RESUMO
BACKGROUND: Nonfunctioning pituitary adenomas are the most common pituitary adenomas in adults and cause significant morbidity unless adequately treated. METHODS: This study retrospectively assessed the medical records of 160 patients operated via pure endonasal endoscopy. The presenting symptoms, results of neurologic and visual examinations, levels of pituitary hormones, results of radiologic examinations, size of the adenoma, rates of resection, results of postoperative visual examination, and pituitary hormone levels at follow-up were recorded to establish the appropriate approach, operative criteria, and outcomes of patients with nonfunctioning pituitary adenoma. RESULTS: Headache was the presenting symptom in 87.5% of the patients. Thirty-three percent had visual loss, and visual examinations on the whole study population revealed a visual field defect in 47.5% of the patients. Only 16.25% of the patients presented with endocrinological symptoms; 52.5% had abnormal anterior pituitary hormone levels. Regarding adenoma size, 56 patients had macroadenoma (35%), 84 (52.5%) had mesoadenoma, and 20 patients had giant adenoma. Gross total resection was achieved in 90% of the patients; subtotal resection was achieved in the remainder. The rate of total resection was lower for giant adenomas and recurrences. Visual symptoms and anterior pituitary hormone levels improved in 27 and 42 patients, respectively, after the operation. CONCLUSIONS: Nonfunctioning pituitary adenomas present frequently as mesoademonas and giant adenomas. Patients with these tumors may have subclinical visual or hormonal deficits at the time of diagnosis. Early and effective surgical treatment is essential for rapid recovery of visual and/or hormonal deficits, particularly in symptomatic cases.
Assuntos
Adenoma/metabolismo , Adenoma/cirurgia , Endoscopia/métodos , Hormônios Ectópicos/metabolismo , Hipofisectomia/métodos , Neoplasias Hipofisárias/metabolismo , Neoplasias Hipofisárias/cirurgia , Adenoma/diagnóstico , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Adulto JovemRESUMO
Delayed posttraumatic cerebrospinal fluid rhinorrhea (CSFr) without meningitis is considered to be relatively rare. However, even years after trauma, recurrence or delayed onset of CSFr and meningitis due to CSFr are possible. In this article, a case of delayed CSFr from the sphenoid sinus without meningitis three years after the transfacial gunshot wound is reported. Plain high-resolution computed tomography sections through the sphenoid sinus showed a bone defect at the roof with CSF-density fluid extending into the sphenoid sinus. Arachnoid membrane herniation into the sphenoid sinus was found and site of CSF fistula confirmed during the surgery. Skull base defect was reconstructed through an endoscopic approach without any complications and the patient was followed up for 12 months without recurrence. The cause, timing, clinical course and location of CSFr make this an apparently unique case. Patients with a skull base defect without CSFr should be closely followed up and may need further evaluation or management due to the possibility of CSFr development. The positive diagnosis of a CSFr raises the matter of choosing the adequate surgical approach for its repair. Endoscopic closure of CSFr is both safe and effective.
Assuntos
Rinorreia de Líquido Cefalorraquidiano/patologia , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Seio Esfenoidal/cirurgia , Ferimentos por Arma de Fogo/complicações , Adolescente , Rinorreia de Líquido Cefalorraquidiano/etiologia , Feminino , Humanos , Neuroendoscopia/métodos , Base do Crânio/patologia , Seio Esfenoidal/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
AIM: Spinal cord injury (SCI) is characterized by posttraumatic inflammatory cascades including excitotoxicity, oxidative stress, and apoptosis. Agents against neuroinflammation are the current scope of studies on experimental SCI with promising results. MATERIAL AND METHODS: Thirty-two male Sprague-Dawley rats weighing 250-320 gram were used. They were randomized and divided into four groups with eight animals in each as sham, control, SCI+PEG (polyethylene glycol) and SCI+atorvastatin group. Rats were anesthetized with intraperitoneal ketamine (80 mg/kg) and xylazine (10 mg/kg) and SCI was induced by the weight-drop model. A single level laminectomy was performed at T10 and the spinal column was immobilized with a stereotactic device. Rats in the treatment group received ip atorvastatin at 0.2 mg/kg. Neurological impairments were examined through Modified Tarlov's and inclined angle scores. The SCI section was resected for electron-microscopic analysis, IL-1ß and IL-6 level. All data were analyzed using one-way ANOVA and Dunnet T3 test. RESULTS: Atorvastatin improved locomotor recovery after rat SCI. The results were further confirmed with a statistically significant decrease of IL-1ß, IL-6 and lipid peroxide levels. This finding revealed the anti-inflammatory and beneficial effect of atorvastatin on rat SCI. CONCLUSION: The present study focused on both B and T cell mediated immunity and confirmed the beneficial effect of atorvastatin with decreased expressions of IL-1ß and IL-6.
