Comparing Quality of Life Before and After Surgery in Patients with Cushing Disease: A Before-After Study

Introduction: Cushing disease is a rare problem that usually has an important effect on the quality of life (QoL). Objective: This survey aimed to evaluate patients’ QoL and determine predictors of improving QoL scores in patients. Materials and Methods: In this before-after study, basic characteristics were collected from 56 patients with Cushing disease who underwent endoscopic transsphenoidal surgery, and their QoL score during one year was assessed. Finally, predictor factors of QoL score improvement were identified. To compare the QoL scores before, 6 months, and 12 months after surgery, repeated measures ANOVA and for determining predictors of QoL score improvement, multivariable logistic regression analysis was used. P<0.05 was considered significant in all tests. Results: The mean±SD age of the samples was 33.92±12.82 years, and 43 (76.8%) were female. In all 56 patients who underwent endoscopic transsphenoidal surgery, the QoL score significantly improved. In multivariable logistic regression analysis, weight loss (OR= 1.2, 95% CI; 1.01-6.5, P=0.01), no fatigue (OR= 2.1, 95%CI; 1.6-8.3, P=0.009), no decreased libido (OR= 1.5, 95% CI; 1.2-10.62, P=0.01), no gonadal axis disorder (OR=2.2, 95% CI; 1.07-4.06, P=0.01) and post-operation no thyroid axis disorder (OR=2.5, 95% CI; 1.8-5.7, P=0.01) were predictors for more QoL score improvement. Conclusion: According to the results of this study, many factors can affect the quality of life in patients with Cushing disease. Therefore, support groups should include the cooperation of physicians and psychologists, provision of health services, and social support to improve the QoL of patients.

An interrupted time series analysis of hospital admissions due to alcohol intoxication during the COVID-19 pandemic in Tehran, Iran

The COVID-19 outbreak affected mental health globally. One of the major concerns following the COVID-19 pandemic was increased incidence of risky behaviors including alcohol consumption. This study evaluates the trend of alcohol poisoning in Loghman-Hakim Hospital (LHH), the main referral center of poisoning in Tehran, during the 2-year period from 1 year prior to 1 year after the onset (February 23rd, 2020) of the COVID-19 epidemic in Iran. All patients admitted with alcohol intoxication from February 23rd, 2019 to February 22nd, 2021 were evaluated and patient data extracted from LHH electronic hospital records. Alcohols were categorized as toxic (methyl alcohol) and non-toxic (ethyl alcohol). Of 2483 patients admitted, 796/14,493 (5.49%) and 1687/13,883 (12.15%) had been hospitalized before and after the onset of the COVID-19 epidemic in Iran, respectively. In total, 140 patients did not survive, of whom 131 (93.6%) were confirmed to have methanol intoxication. Mortality was significantly higher during the outbreak (127 vs 13; P < 0.001; OR: 4.90; CI 95%: 2.75 to 8.73). Among the patients, 503 were younger than age 20. Trend of alcohol intoxication showed increases in children (57 vs 17) and adolescents (246 vs 183) when compared before and after the COVID-19 epidemic outbreak. A total of 955 patients were diagnosed with methanol toxicity which occurred more frequently during the COVID-19 era (877 vs 78; P < 0.001; OR: 10.00; CI 95%: 7.75 to12.82). Interrupted time series analysis (April 2016–February 2021) showed that in the first month of the COVID-19 epidemic (March 2020), there was a significant increase in the alcohol intoxication rate by 13.76% (P < 0.02, CI = [2.42–24.91]). The trend of alcohol intoxication as well as resulting mortality increased in all age groups during the COVID-19 epidemic in Iran, indicating urgent need for the prevention of high-risk alcohol use as well as improved treatment.

Hospital-treated intentional self-poisoning events and in-hospital mortality in Tehran before and during the COVID-19 pandemic

Hospital-treated intentional self-poisoning is common. The possibility of changed (increased) suicidal behaviors during the COVID-19 pandemic has been raised. To compare frequencies in self-poisoning events (SPEs) and the proportions with in-hospital mortality, in the year prior to and following the official onset of the COVID-19 pandemic, in a population of hospital-treated self-poisoning patients in Iran. All self-poisoned patients admitted to Loghman-Hakim Hospital, a clinical toxicology specialty hospital in Tehran, were included. The frequency of SPEs was compared between the one-year periods immediately before and after the onset of COVID-19 pandemic using Poisson regression. Differences in proportions of in-hospital mortality were also compared using logistic regression. A total of 14,478 patients with 15,391 SPEs (8,863 [61.2%] females) were evaluated in the study. There was no difference in the overall frequency of SPEs (relative risk [RR] of 0.99 [CI95% 0.96-1.03]), but a small increase in males (RR 1.07; 1.02-1.13) and a minor decrease in females (RR 0.95; 0.91-0.99). In total, 330 patients died (2.3% of all SPEs). There was no difference in overall in-hospital mortality odds ratio (OR: 0.98 [0.79-1.22]), in females (OR = 1.14 [0.80-1.60]) or males (OR = 0.92 [0.69-1.23]). There was no change in the frequency of SPEs and no difference in the in-hospital mortality proportions, suggesting that the COVID-19 pandemic had little or no effect on these aspects of suicidal behavior in Iran.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03248-y.

Altered serum and cerebrospinal fluid TNF-α, caspase 3, and IL 1β in COVID-19 disease

Background

We evaluated the levels of the tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and caspase-3 in the cerebrospinal fluid (CSF) and serum of COVID-19 patients to improve our knowledge about underlying mechanisms caused by this virus in central nervous system involvement.

Case Presentation

This case series study included six COVID-19 patients from March 26, 2020, to April 17, 2020, and six healthy control patients. CSF and serum levels of TNF-α, IL-1β, and caspase-3 have been assayed using monoclonal antibodies-based ELISAs.Patients with COVID-19 had significantly higher level of IL-1β, TNF-α, and caspase-3 in serum (239.16±35.73 pg/ml, 100.50±12.49 pg/ml, 3.58±0.11pg/ml, p < 0.001) and CSF (146.66±17.55 pg/ml, 63.16±14.68 pg/ml,3.22±0.03pg/ml, p<0.001), respectively as compared to control. In addition, our results showed that these biomarkers were significantly higher in serum compared with CSF of the COVID-19 patients (p<0.001).

Conclusion

This study provides essential information for understanding the pathogenesis of COVID-19 infection and sheds light on the potential mechanisms of virus transmission. The obtained data could be useful for designing new prevention and treatment strategies for COVID-19.

Molecular Insight Into the Therapeutic Potential of Long Non-coding RNA-Associated Competing Endogenous RNA Axes in Alzheimer's Disease: A Systematic Scoping Review

Alzheimer’s disease (AD) is a heterogeneous degenerative brain disorder with a rising prevalence worldwide. The two hallmarks that characterize the AD pathophysiology are amyloid plaques, generated via aggregated amyloid β, and neurofibrillary tangle, generated via accumulated phosphorylated tau. At the post-transcriptional and transcriptional levels, the regulatory functions of non-coding RNAs, in particular long non-coding RNAs (lncRNAs), have been ascertained in gene expressions. It is noteworthy that a number of lncRNAs feature a prevalent role in their potential of regulating gene expression through modulation of microRNAs via a process called the mechanism of competing endogenous RNA (ceRNA). Given the multifactorial nature of ceRNA interaction networks, they might be advantageous in complex disorders (e.g., AD) investigations at the therapeutic targets level. We carried out scoping review in this research to analyze validated loops of ceRNA in AD and focus on ceRNA axes associated with lncRNA. This scoping review was performed according to a six-stage methodology structure and PRISMA guideline. A systematic search of seven databases was conducted to find eligible articles prior to July 2021. Two reviewers independently performed publications screening and data extraction, and quantitative and qualitative analyses were conducted. Fourteen articles were identified that fulfill the inclusion criteria. Studies with different designs reported nine lncRNAs that were experimentally validated to act as ceRNA in AD in human-related studies, including BACE1-AS, SNHG1, RPPH1, NEAT1, LINC00094, SOX21-AS1, LINC00507, MAGI2-AS3, and LINC01311. The BACE1-AS/BACE1 was the most frequent ceRNA pair. Among miRNAs, miR-107 played a key role by regulating three different loops. Understanding the various aspects of this regulatory mechanism can help elucidate the unknown etiology of AD and provide new molecular targets for use in therapeutic and clinical applications.

