Intraventricular Hemorrhage and Related Hydrocephalus Patients Demographics in a University Hospital NICU: Single-Center Data.

AIM: To analyze the demographic and clinical data of preterm or low birth weight newborns with periventricular hemorrhage. MATERIAL AND METHODS: This retrospective study analyzed patients admitted to the neonatal intensive care unit of a Bahcesehir University School of Medicine-Affiliated Hospital due to preterm birth or low birth weight between June 1, 2012, and April 30, 2021. Categorical values were evaluated by Pearson chi-square or Fisher's exact test. The Mann-Whitney U test compared continuous values between the groups. Logistic regression was used to evaluate the factors that affected permanent cerebrospinal fluid (CSF) diversion. RESULTS: The study finally evaluated 180 newborns. Ninety-one newborns (50.5%) had grade I, 18 (10%) had grade II, 22 (12.2%) had grade III, and 49 (27.2%) had grade IV hemorrhage. One hundred and forty-nine patients (82.8%) were delivered by cesarean section, and 31 (17.2%) were delivered vaginally. All patients with low-grade hemorrhage who needed temporary CSF diversion eventually required permanent CSF diversion. For high-grade hemorrhage, 15 (grade III, 1; grade IV, 14) of 51 (29.4%) patients with ventricular access device (VAD) insertion required permanent CSF diversion. Fifteen (grade III, 6; grade IV, 9) of these 51 (29.4%) patients did not need permanent CSF diversion; thus, their VADs were removed. CONCLUSION: The permanent CSF diversion rate was significantly higher in the high-grade hemorrhage group, which had significantly lower weight and gestational age at birth. Moreover, only weight at VAD insertion had minimal effect on the need for permanent CSF diversion.

Intracranial hemangiopericytoma after radiation treatment: first case in the literature.

BACKGROUND: Radiation exposure is a known risk factor for meningioma but there are no data regarding hemangiopericytoma and radiation exposure. CASE DESCRIPTION: We report a 29-year-old pineoblastoma patient diagnosed with a hemangiopericytoma at a different location, after a successful surgical excision and adjuvant radiotherapy for the original tumor 4-year prior. CONCLUSION: Hemangiopericytoma emergence can be seen after radiotherapy.

Magnetic Resonance Imaging of Unusual Neoplasms Related to Foramen of Luschka: A Review for Differential Diagnosis.

There are many types of neoplasms in or around the foramen of Luschka (FL), and definitive diagnosis in some cases requires knowledge of imaging findings. The uncommon and challenging neoplasms with FL involvement considered in this study are exophytic brainstem glioma, primary glioblastoma of the cerebellopontine angle (CPA), primary anaplastic ependymoma of the CPA, choroid plexus papilloma of the FL, solitary FL choroid plexus metastasis, extraskeletal myxoid chondrosarcoma of the jugular foramen, paraganglioma of the jugular foramen, exostosis of the jugular foramen, psammomatous meningioma in the lateral cerebellar medullary cistern, epidermoid tumor of the fourth ventricle, and a hypoglossal schwannoma. These neoplasms may have overlapping clinical and imaging features, but some have relatively distinct imaging features. Knowledge of the key clinical and magnetic resonance imaging features of these unusual lesions with FL involvement is important for radiologists to improve diagnostic ability and to assist the referring physician in the appropriate management of the patient.

Cervical Venous Vascular Anatomy for Ventriculoatrial Shunt Applications: Anatomical Study and Surgical Approach Recommendation.

AIM: To develop an approach for atrial application of ventriculoatrial (VA) shunts after revealing the venous anatomy with facial and cervical anatomical dissections. MATERIAL AND METHODS: Five cephalic cadavers were used in the study. Facial and cervical regions of the cephalic cadavers were examined with layer by layer anatomical dissection. Venous angiography and ultrasonography were performed to obtain additional data on the cervical venous vascular anatomy. Subsequently, we developed an approach for atrial catheter applications. RESULTS: No anatomical variations were detected in the dissections. The common facial vein, which was formed by the facial vein and retromandibular vein, was observed to drain into the internal jugular vein. As a result of dissections and examinations, an incision approximately 2 cm below the mandible, extending from the projection of the submandibular notch to the trace of the angulus mandible, was considered adequate to expose the common facial vein for atrial catheter insertion. CONCLUSION: The approach described in our study is appropriate for the application of an atrial catheter for VA shunts. Revealing the venous anatomy with examinations contributes to the success of the operation.

