Risk factors associated with mortality and survival of acute subdural hematoma: A retrospective study.

BACKGROUND: Acute subdural hematoma (ASDH) is mostly seen after head injury and is a major cause of morbidity and mortality. We studied the risk factors for ASDH and the effects of these factors on mortality as well as on survival with 100 cases from the rural area of Anatolia region. MATERIALS AND METHODS: One-hundred cases of the ASDH that had been treated surgically between 2011 and 2014, at three different health-care centers from the rural area of Anatolia region, were retrospectively reviewed. Demographic data of patients, etiology, Glasgow Coma Scale (GCS) on admission, survival, presence of comorbid disease, unilaterality or bilaterality of the hematoma, and length of stay in the Intensive Care Unit (ICU) and/or neurosurgery clinic were recorded from the patients' files. RESULTS: The total mortality rate was 34%. Age, etiology, GCS on admission, and laterality of the hematoma (unilateral or bilateral) affected the mortality rates (P = 0.005, P = 0.001, P = 0.001, and P = 0.001, respectively). Advanced age, low GCS on admission, and bilaterality of the hematoma were related with high mortality rates (P = 0.005, P = 0.001, and P = 0.001, respectively). The presence of comorbid disease and gender had no effect on patient survival (P = 0.299 and P = 0.861). CONCLUSION: The most important factors affecting the mortality rate were GCS on admission, etiology, age, and laterality of the hematoma in this study. Advanced age, low GCS on admission, and bilaterality of the hematoma were related with high mortality rates. Etiology had an important role in mortality rates, especially in the pedestrian injury group.

Relationship between hydrocephalus etiology and ventriculoperitoneal shunt infection in children and review of literature.

OBJECTIVE: The purpose of this retrospective study was to clarify the relationship of shunt infection to childhood hydrocephalus etiology. METHODS: We analyzed 1021 patients with childhood hydrocephalus who underwent V-P shunting over a period of approximately 15 years. The etiology of 1021 patients include myelomeningocele (794 patient), congenital (165 patient) and intraventricular haemorrhage (62 patient). RESULTS: Of the 1021 patients who underwent V-P shunting, 19.32% exhibited shunt infection. Shunt infection developed in 180 (22.67%) of 794 patients with myelomeningocele, 9 (5.45%) of 165 patients with congenital obstructive hydrocephalus, and 9 (14.51%) of 62 patients with intraventricular haemorrhage. Recurrent shunt infection was detected in 54 (27.27%) of 198 patients with a previous shunt infection. CONCLUSIONS: Patients with previous shunt infection as well as those with shunts associated with myelomeningocele were observed to be at a greater risk for shunt infection. Results indicated that patients with congenital obstructive hydrocephalus may be less prone to shunt infections.

Resveratrol Treatment Prevents Hippocampal Neurodegeneration in a Rodent Model of Traumatic Brain Injury.

AIM: Traumatic brain injury (TBI) is a complex process. Increasing evidence has demonstrated that reactive oxygen species contribute to brain injury. Resveratrol (RVT) which exhibits significant antioxidant properties, is neuroprotective against excitotoxicity, ischemia, and hypoxia. The aim of this study was to evaluate the neuroprotective effects of RVT on the hippocampus of a rat model of TBI. MATERIAL AND METHODS: Twenty eight rats were divided into four groups. A moderate degree of head trauma was induced using Feeney"s falling weight technique. Group 1 (control) underwent no intervention or treatment. Head trauma was induced in Group 2 (trauma) and no drug was administered. Head trauma was induced in Group 3 and low-dose RVT (50 mg/kg per day) was injected. In Group 4, high-dose RVT (100 mg/kg per day) was used after head trauma. Brain tissues were extracted immediately after perfusion without damaging the tissues. Histopathological and biochemistry parameters were studied. RESULTS: Brain tissue malondialdehyde (MDA) levels in the trauma group were significantly higher than those in the control, lowdose RVT-treated, and high-dose-RVT-treated groups. The superoxide dismutase (SOD) levels in the control group were significantly higher than those in the trauma, low-dose RVT-treated, and high-dose RVT-treated groups. Glutathione peroxidase (GSH-Px) levels in the control group were significantly higher than those in the trauma and low-dose RVT-treated groups. The level of oxidative deoxyribonucleic acid (DNA) damage (8-OHdG/106 dG) in the trauma group was higher than that in the control group, low-dose RVT-treated, and high-dose RVT-treated groups. CONCLUSION: Resveratrol has a healing effect on neurons after TBI.

