Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 2 3 2016 12 1 Editorial: What Is Brain Mapping? 6 7 EN Babak Kateb M.D. Scientific Director & Chief Strategy Officer (CSO), California Neurosurgical Institute, Los Angeles, CA G20 World Brain Mapping Initiative (Neuroscience/N-20) is Putting Brain Mapping on the top of Global Economic Issues The Society for Brain Mapping, Therapeutics, and Brain Mapping Foundation are propelling therapeutic advances in Nano-Neurosurgery, Nano-Bio-Electronics, Artificial Intelligence, Neuro-Supercomputing and ‘cross-pollination’ among the bio-medical sciences and engineering worldwide. “Think of Brain Mapping as a google map, the snapshot of earth being equivalent of the MRI. Now zoom down to the cities, which represents a Functional MRI, then zoom on the roads, which represent brain connectomics. If you zoom down further, you will see the cars, which represent brain cells and people in the car represent brain genomics and nanoscale structures” explains Dr. Babak Kateb, Founding Chairman of the Board of SBMT, Scientific Director of California Neurosurgical Institute.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 2 3 2016 12 1 Role of Tranexamic Acid in Treatment of Patients with Epidural Hematoma 8 10 EN Parviz Samadi-Motlagh Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran Mohammad Shimia Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran Moslem Shakeri Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran Azad Mohammadzadeh Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran Firooz Salehpour Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran Atta Mahdkhah Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran Farhad Mirzaiee Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran Introduction: Traumatic brain injury is considered as the major cause of mortality and hospitalization of about ten million people across the globe. Most of these patients are young and active people suffering disabilities. Tranexamic acid therapy is commonly used to reduce blood loss and need for blood transfusions in surgical cases. This study aimed at investigating the effect of tranexamic acid drug in patients with epidural hematoma. Methods &Materials/Patients: In a clinical trial study, 100 patients with acute epidural hematoma diagnosed with traumatic brain injury were enrolled. The patients in two groups were matched for age and sex. We treated 50 patients with tranexamic acid drug that were compared with 50 patients in the control group. Hematoma size variations (diameter and volume) between the two groups were studied. Results: We studied 100 patients with traumatic brain injury with a mean age of 34.2 ± 7.9. Of the patients, 69% were male, and 31% were female. Hematoma occurrence rate was 33%, 39%, and 28% in parietal, frontal, and temporal region, respectively. Hematoma diameter was 3.71 ± 1.8 mm after treatment with tranexamic acid, and 4.03 ± 1.6 mm in the control group. There was no statistically significant difference between the two groups. The volume of hematoma was 8.04 ± 3.2 cc in patients treated with tranexamic acid, and 10.4 ± 3.7 cc in the control group. There was statistically significant difference between the two groups. Conclusion: According to our study, tranexamic acid drug can be effective on bleeding control in patients with acute epidural hematoma. The role of these drugs in elective surgeries has been proven. In cases of brain trauma, they can be useful and improve the prognosis of patients.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 2 3 2016 12 1 Concomitance of Obesity and Overweight with Disc Height and Disc Herniation in Lumbar Spine 11 14 EN Sima Falah Arzpeyma Assistant Professor, Radiology Department, Guilan University of Medical Sciences, Rasht, Guilan, Iran Gholamreza Mahfoozi Assistant Professor, Statistician, Department of Management, University of Guilan, Rasht, Guilan, Iran Parisa Sedighi Moghadam Pour Radiologist, Guilan University of Medical Sciences, Rasht, Guilan, Iran Background & Aim: Low back pain is the most debilitating condition, and can lead to decreased physical function, compromised quality of life, and psychological distress. Several studies have been conducted to recognize the risk factors of low back pain, but despite of strong relationship between obesity and low back pain, the underlying mechanisms are unclear. The aim of this study was to evaluate the association between obesity/overweight and disc height and disc bulging at each level and total levels in lumbar