Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 7 4 2021 10 1 Depression and Anxiety in Patients With Multiple Sclerosis: A Systematic Review 171 178 EN Sajjad Saadat Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran Maryam Vaghari Department of Psychology, Faculty of Humanities, Rasht Branch, Islamic Azad University, Rasht, Iran Shahrzad Hoodinshad Department of Psychology, Faculty of Humanities, Tehran North Branch, Islamic Azad University, Tehran, Iran Adele Isanazar Department of Psychiatry, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran Mozaffar Hosseininezhad Department of Neurology, Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran Background and Aim: Multiple Sclerosis (MS) is among the most prevalent chronic and progressive neurological diseases with high simultaneity. MS is associated with some psychological conditions, such as depression and anxiety. Thus, we examined depression and anxiety in individuals with MS in this review study. Methods and Materials/Patients: We conducted this study using a systematic review method relying on the search from January 2010 to December 2020. Accordingly, we searched the following keywords: “multiple sclerosis, MS, psychiatric issues, psychological disorders, psychological problems, anxiety, mental health, quality of life, and depression” in 4 online databases (PsycNET, PubMed, Scopus, and Magiran). Ultimately, we selected 14 comprehensive papers that quantitatively and qualitatively examined psychiatric disorders in patients with MS. Results: A total of 14 studies were analyzed that included 27106 patients with MS. The results achieved by the analytical studies explained that depression and anxiety are significantly higher in patients with MS, compared with the healthy population. The prevalence of depression and anxiety in MS patients was reported to be heterogeneous. Conclusion: Data related to a large number of patients with MS presented a high prevalence of depression and anxiety in them; however, not separating the symptoms from the disorder can be misleading. Consequently, it is recommended to conduct further research to precisely assess the prevalence of depression and anxiety in these patients. It is required that future studies consider the further use of clinical interviews instead of self-reported questionnaires, using sample selection methods, and providing a complete report of patients' demographic, and clinical information.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 7 4 2021 10 1 The Effects of Skill Lab Programs in Training of Neurosurgery Residents 179 184 EN Amir Saied Seddighi Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran Hesam Rahimi Baghdashti Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran Afsoun Seddighi Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran Morteza Hosseini Professor of Neurosurgery, Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence Mostafa Hosseini Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran Alireza Zali Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran Shiva Jamshidi Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran Background and Aim: Nowadays, surgical educations and training experience new problems. Legal issues and patients' rights are a matter of concern in educational hospitals. The high cost of modern technology-based surgical education has also made the training of the residents increasingly difficult. Therefore, it seems that new approaches in the training of surgeons are necessary. One of the strategies for this purpose is the establishment of clinical skill lab programs. Methods and Materials/Patients: In this study, 4 clinical skill lab workshops were designed to increase the residents' clinical skills in a very low-cost setting. We recruited 13 residents in this study. The workshops were categorized as craniotomy, working with a microscope, tissue resection, and microsurgical dissection. After the workshop, the residents and their attending physicians were evaluated by answering the questions about the workshops. Results: According to the evaluations, both residents and their attending physicians believed that these workshops were significantly effective in enhancing these skills. Conclusion: It seems that adding clinical skill lab workshops into the residency curriculum can improve the quality of their training and avoid the stressful environment of an actual operating room and the possible legal problems. Also, residents can learn more in a shorter time and have better self-esteem for training in neurosurgery.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 7 4 2021 10 1 Evaluation of Pain Tolerance Threshold Following Administration of Anti-TNF-α in REM Sleep-deprived Male Wistar Rats 185 190 EN Mohammadjavad Hoseinpourfard Institute for Cognitive Science Studies,Tehran, Iran; and Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran; and International Travel Medicine and Global Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran Mohammad Nasehi Institute for Cognitive Science Studies, Tehran, Iran; and Cognitive and Neuroscience Research Center, Tehran Medical Sciences Branch, Islamic Azad, Tehran, Iran Mohammad-Reza Zarrindast Institute for Cognitive Science Studies, Tehran, Iran; and Department of Pharmacology School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Morteza Izadi International Travel Medicine and Global Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran Mohammad Nami Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran Background and Aim: The level of Tumor Necrosis Factor-alpha (TNF-α) changes by REM sleep deprivation. TNF-α is a known biomarker of REM sleep deprivation (RSD). Prior studies have shown that any alteration in REM sleep can increase the amount of TNF-α. Accordingly, the Pain Tolerance Threshold (PTT) is believed to be increased in patients with insomnia after using anti-TNF-α or Infliximab (IFX). The present study aims to demonstrate the effect of IFX and its importance in the pain management of hospital inpatients. Methods and Materials/Patients: Seventy-two male Wistar rats in 9 groups were studied after obtaining the approval of the ethics committee of Tehran University of Medical Sciences (CNS.Protocol-ICSS-940816). Remicade was used for inducing the anti-TNF-α. Multiple platform water-tank was used for REM sleep deprivation induction. Pain tolerance was measured on a hot plate apparatus. Results: There was a significant increase in the duration of the rats’ tolerance on the hot plate between the saline group and the group that received IFX (0.2 mg/kg) (F2 = 8.363) (P = <0.001). Conclusion: Chronic SD can cause neuronal damage due to neuroinflammatory insult. REM sleep deprivation, in the long run, sensitizes the brain to neurodegenerative insults via the inflammatory mechanism, to some extent through the TNFα-associated pathways.