1 2423-6497 Neurolosurgical Society of Iran 9 Gamma Knife Radiosurgery Pharmacotherapy to Improve the Acquired Aphasia following Brain Damages: A Review Study Ramezani Sarah b Reihanian Zoheir c Yousefzadeh-Chabok Shahrokh d Sarraf-Razavi Mehdie e b Ph.D Candidate, Neuroscience Department, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran. c MD, Resident of Neurosurgery, Neurosurgery Department, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran. d MD, Professor of Neurosurgery, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran. e Ph.D Candidate, Neuroscience Department, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran. 1 12 2015 1 2 10 16 23 07 2016 05 01 2017 Background & Aim: Using pharmaceutical agents in treatment of aphasia has caught the attention of many neurologists and neuroscientists. This short review study has sought the role of pharmacotherapy in treatment of aphasia, a linguistic impairment after acquired brain lesions. The pharmacological principles and mechanisms related to the effects of drugs used in aphasia rehabilitation are pointed. Then, some evidence of clinical trials on different drugs in this field is presented. Methods & Materials/Patients: A comprehensive search in databases including MEDLINE, Cochrane, PubMed, Scopus, EMBASE, Science Direct on experimental studies and clinical trials associated with pharmacotherapy of aphasia after neurological damages was performed. Results: Pharmacological interventions through manipulating neurochemical levels in synapses, the pre- and post-synaptic spaces and even inside neurons start to modulate the disturbed balance of neurotransmitters due to brain lesions. Pharmacotherapy is based on the principle that drugs via balancing the molecular signaling cascades triggered due to neuronal damage can restore the function of neurons, facilitate the brain plasticity process and improve the linguistic deficits in aphasic patients. Among the drugs that have been studied in treatment of aphasia, those acting on central cholinergic and glutamergic systems were more effective and led to better clinical outcomes. Conclusion: Although existing evidence has proved the pivotal role of pharmacotherapy in treatment of aphasia after acquired brain lesions in adults, further research is required to assure the clinicians in using pharmacotherapy as a standard approach in treatment of aphasia.
10 Gamma Knife Radiosurgery Effect of Intravenous Injection of Erythropoietinon Hospitalization Period in Patients with Acute Spinal Cord Trauma Meshkini Ali f Salehpour Firooz g Pourhajshokr Nasrin h Samadi Mothagh Parviz i Ghojazadeh Morteza j f Professor of Neurosurgery, Neuroscience Research Center (NSRC), Department of Neurosurgery, Imam Reza Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, East Azarbaijan, Iran g Professor of Neurosurgery, Department of Neurosurgery, Imam Reza Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, East Azarbaijan, Iran h Resident of Neurosurgery, Department of Neurosurgery, Imam Reza Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, East Azarbaijan, Iran i Assistant Professor of Neurosurgery, Department of Neurosurgery, Imam Reza Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, East Azarbaijan, Iran j Associate Professor, RDCC, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, East Azarbaijan, Iran 1 12 2015 1 2 17 21 23 07 2016 05 01 2017 Background & Aim: Spinal cord injury (SCI) has a very long history, and its cases form a large proportion of patients admitted to trauma centers in Iran. Studies show that repair after spinal cord injury can be done. In fact, many pharmaceutical agents, such as erythropoietin (EPO), are applied to reduce secondary injury following the initial disorder and to maintain the nerve tissue. Methods & Materials/Patients: In this clinical trial, 60 patients with acute spinal cord injury classified as A to C according to Frankel classification grading system were selected and matched with regard to the Frankel classes, the cervical and dorsal levels and then divided into two groups A and B (each containing 30 patients). Group A, in addition to receive conventional treatment, took EPO and was evaluated in terms of hospitalization period outcomes (mean length of stay, lower extremity thrombosis, intubation, bedsores) and was compared with group B (receiving conventional medicines, such as methylprednisolone). Results: Of the 60 patients, 15 patients were female and 45 were male, with the age range of 19-72 years. The mean length of stay in the case and control group was 10.6±6.52 and 13.8±10.37 days, respectively. Six patients died during hospitalization, including three patients in the case group and three patients in the control group. 