Ventriculoperitoneal Shunting in Alobar Holoprosencephaly: Does it Work Even When Patient Has No Sign of Raised Intracranial Pressure?

Holoprosencephaly (HPE) is a developmental anomaly of forebrain characterized by a failure of division of the embryonic forebrain into hemispheres. It is associated with a set of facial anomalies at a rate of 80%. Survival rate, particularly in alobar HPE, is quite low. Alobar HPE is usually associated with a large dorsal cyst which might eventually lead to hydrocephalus and raised intracranial pressure. Placement of ventriculoperitoneal (VP) shunt has been reported to be beneficial in symptomatic hydrocephalus accompanying HPE. Here we report a preterm infant born with alobar HPE and undergoing VP shunt placement although there was no sign of raised intracranial pressure. She is 12 months old now having near-normal developmental progress. This case has revealed that the placement of VP shunt, particularly inserting the catheter tip into dorsal cyst of HPE, might be beneficial and contribute to the survival and further brain development even in the absence of the signs of raised intracranial pressure.

Electrophysiological and clinical assessment of response to surgery in carpal tunnel.

The objective of this study was to assess the clinical and electrophysiological changes before and after surgery in 44 patients who underwent surgical intervention due to the diagnosis of carpal tunnel syndrome (CTS). Patients who were diagnosed with a slight, moderate, and severe idiopathic CTS were assessed clinically and by electrophysiological tests before (mean 2-4 weeks) and after surgery (at sixth month). Improvement in clinical parameters was achieved more significantly than electrophysiological recovery.

Neuroprotective Efficiency of Cyclosporine After Traumatic Brain Injury in Rats.

AIM: To evaluate the possible neuroprotective effects of systemic administration of cyclosporine (Cyclosporin A) after traumatic brain injury in rats. MATERIAL AND METHODS: The modified Feeney method was used as the trauma model in male Sprague Dawley rats. After the trauma, 20 mg/kg of cyclosporine was administered to the one group of the rats (n=12) intraperitoneally. Twenty-four hours after injury, the subjects were sacrificed, and brain samples were removed. The level of brain edema was evaluated through the wet-dry weight method, the lipid peroxidation ratio, and histological examination by transmission electron microscopy. RESULTS: The level of brain edema and lipid peroxidation ratio significantly decreased in the rats that received cyclosporine. Ultrastructural neurodestruction was graded, and a comparison of the scores between the experimental groups revealed significant neuroprotective effects of cyclosporine. CONCLUSION: The results demonstrated that systemic administration of cyclosporine produces a statistically significant decrease in both the level of brain edema and lipid peroxidation ratio when compared with "no treatment". Cyclosporine, which is regularly used as an immunosuppressant agent, is also known to prevent opening of the mitochondrial permeability transition pore by unbinding mitochondrial matrix cyclophilin. Regulation of transition pore for mitochondrial permeability by cyclosporine implies that mitochondrial dysfunction following traumatic brain injury is an important event in the progressive loss of neuronal tissue.

Granulocyte colony-stimulating factor protects the brain against experimental stroke via inhibition of apoptosis and inflammation.

OBJECTIVES: The molecular mechanisms of the anti-apoptotic and anti-inflammatory properties of granulocyte-colony stimulating factor (G-CSF) following focal cerebral ischemia in rats were examined in this study. METHODS: Sprague-Dawley rats were randomly divided into three groups: sham, middle cerebral artery occlusion (MCAO) non-treatment and MCAO with G-CSF treatment. Focal ischemia was induced with the suture occlusion method for 90 minutes, and treatment was given at the onset of reperfusion. All animals were killed 24 hours after reperfusion. Assessment included neurological scores, infarction volumes, histology, immunofluorescent staining and Western blotting. RESULTS: G-CSF significantly reduced the infarct volume and ameliorated the early neurological outcome scores. Western blot analysis showed that G-CSF treatment significantly elevated the cIAP2 levels and decreased the activation of caspase 3 in the ischemic cortex compared with the non-treated rats. Immunofluorescent works also showed that G-CSF treatment inhibited both neuronal and glial tumor necrosis factor alpha and interleukin 1beta expressions. DISCUSSION: The neuronal anti-apoptotic action of G-CSF may be mediated in part by the anti-apoptotic protein cIAP2. G-CSF also exerts anti-inflammatory actions after focal cerebral ischemia by preventing both neuronal and glial pro-inflammatory cytokine expressions.

