The effect of flurbiprofen on the development of anencephaly in early stage chicken embryos.

OBJECTIVE: The study investigated the effect of flurbiprofen on the development of anencephaly in early stage chicken embryos. MATERIAL AND METHODS: We looked at four groups with a total of 36 embryos. There was a control group, a normal saline group, a normal-dose group and a high-dose group with ten, ten, eight and eight eggs with embryo respectively. RESULTS: Two embryos in the control group, studied with light microscopy at 48 h, were consistent with 28-29 hours' incubation in the Hamburger-Hamilton System. They had open neural tubes. The other embryos in this group were considered normal. One embryo in the normal saline group was on the occlusion stage at 48 h. One embryo showed an open neural tube. They were compatible with 28-29 hours' incubation in the Hamburger-Hamilton system. The remaining eight embryos showed normal development. In the normal dose group, one embryo showed underdevelopment of the embryonic disc and the embryo was dead. In four embryos, the neural tubes were open. One cranial malformation was found that was complicated with anencephaly in one embryo. In two embryos the neural tubes were closed, as they showed normal development, and they reached their expected stages according to the Hamburger-Hamilton classification. There was no malformation or growth retardation. Four experimental embryos were anencephalic in the high dose group, and three embryos had open neural tubes. One embryo exhibited both anencephaly and a neural tube closure defect. None of the embryos in this group showed normal development. CONCLUSIONS: Even the usual therapeutic doses of flurbiprofen increased the risk of neural tube defect. Flurbiprofen was found to significantly increase the risk of anencephaly. The provision of improved technical materials and studies with larger sample sizes will reveal the stage of morphological disruption during the development of embryos.

Prominent Neurosurgery Books of the Western World: How They Defined the Era of Modern Neurosurgery in the 19th Century.

The aim of this article is to introduce the 19th century neurosurgery books to reveal their contributions to modern neurosurgery. Methods In this study, 29 books were accessed, and reviewed, and the resources from the late 18th century and early 20th century were included. However, neurology or general surgery books that included neurosurgical subjects or chapter were excluded unless there were revolutionary ideas in their relevant chapters. The books of this period observed to have some common differences from the books that were written in the previous century. Parallel to the concept of cerebral localization, which started to develop in this period, neurosurgery evolved from skull surgery to brain surgery. Due to the advancements in patient care, anesthesia and sterile techniques, surgical medical branches showed rapid development in the 1800s. During this period, cerebral localization concept changed the comprehension and approach in neurosurgery and opened the gate of a new era in the field of neurological surgery unlike other branches and helped to establish modern neurosurgery. 19th century surgeons became able to operate on more complex cases with more advanced techniques. Knowledge of published pioneer papers and books help understanding of emergence of neurological surgery as a separate discipline.

Does cranial incidence angle have a role in the tendency toward cervical degenerative disc disease?

Purpose: The purpose is to investigate if a correlation existed between the frequency of cervical degenerative disc disease occurrence and cranial incidence (CI) angle. Materials and Methods: A retrospective analysis of case series. Sagittal parameters of the case series were compared with the sagittal parameters of the same number of consecutive patients with neck pain only but no cervical degenerative disc disease (CDDD). Moreover, CI angle values were noted to be significantly different among groups on variable-based examination. Furthermore, the cervical lordosis (CL) values of men were observed to be significantly different. Therefore, the significant intergroup differences related to the CI angle and CL values support the study hypothesis. Results: No intergroup differences were noted regarding gender and age distribution (p = 0.565; p = 0,498). A significant intergroup difference was observed regarding CS values and the mean vector of CI angle and CL values for men and women (p = 0.002). CI angle values were noted to be significantly different among groups upon variable-based examination (p < 0.001). The CL values of men were observed to be significantly different, but not the CL values of women (p = 0.850). Therefore, the significant intergroup differences related to the CI angle and CL values support the study hypothesis. Conclusions: A reverse correlation between CI angle and CDDD development is demonstrated. This correlation is valid between CL and CDDD development. Therefore, cervical sagittal profile and the CI angle and CL measurements should be performed to follow-up patients with cervical pain.

Morphometric measurements of safety zones and orientation angles for freehand placement of revision screws in atlas lateral mass.

