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BACKGROUND: Galantamine is well-known for its neuroprotective effects and is currently used in the treatment of individuals with Alzheimer's disease. In this study, we induced experimental sciatic nerve injury (SCI) in rats to test the beneficial effects of galantamine. METHODS: Thirty male Wistar albino rats were divided into three groups, as follows: sham, SCI + saline, and SCI + galantamine. After the administration of an intraperitoneal ketamine and xylazine mixture, which was used for anesthesia, SCI was induced by sur-gical clip compression at the midthigh region of the rats. After surgery, a single daily intraperitoneal dose of galantamine was adminis-tered for 7 days, and nerve tissue sections were obtained 1 week after injury. Histopathology studies were performed to assess neural thickness and apoptotic cell counts, and light microscopic morphological examination was used to determine a potential beneficial effect of galantamine on peripheral nerve degeneration. RESULTS: We observed a markedly increased microvasculature, increased nerve fiber thickness, and a statistically significant increase in apoptotic cell counts distal to the level of injury in the saline group compared with the sham group. However, the increases in nerve fiber thickness and apoptotic cell counts were less in the galantamine group compared with the saline group. CONCLUSION: In our experimental model, pharmacological intervention with galantamine demonstrated a protective effect on degeneration after peripheral nerve injury.
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Lesões por Esmagamento , Tecido Nervoso , Traumatismos dos Nervos Periféricos , Animais , Galantamina/farmacologia , Masculino , Degeneração Neural , Traumatismos dos Nervos Periféricos/tratamento farmacológico , Ratos , Ratos Wistar , Nervo Isquiático/lesõesRESUMO
OBJECTIVES: This study aims to examine the effect of surgical timing on the sphincter function and improvement of motor function in patients with cauda equine syndrome (CES) due to lumbar disc herniation (LDH). PATIENTS AND METHODS: Between January 2005 and December 2013, a total of 33 patients (18 males, 15 females; mean age 48.6±2.2 years, range, 24 to 73 years) who underwent lumbar spinal surgery and were diagnosed with CES due to LDH were retrospectively analyzed. Data including demographics, muscle weakness, sensory deficit, sphincter control, LDH level, time from the initiation of symptoms to admission, and time to surgery were documented. The latest muscle weakness, sensory deficits, and sphincter control were also recorded. The patients were divided into two groups according to the rate of muscle strength improvement and data including age, sex, and operation time were compared. RESULTS: The weakness remained unchanged in 11 (33.3%), improved in 13 (39.4%), and returned to normal in nine (27.3%) patients. Sphincter control resolved in five patients. Sensory loss resolved in two patients. While admission duration was shorter in the group with improved muscle strength (p=0.02), there was no significant difference in the time to surgery (p=0.63). Logistic regression analyses revealed that only the admission within 0 to 24 hours was significant for the muscle strength improvement (regression coeeficient [B]=2.83, standard error [SE]=0.86, p=0.006). CONCLUSION: A significant improvement in the motor strength can be achieved in patients with CES who are operated within 24 hours. On the other hand, patients with CES should be received surgery immediately when first seen, regardless of the time, since the muscle strength is slightly improved.
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AIM: To evaluate the effectiveness of lumboperitoneal (LP) shunt procedures in the treatment of normal pressure hydrocephalus (NPH). MATERIAL AND METHODS: A medical record review was conducted to obtain demographic, clinical, laboratory data, as well as pre-, intra, -postoperative details of 65 patients who underwent LP shunt surgery for NPH between January 1, 2001 and January 1, 2014 in the Neurosurgery Clinics of Ankara Training and Research Hospital and Ankara Numune Hospital. RESULTS: At the 3rd month after LP shunt surgery, headache was resolved in almost all patients. At the end of first year, while statistically significant improvements were noted in the Modified Rankin Scale Scores and Mini-Mental State Examination Scores, gait disturbance, urinary incontinence and cognitive functions were improved by 86%, 72% and 65% of the patients, respectively. CONCLUSION: LP shunt surgery is associated with a lower rate of complication in comparison to ventriculoperitoneal shunt surgery and is an effective procedure in the treatment of NPH.