Emerging Role of Non-Coding RNAs in Regulation of T-Lymphocyte Function

T-lymphocytes (T cells) play a major role in adaptive immunity and current immune checkpoint inhibitor-based cancer treatments. The regulation of their function is complex, and in addition to cytokines, receptors and transcription factors, several non-coding RNAs (ncRNAs) have been shown to affect differentiation and function of T cells. Among these non-coding RNAs, certain small microRNAs (miRNAs) including miR-15a/16-1, miR-125b-5p, miR-99a-5p, miR-128-3p, let-7 family, miR-210, miR-182-5p, miR-181, miR-155 and miR-10a have been well recognized. Meanwhile, IFNG-AS1, lnc-ITSN1-2, lncRNA-CD160, NEAT1, MEG3, GAS5, NKILA, lnc-EGFR and PVT1 are among long non-coding RNAs (lncRNAs) that efficiently influence the function of T cells. Recent studies have underscored the effects of a number of circular RNAs, namely circ_0001806, hsa_circ_0045272, hsa_circ_0012919, hsa_circ_0005519 and circHIPK3 in the modulation of T-cell apoptosis, differentiation and secretion of cytokines. This review summarizes the latest news and regulatory roles of these ncRNAs on the function of T cells, with widespread implications on the pathophysiology of autoimmune disorders and cancer.

Mechanistic Insight Into the Regulation of Immune-Related Genes Expression in Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a severe neurodevelopmental disorder featuring impairment in verbal and non-verbal interactions, defects in social interactions, stereotypic behaviors as well as restricted interests. In recent times, the incidence of ASD is growing at a rapid pace. In spite of great endeavors devoted to explaining ASD pathophysiology, its precise etiology remains unresolved. ASD pathogenesis is related to different phenomena associated with the immune system; however, the mechanisms behind these immune phenomena as well as the potential contributing genes remain unclear. In the current work, we used a bioinformatics approach to describe the role of long non-coding RNA (lncRNA)-associated competing endogenous RNAs (ceRNAs) in the peripheral blood (PB) samples to figure out the molecular regulatory procedures involved in ASD better. The Gene Expression Omnibus database was used to obtain the PB microarray dataset (GSE89594) from the subjects suffering from ASD and control subjects, containing the data related to both mRNAs and lncRNAs. The list of immune-related genes was obtained from the ImmPort database. In order to determine the immune-related differentially expressed mRNAs (DEmRNAs) and lncRNAs (DElncRNAs), the limma package of R software was used. A protein-protein interaction network was developed for the immune-related DEmRNAs. By employing the Human MicroRNA Disease Database, DIANA-LncBase, and DIANA-TarBase databases, the RNA interaction pairs were determined. We used the Pearson correlation coefficient to discover the positive correlations between DElncRNAs and DEmRNAs within the ceRNA network. Finally, the lncRNA-associated ceRNA network was created based on DElncRNA-miRNA-DEmRNA interactions and co-expression interactions. In addition, the KEGG enrichment analysis was conducted for immune-related DEmRNAs found within the constructed network. This work found four potential DElncRNA-miRNA-DEmRNA axes in ASD pathogenesis, including, LINC00472/hsa-miR-221-3p/PTPN11, ANP32A-IT1/hsa-miR-182-5p/S100A2, LINC00472/hsa-miR-132-3p/S100A2, and RBM26-AS1/hsa-miR-182-5p/S100A2. According to pathway enrichment analysis, the immune-related DEmRNAs were enriched in the "JAK-STAT signaling pathway" and "Adipocytokine signaling pathway." An understanding of regulatory mechanisms of ASD-related immune genes would provide novel insights into the molecular mechanisms behind ASD pathogenesis.

Distribution of HLA Alleles and Genotypes in Patients with Chronic Inflammatory Demyelinating Polyneuropathy

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired immunological disorder. Although the precise pathoetiology of CIDP has not been clarified yet, it is believed that both B and T cells of immune system contribute in this disorder. Based on the importance of human leukocyte antigen (HLA) cluster in the regulation of immune responses, this family of proteins is putative determinants of risk of CIDP. We conducted the current investigation to appraise association between HLA alleles/genotypes/haplotypes and risk of CIDP in Iranian patients. HLA-DQB1*02 allele was significantly more prevalent among cases compared with controls (OR [95% CI] = 4.82 [2.06, 11.3], P value = 0.000215, adjusted P value = 0.0124). A*01-B*52-C*12-DRB1*15-DQB1*02 and A*23-B*35-C*04-DRB1*11-DQB1*03 haplotypes with frequency of 0.03 were the most frequent HLA haplotypes. These haplotypes were not detected among healthy controls. The present study introduces HLA-DQB1*02 allele as a risk allele for CIDP among Iranian patients and further supports the importance of HLA region in this immunological condition.

Patterns of extrasellar invasive growth of pituitary adenomas with normal sellar cavity size

BACKGROUND

Pituitary adenomas (PAs) are among the most common brain tumors which characteristically become symptomatic due to the mass effect on surrounding structures and/or hormonal imbalances. This study describes 28 cases of PAs with an extrasellar invasive growth (EIG) at the early stage of tumor growth with normal sellar cavity size.

METHODS

1200 cases of PAs either treated medically or via Endoscopic transsphenoidal surgery were reviewed during a 10-year period. Pre-operative imaging was analyzed to evaluate the tumor expansion pattern, tumor invasion sites and other relevant tumor properties. A comprehensive preoperative endocrinological along with postoperative histopathological studies were conducted to evaluate the subjects' homeostasis and further identify the lesions characteristics.

RESULTS

Of the 28 patients, patients 19, 2, 1 and 6 had a growth hormone (GH)-secreting PA, an adrenocorticotropic hormone (ACTH)-secreting PA, a nonfunctional PA (NFPA) and a mix-hormones secreting PA, respectively. There was a statistically significant difference between patients with and without EIG regarding types of PAs (P = 0.000). Post-hoc tests demonstrated that GH-secreting PAs (P = 0.0003) and mix-hormones secreting PAs (P = 0.0000) are significantly more invasive, while NFPAs (P = 0.0000) are less invasive. There was not a statistically significant difference between the invasion sites and different types of PAs (P = 0.122).

CONCLUSION

Among different histological subtypes of PAs, GH-secreting PAs revealed a remarkable tendency for EIG with normal sellar cavity size. The extra-sellar tumor extension with a normal sella did not correlate with atypical histology. Considering EIG patterns, surgeons should be vigilant to investigate and follow the tumor spreading to its enclosing boundary during surgery, the clival part of sphenoid bone should be more exposed, and both inferomedial and lateral borders of the sphenoid sinus should be carefully explored in order to remove the tumor.

Umifenovir in hospitalized moderate to severe COVID-19 patients: A randomized clinical trial

INTRODUCTION

The effectiveness of umifenovir against COVID-19 is controversial; therefore, clinical trials are crucial to evaluate its efficacy.

