Effect of humic acid on oxidative stress and neuroprotection in traumatic spinal cord injury: an experimental study.

Background/aim: Traumatic spinal cord injury (TSCI) is an important health problem, especially in developing countries with additional socioeconomic loss. Humic acid (HA) usually has antioxidant, antiinflammatory, blood circulating, and antiviral effects. Hence, it was aimed herein to show the effect of HA on neuroprotection in a TSCI model. Materials and method: A TSCI model was used, in which 24 Wistar albino rats were divided into 4 groups: control group: subjected to only laminectomy; sham group: subjected to laminectomy + TSCI; HA 5 mg/kg group: subjected to laminectomy + TSCI + intraperitoneal (IP) injection of 5 mg/kg of HA; and HA 10 mg/kg group: subjected to laminectomy + TSCI + IP injection of 10 mg/kg of HA. Intracardiac blood samples were obtained preoperatively (preop), and at 1 and 24 h postoperatively (postop). The total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) levels were evaluated in the serum. The motor functions were evaluated using the Modified Tarlov Score at 24 h postop. Results: There were no significant changes in the TAS values between the sham and HA 5 mg/kg and HA 10 mg/kg groups (p = 0.77/0.21). However there was a significant decrease in the TOS values at 24 h postop when comparing the sham and HA 5 mg/kg groups (p = 0.02). The pathological evaluation showed a significant decrease in the severity of edema, hemorrhage, polymorphonuclear leucocyte (PNL) infiltration, and mononuclear leucocyte (MNL)/macrophage/microglia infiltration when compared with the control group (p < 0.05). There was a significant recovery at the paraplegia level when the HA 5 mg/kg and HA 10 mg/kg groups were compared with the control group (p < 0.001). Conclusion: The effects of HA in the early stages of TSCI on oxidative stress, histopathological changes, and neurological improvement were investigated herein. It is thought to be a potential therapeutic agent in acute TSCI but needs to be further evaluated to determine the extent of its effect on other neuroprotective pathways in larger series.

Endoscopic trans-eustachian tube approach: identifying the precise landmarks, a novel radiological and anatomical evaluation.

PURPOSE: The endoscopic trans-eustachian approach (ETETA) is a less invasive approach to the infratemporal fossa (ITF), providing superior exposure compared to traditional transcranial approaches. The anatomy of the pharyngotympanic (eustachian) tube and adjacent neurovascular structures is complex and requires in-depth knowledge to safely perform this approach. We present a cadaveric and radiological assessment of critical anatomic considerations for ETETA. METHODS: Six adult cadaveric heads were dissected alongside examination of 50 paranasal sinus CT scans. Key anatomic relationships of the pharyngotympanic tube and adjacent structures were qualitatively and quantitatively evaluated. Descriptive statistics were performed for quantitative data. RESULTS: Anatomical and radiological measurements showed lateralization of the pharyngotympanic tube allows access to the ITF. The pharyngotympanic tube has bony and cartilaginous parts with the junction formed by the sphenoid spine and foramen spinosum. The bony part and tendon of the tensor tympani muscle were located at the posterior genu of the internal carotid artery. The anterior and inferior wall of the carotid canal was located between the horizontal segment of the internal carotid artery and petrous segment of the cartilaginous pharyngotympanic tube. CONCLUSION: The combination of preoperative radiographic assessment and anatomical correlation demonstrates a safe and effective approach to ETETA, which allowed satisfactory visualization of ITF. The morphological evaluation showed that the lateralization of the pharyngotympanic tube and related structures allowed a surgical corridor to reach the ITF. Endoscopic surgery through the pharyngotympanic tube is challenging, and in-depth understanding of the key anatomic relationships is critical for performing this approach.

Comparison of the Retrosigmoid Suprameatal and Anterior Subtemporal Transpetrosal Approaches After Full Exposure of the Internal Acoustic Meatus.