Electromagnetic Waves from Mobile Phones may Affect Rat Brain During Development.

AIM: To investigate the effects of electromagnetic waves (EMWs) from mobile phones (MPs) on rat brains of rats by morphological and biochemical analysis. MATERIAL AND METHODS: EMW was applied for two hours/day until birth in stand-by fetal and EMW fetal groups and postnatal 60 < sup > th < /sup > day in stand-by and EMW groups. The control group was not exposed to MP. On postnatal 60 < sup > th < /sup > day, brain malondialdehyde (MDA) and glutathione (GSH) levels were measured, and western blot analysis was performed to determine glial fibrillary acidic protein (GFAP) content. Hematoxylin and eosin staining and GFAP immunohistochemistry were applied. Trigeminal nerves were examined using the transmission electron microscope. RESULTS: In comparison to controls, rats exposed to MP in stand-by or talk modes had significantly increased neuronal damage in the cortex and hippocampus. Increased MDA levels in the EMW group and decreased GSH levels in the stand-by, EMW fetal and EMW groups were found compared with controls. Increased GFAP content in the EMW group and increased GFAP staining in the EMW fetal and EMW groups compared to controls were observed. EMW group had a significantly decreased number of myelinated axons than control animals. CONCLUSION: The results of this study suggests that 1800 MHz EMWs (SAR=1.79 W/kg) exposure in the prenatal and early postnatal life may lead to trigeminal nerve damage in addition to oxidative stress-induced neuronal degeneration and astroglial activation in the rat brain. Effects seem to be mode related, being more detrimental in groups exposed to MP during talk mode.

Investigating the effects of subthalamic Nucleus-Deep brain stimulation on the voice quality.

Introduction: Deep brain stimulation (DBS) is a standard surgical treatment method which is generally applied to subthalamic nucleus in Parkinson's patients in cases where medical treatment is insufficient in treating the motor symptoms. It is known that Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) treats many motor symptoms. However, the results of studies on speech and voice vary. The aim of the study is analysing the effect of STN-DBS on the characteristics of voice.Materials/methods: A total of 12 patients, (8 male-4 female) with an age average of 58.8 ± 9.6, who have been applied DBS surgery on STN included in the study. The voice recordings of the patients have been done prior to surgery and 6 months after the surgery. The evaluation of voice has been carried out through the instrumental method. The patients' voice recordings of the /a,e,i/ vowels have been done. The obtained recordings were evaluated by the Praat programme and the effects on jhitter, shimmer, fundamental frequency (F0) and noise harmonic rate (NHR) were analysed.Results: Numerical values of F0 of all female participants have been decreased for all of the vowels postoperatively. In the females; jhitter and fraction parameters were found to be significantly different (0.056 and 0.017, perspectively) for the vowel /e/. In addition, p values in the shimmer for vowels /e,i/ were thought to be clinically significant (.087, .079 and .076) respectively. All these changes in second measurements were found to indicate worsening vocal quality after the DBS in females. In males, there is not any significant difference observed between two measures in any of the parameters of any vowels.Conclusions: Acoustic voice quality deteriorated after STN-DBS predominantly for females however this deterioration was not prominent audio-perceptually. This finding commented as a result of the fact that that voice quality deviance of the participants was not severe.

The Surgical Treatment of a Large Cortical Atherosclerotic Middle Cerebral Artery Aneurysm Presenting With Parietal Lobe Infarction.

Distal MCA aneurysms are rarely seen in daily neurosurgical practice and they are, more commonly associated with infectious processes. Here, the authors present a 65-year-old, patient who had an atherosclerotic M4 segment located aneurysm. It was confirmed, that the aneurysm was not related with any infectious process. The patient had, presented clinically by a parietal infarction and she had been successfully operated. The neuronavigation system for this particular case aided us for a precise localization of the aneurysm and gave a chance for a smaller craniotomy.

