Primary intracerebral malignant fibrous histiocytoma mimicking a meningioma.

We describe herein a patient with primary intracerebral malignant fibrous histiocytoma (MFH) to demonstrate this very rare central nervous system tumor. A 42-year-old male was admitted to our institute with the complaints of headache and speech impairment. Magnetic resonance imaging (MRI) revealed a tumor consistent with meningioma and we decided the surgery. The tumor was excised totally during the initial surgery. Histopathological examination revealed a mesenchymal tumor with an invasion of the adjacent brain and underlying dura mater. On the postoperative 4th month, the follow up MRI showed tumor recurrence at the same location and of similar size. Reoperation was performed and the tumor was again removed gross totally. However, the patient demonstrated a rapidly progressive course leading to death within the first year after the surgery. Two significant points of this case of primary central nervous system MFH are the rarity of its occurrence and its mimicking a meningioma.

Intraoperative perineural infiltration of lidocaine for acute postlaminectomy pain: preemptive analgesia in spinal surgery.

STUDY DESIGN: Prospective, cohort, and clinical study. SUMMARY OF BACKGROUND DATA: It was proven that effective control of postoperative pain in lumbar disk surgery improves the patient's recovery. Despite the many advances in surgical and nonsurgical techniques, the most accurate approach in pain relief is still under debate. OBJECTIVE: In this study, our aim was to determine whether neural root blockade before the onset of noxious stimuli could inhibit the production of pain. METHODS: Forty-five patients undergoing unilateral 1 spinal level (lumbar 5) hemipartial laminectomy were included in the study. In 20 of the patients (group 2), 0.5 mL 2% lidocaine was infiltrated onto the neural root immediately after the exposure; the 25 patients in the control group (group 1) were not injected. All patients were monitored regarding pain determination using a visual analog scale, and the exact time of analgesic requirement during the first postoperative day was noted. Total analgesic dose given during the first postoperative day was also recorded. RESULTS: Perineural lidocaine infiltration extended the early postoperative analgesic period. Although the pain was not completely suppressed, the lidocaine infiltration helped to manage the postoperative pain more effectively. The patients (group 2) who received lidocaine infiltration intraoperatively onto the neural root had a statistically significant longer time before analgesia requested (P<0.001) and also required significantly less analgesic when compared with the control group (P<0.001). CONCLUSIONS: For preemptive analgesia for acute postoperative pain in laminectomy surgery, which remains a major concern, we suggest that lidocaine infiltration onto the dorsal neural sheath immediately before retraction of the root may extend the time before analgesia requested and the total analgesic drug consumption.

The effects of pre-emptive analgesia with bupivacaine on acute post-laminectomy pain.

INTRODUCTION: This is a prospective, non-randomized, hospital-based, case-controlled, clinical trial to assess the efficacy of perineural infiltration with bupivacaine at the related neural root for acute pain relief after lumbar laminectomy. METHOD: Fifty-one patients undergoing unilateral one spinal level (lumbar 4) hemi-partial laminectomy were included in the study. In 22 of the patients (Group 2), bupivacaine was infiltrated onto the neural root immediately after the exposure; the 29 patients in the control group (Group 1) were not infiltrated. All patients were monitored post-operatively regarding pain determination using a visual analog scale, and the exact time of analgesic requirement during the first post-operative day was noted. Total analgesic dose given during the first post-operative day was also recorded. RESULTS: The patients who received bupivacaine infiltration intraoperatively onto the neural root (Group 2) had a statistically significantly longer time to first analgesia request (P < 0.001) and also required significantly less analgesic when compared to the control group (Group 1) (P < 0.001). Perineural bupivacaine infiltration extended the early post-operative analgesic period. While the pain was not completely suppressed, the bupivacaine infiltration helped to manage the post-operative pain more effectively. CONCLUSION: Our data suggests that pre-emptive analgesia via perineural infiltration of bupivacaine is a simple, and effective method for post-operative acute pain relief.

Unusual location of hydatid cysts in pediatric patients.

OBJECTIVE/AIMS: To emphasize the importance of diagnosis and treatment of unusually localized hydatid cysts in pediatric cases. METHODS: Hydatid cyst patients of two departments were listed who had undergone surgery between January 2001 and December 2008. Of the 7 pediatric patients, 3 were chosen as the ones with unusual localization. Cyst removal with Dowling's technique was performed in 2 cases and total removal of the cyst wall was achieved after cyst aspiration in the other patient. RESULTS: Two patients did not show any signs of recurrence. Some of the cranial multiple cysts of the patient who had undergone her first surgery in another clinic with cyst rupture were successfully removed in our clinic. Six months later, she was admitted with spinal seedings. CONCLUSION: Hydatid cyst removal without rupture should be the surgical goal in all cases. Radiological evaluation is of utmost importance for differential diagnosis. When a cystic lesion is found in the central nervous system on radiological evaluation, hydatid disease must be considered in countries where the disease is endemic and surgery is to be planned emergently especially for pediatric cases with increased intracranial pressure. The study focuses on the strategy for the correct diagnosis and the appropriate treatment of unusually localized hydatid cysts.