BACKGROUND AND OBJECTIVES: Surgical approaches to the ventral brainstem and petroclival regions are complex, and standard retrosigmoid and subtemporal approaches are often inadequate. Retrosigmoid suprameatal tubercle (RSMTA) and anterior subtemporal transpetrosal (ASTA) approaches may provide extended surgical exposure with less brain retraction. The objective of this study was to evaluate advantages and disadvantages of RSMTA vs ASTA, and illustrate the surgical corridors and 3-dimensional microsurgical anatomy of the related structures. METHODS: Four silicone-injected adult cadaver heads (8 sides) were dissected to evaluate the accessibility of lesions located at the petrous apex, ventral brainstem, and pontomedullary region using ASTA and RSTMA. RESULTS: Both ASTA and RSMTA provide access from the petrous apex to the ventral lower pons and pontomedullary junction. A greater extent of safely resected bone was found in ASTA vs RSMTA. ASTA provides a larger surgical view to the ventrolateral midpons, peritrigeminal region, superior neurovascular complex, pontomesencephalic junction, and posterior cavernous sinus. Meanwhile, through cranial nerve V mobilization, RSMTA provides a larger surgical view to the lower half part of the pons, ventrolateral part of the pontomedullary junction, and middle and lower neurovascular structures. CONCLUSION: The choice of surgical approach is determined by considering the area where the lesion originates, lesion size, the anatomic structures to which it extends, and evaluation of the area that can be surgically exposed. Our study highlights the differences between these approaches and important surgical anatomic considerations.

Endoscopic Endonasal Approach to the Third Ventricle Using the Surgical Corridor of the Reverse Third Ventriculostomy: Anatomo-Surgical Nuances.

Objective Surgical access to the third ventricle can be achieved through various corridors depending on the location and extent of the lesion; however, traditional transcranial approaches risk damage to multiple critical neural structures. Methods Endonasal approach similar to corridor of the reverse third ventriculostomy (ERTV) was surgically simulated in eight cadaveric heads. Fiber dissections were additionally performed within the third ventricle along the endoscopic route. Additionally, we present a case of ERTV in a patient with craniopharyngioma extending into the third ventricle. Results The ERTV allowed adequate intraventricular visualization along the third ventricle. The extracranial step of the surgical corridor included a bony window in the sellar floor, tuberculum sella, and the lower part of the planum sphenoidale. ERTV provided an intraventricular surgical field along the foramen of Monro to expose an area bordered by the fornix anteriorly, thalamus laterally, anterior commissure anterior superiorly, posterior commissure, habenula and pineal gland posteriorly, and aqueduct of Sylvius centered posterior inferiorly. Conclusion The third ventricle can safely be accessed through ERTV either above or below the pituitary gland. ERTV provides a wide exposure of the third ventricle through the tuber cinereum and offers access to the anterior part as far as the anterior commissure and precommissural part of fornix and the whole length of the posterior part. Endoscopic ERTV may be a suitable alternative to transcranial approaches to access the third ventricle in selected patients.

Microsurgical endoscopy-assisted presigmoid retrolabyrinthine approach with mastoid bone drilling: an anatomical laboratory investigation.

PURPOSE: This study aims to evaluate the applicability of the endoscopy-assisted presigmoid retrolabyrinthine approach, advantages, disadvantages, and the applicability of surgery with pre-op radiological parameters; identify important landmarks; and to reveal their relationships with important structures in the surgical field with objective data. Also, we aim to improve the surgical technique for increasing reachable anatomic structure. METHODS: Mastoid drilling and endoscopy-assisted presigmoid retrolabyrinthine approach were performed and endoscopic instruments were used to obtain the three-dimensional pictures. Computed tomography images were evaluated to correlate to the anatomic data. RESULTS: In terms of pre-operative radiological evaluation of the applicability of the presigmoid approach were investigated with selected radiological parameters. The endoscopy-assisted presigmoid retrolabyrinthine approach applied to cadavers the relationship, distances between important anatomical landmarks, and anatomical structures in the surgical field recorded. The anatomical structures that could reach with the application of the procedure were recorded. The relationship between pre-operative measured radiological parameters and surgical results was evaluated with objective data. Additional combinations to improve this surgical method discussed and the results of our combination were recorded with photographs. CONCLUSION: Although the presigmoid retrolabyrinthine approach has facilitated with the assistance of endoscope, it has observed that there are still some difficulties, and it has been concluded that the radiological parameters are useful in evaluating the applicability of this surgery. It observed that this surgery can be performed more effectively with combinations.