Rapidly Progressive Spontaneous Spinal Epidural Abscess.

Spinal epidural abscess (SEA) is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI) remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.

Powder Topical Rifampin for Reducing Infections After Neural Tube Defect Surgery in Infants.

OBJECTIVE: The correct timing and technique of neural tube defect (NTD) repairs significantly decrease the morbidity and mortality of NTD cases. However, infections related to the surgery are still common. We investigated the effects of topical rifampin combined with routine prophylaxis in newborns with open NTDs. METHODS: This retrospective study included 86 patients who had undergone NTD surgery. The experimental group comprised 30 patients who were started on topical rifampin before surgery, and the control group comprised 56 patients who were not administered topical rifampin. Surgical site infections (SSIs) and meningitis/ventriculoperitoneal (VP) shunt infections that developed within 6 months after the surgical intervention were evaluated. RESULTS: In the postoperative period, meningitis/VP shunt infections and SSIs were observed in 6.7% and 3.3%, respectively, of the experimental group treated with topical rifampin. Meningitis/VP shunt infections and SSIs were observed in 37.5% and 21.4%, respectively, of the control group. External ventricular drainage and not using topical rifampin were identified as important relative risk (RR) factors for meningitis/VP shunt infections (RR 19.28, 95% confidence interval [CI] [3.53, 105.33], P = 0.001; RR 18.10, 95% CI [2.38, 137.68], P = 0.005). A flap transposition, cerebrospinal fluid leaks, and not using topical rifampin were identified as RR factors for SSIs (RR 22.21, 95% CI [4.81, 102.47], P < 0.001; RR 13.04, 95% CI [1.22, 139.33], P = 0.034; RR 7.09, 95% CI [1.12, 53.99], P = 0.042). We did not observe any local or systemic side effects resulting from the use of rifampin. CONCLUSIONS: The use of topical rifampin is an easy and effective method for reducing SSIs and meningitis/VP shunt infections related to NTD surgery.

Imaging Findings for Bilateral Giant Vestibulocochlear Schwannoma.

Neurofibromatosis type 2 mostly develops with multiple neoplasms of the central and peripheral nervous system and is associated with ocular abnormalities. The presented case is a 19-year-old female patient with bilateral vestibulocochlear schwannomas in both pontocerebellar corners, intradural intra-extramedullary masses, and multiple neurofibromas in the spinal canal. The clinical picture for NF-2, also called central neurofibromatosis, is completely different from von Recklinghausen disease. Untreated bilateral vestibulocochlear schwannoma may cause hydrocephalus in NF-2, and lead to death. Therefore, it is recommended to carefully monitor and treat bilateral vestibulocochlear schwannoma in accordance with its stage.

Effects of Low-Intensity Treadmill Exercise on Sciatic Nerve in Experimental Diabetic Neuropathy.

OBJECTIVE: To investigate the potential beneficial effects of low-intensity exercise on histopathological changes of sciatic nerves in streptozotocin (STZ)-induced diabetic rats. STUDY DESIGN: The rats were allotted randomly into 3 experimental groups: A (control), B (diabetic untreated), and C (diabetic treated with low-intensity exercise); each group contained 8 animals. Groups B and C received STZ. Diabetes was induced in 2 groups by a single intraperitoneal injection of STZ (40 mg/kg, freshly dissolved in 0.1 M citrate buffer, pH 4.2). Two days after STZ treatment, diabetes in 2 experimental groups was confirmed by measuring blood glucose levels. Rats with blood glucose levels ≥ 250 mg/dL were considered to be diabetic. Animals in the exercise group were made to run the treadmill once a day for 4 consecutive weeks. Exercise started 3 days prior to STZ administration. RESULTS: The treatment of low-intensity exercise caused a sharp decrease in the elevated serum glucose and an increase in the lowered serum insulin concentrations in STZ-induced diabetic rats. STZ induced a significant decrease in the area of insulin-immunoreactive ß cells. Low-intensity exercise treatment resulted in increased area of insulin-immunoreactive ß cells signficantly. Myelin breakdown decreased significantly after treatment with low intensity exercise. The ultrastructural features of degenerated axons also showed remarkable improvement. CONCLUSION: We believe that further preclinical research into low-intensity exercise may indicate its usefulness as a potential treatment for peripheral neuropathy in STZ-induced diabetic rats.