METHODS

The study was conducted as a single-center, randomized, open-label clinical trial. Eligible moderate-severe hospitalized patients with confirmed SARS-Cov-2 infection were randomly segregated into intervention and control groups. The intervention group were treated with lopinavir/ritonavir (400 mg/100 mg bid for 10-14 days) + hydroxychloroquine (400 mg single dose) + interferon-β1a (Subcutaneous injections of 44 µg (12,000 IU) on days 1, 3, 5) + umifenovir (200 mg trice daily for 10 days), and the control group received lopinavir/ritonavir (same dose) + hydroxychloroquine (same dose) + interferon-β1a (same dose).

RESULTS

Of 1180 patients with positive RT-PCRs and positive chest CT scans, 101 patients were finally included in the trial; 50 were assigned to receive IFNβ1a + hydroxychloroquine + lopinavir/ritonavir group and 51 were managed to treat with IFNβ1a + hydroxychloroquine + lopinavir/ritonavir + umifenovir. Since all patients received the intended treatment as scheduled, the analysis just included as the ITT population. Time to clinical improvement (TTCI) did not hold a statistically significant difference between intervention and control groups (median, 9 days for intervention group versus 7 days for the control group; P: 0.22). Besides, Hazard Ratio for TTCI in the Cox regression model was 0.75 (95% CI: 0.45-1.23, P:0.25) which also confirmed that there was no statistically significant difference between the treatment group and the control group. The mortality was not statistically significant between the two groups (38% in controls vs 33.3% treatment group).

CONCLUSIONS

Our findings shed new lights on the facts that additional umifenovir has not been found to be effective in shortening the duration of SARS-CoV-2 in severe patients and improving the prognosis in non-ICU patients and mortality.

TRIAL REGISTRATION

The trial was confirmed by the Ethics in Medical Research Committee of the Shahid Beheshti University of Medical Sciences. signed informed consents were obtained from all the participants or their legally authorized representatives. This trial has been registered as ClinicalTrials.gov, NCT04350684.

The Sensorineural Hearing Loss Related to a Rare Infratentorial Developmental Venous Angioma: A Case Report and Review of Literature

BACKGROUND

 Developmental venous anomaly (DVA) is a benign venous abnormality draining normal brain parenchyma. It is mostly asymptomatic; however, rare complications such as hemorrhage may lead to symptomatic conditions. Headache and seizure are the most common symptoms. Hearing loss is an extremely rare presentation of DVA. To our knowledge, only five cases of DVA, presenting with hearing loss, had been reported so far.

CASE PRESENTATION

 We report the case of a 27-year-old woman who presented with a sensorineural hearing loss followed by facial paresis. Magnetic resonance imaging (MRI) and computed tomography (CT) angiography revealed hematoma with adjacent converging veins showing a typical "caput medusa" sign in the left middle cerebellar peduncle, in favor of DVA. Due to the compression effect of hematoma, she underwent surgery. Hearing loss and facial paresis improved significantly during the postoperative follow-up.

CONCLUSION

 Although DVA is mostly benign and asymptomatic, complications such as hemorrhage rarely occur. Hearing loss is an extremely rare presentation that can be attributable to the compression effect on the cranial nerve VII to VIII complex. In the case of compression effect or progression of symptoms, surgical intervention is necessary. A good clinical outcome could be expected postoperatively.

Trends of acute drug and chemical toxicities in adults and adolescents in Tehran, Iran between 2012 and 2018: a retrospective chart review

Poisoning is among the top three common causes of suicidal deaths in Iran. We aimed to evaluate the epidemiologic trend of poisoning and its mortality rate in the largest tertiary toxicology referral center in Iran between 2012 and 2018. A total of 84,242 patients were hospitalized or died due to poisoning in this center during the study period, of whom 2114 (2.5%) died. The most frequent poisonings were those with antiepileptics, sedativehypnotics, and antiparkinson medications (T42) followed by narcotics and psychodysleptics (T40). Psychodysleptics had the highest mortality rate (684; 32.4% of the deaths). Among drugs of abuse, methadone was the most common cause of admission reported in 10,398 cases (12.3%). In conclusion, suicidal or recreational methadone poisoning is becoming the most common cause of admission to poisoning referral wards in Iran. Rigorous supervision of daily dosing at opioid maintenance clinics as well as efforts to control the black-market offering methadone are needed to prevent further methadone-related acute poisonings and deaths.

Non-Coding RNAs Participate in the Pathogenesis of Neuroblastoma

Neuroblastoma is one of the utmost frequent neoplasms during the first year of life. This pediatric cancer is believed to be originated during the embryonic life from the neural crest cells. Previous studies have detected several types of chromosomal aberrations in this tumor. More recent studies have emphasized on expression profiling of neuroblastoma samples to identify the dysregulated genes in this type of cancer. Non-coding RNAs are among the mostly dysregulated genes in this type of cancer. Such dysregulation has been associated with a number of chromosomal aberrations that are frequently detected in neuroblastoma. In this study, we explain the role of non-coding transcripts in the malignant transformation in neuroblastoma and their role as biomarkers for this pediatric cancer.

Emerging Role of Long Non-Coding RNAs in the Pathobiology of Glioblastoma

Glioblastoma is the utmost aggressive diffuse kind of glioma which is originated from astrocytes, neural stem cells or progenitors. This malignant tumor has a poor survival rate. A number of genetic aberrations and somatic mutations have been associated with this kind of cancer. In recent times, the impact of long non-coding RNAs (lncRNAs) in glioblastoma has been underscored by several investigations. Up-regulation of a number of oncogenic lncRNAs such as H19, MALAT1, SNHGs, MIAT, UCA, HIF1A-AS2 and XIST in addition to down-regulation of other tumor suppressor lncRNAs namely GAS5, RNCR3 and NBAT1 indicate the role of these lncRNAs in the pathogenesis of glioblastoma. Several in vitro and a number of in vivo studies have demonstrated the contribution of these transcripts in the regulation of cell proliferation and apoptosis, cell survival, invasion and metastasis of glioblastoma cells. Moreover, some lncRNAs such as SBF2-AS1 are involved in conferring resistance to temozolomide. Finally, few circularRNAs have been identified that influence the evolution of glioblastoma. In this paper, we discuss the impacts of lncRNAs in the pathogenesis of glioblastoma, their applications as markers and their implications in the therapeutic responses in this kind of cancer.

Post-mortem Histopathologic Findings of Vital Organs in Critically Ill Patients with COVID-19

BACKGROUND

The scientific evidence concerning pathogenesis and immunopathology of the coronavirus disease 2019 (COVID-19) is rapidly evolving in the literature. To evaluate the different tissues obtained by biopsy and autopsy from five patients who expired from severe COVID-19 in our medical center.

METHODS

This retrospective study reviewed five patients with severe COVID-19, confirmed by reverse transcription-polymerase chain reaction (RT-PCR) and imaging, to determine the potential correlations between histologic findings with patient outcome.

RESULTS

Diffuse alveolar damage (DAD) and micro-thrombosis were the most common histologic finding in the lung tissues (4 of 5 cases), and immunohistochemical (IHC) findings (3 of 4 cases) suggested perivascular aggregation and diffuse infiltration of alveolar walls by CD4+ and CD8+ T lymphocytes. Two of five cases had mild predominantly perivascular lymphocytic infiltration, single cell myocardial necrosis and variable interstitial edema in myocardial samples. Hypertrophic cardiac myocytes, representing hypertensive cardiomyopathy was seen in one patient and CD4+ and CD8+ T lymphocytes were detected on IHC in two cases. In renal samples, acute tubular necrosis was observed in 3 of 5 cases, while chronic tubulointerstitial nephritis, crescent formation and small vessel fibrin thrombi were observed in 1 of 5 samples. Sinusoidal dilation, mild to moderate chronic portal inflammation and mild mixed macro- and micro-vesicular steatosis were detected in all liver samples.