Desmoplastic infantile ganglioglioma: case report.

Desmoplastic infantile gangliogliomas are very rarely encountered, large supratentorial masses, derived from neuroepithelial origin, which have cystic and solid components and contain cells with astrocytic and ganglionic differentiation. These tumors are benign tumors of childhood that become symptomatic when they reach giant sizes. Sixty cases of desmoplastic ganglioglioma have been reported to date. In the present study, a case of giant desmoplastic infantile ganglioglioma in a 22-month-old patient is presented, which had an aggressive radiological appearance in the midline and presented with atypical symptoms.

Intrasellar epidermoid cyst presenting as pituitary apoplexy.

We herein present a patient with intrasellar epidermoid cyst presenting as pituitary apoplexy, who was operated upon with a trans-sphenoidal approach. The clinical presentation, radiological and histological differential diagnosis and type of surgical intervention for intrasellar epidermoid cysts are discussed.

The effect of meperidine-impregnated autogenous free fat grafts on postoperative pain management in lumbar disc surgery.

STUDY DESIGN: Prospective, randomized, double-blind clinical study. OBJECTIVE: To examine the effect of meperidine-impregnated autogenous free fat grafts (AFFGs) on postoperative pain management after 1-level, first-time lumbar disc surgery. SUMMARY OF BACKGROUND DATA: Uncontrolled postoperative pain impedes patient recovery. Insufficient control of postoperative pain makes it difficult to convince new patients to undergo the lumbar disc surgery. METHODS: Twenty-seven patients scheduled to undergo lumbar microdiscectomy for the first time were divided into 2 groups by a randomized double-blind method. Group 1 patients received a meperidine-impregnated AFFG in the epidural area. Group 2 received the graft without meperidine impregnation. Both groups were asked to use a Patient Controlled Analgesia device to deliver tramadol, and at 1, 4, 12, and 24 hours postoperatively, the amounts of tramadol used and pain severity on the 10-cm Visual Analog Scale (VAS) were recorded. RESULTS: The VAS scores and total tramadol use were both lower in group 1 compared with the control group (P<0.05). The first hour of VAS scores were significantly lower in group 1 than in the control group (P<0.05). CONCLUSIONS: In this study, we helped patients, who underwent 1-level, first-time lumbar microdiscectomy have a postoperative pain-free and comfortable period by using epidural meperidine-impregnated AFFGs.

Primary lumbar vertebral hydatid cyst.

Spinal hydatid cyst is a serious and rare infectious disease. We report a case of spinal hydatid cyst at the second lumbar vertebra, and we discuss the clinical presentation, diagnosis and surgical treatment of vertebral hydatid cyst.

Intradural herniation of intervertebral disc at the level of Lumbar 1-Lumbar 2.

Intradural disc herniation is a serious and rare complication of intervertebral disc rupture. The preoperative diagnosis of intradural disc herniation is still difficult despite new neuroradiologic investigation possibilities including computerized tomography and magnetic resonance imaging and it is usually diagnosed by during surgery. Here we present an intradural disc herniation case at the level of L1-L2 with accompanying significant myelopathic neurologic deficits. A 50-year-old female patient was admitted to the hospital with pain and weakness in both legs. Her neurological examination revealed paraparesis. Magnetic resonance imaging showed an extruded disc hernia of central localization at the L1-L2 level. She underwent total laminectomy at the level of L1-L2 and her intradural disc fragment was extirpated by microsurgical methods.

Abdominal vascular injury during lumbar disc surgery: report of three cases.

Anterior longitudinal ligament perforation and abdominal vascular injury is one of the most critical complications that may develop during lumbar disc surgery. The vascular injury-related symptoms that warns the surgeon may be late to appear; they usually turn out to be mortal. The hypotension during the operation, tachycardia and pulsatile unstoppable hemorrhage observed in the disc space are the major findings. Urgent detection of this complication and the repair of the vascular injury prevent the case from turning out to be fatal. In the present study, three patients who underwent surgical treatment of abdominal vascular injuries that had developed during lumbar disc surgery, were presented.

Effect of iloprost on adrenal medullary grafts in central nervous system transplantation and apoptosis.