Primary intracranial low-grade fibromyxoid sarcoma (Evans tumor).

Low-grade fibromyxoid sarcoma was first described in 1987 as a rare soft tissue neoplasm characterized by a bland and deceptively benign histological appearance but with aggressive behavior. A 20-year-old male patient presented with a recent history of headache and seizure. A right frontal mass was detected on MRI and he was operated upon to remove the intracranial mass. Histological examination revealed mildly atypical fibroblastic cells embedded within a myxoid matrix. Nuclear atypia and pleomorphism were minimal, and necrosis was not present. The lesion was diagnosed as a low-grade fibromyxoid sarcoma. Although primary intracranial low-grade fibromyxoid sarcoma has characteristic histological features, clinical and radiological correlation is necessary to make the correct diagnosis.

Dermoid tumour of the lateral wall of the cavernous sinus.

Congenital intracranial dermoid tumors are very rare. Supratentorial dermoid cysts have been more frequently reported over the past decade and they are known to have a predilection for the cavernous sinus. Dermoid tumors originating from the cavernous sinus are usually interdural and thus, presentation with ophthalmoplegia is uncommon. They are congenital benign tumors and are believed to originate from ectopic inclusion of epithelial cells during closure of the neural tube during embryonic development. The location of these dermoid lesions in the cavernous sinus and the complexity of the operative procedure for these lesions have been noted by several authors. In this report, we describe the case of a dermoid cyst that was embedded in the lateral wall of the cavernous sinus and review the literature relating to related cavernous dermoid lesions.

Dysphagia due to diffuse idiopathic skeletal hyperostosis of the cervical spine.

Diffuse idiopathic skeletal hyperostosis (DISH) or Forestier's disease is a common disorder of unknown etiology that is characterized by ossification of the anterior longitudinal ligament of the spine and various extra-spinal ligaments. We present the case of a 54-year-old woman with progressive dysphagia due to DISH of the cervical spine, which is a relatively rare pathology in neurosurgical practice. The cervical osteophytes extending from C2 to C4 and external compression of the pharyngoesophageal segment by the large osteophytes were demonstrated by X-ray, magnetic resonance imaging, and computed tomography. Surgical removal of the large osteophytes and a shortterm nonsteroidal anti-inflammatory drug regimen led to the resolution of dysphagia. The clinical manifestations, diagnosis, and treatment of this unusual condition are discussed.

Diagnosis, Treatment, and Management Strategy of Meningioma during Pregnancy.

The most common benign tumor of the brain is meningiomas. Usually diagnosed between the ages of 40-60, they are more common in women. Studies have shown a strong relationship between hormones and malignancies. Although meningiomas are slow-growing tumors of the brain, pregnancy seems to induce its growth speed. Studies concerning meningiomas and hormone relationship may explain the reason why symptoms during pregnancy flare. More specifically, the estrogen and progesterone receptor may take an active role through signal transduction in inducing the growth of the tumor. Thus, the dilemma of pregnancy + meningioma arises. In this case, a 21-year-old pregnant with a giant meningioma diagnosed on the symptom of loss of sight is reported. Her pregnancy was terminated, and the tumor was excised. Her vision improved and the histopathological examination showed a progesterone receptor positive meningioma. It is a challenging decision to be made by the physician, the patient and the family when deciding if and when pregnancy should be terminated once an intracranial meningioma is diagnosed.

Intracranial sewing needle.

A 45-year-old patient was found to have an intracranial sewing needle, located in the left frontal lobe. The needle was detected incidentally after minor head trauma. The clinical and radiological findings suggested that it might have entered the brain through the anterior fontanelle.

Trigeminal Neuralgia as an Unusual Isolated Symptom of Pituitary Adenoma: Case Report and Review of the Literature.

Pituitary adenomas account for approximately 10% of intracranial tumors and 5% are locally invasive. Cavernous sinus invasion by pituitary tumors presents mostly with cranial nerve palsies, especially involving the third, fourth and sixth cranial nerves, which is well documented in the literature. However, an isolated complaint of trigeminal neuralgia due to pituitary adenoma is an extremely rare entity with a limited number of reported cases. A 51-year-old female patient presented to our clinic with complaints of pain and numbness on the left side of face for six months, with each event lasting 5-10 seconds. No improvement was obtained with administration of carbamazepine therapy. Magnetic resonance imaging of the sellar region revealed a mass with the left cavernous sinus invasion. The patient underwent surgery via endoscopic transsphenoidal approach and after than radiosurgery with gamma-knife. The patient's complaints resolved totally after gamma-knife radiosurgery. We report herein a case of pituitary adenoma with an isolated complaint of trigeminal neuralgia. Pituitary adenomas may be presented with cavernous sinus invasion and multiple cranial nerve palsies but isolated trigeminal neuralgia due to pituitary adenoma is an extremely rare entity.