Decreased Vertebral Artery Hemodynamics in Patients with Loss of Cervical Lordosis.

BACKGROUND Because loss of cervical lordosis leads to disrupted biomechanics, the natural lordotic curvature is considered to be an ideal posture for the cervical spine. The vertebral arteries proceed in the transverse foramen of each cervical vertebra. Considering that the vertebral arteries travel in close anatomical relationship to the cervical spine, we speculated that the loss of cervical lordosis may affect vertebral artery hemodynamics. The aim of this study was to compare the vertebral artery values between subjects with and without loss of cervical lordosis. MATERIAL AND METHODS Thirty patients with loss of cervical lordosis and 30 controls matched for age, sex, and body mass index were included in the study. Sixty vertebral arteries in patients with loss of cervical lordosis and 60 in controls without loss of cervical lordosis were evaluated by Doppler ultrasonography. Vertebral artery hemodynamics, including lumen diameter, flow volume, peak systolic velocity, end-diastolic velocity, and resistive index, were measured, and determined values were statistically compared between the patient and the control groups. RESULTS The means of diameter (p=0.003), flow volume (p=0.002), and peak systolic velocity (p=0.014) in patients were significantly lower as compared to controls. However, there was no significant difference between the 2 groups in terms of the end-diastolic velocity (p=0.276) and resistive index (p=0.536) parameters. CONCLUSIONS The present study revealed a significant association between loss of cervical lordosis and decreased vertebral artery hemodynamics, including diameter, flow volume, and peak systolic velocity. Further studies are required to confirm these findings and to investigate their possible clinical implications.

The acute effects of thymoquinone on acute peripheral nerve injury: an experimental study.

BACKGROUND: The purpose of this study was to evaluate the acute effects of thymoquinone (TQ) on acute nerve injury. METHODS: A rat model of crush injury of the sciatic nerve was used. Animals were divided into 3 groups: control, trauma, and TQ treatment groups (n=6 per group). Seven days after injury, sciatic nerve specimens were obtained from the site of the injury and analyzed histologically and stereologically. Axon diameter, myelin thickness, and axon density were measured. RESULTS: There were no significant differences in axon diameter, myelin thickness, or axon density among groups. CONCLUSION: TQ has no acute therapeutic effect on acute nerve injury.

Neuroprotective Effects of Thymoquinone on the Hippocampus in a Rat Model of Traumatic Brain Injury.

BACKGROUND: Traumatic brain injury is a leading cause of morbidity and mortality worldwide. We evaluated the neuroprotective effects of thymoquinone (TQ) in a rat model of traumatic brain injury by using biochemical and histopathologic methods for the first time. MATERIALS AND METHODS: Twenty-four rats were divided into sham (n = 8), trauma (n = 8), and TQ-treated (n = 8) groups. A moderate degree of head trauma was induced with the use of Feeney's falling weight technique, and TQ (5 mg/kg/day) was administered to the TQ-treated group for 7 days. All animals were killed after cardiac perfusion. Brain tissues were extracted immediately after perfusion without damaging the tissues. Biochemical procedures were performed with the serum, and a histopathologic evaluation was performed on the brain tissues. Biochemical experiments included malondialdehyde (MDA), reduced and oxidized coenzyme Q10 analysis, DNA isolation and hydroylazation, and glutathione peroxidase, and superoxide dismutase analyses. RESULTS: Neuron density in contralateral hippocampal regions (CA1, CA2-3, and CA4) 7 days after the trauma decreased significantly in the trauma and TQ-treated groups, compared with that in the control group. Neuron densities in contralateral hippocampal regions (CA1, CA2-3, and CA4) were greater in the TQ-treated group than in the trauma group. TQ did not increase superoxide dismutase or glutathione peroxidase antioxidant levels. However, TQ decreased the MDA levels. CONCLUSIONS: These results indicate that TQ has a healing effect on neural cells after head injury and this effect is mediated by decreasing MDA levels in the nuclei and mitochondrial membrane of neurons.