Effect of Humic Acid on Oxidative Stress and Neuroprotection in Traumatic Spinal Cord Injury: An Experimental Study.

OBJECTIVE: Traumatic spinal cord injury (TSCI) is an important health problem especially in developing countries with additional socio-economic loss. Humic acids (HA) usually have anti-oxidant, anti-inflammatory, blood-circulating and antiviral effects. We aimed to show effect of HA on neuroprotection in TSCI model. METHODS: We performed TSCI model in Twenty-four Wistar-Albino rats in four groups. Control group underwent only laminectomy. Sham group underwent laminectomy followed by TSCI. Low dose HA (5mg/kg) and high dose HA (10mg/kg) groups underwent laminectomy and TSCI followed by peritoneal administration of HA. Preoperative, postoperative 1st hour and postoperative 24th hour cardiac blood samples were obtained. Total Antioxidant Status (TAS), Total Oxidant Status (TOS) and Oxidative Index (OI) levels were evaluated in serum. The 24th hour motor functions were evaluated by Modified Tarlov Score. RESULTS: There were no significant changes in TAS values between sham- low dose and high dose humic acid groups (p:0.77/0.21). However there were a significant decrease of TOS levels in the 24th hour post operative blood samples comparing the sham group with low dose humic acid group (p=0.02). Pathological evaluation showed a significant decrease in the severity of edema, hemorrhage, Polymorphonuclear leucocytes (PNL) and Mononuclearleucocytes (MNL) /macrophage/microglia when we compare with the control group (p<0.05). There is a significant recovery in paraplegia level as we compared the HA groups with control groups (p<0.001). CONCLUSION: In this study, we showed the effects of HA in the early stages of TSCI on oxidative stress, histopathological changes and neurological improvement. It is thought to be a potential therapeutic agent in acute TSCI but needs to be further evaluated by showing proper effect on other neuroprotective pathways in larger series.

A rare case series of central nervous system cystic echinococcosis.

INTRODUCTION: A total of three cases of childhood central nervous system (CNS) echinococcosis with spinal or posterior fossa involvement having rare localizations, have been presented. CASE PRESENTATION: A 7-year-old boy with spinal involvement applied to our hospital with left leg weakness and inability to walk. A 16-year-old girl with posterior fossa involvement had peripheral facial paralysis, while a 9-year-old girl had headache and vomiting. These cases, diagnosed with cystic echinococcosis with the necessary laboratory and imaging methods, improved with appropriate medical treatment and surgery. DISCUSSION: Especially in endemic areas, it should be kept in mind that cystic echinococcosis may present with CNS involvement and should become to mind in the differential diagnosis when neurological findings are detected. Lay Summary: With this report, we attempted to share our experience with cystic echinococcosis in the spinal region and posterior fossa in three children over 1 year, including a description of associated signs and symptoms as well as laboratory and radiological findings. It should be kept in mind that cystic echinococcosis may present with CNS involvement in endemic areas and should be considered in the differential diagnosis when neurological findings are detected. Afterward, the diagnosis should be confirmed with appropriate laboratory and imaging methods. In these cases, rapid recovery can be achieved with appropriate surgical intervention as well as medical treatment.

Dentate Nucleus: Connectivity-Based Anatomic Parcellation Based on Superior Cerebellar Peduncle Projections.

