Iranian Journal of Neurosurgery
Volume:3 Issue: 1, Winter 2017

In the present study, the cerebral surface landmarks in human fresh autopsy specimens were investigated.
Methods and Materials/Patients: Totally, 37 fresh adult autopsy human brain specimens from the Rasht Forensic Medicine Center were enrolled. Four specimens were excluded because of some traumatic injuries to cerebral cortex. Demographic information of all cases was obtained. Length of bilateral central sulcuses and posterior ramous of Sylvian fissures, thickness of superior, middle, and inferior gyri of temporal lobes, as well as the distance from frontal poles to midpoint of central sulcuses were measured and analyzed using SPSS software.
In total, 25 male (75.8%) and 8 female (24.2%) specimens were included. Mean (range) length of posterior ramus of right and left Sylvian fissure was 75.61 mm (50-95) and 74.55 mm (49-100), respectively. Mean (range) length of right and left central sulcus was 94.85 mm (75-115) and 97.24 mm (65-125), respectively. Mean (range) thickness of right and left superior temporal gyrus was 16.66 mm (5-20) and 15.33 mm (7-25), respectively. Mean (range) thickness of right and left middle temporal gyrus was16.63 mm (5-25) and 16.42 mm (8- 25), respectively. Mean (range) thickness of right and left inferior temporal gyrus was 10.30 mm (5-20) and 10.70 mm (5-22), respectively. Mean (range) distance from right and left frontal pole to midpoint of right and left central sulcuse was 81.27 mm (55-105) and 82.63 mm (60-105), respectively. There were no statistically significant differences between two h emisphere measurements.
It can be said that the two hemispheres are similar in cerebral surface landmarks.

One of the main concerns in different countries is training young neurosurgeons to treat patients. Each country is dealing with this issue with a certain strategy considering its goals. Training physicians is far different from many other fields, as it cannot be accomplished in the library or by reading books. This fact becomes even more notable when it comes to the neurosurgery which requires meticulous surgical skills and knowledge. Training a capable neurosurgeon starts with the process of accepting, develops with residency education, and is solidified by a post-graduation training (e.g. fellowships) which will be reviewed briefly here

Chronic back pain is one of the most important reasons of individuals’ referring to clinic, so that no determined recognition is posed in considerable number of such individuals. Spondylolysis and spondylolisthesis are two important pathologies that people might be afflicted with for years but they might be unaware of it. Therefore, such diseases may account for chronic back pain. This study aims at analyzing prevalence of these two injuries in individuals afflicted with chronic back pain.
Methods and Materials/Patients: This has been a cross-sectional study for two years on individuals who referred to our clinic with complaining about chronic back pain with taken MRI and radiography of spine for diagnosis of their problem. Information related to current pathologies in imaging was extracted and registered from an interpretation of physician and radiologist report.
In this study, 289 out of 692 studied individuals were male. Spondylolysis and spondylolisthesis were observed in 8.6% and 13% of them, respectively. Prevalence of spondylolisthesis in women (18%) was significantly more than that in men especially by aging. There was no statistically significant relationship between spondyloysis and spondylolisthesis.
Spondylolisthesis and spondylolysis are seen among the main reasons of chronic back pain in aged women with prevalence of 13% and 8.6%, respectively.

Topography of the human insula has occasionally been studied in different populations. The purpose of this study was to evaluate the morphology of human insula in Iranian population and its relationship with sex, age, and handedness via magnetic resonance imaging.
Methods and Materials/Patients: In our study, 380 normal magnetic resonance imaging were enrolled. The number of short and long insular gyri, as well as their relationship with sex, age, hemispheres and handedness were assessed.
No significant differences were seen in number of insular gyri among right and left hemispheres, and males and females, but gyri number of left insula in right handers were significantly more than that in left handers. Maximum anterior – posterior distance of base of insula was longer in male and left insula compared to female and right insula, respectively. Younger individuals had more gyri than the older ones. The middle short insular gyrus can be absent more frequently than anterior and posterior short gyri.
The sagittal magnetic resonance imagings in our study can be appropriate for numbering the insular gyri and help to understand the complicated anatomical structures of insula. The findings of this study demonstrate an insular gyri pattern of handedness and age-related morphology in Iranian population, with similar gyri pattern in both males and females.

Decompressive craniectomy (DC) can be life-saving for patients with severe traumatic brain injury (TBI), but many questions about its ideal application, indications, timing, technique, and even the definition of success of DC remains unclear. The aim of this study was to assess the factors associated with prognosis and outcome of patients with TBI who had undergone a rapid decompressive craniectomy.
Methods and Materials/Patients: We investigated 61 patients, who had underwent rapid decompressive craniectomy. The effect of variables including demographic features of patients, primary level of consciousness, pupil size and reactivity, midline shift in patients brain CT scan on outcome of patients were assessed.
Sixty-one patients (36 males and 25 females) underwent rapid surgical DC within 4.5 ± 2 hours after trauma. Mean age of patients was 36.09± 15.89 years old (range 16 to 68). Of 61 patients, 33 (54.1%) had favorable and 28 (45.9%) had unfavorable outcome. Patients with following conditions had significantly worse outcome; older than 60 years, bilateral non-reactive mydriasis, critical head injury (GCS 10 mm had 6.15 times more risk of unfavorable outcome compared to those with lower than 10 mm of midline shift.
In this study we found that age more than sixty years and GCS less than five were associated with poor outcome. Patients with these conditions could not benefit much from early DC.

Background and Importance: Abscess of the hypophysis or pituitary adenoma is a very rare entity, and its preoperative diagnosis could be challenging. The clinical presentation is less specific, and despite the recent advancement in imaging, diagnosis before surgery is still difficult.
We reported two cases of pituitary abscesses in patients aged 38 and 42 years. The first patient was managed for maxillary sinusitis associated with pituitary adenoma whose diagnosis was made following surgery. For the second patient, the diagnosis was proposed before surgery following an MRI which showed a ring enhancement lesion of the hypophysis. Both patients benefitted from surgery where one had sub-labial rhino-septal trans-sphenoidal approach and the other through endoscopic endonasal trans-sphenoidal approach. Both received intravenous broad spectrum antibiotics.
Post-operative evolution was good with control MRI showing complete disappearance of the sellar lesion. Early diagnosis and treatment improved the prognosis.