CONCLUSION

Our observations suggest that clinical pathology findings on autopsy tissue samples could shed more light on the pathogenesis, and consequently the management, of patients with severe COVID-19.

Clinical and Epidemiological Characteristics of Coronavirus Disease 2019 in Iran: a Hospital-Based Observational Study

BACKGROUND

Coronavirus disease 2019 (COVID-19) has been pandemic and has caused a great burden on almost all countries across the world. Different perspectives of this novel disease are poorly understood. This study sought to investigate the clinical and epidemiological characteristics of COVID-19 to efficiently assist the health system of Iran to conquer the outbreak.

MATERIALS AND METHODS

This retrospective observational study was performed on 394 patients with a diagnosis of COVID-19. The patients should have a history of hospitalization at Loghman-Hakim hospital, Tehran, Iran, for 10 weeks, beginning from the first official report of the disease in Iran. In the subsequent step, the baseline demographic and clinical and paraclinical information of the patients was documented. Finally, the patients were assessed if they had exhibited any morbidity or mortality.

RESULTS

The epidemiological examination of the COVID-19 population suggested a bell diagram pattern for the hospitalization rate, in which the 4th week of the study was the peak. The highest rate of secondary adverse events due to the virus was observed at the 6th and 7th weeks of the study course. On another note, clinical evaluations resulted in identifying specific abnormalities, such as bilateral opacity in chest computed tomography scans or low oxygen saturation in laboratory data.

CONCLUSION

This study provides evidence concerning the clinical and epidemiological characteristics of COVID-19 in the first phase of the virus outbreak in Iran. Further studies comparing the disease features in the subsequent phases with findings of this study can pave the way for additional information in this regard.

Assessment of the role of non-coding RNAs in the pathophysiology of Parkinson's disease

Parkinson's disease (PD) is the second main neurodegenerative disease causing motor abnormalities in the middle-aged and old individuals. In some cases, cognitive dysfunction also occurs. The clinical signs of PD are bradykinesia, rigidity and resting tremor. As these signs might be detected in other neurological conditions such as multiple systems atrophy and corticobasal degeneration, it is necessary to find specific and sensitive markers for this disorder. Non-coding RNAs are implicated in the different PD-associated features such as α-synuclein expression and Lewy body construction, mitochondrial dysfunction, apoptosis, neuroinflammation and defects in glial cell-derived neurotrophic factor. Several researches have confirmed dysregulation of long non-coding RNAs (lncRNAs) and microRNAs (miRNAs) in brain tissues, plasma exosomes and leukocytes of affected individuals or animal models of PD. A number of these transcripts directly regulate the neurodegenerative process in PD. In the current study, we review the current data about dysregulation of ncRNAs and the role of their genomic variants in the pathogenesis of PD.

Does vitamin D administration play a role in outcome of patients with acute ischemic stroke? A randomized controlled trial

Background: Clinical studies have reported improved neurological outcomes in patients who were taking vitamin D supplements. This study investigates the effect of intramuscular (IM) vitamin D supplementation in patients with acute ischemic stroke (AIS) on neurological outcomes and inflammatory marker levels. Methods: This study included patients diagnosed with AIS (n = 60) from the Neurology Unit of Loghman Hakim Hospital, Tehran, Iran, during the year 2019. Patients with AIS were allocated randomly into two groups who received a single dose of 300000 IU IM vitamin D and a control group that did not receive vitamin D supplementation. Serum vitamin D concentration, interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) levels, as primary outcomes, and the Modified Rankin Scale (MRS), the National Institute of Health Stroke Scale (NIHSS), and the Mini-Mental State Examination (MMSE), as secondary outcomes, were measured at the baseline and the end of the study (6 weeks). Results: Eventually, 59 patients with AIS completed the intervention study. A single dose of 300000 IU increased vitamin D level; moreover, vitamin D supplementation improved MRS and IL-6 levels significantly (P = 0.01, P = 0.02, respectively). There were reverse correlations between serum vitamin D and NIHSS and TNF-α after vitamin D administration. However, no statistically significant effect of vitamin D on the TNF-α or NIHSS and MMSE was seen compared to the control group. Conclusion: Vitamin D probably due to a single dose and short duration of administration, as well as a short follow-up period, had no favorable effects on TNF-α level and NIHSS score.

Surgical management of the fourth ventricular tumors using telovelar approach and the role of neuroendoscopy: Post-operative outcome and long-term results in a series of 52 cases

OBJECTIVES

The telovelar approach is a surgical method performed through natural corridors of the brain to access the fourth ventricle. The aim of this study is to assess the results of this approach as well as the role of neuroendoscopy in surgical management of fourth ventricle tumors.

MATERIAL AND METHODS

A retrospective study was designed, and a series of 52 consecutive patients (32 male, 20 female) with fourth ventricle tumor undergoing telovelar approach was undertaken. In 10 patients (19 %) with a tumor invading the rostral fourth ventricle, an adjustable angle endoscope was also used to ensure total resection of the tumor.

RESULTS

Complete resection was obtained in majority of patients (94 %). 30 patients (57 %) required insertion of an external ventricular drain which was discontinued in all patients after 72 h. 2 patients (4 %) underwent permanent ventriculoperitoneal shunt. The postoperative complications included meningitis (8 %), transient facial nerve paralysis (8 %), transient sixth cranial nerve paralysis (6 %) and transient unilateral absence of the gag reflex (4 %). No patient experienced mutism and there was a mortality rate of 2 % (1 case) in current study.

CONCLUSION

In our experience, a high rate of total resection of the fourth ventricle tumors could be achieved with the telovelar approach associated with a low risk of surgical morbidity and mortality. Moreover, the use of an adjustable angle endoscope could be useful in patients with a tumor involving the rostral fourth ventricle to ensure total resection of the tumor and also to minimize the extent of telovelar dissection.

Coenzyme Q10 Insufficiency Contributes to the Duration and Frequency of Seizures in Epileptic Patients

Introduction:

Oxidative stress has recently emerged as a possible mechanism in the pathogenesis of epilepsy. Coenzyme Q10 (CoQ10) is a strong endogenous antioxidant that protects cells from lipid oxidation and Reactive Oxygen Species (ROS) production; however, the impact of CoQ10 on seizure characteristics in epileptic patients is unclear.

Methods:

The current study enrolled patients with Epileptic Seizure (ES) to evaluate their serum concentration of CoQ10 and to investigate whether a relationship exists between CoQ10 levels with the duration, frequency, and type of seizure.

Results:

A total of 39 patients with epileptic seizures and 35 healthy controls were included in the study. The levels of CoQ10 in ES patients were significantly lower in comparison with healthy controls (11.99±5.93 vs (ng/ml). 16.48±4.20 (ng/ml) P<0.001). We also found that the duration of epilepsy and seizure frequency was negatively correlated with serum CoQ10 levels.

Conclusion:

These findings indicate that CoQ10 deficiency might substantially contribute to the clinical signs of epileptic patients.

miRNA signature in glioblastoma: Potential biomarkers and therapeutic targets

MicroRNAs (miRNAs) are transcripts with sizes of about 22 nucleotides, which are produced through a multistep process in the nucleus and cytoplasm. These transcripts modulate the expression of their target genes through binding with certain target regions, particularly 3' suntranslated regions. They are involved in the pathogenesis of several kinds of cancers, such as glioblastoma. Several miRNAs, including miR-10b, miR-21, miR-17-92-cluster, and miR-93, have been up-regulated in glioblastoma cell lines and clinical samples. On the other hand, expression of miR-7, miR-29b, miR-32, miR-34, miR-181 family members, and a number of other miRNAs have been decreased in this type of cancer. In the current review, we explain the role of miRNAs in the pathogenesis of glioblastoma through providing a summary of studies that reported dysregulation of these epigenetic effectors in this kind of brain cancer.

