Pentraxin-3 level in subarachnoid haemorrhage: Is it a prognostic factor?

OBJECTIVE: The current study was planned to investigate the relationship of serum level of pentraxine-3 with various clinical and neurological scales and scores. METHODS: The prospective case-control study was conducted at the Emergency Department of the Ondokuz Mayis University, Samsun, Turkey, from March 2013 to June 2014, and comprised subarachnoid haemorrhage patients and healthy. Pentraxine-3levels were measured from serum samples and compared with sub-groups of the various scales and scores used in the study. Data was analysed using SPSS 15. RESULTS: Of the 77 subjects, 40(52%) were patients and 37(48%) were controls. Pentraxine-3levels in the cases were significantly higher than the controls (p<0.001). Among the cases, pentraxine-3level of the Glasgow Coma Scale sub-group was significantly different between the severe and mild categories (p=0.048). Likewise, pentraxine-3 levels were significantly different in terms of Fisher scale in patients with minor haemorrhage compared to those with massive haemorrhage (p=0.026). Also, pentraxine-3 levels were significantly higher in patients who died compared to those who fully recovered (p=0.042). CONCLUSIONS: There was found to be a relationship between pentraxine-3 level and the clinical severity of subarachnoid haemorrhage patients.

Spontaneous thrombosis of a giant cerebral varix in a pediatric patient.

INTRODUCTION: Cerebral cortical venous aneurysm also known as cerebral varix is a rare entity that usually occurs in relation to high-flow draining veins of arteriovenous fistulas, arteriovenous malformations, and venous angioma. Isolated cerebral varix is an extremely rare entity. CASE REPORT: We present a 1-year-old male with isolated cerebral varix. During follow-up, the varix thrombosed spontaneously without causing any neurological deficits. CONCLUSION: To the best of our knowledge, spontaneous asymptomatic thrombosis of an isolated cerebral varix without any clinical finding was reported for the first time in the literature.

Ultrasound neurography in the evaluation of sciatic nerve injuries.

[Purpose] The aim of this clinical study was to investigate the benefits and the basic principles of ultrasonographic examination in the evaluation of sciatic nerve injuries. [Subjects and Methods] Patients with sciatic nerve injury were evaluated using a real-time utrasonographic examination. The capabilty of ultrasonography in terms of determination of the type and the localization of injury, the position of the proximal and distal nerve segments, the presence or absence of a neuroma, and perilesional scar tissue were evaluated in all cases. [Results] Ten cases with sciatic nerve injury were evaluated with real time sonography. Perilesional scar tissue formation was found in 4 (40%) cases. Two (20%) cases had stump neuroma diagnosed by sonographic examination. The capability of ultrasonographic examination was satisfactory for all evaluation parameters. [Conclusion] Ultrasonographic examination of sciatic nerve lesions may be used for the description of the degree of injury, determination of complete or incomplete nerve sectioning, the presence of hematoma and foreign body, the continuity of nerve, determination of nerve stumps, formation of perilesional scar tissue, and the presence of neuroma.

Usefulness of S100B protein in neurological disorders.

In recent years, there has been an increased interest in the clinical use of brain markers. The S100B is a calcium-binding peptide and is used as a parameter of glial activation and/or death in many disorders of the central nervous system (CNS). It plays important roles in normal CNS development and recovery after injury. Although S100B is mainly found in astroglial and Schwann cells, it also has extracerebral sources. S100B is a useful neurobiochemical marker of brain damage such as in circulatory arrest, stroke and traumatic brain injury. S100B is also associated with neurodegenerative diseases like Alzheimer's disease or other chronic neurological diseases. Moreover, S100B may have a potential in predicting the efficiency of treatment and prognosis. In this review, an updated overview of the role of S100B in human neurological disorders is presented.

The Effect of Biomarkers and Optic Nerve Sheath Diameter in Determining Mortality in non-Traumatic Subarachnoid Hemorrhage.