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Hidrocefalia de Pressão Normal/fisiopatologia , Hidrocefalia de Pressão Normal/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Derivação Ventriculoperitoneal/métodos , Adulto , Idoso , Feminino , Seguimentos , Marcha/fisiologia , Humanos , Hidrocefalia de Pressão Normal/complicações , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/etiologia , Transtornos dos Movimentos/fisiopatologia , Transtornos dos Movimentos/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
Cavernous Hemangiomas (CH) arise from any part of the cerebrum. Intraventricular lesions are rare and pure third ventricular localization is rare for CHs. Cavernomas of the ventricles may present with bleeding or signs associated with hydrocephalus. Radical excision is advocated for optimal management of cavernomas. In the present study, we present two cavernomas of the third ventricle which were completely excised via interhemispheric transcallosal transforaminal and Sylvian approaches. Radical excision should be the aim of the surgeon since reoperation for residual cavernomas is more commonly associated with complications and poor outcome. Total excision should be the goal of the treatment due to risk of rebleeding or regrowth.
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Neoplasias do Ventrículo Cerebral , Hemangioma Cavernoso , Terceiro Ventrículo , Humanos , Procedimentos NeurocirúrgicosRESUMO
Background This study investigated the effect of Punica granatum L. (pomegranate) juice on the rabbit basilar artery in an experimental subarachnoid hemorrhage (SAH) model. Methods Eighteen adult male New Zealand white rabbits were randomly divided into three groups: a control group (n = 6), SAH group (n = 6), and SAH + treatment group (n = 6). Basilar artery diameter was measured with magnetic resonance angiography (MRA) in all groups at the beginning of the study. Experimental SAH was created by injecting autologous arterial blood into the cisterna magna. In the treatment group, the subjects were administered a daily dose of 30 ml/kg pomegranate juice via gastric gavage for 4 days after the SAH. The SAH group and SAH + treatment group underwent cerebral MRA after 72 hours. After a neurologic score assessment, all the animals were killed. The wall thickness and lumen area of the basilar artery were measured histometrically in all groups, and the apoptotic cell percentage in the artery was identified. The mean diameter of the basilar artery during MRA was measured. Results Pomegranate improved neurologic functions compared with the SAH group (p < 0.01). The mean basilar artery diameter on MRA in the SAH + treatment group was larger than in the SAH group and smaller than in the control group (p < 0.01 and p < 0.05, respectively). The mean vessel wall thickness value in the SAH + treatment group was lower than in the SAH group (p < 0.01), whereas there was no difference between the control and the SAH + treatment group (p > 0.05). The apoptotic cell rate in the SAH + treatment group was significantly lower than in the SAH group (p < 0.001). Evaluation of the basilar artery luminal area showed no difference between the three groups (p > 0.05). Discussion Pomegranate was shown to have a vasospasm- attenuating effect on the basilar artery in the rabbit SAH model for the first time in our study.
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Apoptose/efeitos dos fármacos , Artéria Basilar/efeitos dos fármacos , Sucos de Frutas e Vegetais , Lythraceae , Fitoterapia/métodos , Hemorragia Subaracnóidea/tratamento farmacológico , Vasoespasmo Intracraniano/tratamento farmacológico , Animais , Artéria Basilar/patologia , Modelos Animais de Doenças , Angiografia por Ressonância Magnética , Masculino , Coelhos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/patologia , Vasoespasmo Intracraniano/etiologia , Vasoespasmo Intracraniano/patologiaRESUMO
AIM: In the present study, we evaluated the association of the Glasgow Coma Scale (GCS) score and amount of blood loss with mortality in patients presenting with traumatic acute subdural hematoma (ASDH). MATERIAL AND METHODS: This retrospective study was performed on 99 patients who were operated for traumatic acute subdural hematoma (ASDH) without any systemic association at a single center. Epidural hematoma was reported to be the most common additional pathology. Age, sex, mechanism of trauma, time interval between onset of trauma and admission to the emergency ward, associated problems, thickness of hematoma and Glasgow Coma Scale (GCS) score at the time of admission and on discharge were all studied. RESULTS: The GCS score was inversely proportional to the thickness of hematoma and interval between onset of trauma and surgery (p < 0.05). Although the mortality rate was reported to be high in traffic accidents, the rate was low in patients with head trauma only (p < 0.05). The mortality rate was high in patients with associated pathologies (p < 0.05). Lost patients were reported to be older patients with more extensive ASDH or those who presented earlier with a low GCS (p < 0.05). CONCLUSION: ASDH is associated with high mortality. GCS score and the thickness of the ASDH are important predictors of mortality. Age, additional trauma, and interval between trauma and hospital admission are major predictive factors for mortality.
