Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Comparison of Vicious Effect of Oral Pantoprazole and Famotidine on New Bone Formation in Patients With Lumbar Spine Fusion Surgery: A Randomized Control Trial 1 11 EN Kaveh Haddadi Department of Neurosurgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Navid Tahmasbi Department of Neurosurgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Abdolrasool Alaee Orthopedics Research Center, Mazandaran University of Medical Sciences, Sari, Iran. Abbas Alipour Orthopedics Research Center, Mazandaran University of Medical Sciences, Sari, Iran. Saeed Ehteshami Orthopedics Research Center, Mazandaran University of Medical Sciences, Sari, Iran. Background and Aim: Due to the increasing use of proton pump inhibitors (PPIs) and their side effects for bone repair and the high percentage of therapy failure in lumbar fusion surgery, especially in various animal studies, the goal of this study was to appraise the consequence of pantoprazole and famotidine on new bone formation in patients experiencing spinal fusion surgery. Methods and Materials/Patients: In this double-blind clinical trial, eighty patients participated based on the inclusion and exclusion criteria, of whom 40 cases received pantoprazole (group P) and 40 received famotidine (group F) for eight weeks. They were followed up for three, six, and twelve months after surgery for cage subsidence, screw loosening, and visual analogue scale (VAS), Oswestry disability index (ODI), Brantigan, Steffee, Fraser (BSF), and Lenke classification for grading their bone formation. A P<0.05 was considered significant. Results: The rate of fusion based on the Lenke score was lower in the group receiving pantoprazole six and 12 months after the surgery compared to group F (the frequency of Lenke grades C and D were 35% and 25% compared to the famotidine group 12.5% and 12.5%, respectively; P=0.042). The VAS Mean±SD score in group F was lower than group P after 12 months (2.48±1.06 and 1.83±0.55, respectively; P=0.008). There was no pharmacologically significant association between subsidence (P=0.43), loosening (P=0.13), ODI (P=0.31), and BSF (P=0.77) 3, 6 and 12 months post-operation. Conclusion: Affording to the preliminary conclusions of this study, the use of pump inhibitors, such as pantoprazole is more destructive for the ossification process in candidates for spinal fusion requiring the chronic use of drugs for controlling their gastric acid secretion, and H2-blocking drugs, such as famotidine are preferable in this situation after further investigations.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Report of the First Completed On-site Vascular Neurosurgery Fellowship Program in Cameroon 12 20 EN Vincent Djientcheu Department of Neurosurgery, Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde, Yaounde, Cameroon. Haman Nassourou Oumarou Department of Neurosurgery, Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde, Yaounde, Cameroon. Potho Thazo Department of Neurosurgery, Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde, Yaounde, Cameroon. Carole Djientcheu Department of Neurosurgery, Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde, Yaounde, Cameroon. Francis Fezeu Department of Neurosurgery, Medical School, Heinrich Heine University Duesseldorf, Düsseldorf, Germany. Alexandros Doukas Department of Neurology and Neurosurgery, Brain Global Non-profit Organization, Salisbury, United States. Leonidas Trakolis Department of Neurosurgery, Christian Albrechts University Kiel, Kiel, Germany. Athanasios K. Petridis Department of Neurosurgery, Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde, Yaounde, Cameroon. Background and Aim: Vascular neurosurgical expertise is highly in demand in African countries.To create a sustainable environment for treating the patients, local neurosurgeons have tobe trained and be able to operate under the local circumstances, and equipment and on-sitefellowship programs are needed. We have reported the results of the first completed on-sitecerebrovascular fellowship in Cameroon and to our knowledge, in central Africa. Methods and Materials/Patients: Forty-two cerebrovascular cases (38 aneurysms) wereoperated by the cerebrovascular expert and his fellows microsurgically from April 2021to November 2022. The expert traveled to Cameroon four times. Online conferences andtheoretical courses were organized.Results: The overall morbidity rate was 10.5% with a long-term functional morbidity rate of5.2%. The intraoperative mortality rate was 0 and the 30-day mortality rate was 2.7%. Aftercompletion of the program, the fellow’s surgical skills concerning operating time, intraoperativecomplications, and mortality improved significantly. Conclusion: The on-site cerebrovascular fellowship program in sub-Saharan countries is feasibleand provides the patient with high-quality surgery with outcomes similar to Western countries.The caseload in two years is sufficient enough to provide excellent training to the local fellows.There is a high demand for further fellowships, like the one we described. It is important for thetrainer to stay dedicated to the program until the completion of it. To provide the fellows with ahigh caseload, only two fellows should be trained, which are participating in every case

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 A Report of Four Cases of Cystic Meningiomas and a Systematic Review 21 37 EN Soliman Noman Abdullah Alborihi Department of Neurosurgery, Al-Thawra Modern General Hospital (TMGH), Sana’a, Yemen. Adnan Abdullah Al-Awadi Department of Neurosurgery, Al-Thawra Modern General Hospital (TMGH), Sana’a, Yemen. Edress Noman Abdullah Alborihi Department of Neurosurgery, A-Jumhairi Teaching Hospital, Sana’a, Yemen. Background and Importance: Cystic components in meningiomas are an infrequent finding and pose diagnostic and therapeutic challenges to neurosurgeons. This study aims to conduct a comprehensive assessment of the clinical characteristics and management approaches for cystic meningiomas (CMs). Case Presentation: The current research investigated rare cases of CM. In the first case (case 1), benign parasagittal CM showed malignant features, including brain swelling and midline shifting. In the second case (case 2), parafalcine CMs demonstrate rare histopathological analysis and have not been documented in previous studies. The third case involved a pregnant woman, while the fourth case showed improvement in an older patient after surgery and indicated that the removal of a CM can result in a good prognosis. All tumors were surgically removed at stage 1 (Simpson stage), and histopathology confirmed World Health Organization (WHO) grade 1 syncytial meningioma in cases 1, 3, and 4. Only case 2 showed grade 3 rhabdoid meningioma. Conclusion: We found that benign CM may cause more brain edema than high-grade meningiomas, especially when they invade the sinus. Parasagittal and parafalcine CM invade the superior sagittal sinus (SSS), making complete excision more challenging and riskier. The presence of the cyst facilitates the removal of the tumor and reduces the risks.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Pain Management Methods and Techniques in Lumbar Disc Surgery: A Narrative Review Study 38 48 EN Somayeh Mehrpour Department of Anesthesiology and Critical Care, School of Medicine, Qom University of Medical Sciences, Qom, Iran. Shahram Shafa Department of Orthopedics, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran. Majid Vatankhah Department of Anesthesiology, Anesthesiology and Critical Care and Pain Management Research Center, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Mehrdad Malekshoar Department of Anesthesiology, Anesthesiology and Critical Care and Pain Management Research Center, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Mohammad Sadegh Sanie Jahromi Department of Anesthesiology, Anesthesiology and Critical Care and Pain Management Research Center, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Tayyebeh Zarei Department of Anesthesiology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran. Mansour Deylami Department of Anesthesiology and Critical Care, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran. Fateme Maleki Department of Emergency Medicine, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran. Roohie Farzaneh Department of Emergency Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Background and Aim: This study examines the complex field of pain treatment related to lumbar disc disorders in a narrative review. Methods and Materials/Patients: Our search strategy involved utilizing specific terms, including ‘pain management,’ ‘lumbar disc surgery,’ ‘methods,’ and ‘techniques.’ We formulated a search query using Boolean operators: (‘Pain management’ OR ‘analgesia’) AND (‘lumbar disc surgery’ OR ‘spinal surgery’) AND (‘techniques’ OR ‘procedures’ OR ‘approaches’ OR ‘methods’) AND ‘narrative review.’ A systematic search was conducted across reputable medical databases including PubMed, MEDLINE, and Cochrane Library. Filters were applied to refine search results based on publication type and date, with a focus on material published within the past two decades to ensure the inclusion of current, high-quality literature. Results: This study synthesized information from several sources, demonstrating the changing methods used to address pain in lumbar disc disorders. The article explored the historical background of medical treatments, emphasized both contemporary surgical and non-surgical methods, and investigated the predicted factors that affect the results. The study investigated the range of surgical incidents and examined the clinical factors to be taken into account for treatments. The value of efficient pain treatment in alleviating chronic back pain and maximizing patient results was emphasized. Conclusion: In conclusion, this review underscores the paramount importance of comprehensive management of lumbar disc pain. It stresses that effective pain control not only alleviates immediate suffering but also plays a pivotal role in ensuring positive surgical experiences, enhancing patient outcomes, and promoting long-term well-being.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Thoracolumbar Paravertebral Intramuscular Myxoma Presenting with Mechanical Back Pain: A Case Report and Review of the Literature 49 55 EN Bilal Bahadır Akbulut Department of Neurosurgery, Faculty of Medicine, Ege University, Izmir, Turkey. Hüseyin Biçeroğlu Department of Neurosurgery, Faculty of Medicine, Ege University, Izmir, Turkey. Taner Akalın Department of Pathology, Faculty of Medicine, Ege University, Izmir, Turkey. Mustafa Serdar Bölük Department of Neurosurgery, Faculty of Medicine, Ege University, Izmir, Turkey. Taşkın Yurtseven Department of Neurosurgery, Faculty of Medicine, Ege University, Izmir, Turkey. Background and Aim: Intramuscular myxomas are uncommon benign tumors that are rarely seen in the paraspinal musculature. They might present with neurological symptoms if situated near the spinal cord or may present with nonspecific symptoms such as back pain. Case Presentation: The case of this study was a 46-year-old female presented with back pain that was exacerbated with movement. A thoracolumbar magnetic resonance imaging revealed a T2 hyperintense 35x25x85 mm mass that extends craniocaudally within the right-sided paraspinal muscles with heterogeneous contrast enhancement on T1 sequence images. Using a paramedian incision, paraspinal muscles were dissected, and a rubbery mass was palpated within. The tumor was mobilized in all quadrants and removed with its pseudocapsule. The tumor internally had a gel-like substance with rubbery margins. The patient was discharged without complications. Conclusion: To our knowledge, this is the 16th case of paraspinal intramuscular myxoma in the literature. Even though it is a rare entity, one must be vigilant for pathologies within the paraspinal muscles in patients with back pain

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Clinical Profile and Surgical Management of Intramedullary Spinal Cord Tumors 56 63 EN Rajeev Mandaka Parambil Department of Neurosurgery, Government Medical College, Kozhikode, India. Binoy Damodar Thavara Department of Neurosurgery, Government Medical College, Kozhikode, India. Byjo Valiyaveetil Jose Department of Neurosurgery, Government Medical College, Kozhikode, India. Premkumar Sasi Department of Neurosurgery, Government Medical College, Kozhikode, India. Radhakrishnan Maniyan Department of Neurosurgery, Government Medical College, Kozhikode, India. Shanavas Cholakkal Department of Neurosurgery, Government Medical College, Kozhikode, India. Ebby Sebastian Department of Neurosurgery, Government Medical College, Kozhikode, India. Background and Aim: Intramedullary spinal cord tumors (IMSCTs) are rare tumors of the spine. The study aims to analyze the clinical profile and surgical management of IMSCTs. Methods and Materials/Patients: This is a retrospective study to review the IMSCTs operated between January 2007 to December 2021. Myxopapillary ependymomas were excluded from the study. Results: There were twenty-seven operated cases of IMSCTs. The Mean±SD age was 39±22 years. Fifteen (55.5%) were males and 12(44.5%) were female patients. There were 6(22%) cervical, 7(26%) cervicodorsal, 9 (33%) dorsal, and 5(19%) dorsolumbar IMSCTs. The Mean±SD duration of symptoms was 10±14 months. Ten (37%) patients had spinal cord syrinx. Motor weakness and pain were the most common symptoms. Intraoperative gross total resection (GTR) was achieved in 12(44.4%) patients, near-total resection in 4(14.8%) patients, subtotal resection in 2(7.4%) patients, decompression in 7(26%) patients, and biopsy in 2(7.4%) patients. Eighteen (66.6%) patients had neurological status same as preoperative status. Four (14.8%) patients had improvement and 5(18.5%) patients had deterioration in neurological status. Ependymoma was the most common histological type of IMSCT (40.5%). Other lesions are glioma, hemangioblastoma, lipoma, schwannoma, lymphoma, capillary hemangioma, arachnoid cyst, and epidermoid cyst with spinal dysraphism. Ependymomas had well-defined margins compared to other gliomas. Duration of stay in the hospital was 9±3.5 days. Conclusion: Dorsal spine is the most common location of IMSCTs and ependymoma is the most common histological type. It is the surgeon’s intraoperative decision regarding the extent of resection of the tumor based on the spinal cord infiltration and tumor type. GTR is possible in the majority of ependymomas and some other histological tumors like schwannoma, arachnoid cyst, and epidermoid cyst.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Transcranial Extraventricular Endoscopic Surgeries: Expanding the Role of Endoscope in Neurosurgery 64 75 EN Rajeev Mandaka Parambil Department of Neurosurgery, Government Medical College, Kozhikode, India. Binoy Damodar Thavara Department of Neurosurgery, Government Medical College, Kozhikode, India. Byjo Valiyaveetil Jose Department of Neurosurgery, Government Medical College, Kozhikode, India. Premkumar Sasi Department of Neurosurgery, Government Medical College, Kozhikode, India. Radhakrishnan Maniyan Department of Neurosurgery, Government Medical College, Kozhikode, India. Shanavas Cholakkal Department of Neurosurgery, Government Medical College, Kozhikode, India. Shinas Hussain Department of Neurosurgery, Government Medical College, Kozhikode, India. Background and Aim: Transcranial endoscopic surgeries are mainly limited to intraventricular lesions. This study aims to elaborate on the various benefits of transcranial endoscopic surgeries in extraventricular regions of the brain. Methods and Materials/Patients: It is a retrospective study of transcranial extraventricular endoscopic surgeries (TEESs) operated between June 2022 to May 2023. The authors described the surgeries done for brain lesions other than intraventricular lesions as extraventricular surgeries. Access to the intracranial region was obtained through the transcranial approach. The transnasal rigid endoscope was used for the surgeries. The surgery was performed as either pure endoscopic surgery or endoscopic-assisted microscopic surgery. Results: The authors have performed 6 microvascular decompressions using an endoscope. Three pineal tumors, 3 craniopharyngiomas, 1 cerebellopontine angle epidermoid cyst, and 1 petrous neurenteric cyst were excised using an endoscope by transcranial approach. One internal carotid artery bifurcation aneurysm was clipped using an endoscope. All patients improved in the postoperative period. Surgeries were done using the 0-degree and 30-degree endoscopes. The endoscopic eye was able to reach the deep-seated area of surgical interest and authors were able to visualize the structures in a wide panoramic view with good illumination and magnification. There was no misinterpretation of structures. Conclusion: Endoscope can reach the deep-seated extraventricular areas of the brain with a narrow corridor, giving good illumination and magnification at the site of surgery. An endoscope can reach beyond the obstructing anatomical structure and visualize the area behind it. It is used as a complimentary to microscope to access the microscopic invisible areas. It has increased the ease of doing surgery, decreased tissue dissection, decreased complications, and improved surgical results. TEES improves the hand-eye coordination of surgeons in transcranial surgeries and it will help in adapting to exoscope easily