vertebra, considering occupational risk factors. Methods & Materials/Patients: This is a cross-sectional study on 102 patients with low back pain referring to MRI department in Poursina hospital in Rasht. Body mass index (kg/m2) categories modified for Asian populations based on World Health Organization guidelines were used. Disc height and disc herniation were evaluated in sagittal T1, sagittal T2 and axial T2 MRI images. We used four risk factors agreed by US-NIOSH (USA-National Institute for Occupational Safety and Health), to evaluate the occupational risk factors. Regression test was used for statistical analysis. Results: Of the 102 patients, 36.3% were men and 63.7% were women. The age range was 15 to 75 years. Results showed that 26.5% of patients had normal body mass index, 39.2% were overweight and 34.3% were obese. Low, moderate, and high level of occupational risk factors were distributed as 36.3%, 17.6%, and 46.1%, respectively. Analysis with regression test showed that the relationship between obesity and overweight and disc height was negative at total levels and all levels, unless L5-S1. At L5-S1 level, there was no association. There was a positive relationship between obesity and total score of disc herniation at L1-S1. There was no association between overweight and total score at this level. At L1-L2, L2-L3 and L5-S1, there were no association between obesity and overweight and disc herniation, and at L3-L4 and L4-L5, there were negative relationships between obesity and disc herniation. Conclusion: Our study noted the positive and significant association between obesity/overweight and disc degenerative changes in lumbar spine. Since there is abundant evidence in the literature demonstrating the strong association of disc degeneration on MRI with low back pain, prevention and treatment of being overweight or obese must be a public health priority. 

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 2 3 2016 12 1 The Effects of Posterior Spinal Fusion in Patients with Limitations of Anterior Approach: The Experience of Six Cases 15 18 EN Hojjat Hossein Pourfeizi Associate Professor of Orthopedic Surgery, Department of Orthopedics Surgery, Faculty of Medicine, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran Ali Sadighi Professor of Orthopedic Surgery, Department of Orthopedics Surgery, Faculty of Medicine, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran Alireza Sadeghpour Associate Professor of Orthopedic Surgery, Department of Orthopedics Surgery, Faculty of Medicine, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran Bahamin Attar Orthopedic Surgery Resident, Department of Orthopedics Surgery, Faculty of Medicine, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran Zahra Azizian Dermatology Resident, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Background & Importance: Spinal deformity is one of the most common disorders among the vertebral diseases that results from unnatural curvatures of spine, such as scoliosis and kyphosis. Spinal fusion surgery is used most commonly to treat certain types of spinal deformity. Herein, we reported the efficacy of posterior spinal fusion accompanied by instrumentation in patients with the limitations of the anterior approach. Case Presentation: This case series study included six patients. There were three cases of severe gibbus deformities, a case of kyphosis deformity and two cases of both kyphosis and scoliosis. Two cases of gibbus deformities had undergone spinal fusion with instrumentation, and relatively satisfactory correction was observed for both patients. One patient, who had been treated with posterior decompression and fixation, returned to leading his normal active life. One case of severe deformities had no dynamic problems four years after receiving the instrumentation surgery. Conclusion: The outcomes of posterior spinal fusion surgery were found to be satisfactory in patients with the limitations of the anterior approach.