Can The Fracture Line of Type II Odontoid Fractures Come to A Neutral Position After Anterior Odontoid Screw Fixation without a Manipulation?

AIM: To examine whether there was an improvement in the displaced fracture line in the follow-up, in which Anterior odontoid screw fixation (AOSF) was performed without manipulation and to determine the "displacement angle range" in which AOSF was possible. MATERIAL AND METHODS: A total of 11 patients with the diagnosis of type II odontoid fracture who underwent AOSF without manipulation were analyzed retrospectively. A control group of 30 cases was formed and odontoid related angle measurements were performed on cervical computed tomographies (CT) of the control group and the patients who were operated. RESULTS: In 6 of 7 cases in the posterior-displaced group along with all cases in the anterior-displaced group, it was determined that the displacement angles returned to the normal range in the 1st year follow-up. In 1 case having posterior displacement with posterior longitudinal ligament (PLL) damage, it was observed that the displacement angle improved to the normal range significantly, but the displacement continued. CONCLUSION: AOSF is a minimally invasive, safe and effective method in patients with displaced type II odontoid fracture, which is between the median odontoidobasal angle range of 100°-134°, whose PLL is preserved, and which cannot be manipulated.

Histopathological Investigation of the Effectiveness of Collagen Matrix in the Repair of Experimental Spinal Dura Mater Defects.

OBJECTIVE: This study investigated the suitability of the collagen matrix as a dural graft in the repair of experimental spinal dura mater defects. MATERIALS AND METHODS: In the study, 30 New Zealand white rabbits were used. The rabbits were divided into a study and control group. In both groups, following exact laminectomy (Th 10 and 11) in rabbits under the isoflorane anesthesia, a spinal dural defect 1×0.5 cm in size was formed. In the study group, the dura mater defect was covered with collagen matrix; in the control group, the excised dura was sutured back to its original position. At the end of the follow-up period, the rabbits were sacrificed. In all subjects, the vertebral colon was excised completely, and it was fixed in 10% formaldehyde solution. Sections 3 pm thick were taken from the specimens, stained with hematoxylin and eosin, and examined under a light microscope. The stained sections were evaluated under light microscopy with regard to the cellular inflammatory response, fibroblastic proliferation, foreign body reaction, and capsule formation. RESULTS: The collagen matrix was completely absorbed, and it was easy to use since it did not require sutures. Foreign body reactions were minimal in the early period and were resolved entirely in the end. Inflammatory response against the collagen matrix was no greater than in the control group in which the dura was sutured primarily and then closed, eventually disappearing entirely, and no adhesion formation resulted. Collagen permits successful regeneration by combining with the dura mater. No capsule formation was observed in either group. CONCLUSION: This study shows that collagen is suitable for duraplastic procedures and that it may be a useful agent in patients in whom the dura cannot be closed primarily due to retraction, constriction, or excision.

Neuroendoscopic approach to quadrigeminal cistern arachnoid cysts.

OBJECTIVE: The introduction of neuroendoscopy has provided a minimally invasive modality for the surgical treatment of quadrigeminal arachnoid cysts. Three pediatric patients with arachnoid cyst of the quadrigeminal cistern treated by endoscopic fenestration are reported. MATERIALS AND METHODS: The hospital records of patients were retrospectively rewieved. All patients had hydrocephalus. A lateral ventricle-cystostomy and endoscopic third ventriculostomy were performed by using rigid neuroendoscopes. RESULTS: There were one boy and two girls with ages 7 months, 9 months and 14 years, respectively. One patient had undergone shunting prior to neuroendoscopic surgery. The postoperative course was uneventful in all cases, with no complications. They showed disappearance of intracranial hypertension symptoms and significant reduction of the cyst size. CONCLUSION: Neuroendoscopic technique is an effective and suitable method for the treatment of quadrigeminal cistern arachnoid cysts and accompanying hydrocephalus.