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Hematoma Subdural Agudo/mortalidade , Hematoma Subdural/mortalidade , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/mortalidade , Traumatismos Craniocerebrais/cirurgia , Feminino , Escala de Coma de Glasgow , Hematoma Epidural Craniano/complicações , Hematoma Subdural/complicações , Hematoma Subdural/cirurgia , Hematoma Subdural Agudo/complicações , Hematoma Subdural Agudo/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Gunshot injuries are the third leading cause of spinal injuries, after falls from a significant height and traffic accidents. Severity of spinal damage from gunshot injury depends upon certain mechanical and biological factors. The aim of the present study was to investigate the effect of biological factors on survival in cases of spinal gunshot injury. METHODS: A total of 110 cases of spinal gunshot injury admitted multiple times to emergency services between 2012 and 2014 were included. Age, sex, region of trauma, additional organ or systemic involvement, treatment modalities (conservative, surgical), and mortality rates were analyzed. Effects of biological factors on survival were evaluated. RESULTS: Mean age of the study population was 25.51±11.74 years (min: 4; max: 55) and 95.5% of the population was male. Regions of trauma were thoracic in 50 (45.4%) subjects, cervical in 42 (38.2%), and lumbar in 18 (16.4%). Most common American Spinal Injury Association (ASIA) score was category A, as was found in 77 (70%) cases. No significant correlation was found among age, sex, ASIA score, treatment modality (conservative or surgical), and survival (p>0.05). Additional organ or systemic injury was present in 66 (60%) patients. Additional organ or systemic injury significantly affected survival, independent of the spinal region of trauma (p<0.01). CONCLUSION: Spinal gunshot injuries are complex, with unclear treatment protocol. Irrespective of the indications of spinal surgery, additional organ injuries unfavorably affect survival in cases of spinal gunshot injury. Appropriate management of all biological factors directly affects mortality rate in cases of spinal gunshot injury.
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Traumatismos da Coluna Vertebral/mortalidade , Ferimentos por Arma de Fogo/mortalidade , Adolescente , Adulto , Fatores Biológicos , Criança , Pré-Escolar , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/patologia , Traumatismos da Coluna Vertebral/cirurgia , Análise de Sobrevida , Turquia/epidemiologia , Ferimentos por Arma de Fogo/diagnóstico por imagem , Ferimentos por Arma de Fogo/patologia , Ferimentos por Arma de Fogo/cirurgia , Adulto JovemRESUMO
AIM: Failure of surgery for lumbar disc herniation (LDH) can be commonly caused by recurrence. There are many debates regarding the risk factors of recurrent LDH (rLDH) and it is very difficult to define them because many clinical and complicated biomechanical parameters are involved. The purpose of study was to evaluate the long term result of re-discectomy for LDH at the same level and adjacent segments. MATERIAL AND METHODS: Between 1999 and 2009, 1898 cases were operated and 142 (6.4%) patients underwent re-discectomy following initial operation. The study included 65 patients who were operated for single level discectomy, and their charts were analyzed retrospectively. RESULTS: There were 33 (50.8%) women and mean age was 45.5 years (24-73 years). rLDH was diagnosed at the initial level in 40 (61.5%) but adjacent and/or opposite level herniation (with or without the first level) was found in the remaining 25 cases (39.1%). Recurrence at the same level (SLG) and adjacent level groups (ALG) were similar according to the clinical outcomes in follow-up (mean 34.1 months). Admission period after initial operation was also parallel in SLG and ALG (54.7 and 53.1 months, respectively). However, the mean age of ALG (49.4 years) was significantly higher (p≤0.05) than SLG (42.8 years). CONCLUSION: After discectomy, collapsed discs are biomechanically more stable than those with preserved disc heights, and responses to axial compression on intervertebral disc pressure produced deformations of adjacent levels despite limitations. Altered biomechanical loading next to a fusion resulted in ongoing degeneration with aging at the affected entire lumbar spine.