Ultrastructural changes in pneumocyte type II cells following traumatic brain injury in rats.

OBJECTIVE: We aimed to demonstrate the time-dependent ultrastructural changes in pneumocyte type II cells following brain injury, and to propose an electron microscopic scoring model for the damage. METHODS: Forty Wistar-Albino female rats weighing 170-200 g were used. The rats were allocated into five groups. The first group was the control and the second was the craniotomy without trauma. The others were trauma groups. Weight-drop method was used for achieving head trauma. Samples were obtained from the right and left pulmonary lobes at 2-, 8-, and 24-h intervals after transcardiac perfusion. An electron microscopic scoring model was used to reveal the changes. RESULTS: There were no ultrastructural pathological findings pointing to lung injury in any rat of the control groups. There was intense intracellular oedema in type II pneumocyte and interstitial oedema in the adjacent tissue in trauma groups. Oedema in mitochondria and dilatation in both smooth endoplasmic reticulum and Golgi apparatus was more evident in the 8- and 24-h trauma groups. The chromatin dispersion was disintegrated in the nucleus in all trauma groups. Scores of all trauma groups were significantly different from the controls (P<0.05). All trauma groups were different from each other at significant levels (P<0.05 for each trauma groups). CONCLUSIONS: The data suggested that ultrastructural damage is obvious at 2 h and deteriorates with time. The electron microscopic scoring model worked well in depicting the traumatic changes, which were supported by lipid peroxidation. Further experiments are needed to determine the exact outcome after brain death model.

The history of neurosurgery in Anatolia and Turkey: the Turkish Neurosurgical Society.

Although the history of neurosurgery in Anatolia goes back ten thousand years, modern surgery began in Turkey in 1890. Neurosurgery in Turkey began in the first half of the 20th century. However, general surgeons began applying neurosurgical techniques back in the late 19th century. Most of these applications included procedures for craniocerebral traumas and infections. Dr. Cemil Topuzlu (1868-1958) is the founder of modern surgery in Turkey. Dr. Abdulkadir Cahit Tuner became the first neurosurgeon with a degree in Turkey in 1923. The first neurosurgery department was established in Istanbul in 1923, and the first training program began in the late 1940s. Currently there are almost 1200 neurosurgeons in Turkey and 75 training clinics at university hospitals and Training and Research Hospitals of the Ministry of Health provide neurosurgery training. The current state of neurosurgery in Turkey is parallel to that of the advanced Western countries. Apart from the application of neurosurgical procedures, there have been many scientific studies from Turkish neurosurgeons contributing to the total body of literature in neurosurgery.

Tenosynovial giant cell tumor in the cervico-thoracic junction.

Tenosynovial giant cell tumor (TGT) rarely arises from the posterior coloumn of the cervical spine. Most lesions of TGT involve the tendon sheath and joint lining of the small joints of the fingers and hands, and consecutively the knee, ankles and feet, and hips. Rate of extra-articular presentation is about 5-15% in all cases. In this report, a case with paraparesis caused by TGT in the cervico-thoracic junction is presented. The clinical manifestations, diagnosis, and treatment of this unusual condition are discussed. In the treatment of TGT of the vertebral column, the main aim should be total surgical excision of the tumor.

The ATA and its surgical importance: a newly described ligament lying between the dural sac and the ligamentum flavum at the L5 level.