AIM: Although radiological methods are sufficient for the diagnosis of spontaneous subarachnoid hemorrhage (SAH), additional biomarkers are needed to predict prognosis. The aim of this study was to investigate the effects of serum S100B protein, Glial Fibrillary Acidic Protein (GFAP) levels and, Optic Nerve Sheath Diameter (ONSD) on mortality and clinical severity in patients with spontaneous SAH. MATERIALS AND METHODS: Fifty-six patients who were diagnosed with SAH after first evaluation in the emergency department (ED) were included in the study group; Forty-six patients who were admitted to the ED with headache of non-intracranial etiology, were included as the control group. Cerebral computed tomography (CT) images and peripheral blood samples were obtained from all patients; at the time of diagnosis and 24 h after diagnosis. Serum S100B protein and GFAP levels were measured from the blood samples and ONSD was measured on CT. RESULTS: Serum S100B protein and GFAP levels and, ONSDs at the time of diagnosis and 24 h after diagnosis were significantly higher in the study group (p < 0.05). Both GFAP levels and ONSD at the time of diagnosis and 24 h after the diagnosis were found to be related with increased mortality (p < 0.05). A similar association was found for serum S100B protein levels 24 h after the diagnosis, but not at the time of diagnosis (p = 0.540). CONCLUSION: Serum S100B protein and GFAP levels and, ONSD were increased in patients with spontaneous SAH. All parameters were found to be associated with increased mortality.

Histopathological evaluation of mesenchymal stem cells in the healing of anastomosed carotid arteries.

The objective of this study was to evaluate the influence of mesenchymal stem cells on the healing of experimental carotid artery anastomoses histopathologically. Twenty-four female Sprague-Dawley rats were used in this study. After random separation of the subjects into two groups, in both groups carotid arteries were transected and anastomosed in end-to-end fashion. Anastomoses were locally treated with 1 ml 0.09% NaCl, and 1 ml mesenchymal stem cell suspension (1×106 cells) in control and trial groups, respectively. Anastomoses were wrapped with an 8 mm sheet of surgicel and soaked with BioGlue in order to sequestrate the stem cells. After patencies were confirmed via Doppler USG, surgical site was closed with 2/0 silk sutures. Histopathological evaluation was carried out after 4 weeks. In respect to endothelial continuity, vessel patency (along with presence or absence of restenosis), integrities of internal and external elastic laminae, muscularis and adventitia; no statistically significant differences were present between the trial and control groups. In Trial and Control Groups, luminal thrombus was present in 8 (66.6%) and 3 (25%) of the 12 subjects, respectively. The difference was statistically significant (P < 0.05). Recanalization was present in 6 subjects in trial group; 1 subjects in Control Group, respectively. Our results suggest that local administration of mesenchyme stem cell does not have a positive influence on success of an anastomosis.

The segments and the inferior boundaries of the odontoid process of C2 based on the magnetic resonance imaging study.

AIM: The aims of this clinical study were to describe the segments and the inferior boundaries of the odontoid process as regards the embryological development of C2 based on the magnetic resonance imaging finding. MATERIAL AND METHODS: Cranial and cervical magnetic resonance images including occiput, C1, and C2, and those obtained for different reasons such as evaluation of cranial and upper cervical pathology were re-evaluated for this study. Synchondroses around the odontoid process were accepted as the boundaries between the neural arch and the body of C2. RESULTS: Thirty cases were included for this study. Fifteen of these were adult cases and the remaining 15 were in pediatric cases. Apicodental, dentocentral, neurocentral, and dentoneural synchondrotic articulations were clear, especially under the ages of 3 years. The dentocentral synchondrosis was found well below the line drawn through the level of superior articulating facets. CONCLUSION: This study demonstrated that the inferior boundary of the odontoid process is not located at the level of superior articulating facets. The real border between the odontoid process and the body of C2 is located well below the level of the superior articulating facets because of the location of the dentocentral synchondrotic articulation. This level should be considered in the classification of C2 fractures.

Ultrasound examination in the surgical treatment of lower extremity peripheral nerve injuries: part II.