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Envelhecimento/patologia , Discotomia/efeitos adversos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Adulto , Idoso , Discotomia/métodos , Feminino , Seguimentos , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/etiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Adalimumab, a new-generation anti-inflammatory agent, exerts its effect through tumor necrosis factor α (TNF-α), secreted from immune response cells such as macrophages and lymphocytes. TNF-α has been shown to play an important role in the processes of apoptosis and demyelination, and blockage of its activity may improve neural healing. Investigated in the present study is the probable neuroprotective influence of adalimumab in rats using a peripheral nerve injury model with biochemical and electron microscopic methods. METHODS: Forty adult Wistar albino rats were randomly divided into control, sciatic nerve trauma, low-dose adalimumab, and high-dose adalimumab groups. Six rats from each group were assigned biochemical microscopy, and 4 were assigned electron microscopy. Neural injury was induced with clip compression following dissection of sciatic nerves. Adalimumab was simultaneously injected. The rats were sacrificed after 2 weeks of adalimumab treatment. RESULTS: Nerve tissue lipid peroxidation values were found to be significantly decreased in both the low- and high-dose adalimumab treatment groups, compared to the group subjected only to sciatic nerve trauma. CONCLUSION: Results demonstrate that adalimumab is an effective neuroprotective agent for neural healing, particularly in the early phase.
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Adalimumab/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Traumatismos dos Nervos Periféricos/prevenção & controle , Nervo Isquiático/lesões , Adalimumab/farmacologia , Animais , Peroxidação de Lipídeos/efeitos dos fármacos , Masculino , Microscopia Eletrônica , Fármacos Neuroprotetores/farmacologia , Traumatismos dos Nervos Periféricos/patologia , Ratos , Ratos Wistar , Nervo Isquiático/ultraestruturaRESUMO
Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus (CS), and can occur as a result of blunt and penetrating head injuries. While occurrence is rare, diagnosis can be made in the emergency department. Described in the present report is the case of a 26-year-old man who presented with complaints of pain, redness, blurred and loss of vision in the right eye, and swelling of the upper face due to a gunshot injury he had sustained 35 days prior.
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Fístula Carótido-Cavernosa/diagnóstico , Traumatismos Cranianos Penetrantes/diagnóstico , Ferimentos por Arma de Fogo , Adulto , Cegueira/etiologia , Fístula Carótido-Cavernosa/complicações , Fístula Carótido-Cavernosa/diagnóstico por imagem , Fístula Carótido-Cavernosa/cirurgia , Diagnóstico Diferencial , Procedimentos Endovasculares , Traumatismos Cranianos Penetrantes/complicações , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/cirurgia , Humanos , MasculinoRESUMO
AIM: An underestimated evaluation of systemic organs in cases with spinal fractures might jeopardize the intervention for treatment and future complications with an increased morbidity and mortality are almost warranted. In the present study, a retrospective analysis of spinal fracture cases associated with systemic trauma was performed to assess surgical success. MATERIAL AND METHODS: A retrospective analysis of patients with thoracolumbar fractures who were admitted to the emergency unit between September 2012 and September 2014 was used for the study. The cases were categorized according to age, sex, reason of trauma, associated trauma, neurological condition and treatment details and results were analysed using SPSS 14.0 for Windows. RESULTS: The most common reason of trauma is detected as falls in 101 cases (64.3%). Radiological evaluation of spinal fractures revealed a compression fracture in 106 cases (67.5%) and other fractures in 51 cases (32.5%). Surgical treatment for spinal fracture was performed in 60.5% of the cases and conservative approach was preferred in 39.5% cases. In non-compressive spinal fractures, an associated pathology like head trauma, lower extremity fracture or neurological deficit was found to be higher in incidence (p < 0.05). Necessity for surgical intervention was found to be more prominent in this group (p < 0.05). However, the fracture type was not found to be associated with morbidity and mortality (p < 0.05). CONCLUSION: A surgical intervention for a spinal fracture necessitating surgery should rather be performed right after stabilization of the systemic condition which might be associated with decreased morbidity and mortality.