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 7 4 2021 10 1 Developing a 3D Reconstruction System for Surgical Planning in Neurovascular Surgery 191 196 EN Amir Saied Seddighi Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran Hesam Rahimi Baqdashti Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran Afsoun Seddighi Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran Morteza Hosseini Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mostafa Hosseini Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran Alireza Zali Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran Shiva Jamshidi Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran Background and Aim: Neurovascular lesions can cause death or disability. Some of them are operable, but surgical approaches are complicated, and proper access to these lesions is crucial. A few of these surgeries occur during the residency educational program, and residents' experience in operating these lesions may be quite inadequate. Using new technologies like 3D-reconstruction of vascular lesion images may result in better training and improve residents' knowledge and understanding of these operations. Methods and Materials/Patients: Four senior neurosurgery residents were enrolled in this study. They were taught to use a 3D image rebuilding program (3D Slicer). They were then asked to rebuild a 3D image of every patient lesion, practice different surgical views, and review anatomical structures around the lesion before surgery. Results: All residents mentioned that their knowledge of surgical approaches improved, and they learned more from each operation. Two of them commented that more self-trust during surgeries led to more effective education. Their ability in surgical planning was enhanced too. Attending physicians of these residents believed that this practice improved the residents' skills and educational quality. Conclusion: New technologies can promote residency educational programs. It seems that working on 3D images of lesions before surgery can boost residents' educational attributes.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 7 4 2021 10 1 The Effects of Body Mass Index on Lumbar Microdiscectomy Outcomes 197 204 EN Amir Abbas Ghasemi Department of Neurosurgery, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran Background and Aim: The incidence of obesity has steadily risen to epidemic proportions in numerous world regions. Surgeons often encounter problems in surgeries on obese patients. This study evaluated the effects of Body Mass Index (BMI) on the outcome of patients undergoing lumbar microdiscectomy. Methods and Materials/Patients: This was primarily a case-series retrospective study of patients who underwent single-level lumbar microdiscectomy at our institution between January 2014 and April 2018. BMI was used to categorize our patients. Outcome measures were Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS). The Patients were also analyzed according to the operative time, average blood loss during surgery, hematoma formation, wound infection, Cerebrospinal Fluid (CSF) leak, deep vein thrombosis, length of stay after surgery, recurrent disc herniation, and neurologic deficit. Analysis of Variance (ANOVA) and regression analysis methods was used to assess differences between the study variables. Results: Five hundred patients (225 male & 275 female) with a Mean±SD age of 40.3±5.2 years (range: 19-70 y) who underwent single-level lumbar microdiscectomy were enrolled for the study. All patients were followed up for 24 months after surgery. The VAS and ODI were significantly improved in all patients. There was no significant difference between groups concerning the operative time, average blood loss during surgery, hematoma formation, wound infection, CSF leak, deep vein thrombosis, length of stay after surgery, recurrent disc herniation, and neurologic deficit. Conclusion: The obtained findings indicated that BMI did not negatively impact the outcome of patients undergoing lumbar microdiscectomy.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 7 4 2021 10 1 Bilateral C5 Palsy Following A Circumferential Surgery for Cervical Spondylotic Myelopathy: A Case Report and Review 205 212 EN Abolfazl Rahimizadeh Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran Mahan Amirzadeh Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran Shahrzad Rahimizadeh Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran Sam Hajialiloo Sami Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran; 2. Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran Shaghayegh Rahimizadeh Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran Naser Asgari Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran Walter L. Williamson Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran Background and Importance: The development of C5 root palsy is a well-known potential complication of cervical spine surgeries for the correction of cervical spondylotic myelopathy. It typically occurs unilaterally, but on extremely rare occasions, bilaterally. The value of intraoperative neurophysiologic monitoring in detecting iatrogenic acute versus delayed onset C5 palsy, the rarity of bilateral C5 palsy, and its optimal management require further discussion. Case Presentation: A 49-year-old woman with quadriparesis due to cervical spondylotic myelopathy is presented. She underwent circumferential 360° cervical spine surgery. This operation was subsequently complicated by a delayed bilateral C5 palsy, despite normal transcranial motor evoked potentials (MEPs). With the utilization of conservative treatment, the complete resolution of this complication took roughly eight months. Conclusion: Bilateral C5 palsy is an infrequent consequence of multilevel cervical spine surgeries. Although intraoperative monitoring of transcranial electrical stimulation-induced MEPs has high sensitivity and specificity in foreseeing the acute-onset C5 palsy, it cannot predict delayed-onset palsy. Including the current case, only seven cases have been reported in the medical literature. Overall, conservative management in adherence to rigorous physical therapy may be an acceptable treatment.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 7 4 2021 10 1 Non-aneurysmal Perimesencephalic Subarachnoid Hemorrhage in A COVID-19 Patient: Case Report and Review on Subarachnoid Hemorrhage Patterns in COVID-19 213 218 EN Mohammad Kazem Sarpoolaki Neurosurgery Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Arad Iranmehr Neurosurgery Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Mohammad Ali Bitaraf Neurosurgery Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Soheil Naderi Neurosurgery Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Mohamad Namvar Neurosurgery Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Background and Importance: The novel SARS-CoV-2 virus has had an undeniable effect worldwide in different aspects. Although cerebrovascular diseases, especially subarachnoid hemorrhage (SAH), have already been reported in COVID-19 patients, little is known about various types and patterns of SAH in these patients. Case Presentation: A 63-year-old woman was admitted to the emergency department with a headache. Her headache was severe (Hunt and Hess score, grade 2). She was diagnosed with COVID-19 by a positive nasopharyngeal swab PCR test. Her CT scan revealed a perimesencephalic hemorrhage, thick SAH without any signs of hydrocephalus or intraventricular hemorrhage. Conclusion: Regarding the different associations of SAH with COVID-19, the perimesencephalic hemorrhage in our case is a novel type. Although not uncommon among non-infected populations, SAH occurrence in COVID-19 patients has not been reported before and needs further investigation.