Review Article

Purpose: To evaluate of Proton therapy (PT) for neurosurgery patients and is also to explain the need for this system in Iran.

Methods: A literature review was conducted (1984–2016). The strategy included a combination of keywords including proton therapy, neck, neurosurgery, brain, head, tumor, spine, arteriovenous malformation (AVMs), cervical and spine in database of PubMed. New generation PT systems were assessed. Findings are summarized, with a focus on the application of PT in neurosurgery. Finally, the future of PT is discussed.

Results: A total of 1329 citations were screened. In all, 60 articles were included. The synthesis of the data showed two applications of PT in neurosurgery, including: (a) the use in head disease such as AVMs, acromegaly, medulloblastoma, primitive neuroectodermal tumors, papillary tumors of the pineal region, low-grade astrocytoma, head and neck adenoid cystic carcinoma, meningioma, mesenchymal tumors, pediatric cranial tumors, squamous cell carcinoma of the head, craniospinal, and skull base chordomas and chondrosarcomas; (b) the apply in the spinal disease as chordoma or chondrosarcoma of the cervical, sacrum, thoracic and lumbar spine, ependymomas, tumor locations included cervical, thoracic, lumbar, S1-S2, and S3 or below. In addition, the combination of a gantry and cyclotron with new proton therapy systems, results in a lower cost.

Conclusion: PT may be associated with better outcomes for selected patients with malignant diseases of the head and spine. The findings suggest that there exists a need for at least one center to treat the patient demand in Iran.

The Relationship betweenSkewed X-chromosome Inactivation and Neurological Disorders Development: A Review

Mahdi Taherian, Hossein Maghsoudi, Kazem Bidaki, Reza Taherian

International Clinical Neuroscience Journal, Vol. 3 No. 2 (2016), 22 September 2016, Page 81-91

X-chromosome inactivation (XCI) is a process by which one of the copies of the X chromosome in mammalian female cells is inactivated. The XCI causes a balanced X-linked gene quantity between male and females; moreover, it results mosaic females which have paternal active X in some cells and maternal active X in others. Cellular mosaicism is a noteworthy phenomenon and lowers the risk of X-linked diseases in women because the presentation of a mutation on both X chromosomes is unlikely. Therefore, in heterozygous females, the XCI will be present only on the half of the X genome. In contrast, a similar mutation will present in all of the cells of men.Female carriers of some neurological disorders such as autism, Rett syndrome, adreno-leukodystrophyand X-linked mental retardation are reported to present XCI. These observations underscore the important role of X chromosome in the brain which may be related to the existence of a chromosomal signature of gene expression associated with the X-chromosome for neurological conditions not normally associated with that chromosome.In this review, we focused on latestinvestigations on the role of XCI in neurodevelopmental disorders and how these investigations can be effective in the treatment of neurodevelopmental disorders.

Original / Research Article

Numerical Simulation of the Cervical Spine in a Normal Subject and a Patient with Intervertebral Cage under Various Loadings and in Various Positions

Seifollah Gholampour, Nikoo Soleimani, Ali Reza Zalii, Fateme Zare karizi, Afsoun Seddighi

International Clinical Neuroscience Journal, Vol. 3 No. 2 (2016), 22 September 2016, Page 92-98

Background: Cervical spine sustains most of thevertebral column injuries, among other injuries, the disc degeneration and damage that lead to replacement of the damaged disc with cage or artificial disc.

Methods: The C4 to C6 vertebrae of a normal subject and a person with interbody fusion cage were 3d modelled and then analyzed using Finite element method. The results of maximum stress and strain in cervical spine of the normal subject and patient were compared in three positions: standing, lying with axial rotation of neck and standing with axial rotation of neck.

Results: The maximum principal strain and stress in the patient are respectively 10.5% and 14.5% greater than those in normal subject in standing position, howeverin lying position when the head has axial rotation, the maximum principal strain and stress are in the normal subject 6.2% and 16.3% greater than those in patient, respectively. The difference between these results and the results of strain and stress in standing position when the head has axial rotation is very small. This outcome is due to smallness of the stress exerted on cervical spine as a result of the head weight (131-150 Pa).

Conclusion: In contrary to the constraint between disc and vertebrae, there is no friction between cage and vertebrae and this leads to maximum stress transfer to the first vertebra above the cage in patient. However, the maximum stress is ultimately less in the patient with fusion cage than the normal subject. Generally, only the neck rotations are the cause of cervical spine injury in normal neck movements.

Effects of Exogenous Estrogen Treatment on Hippocampal Neurogenesis of Diabetic Ovariectomized Rats

Behnamedin Jameie, Shayesteh Mehdinejadiani, Mona Farhadi, Maryam Solimani, Sajad Hassanzadeh, Mahdieh Kerdari, Manasadat Jameie, Melikasadat Jameie

International Clinical Neuroscience Journal, Vol. 3 No. 2 (2016), 22 September 2016, Page 99-108

Background: Mellitus Diabetes (DM) is the most important metabolic diseases. The incidence of DM is prone to increase. Vasculopathy, retinopathy, central and peripheral neuropathy are the most important reported side effects of DM. Cognitive dysfunction following DM reported in both sexes. Hippocampus is a major part of brain involving in cognitive function, its cells are able to neurogenesis, so it is possible that DM affects the hippocampus. In addition, neuroprotective effects of female sex steroids are reported elsewhere. In order to answer the question of whether female sex steroid are able to suppress the effects of DM on neurogenesis of dentate gyrus (DG) in diabetic ovariectomized rat the present study designed.