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Procedimentos Ortopédicos/métodos , Fraturas da Coluna Vertebral/cirurgia , Ferimentos e Lesões/cirurgia , Adulto , Idoso , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/cirurgia , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Humanos , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Planejamento de Assistência ao Paciente , Estudos Retrospectivos , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Fatores de Tempo , Ferimentos e Lesões/complicaçõesRESUMO
AIM: The aim of this study was to investigate the effects of metamizole sodium on neural tube development in the early stage chick embryo model that complies with the first month of embryonic development in mammals. MATERIAL AND METHODS: A total of 40 fertilized chicken eggs were divided into 4 equal groups. The eggs were incubated in the incubator at a temperature of 37.8±2°C with 60±5% humidity. Group A was the control, Group B was administered physiological saline, Group C was administered 30 mg/kg metamizole sodium (based on the therapeutic index range of it used in humans) and Group D was administered 90 mg/kg metamizole sodium. All embryos were removed from the egg at the 48th hour and morphologically and histologically examined. RESULTS: Normal development was seen and the neural tube was closed in 17 embryos in Groups A and B. A neural tube defect was seen in 2 embryos in group A and in 1 embryo in group B. A neural tube closure defect was seen in all embryos in group C and 9 embryos in group D. There was 1 dead embryo in Group D. CONCLUSION: Metamizole sodium was seen to produce a neural tube defect in the chicken embyro model.
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Anti-Inflamatórios não Esteroides/toxicidade , Dipirona/toxicidade , Defeitos do Tubo Neural/induzido quimicamente , Animais , Embrião de Galinha , Desenvolvimento Embrionário/efeitos dos fármacos , Tubo Neural/embriologia , Defeitos do Tubo Neural/diagnóstico por imagem , Defeitos do Tubo Neural/patologiaRESUMO
OBJECTIVE Ischemia-reperfusion (I/R) injury of the spinal cord following thoracoabdominal aortic surgery remains the most devastating complication, with a life-changing impact on the patient. Thymoquinone (TQ), the main constituent of the volatile oil from Nigella sativa seeds, is reported to possess strong antioxidant, antiinflammatory, and antiapoptotic properties. This study investigated the effects of TQ administration following I/R injury to the spinal cord. METHODS Thirty-two rats were randomly allocated into 4 groups. Group 1 underwent only laparotomy. For Group 2, aortic clip occlusion was introduced to produce I/R injury. Group 3 was given 30 mg/kg of methylprednisolone intraperitoneally immediately after the I/R injury. Group 4 was given 10 mg/kg of TQ intraperitoneally for 7 days before induction of spinal cord I/R injury, and administration was continued until the animal was euthanized. Locomotor function (Basso, Beattie, and Bresnahan scale and inclined plane test) was assessed at 24 hours postischemia. Spinal cord tissue samples were harvested to analyze tissue concentrations of malondialdehyde, nitric oxide, tumor necrosis factor-α, interleukin-1, superoxide dismutase, glutathione-peroxidase, catalase, and caspase-3. In addition, histological and ultrastructural evaluations were performed. RESULTS Thymoquinone treatment improved neurological outcome, which was supported by decreased levels of oxidative products (malondialdehyde and nitric oxide) and proinflammatory cytokines (tumor necrosis factor-α and interleukin-1), increased activities of antioxidant enzymes (superoxide dismutase, glutathione-peroxidase, and catalase), as well as reduction of motor neuron apoptosis. Light microscopy and electron microscopy results also showed preservation of tissue structure in the treatment group. CONCLUSIONS As shown by functional, biochemical, histological, and ultrastructural analysis, TQ exhibits an important protective effect against I/R injury of the spinal cord.