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Retrieving Polyaxial Tulip-Head Pedicle Screws in Revision Spine Surgery: A Technical Note 76 79 EN Abolfazl Rahimizadeh Pars Advanced and Minimally Invasive Manners Medical Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran. Saber Zafarshamspour Pars Advanced and Minimally Invasive Manners Medical Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran. Housain Soufiani Pars Advanced and Minimally Invasive Manners Medical Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran. Ali Mohammadi Moghadam Pars Advanced and Minimally Invasive Manners Medical Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran. Background and Aim: Tulip-head screws are among the many implant systems developed with advances in spinal surgery. A screw is retrieved during revision spine surgery to be replaced with a larger diameter screw or before different types of osteotomies. This study aims to provide a simple and practical method to retrieve tulip-head screws during revision spine surgery or implant removal. Methods and Materials/Patients: We provide a step-by-step description of the technique, which requires only an Allen wrench, an anti-torque wrench, and a one-inch rod. The technique is easily and routinely applied in revision spine surgery to retrieve tulip-head screws without any complications. Conclusion: Our method is a simple and practical way to remove tulip-head polyaxial screws

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 The International Spinal Cord Injury Survey in Iran (InSCI-IR) 80 86 EN Enayatollah Homaie Rad Social Determinants of Health Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran. Diana Pacheco Barzallo Faculty of Health Sciences & Medicine, University of Lucerne, Lucerne, Switzerland. Leila Kouchakinejad-Eramsadati Guilan Road Trauma Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran. Sara Sharifnia Social Determinants of Health Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran. Zahra Mohtasham-Amiri Guilan Road Trauma Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran. Shahrokh Yousefzadeh-Chabok Guilan Road Trauma Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran. Zahra Haghdoust Nursing and Midwifery School of Shahid Beheshti, Guilan University of Medical Sciences, Rasht, Iran. Background and Aim: Spinal cord injury patients are faced with many neglected side effects that threaten the health, wealth, and life of the patients and their families. For this purpose, the international spinal cord injury survey (InSCI) was conducted in 2017 by adding 22 countries to follow up the patients facing spinal cord injury. Iran as a developing country was added to the survey in 2022 focusing on the catastrophic health expenditures of spinal cord injury patients. The survey is named: The International spinal cord injury survey in Iran (InSCI -IR). Methods and Materials/Patients: This study will be performed in Guilan Province, Iran and the primary data of the patients will be gathered from the Poursina Hospital of Rasht and the Iranian National Registry of Spinal Cord Injury Patients. InSCI-IR contains two parts; the general questionnaire which gathers the data for the InSCI and the specific questionnaire which gathers data for calculating catastrophic expenditures. Results: It is estimated that 600 patients will participate in the study and more than 200 cases are faced with paraplegia or tetraplegia. The international questionnaire contains 11 sections on the living situation of patients with SCI, sociodemographic questions, injury characteristics, mental and physical health, feeling and work conditions, environmental factors, and access to health services. The catastrophic expenditure part contains questions about the cost of treatment, medication, caregiving, transportation, and household income loss related to spinal cord injury, wealth index, and household total income. Both parts will be edited in psychometrics processes.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Investigating the Surgical Management of Large Basal Ganglia Hemorrhage: A Bi-institutional Experience 87 97 EN Rahul Varshney Department of Neurosurgery, PGIMER & Dr. RML Hospital, New Delhi, India. Binoy Kumar Singh Department of Neurosurgery, North Eastern Indra Gandhi Regional Institute of Health and Medical Sciences, Shillong, India. Ajay Choudhary Department of Neurosurgery, PGIMER & Dr. RML Hospital, New Delhi, India. Background and Aim: Numerous prognostic factors for spontaneous intracerebral hemorrhage have been advocated; however, only a few studies have specifically addressed basal ganglia bleed prognosis and management. Regarding basal ganglia bleeding, this study determines the predictors of functional outcomes and predictors of severe disability or death in surgically treated cases. Methods and Materials/Patients: This was a one-time follow-up study of 271 spontaneous basal ganglia bleed patients undergoing surgical intervention over 3 years. An electronic hospital database was used to collect data regarding clinical and radiological parameters and functional outcomes according to the glasgow outcome scale (GOS) three months after the hemorrhage. Results: We analyzed 271 cases, with a mean age of 50.8±13.57 years. At the end of 3 months, 53.87% of patients had favorable outcomes (GOS=4, 5), 9.59% had poor outcomes (GOS=2, 3) and mortality was 37.75% (GOS=1) at the end of 3 months. Independent predictors of poor outcome were age (odd ratio [OR]=1.81, 95% CI, 1.09%, 3.02%, GCS OR=6.93, 95% CI, 1.52%, 31.51%), hematoma volume more than 60 mL (OR=12.73, 95% CI, 3.29%, 49.23%, midline shift (OR=2.78, 95% CI, 1.64%, 4.73%), the left side of bleed (OR=1.81, 95% CI, 1.11%, 2.94%), intraventricular hemorrhage (OR=2.94, 95% CI, 1.72%, 5.02%) and intraventricular hemorrhage associated with hydrocephalus (OR=22.30, 95% CI, 6.35%, 78.27%). There was a significant association between these factors and poor outcomes (P<0.05). Conclusion: Almost half of the patients with large basal ganglia hemorrhage survivors were severely disabled or died within three months after the event. Basal ganglia hemorrhage was associated with severe disability or death among patients aged over 60 years with left-side bleeding, low GCS on admission, preoperative computed tomography scan showing midline shift of more than 5mm with the presence of intraventricular hemorrhage or associated hydrocephalus and a large hematoma volume.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Investigating Delayed Surgical Management of a Giant Rhabdomyomatous Meningioma: A Case Report 98 104 EN Iran Chanideh Clinical Research Development Center, Taleghani and Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran Masoud Ghadiri Students Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran Seyed Hamid Madani Molecular Pathology Research Center, Imam Reza Hospital, Kermanshah Universitiy of Medical Science, Kermanshah, Iran Ali Shoghi Clinical Research Development Center, Taleghani and Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran Sasan Alaghemand Clinical Research Development Center, Taleghani and Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran Tahereh Mohammadi Majd Clinical Research Development Center, Taleghani and Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran Saeed Gharooee Ahangar Clinical Research Development Center, Taleghani and Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran Background and Importance: Rhomboid meningioma (RM) is one of the rare and aggressive types of meningioma, typically classified as a central nervous system grade III anaplastic meningioma by WHO. In this report, we present an unusual case of RM. Case Presentation: The patient was a 67-year-old man, living in Kermanshah City, Iran. He came to a neurosurgery clinic with a chief complaint of a huge and unusual mass on his skull. Following the brain computed tomography scan and magnetic resonance imaging, the diagnosis of meningioma was considered. The patient underwent surgical intervention for the excision of the mass. Immunohistochemical findings demonstrated the diagnosis of RM (WHO grade III). Conclusion:  RM is a rare and aggressive subtype of meningiomas with a high growth rate and poor prognosis. Early diagnosis and treatment especially in invasive ones can prevent many unpleasant and critical complications; although tumor location has a pivotal role in determining treatment strategy.  