Posterior fossa astroblastoma in a child: a case report and a review of the literature.

A 4-year-old girl presented to the hospital with a progressive headache, difficulty walking, and persistent daily vomiting for 3 weeks. Papilledema was observed on fundoscopic examination. A large left cerebellovermian tumor with "bubbly" appearance was discovered. Total removal of the tumor mass was performed, and a diagnosis of low-grade astroblastoma was made. Adjuvant radiotherapy was performed due to the risk of recurrence. The patient is disease-free and has been kept on close follow-up for 6 months. The occurrence of posterior fossa astroblastoma has been rarely reported in the literature. Thus, when a "bubby" appearance enhancing cystic solid tumor is located on the cerebellar hemisphere in a child, an astroblastoma should also be included in the differential diagnosis.

An ioMRI-assisted case of cervical intramedullary diffuse glioma resection.

PURPOSE: To date, application of intraoperative magnetic resonance imaging (ioMRI) to enhance surgical quality for spinal intramedullary neoplastic lesions has been rarely reported. Moreover, in developing countries or regions, ioMRI accessibility remains very limited. This report describes a technology design of high-field ioMRI accessible for multioperation rooms via a case presentation of an imaging-assisted surgical excision of human cervical spinal cord diffuse glioma. PATIENT AND METHODS: The patient was a 44-year-old woman with symptomatic and progressive C2-5 intramedullary diffuse glioma (IDG). Our ioMRI system was designed and arranged with accessibility to multiple operation rooms, which was used to assure more complete spinal cord or brain tumor removal. The intraoperational diagnostic aspects and the system setup technical details are presented for future applications of the system in hospitals where a designated ioMRI suite is not available. RESULTS: After a conventionally defined complete removal of C2-C5 IDG using a well-established surgical approach, ioMRI examination was able to detect residual tumor tissues that were indistinguishable under the surgical microscope. The IDG clusters were subsequently excised. The operation regimen resulted in a gross total elimination of the tumor, which enabled the patient to show very satisfactory postsurgery recovery and prognosis. CONCLUSION: ioMRI-assisted surgical removal of cervical spinal cord diffuse glioma should be systematically developed and applied to enhance therapeutic efficacy. The reported logistic flow of operating room tasks and imaging technical management are innovative for performing the tumor removal procedures in hospitals where designated ioMRI surgical suites do not exist. Critically, we emphasize implementation of stringent quality control measures for patient transportation safety and contamination prevention in establishing and maintaining such a system.

Falcine Myxoid Chondrosarcoma: A Rare Aggressive Case.

Chondrosarcoma is the second most common primary malignancy of bone after osteosarcoma. Cranial primary chondrosarcomas mostly originate from the skull base cartilage formation zones. Parasagittal falcine origin is very rare for primary extra-skeletal intracranial chondrosarcomas. We report a rare case of primary myxoid chondrosarcoma at falx cerebri. The patient was a 35-year-old lady with right arm and leg weakness. Her brain magnetic resonance imaging depicted a left parasagittal mass lesion attached to the falx cerebri. En bloc resection via left frontal craniotomy was performed. Three more local recurrences occurred in 9 months' time since the index surgery, which were all managed with re-surgeries and/or adjuvant stereotactic radiosurgeries. This is the second case of myxoid type parasagittal chondrosarcoma but with the most protracted disease course. Even though surgery remains the mainstay of treatment for parasagittal chondrosarcomas, adjuvant therapy might be necessary in aggressive ones.

Use of programmable versus nonprogrammable shunts in the management of normal pressure hydrocephalus: A multicenter retrospective study with cost-benefit analysis in Turkey.