12 patients were intubated during this period, including five patients in the case group and seven patients in the control group. Of the 29 patients with bedsores, 14 patients were in the case group and 15 patients were in the control group. None of the patients had lower extremity venous thrombosis during hospitalization. Conclusion: No significant difference was found between the case and control group in the hospital stay length, intubation, bedsores and lower extremities venous thrombosis. 11 Gamma Knife Radiosurgery Curb the Pain of Spondylolisthesis; Comparing Posterolateral Fusion with Posterior Lumbar Interbody Fusion Alijani Babak k Emamhadi Mohammadreza l Behzadnia Hamid m Azar Maziar n Kazemnejad-Leili Ehsan o Yousefzadeh-Chabok Shahrokh p Razzaghi Alireza Aramnia Ali k MD, Assistant Professor of Neurosurgery, Neurosurgery Department, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran l MD, Associate Professor of Neurosurgery, Neurosurgery Department, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran m MD, Assistant Professor of Neurosurgery, Neurosurgery Department, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran n MD, Associate Professor of Neurosurgery, Neurosurgery Department, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran o Ph.D, Associate Professor of Biostatistics, Guilan University of Medical Sciences, Rasht, Guilan, Iran p M.D, Professor of Neurosurgery, Guilan Road Trauma Research Center, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran MSc in Epidemiology, Guilan Road Trauma Research Center, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran MD, Chief Resident of Neurosurgery, Neurosurgery Department, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran 1 12 2015 1 2 22 26 23 07 2016 05 01 2017 Background & Aim: The purpose of this study was to evaluate and compare the pain of patients with spondylolisthesis who had undergone either of the surgery techniques: posterolateral fusion (PLF) or posterior lumbar interbody fusion (PLIF). Methods & Materials/Patients: In a prospective observational study, 102 surgical candidates with low grade degenerative and isthmic spondylolisthesis were enrolled from 2012 to 2014. The observed patients were into two groups: PLF and PLIF. Assessing of pain has been done by a questionnaire using Visual Analogue Scale (VAS) scores. The questionnaire was completed by all patients before surgery, the day after surgery, after six months and after one year. Results: There were no statistically significant differences in terms of age and sex distribution, type of spondylolisthesis and pre-operation pain between groups (p>0.05). Comparison of the mean VAS scores of two groups over the whole study period showed a significant statistical difference (p-value<0.05), although comparison of VAS at three points in time showed a mixed result. VAS scores showed no significant differences between two groups before surgery, the day after surgery and one year after surgery (p>0.05), but the difference of mean VAS scores between groups 6 months after surgery was statistically significant (p<0.05). Analyzing the course of VAS scores over the study period showed a descending pattern for either of the groups (p<0.0001). Conclusion: Both surgical fusion techniques (PLF & PLIF) showed to be effective in treating low grade degenerative and isthmic spondylolisthesis, but PLIF was related to better outcome with respect to pain control. 12 Gamma Knife Radiosurgery Comparison of Prooxidant-antioxidant Balance between Patients with High Grade Gliomas (IV) and Control Group Farajirad Elnaz Ghaemi Kazem Khajavi Mehdi Hamidi Alamdari Daryoush Hassan Arjmand Mohammad Farajirad Mohammad Head of Ghaem Health Center, Mashhad University of Medical Sciences, Mashhad, Iran. Associate Professor of Neurosurgery, Head of Neurosurgery Department, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran. Resident of Neurosurgery, Neurosurgery Department, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Stem Cell and Regenerative Medicine Research Group, Biochemistry & Nutrition Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Master of Biochemistry, Surgery Department, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Professor of Neurosurgery, Head of Neurosurgery Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 1 12 2015 1 2 27 30 23 07 2016 05 01 2017 Background & Aim: The most common primary brain tumors of the central nervous system are gliomas. Among a number of different biomolecular events, a strong relation between oxidative stress pathways and the development of this cancer has been proved. Oxidative stress (OS) is the consequence of an imbalance between pro-oxidants and antioxidants towards pro-oxidants. The pro-oxidants cause lipid peroxidation of cell membranes, protein, DNA oxidation and changes in