Tethered cord syndrome in childhood: special emphasis on the surgical technique and review of the literature with our experience.

AIM: Surgery is the treatment of choice for children who had tethered cord syndrome (TCS). However, a detailed technique for the release of spinal cord is not described yet. The aims of this study are to present our series of TCS in children and to focus on the details of surgical technique. MATERIAL and METHODS: Forty-nine children with tethered cord syndrome underwent surgical treatment for the release of spinal cord between 2004 and 2009. The mean age was 4.6 years (2 days-13 years). Twenty (40.8%) patients were female and 29 (59.2%) were male. Among the 49 children, 41 (83.7%) had different spinal malformations and 8 (16.3%) had no associated lesion. Sectioning of the filum terminale, cutting the arachnoid and fibrous bands, protection of the rootlets and correction of the associated malformations was the standard surgical method to release the spinal cord. RESULTS: Neurological improvement was observed in 4 (8.2%) patients, while the neurological status was unchanged in the others. Cerebrospinal fluid fistula was the main complication and was observed in 3 patients. No mortality or neurological deterioration was encountered. CONCLUSION: Spinal cord release with appropriate technique seems to be beneficial in maintaining neurological functioning in children with TCS.

The complications of cerebral hydatid cyst surgery in children.

PURPOSE: Complications related to cerebral hydatid cyst surgery are not uncommon but require prompt diagnosis and treatment. The aim of this study is to demonstrate the radiological findings that would indicate complications after cerebral hydatid cyst surgery in children and to report our results. METHOD: The data of 25 pediatric patients who underwent surgery for cerebral hydatid cysts over a 16-year period were analyzed retrospectively. The complications related to surgical technique and cyst location were recorded. Postoperative radiological findings of the patients were documented. RESULTS: Intraoperative cyst rupture occured in three patients. Subdural effusion developed in five patients, porencephalic cyst in four, subdural effusion associated with porencephalic cyst in two, hemorrhage in two, epidural hematoma in one, and pneumocephalus in three patients. Subdural-peritoneal shunt was placed in two patients. Recurrence of cerebral hydatid cyst was observed in only one patient who experienced intraoperative cyst rupture. There was no surgery-related death. CONCLUSIONS: The complications following cerebral hydatid cyst surgery in children are various and usually not fatal. When appropriate surgical procedures are planned and carefully applied, the results will be excellent with no mortality.

Cerebral hydatid cysts: technique and pitfalls of surgical management.

OBJECT: Hydatid cysts are rare, but most often they occur in the liver and lungs. Cerebral manifestation is very rare, and surgery is the main treatment. The goal of surgery is to remove the cysts in toto without rupture. The aim of this study was to investigate the surgical technique of removing cerebral hydatid cysts and to show the possible pitfalls of surgery. METHODS: This study included 17 patients who underwent surgery for an intracranial hydatid cyst. The Dowling technique was used in all patients. This technique is based on the large cranial opening, careful handling, meticulous cortical dissection, and removal of the cyst by hydrostatic assistance. RESULTS: The hydatid cysts were removed unruptured in 88% of the cases. The cysts ruptured intraoperatively in 2 patients, and the ventricular system was opened in 1 of them. Anaphylactic reaction or chemical meningitis did not occur, but recurrence and spinal seeding were observed in the follow-up of these patients. The thin cyst wall, periventricular locations, and microadhesions to the surrounding brain tissue were the main surgical problems. None of the patients died after the surgery. CONCLUSIONS: Although this technique seems safe and easy, there are some pitfalls concerning the cyst location and surgical approach. Successful management requires a flexible therapeutic strategy and meticulous dissection by an experienced surgeon.

A new technique for laryngeal mask airway insertion in a newborn with pierre-robin syndrome: a case report.