Ventriculoperitoneal shunt systems that are used in the treatment of normal pressure hydrocephalus are often associated with drainage problems. Adjustable shunt systems can prevent or treat these problems, but they may be expensive. The aim of our study is to compare the complications and total cost of several shunt systems.Patients with normal pressure hydrocephalus who underwent ventriculoperitoneal shunting between 2011 and 2016 were included in the study. The study involves patient consent and the informed consent was given. Complications and the average cost per person were compared between patients with adjustable and nonadjustable shunts. Shunt prices, surgical complications, and revision costs were taken into account to calculate the average cost.Of the 110 patients who were evaluated, 80 had a nonadjustable shunt and 30 had an adjustable shunt. In the group with adjustable shunts, the rates of subdural effusion and hematoma were 19.73% and 3.29%, respectively. In the group with nonadjustable shunts, these rates were 22.75% and 13.75%, respectively. One patient in the adjustable group underwent surgery for subdural hematoma, while 8 patients in the nonadjustable group underwent the same surgery. Ten patients required surgical intervention for subdural effusion and existing shunt systems in these patients were replaced by an adjustable shunt system. When these additional costs were factored into the analysis, the difference in cost between the shunt systems was reduced from 600 United States dollars (USD) to 111 USD.When the complications and additional costs that arise during surgical treatment of normal pressure hydrocephalus were considered, the price difference between adjustable and nonadjustable shunt systems was estimated to be much lower.

Posttraumatic Progressive Vertebral Hemangioma Induced by a Fracture.

The authors present an extremely rare case of an aggressive and progressive vertebral capillary hemangioma of the lumbar spine secondary to a trauma. A 40-year-old man who complained of back and leg pain due to a hemangioma of L1 that had begun a year after the fracture of the same vertebra was subsequently operated on. Due to the profuse bleeding, only a subtotal removal was possible. Histopathological diagnosis of the lesion revealed a capillary hemangioma. Postoperative control MRI taken at eight months showed that the lesion and destruction of the L1 vertebra were progressive. A second embolization procedure was performed and this time the hemangioma was totally removed via an anterior approach and corpectomy. Fusion was achieved by Th12-L2 graft and plaque. In the fourteenth year of follow-up, he was symptom-free and radiologically clear of this lesion. We propose that progressive hemangioma is extremely rare and that its cure is possible by total surgical removal of the lesion. This case is the second extradural capillary hemangioma secondary to spinal trauma ever to have been documented in English literature. The emergence of a hemangioma in a fractured vertebra suggests that its pathogenesis can be related to the deviation of the angiogenetic pathways from the normal healing process.

Publication Rates of Presentations at Annual Scientific Meetings of the Turkish Neurosurgical Society.

AIM: National and international society meetings are suitable mediums at which diverse research topics from basic, clinical and translational sciences can be presented to an audience of peers. In this study, our purpose was to evaluate publication rates of presentations in the last recent four years" annual scientific meetings of Turkish Neurosurgical Society (TNS). MATERIAL AND METHODS: Abstracts of both podium and poster presentations were retrieved from the congress booklets of TNS. Study timeline included TNS annual scientific meetings of 2011, 2012, 2013, and 2014. Abstract titles and author names of the abstracts were searched in Pubmed/MEDLINE and Google Scholar databases. RESULTS: In total, 3105 presentations to an audience took place in the annual scientific meetings of TNS organized between 2011 and 2014. Acceptance rate of these studies by peer-reviewed scientific journals was 326 (10.5%). In sub-analysis, there were 2408 electronic posters (148 accepted, 6.1%), 195 poster presentations with discussion (44 accepted, 22.6%), and 502 podium presentations (134 accepted, 26.7%). CONCLUSION: Acceptance rate of podium presentations in annual scientific meeting of TNS is at comparable levels with similar organizations on the world. However, the rate is lower for poster presentations.

Bilateral Central Foot Drop in a Pediatric Patient.

Foot drop is an inability to dorsiflex the ankle and toe. Primary causes of foot drop are compression or lesion of the 5th lumbar nerve and entrapment of the peroneal nerve at the head of the fibula. Rarely, some central nervous system lesions lead to foot drop. A 16-year-old boy was admitted with blunt head trauma that had happened in an assault. The muscle strength of the bilateral tibialis anterior, bilateral extensor digitorum longus and bilateral extensor digitorum brevis were Medical Research Council grade 1. Deep tendon reflexes of both ankles were hyperactive, with bilateral clonus and bilateral Babinski sign. There were cerebral contusions with peripheral edema in both motor strip areas extending anteriorly into the frontal lobes, with right-sided epidural-subdural hematoma. On brain MRI, the superior sagittal sinus was open. The epidural-subdural hematoma did not progress in its dimensions. The patient was treated conservatively. He recovered fully with regression of the contusions and epidural-subdural hematoma 4 months after the trauma. Foot drop due to upper motor neuron pathologies is more spastic in nature, different from what happens following lumbar disc herniation or peroneal nerve dysfunction. Treatment of central foot drop should be planned according to the underlying pathology.