Assuntos
Ácidos Heptanoicos/farmacologia , Atividade Motora/efeitos dos fármacos , Pirróis/farmacologia , Traumatismos da Medula Espinal/tratamento farmacológico , Animais , Atorvastatina , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Peroxidação de Lipídeos/efeitos dos fármacos , Masculino , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Medula Espinal/efeitos dos fármacos , Medula Espinal/ultraestrutura , Traumatismos da Medula Espinal/metabolismo , Traumatismos da Medula Espinal/patologia , Traumatismos da Medula Espinal/fisiopatologiaRESUMO
Angiosarcomas are rare malignant vascular tumors that comprise only approximately 2% of all soft tissue sarcomas. They are mainly located in the head and neck area and spinal involvement is particularly very uncommon, reported only in occasional case reports or as single cases as part of a clinical series. There is therefore limited data in the literature regarding the optimum treatment strategy. Due to the aggressive nature of these lesions total resection is challenging and the overall survival time is short. In this report the authors report the successful management of a 37-year-old male harbouring spinal angiosarcoma involving the L2 level via en-bloc resection and adjuvant radiotherapy. The patient is disease-free at the 4th year follow-up and the radiological investigations are without the evidence of local recurrence, metastasis or implant failure. En bloc resection of spinal angiosarcomas can significantly improve survival and the surgical treatment should aim for this whenever possible.
Assuntos
Hemangiossarcoma/terapia , Vértebras Lombares , Neoplasias da Coluna Vertebral/terapia , Adulto , Seguimentos , Hemangiossarcoma/radioterapia , Hemangiossarcoma/cirurgia , Humanos , Fixadores Internos , Imageamento por Ressonância Magnética , Masculino , Radioterapia Adjuvante , Neoplasias da Coluna Vertebral/radioterapia , Neoplasias da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
AIM: Postoperative cerebrospinal fluid (CSF) leak following endoscopic endonasal transsphenoidal surgery (EETS) is associated with increased morbidity and mortality. This prospective study is the first evaluation of using autologous fibrin sealant for preventing postoperative CSF leak and related complications. MATERIAL AND METHODS: 200 endoscopic endonasal transsphenoidal approaches were included in the study and reviewed retrospectively from September 2010 to June 2012. A total of 55 patients who have large skull base and diafragma sella defects, connected with basal cisterns or ventricles, were chosen for the study. The patients were operated via extended or classical endoscopic endonasal transsphenoidal approach. The skull base has been repaired using AFS combined with multilayer reconstruction in all cases. The incidence of CSF leak as a complication of EETS was analyzed. RESULTS: The ages of the patients ranged from 20 to 83 years (mean 49.3 years). There were 25 (46%) male patients and 30 (54%) females. All patients had tumors with suprasellar or parasellar extension. Postoperative CSF leak was determined in 2 patients (3.6%). There were no complications and allergic reactions associated with the use of AFS. CONCLUSION: Using of AFS combined with multilayer reconstruction technique is a safe and effective method to prevent CSF leak in large defects following EETS.
