Iranian Journal of Neurosurgery
Volume:1 Issue: 3, Summer 2015

DBS (deep brain stimulation) is a new and successful technique in treatment of symptoms of Parkinsonism especially after drug resistance. Research in this field is mostly designed for evolution of this technique. The present study aimed at evaluating the relationship between the angle formed in midsagittal and STN (sub-thalamic nucleus) axis line and recording length in the final electrode p lacement.
Methods & Materials/Patients: 46 patient candidates for DBS operation were studied in terms of demographic variables, STN nucleus length, the angle between midsagittal line and STN axis (p angle), the number of tested electrodes, force and length of final electrode registration and final coordinates of the placed electrode. The primary information was obtained from patients records and other technical information based on MRI imaging using Stereonata software and during surgery. The information were analyzed using SPSS (version 16) and descriptive analysis and linear relationship.
The mean force of the recording from trial microelectrodes implanted in the right side ranged from 1.49 ± 1.45 to 2.65 ± 1.42 and in the left side from 1.53 ± 1.35 to 2.65 ± 2.30. In comparative analysis, no significant statistical relationship was found between P angle of the right side and degree registered in the final electrode of the right side (Pearson correlation: 0.314, P value= 0.049).
Not only accurate electrodes positioning in the STN can lead to improved outcome within bilateral STN DBS, but also optimizing defined P angle can have beneficial effects on intraoperative outcome after STN DBS.

We described the presentation, management and subsequent treatment outcomes of children and adolescents diagnosed with a pituitary adenoma in a joint neuroendocrine setting followed up by a single service as well as assessing long-term outcomes in terms of endocrine status and neurology symptoms.
Methods & Materials/Patients: A total of 21 participants with histologically verified pituitary adenoma between January 2011 and June 2014 were studied. Patient's data from clinical, radiological and pathological records were analyzed using SPSS (Version 16).
All these children and adolescents with pituitary adenomas were managed with microscopic transsphenoidal surgery. The most common symptom was Cushing (47.6%, n=10). The functional type 76.2%, n=16) was more than the non-functional. The post-operative control MRI of most of them was clear (90.5%, n=19). The lab control of most of them was normal (76.2%, n=16). Apoplexy was seen in 5 patients (33.8%). Gross total resection (GTR; 100% tumor removal as judged by early post-operative imaging) was achieved in 19 cases. Only one of these patients showed evidence of radiologic recurrence.
In our study, all patients underwent microscopic transsphenoidal surgery due to limitation of endoscopic approach in pediatric and avoided wide anatomical deficit. Doing a comparative study between these two approaches will bring about promising results.

Glioblastoma multiforme (GBM), the highest grade glioma (grade IV), is the most malignant form of astrocytoma in adults. This study aimed at evaluating the relationship between demographic, clinical and medical factors with GBM outcome.
Methods & Materials/Patients: Through a cross-sectional design, 58 patients with newly diagnosed GBM were studied from 1999 to 2015 in Guilan province (North of Iran). Demographic, clinical and medical data including age, gender, score of Karnofsky Performance Scale (KPS), status at discharge, extent of resection (EOR) and administration of post operative radio-chemotherapy were recorded in an individual questionnaire. The data were analyzed using chi-square and fisher exact tests.
Of all patients, 35 (60.3%) cases were men and 23 (39.7%) were women. Age range (at the time of diagnosis of GBM) was 18-82 years (54.86±16.34). The most common side and location of tumor were left hemisphere and frontal lobe, respectively. 41 patients (70.7%) received total surgical resection. Half of patients were treated with simultaneous post operative radiation therapy and chemotherapy.11 (19%) of all cases died. About 41 (70.6%) of patients demonstrated KPS 50-70.
GBM is a frequent malignant brain tumor with male predominance and high occurrence in age range of ≥50 years. The number of dead patients increases with decreased KPS. Total surgical resection followed by concomitant radiation therapy and chemotherapy were common standard therapeutic regimens.