Familial occurrence of brain arteriovenous malformation: a novel ACVRL1 mutation detected by whole exome sequencing.

OBJECTIVE Brain arteriovenous malformations (AVMs) can occur in patients with hereditary hemorrhagic telangiectasia (HHT). However, brain AVM without HHT has also been reported. Using whole exome sequencing, the authors performed comprehensive genomic characterization of a 6-person Turkish family with 3 cases of brain AVM without HHT. METHODS Three siblings with brain AVM, one of whom also had spinal AVM, were evaluated. The parents and the fourth sibling had no AVM on cranial MRI. The authors performed a whole exome capture and Illumina sequencing on blood samples from 2 siblings with AVM. RESULTS An ACVRL1 heterozygous mutation (p.Lys332Glu) was identified in 2 patients via whole exome sequencing. Variant segregation was confirmed using direct Sanger sequencing. CONCLUSIONS Study results suggested that whole exome sequencing analysis is particularly useful in cases of locus heterogeneity and uncertain diagnostic classification schemes in patients with hereditary brain AVM.

Relapsed Wilms' tumor with multiple brain metastasis.

Wilms' tumor is the most common malignant renal tumor in childhood. The brain metastasis of a Wilms' tumor with anaplastic histopathology is rare. We present the case of an 8-year-old girl with Wilms' tumor, who presented with multiple brain metastases 5 years after her primary diagnosis. The brain masses were diagnosed after a generalized tonic-clonic seizure attack. The big solid mass in the cerebellum was resected, and whole-brain radiotherapy was performed, after which, she succumbed to her disease. In the case of clinical suspicion, cranial surveillance should be included in the routine clinical work-up for Wilms' tumor. Combined aggressive therapy (surgery+radiotherapy+chemotherapy) should be applied whenever possible, for both better survival and palliative aspects.

Surgical anatomy of the cavernous sinus, superior orbital fissure, and orbital apex via a lateral orbitotomy approach: a cadaveric anatomical study.

BACKGROUND: Tumors of the middle fossa or cavernous sinus (CS), or intraorbital tumors, can penetrate each other through the superior orbital fissure (SOF) or neighboring tissue. These complicated pathologies are often treated with highly invasive surgical procedures. In this article, we demonstrate surgical anatomic dissections of the CS, SOF, orbital apex (OA), and dura mater extending to the periorbita from the middle fossa, by performing an epidural dissection via a lateral orbitotomy approach, and discuss findings that may provide guidance during surgery in these regions. METHODS: Lateral orbitotomy was performed on latex-injected cadaver heads by making a 2-cm skin incision lateral to the lateral canthus, drilling the lesser and greater sphenoid wings that form the SOF borders, and removing the bone section between the middle fossa and orbit. Dura mater from the middle fossa to the periorbita was exposed to perform anterior clinoidectomy. Meningeal dura was dissected from the endosteal dura, which forms the lateral wall of the CS, to expose the CS, SOF, and OA for dissections. RESULTS: Changing the orientation of the microscope from posterior to anterior enabled regional control for dissection from the Gasserian ganglion to the OA. Cranial nerves that pass through the CS, SOF, and OA were dissected and exposed. The annular tendon was opened, revealing the oculomotor nerves and its branches, as well as the abducens and nasociliary nerves, which pass through the oculomotor foramen and course within the OA and orbit. CONCLUSIONS: This approach causes less tissue damage; provides control of the surgical area in spheno-orbital tumors invading the fissure and foramen by changing the orientation of the microscope toward the orbit, OA, SOF, CS, and middle fossa; and expands the indication criteria for lateral orbitotomy surgery. This approach, therefore, represents an alternative surgical method for excising complicated tumors in these regions.

