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INTRODUCTION: Primary intradiploic meningiomas account for <1% of all osseous calvarial lesions and are categorized as bone tumors. They are frequently observed in the frontotemporal region of the calvarium, anterior cranial fossa, and orbit. We present a case of intradiploic meningioma of the orbital roof, which is rarely observed in the pediatric age-group; it was surgically treated with a unique minimally invasive approach. CASE PRESENTATION: A 16-year-old male with chief complaints of headache on the right side for approximately 1 year was presented to our clinic. Cranial MRI revealed an intradiploic mass with homogeneous, hypointense contrast patterns on the T1W and T2W images of the right orbital roof. A skin incision was made through the right eyebrow, and the frontal sinus anterior wall was opened by craniotomy. Gross total resection was achieved by reaching the tumor present in the orbital roof. The mass was characterized as psammomatous meningioma by a pathological examination. DISCUSSION/CONCLUSION: In cranial oncologic surgery, lesion localization and possible pathological diagnosis are essential for the determination of the correct surgical technique. In particular, in pediatric cases, selecting a method that will reduce the need for transfusion, shorten the surgical time, minimize the chances of facial deformity, and facilitate postoperative care will ensure compliance with the correct and appropriate treatment process.
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Sobrancelhas , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Neoplasias Orbitárias/cirurgia , Adolescente , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Órbita/diagnóstico por imagem , Órbita/cirurgia , Neoplasias Orbitárias/diagnóstico por imagemRESUMO
Posterior fossa tumors (PFTs) include medulloblastomas, atypical teratoid/rhabdoid tumors, pilocytic astrocytomas, ependymomas, and brainstem gliomas. We evaluated patients with surgery at our clinic, comparing epidemiological, clinical, radiological, and pathological characteristics of medulloblastoma and ependymoma to identify factors that might assist preoperative diagnosis, help to develop treatment algorithms, and have prognostic value after surgery. Pediatric patients from 0 to 16 and young adults from 16 to 29 years of age with surgery for pathologically confirmed ependymomas or medulloblastomas between January 2014 and January 2020 were eligible. The study included 19 patients, seven with ependymoma (37%) and 12 with medulloblastoma (63.2%). The ependymoma patients were 5.29 ± 5.85 years of age, the medulloblastoma patients were 11.58 ± 8.17 years of age, and 16 patients (84%) were children.Fifteen patients (79%) presented with signs of increased intracranial pressure and four (21%) presented with cerebellar findings. MRI found that 74% (14) of the PSTs were located in the midline, including six of the seven ependymomas (86%) and eight of the 12 medulloblastomas (67%). Enhancement was significantly greater in medulloblastomas compared with ependymomas (p = 0.022). In according to pathology results; synaptophysin, NSE, chromogranin and 50% GFAP positivity were observed in medulloblastoma. Ependymomas were S100 (43%) and vimentin (29%) positive. Ependymoma patients were younger than medulloblastoma patients and more were female. There were no significant differences in the clinical findings, but ependymomas were larger and had greater rates of enhancement and spinal metastasis compared with medulloblastomas.
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Neoplasias Cerebelares , Ependimoma , Meduloblastoma , Adolescente , Adulto , Neoplasias Cerebelares/diagnóstico , Criança , Pré-Escolar , Fossa Craniana Posterior , Diagnóstico Diferencial , Ependimoma/diagnóstico por imagem , Feminino , Humanos , Meduloblastoma/diagnóstico por imagem , Adulto JovemRESUMO
OBJECTIVE: To evaluate pediatric patients who were operated with the diagnosis of depressed skull fracture. METHODS: The records of pediatric patients who presented with traumatic head injury to multicenter neurosurgery clinics between 2002 and 2018 and who were operated with a diagnosis of depressed skull fracture were retrospectively reviewed. All of the patients underwent primary bone fragment replacement operation, and the patients' own bone flaps were used to repair depressed skull fractures in all of them. RESULTS: A total of 78 patients were included in the study. Of the study group, 20 patients presented with mild head injury, 37 had moderate head injury, and 21 had severe head injury. Dural injury was present in 67 patients (86%) and the dura was intact in 11 patients (14%). After surgery, 63 patients (81%) had good outcome, 8 patients (10%) had moderate disability, and 5 patients (6.5%) had severe disability. Two patients with multiple accompanying cranial pathologies died and the mortality rate was 2.5%. Infection was detected in only 2 of the 78 patients who were treated within the first 72 h after trauma. One of them had meningitis and the other skin infection. Both patients were treated with appropriate antibiotherapy. None of the patients in the study group had an infection involving the bone, such as osteomyelitis, or the tissues under the bone, such as subdural-epidu-ral empyema or abscess. None of the patients required reoperation and removal of the bone. CONCLUSION: In the present study, as the pathologies accompanying the depressed skull fractures of the patients increased, Glasgow Coma Scale scores at arrival and Glasgow Outcome Scale scores at discharge decreased. Regardless of whether the depressed fracture is simple or compound, primary bone fragment replacement with appropriate decontamination of the fractured bone and operation area via single-session intervention gives good results. It is important to perform the surgery as soon as possible to reduce the risk of contamination. Primary bone fragment replacement seems to be an appropriate treatment option for depressed skull fractures.