Third ventricle hydatid cyst: A rare case report and review of the literature

A primary intraventricular hydatid cyst is a very rare phenomenon, which is mostly located in the lateral ventricle. To the best of our knowledge, only two cases of third ventricle hydatid cyst have been reported. Herein, we present a very rare case of third ventricle hydatid cyst in a four- year-old boy with nausea, vomiting, and progressive drowsiness. Neuroradiological examination revealed a large, spherical, well-defined cystic lesion within the third ventricle. The patient underwent surgery using the anterior interhemispheric transcallosal approach, and the cyst was successfully removed using the Dowling's technique. In this case report, we described the first case of transcallosal removal of a rare third ventricle hydatid cyst, which can be considered in the differential diagnosis of suprasellar arachnoid cysts. Caution must be taken in determining the best surgical approach to prevent unexpected complications.

Ginkgo biloba modulates hippocampal BDNF expression in a rat model of chronic restraint stress-induced depression

Introduction: Mood disorders such as depression and anxiety disorders have been affecting a relatively high proportion of the world's population. Neuroplasticity hypothesis of depression proposes that lack of brain-derived neurotrophic factor (BDNF) can cause structural changes in the brain. The extract of Ginkgo biloba (Gb) leaves can restore much of the damage in the nervous system. We examined the antidepressant role of Gb extract (EGb 761) on BDNF expression modulation in the hippocampus of rats subjected to repeated restraint stress (RRS). Methods: Adult male rats were randomly divided into 10 groups: control, control-vehicle treated, stress, stress-vehicle treated, as well as three control and three experimental groups pretreated with EGb (15, 30, 60mg/kg, IP daily) for 21 days. They underwent restraint stress on a daily basis, 6 hours for 21 consecutive days. Weight changes, locomotor activity and forced swim test (FST) were employed to assess depressive-like symptoms. The serum corticosterone level was also measured by ELISA. Hippocampal BDNF DNA methylation and protein expression were assayed by methylation sensitive restriction enzymes (Real Time PCR) and Western-blotting respectively in all groups. Results: Pre-treatment with 30 and 60 mg/kg/day of Gb extract significantly attenuated depressive-like effects in the body weight, FST and serum corticosterone level in RSS rats compared to control groups. Further, it inhibited chronic stress-induced alterations in the hippocampal BDNF DNA methylation and protein expression. Conclusion: These findings suggest that Gb can induce an antidepressant role through its modulation effect on the hippocampal BDNF expression.

The Role of Anxiety and Cortisol in Outcomes of Patients With Covid-19

Introduction:

The outbreak due to Coronavirus Disease 2019 (COVID-19) is n global public health emergency and challenges psychological resilience. The central nervous system, endocrine system, and immune system are complex interacting systems. Cortisol has been implicated as the cause of a wide range of mental and physical health disorders; however, the impact of cortisol on outcomes in patients with COVID-19 is not clear.

Methods:

The current study enrolled patients with COVID-19 (onset of disease within 7 days of the first symptom) to evaluate the serum concentration of cortisol and levels of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) to investigate a possible relationship between cortisol, depression, and anxiety levels and outcomes of patients with COVID-19.

Results:

A total of 30 patients with COVID-19 were studied. The levels of cortisol and HADS score in patients who died of Covid-19 were significantly higher in comparison with surviving patients (P<0.017 and P<0.001 respectively). We also found that the HADS score was positively correlated with serum cortisol levels (r= 0.842, P=0.004).

Conclusion:

Our findings showed that stress and anxiety are associated with patients’ outcomes. Psychological interventions can improve the mental health of vulnerable groups during the COVID-19 epidemic.

Trans-nasal Trans-sphenoidal Endoscopic Resection of Spindle Cell Oncocytoma of Adenohypophysis: The First Case Report in a Child and a Review of Literature

Spindle cell oncocytoma (SCO) is a rare tumor of adenohypophysis, arising from the sellar region. So far, about 35 cases of SCO in the sellar region have been reported. In this report, we present the first case of pediatric SCO and review the literature concerning the tumor origin, clinical presentations, radiological features, and treatment modalities. An 8-year-old male was referred to our clinic with progressive visual loss in the left eye and headache over the past 6 months. Cranial magnetic resonance imaging revealed a solid adenohypophysis mass with suprasellar extension, as well as compression and displacement of the optic chiasm. The patient underwent endoscopic trans-sphenoidal resection of the tumor. The tumor was diagnosed as SCO based on the histological study. He did not receive radiation therapy. The patient's condition remained stable, with no radiological recurrence in the past follow-up 2 years after the surgery.

The Therapeutic Effect of Endoscopic Tumor Resection on Acromegalic Cardiomegaly in Patients With Pituitary Adenoma

Background: Acromegaly defines as chronic elevations of insulin-like growth factor-1 (IGF-1) and growth hormone (GH), which results in enlargement of organs and soft tissues. Cardiovascular complications of acromegaly such as cardiomegaly, hypertension contributing to a high risk of cardiovascular events. This study aimed to identify the determinants of the prevalence of cardiomegaly as cardiovascular comorbidity of acromegaly and the potential effect of the curative intervention. Methods: A total of 160 patients with acromegaly due to pituitary adenoma participated in this study. Acromegaly diagnosed was based on clinical manifestations, age-adjusted plasma IGF-I, and elevated plasma GH levels, not suppressible during an oral glucose tolerance test (75 g). Electrocardiogram and chest X-ray obtained in all patients. Treatment approaches included transsphenoidal surgery and hormonal evaluation performed before and six months after surgery. Results: The GH serum level was elevated in all patients before surgery, with a mean of 33.7 ng/ mL that reached 5.7 ng/mL after surgery. Mean IGF-1 was 794.1 ng/mL that reached 395.6 ng/mL postoperatively. The prevalence of cardiomegaly was 15% that improved in 5% of patients after trans sphenoidal surgery. Conclusion: Appropriate surgical intervention in acromegaly that complicated by cardiomegaly may result in significant improvement of the cardiac structure.

Pituitary macroadenoma resulting from primary hypothyroidism; a 16-year-old girl

Background:

Primary hypothyroidism is a common medical condition. It can lead to pituitary adenoma which is usually asymptomatic, but it can also lead to symptomatic macroadenomas which are hard to diagnose due to different clinical presentations.

Case presentation:

A 16-year-old girl presented for endocrinology consultation prior to neurosurgical operation. She had galactorrhea which was accompanied by vertigo & low grade blurred vision without a headache and was diagnosed with pituitary macroadenoma and was planned for a surgery. She had TSH level of more than 100 mU/L, free thyroxine of 1.9 pmol/L. Her thyroid peroxidase (TPO) antibody level was 13.3 IU/mL, insulin growth factor-1 392 µ/l and serum prolactin level 42 ng/ml. During physical exam and with the laboratory findings, we suspected for a primary hypothyroidism as the leading cause of pituitary macroadenoma. As the result, we cancel the surgery and start levothyroxine therapy 100µg daily for her. In the follow-up it revealed that our diagnosis was correct and she went into remission with pituitary gland shrinking and decreasing TSH and prolactin levels.

Conclusion:

It is important to understand the different presentation of primary hypothyroidism to decrease the unnecessary risk of maltreatment in patients.

Pineal region tumors: Long-term results of endoscopic third ventriculostomy and concurrent tumor biopsy with a single entry approach in a series of 64 cases

OBJECTIVES

Endoscopic third ventriculostomy and concurrent biopsy is increasingly used in management of the pineal region tumors. Our objective was to assess the results of single entry approach to surgically manage the tumors of the pineal region.