OBJECTIVE: Projections from the dentate nucleus (DN) follow a certain organized course to upper levels. Crossing and noncrossing fibers of the dentatorubrothalamic (DRT) tract terminate in the red nucleus and thalamus and have various connections throughout the cerebral cortex. We aimed to establish the microsurgical anatomy of the DN in relation to its efferent connections to complement the increased recognition of its surgical importance and also to provide an insight into the network-associated symptoms related to lesions and microsurgery in and around the region. METHODS: The cerebellum, DN, and superior cerebellar peduncle (SCP) en route to red nucleus were examined through fiber dissections from the anterior, posterior, and lateral sides to define the connections of the DN and its relationships with adjacent neural structures. RESULTS: The DN was anatomically divided into 4 areas based on its relation to the SCP; the lateral major, lateral anterosuperior, posteromedial, and anteromedial compartments. Most of the fibers originating from the lateral compartments were involved in the decussation of the SCP. The ventral fibers originating from the lateral anterosuperior compartment were exclusively involved in the decussation. The fibers from the posteromedial compartment ascended ipsilaterally and decussated, whereas most anteromedial fibers ascended ipsilaterally and did not participate in the decussation. CONCLUSIONS: Clarifying the anatomofunctional organization of the DN in relation to the SCP could improve microneurosurgical results by reducing the complication rates during infratentorial surgery in and around the nucleus. The proposed compartmentalization would be a major step forward in this effort.

Management Strategy for a Patient with Coexistence of Meningioma and Paraophthalmic Aneurysm.

The coexistence of intracerebral aneurysm and meningioma is a rare occurrence. There is no consensus about the treatment options. We aim to present a case of a 61-year female admitted to this clinic with persistent headache and loss of vision in both eyes, especially on the left. Radiological images demonstrated a para-ophthalmic saccular aneurysm coexisting with an extra-axial homogenously enhancing mass in the right cavernous sinus, which was possibly a meningioma. A flow diverting stent, following the coil embolisation of the aneurysm, was placed. Then the patient underwent stereotactic radiosurgery for the cavernous sinus meningioma. Diagnosis and treatment of such pathologies are easily achieved with the technological advancements of imaging techniques. The hypothesis of increased hemodynamic pressures, due to meningioma causing intracranial aneurysms, may explain this coexistence. Endovascular surgery, followed by stereotactic radiosurgery, may be a reliable approach for a patient with coexistent meningioma and aneurysm. Key Words: Meningioma, Aneurysm, Cavernous sinus.

The benefits of inferolateral transtubercular route on intradural surgical exposure using the endoscopic endonasal transclival approach.

BACKGROUND: Surgical access to the ventral pontomedullary junction (PMJ) can be achieved through various corridors depending on the location and extension of the lesion. The jugular tubercle (JT), a surgically challenging obstacle to access the PMJ, typically needs to be addressed in transcranial exposures. We describe the endoscopic endonasal transclival approach (EETCA) and its inferolateral transtubercular extension to assess the intradural surgical field gained through JT removal. We also complement the dissections with an illustrative case. METHODS: EETCA was surgically simulated, and the anatomical landmarks were assessed in eight cadaveric heads. Microsurgical dissections were additionally performed along the endoscopic surgical path. Lastly, we present an intraoperative video of the trans-JT approach in a patient with lower clival chordoma. RESULTS: The EETCA allowed adequate extracranial visualization and removal of the JT. The surgical bony window-obtained along the clivus and centered at the JT via the EETCA-measured 11 × 9 × 7 mm. Removal of the JT provided an improved intradural field within the lower third of the cerebellopontine cistern to expose an area bordered by the cranial nerves VII/VIII and flocculus superior and anterior margin of the lateral recess of the fourth ventricle and cranial nerves IX-XI inferiorly, centered on the foramen of Luschka. CONCLUSIONS: Removal of the JT via EETCA improves exposure along the lower third of the cerebellopontine and upper cerebellomedullary cisterns. The inferolateral transtubercular extension of the EETCA provides access to the lateral recess of the fourth ventricle, in combination with the ventral midline pontomedullary region.

Microsurgical Management of the Middle Cerebral Artery Bifurcation Aneurysms: An Anatomic Feasibility Study.