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Transplante Ósseo/métodos , Fratura do Crânio com Afundamento/diagnóstico por imagem , Fratura do Crânio com Afundamento/cirurgia , Adolescente , Transplante Ósseo/tendências , Criança , Pré-Escolar , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Vertebral artery aneurysms form a group of aneurysms having high rates of rebleeding, morbidity, and mortality, poor treatment outcomes, as well as low rate of surgical treatment. Examinations for subarachnoid bleeding revealed a vertebral artery aneurysm with a diameter of 12 mm in a 67-year-old man who presented with headache. The vertebral artery aneurysm with saccular and fusiform segments was shrunk and clipped via lateral left suboccipital approach. No neurologic deficit was present at the postoperative period. Control digital subtraction angiography showed complete shrinkage of aneurysm with continued blood flow and no residue. Clinical findings, treatments, and surgical approaches of VA aneurysms are different from anterior and posterior circulation aneurysms. Microneurosurgical clipping is the most effective treatment of vertebral artery aneurysms in suitable cases. Although endovascular intervention is commonly applied as therapeutic modality for patients with vertebral artery aneurysm, researchers have also emphasized that saccular vertebral aneurysms with fusiform extension can also be surgically treated in suitable cases.
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Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/prevenção & controle , Artéria Vertebral/cirurgia , Idoso , Humanos , Masculino , Resultado do TratamentoRESUMO
The goal of this effort is to evaluate the anatomy of the foramen magnum (FM) using 3-dimensional computed tomography (3D CT), and determine whether or not the anatomical features of vascular structures and condylar foramen (CF) affect the types of FM.The CT angiography records of 101 patients (44 men and 57 women) were retrospectively examined in this study. Details of the FM, CF, and the vertebral and basilar arteries were examined using maximum intensity projection and 3D rendering images. The average age of the 101 patients was 45.28 ± 16.3 years. The 8 types of FM, in order of their frequency of occurrence, are as follows: round (19 cases; 18.8%), 2 semicircles (18; 17.8%), egg-shaped (15; 14.9%), hexagonal (14; 13.9%), tetragonal (11; 10.9%), oval (11; 10.9%), pentagonal (9; 8.9%), and irregular (4; 4%). There was no statistically significant relationship between the anatomical features of the vertebral and basilar arteries and the CF with the different types of FM (P ≥ 0.05). In our study, the diameter of the anteroposterior (AP) FM was 34.7 ± 3.6 mm, and the transverse (T) diameter was 29.5 ± 2.5 mm. The AP and T diameters were significantly higher in men than in women (P = 0.006 and P ≤ 0.001, respectively).Our study revealed that 3D CT is a safe and easy method for visualizing the anatomical structure of the FM and neighboring structures. Furthermore, this study was the first to demonstrate that there is no correlation between the 8 types of FM and the vertebral artery, basilar artery, and CF.