OBJECTIVE: The aim of this clinical study was to evaluate the benefits of ultrasonographic imaging in the surgical treatment of lower extremity peripheral nerve lesions. METHODS: Peripheral nerves in the lower extremity were evaluated by using real-time ultrasonographic examination. The capability of ultrasonography in terms of determination the type of injury, the position of the proximal and distal nerve stumps, the presence or absence of a neuroma, and perilesional scar tissue were evaluated. RESULTS: Twenty-two cases with lower extremity peripheral nerve injuries aged between 21-52 years old were included in this study. Five (23%) had femoral nerve injuries and 17 (77%) sciatic nerve injuries. A total nerve transsection was diagnosed in 1 (5%) case while the remaining 21 (95%) cases had incomplete sectioning of the nerves. CONCLUSION: Preoperative and intraoperative ultrasonography for lower extremity peripheral nerve lesions may be used in the description of the degree of injury, determination of complete or incomplete nerve sectioning, the presence of hematoma and foreign body, the continuity of the nerve, determination of nerve stumps, perilesional scar tissue, and the presence of neuroma.

Ultrasound examination in the surgical treatment for upper extremity peripheral nerve injuries: part I.

AIM: The aim of this clinical study was to evaluate the benefits of ultrasonographic imaging in the surgical treatment of upper extremity peripheral nerve lesions. MATERIAL AND METHODS: Peripheral nerves in the upper extremity were evaluated by using real-time ultrasonographic examination. The capability of ultrasonography in terms of determination the type of injury, the position of the proximal and distal nerve stumps, the presence or absence of a neuroma and perilesional scar tissue were evaluated in cases with peripheral nerve injury. RESULTS: Thirty-six cases with upper extremity peripheral nerve injury aged between 24 and 60 years were included in this study. Four (11%) had brachial plexus injury, 9 (26%) ulnar nerve injury, 6 (16%) radial nerve injury and the remaining 17 (47%) cases had median nerve injury. The capability of ultrasonographic examination was satisfactory for all evaluation parameters. CONCLUSION: Preoperative and intraoperative ultrasonography for upper extremity peripheral nerve lesions may be used in the description of the degree of injury, determination of complete or incomplete nerve sectioning, the presence of hematoma and foreign body, the continuity of the nerve, determination of nerve stumps and perilesional scar tissue, and the presence of neuroma.

Segmental artery pseudoaneurysm associated with thoracic spinal fracture.

Segmental artery pseudoaneurysm is a rare complication of spinal trauma. We present an unusual case of thoracic 11-12 segmental artery pseudoaneurysm caused by thoracal spine fracture. A 72-year-old man was admitted to our emergency department because of a car accident. Neurological examination revealed complete motor and sensorial deficiency below the level of T10. Direct x-ray of the thoracic and lumbar spine was performed together with Computerized Tomography (CT) at the level of T9-10-11. Magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) were also performed. X-ray revealed anterior displacement of thoracic 10 with the burst fracture of thoracic 11 vertebral bodies. The computerized tomography (CT) of this region showed a pseudo-aneurysm formation located in the left aortic region. Surgical decompression and stabilization of the involved thoracic vertebras was performed. After surgery, the patient was referred to cardiovascular surgery and endovascular radiology department for further treatment of the pseudoaneurysm.

A fracture of unilateral pars interarticularis of the axis: a case report.

OBJECTIVE: To present a case of a fracture of the unilateral pars interarticularis of the C2. METHODS: There is confusion in the use of anatomic terminology of the pars interarticularis and pedicle of the C2 in literature. A fracture of the unilateral pars interarticularis of the C2 was diagnosed and treated nonsurgically by a Philadelphia collar. RESULT: The patient was free of pain and obtained a full range of motion. CONCLUSION: The presumed mechanism of injury in the fracture described here was hyperextension and axial loading.

Ultrasonographically checking the sectioning of the transverse carpal ligament during carpal tunnel surgery with limited uni skin incisions.

AIMS: The goal of this clinical study was to evaluate the capability of intraoperative ultrasonographical examination to demonstrate the sectioning of the transverse carpal ligament during open surgical treatment of carpal tunnel syndrome with limited uni skin incision (mini skin incision technique). METHODS AND MATERIAL: Intraoperative ultrasonography was used in the detection of complete sectioning of the transverse carpal ligament, and sufficient release of median nerve. Thirty-two female cases were operated with the limited uni skin incision technique. Intraoperative ultrasonography showed the sectioned transverse carpal ligament in all cases. RESULTS: We adopted the sonographic examination to check the ligament during surgical intervention. The capability of ultrasonography is sufficient to demonstrate the median nerve and transverse carpal ligament especially when performing limited uni mini skin incision technique for carpal tunnel surgery. CONCLUSIONS: We suggest the use of ultrasonography for intraoperative checking of the sectioning of the transverse carpal ligament during the surgical treatment of carpal tunnel syndrome with limited uni skin incision.

