[A Case Report on Subarachnoid Hemorrhage Secondary to Neurobrucellosis in a Patient with Cerebral Aneurysm]. / Serebral Anevrizmali Hastada Nörobrusellozise Sekonder Subaraknoid Kanama: Olgu Sunumu.

Brucellosis is a multisystemic infection produced by a gram-negative bacillus that can develop a variety of clinical symptoms and complications. Involvement of the central nervous system is a challenging and dangerous consequence of systemic brucellosis. The neurobrucellosis clinical spectrum can be classified as central and peripheral. Meningitis, encephalitis, polyradiculoneuritis, cranial nerve involvement, depression, abscess and cerebrovascular events are some of the potential complications that may develop. The link between neurobrucellosis and cerebrovascular accident has been reported infrequently in the literature. In this report, a case of neurobrucellosis confirmed by cerebrospinal fluid agglutination test and who developed subarachnoid hemorrhage associated with cerebral aneurysm, which is a rare condition in its course was presented. Serum Rose Bengal test and serum Brucella standard tube agglutination (STA) tests were positive at a titer of 1/640 in a 38-year-old male patient who had complaints of fever, sweating, myalgia, arthralgia, weakness, head-neck-back pain and difficulty in walking for 14 days. On magnetic resonance imaging, Brucella sacroiliitis was identified. The patient's fever, head and neck pain continued and nuchal rigidity was found to be positive. Neurobrucellosis was diagnosed based on the cerebrospinal fluid (CSF) examination, which revealed a high white blood cell count, high protein, low glucose level, and STA in CSF at 1/640 titers. Imaging of the brain was conducted concurrently with cerebrospinal fluid analysis indicated subarachnoid hemorrhage caused by cerebral aneurysm rupture. In addition to the medical treatment, the aneurysm rupture was closed with surgical intervention. Three months of simultaneous triple antibiotic treatment were administered to the patient. In the third month of the treatment, the patient was completely cured and no longer had any problems. Although uncommon, subarachnoid hemorrhage due to aneurysm rupture is one of the cerebrovascular consequences of neurobrucellosis. In the process of differential diagnosis of cerebrovascular occurrences, particularly in areas where brucellosis is an endemic disease, it is important to keep in mind that neurobrucellosis can imitate a variety of diseases and cause cerebrovascular events.

Effectiveness of Derivo® Flow Diverter Device in the Endovascular Treatment of Cerebrovascular Aneurysms.

AIM: To report our experience with flow diverter devices in the treatment of intracranial aneurysms, and to share the efficacy and clinical results of the Derivo® flow diverter device in the endovascular treatment of cerebrovascular aneurysms. MATERIAL AND METHODS: This retrospective study was conducted at a regional training and research hospital between October 2015 and March 2020 after approval by the Clinical Research Ethics Committee. The radiology and file records of 21 patients with cerebrovascular aneurysms treated endovascularly using a Derivo® flow diverter device were examined. RESULTS: As per our findings, flow diverter devices were used to treat 27 aneurysms from 21 cases. Among the treated aneurysms, 3, 2, and 22 were in the middle cerebral artery, anterior communicating artery, and internal cerebral artery, respectively. Eight of the patients with a mean age of 56.9 years presented with subarachnoid hemorrhage. Derivo® flow diverters were used alone in 19 cases, whereas concurrent diverter device and coiling were used in only 3 patients. Complete closure of the aneurysms was observed in 3 (14.2%) cases; meanwhile, a 50% reduction in aneurysm size was observed in 2 (9.5%) cases. Complete aneurysm closure occurred in 20 cases (95%) at the 6-month follow-up. Mortality and morbidity each occurred in 1 (4.7%) case. CONCLUSION: Flow diverter devices provide an efficient and safe method of treatment, especially for fusiform, large, giant, widenecked intracranial aneurysms. Endovascular coil embolization treatment is deemed inappropriate for small aneurysms.

Endoscopic Untethering of Tight Filum Terminale: An Operative Technique.