PATIENTS AND METHODS

A retrospective study was designed, and a series of 64 consecutive patients (31 male, 33 female) with pineal region tumor undergoing endoscopic third ventriculostomy and concurrent biopsy of the tumor was undertaken.

RESULTS

A total of 64 patients underwent simultaneous endoscopic third ventriculostomy and biopsy of the pineal tumors with a single entry approach. A positive initial diagnosis was established in 97% of patients. 5 patients (7%) required the insertion of an external ventricular drain which was removed in all patients after 72 h but in one case (1%) undergoing permanent VP shunt insertion. The postoperative complications were divided into two transient and permanent complications. The transient complications included intraventricular hemorrhage (18%), seizure (1 to two episodes of seizure) (5%), diabetes insipidus (3%) and meningitis (3%) all were successfully managed. The only permanent complication was memory deficits occurred in one patient (1%). There was no mortality rate in current study.

CONCLUSION

The results of this study support the safety and efficacy of endoscopic third ventriculostomy and concurrent biopsy of the pineal region tumors as a less invasive surgical method associated with low morbidity and mortality rate. Our data demonstrated how simultaneous endoscopic third ventriculostomy and biopsy of the pineal region tumors with a single entry approach can produce favorable results.

Pineal Region Tuberculoma Caused by Mycobacterium bovis as a Complication of Bacille Calmette-Guérin Vaccine: Case Report and Review of the Literature

BACKGROUND

Brain tuberculoma is a rare manifestation of tuberculosis especially in immunosuppressed patients. The definitive diagnosis may be difficult owing to mimicking brain tumors and the absence of the common presentation. Bacille Calmette-Guérin (BCG) vaccine is used for protection against tuberculous meningitis and miliary disease, more so in children, and also for the treatment of bladder cancer.

CASE DESCRIPTION

The following case of brain tuberculoma is a boy aged 6 months who was presented to our hospital with poor feeding, nausea and vomiting, and confusion lasting 1 month. A brain magnetic resonance imaging scan showed a large mass lesion in the pineal region with generalized hydrocephaly in which polymerase chain reaction assays of the tissue was positive for Mycobacterium bovis and had a good response to antituberculosis drugs and surgery.

CONCLUSIONS

We present a case of brain tuberculoma as the complication of BCG vaccine. To our knowledge, this case is the first case of brain tuberculoma after BCG vaccination. We should consider brain tuberculoma that presents with a similar presentation in any infants with a history of BCG vaccination.

Protective effect of [Pyr1]-apelin-13 on oxidative stress-induced apoptosis in hair cell-like cells derived from bone marrow mesenchymal stem cells

Oxidative stress plays an important role in auditory dysfunction. Exogenous cell therapy has brought new hopes for repairing mammalian inner ear hair cells. However, poor cell viability of transplanted cells under oxidative stress conditions has limited their therapeutic potential. The adipocytokine apelin-13 was isolated from a bovine stomach. Apelin-13 might protect oxidative stress-induced hair cell damage was raised considering other oxidative stress-induced injury, including brain ischemia-induced cell death. Therefore, we evaluated the protective effects of apelin- 13 on the damage induced by hydrogen peroxide (H2O2) to the hair cells-derived from bone marrow mesenchymal stem cells (BMSCs) in vitro. Stem cells were differentiated into hair cell- like cells with B27, FGF, EGF and IGF-1. Expression of neuron specific markers including β tubulin III, Nestin, MAP2, Neurofilament 68 and GFAP was tested by flow cytometry. As well, inner ear hair cell markers such as Myosin VIIA, Sox2 and TrkB expression were assayed by immunocytochemistry (ICC) method. We designed an in vitro model of oxidative stress by exposing hair cell- like cells to H2O2. Protein expression levels of caspase-3, Bax and Bcl-2 were detected by western blot. Apoptotic cells were also detected by acridin-orange staining and TUNEL assay. Protein expression of caspase-3 and Bax/Bcl-2 ratio was significantly lower in the apelin-13-pretreated group than only H2O2 treated group. In addition, apoptotic cells were significantly decreased in the apelin-13+H2O2 co-treated cells compared to the H2O2-treated group. Treating hair cells-like cells with apelin13 increases their survival against oxidative stress damage by inhibition of apoptosis signaling pathway.

Desmoid tumor after resection of cerebellar hemangioblastoma

Desmoid tumors are histologically benign but locally invasive tumors that rarely can occur in the head and neck. In this article, we illustrate a rare case of desmoid tumor formation in intracranial posterior fossa after suboccipital craniotomy for hemangioblastoma. A 43-year-old woman presented with headaches, dizziness, equilibrium disorders, nausea, and vomiting due to a hemangioblastoma in posterior fossa. A gross total resection was achieved. Three years postoperatively, the patient developed a growing mass at the intracranial intradural regions in posterior fossa near the previous incision. Surgical resection of the lesion was performed and the mass was totally resected. Postoperative imaging demonstrated no residual evidence of tumor and the pathological review of the surgical tumor specimen demonstrated desmoid tumor in intracranial posterior fossa. As desmoid tumors seem to arise at the location of a previous surgical site, they should be considered in the differential diagnosis for superficial masses occurring in the surgical bed after posterior surgery. Additionally, identifying the relationship between the basic effects of tumor surgery and desmoid tumor formation is considerably needed.

Delay Posttraumatic Paradoxical Cerebrospinal Fluid Leak with Recurrent Meningitis

Cerebrospinal fluid (CSF) rhinorrhea complicates 2% of all head traumas, and 12%–30% of all basilar skull fractures. Posttraumatic CSF rhinorrhea usually occurs within the first 48 h, and majority of them occur in the first 3 months, whereas delayed CSF leak beyond 3 months is rare. On the other hand, CSF usually leaks through dural tearing associated with fracture of the anterior skull base. CSF leak through fractures of middle cranial fossa to the nose through the eustachian tube is very rare. We present a 52-year-old woman with delayed posttraumatic paradoxical CSF rhinorrhea and recurrent meningitis.

Serum Coenzyme Q10 Is Associated with Clinical Neurological Outcomes in Acute Stroke Patients

Disruption of prooxidant-antioxidant balance may lead to oxidative stress which is known as a mechanism contributing to ischemic stroke. Coenzyme Q10 (CoQ10) is an endogenous antioxidant that could be effective in preventing oxidative stress. However, the contribution of serum levels of CoQ10 in clinical neurological outcomes following ischemic stroke has not been clearly established. This study aims at measuring serum concentration of CoQ10 along with major indicators of antioxidant and oxidant among patients within 24 h after onset of the stroke symptoms, and investigating their relation with the clinical status of patients. Serum levels of CoQ10, superoxide dismutase (SOD), and malondialdehyde (MDA) were measured in 76 patients and 34 healthy individuals. Severity of the neurological deficit, functional disability, and cognitive status in ischemic subjects were respectively studied with the National Institutes of Health stroke scale (NIHSS), modified Rankin Scale (MRS), and Mini-Mental State Examination (MMSE). Stroke patients had significantly lower serum level of CoQ10 and SOD as compared to controls (27.34 ± 35.40 ng/ml, 18.58 ± 0.76 μ/ml, respectively; p < 0.05), whereas the serum MDA level was significantly higher (38.02 ± 2.61 μm, p < 0.05). A significant negative correlation was detected between the serum CoQ10 level and scores of NIHSS and MRS. A similar association was discerned between the SOD level and the neurological deficit score. The serum MDA level was also found to be strongly correlated with all three neurological scales. These findings suggest that the serum level of CoQ10 like other antioxidant and oxidant markers can significantly change early after ischemic stroke and they are substantially associated with clinical neurological outcomes.

