Endoscopic Evacuation of Subdural Collections.

AIM: Intraoperative use of the endoscope is a hot topic in neurosurgery and it gives broader visualization of critical and hardlyreached areas. Endoscope-assisted surgical approach to chronic subdural haematoma (SDH) is a minimally invasive technique and may give an expansion to the regular method of burr-hole haematoma drainage. MATERIAL AND METHODS: Endoscope-assisted haematoma drainage with mini-craniotomy was performed over a 24-month period, and prospectively collected data is reviewed. A total of 10 procedures (8 patients) were performed using the endoscopeassisted technique. Four of them were chronic SDH and six were subacute SDH. RESULTS: Procedures were extended 20 minutes in average because of endoscopic intervention. There was no extra-morbidity through the study as a consequence of endoscopic assessment. CONCLUSION: Endoscope-assisted techniques can make the operation safe in selected circumstances with improved intraoperative visualization. It may likewise take into consideration the identification and destruction of neo-membranes, septums and solid clots. In addition, the source of bleeding can be easily coagulated. The endoscope-assisted techniques, with all of these features, can alter the pre- and intra-operative decision-making for selected patients.

Retroperitoneal cystic lymphangioma: a diagnostic and surgical challenge.

A lymphangioma is a benign proliferation of lymph vessels, producing fluid-filled cysts that result from a blockage of the lymphatic system. The incidence of abdominal lymphangiomas is unknown; however they account for from 3% to 9.2% of all pediatric lymphangiomas, with retroperitoneal lymphangioma representing less than 1% of abdominal lymphangiomas. Due to rarity, preoperative diagnosis is often difficult.

A proton magnetic resonance spectroscopic study in juvenile absence epilepsy in early stages.

PURPOSE: The aim of this study to evaluate the hippocampal, frontal and thalamic lobe functions in the early stage of the juvenile absence epilepsy (JAE) by magnetic resonance proton spectroscopy (MRS). METHOD: Fourteen patients with juvenile absence epilepsy with typical absence seizures and 10 healthy volunteer controls were included in this study. The diagnosis of the patients was in accordance with EEG findings and seizure semiology. All patients had minimum twice EEG recordings and all had typical 3-Hz generalized spike and slow-wave discharges at least on one EEG. All patients had bilateral MRS of frontal, thalamic and hippocampal regions and NAA, NAA/Cr, NAA/Cho, NAA/Cho+Cr levels were detected. RESULTS: The mean age was 14.9+/-2.05 and 14.5+/-1.7 of the JAE patients and control subjects, respectively. Mean seizure onset duration were 2.3+/-0.9 years. In patient group the frontal, thalamic and hippocampal NAA/Cr ratios were 1.65, 1.78, 1.47 in right and 1.75, 1.90, 1.42 in left, respectively. While in the control group NAA/Cr ratios were 1.64, 2.42, 1.57 in right and 1.83, 2.44, 1.47 in left, respectively. There weren't any difference in frontal and hippocampal regions, but the bilateral thalamic NAA, NAA/Cr ratios of the patients were significantly lower than control group even in early stages of the disease. CONCLUSION: The observed reductions in NAA levels and NAA/Cr ratios of bilateral thalamic regions are consistent with epilepsy related excitoxicity as a possible underlying mechanism even in early stage of JAE. However, we believe that to generalize the results of our study a prospective multicenter study is required.