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 The Association of the Changes in Pain Severity and Cervical Cobb Angle before Versus After Anterior Cervical Discectomy With Fusion Surgery 105 115 EN Naghmeh Khoshsima Guilan Road Trauma Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran. Seifollah Jafari Department of Neurosurgery, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran. Babak Alijani Department of Neurosurgery, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran. Hamid Behzadnia Department of Neurosurgery, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran. Enayatollah Homaei Rad Social Determinants of Health Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran. Shahrokh Yousefzadeh- Chabok Neuroscience Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran. Zoheir Reihanian Department of Neurosurgery, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran. Background and Aim: Axial neck pain due to degenerative cervical myelopathy can be improved after repairing anterior cervical discectomy with fusion (ACDF) surgery. However, whether changes in postoperative pain can be associated with improvement in the Cobb angle following surgery is still controversial. This study aims to assess the trends of the changes in pain severity and also Cobb angle and then test the relationship between the changes in two parameters. Methods and Materials/Patients: This longitudinal study was performed on 60 consecutive patients who were scheduled to undergo ACDF surgery due to neck disc or degenerative cervical myelopathy (DCM) and had axial neck pain before the operation. Before operation as well as 2 weeks, 2 months and 6 months after surgery, the pain score and value of Cobb angle were measured. Results: Before surgery, the patients suffered from significant axial neck pain with a mean pain score of 7.47±2.02, but after surgery, patients experienced a downward trend of changes in pain score as the mean pain score of 0.92±1.46 at two weeks, 1.31±1.63 at two months and 1.32±1.64 at six months after operation. The repeated measure analysis of variance (ANOVA) test showed a significant reduction in pain scores within follow-up time (P<0.001). A significant improvement was also revealed in the Cobb angle after the operation and the mean value of this angle was significantly lower at two weeks, two months, and six months after surgery than before surgery. Using the multivariate linear regression modeling with the presence of baseline parameters, the relationship between pain score and Cobb angle remained insignificant (P=0.387). Conclusion: Following ACDF surgery, the improvement in axial neck pain and Cobb angle is predictable, but the relationship between these two indicators will not necessarily be significant.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Intraventricular Empyema Features of Surgery and Conservative’s Outcome: A Scoping Review 116 125 EN Farhad Balafif Department of Surgery, Division of Neurosurgery, Facult of Medicine, Saiful Anwar Academic General Hospital, Brawijaya, Malang, Indonesia. Donny Wardhana Department of Surgery, Division of Neurosurgery, Facult of Medicine, Saiful Anwar Academic General Hospital, Brawijaya, Malang, Indonesia. Tommy Nazwar Department of Surgery, Division of Neurosurgery, Facult of Medicine, Saiful Anwar Academic General Hospital, Brawijaya, Malang, Indonesia. Mustofa Mustofa Department of Surgery, Division of Neurosurgery, Facult of Medicine, Saiful Anwar Academic General Hospital, Brawijaya, Malang, Indonesia. Background and Aim: Intraventricular empyema (IVE), a rare and life-threatening neurological infection, challenges healthcare providers due to its complexity and limited data on optimal management. This scoping review seeks to bridge the existing literature gap by systematically summarizing current knowledge, identifying consensus, and highlighting research opportunities. Methods and Materials/Patients: The inclusion criteria included all ages diagnosed with IVE based on the population, concept, and context (PCC) framework. The search strategy involved utilizing keywords and controlled vocabulary terms in databases, such as PubMed, Science Direct, MEDLINE, Embase, Scopus, and Google Scholar. The study selection process adhered to predefined inclusion and exclusion criteria, with data extraction and mapping performed to summarize key information from the literature, including demographics, symptoms, treatment modalities, and outcomes Results: Analysis of 12 articles shows that IVE predominantly affects men between the ages of 17 to 81 years, with various symptoms, including headaches, fever, and neurological issues. Infections are found in multiple ventricular sites, often complicated by drug-resistant strains and negative cerebrospinal fluid (CSF) cultures. While surgical interventions, such as ventriculostomy are common, conservative treatments also show favorable outcomes, emphasizing the need for tailored management and timely interventions in optimizing patient outcomes for central nervous system (CNS) infections. Conclusion: In conclusion, the diagnosis and management of intraventricular infections necessitate a multidisciplinary approach involving clinical evaluation, imaging, and therapeutic interventions. Imaging features like ventricular debris on computed tomography (CT) and magnetic resonance imaging (MRI) aid diagnosis, supplemented by other modalities, such as nuclear scintigraphy. Cerebrospinal fluid analysis is crucial, highlighting increased leukocyte counts and commonly implicated pathogens like gram-negative organisms and Streptococcus species.  

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Traumatic Brain Injuries in Male Soccer Players 126 133 EN Uzair Yaqoob Department of Neurosurgery, Civil Hospital, SMBB Trauma Centre, Karachi, Pakistan. Roshan Dhakal Department of Internal Medicine, Nepal Medical College, Kathmandu, Nepal. Deeven Karki Department of Internal Medicine, Nepal Medical College, Kathmandu, Nepal. Sujha Ghimire Department of Internal Medicine, Nepal Medical College, Kathmandu, Nepal. Naveed Ahmed Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Tabeer Tanwir Awan Dow Institute of Physical Medicine and Rehabilitation, Karachi, Pakistan. Background and Aim: Traumatic brain injury (TBI) is a significant concern, often referred to as a "silent pandemic" due to its high prevalence and limited public awareness. This study explores TBIs in soccer, focusing on incidence, contact mechanisms, player positions, and the impact of injuries. Methods and Materials/Patients: The authors went through PubMed, Scopus, and Google Scholar databases. The publications from the last two decades were considered. This review evaluates various leagues, including the German Bundesliga, American Soccer League, and the English Premier League (EPL), to analyze TBI occurrences and associated symptoms. Results:  Concussions were the most common type of TBIs in soccer players. Head-to-head contact mechanism with an aerial challenge during play frequently causes a concussion. Defensive and midfield players were suffering from TBIs more because they are defined to perform more "distance headers". Dizziness and headache were the frequent symptoms seen in soccer players. Medical staff is suggested to make a precise and timely diagnosis of probable injury, with educating the members by the latest guidelines.  Conclusion: Early injury diagnosis is crucial, and everyone involved, including officials, coaches, players, and medical personnel, must be aware of this issue. More research is necessary to develop preventive measures and management strategies prioritizing player safety.  