Assuntos
Rinorreia de Líquido Cefalorraquidiano/prevenção & controle , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Adesivo Tecidual de Fibrina , Cavidade Nasal/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Base do Crânio/cirurgia , Osso Esfenoide/cirurgia , Adesivos Teciduais , Tecido Adiposo/transplante , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/cirurgia , Vazamento de Líquido Cefalorraquidiano , Feminino , Adesivo Tecidual de Fibrina/efeitos adversos , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/cirurgia , Procedimentos de Cirurgia Plástica , Estudos Retrospectivos , Sela Túrcica , Base do Crânio/patologia , Adesivos Teciduais/efeitos adversos , Adulto JovemRESUMO
AIM: In the present study, we investigate the neuroprotective effects of rituximab, a monoclonal antibody directed towards B cell mediated humoral immunity, on a rat spinal cord injury (SCI) model with immunohistochemical methods. MATERIAL AND METHODS: Twenty-four rats were used for the study. Rats were divided as control, SCI, and rituximab-treated SCI groups. Intraperitoneal rituximab administration was performed on days 0, 3 and 5 in the third group. Rats were sacrificed 7 days after trauma. Antibodies against IL-1ß, IL-6, TNF-α and CD20 were studied with the ELISA method together with electron microscopic analysis. RESULTS: It was found that rituximab suppressed oligodendrocytes at the phagocytic stage but was still inefficient for the regenerative phase. TNF-α expression was markedly increased in rats subjected to SCI and suppressed after rituximab treatment. Decreased CD20 expression was another prominent finding in rats under rituximab therapy. However, expressions of IL-1ß and IL-6 were both increased in glial cells without significant change after rituximab administration. CONCLUSION: TNF-α expression was augmented at the level of SCI both in neuronal and glial cells, particularly in oligodendrocytes. All were suppressed after rituximab administration and rituximab reduced CD20 expression both in neuronal and supportive glial cells which may be related to neural healing.
Assuntos
Anticorpos Monoclonais Murinos/farmacologia , Antineoplásicos/farmacologia , Fármacos Neuroprotetores , Traumatismos da Medula Espinal/tratamento farmacológico , Traumatismos da Medula Espinal/patologia , Animais , Antígenos CD20/metabolismo , Linfócitos B/efeitos dos fármacos , Ensaio de Imunoadsorção Enzimática , Imuno-Histoquímica , Interleucina-1/metabolismo , Interleucina-6/metabolismo , Masculino , Microscopia Eletrônica de Transmissão , Ratos , Ratos Wistar , Rituximab , Fixação de Tecidos , Fator de Necrose Tumoral alfa/metabolismoRESUMO
AIM: This study aimed to investigate the effects of a new generation antiepileptic agent, levetiracetam, on the neural tube development in a chick embryo model that corresponds to the first month of vertebral development in mammals. MATERIAL AND METHODS: Forty-five Atabey® breed fertilized chicken eggs with no specific pathogens were randomly divided into 5 groups. All of the eggs were incubated at 37.8±2°C and 60±5 % relative humidity in an incubator. Group A was control group. The other eggs were applied physiological saline and drugs at a volume of 10 µL by the in ovo method at the 28th hour of the incubation period. Group B was given distilled water; Group C, physiological saline; Group D, Levetiracetam (L8668) at a dose equivalent to the treatment dose for humans (10 mg/ kg), and Group E, Levetiracetam (L8668) at a dose of 10 times the treatment dose. The embryos in all of the groups were removed from the shells at the 48th hour and morphologically and histologically evaluated. RESULTS: Of the 45 embryos incubated, neural tubes of 41 were closed and the embryos displayed normal development. CONCLUSION: Levetiracetam, at a dose equivalent to human treatment dose and 10 times the treatment dose, was shown not to cause neural tube defects in chick embryos.