Endoscopic Strategy in Surgical Treatment of Adult Idiopathic Bilateral Occlusion of the Foramen of Monro and Review of the Literature

BACKGROUND

Endoscopic approach has been used increasingly for the surgical treatment of adult idiopathic bilateral occlusion of the foramen of Monro (AIOFM). The aim of this study is to assess and compare the results of this strategy with other surgical methods of treating AIOFM.

METHODS

A retrospective study was performed to identify patients with AIOFM treated in our department from 2012 to 2017. We also performed a search of the literature to detect any case of AIOFM reported from 1980 to 2017 to provide a comprehensive assessment of the treatment of this condition. AIOFM was classified as 4 groups, including bilateral true stenosis of the foramen of Monro (FM), bilateral membrane occlusion of the FM, unilateral true FM stenosis with septum deviation, and unilateral membrane occlusion of the FM with septum deviation all assessed and discussed separately.

RESULTS

We found four patients with AIOFM surgically treated with endoscopic procedures in our department between the years of 2012 to 2017 with an excellent outcome. Fourteen studies were also detected during our review of the literature, most of which involved treatment with neuroendoscopy and excellent outcomes. We found that neuroendoscopy could be the first-line strategy to treat all 4 types of AIOFM.

CONCLUSIONS

Endoscopic strategy is associated with excellent outcomes and fewer risks in treatment of all types of AIOFM; it is also less invasive compared with ventriculoperitoneal shunt insertion.

Investigating related factors with mortality rate in patients with postoperative meningitis: One longitudinal follow up study in Iran

Background: Postoperative meningitis (POM) is the most dreaded cause of morbidity and mortality in neurosurgery patients. This study aimed to identify incidence and mortality rate as well as related factors to outcome in patients with POM. Methods: This descriptive longitudinal study conducted on patients with POM in duration of 2 years. Incidence and mortality rates as well as related factors were studied. Results: The incidence and mortality rates of POM was 8.9% and 50%, respectively. There were statistically significant association between male gender, as well as having mechanical ventilation, and death outcome in univariable analysis. In addition, in multivariable logistic regression analysis, length of intensive care unit (ICU) stay of more than 7 days [Odds ratio (OR): 1.2, confidence interval of 95% (95%CI): 1.02-6.2), mechanical ventilation (OR: 1.1, 95%CI: 1.05-5.1], positive cerebrospinal fluid (CSF) culture (OR: 2.4, 95%CI: 1.9-4.08) were predicting factors to death outcome. Finally, we found an inverse relationship between survival function and length of ICU stay in patients with POM. Conclusion: According to the high rates of incidence and mortality due to POM in this study, preventive studies to decrease this dreaded cause of morbidity and mortality in neurosurgery patients should be the planned.

Hydrocephalus as a rare compilation of vertebrobasilar dolichoectasia: A case report and review of the literature

Background:

Vertebrobasilar dolichoectasia (VBD) is a rare disease characterized by significant expansion, elongation, and tortuosity of the vertebrobasilar arteries. Hydrocephalus is a rare compilation of VBD.

Case Description:

In this study, we report a 68-year-old male presenting with headache, progressive decreased visual acuity, memory loss, imbalance while walking, and episodes of urinary incontinency. The patient was diagnosed with dolichoectasia of basilar artery causing compression of the third ventricular outflow and thus, presenting with hydrocephalus documented with brain computed tomography scan and brain magnetic resonance imaging. The patient underwent surgical operation and ventriculoperitoneal shunt placement.

Conclusion:

In the case of hydrocephalus or normal pressure hydrocephalous, VBD should be considered as a differential diagnosis.

Solitary aneurysm of the filum terminale artery: A case report and review of the literature

BACKGROUND

We report a rare case of aneurysmal dilatation of filum terminale artery after resection of filum terminal myxopapillary ependymoma.

CASE DESCRIPTION

The authors report a rare aneurysmal dilatation of the filum terminale artery following removal of a filum terminal myxopapillary ependymoma in a 10-year-old male. The patient presented with 6-month history of increasing back pain without a focal neurological deficit. Magnetic resonance (MR) showed an intradural filum terminale lesion that was completely excised. Three months later, the MR again revealed a lesion involving the filum terminale. During the second surgery, however, an aneurysmal dilation of the filum artery was found, which was coagulated and resected. Following the secondary surgery, the patient's symptoms gradually resolved, and he remains intact.

CONCLUSION

Although rare, a true aneurysm after spinal surgery should be considered among the differential diagnostic consideration in the region of the filum terminale.

S100 B: A new concept in neurocritical care

After brain injuries, concentrations of some brain markers such as S100B protein in serum and cerebrospinal fluid (CSF) are correlated with the severity and outcome of brain damage. To perform an updated review of S100B roles in human neurocritical care domain, an electronic literature search was carried among articles published in English prior to March 2017. They were retrieved from PubMed, Scopus, EMBSCO, CINAHL, ISC and the Cochrane Library using keywords including "brain", "neurobiochemical marker", "neurocritical care", and "S100B protein". The integrative review included 48 studies until March 2017. S100B protein can be considered as a marker for blood brain barrier damage. The marker has an important role in the development and recovery of normal central nervous system (CNS) after injury. In addition to extra cerebral sources of S100B, the marker is principally built in the astroglial and Schwann cells. The neurobiochemical marker, S100B, has a pathognomonic role in the diagnosis of a broad spectrum of brain damage including traumatic brain injury (TBI), brain tumor, and stroke. Moreover, a potential predicting role for the neurobiochemical marker has been presumed in the efficiency of brain damage treatment and prognosis. However further animal and human studies are required before widespread routine clinical introduction of S100 protein.

Spontaneous corynebacterium spondylodiskitis in an immunocompetent patient: A case report and literature review

BACKGROUND

Spontaneous Corynebacterium spondylodiskitis is an unusual diagnosis of spondylodiskitis, especially in healthy patients without any significant past medical history.

MATERIALS AND METHODS

We describe the case of a 78-year-old man with progressive low back pain for 3 months, irradiating down the lower limbs through L5 and S1 root pathways, associated with distal muscle weakness in both lower limbs. He had no history of trauma or medical problems. Laboratory investigation revealed elevated serum C-reactive protein (CRP) and erythrocyte sedimentation rate, without leukocytosis. The magnetic resonance findings demonstrated an extensive L5-S1 spondylodiskitis and L4-L5 anterolisthesis. Prior to spinopelvic fixation and posterolateral fusion, a substantial debridement was performed. The obtained tissue samples were submitted to pathological and microbiological studies, which identified Corynebacterium infection.

RESULTS

One month after surgery, the pain diminished dramatically and the CRP titer diminished significantly.

CONCLUSION

Although cases are very rare, spontaneous Corynebacterium spondylodiskitis, with substantial invasion of the spine, may develop in patients lacking any history of medical or surgical problems.

Congenital Posterior Spinal Agenesis Leads to L2-L3 Instability: a Case Report and Review of the Literature

Congenital absence of posterior elements of the lumbar column is an extremely uncommon anomaly and we found no any reported cases of incomplete congenital absence of the posterior elements of lumbar vertebra in the literature.  Here, we present a case with congenital absence of posterior elements of lumbar vertebra. The patient was a 51-year-old man with a history of 20 years of back pain. Imaging of the lumbar spine revealed instability in L2 and L3 and there was evidence of retrolisthesis, agenesis of pars interarticularis, spinous processes, lamina, transverse processes and facets at L2 and L3. The patient underwent lumbar discectomy and posterior spinal fixation and instrumentation was then done using pedicle screw fixation. Four pedicle screws, two rods, and one cross link were employed to bilaterally fix the L2 and L3 and then we used autograft and allograft bone for interbody fusion, substitutes from iliac crest for posterior fusion. There were no postoperative complications, and at 6, 12 and 24 months of follow-up, his leg and back pain had improved, and the patient did not need any analgesic for pain relief. Complete congenital absence of the lumbar posterior element has been rarely reported in the literature. Patients whose congenital anomalies lead to segmental instability are surgical fusion candidates, but if these anomalies occur in pars interarticularis such as spondylolysis isthmus, fixation and inter segmental fusion techniques are useful.