AIM: To demonstrate the possibility of revision screw placement to the atlas, as well as define the safety zones and orientation angles. MATERIAL AND METHODS: This retrospective study analysed the records of four patients who were operated for AAI earlier. Because they needed revision of Atlas screws, they were re-operated after obtaining the measurements mentioned in this study. In addition, measurements of 50 healthy subjects were included in the study as the control group. Maximum screw lengths were also measured. RESULTS: Safe zone in the ideal sagittal direction were wider. As the screw projection becomes more cephalic direction in the sagittal plane, the safe zone for the screw becomes narrower. With the sagittal angle moving forwards cranially, the screw length becomes longer. CONCLUSION: Atlas lateral mass screws could be safely revised whenever needed. The fact that needs to be considered is that the angular range becomes narrower, and the screw length becomes longer when the screw is directed more cranially.

Delayed pseudomyelomeningocele: a rare complication after foramen magnum decompression for Chiari malformation.

BACKGROUND: A variety of complications after FMD with or without duraplasty for Chiari malformation have been described. Although cerebellar ptosis through the dural opening and pseudomeningocele are well-known rare complications of this procedure, spinal cord herniation manifesting as pseudomyelomeningocele formation has not previously been cited in the literature. In this report, we present a case of delayed pseudomyleomeningocele after FMD. CASE DESCRIPTION: A 22-year-old man presented with progressive spinal cord compression symptoms 7 years after undergoing FMD for Chiari malformation. Craniocervical MRI of the patient revealed pseudomyelomeningocele at C1 level together with cord distortion. The patient underwent untethering surgery for spinal cord adhesions; neural tissue was freed microsurgically from the adjacent structures and duraplasty was performed with synthetic graft. In the early postoperative period, his symptoms resolved moderately. CONCLUSION: Neural tissue shift including the spinal cord through the dural opening may occur after a large posterior fossa decompression without duraplasty for Chiari malformation. Postoperative inadequate CSF circulation due to arachnoid scarring around the decompression area may facilitate this type condition. Early diagnosis of such a complication is of vital importance to prevent serious neurologic deficits, and release surgery with proper duraplasty and also restoration of CSF circulation is the choice of treatment.

Functional and clinical evaluation for the surgical treatment of degenerative stenosis of the lumbar spinal canal.

OBJECT: This study was designed to evaluate the efficacy of decompressive surgery for degenerative lumbar spinal stenosis (LSS) on a functional and clinical basis. METHODS: A prospective analysis and follow-up of 125 consecutive patients with degenerative LSS between 2000 and 2006 were performed. All patients underwent surgery for lumbar stenosis. Functional evaluations of the patients were performed using a treadmill, the visual analog scale, and the Oswestry Disability Questionnaire (ODQ). These parameters were recorded before surgery and the 3rd month and 1st and 2nd years after treatment. The first symptom time (FST), maximal walking duration (MWD), and thecal sac cross-sectional area (CSA) before and after surgery were also recorded. Statistical relations between variables were calculated. RESULTS: As patient ages increased, the CSA of the thecal sac decreased. Decompressive surgery reached the target according to the difference between the preoperative and postoperative thecal sac CSA. A correlation between the CSA of the thecal sac and FST, and between the CSA of the thecal sac and MWD could not be established. There was a significant correlation between the FST and MWD, and a negative correlation could be established between the MWD and the ODQ score. Surgery led to significant decreases in the ODQ score. Maximal improvement was observed in the 3rd month after decompressive surgery. CONCLUSIONS: The treatment for LSS should be decided using functional criteria; radiological criteria may not correlate with the severity of the disease. Improvements following lumbar decompression surgery continued within 1 year of treatment according to the ODQ and did not change significantly thereafter.

The Preventative Effect of α-Tocopherol on Spinal Epidural Fibrosis After Laminectomy in a Rat Model.

AIM: To assess the efficacy of α-tocopherol as a topical antifibrotic agent on epidural fibrosis in lumbar laminectomy procedures. MATERIAL AND METHODS: A total of 32 adult rats were assigned into four groups, with eight rats in each group. Standard laminectomy was performed in every rat. In group 1, no treatment was administered after laminectomy. In group 2, a saline-soaked absorbable gelatin sponge was left on the dura mater after laminectomy. In group 3, only α-tocopherol was used on the dura mater after laminectomy. In group 4, a gelatin sponge soaked with α-tocopherol was used after laminectomy. En bloc vertebral columns between T10 and L5 were removed after sacrifice on postoperative day 30. Specimens were evaluated for degree of fibrosis and arachnoidal invasions. RESULTS: Statistically significant differences were found in the mean of fibrosis grades between groups (p=0.001). Differences in mean arachnoidal invasion were not statistically significant (p > 0.05). CONCLUSION: Topical application of α-tocopherol could effectively reduce the development of epidural fibrosis in an experimental laminectomy model.