Cortical anastomotic veins occlusion in the rat including the assessment of cerebral swelling.

A rat model composed of the sacrifice of the anterior and posterior cortical anastomotic veins by microsurgical techniques was used for the assessment of brain swelling. Twenty male, 15-week-old Sprague-Dawley rats were used in this animal experiment. Small burr-holes were made over the anterior (the intersection of the line drawn from the posterior border of the orbital rim and the line drawn along the para-midline to the superior sagittal suture) and posterior (inferior point of the posterior end of the zygomatic arch) anastomotic veins. After performing a final inspection and describing the venous vessels, they were sacrificed using bipolar coagulation technique and micro-scissors. Specimens were evaluated using histopathological approach, albumin immunostaining technique and a stereological method. Hemispheric swelling, midline shift, brain oedema, subcortical petechial haemorrhagia, ischemia and necrosis were histopathological findings observed in this experimental study. The albumin immunostaining study demonstrated disrupted areas of the blood-brain barrier in the operated hemisphere. Stereological volumetric analysis revealed an 8% brain swelling in the operated hemispheres compared with unoperated ones. Our results suggest that the sacrifice of the anterior and posterior anastomotic veins may be used as an experimental rat model in the evaluation of brain damage and swelling caused by the occlusion of the venous anastomotic outflow.

Electrophysiological and histopathological effects of mesenchymal stem cells in treatment of experimental rat model of sciatic nerve injury.

AIM: The aim of this study was to evaluate electrophysiological and histopathological effects of mesenchymal stem cells in treatment of sciatic nerve injury. MATERIAL AND METHODS: Thirty-two female Spraque-Dawley rat were used in this study. Eight rats were used as a reference group in electrophysiological analysis for evaluation of non-injured nerve recordings (Control Group). Twenty-four rats were used for experimental evaluation. Twelve rats were anastomosed without treatment with mesenchymal stem cells (Sham Group) and twelve other rats were anastomosed and treated with mesenchymal stem cells (Stem Cell Group). Surgicel and bioglue were used in anastomosed line in both Groups. Eight weeks after the surgery, electrophysiological evaluation of rats was performed and, then, rats were decapitated under anesthesia and specimens including sciatic nerves and anastomosed line were taken for histopathological evaluation. Electromyography and nerve conduction velocity testing and histopathological scoring including rate of Wallerian degeneration, and neuroma and scar formation were evaluated for both Groups. RESULTS: There were no statistically significant differences between Sham and Stem Cell Groups with respect to histopathological evaluation. However, nerve conduction velocity showed significant difference between groups (P = 0.001). Nerve conduction velocity was significantly improved in Stem Cell Group when compared to Sham Group. CONCLUSION: In this study, based on nerve conduction velocity data, it was concluded that treatment with mesenchymal stem cells during end-to-end anastomosis improves functional regeneration.

Use of intraoperative ultrasonography during the surgical repair of pediatric cystic spinal dysraphism--technical note.

The present study investigated the benefits of intraoperative ultrasonographic guidance during the surgical repair of congenital cystic spinal dysraphic lesions. Twenty-one children with cystic spinal dysraphism who underwent surgical repair were examined by real-time ultrasonography during the surgical intervention. Five children had meningoceles, six had myelomeningoceles, four had open neural plaques, three had lipomyelomeningoceles, and three had diastematomyelia. Visualization of the cystic compartments, identification of the neural structures, and identification and localization of the associated lesions were all reliably achieved in all cases. Intraoperative ultrasonographic guidance could determine the type of lesion and the associated lipomas, ectopic tissues, dermoid and epidermoid cysts, and doubling of the spinal cord, and locate diastematomyelic spurs, bands, and adhesions. Components filled with cerebrospinal fluid appeared as anechoic areas, and lipomas as hyperechoic. Intraoperative ultrasonographic guidance allowed the surgeon to correlate the complex anatomy identified on preoperative computed tomography and magnetic resonance imaging to the surgical site during the operation. Better orientation to the defect allows appropriate repair of the lesion with optimal preservation of neural tissues.