Recurrent Cranial Chronic Subdural Hematoma due to Cervical Cerebrospinal Fluid Fistula: Repair of Both Entities in the Same Session.

Cranial chronic subdural hematoma (CSH) occurs secondary to trauma or just spontaneously. In this clinical report, the authors presented a 39-year-old male patient who was admitted with cranial CSH. In further assessment of the patient, the authors found an underlying cerebrospinal fluid (CSF) leak at the level of cervical spine. Following evacuation of the CSH, it recurred. In the second session, the hematoma was re-evacuated and the CSF fistula repaired. The CSH did not recur again. In young adult patients with recurrent CSH and prior presence of bilateral CSH, a survey for an underlying spinal CSF leak should be considered in the differential, especially in the background of trauma. Conservative treatment, epidural blood patching, or microsurgical repair of the dural defect should be conceptualized according to the circumstances of the individual patients with spontaneous intracranial hypotension and spinal CSF fistula.

A Very Quickly Prepared, Colored Silicone Material for Injecting into Cerebral Vasculature for Anatomical Dissection: A Novel and Suitable Material for both Fresh and Non-Fresh Cadavers.

AIM: Cadaveric studies have a great impact on neuroanatomy learning. Cadaver preparation may take a lot of effort, especially at the phase of intravascular color filling. The authors describe their silicone dye technique and a novel mixture which is self-curing, quick to prepare and easy to inject. MATERIAL AND METHODS: The first one of these processes is undoubtedly embalming and decapitation of the cadaver. If possible, the most appropriate time that should be preferred is immediately after the donor's death. Preparation for cadaveric dissection of the brain requires some fundamental steps that can be summarized into: a) Embalming and decapitation, b) Exposing, cannulization and irrigation of main vascular structures, c) Preparing colored silicone, d) Injection of colored silicone and staining the vascular tree, e) Sample maintenance RESULTS: Our method of preparation of silicone dye and injection enables neurosurgeons and anatomists to fill cerebral and dural vascular structures, and even diploic veins nicely in both fresh and aged cadaveric heads. Moreover, the main vascular structures and their branches in the lateral and third ventricles are painted remarkably beautifully. CONCLUSION: We tried to provide our experience about the preparation of head cadavers for anatomical dissection using a novel mixture of colored silicone that is very easy to prepare and inject with very satisfactory results.

Vertebral artery loops in surgical perspective.

PURPOSE: Vertebral artery loop is a congenital or acquired anomaly. Vertebral artery loops are incidentally diagnosed during evaluation of neck problems and trauma. We aimed to present the incidence of VA loops using magnetic resonance angiography in consecutive patients and discuss epidemiological data including the gender, age, location, signs and symptoms, treatment approaches and outcomes of VA loops via analyzing literature. METHODS: In the first leg of our two-legged study, consecutive patients were evaluated using magnetic resonance angiography to detect any medial loop of vertebral arteries. The study period was from October 2015 to March 2016. In the second leg, academic databases about medial loop of vertebral artery were screened. Case reports, case series, abstracts and references of relevant literature were searched manually to avoid any missing cases. RESULTS: We evaluated 239 consecutive patients using magnetic resonance angiography. Twenty-one patients were excluded from the study due to inadequate image acquisition, aplastic vertebral artery and/or concomitant vertebral artery stenosis. Medial loop of V2 vertebral artery was observed in 13 patients (5.9 %): 9 with left, 2 with right and 2 with bilateral medial V2 loop. Patients with medial V2 loop were significantly older than patients with straight vertebral arteries (70.30 vs. 62.36, p = 0.028). In the literature analysis, VA loops were more commonly observed at V2 segment (90.5 %). Vertebral artery loops were mostly diagnosed at the 5th and 6th decades of life predominantly in females. The most common signs and symptoms were radiculopathy and/or neck pain, and signs and symptoms of vertebrobasilar insufficiency. CONCLUSIONS: Concise pre-operative evaluation of the vertebral arteries is essential to avoid the injury of undiagnosed VA loops during surgery, which might result in catastrophic circumstances. Further evaluation of the vertebral arteries using MR angiography is required, especially in elder age, before cervical spine surgeries.