Investigation of Lateral Epicondylitis in Neurosurgeons.

AIM: To investigate the frequency of lateral epicondylitis (LE), depending on the tasks performed by neurosurgeons, and to determine whether it can be accepted as an occupational disease depending on its frequency. MATERIAL AND METHODS: All neurosurgery specialists enrolled in the Turkish Neurosurgical Society website were prospectively included. A questionnaire form was shared, and the subsequent responses were recorded. Those who provided incomplete responses were excluded from the study. The respondents diagnosed with LE were recorded. Exclusion criteria were investigated on complaints of pain. They were examined by an orthopedics and traumatology specialist with application of Thomsen test and necessary maneuvers. RESULTS: The study was conducted with 216 neurosurgeons. Those with more than 30 operations per month (p=0.002), those with a specialization duration of 10-20 years and > 20 years (p=0.001), and those who specialized in spinal surgery (p=0.014) had a significantly higher prevalence of epicondylitis. Considering the relationship between lumbar/thoracic pedicle screw insertion and epicondylitis, the epicondylitis diagnosis rate was significantly higher in physicians inserting 20â€"60 screws per month than those inserting < 20 screws (p=0.009). CONCLUSION: LE frequently occurs in neurosurgeons who regularly perform spinal instrumentation and appears to be an occupational disease. However, data obtained during the current study should be combined with findings from case-control studies of neurosurgeons.

Effect of topical rifamycin application on epidural fibrosis in rats.

OBJECTIVES: This study aims to investigate the effects of topical rifamycin SV application on epidural fibrosis formation in a rat model. MATERIALS AND METHODS: Between March 2015 and April 2015, a total of 20 Wistar rats were equally and randomly divided into laminectomy only group (control group) and laminectomy and rifamycin SV group (treatment group). Laminectomy was performed between L3-L5 in all rats. Surgical field was irrigated with 1 mL rifamycin SV (1 mL). After four weeks, vertebral columns of the rats were removed en bloc between the L1 and L5 levels, and epidural fibrosis and arachnoid involvement were histopathologically evaluated and graded. RESULTS: Grade 3 epidural fibrosis formation ratio was lower in the treatment group (40%) compared to the control group (80%). However, there was no statistically significant difference between the treatment and control groups in terms of epidural fibrosis (p=0.164) and arachnoid involvement (p=0.303). CONCLUSION: Intraoperative rifamycin irrigation tends to reduce epidural fibrosis formation risk, although not statistically significant.

Medullomyoblastoma: teratoid nature of a quite rare neoplasm.

BACKGROUND: Medullomyoblastoma is a quite-rarely reported biphasic histologic variant of medulloblastoma since the first published description of a tumor consisting of medulloblastic and myogenic elements. Controversy over its origin still goes on. Here, an additional case of medullomyoblastoma variant is reported, and discussed are the clinicopathologic features and pathophysiologic mechanisms of and treatment options for this neoplasm. CASE REPORT: A 7-year-old girl was admitted to our clinic with headache, vomiting, and gait disturbances. An MRI scan on admission showed a solid tumor with a 2.5-cm axial diameter located in cerebellar vermis. The tumor was removed totally. Histologic examination revealed loose mesenchymal structures of the tumor and small muscle strands and isolated cells having large eosinophilic cytoplasm with striations. The muscular strands also demonstrated striations under light microscope. Glial fibrillary acidic protein, synaptophysin, and myogenin positivity are observed. CONCLUSION: There are some strong evidences that the medullomyoblastoma may be a teratoma. Survival time with the tumor is very short, outcome is poor, and the tumor can spread along cerebrospinal fluid pathways. Total resection, chemotherapy, and craniospinal irradiation are mainstays of the treatment of medullomyoblastomas.

Multifocal Ewing's sarcoma of the brain, calvarium, leptomeninges, spine and other bones in a child.