AIM: To demonstrate the various technical advantages of minimally invasive endoscopic untethering of tight filum terminale for the treatment of tethered cord syndrome (TCS). MATERIAL AND METHODS: In five pediatric cases of TCS, we performed untethering by using the endoscopic technique. The age of the patients were 6, 7, 8, 9, and 12 years old. We used a nasal speculum of the transsphenoidal approach during the endoscopic surgical procedure. RESULTS: All the procedures were performed uneventfully, except for one case with a split cord malformation that showed neurologic deterioration caused by excision of the diastematomyelic fibrous septum at the thoracic level (unrelated to the endoscopic procedure at the L5-S1 level). This patient was referred to a rehabilitation clinic 5 days after surgery and showed significant improvement by the third postoperative month. The other four patients were discharged 1 day after the operation. CONCLUSION: Endoscopic release of filum terminale is a safe technique especially if it is performed with neuromonitoring. This technique may shorten the length of hospital stay and reduce perioperative blood loss. However, futher studies with a larger number of patients and long-term follow-up are needed.

A New Less Invasive Technique for Multiple-Level Spontaneous Spinal Epidural Hematomas: Wash-and-Go Technique.

Aim Spinal epidural hematomas are rare entity in neurosurgery practice. Most of them are spontaneous due to anticoagulant therapy and called spontaneous spinal epidural hematomas (SSEHs). Laminectomy or hemilaminectomy for affected levels is still the first choice in the operative treatment of an SSEH. We describe a new less invasive surgical technique, performing single-level laminectomy and washing with 0.9% sodium chloride through a thin soft catheter for a 12-level thoracic-cervical SSEH in a patient under anticoagulant therapy. Patient and Operative Technique A 55-year-old woman was brought to the emergency department with a rapid onset of pain in her upper back and both legs with weakness of her lower extremities. An urgent magnetic resonance imaging (MRI) of the whole spine showed a SEH. During the operation, after T2 laminectomy, a thin soft catheter was epidurally placed under the T1 lamina and gently pushed forward rostrally. Then continuous saline irrigation was utilized and aspiration made via the catheter to wash out the hematoma. Drainage of blood was observed. The procedure was performed for 15 minutes. Then the catheter was epidurally placed under the T3 lamina, and the procedure for the hematoma in the lower segment was repeated. Decompression of spinal cord and nerve roots was observed. Result Postoperative early MRI of the thoracic-cervical spine showed gross total evacuation of the SEH. Accordingly, the patient's muscle strength improved. Conclusion Although multiple laminectomy or hemilaminectomy for affected levels to evacuate the hematoma and decompress the spinal cord is the main choice of surgical treatment, single-level laminectomy and irrigation plus aspiration via a thin soft catheter can be performed successfully with good results in SSEH.

Cervical disc hernia operations through posterior laminoforaminotomy.

OBJECTIVE: The most common used technique for posterolateral cervical disc herniations is anterior approach. However, posterior cervical laminotoforaminomy can provide excellent results in appropriately selected patients with foraminal stenosis in either soft disc prolapse or cervical spondylosis. The purpose of this study was to present the clinical outcomes following posterior laminoforaminotomy in patients with radiculopathy. MATERIALS AND METHODS: We retrospectively evaluated 35 patients diagnosed with posterolateral cervical disc herniation and cervical spondylosis with foraminal stenosis causing radiculopathy operated by the posterior cervical keyhole laminoforaminotomy between the years 2010 and 2015. RESULTS: The file records and the radiographic images of the 35 patients were assessed retrospectively. The mean age was 46.4 years (range: 34-66 years). Of the patients, 19 were males and 16 were females. In all of the patients, the neurologic deficit observed was radiculopathy. The posterolaterally localized disc herniations and the osteophytic structures were on the left side in 18 cases and on the right in 17 cases. In 10 of the patients, the disc level was at C5-6, in 18 at C6-7, in 2 at C3-4, in 2 at C4-5, in 1 at C7-T1, in 1 patient at both C5-6 and C6-7, and in 1 at both C4-5 and C5-6. In 14 of these 35 patients, both osteophytic structures and protruded disc herniation were present. Intervertebral foramen stenosis was present in all of the patients with osteophytes. Postoperatively, in 31 patients the complaints were relieved completely and four patients had complaints of neck pain and paresthesia radiating to the arm (the success of operation was 88.5%). On control examinations, there was no finding of instability or cervical kyphosis. CONCLUSION: Posterior cervical laminoforaminotomy is an alternative appropriate choice in both cervical soft disc herniations and cervical stenosis.