Babies with Pierre Robin syndrome have serious life-threatening risks because of acute respiratory distress and difficult airway management. It is difficult to perform endotracheal intubation in these babies for general anesthesia. We present successful insertion of laryngeal mask airway in a neonate with typical clinical features of Pierre-Robin syndrome using a size 1 laryngeal mask airway for a ventriculoperitoneal shunt operation. The patient had micrognathia, glossoptosis with cleft palate, and partial trismus. His mouth opening was restricted to 0.6 cm. Anesthesia was deepened with sevoflurane, maintaining spontaneous ventilation, but laryngoscopy was impossible because of the limited mouth opening. After unsuccessful attempts to insert an LMA by standard and rotational techniques, it was inserted using a novel modified rotational LMA insertion technique, which we have termed the 'squeezing technique'.

Triple occipital meningoceles in a newborn. Case report.

The coexistence of three cranial meningoceles in a single patient is an extremely rare event. Multiple cranial meningoceles have not been reported in the literature. The rare case of a newborn with three distinct occipital meningoceles, of which one was rudimentary, is presented. Diagnostic tools and treatment options are also reviewed.

Neurenteric cyst of the upper cervical spine: excision via posterior approach.

Neurenteric cyst of the cervical spine is an uncommon congenital lesion and usually associated with many craniocervical anomalies. Solitary neurenteric cyst of the upper cervical spine is very rare. Surgery is the main treatment method. An 11-year-old female child presented with the symptoms of neck pain that radiated to both shoulders and arms. Magnetic resonance imaging of the patient showed a cystic mass lesion ventral to the spinal cord and lying at the level from C1 to C3. She underwent surgical resection via a posterior approach and complete cyst resection was performed. Although removal of a neurenteric cyst through a posterior approach may result in spinal cord injury, this method is easier and safer than the anterior approach, especially in children.

Acute interhemispheric subdural hematoma due to hemodialysis: case report.

BACKGROUND: Acute interhemispheric subdural hematoma (AISH) is an extremely limited complication in patients on maintenance hemodialysis. Diagnostic difficulties result from a fact that symptoms of acute hematoma such as headache, nausea, vomiting, apathy, sleepiness, paresthesia and seizures may also suggest dysequilibrium syndrome, dialytic dementia as well as hypertensive encephalopathy. CASE DESCRIPTION: A case of acute interhemispheric subdural hematoma during long-term dialysis is presented. CONCLUSION: AISH caused by hemodialysis is a very important complication. It is sometimes difficult to differentiate from dysequilibrium or dialysis dementia. Clinicians must pay closer attention on neurological examination of hemodialyzed patient. Surgical treatment must be as prompt as possible because of the possible sudden worsening of the patient's clinical condition.

Anterior sacral meningocele: excision by the abdominal approach.

Anterior sacral meningocele is a unilocular or multilocular extension of the dura mater and arachnoid out of the sacral spinal canal into the retroperitoneal and infraperitoneal space. It contains CSF, which in some of the reported cases has been discolored (slightly yellow), and has had an elevated protein content. Surgery with sacral laminectomy and surgery by the transabdominal approach are the treatment options for this malformation. We report a case of a 16-year-old female patient having a large anterior sacral meningocele. She underwent surgical treatment by the abdominal approach, and the meningocele sac was excised. We presented the clinical and radiological features of our patient and discussed them with reference to the literature.

The clinical, radiological and surgical aspects of cerebral hydatid cysts in children.

A series of 13 pediatric patients underwent surgery for cerebral hydatid cysts at the Department of Pediatric Neurosurgery between 1993 and 2003. Headache and motor weakness were the main initial signs of these patients. A round cystic lesion was the characteristic appearance on computed tomography of each patient. Different cyst locations such as the liver, kidney or spleen were detected in 5 patients. Surgery using Dowling's technique was performed in all patients as the main treatment. Intraoperative rupture and cyst recurrence were observed in only 1 patient. Subdural effusion, intraparenchymal air and hemorrhage were the main complications observed after surgery. None of the patients died after surgery. Because of its efficacy combined with excellent results, surgery is currently the method of choice in the treatment of cerebral hydatid cyst in children.