An aneurysm at the site of the fenestration of the middle cerebral artery in a patient with multiple aneurysms: A case report

Background:

Middle cerebral artery (MCA) fenestration is a very rare anatomical variant of the MCA, incidentally found during magnetic resonance or computed tomography angiography. It has an incidence of 0.6%. Unlike fenestration of the posterior cerebral arterial circulation, fenestration of the anterior cerebral arterial circulation has not been well described.

Methods:

We present the rare case of a patient who was admitted for a ruptured aneurysm of the MCA arising at the site of the fenestration of the MCA and also an unruptured fusiform aneurysm of the right posterior communicating artery and a distal anterior cerebral artery (ACA) aneurysm.

Results:

The patient underwent craniotomy with microsurgical aneurysm clipping and the previously undiagnosed ruptured aneurysm, at the site of the fenestration of the MCA, arose immediately. Postoperatively, the patient awoke without a deficit. After treatment of postoperative bacterial meningitis, he was discharged on the 26^th postoperative day in good condition without any neurologic deficit. Six months after the first surgery, he was operated for the distal azygos ACA aneurysm.

Conclusion:

Anomalies of the intracranial vasculature are common, and we describe a rare case of left MCA fenestration with an associated ruptured aneurysm at the site of the fenestration. In the literature, cases of fenestration of the MCA are sporadically reported and are only incidental findings.

Hard calcified intrasellar schwannoma mimicking pituitary adenoma: a case report and review of the literature

BACKGROUND

Intrasellar location of schwannoma is extremely rare, although intracranial schwannomas are common in the central nervous system. The aim of the present study is to describe a calcified intrasellar schwannoma case.

MATERIALS AND METHODS

We represent a 45-year-old woman who had suffered from headaches; right side facial pain and visual disturbance which had worsen during the last week prior to admission. Physical examinations were normal except for the bitemporal visual field hemianopia which match with perimetry examination. MRI demonstrated an unusual seemingly calcified mass lesion in the sellar region which was mimicking pituitary macro adenoma.

RESULT

Total resection of the tumor achieved through endoscopic transnasal transsphenoidal approach by extracapsular dissection and pathologic examination of the tumor revealed calcified schwannoma.

CONCLUSION

The differential diagnoses of sellar and suprasellar lesions include pituitary adenomas, craniopharyngiomas, meningiomas, and many others. However, schwannoma is not usually included, because the occurrence of schwannoma in the sellar or suprasellar region is extremely rare. Only few cases of intrasellar schwannomas have been reported in the literature, all of which presented a suprasellar extension similar to that of our case. Fascinating surgical point is managing very firm tumor through transsphenoidal corridor which we handle it by very sharp, debulking and extracapsular removal.

Endoscopic Surgery in Nonhydrocephalous Third Ventricular Colloid Cysts: A Feasibility Study

BACKGROUND

The aim of this study was to investigate the feasibility and effectiveness of endoscopic neurosurgery for patients with third ventricular colloid cysts but without ventriculomegaly.

METHODS

Seventy-one patients with third ventricular colloid cysts were identified and recruited to this study. Eighteen of these patients did not have concomitant hydrocephalus and underwent primary endoscopic surgery for cyst resection. The surgical technique, the success rate, and patients' outcome were assessed and compared with another 53 patients with hydrocephalus who underwent similar procedures. Our study was performed in a retrospective basis, although in middle of our work we decided to study and follow nonhydrocephalus cases prospectively.

RESULTS

The ventricular compartments were successfully cannulated and gross total resection and near total resection of the colloid cysts was achieved in all patients. There were no persistent operative complications related to the endoscopic procedure. The success rate for endoscopic surgery in patients without hydrocephalus was similar to its value in patients with hydrocephalus.

CONCLUSIONS

Endoscopic resection of third ventricular colloid cyst in patients without hydrocephalus seems to be feasible, effective, and not contraindicated.

An outcome measure of functionality and quality of life in patients with cervical myelopathy

Background:

Cervical spondylotic myelopathy (CSM) is a common cause of significant clinical morbidity. The Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) is a measure of health-related quality of life in these patients.

Objectives:

This study aimed to cross-culturally translate and validate the JOACMEQ in Iran.

Patients and Methods:

This study was a prospective clinical validation one. Forward-backward procedure was applied to translate the questionnaire from English into Persian. The translation and cross-cultural adaptation were performed in accordance with the published guidelines. A sample of patients with CSM was asked to respond to the questionnaire at two times: providing preoperative and postoperative assessments (6 months follow-up). To test the reliability, the internal consistency was assessed by Cronbach α coefficient and the validity was assessed by convergent validity. Responsiveness to change was also assessed comparing patients’ preoperative and postoperative scores.

Results:

All 87 patients completed the questionnaire. The Cronbach α coefficient for the JOACMEQ at preoperative and postoperative assessments ranged from 0.71 to 0.82 indicating a good internal consistency for the questionnaire. In addition, the correlation of each item with its hypothesized subscale of the JOACMEQ showed satisfactory results suggesting that the items had a substantial association with their own subscales. Further analysis also indicated that the questionnaire was responsive to change (P < 0.001).

Conclusions:

In general, the findings suggest that the Persian version of the JOACMEQ is a reliable and valid measure of functionality and quality of life evaluation among Iranian patients suffered from CSM.

Angiosarcoma of skull in a pregnant woman: case report and review of the literature

Angiosarcoma is a rare tumor of bone that uncommonly involves the skull. Primary neoplasms of the skull represent 2.6% of primary neoplasms of bone. We wish to report a case of angiosarcoma of he skull in an 18-year-old pregnant woman who presented with a rapidly growing left frontotemporal mass. Neuroimaging revealed a left frontotemporal mass with destruction of diploic space and both tables and with extension to the subgaleal and epidural spaces. The patient underwent surgery and the tumor was removed totally. Histological features of angiosarcoma were seen in the pathology study. She received adjuvant chemotherapy and radiation therapy. She has remained well during 6 years of follow-up with no evidence of recurrence. Angiosarcoma is a rare malignant bone tumor of vascular origin. Our case is the only female patient with skull angiosarcoma that has been reported so far.

The anatomical relation between the superior sagittal sinus and the sagittal suture with surgical considerations

OBJECTIVE

Localization of superior sagittal sinus before craniotomy is very crucial to prevent the complications of surgery. The goal of this study was to verify the anatomical relationship between the sagittal suture and the superior sagittal sinus (SSS).

METHODS

Fifty adult cadavers were included in this descriptive analytic study. The length of sagittal suture and the width of sagittal suture and SSS were measured in three points: (bregma), (lambda) and midpoint of sagittal suture. Anatomical relationship between SSS and sagittal suture was analyzed.

RESULTS

Superior sagittal sinus was deviated to the right side of the sagittal suture in 54% of cases at bregma and 64% of cases at the midpoint of sagittal suture and lambda. SSS was located at the right side of sagittal suture about 3.5mm at bregma, 4.5mm at midpoint of sagittal suture and 5.7 mm at lambda. The right transverse sinus was dominant in 76% of cases. No gender-associated difference was noticed.

CONCLUSION

Our study demonstrates that SSS is deviated to the right side of sagittal suture in the majority of cases. Maximum deviation of SSS to the right side is about 10mm. Neurosurgeons are advised to be aware of this anatomical relation while operating around SSS.