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Apoptose/efeitos dos fármacos , Benzoquinonas/farmacologia , Fármacos Neuroprotetores/farmacologia , Estresse Oxidativo/efeitos dos fármacos , Traumatismo por Reperfusão/tratamento farmacológico , Isquemia do Cordão Espinal/tratamento farmacológico , Animais , Antioxidantes/metabolismo , Apoptose/fisiologia , Caspase 3/metabolismo , Modelos Animais de Doenças , Interleucina-1/metabolismo , Masculino , Malondialdeído/metabolismo , Neurônios Motores/efeitos dos fármacos , Neurônios Motores/patologia , Neurônios Motores/fisiologia , Neuroimunomodulação/efeitos dos fármacos , Neuroimunomodulação/fisiologia , Óxido Nítrico/metabolismo , Estresse Oxidativo/fisiologia , Distribuição Aleatória , Ratos Wistar , Traumatismo por Reperfusão/patologia , Traumatismo por Reperfusão/fisiopatologia , Medula Espinal/efeitos dos fármacos , Medula Espinal/patologia , Medula Espinal/fisiopatologia , Isquemia do Cordão Espinal/patologia , Isquemia do Cordão Espinal/fisiopatologia , Fator de Necrose Tumoral alfa/metabolismoRESUMO
STUDY DESIGN: The study retrospectively investigated 15 cases with multilevel noncontiguous spinal fractures (MNSF). PURPOSE: To clarify the evaluation of true diagnosis and to plane the surgical treatment. OVERVIEW OF LITERATURE: MNSF are defined as fractures of the vertebral column at more than one level. High-energy injuries caused MNSF, with an incidence ranging from 1.6% to 16.7%. MNSF may be misdiagnosed due to lack of detailed neurological and radiological examinations. METHODS: Patients with metabolic, rheumatologic diseases and neoplasms were excluded. Despite the presence of a spinal fracture associated clearly with the clinical picture, all patients were scanned within spinal column by direct X-rays, computed tomography and magnetic resonance imaging. When there were ≥5 intact vertebrae between two fractured vertebral segments, each fracture region was managed with a separated stabilization. In cases with ≤4 intact segments between two fractured levels, both fractures were fixed with the same rod and screw system. RESULTS: There were 32 vertebra fractures in 15 patients. Eleven (73.3%) patients were male and age ranged from 20 to 64 years (35.9±13.7 years). Eleven cases were the American Spinal Injury Association (ASIA) E, 3 were ASIA A, and one was ASIA D. Ten of the 15 (66.7%) patients returned to previous social status without additional deficit or morbidity. The remaining 5 (33.3%) patients had mild or moderate improvement after surgery. CONCLUSIONS: The spinal column should always be scanned to rule out a secondary or tertiary vertebra fracture in vertebral fractures associated with high-energy trauma. In MNSF, each fracture should be separately evaluated for decision of surgery and planned approach needs particular care. In MNSF with ≤4 intact vertebra in between, stabilization of one segment should prompt the involvement of the secondary fracture into the system.
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AIM: Surgical approaches to the pituitary have undergone numerous refinements over the last 100 years. The fully endoscopic transsphenoidal approach has gained widespread use all around the world. We report the results of a consecutive series of patients who underwent pituitary surgery using a pure endoscopic endonasal approach and the results of the evaluation of the efficacy and safety of this procedure. MATERIAL AND METHODS: We retrospectively reviewed the hospital database of 80 consecutive pituitary adenomas that were resected with the purely endoscopic endonasal transsphenoidal technique. RESULTS: The preoperative clinical condition of the patients, hormone profile, visual field, computed tomography and magnetic resonance imaging findings, and the Hardy-Vezina and Knosp scores were evaluated and revealed the importance of the parameters for surgery. Surgical technique, postoperative clinical condition of the patients, hormone profile, complications and follow-up period were reviewed. CONCUSION: Endonasal endoscopic pituitary surgery is a safe and effective surgical technique.
