Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 3 2 2017 9 1 Chiari Formation: Atlantoaxial Instability is the Cause 36 38 EN Atul Goel Department of Neurosurgery, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai – 400012, India The entity of Chiari formation was described by Hans Chiari in 1891 [1,2]. Since then the subject has been evaluated elaborately by a number of authors. However, it may only be correct to state that confusion in the understanding of pathogenesis and the nature of anomaly, significance of associated  abnormal soft tissue and bone anomalies and more importantly the treatment of the entity has not been resolved. The number of described treatment patterns are a testimony to the inadequacy of the understanding. The general consensus is that uncal herniation and tonsillar herniation are both similar in their pathogenesis wherein the part of the temporal brain or the cerebellum are pushed out of their compartment through a hiatus or hole into the other body compartment. In the process of herniation, there is congestion of space and compromise of the neural structures in the vicinity that leads to neurological symptoms or deficits. The factor that causes the push in case of Chiari malformation is unclear. However, the presence of an increased volume of cerebellar mass, a smaller volume of the posterior cranial fossa bone compartment or a combination of both these factors could be the possible cause. The general understanding is that the addition of the tonsillar volume in the foramen magnum limits the space for the neural structures that are compressed and results in related symptoms. Foramen magnum decompression is an established and a gold standard form of treatment.  

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 3 2 2017 9 1 Role of Minimally Invasive Spine Surgery in Adults with Degenerative Lumbar Scoliosis: A Narrative Review 39 50 EN Tony Tannoury Director of Spine Fellowship Program, Boston University Medical Center, Boston, MA-02118 kaveh haddadi Spine Fellowship Scholar of Boston University Medical Center. Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran Harish Kempegowda Department of Orthopedics, Boston University Medical Center, Boston, MA-02118 Abhijeet Kadam Department of Orthopedics, Boston University Medical Center, Boston, MA-02118 Chadi Tannoury Director of Spine Research, Director of Orthopedic Ambulatory Clinic, Co-Director of Spine Fellowship Program, Boston, MA 02118 Background and Aim: Degenerative lumbar scoliosis is a spinal deformity resulting from advanced disc degeneration and facet arthropathy. Given the inconclusive available literature and lack of high-quality data supporting the role of minimally invasive surgical management of degenerative lumbar scoliosis, this review intends to highlight and compare the various viable minimally invasive surgical methods for adult degenerative deformity correction. Methods and Materials/Patients: Online databases search including Medline, PubMed and Ovid was preformed using the keywords: adult, degenerative, lumbar scoliosis, etiology, clinical issues, diagnostic imaging, spinopelvic alignment, non-operative and surgical treatment options, minimally invasive, interbody fusion, and percutaneous pedicle screw fixation. Eighty-three studies, published after 2000, on degenerative lumbar scoliosis epidemiology, classification and management were identified and reviewed. Results: Minimally invasive surgical techniques available for interbody fusion include posterior lumbar interbody fusion, transformational lumbar interbody fusion, oblique lumbar interbody fusion, anterior lumbar interbody fusion, and extreme lateral interbody fusion. Each surgical option warrants technical considerations, indication, complications awareness, and functional and radiological outcomes assessment. Sound patients’ selection is key for improved outcomes, and therefore the following factors should be well examined prior to surgical intervention: the patient’s medical condition and underlying morbidities, the extent of the involved disc spaces, imaging characteristics, and surgeon skills. Conclusion: The superiority of one surgical technique over the others, was not proven due to lack of strong and supportive data. However, a comprehensive review of indications, benefits, and disadvantages of the minimally invasive surgical procedures is presented. There is an interest in minimally invasive surgery of the spine owing to lower complication rates and morbidity, with limited soft tissue disturbance, decreased blood loss, improved cosmesis, shorter hospital stay, earlier return to work, and therefore decreased general health care costs.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 3 2 2017 9 1 Impact of Acute Phase Epigallocatechin-3-gallate Supplementation on Consciousness and S100B Serum Levels in TBI Patients: A Double Blind Randomized Clinical Trial 51 57 EN Leila Zareian MSc, Animal Physiology Department, Basic Sciences Faculty, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran Amir Azarhomayoun MD, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran Maysam Alimohamadi MD, Brain and Spinal Cord Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran Mohammadreza Khajavi MD, Department of Anesthesiology, Sina hospital, Tehran University of Medical Sciences, Tehran, Iran Soodeh Razeghi-Jahromi PhD, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran Background and Aim: Traumatic brain injury is one of the leading causes of mortality and disability in young adults. Epigallocatechin-3-gallate, the antioxidant compound of green tea, has been proposed to have antioxidant and anti-inflammatory properties. This study evaluates the potential effects of epigallocatechin-3-gallate on the early clinical outcome and serum S100B levels (biomarker for brain tissue damage severity) in patients with moderate to severe traumatic brain injury. Methods and Materials/Patients: Thirty patients with moderate to severe traumatic brain injury admitted to the intensive care unit were enrolled. The patients were randomly allocated to treatment with either a daily oral dose of 400 mg epigallocatechin-3-gallate or placebo (distilled water) for seven days. The main outcome measures were duration of mechanical ventilation and ICU stay, Glasgow Coma Scale, and S100B protein level. Results: The results revealed a significant improvement in consciousness level after seven days in the epigallocatechin-3-gallate group (2.93±3.9 unit improvement in GCS versus 0.14±3.05 reduction in GCS, p-value:0.033). There was also a significantly shorter duration of mechanical ventilation in the epigallocatechin-3-gallate compared to the control group (5.1 days versus 9.8 days, p-value:0.02). Reduction of the serum S100B level was slightly higher in the epigallocatechin-3-gallate group (23.96 versus 18.6 pg/ml) but the difference was not statistically significant. Conclusion: Epigallocatechin-3-gallate supplementation had beneficial effects on consciousness level of the patients with moderate to severe traumatic brain injury in the acute phase.  