BACKGROUND: The proper head positioning decreases the surgical complications by enabling a better surgical maneuverability. Middle cerebral artery (MCA) bifurcation aneurysms have been classified by Dashti et al. [Surg Neurol. 2007 May;67(5):441-56] as the intertruncal, inferior, lateral, insular, and complex types based on dome projection. Our aim was to identify the optimum head positions and to explain the anatomic variables, which may affect the surgical strategy of MCA bifurcation aneurysms. METHODS: The lateral supraorbital approach bilaterally was performed in the 4 cadaveric heads. All steps of the dissection were recorded using digital camera. RESULTS: The distal Sylvian fissure (SF) dissection may be preferred for insular type and the proximal SF dissection may be preferred for all other types. Fifteen degrees head rotation was found as the most suitable position for the intertruncal, lateral type and subtype of complex aneurysms related with superior trunk. Thirty degrees head rotation was found the most suitable position for the inferior type, insular type, and subtype of complex aneurysms related with inferior trunk. CONCLUSIONS: The head positioning in middle cerebral bifurcation aneurysms surgery is a critical step. It should be tailored according to the projection and its relationship with the parent vessels of the middle cerebral bifurcation.

Endoscopic endonasal transclival approach to the ventral brainstem: Radiologic, anatomic feasibility and nuances, surgical limitations and future directions.

The endoscopic endonasal transclival approach (EETA) is less invasive than traditional open approaches; however, there is currently limited data on the pre-operative features that may predict success of the EETA. Surgical landmarks and exposure of the EETA and expanded EETA are assessed. We retrospectively measured multiple anatomic features in 154 adult dry skulls, 22 C1 and C2 dry bone vertebrae, and 500 paranasal sinus computed tomography (CT) scans. We also dissected 13 formalin-fixed, silicone-injected adult cadaveric heads. Relevant qualitative and quantitative data were obtained with CT (n = 10) and cadaveric dissection (n = 13). They are expressed as mean (SD), as appropriate and compared with unpaired t tests. Categorical variables were compared with χ2 tests. We determined the prevalence of clival and sphenoid sinus anatomic variations and assessed potential exposure of the craniovertebral region, based on the relative position of the nasal bone tip, posterior point of the hard palate, and their relation to the position of C1 and C2. Depending on anatomic features, EETA should allow visualization of the ventral brainstem. The mean (SD) dimensions of the surgical window for EETA were 43.2 (5.1) × 18.3 (1.1) mm, in the craniocaudad and horizontal dimensions, respectively. The craniocaudad dimension enlarged to 60.2 (4.7) mm with expanded EETA. The EETA allowed satisfactory exposure for odontoid and C1 anterior arch resection (expanded EETA) in all specimens, regardless of the orientation of the palate. The combination of preoperative radiographic assessment and intraoperative considerations allows safe and effective application and facilitate selection of the most appropriate approach.

Neuroanatomical Aspects of the Temporo-Parieto-Occipital Junction and New Surgical Strategy to Preserve the Associated Tracts in Junctional Lesion Surgery: Fiber Separation Technique.

AIM: To describe the location of each white matter pathways around the temporo-parieto-occipital junction (TPOJ) and the dissections performed using focal fiber dissection and fiber separation techniques (FST). These areas play an important role in human language processing and high-level brain functions. Thus, it is important to identify the association of the fascicles as well as their courses to plan safe and effective surgical target vectors. MATERIAL AND METHODS: Thirty formalin-fixed human hemispheres and two formalin-fixed human heads were dissected with focal fiber dissection and FST under 6-40x magnification using a surgical microscope and real-time magnetic resonance imaging navigation system. Two- and three-dimensional anatomical and surgical pictures were obtained and processed using high dynamic range photography (Photomatix) and were correlated to radiological images of the case with glioblastoma of the TPOJ. RESULTS: The trajectory and connectivity of these fibers as well as their surgical importance in performing FST in cadaver dissections were demonstrated with correlation of the surgical, radiological, and anatomical images. CONCLUSION: The microanatomy of the TPOJ and related structures, emphasizing the position of each white matter pathway, has been described. Understanding the composition of each region is critical in preventing intraoperative brain injury that could lead to functional deficits.

Anal Extrusion of a Ventriculoperitoneal Shunt.