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Forame Magno/diagnóstico por imagem , Imageamento Tridimensional/métodos , Tomografia Computadorizada Multidetectores/métodos , Adulto , Angiografia/métodos , Artéria Basilar/anatomia & histologia , Artéria Basilar/diagnóstico por imagem , Cefalometria/métodos , Meios de Contraste , Feminino , Forame Magno/irrigação sanguínea , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Artéria Vertebral/anatomia & histologia , Artéria Vertebral/diagnóstico por imagemRESUMO
OBJECTIVE: The measurement of optic nerve sheath diameter is a noninvasive, practical, and economical method used to identify increased intracranial pressure. The purpose of this study is to detect the preoperative and postoperative changes in optic nerve sheath diameter in patients with intracranial mass, to correlate these changes with optic nerve diameter variations, and to evaluate the impact of hydrocephalus on these alterations. MATERIAL AND METHOD: This study was conducted with patients who presented to our clinic with complaints of intracranial mass, were decided for surgery, and underwent surgical procedures. FINDINGS: The optic nerve and optic nerve sheath diameter measurement values were different preoperatively and postoperatively, with a significant decrease in the optic nerve sheath diameter in all groups in postoperative measurements, while the optic nerve diameter significantly increased. CONCLUSIONS: Although there was no significant difference between the effects of hydrocephalus and intracranial mass-related increase in intracranial pressure on the optic nerve and optic nerve sheath, it was observed that hydrocephalus increased intracranial pressure when considering the Evans ratio. It has been determined that as ventricular dilatation increases, so does intracranial pressure, which leads to an increase in the diameter of the optic nerve sheath, resulting in papilledema and thinning of the optic nerve. These findings indicate the importance of early cerebrospinal fluid diversion and monitoring optic nerve sheath diameter in the management.
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Hidrocefalia , Nervo Óptico , Humanos , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/patologia , Hidrocefalia/cirurgia , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Pressão Intracraniana/fisiologia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Papiledema/etiologia , Adulto Jovem , Hipertensão Intracraniana/diagnóstico por imagem , Hipertensão Intracraniana/complicações , AdolescenteRESUMO
BACKGROUND: Revascularization before infarct development after cerebral ischemia may affect morbidity. The success of revascularization can be less than expected because of spontaneous thrombosis or restenosis with intimal hyperplasia. The aim of this study was to compare dabigatran etexilate, a direct thrombin inhibitor, with bemiparin sodium, a second-generation low-molecular-weight heparin, after carotid artery anastomosis. METHODS: This study used 24 randomly selected Sprague-Dawley rats. The rats were separated into 3 equal groups: group 1 (control group); group 2 (dabigatran group), in which dabigatran 10 mg/kg was orally administered for 7 days; and group 3 (bemiparin group), in which bemiparin 250 IU/kg was subcutaneously administered for 7 days. The right-side carotid artery of rats was used for anastomosis and the left-side carotid artery was used for the control. The carotid artery was explored and transected. Anastomosis was applied using 10/0 polypropylene sutures. After 7 days of treatment, the right and left carotid arteries were removed. Lumen diameter, lumen area, tunica media thickness, edema, vessel wall injury, intimal hyperplasia, thrombus, and inflammation were evaluated in tissue biopsy specimens. RESULTS: Bemiparin used after anastomosis caused less thickening of tunica media and reduced intimal hyperplasia but did not decrease lumen diameter and area. Dabigatran increased edema and inflammation but did not prevent intimal hyperplasia. CONCLUSIONS: Bemiparin reduced intimal hyperplasia and prevented thrombosis angiogenesis, but dabigatran did not prevent intimal hyperplasia, and its anticoagulation effect was more than the antithrombotic effect.
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Anticoagulantes/farmacologia , Antitrombinas/farmacologia , Artérias Carótidas/efeitos dos fármacos , Revascularização Cerebral/métodos , Dabigatrana/farmacologia , Heparina de Baixo Peso Molecular/farmacologia , Neointima/prevenção & controle , Trombose/prevenção & controle , Animais , Anticoagulantes/uso terapêutico , Antitrombinas/uso terapêutico , Dabigatrana/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Ratos , Ratos Sprague-DawleyRESUMO
AIM: Posterior epidural migration of a sequestered lumbar intervertebral disc fragment (PEMSLIDF) is an extremely rare condition published so far only as case reports or small case series (ranging between 2 to 8 cases). Diagnosing this condition is often challenging and the diagnosis is usually made intraoperatively. The affected patients usually suffer cauda equina syndrome (CES). In the present study, we aimed to discuss the clinical and radiological findings, types and features of surgical therapies, and outcomes of 9 patients with PEMSLIDF. MATERIAL AND METHODS: This study included 9 (0.36%) patients with PEMSLIDF among 2470 patients who underwent lumbar disc hernia surgery between August 2002 and September 2012. The preoperative clinical and radiological properties of the patients were evaluated. The postoperative outcomes were assessed using neurological examination, radiological imaging, visual analog scale (VAS) and modified Odom criteria. RESULTS: As far as we know, this study is the largest case series examining the characteristics of PEMSLIDF. Seven (77.8%) of our patients were male and 2 (22.2%) were female and they had a mean age of 49.5 years (range 28-70 years). The mean duration from symptom onset to hospital admission was 7.4 days. Seven patients had CES. All patients underwent sequestrectomy and discectomy via posterior microsurgery. The patient outcomes were evaluated by the Modified Odom criteria and the outcome was excellent in two (22.2%) patients, good in 4 (44.5%), fair in 2 (22.2%), and poor in 1 (11.1%). CONCLUSION: The entire free fragment can usually be excised via the posterior microsurgery technique. Early surgical treatment is of great importance to prevent more serious neurological deficits.