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Adenoma/cirurgia , Neuroendoscopia/métodos , Neoplasias Hipofisárias/cirurgia , Adulto , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Nariz , Hipófise/patologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemRESUMO
AIM: Deep venous thrombosis (DVT) and pulmonary embolism (PE) are the most frequent surgical problems and associated with high morbidity and mortality. Neurosurgical patients constitute a unique group where prophylaxis with anticoagulant and antiaggregant agents are relatively contraindicated due to the natural course of vascular problems such as aneurysms, hemorrhagic tumors or hematomas or increased vulnerability to complex spinal surgeries and trauma. MATERIAL AND METHODS: We included 67 patients predicted to be immobilized for 2 or more months in this retrospective analysis. A vena cava filter was inserted between the first and seventh postoperative day in 40 patients in a prophylactic manner whereas 27 patients received low dose heparin for the same purpose. The patients were evaluated for symptomatic DVT or PE. RESULTS: Percutaneous insertion was performed for all filters without any complication. DVT occurred in two patients of the filter group and 1 patient of the heparin group. There was no PE recorded in any patient of either group. Patients were followed up for 22 months in the filter and 16 months in the heparin group. CONCLUSION: We conclude that prophylactic filter use in high risk neurosurgical patients is not beneficial and not superior to low-molecular-weight heparin use. Nevertheless, it is reasonable to prevent PE in patients with proven DVT who have no contraindication for anticoagulant drugs.
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Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Filtros de Veia Cava , Tromboembolia Venosa/prevenção & controle , Adulto , Idoso , Feminino , Humanos , Imobilização/efeitos adversos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Período Pós-Operatório , Embolia Pulmonar/prevenção & controle , Estudos Retrospectivos , Trombose Venosa/prevenção & controleRESUMO
AIM: Spongostan™ is a sterile, water-insoluble, porcine gelatin absorbable sponge, which is widely used as a hemostatic material. The aim of this study is to test the anti-fibrotic capacity of Spongostan™, using a craniotomy model in an experimental rabbit model. MATERIAL AND METHODS: Eighteen rabbits were divided into two groups: Each group consisted of 9 rabbits, duratomy plus Spongostan™ (group 1), and duratomy without Spongostan™ (group 2). Right parietal bone was removed via trephine and low speed drill and dura was opened. On the group 1 rabbits, an appropriate piece of Spongostan™ was meticulously placed under dural layer. On group 2 rabbits, same procedures were repeated without Spongostan™. Histological sections were taken from each group and evaluated for degree of fibrosis and collagen fibers. RESULTS: There was marked increase in number of fibroblasts and collagen fibers in group 2 rabbits, however most of the rabbits in Spongostan™ group demonstrate scarce histopathological findings for fibrosis. CONCLUSION: We conclude that an appropriately placed subdural Spongostan™ over cerebral tissue may prevent postoperative surgical adhesions after neurosurgical operations.