OBJECTIVE: To investigate whether iloprost, a stable analog of prostacyclin, is useful for the preservation of neural grafts in transplantation surgery. METHODS: This study was conducted at the Microsurgery Laboratory of the Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey in 2003. The animals (rabbits) were divided into 3 groups. In group I, autografts taken from the adrenal medulla were stored in 0.9% sodium chloride (NaCl) solution for 45 minutes before transplantation. In group II, autografts taken from the adrenal medulla were stored in iloprost solution (50 ng/ml) for 45 minutes before transplantation. Graft transplantation was not performed in the third group. RESULTS: In group I, the grafts partially preserved their viability. In group II, the large adrenal medullary cells had evident euchromatin nuclei fused with neurons, and there was an increase in vascularization. CONCLUSION: Three weeks after transplantation surgery, it was determined that iloprost maintained the viability of the graft tissue and probably prevented apoptosis, and facilitated the integration of the graft tissue into the host brain.

Bilateral traumatic neuroma of the anterior cervical nerve root: case report.

STUDY DESIGN: Case report. OBJECTIVES: A rare case of anterior cervical second root traumatic neuroma with no history of trauma is reported, and possible etiology is discussed. SUMMARY OF BACKGROUND DATA: Traumatic neuroma is the reactive, nonneoplastic proliferation in the injured nerve. Several atypical locations of traumatic neuroma have been reported. To date, only 4 cervical traumatic neuroma cases with no history of trauma have been reported, and, to our knowledge, there is no case of bilateral cervical traumatic neuroma published in the literature. METHODS: A patient with a history of neck and left upper extremity pain, who had hypoesthesia in left C2 dermatome on neurologic examination is presented. A left C2-C3 hemilaminectomy and tumor extirpation were performed. RESULTS: A histopathologic study revealed features of a typical traumatic neuroma. The patient had no deficits on her postoperative neurologic examination, and her neck and left arm pain improved. The unusual location of this lesion and possible etiology of such a traumatic neuroma are discussed. CONCLUSIONS: A rare case of anterior bilateral cervical second root traumatic neuroma with no history of trauma is reported. An unnoticed history of trauma may play an etiologic role in the development of these lesions.

Trigeminal neuralgia in a patient with Dandy-Walker malformation.

BACKGROUND: Trigeminal neuralgia may be idiopathic or secondary to a number of cranial pathologies. We report a novel case of trigeminal neuralgia associated with Dandy-Walker malformation, which may be an etiologic factor. CASE DESCRIPTION: A 32-year-old male presented with shock-like pain in the somatosensory distribution of the right trigeminal nerve, which was refractory to all medication. MRI revealed a cystic lesion in the posterior fossa and a hypoplastic vermis. The pain was diagnosed as trigeminal neuralgia and was thought to be secondary to the Dandy-Walker malformation. The trigeminal neuralgia was treated successfully with radiofrequency thermocoagulation rhizotomy (RF-TR). CONCLUSION: Trigeminal neuralgia may be associated with Dandy-Walker malformation, however an etiological relationship is not proven. We suggest that traction on the trigeminal nerve may be significant. The posterior fossa cyst of Dandy-Walker malformation may be a complicating factor when considering microvascular decompression to treat the trigeminal neuralgia. Collapse of the cyst at surgery may destabilize the posterior fossa and further deform the trigeminal nerve. We suggest that RF-TR, which is minimally invasive and reliable, may be preferable.

Petrous bone osteoblastoma invading the cavernous sinus.

A 45-year old female was admitted complaining of double vision. A CT scan revealed a mass originating from the petrous part of the temporal bone with infiltration of the cavernous sinus. The patient was operated and a subtotal excision of the tumor was achieved. Pathological examination revealed benign osteoblastoma. During an 18 year follow up period, no progression of tumor has been detected.

Ruptured aneurysm of the posterior spinal artery of the conus medullaris.

A case of a posterior spinal artery aneurysm of the conus medullaris is presented. The patient presented with severe lower back pain with radiation into the right leg. Spinal angiography was consistent with a partially thrombosed arteriovenous malformation (AVM) or an aneurysm. At operation a partially thrombosed aneurysm of the posterior spinal artery was found at the level of conus medullaris, which, after review of the literature, is the first case treated with total microsurgical excision.

Extra-axial ependymoma of posterior fossa extending to the Meckel's cave.

An extra-axial ependymoma extending from the left cerebellopontine corner to the Meckel's cave is reported. This lesion's clinical, radiological, and histological characteristics are presented. This tumor's infrequent extra-axial location, extension to the Meckel's cave and possible origin are discussed.