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 A Rare Case of Spinal Intradural Neurenteric Cyst in a Septuagenarian Causing Acute Paraparesis 134 139 EN Binoy Damodar Thavara Department of Neurosurgery, Government Medical College, Kozhikode, India. Rajeev Mandaka Parambil Department of Neurosurgery, Government Medical College, Kozhikode, India. Byjo Valiyaveetil Jose Department of Neurosurgery, Government Medical College, Kozhikode, India. Umasankar Parol Department of Pathology, Government Medical College, Kozhikode, India. Prem kumar Sasi Department of Neurosurgery, Government Medical College, Kozhikode, India. Gorijavolu Sai Sree Krishna Department of Neurosurgery, Government Medical College, Kozhikode, India. Background and Importance: Neurenteric cysts (NCs) account for 0.7 to 1.3% of all spinal tumors and are most commonly present during the first three decades of life. Only two cases have been reported in individuals in their 7th and 8th decades of life. This study described a rare case of an NC in a septuagenarian (70 – 79 years of age) who presented with atypical features of the disease. Case Presentation: A 77-year-old female patient presented with acute onset paraparesis. Magnetic resonance imaging revealed a 13.6 × 14.1 × 15.4 mm intradural extramedullary cystic lesion, which was anteriorly located at the C7-D1 level. It was T1 hypointense, T2 hyperintense, and showed faint contrast enhancement at the junction between the cyst and the spinal cord. At surgery, a cyst with a greyish-white thin wall was noted in the spinal canal, displacing the spinal cord posteriorly. The cyst wall was partially excised, and a small portion adhering to the spinal cord was left behind. The histopathology report was consistent with an NC. At the 2-week follow-up, the patient’s lower limb strength had improved. Conclusion: Although rare, NCs can present in the seventh decade of life. Magnetic resonance imaging may reveal unusual findings, like T1 hypointensity and faint contrast enhancement of the cyst wall. In elderly patients, a portion of the cyst wall may be left behind if it adheres to the spinal cord to avoid the risk of neurological deterioration.  

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Bibliometric Analysis of Neurosurgery Education From 1962 to 2023 140 148 EN Mansour Deylami Department of Anesthesiology and Critical Care, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran. Maryam Ziyaei Department of Emergency Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Roohie Farzaneh Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Fateme Maleki Department of Emergency Medicine, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran Amin Dalili Department of Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Mehrdad Sayadinia Department of Surgery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Tayyebeh Zarei Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Navid Kalani Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran. Background and Aim: Evaluating our scientific trend and patterns in the education of neurosurgery can benefit in determining the needs and the future of the research path, therefore we performed a bibliometric analysis in the Web of Science (WoS) dataset. Methods and Materials/Patients: This was a bibliometric study of literature for studies on neurosurgery education. The WoS database was used for this study. The collected dataset was entered into the R shiny package of bibliometrics and was used for data analysis. Annual scientific production, citations, journals, and affiliation patterns were evaluated. Bradford’s and Lotka’s laws were used to interpret the patterns of contributions. Reference publication year spectroscopy (RPYS) was used to find source literature articles. Results: From 1962 to 2023, 1740 articles from 266 journals were included in this study. The annual growth rate of publishing neurosurgery education studies was 8.16%. “World neurosurgery” and “neurosurgery” journals with 441 articles (25.34%) were in zone 1 based on Bradford’s law, showing inequality in publishers of neurosurgery education studies. Also, Lotka’s law showed author productivity inequality, with most authors (approximately 75.5%) having only contributed a single article, while an Indian researcher has authored 28 articles as well as some other researchers with more than 20 articles. The USA led the way with 775 articles. Historical origins of research stemmed from studies about the virtual model of the temporal bone, the depiction of neurosurgery in cinematic genres, and a realistic neurosurgical simulator. Seminal neurosurgery education research has focused on anatomy education using imaging methods, informing later developments in simulated learning approaches. Based on the RPYS, seminal neurosurgery education research has focused on anatomy education like using imaging methods, which has contributed to later developments in simulated learning. Conclusion: Bibliometric analysis of neurosurgery education literature reveals increasing annual production, inequality in publishing, and author productivity, identified with the USA’s leading contributions and diverse research origins.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Thoracolumbar Extradural Arachnoid Cysts: Report of Two Adult Cases 149 156 EN Abolfazl Rahimizadeh Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran Walter Williamson The Office of Clinical Research (OCR), Baylor College of Medicine, Houston, USA. Zahed Malekmohammadi Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran. Shaghayegh Rahimizadeh Anderson Cancer Research Center, University of Texas, USA. Mahan Amirzadeh Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran. Mohsen Homae Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran. Sayed Ali Ahmadi Department of Pathology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Background and Aim: Extradural spinal arachnoid cysts are a rare compressive pathology of the spinal cord. They are believed to arise from congenital defects in the dura mater, with gradual enlargement occurring over time. The mainstay of treatment for spinal extradural arachnoid cysts (EDACs) consists of closing the minute dural defect or ostia through which the arachnoid layer has subsequently herniated. Exposure and ligation of the fistula tract at the ostia can then be achieved by utilizing either multilevel or single level laminectomy. Case Presentation: Two cases are presented herein that exhibited progressive weakness of the lower limbs. Magnetic resonance imaging in both patients displayed an extradural cystic mass at the thoracolumbar spine compatible with an extradural arachnoid cyst. In each case, following surgical excision of the arachnoid cyst, the corresponding ostia or tiny dural defect was securely closed with silk sutures. Postoperatively, neither patient reported any issues related to recovery during a six-month follow-up encounter. Conclusion: EDACs are rare, benign, but potentially debilitating causes of spinal cord compressions. The mainstay of treatment is the closure of the dural defect or ostia. If the radiological localization of the ostia can be identified preoperatively, selective closure of the ostia using a minimally invasive surgical procedure is the intervention of choice. Otherwise, closure of the dural defect will be possible following a multilevel laminectomy and total resection of the arachnoid cyst.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Predicting the Consistency of Meningiomas Preoperatively Using Magnetic Resonance Imaging 157 167 EN Seema Rohilla Department of Radiodiagnosis, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India. Shweta Yadav Department of Radiodiagnosis, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India. Ishwar Singh Department of Neurosurgery, Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India. Background and Aim: Knowledge of the consistency of meningioma is very helpful for neurosurgeons during surgery. Our study aimed to objectively demonstrate the effectiveness of the tumor/cerebellar peduncle T2-weighted imaging intensity (TCTI) ratio, diffusion tensor imaging (DTI), and magnetization transfer ratio (MTR) in predicting the consistency of meningiomas. Methods and Materials/Patients: Twenty-five patients with meningiomas were examined using three Tesla MR (Discovery 750 w with GEM Suite from GE, Milwaukee, WI, USA) imaging. T1W, T2W, T2W/FLAIR, DWI, DTI, and MT sequences were performed. Regions of interest (ROIs) were drawn on the tumor and cerebellar peduncle, and the TCTI ratio was calculated. Similarly, ROIs were drawn on magnetization transfer images (MT on and MT off images), and the magnetization transfer ratio (MTR) was calculated. DTI data were transferred to ReadyView software, on AWS server version 3.2, where ROIs were placed on the tumor, and fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were calculated. Tumor consistency was correlated with the TCTI ratio, FA, MD, AD, RD, and MTR. Results: Out of 25 meningiomas, nine were soft and 16 were firm. The Wilcoxon-Mann-Whitney U test comparing these groups was statistically significant only for the TCTI ratio. The mean TCTI ratio in firm meningiomas was 1.44, while in soft meningiomas it was 1.65. A single cutoff TCTI value of 1.5 for soft versus firm tumors was found to be 78% sensitive and 75% specific. There was no significant correlation between consistency and DTI parameters or MTR. Conclusion: The TCTI ratio showed a significant correlation with the consistency of meningiomas with fair sensitivity and specificity. However, MTR, FA, and mean, axial, and radial diffusivities failed to show a significant correlation with the consistency of meningioma.  