Conjoined nerve root is defined as two adjacent nerve roots that share a common dural envelope at some points during their course from the thecal sac. This study reports our experience of conjoined roots involving three cases in Dakar.
Methods & Materials/Patients: This is a consecutive study from 2013 to 2015 involving patients supported for disc herniation and who have presented conjoined nerve root anomalie s.
Three patients aged 32, 35 and 55 including two men have been concerned. Clinical analysis was done on sciatica with neuropathic occurrences in one case and lumbosciatica in two cases. The Lasegue sign was present in two patients at 45°. All three patients benefited a lumbar computerized tomography (CT scan) highlighting a degenerative disc disease with two in L5S1 space and one in L4L5 space. The imaging has not objectified radicular emerging anomalies. MRI objectified only one big root. A surgical root decompression was realized through interlaminar discectomy approach; foraminotomy and full laminectomy enabling diagnosis in intraoperative period. The evolution was favourable in all three cases with full recession of sympto matology.
This study is the first Senegalese series on the lumbo-sciatica by anomaly of root emergence and highlights especially the difficulties for the diagnosis of these anomalies like other sub-Saharan African countries where expansion of MRI for the diagnosis is low, and still very expensive. MRI provides guidance signs and a large root appearance can warn about the existence of these anomalies. A good root release improves the symptoms.

Background & Importance: Idiopathic stenosis of the foramina of Magendie and Luschka is a rare cause of obstructive hydrocephalus involving the fourth ventricle.
We reported the case of a 40-year-old woman who developed headaches and vertigo for several months and more recently gait disturbance. The CT scan showed quadri-ventricular hydrocephalus involving mainly the fourth ventricle with dilated lateral recesses. Craniocervical MRI confirmed hydrocephalus and also showed the brainstem and cerebellar tonsil herniation through the foramen magnum with hydromyelia and a hyperintense signal on T2 weighted MRI of cervical spinal cord. Biological analyses were normal. She underwent endoscopic third ventriculostomy (ETV). No complication was observed. The patient became asymptomatic during the weeks following the surgical procedure and remained stable at a mean follow-up interval of 20 months. Postoperative MR images demonstrated regression of the hydrocephalus; complete disappearance of brainstem and cerebellar tonsil herniation, hydromylia and the hyperintense signal on T2 weighted MRI of cervical spinal cord.
This case confirms the existence of hydrocephalus caused by idiopathic fourth ventricle outflows obstruction in adult and the efficacy of ETV for this rare indication.

Background & Importance: Acute epidural hematoma is a very rare complication of ventriculoperitoneal shunt insertion. The insertion of a ventriculoperitoneal shunt can cause sudden decompression of the brain, subsequent to which epidural hematoma occurs due to CSF drainage. To our knowledge, there are only a few cases of acute epidural hematoma in the literature which required acute evacuation.
In this report, we present a case of epidural hematoma close to ventriculoperitoneral shunt insertion site in a 30-year-old man after failure of endoscopic surgery for opening of the wall of a suprasellar arachnoid cyst. Secondary to communication between cyst and ventricles and clinical symptoms and sings, the patient underwent the shunt insertion. The patient became comatose two hours following the insertion of the shunt, developing a voluminous right temporo-parietal epidural hematoma that had to be evacuated immediately. Here, we intend to discuss both the pathophysiology and treatment.
Development of epidural hematoma after ventriculoperitoneal shunt surgery is a devastating complication. Dehisensce formation between the skull and dura matter, which may be facilitated by lax adhesion between the two, is a common underlying pathology. We recommend a close post-surgical observation for immediate diagnosis and reoperation of this event.

Background & Importance: Infections of the craniocervical junction are rare.
We present a case of infection by methicillin-sensitive Staphylococcus aureus and Streptococcus mitis that was not previously reported.
Neurosurgeons must suspect for diagnosis and initiate broad antimicrobial therapy, including active agents against gram-negative and then initiate a targeted therapy. The purpose of this report is to highlight the importance of early diagnosis for a successful medical treatment.