achieved. Seven lesions were resected subtotally and six partially; one lesion was debulked. Complications occurred in 26 (59.1%) of the 44 operations and mostly consisted of cerebrospinal fluid leakage. The surgery-related mortality rate was 6.8% (three patients). Based on their pre- and postoperative Karnofsky Performance Scale scores, 86.4% of patients improved or remained the same. CONCLUSIONS: The radical transbasal approach increases the midline craniofacial corridor by allowing the globes to be safely retracted laterally. It also enhances exposure of the maxillary sinus from above. The morbidity and mortality rates associated with this procedure are high but consistent with the known rates for craniofacial surgery. This approach is best suited for the treatment of anterior skull base tumors that extend into the nasal cavity, orbit, ethmoid sinus, nasopharynx, and upper clivus. The approach may allow resection of tumors involving the maxillary sinus area without the need for an additional transfacial approach.

Adolescent↗