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 A Dangerous Acute Presentation of Hemorrhagic Meningioma 168 172 EN Hamidreza Doostabadi Department of Neurosurgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Mohammad Mahdi Talimkhani Department of Neurosurgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran Mahdi Arjipour Department of Neurosurgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran Background and Aim: Meningioma is one of the most common intracranial tumors. Its incidence rate is 37.6% of all primary brain tumors and 53.3% of benign tumors. Hemorrhagic meningioma is rare, with only 120 cases reported in the literature between 1980-2021. The most common type of hemorrhagic meningioma is acute subdural hematoma (SDH) and then intraparenchymal (IPH) (49 cases and 44 cases, respectively, approximately one case per year). The risk of rebleeding in this case is high (74%), therefore prompt surgical treatment is recommended. Case Presentation: The presenting case is a very rare hemorrhagic meningioma associated with SDH and IPH. A 69-year-old woman with a history of hypertension complained of severe and sudden headaches and mild confusion. He had no anticoagulant in her drugs. Brain computed tomography (CT) and magnetic resonance imaging (MRI) showed right frontoparietal meningioma with acute SDH and associated IPH with midline shift. The patient was operated and the tumor was resected, the hematoma was evacuated and then discharged in good condition. Conclusion: Each acute SDH and IPH is a rare presentation of meningiomas and their association as in this case is extremely rare. Due to the high risk of rebleeding in similar reported cases, prompt surgical treatment is recommended. A precise understanding of pathogenesis needs to be evaluated in these cases.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Trends in Traumatic Spine and Spinal Cord Injuries in Southeast Iran: A Ten-year Single-center Study 173 179 EN Seyed Danial Alizadeh Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran. Mohammad-Rasoul Jalalifar Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran. Soheil Mehmandoost HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Hamed Reihani-Kermani Department of Neurosurgery, Kerman University of Medical Sciences, Kerman, Iran. Background and Aim: Several studies have been conducted on traumatic spine and spinal cord injuries (SCI) in Iran. A paucity of them is focused on epidemiological trends. A ten-year single-center retrospective analysis was conducted to demonstrate epidemiological trends of traumatic spinal injuries (TSI). Methods and Materials/Patients: The study was conducted on 1494 spine-injured patients who were admitted to the main referral spine trauma center in southeast in Iran between 2013 to 2022. Descriptive statistics and multivariable logistic regression were used to examine the patient’s demographics, level of injury, leading causes, locations, and management. Results: Over 10 years, the male-to-female ratio remained consistent at 3.6:1. The Mean±SD of the age of patients was 37.5±15.7 years old. The prevalence of SCI was 23.2% and the odds of SCI increased by 5% over ten years and decreased by 2% with increasing age. The cervical injury (adjusted odds ratio [aOR]=2.84), thoracic injury (aOR=1.41), and age (aOR=0.98) were significantly associated with SCI. Car accident was the most common (36.2%) leading cause of spine injury and had 12% higher odds of SCI over ten years while occupants of pickup trucks, vans, and buses had a 7% decrease in SCI. Conclusion: This study highlighted that the SCI risk increased and car occupants had a higher risk of SCI over ten years. Therefore, preventive strategies to decrease traumatic spine and spinal cord injuries should be considered.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Tracheal Tube Cuff Pressure Measurement Methods in Lumbar Disc Surgery 180 187 EN Mohammad Sadegh Sanie Jahromi Department of Anesthesiology, Jahrom University of medical sciences, Jahrom, Iran. Meysam Zarei Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran. Lohrasb Taheri Department of Surgery, Jahrom University of Medical Sciences, Jahrom, Iran. Mansour Deylami Department of Anesthesiology and Critical Care, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran. Navid Kalani Department of Anesthesiology, Jahrom University of medical sciences, Jahrom, Iran. Background and Aim: Accurate tracheal tube cuff pressure measurement is crucial to prevent complications in patients undergoing mechanical ventilation. However, manual inflation methods, which are still commonly used in clinical practice, may lead to inaccurate cuff pressure measurements, compromising patient safety. Therefore, this study aims to compare the accuracy of manual and manometric methods for tracheal tube cuff pressure measurement in patients undergoing lumbar disc surgery in the prone position and to assess the safety implications of manual inflation methods. Methods and Materials/Patients: This prospective analytical descriptive study was conducted on 60 patients undergoing lumbar disc surgery in the prone position. Tracheal tube cuff pressure was initially recorded in the supine position using both the manual method and the manometric method. Following the prone positioning of the patient, the cuff pressure was immediately recorded and adjusted by manometry. Subsequent recordings were made every 15 minutes until the conclusion of the surgery, using only the manometric method. Data were analyzed using descriptive statistics, including mean and percentage, as well as relevant statistical tests, such as repeated measurement and analysis of variance (ANOVA) using SPSS software, version 16. Results: Significant differences were observed in tracheal tube cuff pressure measurements between the two instrumental (manometer) and manual methods in patients in the prone position (P<0.001). Tracheal tube cuff pressure, measured by both instrumental (manometer) and manual methods, exhibited significant differences at various time points (zero, 15 minutes, 30 minutes, 60 minutes, and 90 minutes) concerning body mass index in prone position patients (P<0.05). Additionally, a significant difference was observed in tracheal tube cuff pressure based on the duration of surgery (P<0.05), with the highest cuff pressure reported in patients with a surgical duration of 2 hours or more in the prone position. Conclusion: The study results showed that tracheal tube cuff pressure measured by the instrumental method (manometer) was consistently lower than that measured by the manual method in patients placed in the prone position. Therefore, the manual approach may cause safety issues for patients.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Serum Superoxide Dismutase as A Biomarker in Severe Traumatic Brain Injury: A Case-Control Study 188 195 EN Sharad Pandey Department of Neurosurgery , A.B.V.I.M.S. and Dr Ram Manohar Lohia Hospital, New Delhi Sourabh Chakraborty Department of Neurosurgery , A.B.V.I.M.S. and Dr Ram Manohar Lohia Hospital, New Delhi Pankaj Kumar Department of Neurosurgery , A.B.V.I.M.S. and Dr Ram Manohar Lohia Hospital, New Delhi Neera Sharma Department of Biochemistry, A.B.V.I.M.S. and Dr Ram Manohar Lohia Hospital, New Delhi L. N. Gupta Department of Neurosurgery , A.B.V.I.M.S. and Dr Ram Manohar Lohia Hospital, New Delhi Amol Mittal Department of Neurosurgery , A.B.V.I.M.S. and Dr Ram Manohar Lohia Hospital, New Delhi Achal Saxena Department of Neurosurgery , A.B.V.I.M.S. and Dr Ram Manohar Lohia Hospital, New Delhi Background and Aim: Traumatic Brain Injury (TBI) is often described as a “hidden epidemic.” Various biochemical markers reflecting cerebral damage can be used to correlate the patient's prognosis and the development of secondary lesions. We studied human Superoxide dismutase (SOD) in the serum to evaluate its role in the outcome of TBI. Methods and Materials/Patients:  This observational study was conducted in patients with severe TBI who presented to a tertiary care hospital in India. A total of 40 patients with severe TBI were enrolled, with 40 healthy people taken as controls. Serum samples were assayed for serum SOD using the ELISA technique. Results:  The most common age group was 28-37 years. Of 40 patients, 28 were male (70%), and 12 were female (30 %). The most common mode of injury was road traffic accident (70%), followed by fall from height (12.5%), physical assault (12.5%) and sports injury (5%). The most common CT finding was intra-cerebral haematoma (55%), followed by sub-arachnoid haemorrhage (SAH) (10 %), skull fracture (10 %), subdural haemorrhage (SDH) (7.5%) and extradural haemorrhage (EDH) (5%). The mean serum SOD value in the severe TBI group was 23.23 U/ml, and in the control group, it was 135.93 U/ml, which was statistically significant. Out of 40 patients, 24 (60%) had a good Glasgow Outcome Scale (GOS) at the time of discharge, and 16(40%) had poor outcomes. There was a significant improvement in outcome after six months compared to GOS at discharge. Conclusion: The results obtained in the study are preliminary, and more extensive prospective studies are needed to reach a definitive conclusion. A handful of studies on protein degradation products are available and need to be more comprehensive. In conclusion, with more extensive studies and continued exploration SOD can become a reliable tool in TBI and can be integrated into standard care protocols.  