Neuroprotective effects of agmatine in experimental peripheral nerve injury in rats: a prospective randomized and placebo-controlled trial.

AIM: The purpose of this study was to demonstrate the activity of agmatine, an inducible nitric oxide synthase (iNOS) inhibitor and selective N-methyl-D-aspartate receptor (NMDAR) antagonist, on reducing tissue damage in distal part of traumatic nerve in an experimental rat peripheral nerve injury model. MATERIAL AND METHODS: Sciatic nerves of 30 Sprague Dawley male rats were used. Rats were divided into 5 groups; group 1 (n=6), control group; group 2 (n=6), axonotmesis + placebo group; group 3 (n=6), axonotmesis + 50 mg/kg agmatine treatment group; group 4 (n=6), neurotmesis + placebo group; group 5 (n=6), neurotmesis + 50 mg/kg agmatine treatment group. Axonolysis, axon degeneration, edema, hemorrhage, and inflammation were evaluated in histopathologic examinations of all the groups. RESULTS: When group 2 was compared with group 3 in histopathologic sections, axonolysis was less in group 3 (p=0.007), as was axon degeneration (p=0.022) and edema (p=0.018). When group 4 was compared with group 5, axonolysis was less in group 5 (p=0.009), as was axon degeneration (p=0.006) and edema (p=0.021). CONCLUSION: This study demonstrated agmatine to have antioxidant and antineurotoxic effects in an experimental rat peripheral nerve injury model.

Neuroprotective effect of acute interferon-beta 1B treatment after spinal cord injury.

AIM: The purpose of this trial was to investigate the effect of a well known immunomodulator -interferon beta- on traumatized spinal cord in terms of biochemical and histopathological features. MATERIAL AND METHODS: Twenty-four rats were used in this trial. The rats were divided into 3 groups. In the first group of rats, spinal cord injury was created by the weight drop method and interferon beta was administered. In the second group, physiological saline was administered. Third group was used as control. Rats were sacrificed 24 hours following trauma. Heat shock protein 70 levels were measured in the spinal cord samples and the samples were examined histopathologically. RESULTS: When the rats in the physiological saline and control groups were compared to rats treated with interferon beta 1b, those treated with interferon beta 1b revealed significant increases in the heat shock protein 70 levels in tissues, and histopathological examination revealed decreases in polymorphonuclear leucocyte infiltration, haemorrhage, oedema and necrosis. CONCLUSION: Although, the results of the study indicated that interferon beta might have some healing effects via increasing the cellular heat shock protein 70 on spinal cord injuries, more studies are needed.

Neuroprotective effect of ACE inhibitors in glutamate - induced neurotoxicity: rat neuron culture study.

AIM: Glutamate is known to be neurotoxic at concentrations of 10-6M and 10-7M. Angiotensin converting enzyme (ACE) inhibitors can be assumed to be neuroprotective as they open the mitochondrial adenosine triphosphate-sensitive potassium channels by inhibiting the degradation of bradykinin. In this study, we investigated whether the ACE inhibitors captopril, ramipril and perindopril have protective effects in glutamate-induced neurotoxicity in newborn rat cerebral cortex cell cultures. MATERIAL AND METHODS: Viability tests were performed among ACE inhibitors by constituting groups of control and 10-7M and 10-6M glutamate doses in newborn rat cortex cultures. RESULTS: While the mean viable cell number was 0.47±0.06 in the control group, it was 0.37±0.03 in the group exposed to 10-7M glutamate (p < 0.05) and 0.37±0.01 in the group exposed to 10-6M glutamate (p < 0.05). Captopril was used at a dose of 10 µM, perindopril was used at a dose of 1 µM, and ramipril was used at a dose of 30 µM against 10-7M and 10-6M glutamate. Ramipril and perindopril reversed the toxicity against 10-6M glutamate (p < 0.05). The neuroprotective properties of captopril, perindopril and ramipril were not found to be statistically significant against 10-7M glutamate at the doses mentioned above. CONCLUSION: Data obtained from this study indicate that ramipril and perindopril can prevent 10-6M glutamate-induced neurotoxicity.