Evaluation of the Medicolegal Process in Neurosurgical Practice with A Scenario.

The main purpose of medicine is to protect humans from diseases and its complications. Patients may be at risk in the course of diseases or during medical and surgical treatments, which can have undesirable consequences, including death. These risks, which are accepted by all medical authorities and medical literature, are called "complications." One of the responsibilities of the physicians is to detect complications on time and to manage them in accordance with the current medical standards. In the last two decades, allegations that any medical practice is "faulty" have been increasing, and these allegations are presented to the press and media regardless of whether they are justified. This situation adversely affects the medical practice, leading to defensive medical practices, affecting the public health. In this article, we presented our medical responsibilities over a neurosurgical scenario and mentioned the legal procedures to be experienced in such a situation. As physicians, we must know all the legal responsibilities of our profession and record all stages of treatments applied, to suffer the least damage from these claims and legal processes that cause pecuniary and non-pecuniary injury.

A Rare Entity in the Lumbar Epidural Region: T-Cell Lymphoblastic Lymphoma.

BACKGROUND: T-cell lymphoblastic lymphoma is a rare disease and an aggressive neoplasm of precursor lymphoblasts. We present a case of lumbar epidural T-cell lymphoblastic lymphoma which appeared with clinical features of epidural spinal cord compression. METHODS: A 38-year-old male patient presented with weakness in the lower extremities and newly developed urinary incontinence. His medical history included precursor T-cell acute lymphoblastic leukemia and treatment with allogeneic bone-marrow transplantation 5 years previously. Spinal magnetic resonance imaging (MRI) revealed an epidural mass lesion at L2-L4 levels and there was no sign of leukemia or lymphoma in clinical, laboratory, and radiological examinations. Surgery was planned for obtaining diagnostic material. Decompressive laminectomy and subtotal excision of the tumor were performed. RESULTS: At surgery, the tumor consisted of yellow-colored and hypovascular soft tissue fragments. It was encircling the spinal cord and spreading through the left L3 foramen. The patient underwent adjuvant chemoradiotherapy after the histopathological evaluation. At 2-month follow-up, the patient was able to walk without assistance, but the urinary incontinence was the same. At 5-month follow-up, the disease progressed, and the patient passed away because of infective endocarditis. CONCLUSION: Spinal lymphomas may display its characteristic "wrap-around" fashion in the MRI. In this report, we shared the microsurgical appearance of this fashion. As the lymphomas are chemoradiosensitive tumors, the treatment should be managed with a multidisciplinary approach.

Cerebral cavernous malformation presenting in childhood: a single-centered surgical experience of 29 cases.

OBJECTIVES: Cerebral cavernous malformations (CMs) are benign vascular hamartomas of central nervous system. Although they are mostly asymptomatic, they may occasionally result in life-threatening complications leading to surgical treatment. The main goal is to evaluate the surgical outcomes of operated pediatric cerebral CMs in our clinic and compare our results with the literature. PATIENTS AND METHODS: The data of 29 pediatric patients who were operated for cerebral CMs in our clinic between 2007 and 2016 were collected. RESULTS: Of 29 patients, 13 were girls and 16 were boys, and the mean age at operation was 11.4 years (range from 2 to 17 years). Main symptoms at presentation were seizures (15 patients, 51.7 %), headache (12 patients, 41.3 %), and focal neurological deficits (4 patients, 13.7 %). The frequency of hemorrhage in CMs was significantly higher in younger patients (p = 0.019). Total excision was achieved in all patients. The mean follow-up period was 27.3 months (range from 12 to 97 months). New neurological deficit following surgery occurred in 1 patient (3.4 %) who completely recovered after 3 months. After surgery, 1 patient (3.4 %) has become free of preoperative deficit; while the rest (27 patients) remained in preoperative neurological status. Of 15 patients presented with seizures preoperatively, 10 patients (66.6 %) were seizure free (Engel Class 1), 4 (26.6 %) were "almost seizure free" (Engel Class 2) and one (6.6 %) experienced "worthwhile improvement" (Engel Class 3) at the last follow up visit. There was no mortality in our series. CONCLUSION: Although management of cerebral CMs in childhood is controversial, total resection ensures good clinical outcome and seizure control. In addition, age can be a predisposing factor for hemorrhage.

Two-Dimensional Video of Surgery on Trochlear Schwannoma.

Trochlear schwannoma in the absence of neurofibromatosis is a rare entity.1 These schwannomas originate usually from the intradural cisternal part of the nerve and expand in the ambient and interpeduncular cisterns as well as inferiorly in the upper part of the cerebellopontine cistern.2 This case involves a rare pontomesencephalic lesion removed successfully via the simple retrosigmoid suboccipital route (Video 1). A 49-year-old woman presented to our institute with decreased sensation on the left side of her body for 2 months. Neurologic examination revealed left hemihypoesthesia. Cranial magnetic resonance imaging revealed a lobulated, heterogeneously enhanced cystic tumor within the right ambient cistern compressing the adjacent midbrain and extending to the cerebellopontine angle. After obtaining consent for surgery, the patient underwent a right suboccipital retrosigmoid approach for exploration and resection of the lesion. During the operation, it was determined that the tumor originated from the trochlear nerve. Nerve-sparing surgery was performed with intraoperative neuromonitoring including cranial nerve V, VII, X, XI, and XII electromyography and muscle motor evoked potentials. Gross total resection of the tumor was achieved. In the early postoperative period, the patient's eye movements were normal in all directions. The patient did not have any visual problems and experienced improvement in hemihypoesthesia. She was discharged on the third postoperative day. Pathologic examination confirmed diagnosis of schwannoma. At 2 months after surgery, the patient's eye movements were intact, and trochlear nerve palsy did not occur. The patient gave written informed consent for surgery and publication of this case report.