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 3 2 2017 9 1 A Technique for Treatment of Overdrainage in Ventriculoperitoneal Shunt 58 62 FA Essossinam Kpélao * Department of Neurosurgery, Sylvanus Olympio University Hospital, Lomé, Togo Katanga Anthony Békéti Department of Neurosurgery, Sylvanus Olympio University Hospital, Lomé, Togo Abdel Kader Moumouni Department of Neurosurgery, Sylvanus Olympio University Hospital, Lomé, Togo Kodjo Mensah Hobli-Ahanogbé Department of Neurosurgery, Sylvanus Olympio University Hospital, Lomé, Togo Agbéko Komlan Doléagbenou Department of Neurosurgery, Sylvanus Olympio University Hospital, Lomé, Togo Komi Egu Department of Neurosurgery, Sylvanus Olympio University Hospital, Lomé, Togo Thierry Alihonou Department of Surgery University Hospital Center of Ouémé and Plateau, Benin Essosolim Hodabalo Bakondé Department of Neurosurgery, Sylvanus Olympio University Hospital, Lomé, Togo Pilakimwé Egbohou Intensive Care Unit, Sylvanus Olympio University Hospital, Lomé, Togo Assang Dossim Department of Neurosurgery, Sylvanus Olympio University Hospital, Lomé, Togo Background and Importance: Overdrainage is a complication of ventriculoperitoneal shunt but adjustable valves and anti-siphon devices can prevent it. These very expensive valves are most often inaccessible, so that the majority of the valves available in Togo are fixed differential pressure valves. Although overdrainage is a widely-known issue, we aimed to introduce a new risk factor and the way we manage this complication. Case Presentation: This case series study included all patients who had overdrainage or a high potential risk of overdrainage (hydranencephaly). Our technique consisted of partial ligation of the peritoneal catheter at the level of the thorax by non-resorbable wire while controlling the drainage rate at the slots. The goal was to transform this fixed differential pressure valve into a pressure-controlled and flow-regulated one. Patients were followed for 1, 3 and 6 months, postoperatively.                                    Conclusion: Hydranencephaly predisposes patients to overdrainage. The partial ligature of the catheter is an effective technique for treating or preventing overdrainage.  

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 3 2 2017 9 1 Intracranial Pial Arteriovenous Fistula Mimicking a Vein of Galen Aneurysm with Hydrocephalus Managed with Endovascular Method: Case Report 67 63 EN Jorge Valderrama National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico Ricardo Garcia National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico Guru Satyarthee Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India Willem Calderon Hospital General Dr.Manuel Gea González, Mexico City, Mexico Samer Hoz Neurosurgeon, Neurosurgery Teaching Hospital, Baghdad, Iraq Alexis Narvaez-Rojas The National Autonomous University of Nicaragua, Managua, Nicaragua Luis Moscote Department of Neurosurgery, University of Cartagena, Colombia. Telephone: +57 5 6646183. rafaelmoscote21@gmail.com Background and Importance: Intracranial pial arteriovenous fistula is a recently described matter as a rare vascular malformation occurring in children. It is usually located in the subpial space in the intracranial cavity with a high-flow shunt. Case Presentation: Authors report on a 2-year-old child with intracranial pial arteriovenous fistula and progressive enlargement of head and seizures mimicking progressive obstructive hydrocephalus for eight months. Cranial computed tomography showed a hyperdense midline vein of Galen and enlarged straight sinus associated with obstructive hydrocephalus. Presence of an aneurysm of the vein of Galen was suspected. Conclusion: Authors believe that cranial screening with computed tomography for suspected early diagnosis is of high importance.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 3 2 2017 9 1 Normal Pressure Hydrocephalus Presentation with a Large Pseudomeningocele 73 77 EN Ehsan Alimohammadi MD, Resident of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran Guive Sharifi MD, Associate Professor of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohammad Samadian MD, Associate Professor of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran Kaveh Ebrahimzadeh MD, Assistant Professor of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran Omidvar Rezaei MD, Professor of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran Background and Importance: This interesting case is about the presence of normal pressure hydrocephalus and a large pseudomeningocele at the same time after 13 months of posterior fossa surgery. Although the occurrence of a pseudomeningocele following posterior fossa surgery is not so rare, such a late large pseudomeningocele development with signs and symptoms of NPH after 13 months of surgery is rather peculiar.   Case Presentation: A 59-year-old man referred to our clinic for a cerebellopontine angle tumor. The patient presented with right hearing loss and mild facial palsy. We operated the patient with retrosigmoid approach, and we discharged him after five days. After about 13 months, the patient referred to our center again with complaint of progressive bulging of previous surgical region and gait apraxia, urinary incontinence and dementia. A large pseudomeningocele in the site of previous surgery was seen. Conclusion: The authors presented a case report on late development (13 months) of a huge pseudomeningocele following vestibular schwannoma surgery with signs and symptoms of normal pressure hydrocephalus. Such a late big pseudomeningocele presentation with signs and symptoms of normal pressure hydrocephalus after posterior fossa surgery is peculiar.