brain cell growth. In this study, the pro-oxidant–antioxidant balance (PAB) was determined in patients with gliomas. Methods & Materials/Patients: Sera of 49 patients with high grade glioma (grade IV WHO) which is called glioblastoma multiform (GBM) and 49 healthy subjects were collected and PAB test was measured. Results: A significant increase of PAB value was observed in patients with GBM (158.10±85.71 HK unit) in comparison to control group (74.54±33.54 HK). Conclusion: The PAB assay showed the oxidative stress in glioblastoma. In further research, this easy elucidation of oxidative stress in these patients can be applied to evaluate the effectiveness of antioxidant therapies in patients with GBM.Keywords: Prooxidant-antioxidant; Balance; High 13 Treatment and Outcome of Chronic Subdural Hematoma in Sub-Saharan Africa and the Country of Benin Hode Luphin Kisito Quenum O. Fatigba Holden Fanou Lionelle G. S. Lansdale Henderson Neurosurgeon, Emergency Service, National University Hospital Center Hubert Koutoukou Manga of Cotonou, Africa Neurosurgeon, Unit of Neurosurgery, Army Training Hospital of Cotonou, Africa Neurosurgeon, Unit of neurosurgery, Departmental Teaching Hospital of Borgou/Alibori, Benin, Africa Neurosurgeon, Unit of Neurosurgery, Army Training Hospital of Cotonou, Africa Graduate Institute, St. John's College, Annapolis, US 1 12 2015 1 2 31 35 23 07 2016 11 01 2017 Background & Aim: Chronic subdural hematoma (CSDH) is a common neurosurgical pathology. The objective of this study was to describe the epidemiology of this pathology and the results in treating it combined from three hospital centers in Benin. Methods & Materials/Patients: From September 2010 to September 2013 a multi-center, retrospective and descriptive study was conducted in three hospital centers in Benin. Inventory was taken of all patients in whom CSDH was diagnosed. Patients were evaluated according to Markwalder classification. All patients received a brain scan. The variables studied include demographic and clinical characteristics, therapeutic modalities and post-operative follow-up. Results: 104 consecutive patients with CSDH were included in the study. The mean age was 49.66, but ranged from six months to 87 years. The M:F sex ratio was 5.11/1. Prior cranial trauma had occurred in 81 patients (77%). Pre-operative neurological Grades 1 or 2 were observed in 56.4% of cases. Surgical treatment was given to 100 patients (96.15%). Events surrounding the surgery were straightforward and results satisfactory in 94% of cases. No relapses were observed. The morbidity was 4% and the mortality among surgical patients was 3%. Conclusion: CSDH is frequently treated in the country of Benin. The mean age of patients is lower than that observed in global literature, and patients are predominantly male. Regardless of the patient condition upon hospital admission, post-operative results compare favorably with the literature. 14 Gamma Knife Radiosurgery Investigation of Surgery Characteristics in Patients with Spondylolisthesis, Rasht, Iran from 2006 to 2011 Yousefzadeh-Chabok Shahrokh Kazemnejad-Leili Ehsan Khatami Seyed-Morteza Kouchakinejad-Eramsadati Leila Alijani Babak MD, Professor of Neurosurgery, Guilan Road Trauma Research Center, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran PhD, Associate Professor of Biostatistics, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran MD, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran BSc in Nursing, MA in Human Resource Management, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran MD, Assistant Professor of Neurosurgery, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran 1 12 2015 1 2 36 39 23 07 2016 05 01 2017 Background & Aim: Spondylolisthesis is a visible deformity in lumbosacral region with vertebral slip and fracture or other deformities of pars interarticularis. This study aims at investigating the characteristics of spondylolisthesis surgery in operated patients. Methods & Materials/Patients: This is a retrospective study which included all the patients who had undergone spondylolisthesis surgery by one same surgeon from 2006 to 2011. Demographic characteristics such as age, gender, and surgery information including type of spondylolisthesis, incision site, laminectomy site, foraminotomy site, fixation site of vertebra and site of vertebral disc evacuation were collected. The data were analyzed using SPSS (Version16). Results: 52 of 63 enrolled patients were women (82.5%) and 11 men (17.5%) with mean age of 49.6 years. Based on frequency, spondylolisthesis types were 60 degenerative (95.2%), 2 post-surgical (3.2%) and 1 post-traumatic (1.6%), respectively. 