Ventriculoperitoneal shunt (VPS) placement is an effective and most frequently used surgical method in the treatment of hydrocephalus, but the mechanical and infective complications are often seen after this surgical procedure. Bowel perforation after VPS surgery is rarely seen complication that is reported ranging between 0.1% and 0.7% in the literature. We report a case of 10-month baby who was shunted at day three of her life and has presented to us with protruding distal end of the ventricular catheter through anus. Mechanism of migration of VPS is unclarified yet; nevertheless, children with myelomeningocele have weakness of the bowel muscles, which probably makes it more sensitive for perforation. Additionally, sharp and stiff end of the VPS, use of trocar by some surgeons, chronic irritation by the shunt, previous surgery, infection and silicone allergy are other possible reasons of bowel perforation. Peritonitis and ventriculitis have a high morbidity and mortality that may occur after VPS-related bowel perforations; hence, it should be managed rapidly and aggressively to reduce morbidity and mortality.

Klippel-Trenaunay-Weber Syndrome with Atypical Presentation of Cerebral Cavernous Angioma: A Case Report and Literature Review.

BACKGROUND: Klippel-Trenaunay-Weber syndrome (KTWS) is a rare syndrome characterized by the triad of cutaneous hemangiomas, venous varicosities, and osseous-soft tissue hypertrophy of the affected limb. Clinical manifestations, genetic testing, and radiologic imaging are the key steps in diagnosing this syndrome. CASE DESCRIPTION: An 18-month-old boy was brought for follow-up brain magnetic resonance imaging (MRI) with a history of right lower limb hypertrophy, cutaneous varicosities, and hemangiomas diagnosed at birth. A baseline MRI at 12 months revealed multiple hemorrhagic lesions within the cerebrum, the largest in the right temporal lobe, which was treated surgically at the age of 18 months because of its rapid growth. This is the youngest patient with KTWS treated surgically for intracranial hemangiomas. CONCLUSION: KTWS is a rare disease with a wide range of manifestations. Multisystemic evaluation of this group of patients should be performed to identify cavernous hemangiomas at the early stage of life and adequately treat them in the future. Treatment of KTWS patients with cavernous hemangiomas should not be different from the treatment of patients with any other hemangiomas, and surgical intervention should be considered on a case-to-case bases.

Hypoxia-Inducible Factor 1α and AT-Rich Interactive Domain-Containing Protein 1A Expression in Pituitary Adenomas: Association with Pathological, Clinical, and Radiological Features.

BACKGROUND: Hypoxia-inducible factor (HIF) plays a major role in tumorigenesis and cancer progression. In hypoxic conditions, HIF is upregulated and has been shown to activate multiple genes required for cells to adapt to hypoxia. AT-rich interactive domain-containing protein 1A (ARID1A), a SWI/SNF (switch/sucrose nonfermentable) chromatin remodeling gene has context-dependent tumor-suppressive and oncogenic roles in cancer. We assessed the correlations between the expression and mutations of HIF1A and ARID1A in histopathologically confirmed pituitary adenomas. METHODS: We performed a retrospective analysis of 71 patients who had undergone surgery for pituitary adenoma. Patient demographic, radiological, and histopathological features were correlated with HIF1A and ARID1A expression. RESULTS: Most cases were HIF1A positive (62%). No significant correlation was found between HIF1A expression and age, gender, tumor size, bone erosion, hemorrhage, or Ki-67 index. An inverse correlation was demonstrated between HIF1A and cavernous sinus invasion (P = 0.035). ARID1A loss was found in 28.2% of pituitary adenomas. No significant correlation was found between ARID1A and any of the assessed variables. CONCLUSIONS: In our patient cohort, we found that most pituitary adenomas expressed HIF1A. To the best of our knowledge, we are the first to assess the presence of ARID1A loss in pituitary adenomas, which occurred in 28.2% of cases. No individual demographic, imaging, or histopathological feature was predictive of ARID1A. Likewise, with the exception of an increased incidence of cavernous sinus invasion, no correlation was found with HIF1A. Given the prognostic value of these markers in other malignancies, their frequency in pituitary adenomas warrants further exploration of their potential role in pituitary adenoma treatment and outcome.