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 2 3 2016 12 1 Iniencephaly with Long Survival: A Rare Condition 19 21 EN Souad Bakhti Professor, Pediatric Neurosurgery Division, Mustapha Pacha University Hospital, Algiers, Algeria Nabila Tighilt Assistant Professor, Pediatric Neurosurgery Division, Mustapha Pacha University Hospital, Algiers, Algeria Wahiba Khoudir Consultant in Neurosurgery, Department of Neurosurgery, Mustapha Pacha University Hospital, Algiers, Algeria Mohamed Djennas Professor, Chief Department of Neurosurgery, Mustapha Pacha University Hospital, Algiers, Algeria Background & Importance: Iniencephaly is a rare cranio-cervical deformity. It belongs to neural tube defects. This disorder is characterized by a retroflexion of head, a very short neck, varying degrees of incomplete posterior closure of vertebrae and cervical and thoracic spinal synostosis. This malformation is associated with central nervous system and systemic malformations. Most of patients are dead born and others die after few hours of life. There are only few long-term survivors reported in literature. Case Presentation: A seven-year-old girl with iniencephaly signs who has been managed conservatively and still alive after six years of follow-up. Conclusion: Iniencephaly is a rare complexe disorder with a dismal prognosis but not uniformly fatal.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 2 3 2016 12 1 Chronic Subdural Hematoma after Lumboperitoneal Shunt Replacement: A Case Report From Iran 22 25 EN Hossein Ghalaenovi Assistant Professor of Neurosurgery, Department of Neurological Surgery, Rasool Akram Complex, Iran University of Medical Sciences, Tehran, Iran Maziar Azar Associate Professor of Neurosurgery, Department of Neurological Surgery, Rasool Akram Complex, Iran University of Medical Sciences, Tehran, Iran Hessam Rahatlou Resident of Neurosurgery, Department of Neurological Surgery, Rasool Akram Complex, Iran University of Medical Sciences, Tehran, Iran Shahrzad Astaraki Neurosurgeon, Rasool Akram Complex, Iran University of Medical Sciences, Tehran, Iran Background and Importance: Lumboperitoneal shunts are commonly used to treat several conditions, but their use can result in significant complications. We discuss a complication of these shunts that has not been reported in the literature to date. Case Presentation: An obese, 41-year-old woman admitted to Rasool Akram Hospital complaining of a severe headache and blurred vision. The physical examination indicated that she had papilledema, and a lumbar puncture demonstrated cerebrospinal fluid opening pressure of 33 cm of H2O. Pseudotumor Cerebri was diagnosed, and the patient underwent surgery to insert a lumboperitoneal (LP) shunt. She suffered from severe headaches and nausea during the post-operative period. The post-operative syndrome was misdiagnosed as shunt-induced cerebellar tonsillar ptosis; however, further evaluation indicated that intracranial chronic subdural hematoma, a very rare complication subsequent to lumboperitoneal shunting, was the cause of the post-operative syndrome. Subdural hematoma was evacuated and her symptoms disappeared thereafter.  Conclusion: Persistent symptoms, such as headache, nausea, and vomiting, after placement of a lumboperitoneal shunt should be taken serious, and imaging, such as a CT of the brain, should be done to rule out subdural hematoma.

Neurolosurgical Society of Iran Iranian Journal of Neurosurgery 2423-6497 2 3 2016 12 1 Huge Sequestered Spinal Disc Mimicking Spinal Intradural Tumor 26 28 EN Guive Sharifi Associate Professor, Shahid Beheshti University of Medical Sciences, Loghman Hakim Hospital, Tehran, Iran Ehsan Alimohammadi Resident of Neurosurgery, Shahid Beheshti University of Medical Sciences, Loghman Hakim Hospital, Tehran, Iran Kaveh Ebrahimzadeh Assistant Professor of Neurosurgery, Shahid Beheshti University of Medical Sciences, Loghman Hakim Hospital, Tehran, Iran Karim Moradian Resident of Neurosurgery, Shahid Beheshti University of Medical Sciences, Loghman Hakim Hospital, Tehran, Iran Omidvar Rezaei Professor of Neurosurgery, Shahid Beheshti University of Medical Sciences, Loghman Hakim Hospital, Tehran, Iran Background and Importance: Disk sequestration can be defined as a herniated disk with perforation of the fibrous ring (or outermost annulus fibrosus) and posterior longitudinal ligament with migration of the disk fragment to the epidural space. Even after the introduction of high-resolution magnetic resonance imaging (MRI), it is still frequently misinterpreted as neoplastic masses. Unfortunately, no particular symptoms or signs are also known to allow differentiation between atypical hernias and spinal tumors. Case Presentation: This study describes a rare case of a huge herniated and sequestrated disc, which is misinterpreted as a spinal tumor on the radiological report. Conclusion: MRI findings are useful in the preoperative diagnosis of disc herniation. The differential diagnosis includes not only metastatic lesions but also some other benign epidural lesions such as synovial cysts, hematomas, and abscesses.