58 patients had spondylolisthesis only in one vertebra and 5 patients in two vertebrae. The total number of slipped vertebrae was 68, in which slip was seen in L3, L4 or L5 vertebrae. In 42 patients, laminectomy was performed only in one vertebra, in 19 patients in two vertebrae, in 1 patient in three vertebrae and in 1 patient in five vertebrae. The total number of vertebrae with foraminotomy was 106. The highest frequency of foraminotomy was seen in L5, L4, and S1 vertebrae, respectively. Except in one case, the rest 62 patients underwent fixation surgery in two or three vertebrae. Conclusion: Based on the results, the frequency of spondylolisthesis was approximately five times in women compared to men. The most common type was degenerative spondylolisthesis. Type of surgery was fixation with pedicle screw and fusion. 15 Gamma Knife Radiosurgery The Role of Surgical Treatment in Traumatic Subdural Hygroma: A Pilot Study Yousefzadeh-Chabok Sharhokh Hosseinpour Marieh Mohtasham-Amiri Zahra Kazemnejad-Leili Ehsan Alijani Babak MD, Professor of Neurosurgery, Neurosurgery Department, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran MSc in Physiology, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran MD, Professor of Social Medicine, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran Ph.D, Associate Professor of Biostatistics, Guilan University of Medical Sciences, Rasht, Guilan, Iran M.D, Assistant Professor of Neurosurgery, Guilan Road Trauma Research Center, Department of Neurosurgery, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran 1 12 2015 1 2 40 43 23 07 2016 05 01 2017 Background and Aim: Traumatic subdural hygroma is the accumulation of CSF (cerebrospinal fluid) in subdural space following head trauma. The mass effect of hygroma on brain can impinge on consciousness. There are still many ambiguities on indications of hygroma surgery. This is an 11-year follow-up study which involves the patients suffering traumatic subdural hygroma who underwent surgery. Methods & Materials/Patients: In this retrospective study, clinical records of 16 patients who were operated due to traumatic subdural hygroma were studied. The data from existing records in the hospital were collected and analyzed. They were then analyzed by Repeated Measures ANOVA using SPSS (Version 18). The differences were considered statistically significant at P≤0.05. Results: In this study, there were 13 men (81.3%) and 3 women (18.7%) (Mean age=62 years old). In 87.75% of patients, hygroma was diagnosed 6 days after head injury. It wasunilateral in majority of patients (56.3%) and located in fronto-parietal area (81.3%). The most frequent concomitant injuries were contusions (25%) and subarachnoid hemorrhage (18.8%), respectively. GCS trend on admission and at discharge was significantly different fromthat of hygroma formation (P<0.05). One-fourth of patients had recurrence of hygroma after surgery. All patients (except one) had good outcome. Conclusion: Subdural hygroma is a delayed lesion and surgical treatment improves the level of consciousness (LOC) in afflicted patients. 16 Gamma Knife Radiosurgery Report of a Case: An Intradural between Roots Capillary Hemangioma of Cauda Equina Rahmanian Abdolkarim Ashraf Mohammad Hossein Owji Sayed Mohammad MD, Associate Professor of Neurosurgery, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran MD, Resident of Neurosurgery, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran MD, Associate Professor of Pathology, Department of Pathology,Shiraz University of Medical Sciences, Shiraz, Iran 1 12 2015 1 2 44 46 23 07 2016 05 01 2017 Background & Importance: Cavernous angiomas are typically superficial lesionscreated by anomalous vessels and found in the skin or mucosa, but intradural locations are rare especially in the spine. We report a case of the spinal intradural Cavernous angiomas of the lumbar spine. Case Presentation: A 53-year-old man presented with a 6-month history of low back pain and bilateral radicular pain. In examinations, the patient was shown to have numbness in the anterior aspect of the right thigh in L2 territoryand a decrease in lower limb tendon reflexes. Magnetic resonance imaging (MRI) revealed at L1-L2 level, a well-defined intradural lesion in conusmedularis measuring about 18*12mm that shows high signal intensity in T1 images and low signal intensity in T2 images, which causes compression on the cauda roots. Laminectomy of L1-2 was performedfor tumor removal and intradural exploration revealed a small oval shape, brownish cystic like mass surrounded by adherent nerve roots. Complete removal of this tumor was accomplished. Histologic diagnosis wascapillary hemangioma. After operation, the patient’s symptoms were improved. Conclusion: We experienced and reported a rare spinal intradural vascular tumor of the lumbar spine. Histologicdiagnosis was Cavernous angiomas.