Superficial Siderosis of the Central Nervous System Due to Recurrent Surgeries of the Thoracic Spine: A Rare Case.

BACKGROUND: Superficial siderosis (SS) of the central nervous system is a rare condition caused by hemosiderin deposition in the subpial layers of the brain and spinal cord. Surgical complications are the primary factor for occurrence of secondary SS. We present a case of SS with an identified bleeding origin in the thoracic spine. CASE DESCRIPTION: A 58-year-old female patient experienced 9 months of continuous progressive dizziness, difficulty with mobilization, drop attacks, and lack of hearing. The patient also had an extensive history of thoracic spinal surgeries. She came to the hospital with gait imbalance. Gradient echo (GE) magnetic resonance imaging (MRI) confirmed hemosiderin deposition along the cerebellar folia and vermis. GE sequences are preferable in this diagnosis, because of higher sensitivity, and for detecting characteristic T2 hypointensity. The dural defect was repaired with an artificial dural patch in thoracal operation area. Clinical findings, imaging studies, intraoperative findings, and literature information are presented. CONCLUSIONS: Performance of an open neurosurgical procedure to repair a dural defect in the presence of MRI confirmed that superficial siderosis is an optimal method and a crucial step to ensure the safe resolution of the condition and to break the circle of emergency admissions of a patient with a dural defect and a history of multiple spinal surgeries.

Recurrent Osteoma Overlying a Methylmethacrylate Bone Cement Cranioplasty: A Rare Case.

Osteomas are generally benign tumors of the skull that affect all age groups and are diagnosed in the fourth or fifth decade of life, and are rare in childhood. Surgical resection is curative and malignant transformation is very rare. A 12-yearboy who had undergone a craniotomy for resection of a parietal osteoma four years ago, followed by a cranioplasty with methylmethacrylate bone cement, presented to our clinic with an expanding mass overlying the cranioplasty. Upon reoperation, the mass was totally excised, and the parietal cranial defect was repaired using methylmethacrylate bone cement. On histologic examination, the mass was found to be a recurrent osteoma overlying the methylmethacrylate bone cement. In this report, we discuss the etiologies of recurrence of osteoma and treatment options of these rare cases. We believe that this recurrence resulted from contamination of the surgical area and cranioplasty materials with osteoma material. Extensive washing of the cranioplasty materials and perioperative area may prevent recurrence of such tumors.

Surgical Management in Cervical Spondylotic Myelopathy Due to Alkaptonuria.

BACKGROUND: Ochronotic arthropathy related to alkaptonuria is a rare condition. Cervical spine involvement with myelopathic features has been even more rarely described, particularly related to atlantoaxial instability. As such, little is known about the optimal surgical management in these patients. CASE DESCRIPTION: We described the first case, to our knowledge, of a patient with alkaptonuria and related cervical spondylotic myelopathy from pannus formation at the atlantoaxial joint. We describe our choices in surgical management of this rare condition in a patient with an excellent outcome. CONCLUSION: Ochronotic cervical spondylotic myelopathy is a rare condition and may require additional considerations in surgical treatment compared to more common causes of cervical spondylotic myelopathy. In our case, we elected for decompression with posterior occipitocervical screw fixation and were able to achieve neurologic recovery with no complications, currently at 2-year follow-up.

Neurological recovery after traumatic Cauda Equina syndrome due to glass fragments: An unusual case.

Penetrating spinal injuries with foreign bodies are exceedingly rare. To date, pathological problems due to glass fragments in the spinal canal have rarely been reported. In this report, the case presenting with a back laceration, leg pain, and leg weakness was found to have glass frag-ments in the spinal canal at the L2-L3 level by lumbar computed tomography and magnetic resonance imaging. After L2 total laminectomy and retrieval of the glass fragments, the dura was re-paired. The patient was discharged from the hospital after complete neurological recovery. In cases of spinal canal injuries due to foreign bodies, early operative decompression of the neural elements is the treatment of choice. Patients with Cauda Equina syndrome due to glass fragments have a good prognosis for functional recovery.