Ewing's sarcoma (ES) is a malignant osseous neoplasm that mostly affects children and young male adults, and usually presents as a solitary bony lesion. Multifocal ES of the central nervous system is extremely rare, with an incidence ranging from 1.1% to 4.3%. Clinically, ES may mimic osteomyelitis. In this report, we describe the case of an 11-year-old boy who had multiple calvarial, leptomeningeal, spinal and various other bony lesions of ES, which were diagnosed radiologically and histopathologically. To the best of our knowledge, this is the first time that multiple brain, calvarial and spinal lesions of ES in a single patient have been reported in the English-language literature. We discuss possible mechanisms and differential diagnoses for this rare pathology.

Spinal subdural abscess: a rare cause of low back pain.

Spinal subdural abscess (SSA) is a rare but well-described entity. It may occur secondary to a systemic infectious focus or following a surgical procedure. There are only two SSA cases in the literature that are unrelated to such conditions and without any well-documented etiology. SSA is a neurosurgical emergency and diagnosis may be difficult. Progressive neurological deficits and severe pain with fever suggest the diagnosis. Surgical drainage and subsequent prompt antimicrobial therapy should be performed without delay. We report a patient with SSA unrelated to any predisposing condition and discuss underlying mechanisms of this disease.

Posterior osseous bridging of C1.

The sulcus of the vertebral artery is located behind the lateral mass of the atlas and in some cases is converted into a foramen by anomalous ossification known as the posterior ponticulus (osseous bridge). This study involved anatomical observations of 158 isolated anatomical specimens of dry C1 vertebrae. The incidence and types of posterior osseous bridging were identified for the 158 dry samples of atlas vertebrae. In nine (5.6%) dry C1 vertebrae, partial osseous bridging was detected (bilaterally in eight vertebrae and unilaterally on the left in one). Complete osseous bridging (arcuate foramen) was observed in six (3.8%) dry C1 vertebrae (bilaterally in one vertebra, unilaterally on the left in three, and on the right in two). Awareness of the types of posterior osseous bridging of C1 in craniocervical junction surgery is essential, and may be helpful in surgical interventions in this region.

Sublabial transseptal approach to pituitary adenomas with special emphasis on rhinological complications.

OBJECTIVE: The aim of this presentation is to show that the sublabial transseptal transsphenoidal approach to pituitary adenomas is the least invasive anatomic route with the lowest postoperative complication rates. PATIENTS AND METHOD: This study was based on a retrospective analysis of 276 patients with a diagnosis of pituitary adenoma who were surgically treated via the sublabial transsphenoidal route. RESULTS: The overall complication rate of the presented series was 14.8%. The recurrence rate was 14.1%; there were no deaths or intranasal complications in this series. Postoperative rhinological complications, such as septal perforation, synechiae, and mucosal tear which impaired nasal function, occur rarely with this approach compared to other approaches. CONCLUSION: Besides the technical advantages of this approach, performance of the initial phase of the operation by an otorhinolaryngologic surgeon is the basis of the low intranasal complication rate in our series.

Delayed neurotoxic complication of intracavitary bleomycin therapy for craniopharyngioma in a child who had previously undergone radiosurgery. Case report.

Local administration of bleomycin for the treatment of craniopharyngioma is occasionally associated with serious regional complications. The authors report a case of a delayed neurotoxic complication associated with bleomycin treatment in a patient who had previously undergone radiosurgery. A 14-year-old boy presented with a cyst recurrence of mixed-type craniopharyngioma. An Ommaya device was placed in the thin-walled cyst, and after confirmation that the device was watertight, the patient received a total dose of 75 mg bleomycin intratumorally during a 5-week period. Six weeks after the final drug administration, the patient experienced complex partial epileptic seizures; a few days later sudden right temporal hemianopia developed. Within 5 days the patient became totally blind in his right eye, and the condition did not respond to corticosteroid therapy. Although drug-related toxic complications occur commonly during the course of intracavitary bleomycin treatment, they may also be encountered during the follow-up period. The reason for this delayed complication could have been previous radiotherapy or hypersensitivity of the tumor capsule to the drug.

Melanotic schwannoma.