STUDY DESIGN: The anatomy of a new ligament in the human spine the ATA is described. OBJECTIVE: To describe a new ligament; the ATA, which lies between the dural sac and the ligamentum flavum at the L5 level and to discuss it's surgical importance. SUMMARY OF BACKGROUND DATA: Postoperative cerebrospinal fluid (CSF) leakage translates into longer hospital stays with significant implications for the patient, the health care system, and society as a whole. To avoid injury to the dural sac during lumbar surgery, it is crucial to know the surgical anatomy and its variations. METHODS: The length and the number of ATAs were examined in 14 consecutive patients, which underwent an L5 laminoflavectomy in our department. The ATA and its anatomic landmarks are described here for the first time in the literature. We named this ligament the ATA; reminding us to pay attention to the Terminal Attachment. RESULTS: The presence of the ATA is demonstrated in 10 patients (71%). There was a double ATA in four patients (40%). The mean length of the ATA was 7.7 ± 1.8 mm. The ATA originates from the dorsal surface of the dura mater at the level of the superior border of the superior facet of the S1 vertebra and projects toward the ligamentum flavum. Histologic examination of the ATA revealed fibrous connective tissue. CONCLUSION: In this preliminary study, we have described a new ligament, the ATA, between the dural sac and the ligamentum flavum at the L5 level. The ATA is an important structure that creates a potential risk for inadvertent dural lacerations during flavectomy. Dissecting the ATA before the flavectomy may be an important step in reducing postoperative cerebrospinal fluid leaks, which may result in significant benefits for patients and health care organizations.

Late angiographic and clinical follow-up results of 100 consecutive aneurysms treated with Onyx reconstruction: largest single-center experience.

We present the long-term clinical and angiographic follow-up results of 100 consecutive intracranial aneurysms treated with Onyx liquid embolic system (MTI, Irvine, Calif.), either alone or combined with an adjunctive stent, in a single center. A total of 100 aneurysms in 94 patients were treated with endosaccular Onyx packing. Intracranial stenting was used adjunctively in 25 aneurysms including 19 during initial treatment and 6 during retreatment. All aneurysms except two were located in the internal carotid artery. Of the 100 aneurysms, 35 were giant or large/wide-necked, and 65 were small. Follow-up angiography was performed in all 91 surviving patients (96 aneurysms) at 3 and/or 6 months. Follow-up angiography was performed at 1, 2, 3, 4 and 5 years in 90, 41, 26, 6 and 2 patients, respectively. Overall, aneurysm recanalization was observed in 12 of 96 aneurysms with follow-up angiography (12.5%). All 12 were large or giant aneurysms, resulting in a 36% recanalization rate in the large and giant aneurysm group. One aneurysm out of 25 treated with the combination of a stent and Onyx showed recanalization. There was also no recanalization in the follow-up of small internal carotid artery aneurysms treated with balloon assistance only. At final follow-up, procedure- or device-related permanent neurological morbidity was present in eight patients (8.3%). There were two procedure-related and one disease-related (subarachnoid hemorrhage) deaths (mortality 3.2%). Delayed spontaneous asymptomatic occlusion of the parent vessel occurred in two patients, detected on routine follow-up. Onyx provides durable aneurysm occlusion with parent artery reconstruction resulting in perfectly stable 1-year to 5-year follow-up angiography both in small aneurysms treated with balloon assistance only (0% recanalization rate) and large or giant aneurysms treated with stent and Onyx combination (4% recanalization rate). Endosaccular Onyx packing with balloon assistance may not be adequate for stable long-term results in those with a large or giant aneurysm. However, the recanalization rate of 36% in these aneurysms is better than the reported results with other techniques, i.e., coils with or without adjunctive bare stents.

Protective effect of erythropoietin on type II pneumocyte cells after traumatic brain injury in rats.

BACKGROUND: The main objective was to evaluate the protective effect of erythropoietin on lung ultrastructure against damage in rats after traumatic brain injury. METHODS: We used forty Wistar-Albino female rats weighing 170-200 gr. The rats were allocated into five groups. The first group was the control and the second was the craniotomy without trauma. The third group was the trauma group. The fourth and fifth groups were erythropoietin (1000 IU/kg) and vehicle (0.4 mL/rat) groups, respectively. A weight-drop method was used for achieving head trauma. Samples were obtained from pulmonary lobes 24-hour post injury. Lipid peroxidation levels were determined and electron microscopic scoring model was used to reveal the ultrastructural changes. RESULTS: Ultrastructural evaluation revealed pathologic changes in the trauma group compared with the control group (p < 0.05). Lipid peroxidation levels were found to be higher in the trauma group (p < 0.05). Erythropoietin significantly reduced both the ultrastructural pathologic changes and the lipid peroxidation levels in the treatment group (p < 0.05). CONCLUSIONS: Erythropoietin protects the ultrastructure of pneumocyte type II cells against damage after traumatic brain injury.