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Espaço Epidural/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/cirurgia , Adulto , Idoso , Discotomia/métodos , Feminino , Humanos , Masculino , Microcirurgia , Pessoa de Meia-Idade , Medição da Dor , Polirradiculopatia/cirurgia , Resultado do TratamentoRESUMO
AIM: To determine local tissue electrical resistance differences generated during a screw pass from the pedicle to another tissue rather than determining all individual electrical tissue resistance values. MATERIAL AND METHODS: We attempted to measure electrical resistance values of regional tissues in addition to fluoroscopic imaging during application of fixation via a transpedicular screw. We also attempted to detect local tissue electrical resistance alterations in case of malposition of the screw inside the pedicle. For this purpose, local tissue electrical resistances of 10 transpedicular tracks opened with standard track openers bilaterally in 5 vertebrae, and of spinal cord accessed by puncturing the medial walls of three vertebrae in a cadaver were measured. These resistance differences were not only measured in human cadaveric tissue but also in 36 pedicles belonging to a total of 18 vertebrae between Th 1-S1 vertebrae of a sheep cadaver. Both medial and lateral walls were drilled to measure local tissue resistance differences in a sheep cadaver. RESULTS: Our results indicated that local tissue electrical resistance changes were statistically significant in both human and sheep cadaver. CONCLUSION: It is possible to prevent screw malposition using a simple and cheap electrical resistance measurement. Local tissue electrical resistance measurement during transpedicular screw insertion is a safe, simple, cheap, and practical method.
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Parafusos Ósseos , Impedância Elétrica , Vértebras Lombares , Vértebras Torácicas , Animais , Cadáver , Feminino , Fluoroscopia , Humanos , OvinosRESUMO
Spinal cord injury (SCI) leads to social and psychological problems in patients and requires costly treatment and care. In recent years, various pharmacological agents have been tested for acute SCI. Large scale, prospective, randomized, controlled clinical trials have failed to demonstrate marked neurological benefit in contrast to their success in the laboratory. Today, the most important problem is ineffectiveness of nonsurgical treatment choices in human SCI that showed neuroprotective effects in animal studies. Recently, attempted cellular therapy and transplantations are promising. A better understanding of the pathophysiology of SCI started in the early 1980s. Research had been looking at neuroprotection in the 1980s and the first half of 1990s and regeneration studies started in the second half of the 1990s. A number of studies on surgical timing suggest that early surgical intervention is safe and feasible, can improve clinical and neurological outcomes and reduce health care costs, and minimize the secondary damage caused by compression of the spinal cord after trauma. This article reviews current evidence for early surgical decompression and nonsurgical treatment options, including pharmacological and cellular therapy, as the treatment choices for SCI.
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Spinal cord trauma is a prominent cause of mortality and morbidity. In developed countries a spinal cord injury (SCI) occurs every 16 min. SCI occurs due to tissue destruction, primarily by mechanical and secondarily ischemic. Primary damage occurs at the time of the injury. It cannot be improved. Following the primary injury, secondary harm mechanisms gradually result in neuronal death. One of the prominent causes of secondary harm is energy deficit, emerging from ischemia, whose main cause in the early stage, is impaired perfusion. Due to the advanced techniques in spinal surgery, SCI is still challenging for surgeons. Spinal cord doesn't have a self-repair property. The main damage occurs at the time of the injury primarily by mechanical factors that cannot be improved. Secondarily mechanisms take part in the following sections. Spinal compression and neurological deficit are two major factors used to decide on surgery. According to advanced imaging techniques the classifications systems for spinal injury has been changed in time. Aim of the surgery is to decompress the spinal channel and to restore the spinal alinement and mobilize the patient as soon as possible. Use of neuroprotective agents as well as methods to achieve cell regeneration in addition to surgery would contribute to the solution.