Assuntos
Anticonvulsivantes/toxicidade , Defeitos do Tubo Neural/induzido quimicamente , Tubo Neural/embriologia , Piracetam/análogos & derivados , Animais , Embrião de Galinha , Relação Dose-Resposta a Droga , Desenvolvimento Embrionário/efeitos dos fármacos , Levetiracetam , Tubo Neural/efeitos dos fármacos , Tubo Neural/patologia , Defeitos do Tubo Neural/patologia , Piracetam/toxicidadeRESUMO
AIM: To assess the incidence, hormonal activity and postoperative follow up of the cases that are histopathologically diagnosed as atypical pituitary adenoma (APA) in our series. MATERIAL AND METHODS: In this study, 13 atypical pituitary adenoma cases, by the WHO 2004 criteria, among the 146 pituitary adenoma patients operated on in our clinic between January 2009 and May 2012 by endoscopic endonasal transsphenoidal approach were included. RESULTS: In histological studies, 133 cases were diagnosed as typical pituitary adenoma (91.1%) and 13 cases were APAs (8.9%) of which 10 were male (76.9%) and 3 were female (23.1%), ranged between 27 and 80 (mean 52.7) ages. Histopathological distribution of APAs was 9 nonsecretory adenomas (69.3%), 3 prolactinomas (23.1%) and 1 somatostatinoma (7.6%). Asymptomatic pituitary apoplexy was diagnosed in 4 cases (30.7%). Eleven cases of typical pituitary adenomas (8.2%) and 5 cases of the atypical pituitary adenomas (38.4%) were re-operated due to tumor recurrences. CONCLUSION: Accurate histopathological examination shows that atypical pituitary adenoma is not a rare disease. Although it is not the only determinant, APAs are more prone to recurrence than typical adenomas. In our opinion, if total resection is not possible for the patients with APA, close postoperative follow up and additional curative therapy modalities are needed.
Assuntos
Adenoma/cirurgia , Hormônios Hipofisários/metabolismo , Neoplasias Hipofisárias/cirurgia , Adenoma/epidemiologia , Adenoma/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Processamento de Imagem Assistida por Computador , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Neoplasias Hipofisárias/epidemiologia , Neoplasias Hipofisárias/metabolismo , Período Pós-Operatório , Osso Esfenoide/cirurgia , Resultado do TratamentoRESUMO
Thoracic disc herniations are associated with serious neurological consequences if not treated appropriately. Although a number of techniques have been described, there is no consensus about the best surgical approach. In this study, the authors report their experience in the operative management of patients with thoracic disc herniations using minimally invasive lateral transthoracic trans/retropleural approach. A series of 33 consecutive patients with thoracic disc herniations who underwent anterior spinal cord decompression followed by instrumented fusion through lateral approach is being reported. Demographic and radiographic data, perioperative complications, and clinical outcomes were reviewed. Forty disc levels in 33 patients (18F/15M; mean age, 52.9) were treated. Twenty-three patients presented with myelopathy (69 %), 31 had radiculopathy (94 %), and 31 had axial pain (94 %). Among patients with myelopathy, 14 (42.4 %) had bladder and/or bowel dysfunction. In the last eight cases (24 %), the approach was retropleural instead of transpleural. Patients were followed up for 18.2 months on average. The mean length of hospital stay was 5 days. None of the patients developed neurological deterioration postoperatively. Among 23 patients who had myelopathy signs, 21 (91 %) had improved postoperatively. The mean preoperative visual analog scale pain score, Oswestry Disability Index score, SF-36 PCS, and mental component summary scores were 7.5, 42.4, 29.6, and 37.5 which improved to 3.5, 33.2, 35.5, and 52.6, respectively. Perioperative complications occurred in six patients (18.1 %), all of which resolved uneventfully. Minimally invasive lateral transthoracic trans/retropleural approach is a safe and efficacious technique for achieving adequate decompression in thoracic disc herniations in a less invasive manner than conventional approaches.