Shoulder traction device for enhanced conventional fluoroscopy during cervical spine operations.

Conventional biplanar fluoroscopic imaging of the cervical spine is commonly used during cervical spinal surgery. We designed an intraoperative traction device to prevent shoulder superimposition on the cervical fluoroscopic imaging. During surgery at the stage of fluoroscopic examination, an operator can apply traction via the traction band of the device. This device is safe and easy to use, and can be preoperatively fitted to patients. Fluoroscopic images obtained with the new traction device were definitely superior compared with images obtained without the traction device. This device may be useful in cases with difficult fluoroscopic imagination of the lower cervical spine.

Use of topical landmarks for percutaneous projection of intracranial tumors for neurosurgical oncology.

AIM: The objective of this study was to introduce a surgical navigation method which provides a safe, quick and effective access to cortical and subcortical tumors, along with a review of other methods in use for this purpose. MATERIAL AND METHODS: 53 patients have been operated using this technique. The area overlying the tumor is shaved and one half of a smoothly cut hazelnut is taped on the skin. The precise localization of the hazelnut is confirmed with MRI and then stained. After general anesthesia, the stained impression is projected firstly to the bone, dura and then cortex respectively by the Midas Rex cutting tip. Cortical landmarks surrounding the tumor's cortical projection are further confirmed with ultrasonography. RESULTS: After removal, cortical and subcortical tumors were separately graded for efficiency. Grade 1 and 2 were accepted as precise access. Our method accordingly yielded 95.2% and 90.6% success rates for cortical and subcortical tumors respectively. CONCLUSION: Considering the method's success rate along with its inexpensiveness and modest technical requirements, it is believed that this method can be of widespread use.

Hippocampal cell loss after an anterior and posterior anastomotic vein occlusion model in rats.

Estimation of the cell number after cortical venous ischemia/infarction induced by anterior and posterior anastomotic veins occlusion in a rat model is very important. Twenty male Sprague-Dawley rats were used in this experiment. Small burr-holes were made over the anterior (the crossing point of the line drawn from the posterior border of the orbital rim and the line drawn along the para-midline to the superior sagittal suture) and posterior (just inferior point of the posterior ending of the zygomatic arch) anastomotic veins. Bipolar coagulation technique and micro-scissor were used to sacrifice the venous vessels after final inspection and description. Specimens were evaluated by histopathological and unbiased stereological methods for microscopic evaluation and volumetric analysis, respectively. Significant cell loss was seen in the pyramidal and granule cells of the cornu ammonis and dentate gyrus of the hippocampus after venous ischemia. Cell loss was also pronounced when seen in the histological examination. The present results suggest that the sacrifice of anterior and posterior anastomotic veins can be used as an experimental rat model in the evaluation of pyramidal and granule cell loss in the hippocampus that often assesses the neural damage inflicted by this intervention.

The borders of the odontoid process of C2 in adults and in children including the estimation of odontoid/body ratio.

The odontoid process of C2 projects upward from the superior roof of the body of C2. There is a confusion about the inferior border of the odontoid. The aims of this clinical study were to describe the inferior border of the odontoid process based on the remnant of dentocentral synchondrosis in adults, and the estimation of the odontoid/body ratio in pediatric and adult ages. Sixty-six cases were included for this study. Forty-four of them were in adult ages and the remaining 22 of them were in pediatric ages. The region of occiput, C1, C2, and C3, was examined with the magnetic resonance imaging (MRI) in all cases. The length of the odontoid process was estimated by using radiological images of MR from the tip of the odontoid to the remnant of dentocentral synchondrosis. The portion located under the level of synchondrosis was considered as the body of C2. The average length of the odontoid was 18. 6 mm in pediatric and 21. 3 mm in adult cases. In adult females, the length of the odontoid process (19. 1 mm in length) was smaller than those of adult males (23. 6 mm in length). The average ratio of odontoid/body was two in pediatric and 1.8 in adult cases. This study demonstrated that the neck of the odontoid segment at the level of superior articulating facets is not the synchondrosis between the odontoid process and the body of C2. The synchondrosis is located well below the level of superior articulating facets. It can be demonstrated with sagittal and coronal images of MR in both of pediatric and adult individuals.