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In neurosurgery practice glucocorticoids are commonly used. Steroids may have central nervous system side effects affecting whole body, including steroid-induced mental agitation and psychosis. In experimental and clinical studies conducted by using dexamethasone (DEX), it has been reported that DEX adversely affects learning and memory skills. Unfortunately, there are yet no clinically accepted clinical approaches to prevent DEX-induced cognitive dysfunction. In this experimental study it was aimed to investigate the effect of chronic DEX administration on learning-memory and locomotor behaviors in adult male Sprague Dawley rats. In addition, it was also aimed to explore the potential favorable contribution of melatonin (MEL) and vitamin C (Vit C) having antioxidant and neuroprotective properties to the effects of DEX on learning-memory and locomotor behaviors. For this purpose, rats were injected 10mg/kg DEX intraperitoneally, both alone and in combination with MEL (40 mg/kg) and Vit C (100mg/kg), for 9 days, and the animals were tested using the radial arm maze and open field apparatus. The test results revealed that DEX caused a significant decrease in spatial memory and locomotor activities and MEL and Vit C failed to reverse losses in these activities. Furthermore, DEX led to a gradual weight loss that reached 30% of the initial weight at 9th day of the injection. DEX administration causes a generalized loss of behavioral activity of rats. Experimental studies devised to investigate effects of DEX should take into account this DEX-induced generalized behavioral loss when assessing the effects of DEX on learning and memory skills. This article is part of a Special Issue entitled SI: Brain and Memory.
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Hiperfunção Adrenocortical/induzido quimicamente , Hiperfunção Adrenocortical/complicações , Dexametasona/toxicidade , Glucocorticoides/toxicidade , Transtornos da Memória/etiologia , Atividade Motora/efeitos dos fármacos , Animais , Antioxidantes/administração & dosagem , Ácido Ascórbico/administração & dosagem , Antagonistas Colinérgicos/farmacologia , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Comportamento Exploratório/efeitos dos fármacos , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Melatonina/administração & dosagem , Transtornos da Memória/diagnóstico , Ratos , Ratos Sprague-Dawley , Escopolamina/farmacologia , Estatísticas não Paramétricas , Fatores de TempoRESUMO
AIM: Cervical spine is the most kinetic segment of the whole vertebrae. The radiologic imaging methods concern with the morphologic changes but give no functional data. At flexion, spinal cord strains, anterior osteophytic compression increases. At extension, spinal canal gets narrower, cord shortens and gets thicker, compression of posterior ligament gets abberant and cord compression increases. MATERIAL AND METHODS: 258 cervical spondylotic myelopathy (CSM) cases were scanned by conventional magnetic resonance imaging (MRI) and additionally dynamic MRI. Contributions of dynamic cervical MRI to the surgical plans and results were evaluated. RESULTS: We had sagittal and axial T2W MR scans at flexion and extension, in addition to the neutral cervical MR imaging. We found that the AP diameter of spinal canal is increased 14.9 % in flexion and decreased 13.4 % in extension relative to the neutral MR imaging. CONCLUSION: The changes of the cord compression and the transvers area of cord which is the most important prognostic indicator in spinal diseases and also the area of spinal cord and subarachnoid space can be detected via dynamic axial sections of MRI. Dynamic MR images may be helpfull in the decision making for the surgical treatment of CSM.