Methods: Sprague-Dawley adult female rats were used in this study. The animals randomly divided in 8 groups including; control, diabetic (Diab), ovariectomy (OVX), Diab+OVX, estrogen treated (E2; Diab+OVX+E2), surgical and vehicle sham. Intrapritoneal injection of STZ, subcutaneous injection of E2 and routine bilateral surgery were used respectively to induce diabetes, estrogen treatment and OVX. Nissl staining, Brdu immunohistochemistry (IHC) and western blotting were used in this study. Statistical analysis was done and the results presented in mean ± SD, Pv < 0.05 considered significant.

Results: Brdu IHC showed that the neurogenesis significantly decreased in OVX, Diab and OVX-Diab groups (Pv < 0.05) in comparison with control and sham groups. Western blotting showed significant increase of Bax and decrease of Bcl2 proteins of trial groups comparing to control. Estrogen treatment significantly improved neurogenesis in animals of Diab+OVX+E2 group. The neurogenesis impairment was more sever in OVX + Diab animals than OVX and Diab ones merely.

Conclusion: Based on our data, cognitive dysfunction caused by DM is related to hippocampal neurogenesis reduction and might improve under the influence of ovarian steroidal hormone therapy.

The Role of Steroid in Post Myelography Headache

Afsoun Seddighi, Amir Saied Seddighi, Hesam Rahimi Baghdashti, Alireza Sheikhi, Shoeib Naimian

International Clinical Neuroscience Journal, Vol. 3 No. 2 (2016), 22 September 2016, Page 109-112

Myelography is a diagnostic procedure to indicate spinal defects. After the inception of new means of spinal cord imaging, use of myelography has been limited. Since there are contraindications for other modalities in some patients, we have to use myelography. The most common complication of myelography is post myelography headache (PMH). Many methods have been proposed to alleviate the pain. In this clinical trial study we assess the role of steroid in PMH.

Biomechanical Assessment of Cervical Spine with Artificial Disc during Axial Rotation, Flexion and Extension

Seifollah Gholampour, Nikoo Soleimani, Fateme Zare Karizi, Ali Reza Zalii, Nooshin Masoudian, Amir Saeed Seddighi

International Clinical Neuroscience Journal, Vol. 3 No. 2 (2016), 22 September 2016, Page 113-119

Background: The cervical spine is the most vulnerable part of the vertebral column and the rotational movements are the most dangerous movements which may cause damages to cervical spine. A good treatment option for the cervical disc disease is the replacement of a damaged disc with an artificial disc that has shown satisfactory clinical results.

Methods: The C4 to C6 vertebrae of a normal subject and a person with an artificial disc between the vertebrae C5 and C6 were 3d modelled and then analyzed using FEM. The results of stress and deformationin both subjects were calculated and compared for three rotational head movements: axial rotation, flexion and extension. A distributed load of 73.6 N was used to simulate the head weight and a moment of 1.8 N.m was used to create all three rotational movements.

Results: The maximum Von Mises stress in the normal subject during the axial rotation was respectively 2.2 and 1.8 times greater than the maximum stress during flexion and extension. These numbers were 2.6 and 2.3 in the subject with artificial disc.Following the artificial disc replacement, the cervical spine strength against the extension improved about 2.7%, however, the strength in axial rotation and flexion decreased 6.9% and 24.3%, respectively. The maximum values of deformation in the normal subject during flexion, extension and axial rotation were 2.8, 2.8 and 2 times of the values in the subject with artificial disc during the similar movements.

Conclusion: The flexion and extension involve risks of hurting the cervical spine, however, the axial rotation is much more dangerous regarding the damages it may cause especially to the C5/6 intervertebral disc. Numerically, there is a much greater possibility of cervical spine injury during axial rotation.

Case Report

Cortical Epandimoma with Extention to Thalamus

Mohamad Ali Fazeli, Farzad Ashrafi, Mehdi Farokhi

International Clinical Neuroscience Journal, Vol. 3 No. 2 (2016), 22 September 2016, Page 120-123

Ependymomas are glial tumors originate from ependymal cells lining the ventricles and the central canal of the spinal cord. Two thirds of ependymomas arise in the infratentorial or intraventriclesandone-third aredetected in supratentorial area. However supratentorial “cortical” ependymomas are veryuncommon. Ependymomas are usually infratentorial, intraventricular tumor, including 2–9% of all central nervous system tumors. We present a unique case of an anaplastic cortical ependymomain a 48-year-old man. The patient presented with transient amnesia and right weakness and seizure. This tumor was located in the left parieto-occipital region with extension to corpus callosum and thalamus. Microscopy and immunohistochemistry showed grade III differentiation ependymoma.

Air in Straight Sinus after Closed Head Injury Surgery

Amirsaeed Sedighi, Mohammad Ali Fazeli, Alireza Ebrahimi, Afsoun Seddighi

International Clinical Neuroscience Journal, Vol. 3 No. 2 (2016), 22 September 2016, Page 124-126

Air in the intracranial vascular compartment is rare and only few case reports are published in the literature. Without surgery or open head trauma, the origin of air bubbles in the venous sinus is still debated. We report an admitted patient in the emergency room one hour after a severe closed head injury, and in whom, the post-surgical cranial CT scan demonstrated feature of air embolism along the straight sinus. Mechanisms explaining how air reaches the venous compartment is discussed.