BACKGROUND: Melanotic schwannomas are tumors of Schwann cell origin, characterized by cytoplasmic deposition of melanin. Melanotic schwannomas are rare. Description of the course of these tumors differs somewhat, but it is generally considered a benign lesion. CLINICAL PRESENTATION: A 54-year-old man presented with hypoesthesia, pain and weakness of the right arm and leg for 4 months. An MRI scan revealed an intradural extramedullary lesion at the level of the foramen magnum and C1. OPERATION: Total resection of the mass was performed. A diagnosis of melanotic schwannoma was made based on histologic morphology and the immunohistochemical profile. Over a 2-year follow-up period there has been no local recurrence. CONCLUSION: Melanotic schwannoma is a rare variant of schwannoma composed of melanin-producing cells with ultrastructural features of Schwann cells. Distinguishing between this tumor and malignant melanoma is important in planning management. Total resection should be performed. Appropriate long-term follow-up is needed for all melanotic schwannomas.

An experimental Staphylococcus aureus meningitis model for investigating induced leptomeningeal and subpial inflammation in rats: a transmission electron microscopy study.

OBJECTIVE: To evaluate leptomeningeal and subpial inflammatory responses of experimental Staphylococcus aureus bacteriemia following intraperitoneal and intravenous applications and to compare the inflammatory reactions in different regions of central nervous system. MATERIAL AND METHODS: Forty anesthetized rats were divided into four groups equal in number. The rats in group-I were given 1 ml suspension of Staphylococcus aureus intraperitoneally. Group-II was the control group of group I; it was administrated 1 ml 0.9% NaCl in water intraperitoneally. The rats in group-III were given the same amount of bacteria intravenously. Group IV was the control group of the group-III; it was administrated 1 ml 0.9% NaCl solution intravenously. The rats were sacrificed on the 21st day. Inflammatory changes of different regions of the central nervous system were examined under transmission electron microscopy. Statistical analysis was done by using variance analysis, Bonferroni, Tamhane post hoc, Student's t and univariate tests. RESULTS: Thoracic and occipital regions were the most vulnerable zones. Increasing of collagen tissue was the most detected inflammatory change. CONCLUSION: This experimental model can be used for inducing subpial and leptomeningeal inflammations and it may be developed for investigations of pathogenesis of leptomeningitis during systemic infections.

Diagnostic and surgical pitfalls of an unusual primary central nervous system lymphoma.

BACKGROUND: Here we describe a case of PCNSL which was located peripherally as a single lesion and showed no evidence of pathological findings of lymphoma at the first biopsy. CASE DESCRIPTION: A 56-year-old man was admitted to the hospital with a talking disorder and attention deficit. The neurological examination was normal. There was a left temporoparietal, 24 x 20 mm. enhanced lesion on MRI. The patient underwent a craniotomy and the lesion was excised totally. The pathological examination revealed glial tissue which showed reactive astrocyte proliferations. A month later, an MRI was performed and a recurrent tumor was seen near the first lesion's location. The second operation was performed via the same craniotomy, the tumor was excised totally and the second pathological examination revealed diffuse large-cell, B-lymphoma. There were no pathological findings on abdominal, thoracic and bone marrow investigations. CONCLUSION: PCNSL may show various biological behaviors. Using steroids before the biopsy may lead to diagnostic and therapeutic failure.

Pituitary adenoma coexisting with a suprasellar arachnoid cyst.

OBJECTIVE: Biochemical and radiological properties of sellar and parasellar lesions are quite similar in some instances. This leads to a difficulty in preoperative diagnosis. Here, a pituitary adenoma and a suprasellar arachnoid cyst in the same patient is presented, and possible etiopathogenetic mechanisms and surgical treatment are discussed. CASE: A 56-year-old male patient was admitted to the hospital with a history of seizures, urinary incontinence and visual disturbances. Preoperative MRI revealed a mass lesion in the sella turcica with suprasellar extension and a coexisting large supra- and parasellar cyst. DISCUSSION AND CONCLUSION: A slow-growing mass lesion beneath the defective mesencephalic leaf of the Liliequist membrane may lead to a one-way valve system on its surface. It might be speculated that CSF will become trapped in the cyst during tumor growth. The other possible mechanism to explain the coexistence is discussed. In light of these comments and intraoperative observations, we suggest a third type of suprasellar arachnoid cyst. a semi-communicative type.

Primary lumbar epidermoid tumor mimicking schwannoma.

A case of a primary lumbar epidermoid tumor is described. Intraspinal epidermoid tumors are rare. The differential diagnosis on this case was a nerve sheath tumor, such as aschwannoma, as the tumor entered the dural sac and caused dural ectasia. The diagnostic pitfalls of this feature of the tumor are discussed.