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Vértebras Cervicais/patologia , Imageamento por Ressonância Magnética/métodos , Espondilose/patologia , Adulto , Idoso , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Espondilose/cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION: Klippel-Trenaunay-Weber syndrome (KTWS) is a rare syndrome in which patients usually present with cutaneous hemangiomas, venous varicosities, and bone and soft tissue hypertrophy of the affected limb. Intracranial lesions in patients with KTWS are extremely rare, and are generally reported as single cases in the literature. We describe a rare case, where a patient with KTWS was found with a hemorrhagic grade IV astrocytoma. Although central nervous system abnormalities such as intracranial aneurysms and cerebral and spinal cord cavernomas have been described in patients with KTWS, to the best of our knowledge, this is the first report of an association between glioblastoma multiforme (grade IV astrocytoma) and KTWS in the English-language medical literature. CASE PRESENTATION: A 61-year-old white Caucasian man with a history of KTWS presented with seizures. Left upper and lower extremity hypertrophy, left foot, leg and ear gigantism and left-sided abdominal capillary hemangiomas were noted in the physical examination. Cranial computed tomography (CT) and magnetic resonance imaging (MRI) were obtained, showing a heterogeneous lesion in the cingulate gyrus, with peripheral and central areas of T1 hyperintensity and layering T2 hypointensity consistent with a hemorrhage. A right parasagittal frontal craniotomy was performed with an interhemispheric approach. We had difficulty controlling the bleeding with bipolar electrocautery during surgery and finally were able to stop the bleeding using surgicel and gelfoam. Postoperative cranial CT and MRI scans showed intraparenchymal hemorrhage centered within the medial right frontal lobe. There was no increase in hematoma size in consecutive CT scans. CONCLUSIONS: Co-occurrence of vascular abnormalities with KWTS should be taken into consideration to avoid perilous preoperative and postoperative complications.
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Neoplasias Encefálicas/etiologia , Glioblastoma/etiologia , Síndrome de Klippel-Trenaunay-Weber/complicações , Neoplasias Encefálicas/diagnóstico , Extremidades/patologia , Evolução Fatal , Glioblastoma/diagnóstico , Hemorragia/complicações , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
The natural history of Moyamoya disease (MD) is variable. Moyamoya disease in children mostly presents with progressive ischemic complications and in adulthood it tends to present with hemorrhage. Surgical strategies depend on augmenting cerebral blood flow to the anterior cerebral circulation. Revascularization is the mainstay treatment for MD. We introduce a 31 year old female with a history of MD and leftsided revascularization as a child, who presented with headache, confusion, and worsening left sided weakness. Cranial computed tomography (CT) showed a right sided putaminal hemorrhage. Cerebral angiogram with selective external runs revealed MD, hypoplastic parietal branch of the superficial temporal artery (STA) on the right side and previous revascularization on the left side. Thus, our decision was made to perform a bypass with the frontal branch of the STA to an M3-M4 segment of the middle cerebral artery and an encephaloduroarteriomyosynangiosis with the parietal branch of the STA. The patient's postoperative course was uneventful. Postoperative CT angiogram confirmed patency of bypass. This technique provides immediate revascularization and seems to provide risk reduction for ischemic and hemorrhagic stroke. We review the natural history and surgical treatment of MD along with a case presentation in which surgical technique is demonstrated in video.
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Revascularização Cerebral , Doença de Moyamoya/diagnóstico , Adulto , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Diagnóstico Diferencial , Feminino , Cefaleia/etiologia , Humanos , Artéria Cerebral Média/cirurgia , Doença de Moyamoya/complicações , Doença de Moyamoya/diagnóstico por imagem , Doença de Moyamoya/cirurgia , Artérias Temporais/cirurgia , Tomografia Computadorizada por Raios X , Gravação em VídeoRESUMO
AIM: To describe a modified technique for the treatment of single level, isthmic spondylolisthesis (IS) MATERIAL and METHODS: Forty-two patients who underwent posterior lumbar interbody fusion (PLIF) with spinolaminar autologous bone graft for the treatment of isthmic spondylolisthesis between May 2007 and November 2011, were retrospectively reviewed. All patients underwent total removal of the spinolaminar process, total discectomy and endplate decortication, and proper size spinolaminar autologous bone graft was sequentially inserted into the disc space with posterior instrumentation. Outcomes of the study included visual analogue scale (VAS), Oswestry disability index (ODI), and radiographic fusion. RESULTS: The average duration of follow-up was 3.5 years. Neither has implant failure been observed nor has revision been required so far. The mean Oswestry Disability Index improved from 53% to 9.5%, and visual analog scale for back pain from 8.5 to 3.8 at the first month and 1.3 at the sixth month postoperatively. Visual analog scale for leg pain from 8.3 to 1.4 at the first month and 0.8 at the sixth month postoperatively. All patients had clinical and radiographic evidence of solid fusion without any need for revision. CONCLUSION: The modified posterior lumbar interbody fusion and posterior instrumentation technique is a safe and effective treatment for isthmic spondylolisthesis.