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Craniotomia/efeitos adversos , Esponja de Gelatina Absorvível/uso terapêutico , Espaço Subdural/patologia , Aderências Teciduais/prevenção & controle , Animais , Dura-Máter/cirurgia , Fibrose/prevenção & controle , Coelhos , Crânio/cirurgia , Espaço Subdural/cirurgia , SuínosRESUMO
BACKGROUND: Cranial firearm injuries (CFAI) are associated with significant morbidity and mortality.This study was aimed to determine the factors affecting mortality of CFAI cases managed in our institution by a retrospective analysis of CT scans and clinical data. METHODS: This multicenter retrospective study examined two hundred and nineteen patients presenting to neurosurgery clinics after CFAI between January 2012 and November 2014. Age, sex, Glasgow Coma Score (GCS), CT findings, and mortality and morbidity rates of the patients were analyzed to determine the factors affecting mortality. RESULTS: Mean age of the study population was 24.19±12.25 years, 85.8% of them were male. The most common CT findings were fracture (100%), intracranial hemorrhage (61.2%), and an intracranially located foreign body (44.3%). A cranial operation was performed in 64.8% of the victims. Mean GCS on admission was 8±3.9, which increased in survivors (p<0.05). CONCLUSION: CFAIs are associated with increased mortality and morbidity. We determined that many factors affected morbidity and mortality rates, and patient age, presence of intracranial hemorrhage, GCS, and treatment protocols were significantly associated with mortality.
Assuntos
Traumatismos Cranianos Penetrantes/cirurgia , Hemorragia Intracraniana Traumática/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Craniotomia , Feminino , Escala de Coma de Glasgow , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/mortalidade , Traumatismos Cranianos Penetrantes/patologia , Humanos , Lactente , Escala de Gravidade do Ferimento , Hemorragia Intracraniana Traumática/diagnóstico por imagem , Hemorragia Intracraniana Traumática/mortalidade , Hemorragia Intracraniana Traumática/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Turquia , Ferimentos por Arma de Fogo/diagnóstico por imagem , Ferimentos por Arma de Fogo/mortalidade , Ferimentos por Arma de Fogo/patologia , Adulto JovemRESUMO
AIM: Catechin is a type of polyphenol, along with epicatechin, epigallocatechin, and epigallocatechin-gallate (EGCG). This study aims to investigate the effect of EGCG, a major metabolite of catechin, which is the principle bioactive compound in green tea, on rats with peripheral nerve injury. MATERIAL AND METHODS: A total of 74 rats were divided into six groups, namely the control, the trauma, the normal saline, a 25mg/kg EGCG, a 50mg/kg EGCG and a daily consumption group (10mg/kg EGCG was given intraperitoneally for 14 days before the trauma). Except the first group, the other groups underwent a 1-minute sciatic nerve compression by clip with 50gr/cm2 pressure. Nerve samples were obtained at 28 day after trauma for the biochemical and histopathological analysis. RESULTS: Our study showed that the Daily consumption, 25mg/kg EGCG and 50mg/kg EGCG groups demonstrated statistically significant decreased lipid peroxidation levels and particularly daily consumption, and the 25mg/kg EGCG group showed a favourable reduction of degeneration and edema histologically. CONCLUSION: This study shows that Catechin and its derivatives have a protective effect on peripheral nerve injury.
Assuntos
Catequina/análogos & derivados , Fármacos Neuroprotetores/farmacologia , Traumatismos dos Nervos Periféricos/tratamento farmacológico , Animais , Catequina/administração & dosagem , Catequina/farmacologia , Modelos Animais de Doenças , Masculino , Fármacos Neuroprotetores/administração & dosagem , Ratos , Ratos WistarRESUMO
BACKGROUND: Head trauma is associated with a significant risk of cerebrospinal fluid (CSF) fistula. METHODS: In this study, it was aimed to report twenty-two cases subjected to operative intervention for otorrhea, rhinorrhea and oculorrhea with associated traumatic lesions. Majority of the cases had moderate to severe head trauma with a Glascow Coma Scale (GCS) score under 14. The study group included eleven cases with depression fractures, 6 with epidural hematomas and 4 with tension pneumocephalus. RESULTS: Rhinorrhea was the most common presenting symptom encountered in fifteen cases; whereas, otorrhea was prominent in 7 and oculorrhea in 2 cases. Two patients having rhinorrhea also had oculorrhea and otorrhea. The patients were operated with unilateral approaches in twelve and bifrontal approaches in ten of the cases. CONCLUSION: Early surgical intervention should be performed in cases presenting with CSF fistula and associated traumatic lesions without considering conservative management to provide an effective control of associated complications due to CSF fistulas.