Assuntos
Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Ortopédicos/métodos , Vértebras Torácicas/cirurgia , Adulto , Idoso , Interpretação Estatística de Dados , Feminino , Humanos , Tempo de Internação , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Procedimentos Ortopédicos/efeitos adversos , Dor/etiologia , Dor/cirurgia , Medição da Dor , Pleura/anatomia & histologia , Pleura/cirurgia , Complicações Pós-Operatórias/epidemiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The thoracic or thoracoabdominal aortic aneurysm surgery may cause spinal cord ischemia because of aortic cross-clamping and may result in severe postoperative complications caused by spinal cord injury. Ischemia/reperfusion injury may directly or indirectly be responsible for these complications. In this study we sought to determine whether combination of iloprost and montelukast can reduce the ischemia/reperfusion injury of spinal cord in a rat model. METHODS: Medulla spinalis tissue concentrations of interleukin-6 (IL-6), myeloperoxidase (MPO) and heat shock protein 70 (HSP-70) were determined in 3 groups of Spraque Dawley rats: control group (operation with cross clamping and intraperitoneal administration of 0.9% saline, n = 7), sham group (operation without cross clamping, n = 7), and study group (operation with cross-clamping and intraperitoneal administration of iloprost (25 ng/kg) and montelukast (1 mg/kg), n = 7). The abdominal aorta was clamped for 45 minutes, with a proximal (just below the left renal artery) and a distal (just above the aortic bifurcation) clip in control and study groups. Hindlimb motor functions were evaluated at 6, 12, 24, and 48 hours using the Motor Deficit Index score. All rats were sacrificed 48 hours after the procedure and spinal cord tissue levels of myeloperoxidase, interleukin-6, and heat shock protein (HSP-70) were evaluated as markers of oxidative stress and inflammation. Histopathological analyses of spinal cord were also performed. RESULTS: The tissue level of HSP-70 was found to be similar among the 3 groups, however, MPO was highest and IL-6 receptor level was lowest in the control group (p = 0.007 and p = 0.005; respectively). In histopathological examination, there was no significant difference among the groups with respect to the neuronal cell degeneration, edema, or inflammation, but vascular congestion was found to be significantly more prominent in the control group than in the sham or in the study group (p = 0.05). Motor deficit index scores at 24 and 48 hours after ischemia were significantly lower in the study group than in the control group. CONCLUSION: This study suggests that combined use of iloprost and montelukast may reduce ischemic damage in transient spinal cord ischemia and may provide better neurological outcome.
Assuntos
Acetatos/uso terapêutico , Iloprosta/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Quinolinas/uso terapêutico , Traumatismo por Reperfusão/prevenção & controle , Traumatismos da Medula Espinal/prevenção & controle , Animais , Biomarcadores/metabolismo , Ciclopropanos , Esquema de Medicação , Quimioterapia Combinada , Injeções Intraperitoneais , Masculino , Estresse Oxidativo , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/patologia , Medula Espinal/metabolismo , Medula Espinal/patologia , Traumatismos da Medula Espinal/metabolismo , Traumatismos da Medula Espinal/patologia , Sulfetos , Resultado do TratamentoRESUMO
AIM: Low back pain (LBP) is a common symptom that causes enormous social, psychological, and economical problems. We studied LBP occurrence in a group of young adults referred to an army hospital for a planned health check and evaluated possible causative factors by prospective questionnaires. MATERIAL AND METHODS: This article is based on a prospective study of 871 novice soldiers of the Turkish Army. Studied factors were combined in the form, which was filled by 5 doctors on the basis of self-reports, interview and physical examination of the participants. They were evaluated by factors; low back pain episodes, monthly income, smoking habits, BMI, labor conditions, and educational status. RESULTS: The median age of the studied population was 21.14±1.4. Complains regarding LBP were observed in 325 (37%) of participants. Twelve participants had pain episodes up to 10 points. 83.69% of the participants with LBP had psychological problems. Heavy lifting and driving for long periods were determined as serious risk factors. CONCLUSION: Determining the impact factors of LBP in primary care groups can help to prevent development of more serious problems.
Assuntos
Dor Lombar/epidemiologia , Militares/estatística & dados numéricos , Condução de Veículo/estatística & dados numéricos , Humanos , Remoção/efeitos adversos , Dor Lombar/etiologia , Masculino , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Turquia/epidemiologia , Adulto JovemRESUMO
Air guns (AGs) are arms that use air or another compressed gas to propel a projectile. Generally, brain injury may occur in children due to their incomplete skull development; however, the less-resistant and thin region of the skull in adults may also be penetrated by an AG shot. In this paper, we present three adult cases treated in our clinic for brain injury caused by an AG. The first case had brain and skull damage related to the high pressure of the compressed gas, and the others additionally had foreign bodies in their brain. All of the patients were operated. Two were discharged without neurological deficit; the third case had a permanent slight hemiparesis. Average follow-up was 11 months and no abscess formation was observed in this period. AGs are known as low-velocity arms; however, they have the potential to cause brain injury, and brain penetration may occur especially in the relatively less resistant and thin sites of the skull such as the orbit and temporal and occipital bones. As cerebrospinal fluid leakage is one of the expected conditions, urgent surgery is usually required.