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Transplante Ósseo/métodos , Discotomia/métodos , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Espondilolistese/cirurgia , Adulto , Idoso , Feminino , Humanos , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The purpose of this study was to investigate the effects of Caffeic Acid Phenethyl Ester (CAPE) on proinflammatory cytokines, IL-1ß and TNF-α, and explore its healing effect after acute spinal cord injury. METHODS: Forty-eight male Wistar-Albino rats were used in this study which was planned as three groups. All groups were divided into two sub-groups. Group 1a was the control group, in which only lower segment thoracic laminectomy was performed. In group 1b, spinal cord trauma was performed with aneurysm clip. In the second group, serum physiologic was given systemically thirty minutes after trauma, and rats were sacrificed after the first and sixth hour. In the third group, CAPE was given systemically thirty minutes after trauma, and rats were sacrificed after the first and sixth hour. Serum IL-1ß and TNF-α levels were analyzed by ELISA in the serum. Histopathological analysis was performed in damaged cord tissues. RESULTS: CAPE suppressed TNF-α and IL-1ß levels in the serum. In histopathological evaluation, it was detected that CAPE decreased hemorrhage and necrosis. CONCLUSION: CAPE suppresses the levels of proinflammatory cytokines, TNF-α and IL-1ß, after acute spinal cord injury in the early phase and contributes to the healing process.
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Ácidos Cafeicos/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Álcool Feniletílico/análogos & derivados , Traumatismos da Medula Espinal/tratamento farmacológico , Animais , Ácidos Cafeicos/administração & dosagem , Ácidos Cafeicos/farmacologia , Citocinas/sangue , Citocinas/efeitos dos fármacos , Interleucina-1beta/sangue , Interleucina-1beta/efeitos dos fármacos , Masculino , Fármacos Neuroprotetores/administração & dosagem , Fármacos Neuroprotetores/farmacologia , Álcool Feniletílico/administração & dosagem , Álcool Feniletílico/farmacologia , Álcool Feniletílico/uso terapêutico , Ratos , Ratos Wistar , Traumatismos da Medula Espinal/sangue , Fator de Necrose Tumoral alfa/sangue , Fator de Necrose Tumoral alfa/efeitos dos fármacosRESUMO
Lumbosacral nerve root anomalies are the leading cause of lumbar surgery failures. Although co-occurrence of lumbar spondylolysis and disc herniation is common, it is very rare to observe that a nerve root anomaly accompanies these lesions. A 49-year-old male patient presented with sudden-onset right leg pain. Examinations revealed L5/S1 lumbar spondylolysis and disc herniation. At preoperative period, he was also diagnosed with lumbosacral root anomaly. Following discectomy and root decompression, stabilization was performed. The complaints of the patient diagnosed with lumbosacral root anomaly at intraoperative period were improved at postoperative period. It should be remembered that in patients with lumbar disc herniation and spondylolysis, lumbar root anomalies may coexist when clinical and neurological picture is severe. Preoperative and perioperative assessments should be made meticulously to prevent neurological injury.
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AIM: An evaluation of treatment methods and outcomes for coccygodynia cases that do not respond to conservative treatment. MATERIAL AND METHODS: Local anesthetic and steroid injections were applied in 32 coccygodynia cases that did not respond to conservative treatment (average of 15 months). Coccyx excision was performed as surgical treatment in 25 cases that had pain relief after the injections but later re-presented with complaints. The patients' pain levels were assessed with VAS. Postacchini classification was used for patient classification based on plain radiography. RESULTS: 20 (62%) of the cases (the total including injection and surgery groups) had a trauma history. Majority of the cases treated with local steroid injection included patients with Type I, while the 25 cases that received surgical treatment predominantly included Type II patients. One case had post-operative skin infection, which was treated with antibiotics. It was observed by comparing pre-operative and post-operative pain scores that both methods provided significant pain relief in all patients. CONCLUSION: While local steroid injection is an effective method of treatment for Type I patients, the coccyx removal is an effective method for controlling the pain in patients with trauma history and in Type II, III and IV patients.
Assuntos
Cóccix/cirurgia , Hiperalgesia/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Raquianestesia , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Feminino , Humanos , Hiperalgesia/terapia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Medição da Dor , Recidiva , Esteroides/administração & dosagem , Esteroides/uso terapêutico , Resultado do TratamentoRESUMO
Gliosarcoma is a rare tumor of the central nervous system and it constitutes about 1 to 8% of all malignant gliomas. In this report we are presenting a recurrent gliosarcoma case during a pregnancy in a 30-year-old woman. This is the first report presenting gliosarcoma in the pregnancy.