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Effect of Hyperosmolar Combined Solution of Mannitol 15% Plus 3.5% NaCl Solution on Cerebral Edema in Patients With Traumatic Brain Injury 196 209 EN Temur Malik Murotov Department of Anesthesiology and Resuscitation, Tashkent Medical Academy, Tashkent, Uzbekistan. Background and Aim: Craniocerebral trauma is one of the vital public health problems and causes elevated intracranial pressure (ICP) and low cerebral perfusion pressure. Methods and Materials/Patients: In this work, 15% hyperosmolar solution colloid-mannitol and 3.5% crystalloid-sodium chloride (NaCl) were used simultaneously. Both have the same mechanism of action creating an osmotic gradient between the blood-brain barrier and brain tissue. In a single-center, randomized open clinical study, 35 patients were treated in the intensive care unit (ICU) with isolated traumatic brain injury aged 18 to 65 years with depression of consciousness (4-12 points on the Glasgow coma scale [GCS]), and abnormal computed tomography (CT) data of the head on admission. Results: The data demonstrated the positive effect of mannitol 15% + NaCl 3.5% on ICP and cerebral blood flow. At 20-25 minutes after administration of a bolus of mannitol 15% + NaCl 3.5%, ICP decreased (stage 2) below 20 mm Hg, reaching an average of 18.1±0.72 mm Hg, which was a 33.2% decrease from baseline. Conclusion: Combined use of mannitol 15% + NaCl 3.5% in the treatment of intracranial hypertension (ICH) in patients with isolated craniocerebral 3.5±0.2 mL/kg can be recommended in patients with baseline hypovolemia and hyponatremia.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Acute Management of Traumatic Intracranial Hematomas in Brazzaville City, Congo: A Study of 115 Cases From 2016 to 2021 210 218 EN Hugues Brieux Ekouele Mbaki Department of Doctoral Training, Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Congo. Danel Rolf Nofane Lani Department of Doctoral Training, Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Congo. Gédéon Colin Thouassa Department of Multipurpose Surgery, University Hospital of Brazzaville, Brazzaville, Congo. Marie Elombila Department of Doctoral Training, Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Congo. Olivier Brice Ngackosso Department of Multipurpose Surgery, University Hospital of Brazzaville, Brazzaville, Congo. Sinclair Brice Kinata Bambino Department of Doctoral Training, Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Congo. Leon Boukassa Department of Doctoral Training, Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Congo. Background and Aim: Traumatic brain injuries (TBI) are a significant global public health concern due to their impact on morbidity, mortality, and the economy. This study aims to describe the management of traumatic intracranial hematoma (TICH) during the acute phase in a neurosurgical environment at the Brazzaville University Hospital Center. Methods and Materials/Patients: This descriptive study was conducted for 6 years, from 2016 to 2021 in the Department of Multipurpose Surgery of the University Hospital Center of Brazzaville City, Congo. The research included all patients hospitalized for TICH; we used a comprehensive sampling method. The variables studied were socio-demographic, clinical, radiological, therapeutic, and outcome-related. Results: A total of 130 subjects were identified as having TICH in the acute phase, representing a frequency of 12.4%. In the 115 cases retained, 78 cases (67.8%) had an epidural hematoma (EDH), 24 cases (20.9%) had an acute subdural hematoma (ASDH) and 13 cases (11.3%) had intracerebral hematoma (ICeH). The median age was 30 years and the sex ratio of 56.5. The trauma was caused by a road traffic accident (RTA) in 93.9% of the cases. The mean Glasgow coma scale (GCS) on admission was 13±1. Surgery was performed in 31 patients, 29 cases for EDH and the remaining two for ASDH. Craniotomy with flap replacement was the technique employed in all patients undergoing surgery. The median interval between the occurrence of trauma and surgical intervention was 36 hours. The evolution was favorable in 110 patients (95.7%), and death occurred in three patients (2.6%). The postoperative mortality rate in our series was 6.4%. Conclusion: One out of four patients (27%) with TICH requires surgery. The latter is carried out within more than 24 hours, in a context of insufficient social coverage (health insurance).

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Subdural Hematoma Hidden by Acute Epidural Hematoma: The First Report of Two Cases 219 224 EN Vikrant Yadav Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. Nityanand Pandey Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. Ravi Shankar Prasad Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. Background and Importance: Epidural hematoma (EDH) and subdural hematoma (SDH) are intracranial emergencies and are extremely lethal if not treated promptly. The coexistence of both of these entities in a patient with traumatic brain injury (TBI) leads to a catastrophe of events. Occurrence of both EDH and SDH, on the same side after single trauma is extremely rare. Sometimes, the EDH volume compresses underlying SDH, which in turn leads to radiological obliteration of SDH, leading to misjudgment in surgical planning. Case Presentation: The authors present two cases of TBIs, in which patients were initially operated on EDH, but later, postoperative scans revealed SDH on the same side, which was not visible in preoperative scans. Identification of SDH in postoperative scans prompted a second surgery. Conclusion: EDHs and SDHs are fatal types of TBIs if left untreated. A large-sized hematoma needs surgical evacuation as early as possible. Intraoperative dural pulsation and bulge determine the decision for durotomy. In both index cases, delay in presentation, extent of primary brain injury, and radiological limitations in diagnosing both EDH and SDH leading to further delay in the complete evacuation of hematoma were the chief reasons for the poor prognosis. Through this article, the authors want to emphasize the fact that surgeons should consider this type of radiological phenomenon, which in turn is useful in maximizing the limited resources of hospitals and minimizing the surgical burden of the patients.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Rare Presentation of Pilocytic Astrocytoma in the Cerebellar Tonsils of an Adult: A Case Report 225 228 EN Bilal Bahadır Akbulut Department of Neurosurgery, Faculty of Medicine, Ege University, Izmir, Turkey. Mustafa Serdar Bölük Department of Neurosurgery, Faculty of Medicine, Ege University, Izmir, Turkey. Taşkın Yurtsevewn Department of Neurosurgery, Faculty of Medicine, Ege University, Izmir, Turkey. Hüseyin Biçeroğlu Department of Neurosurgery, Faculty of Medicine, Ege University, Izmir, Turkey. Background and Aim: Low-grade gliomas (LGGs) in the infratentorial region are rare in adults. Case Presentation: A 31-year-old man presented with a 2-year history of neck pain and progressive numbness in the face and left arm. Neurological examination upon admission revealed no cranial nerve involvement, motor or sensory deficits, or signs of cerebellar dysfunction. The patient’s medical history was unremarkable. Cranial magnetic resonance imaging (MRI) revealed a 2-cm T2 hyperintense lesion with focal cystic components in the right cerebellar tonsil, suggestive of a LGG. The lesion was surgically removed without any complications. Post-operative MRI showed total removal of the tumor. Histopathological analysis confirmed the lesion to be a pilocytic astrocytoma. No adjuvant therapy was given, and the patient is recurrence-free at 1-year follow-up. Conclusion: This case underlines the possibility of such rare diagnoses in adult patients and the effectiveness of the surgical treatment.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 The Relationship Between the Number of Blood Gauze Consumed and Hemoglobin Drop in Craniotomy Surgeries 229 238 EN Ali Ashraf Poursina Clinical Research Development Unit, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran. Shahrokh Yousefzadeh-Chabok Guilan Road Trauma Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran. Mehrnoosh Shakeri Boroujeni Poursina Clinical Research Development Unit, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran. Amirhossein Fahimi Poursina Clinical Research Development Unit, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran. Talat Kaviyani Jebeli Poursina Clinical Research Development Unit, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran. Habib Eslami kenarsari Vice-Chancellorship of Research and Technology, Guilan University of Medical Sciences, Rasht, Iran. Background and Aim: One of the common complications in craniotomy surgery is bleeding, which is associated with serious and sometimes life-threatening complications. It is essential to accurately estimate the amount of blood lost and compensate for it. This study was conducted to examine the relationship between suctioned blood volume, blood gauze volume, and hemoglobin (Hb) drop rate after craniotomy surgery and identify factors affecting it in hospitalized patients. The results of this research can help doctors accurately predict the amount of blood loss during the operation and avoid unnecessary blood transfusions. Methods and Materials/Patients: Ninety-seven patients with a history of craniotomy surgery in the first 6 months of 2019 were included in the study. The information on the patients was recorded based on laboratory documentation. To calculate the volume of blood lost during the operation, the volume of blood suctioned from the operation description sheet and the volume of blood absorbed by gauzes were calculated and recorded by weighing them. Data were analyzed with SPSS software, version 22. Results: In this study, 32% of patients received blood during craniotomy. According to the obtained results, the blood volume obtained from blood gauze and suctioned blood and the total blood volume were significantly related to Hb drop, and their ability to predict Hb drop were 6.6%, 14.1%, and 11.2%, respectively. Based on Spearman’s correlation coefficient, the intensity of the correlation between the number of blood gauzes and the amount of blood obtained from blood gauzes was greater than the change in the volume of blood sucked and the amount of total bleeding. Conclusion: This study showed that measuring the blood volume of gauze consumed in craniotomy surgery can be more effective in predicting the amount of blood loss and Hb drop of the patient after the operation even than the amount of suctioned blood.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Spinal Cord Injury and Neuroplasticity 249 256 EN Ashkan Asgari Gashtrodkhani School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Samaneh Ghorbani Shirkouhi School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran. Sasan Andalib Research Unit of Neurology, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. Background and Aim: Spinal cord injury (SCI) leads to sensory, motor, and autonomic dysfunctions and changes in different nerve fibers that can greatly impact the quality of life of many people. Neuroplasticity is a spontaneous mechanism of the nervous system to adapt to different molecular, physiological, and anatomical changes after SCI. Methods and Materials/Patients: A literature search of relevant articles was made with a focus on recent publications. Results: This narrative review first discusses the definition of neuroplasticity in the nervous system and cellular processes of neuroplasticity in the synapses and their effects on synaptogenesis and neuroplasticity. We describe some of the important central and spinal neuronal pathways and their role in voluntary movements and the regenerative capacity in neuroplasticity and functional recovery. Then this review focuses on the effects of exercise and training programs and different neuromodulation techniques using electrical stimulation (ES) on the development of neuroplasticity. These rehabilitation and neuromodulation techniques accelerate the release of some neurotrophic factors to enhance neuroplasticity and functional sensorimotor recovery. Conclusion: This narrative review emphasizes the importance and capability of neuroplasticity in improving functional recovery and quality of life of the people following SCI. It identifies that different physical rehabilitation and neuromodulation strategies induce significant improvements in sensorimotor recovery and underlines that the combination of rehabilitation and neuromodulation techniques provides greater functional outcomes. There is a need for further investigation using preclinical and clinical studies in the future that should concentrate on the basic molecular and cellular processes of neuroplasticity and investment in enhancing the rehabilitation and neuromodulation techniques and finding new techniques.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Gut-brain Axis Roles in Brain Tumors: Pathophysiological Insights and Research Advances 239 248 EN Arezoo Karimzadeh School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Shahrokh Yousefzadeh-Chabok Guilan Road Trauma Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran. Hossein Hemmati Department of General Surgery, Faculty of Medicine, Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran. Sasan Andalib Research Unit of Neurology, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. Background and Aim: This study reviewed the association between gut microbiota and primary brain malignancies, with a focus on underlying metabolic and immunologic mechanisms, and possible therapeutic approaches. Methods and Materials/Patients: A literature search was carried out for a narrative review related to the microbial components of the gut-brain axis (GBA) and their potential effects on brain tumors’ formation, growth, and course of treatment with a focus on recent publications. Results: Studies have highlighted likely mechanisms of the crosstalk between the gut and brain through an anatomical and physiological pathway, known as the GBA. Moreover, the metabolites and signaling molecules produced by gut microbiota were found to be involved in maintaining the blood-brain barrier (BBB) integrity and brain homeostasis. In addition, studies have revealed the potential negative effect of gut dysbiosis on tumorigenesis and deleterious inflammatory and immunological cascades within the brain. Pre-clinical and clinical investigations indicated the role of modulation of gut microbiome in brain tumors. Conclusion: Previous investigations on interactions between gut microbiome and central nervous system (CNS) have revealed potential pathways through which interventions on microbiota can regulate brain tumor epigenetics and microenvironment. The findings on modifying microbiota utilizing probiotics, fecal microbial transplantation, and supplemented dietary regimen were promising; nonetheless, further investigation is needed to translate these findings into clinical brain cancer treatment applications.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 10 Continuous Publishing 2024 1 1 Impact of Age on Neurosurgical Outcomes and Complications in Intracranial Meningioma 257 264 EN Mahsa Pakseresht Mogharab Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Hamid Behzadnia Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Babak Alijani Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Zoheir Reihanian Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Sasan Andalib Research Unit of Neurology, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. Background and Aim: Despite advancements in neuroimaging and surgical techniques, the management of meningioma in older patients remains challenging. In this study, we aimed to compare the impact of age on complications and outcomes of surgical resection of intracranial meningioma. Methods and Materials/Patients: This retrospective cohort used medical records of 62 patients with confirmed intracranial meningioma who underwent surgical removal including 31 patients aged 18 to 65 (group 1) and 31 patients aged 65 and older (group 2). Demographic data along with discharge and six-month post-surgery Glasgow Outcome Scale (GOS) scores and complications were collected and compared between the two groups. Results: Group 1 included 8(42.11%) males and 23(53.49%) females with a mean age of 44.39±6.44 years. Group 2 had 11(57.89%) males and 20(46.51%) females with a mean age of 68.65±4.54 years. The discharge and overall six-month mortality rate were 0% in group 1 and 6.45% in group 2. Unfavorable outcomes (GOS scores of 2 and 3) were seen in 1(3.23%) of the younger and 1(3.45%) of the older groups. The prevalence of the recorded postoperative complications was 9.68% (peritumoral edema), 8% (cerebral hemorrhage), and 4.84% (wound infection) of the participants. There was no statistical difference between the study groups concerning postoperative mortality rate, outcomes, or complications. Conclusion: Our results suggest that age does not increase the incidence of mortality, unfavorable outcomes, or surgical complications following meningioma removal. Regardless of age, proper patient selection for meningioma surgery may lead to favorable outcomes.