A Single-Center Experience of CNS Anomalies or Neural Tube Defects in Patients With Jarcho-Levin Syndrome.

Jarcho-Levin syndrome (JLS) is a genetic disorder characterized by distinct malformations of the ribs and vertebrae, and/or other associated abnormalities such as neural tube defect, Arnold-Chiari malformation, renal and urinary abnormalities, hydrocephalus, congenital cardiac abnormalities, and extremity malformations. The study included 12 cases at 37-42 weeks of gestation and diagnosed to have had Jarcho-Levin syndrome, Arnold-Chiari malformation, and meningmyelocele. All cases of Jarcho-Levin syndrome had Arnold-Chiari type 2 malformation; there was corpus callosum dysgenesis in 6, lumbosacral meningmyelocele in 6, lumbal meningmyelocele in 3, thoracal meningmyelocele in 3, and holoprosencephaly in 1 of the cases. With this article, the authors underline the neurologic abnormalities accompanying Jarcho-Levin syndrome and that each of these abnormalities is a component of Jarcho-Levin syndrome.

Prognostic Factors in Oligodendrogliomas: a Clinical Study of Twenty-Five Consecutive Patients.

BACKGROUND: The purpose of this study was to evaluate the prognostic significance of Ki-67 and subjective microvascular density (SMVD) indexes together with other factors in patients with oligodendroglioma. MATERIALS AND METHODS: In this retrospective study, oligodendroglioma specimens obtained from twenty-five consecutive patients were evaluated for Ki-67 and SMVD indices to help determine histological grading and investigate the fidelity of these markers in clinical prognosis. Other potentially prognostic factors were Karnofsky performance scale, tumor histological grade, and adjuvant radiotherapy. RESULTS: The Ki-67 proliferation index appeared to have a strong correlation with the grade of the tumor and the survival. Age, gender, adjuvant radiotherapy, surgical resection type (complete versus incomplete) did not have any influence on recurrence. The SMVD index correlated significantly with the 3 to 5-year survival. CONCLUSIONS: Ki-67 and MVD indexes are important and useful markers in estimating the prognosis of oligodendrogliomas.

The effect of disease control on mean platelet volume and red blood cell distribution in patients with acromegaly.

OBJECTIVES: Several studies have shown increased atherogenic risk factors and biomarkers of inflammation and atherosclerosis in association with growth hormone excess. Mean platelet volume (MPV) and red blood cell distribution (RDW) are currently gaining interest as new independent cardiovascular risk factors. The aim of this study was to evaluate the effect of disease control on MPV and RDW in acromegaly patients. MATERIALS AND METHODS: We retrospectively enrolled 36 acromegaly patients (23 males, 13 females; mean age 41.94 ± 11.55). Patients were divided into two groups: disease controlled by surgical treatment alone (group A) or by somatostatin analog (SSA) therapy (group B). MPV and RDW measurements were evaluated during active and inactive disease periods in the two groups. RESULTS: There were statistically significant increases in MPV and RDW in patients receiving SSA therapy (P = 0.012 and P = 0.020, respectively). The differences in MPV and RDW changes in patients receiving surgical treatment alone were not statistically significant (P=0.364 and P=0.339, respectively). CONCLUSIONS: This is the first report on the evaluated the effect of disease control on MPV and RDW in acromegaly patients. Our study results showed that MPV and RDW measurements are significantly increased in acromegaly patients with disease controlled by SSA therapy. Therefore, acromegalic patients treated with SSAs may have increased cardiovascular risk based on an increase in MPV and RDW.

Spontaneous Rupture of the Middle Fossa Arachnoid Cyst into the Subdural Space: Case Report.

BACKGROUND: Arachnoid cysts are congenital, benign and intra-arachnoidal lesions. A great majority of arachnoid cysts are congenital. However, to a lesser extent, they are known to develop after head trauma and brain inflammatory diseases. Arachnoid cysts are mostly asymptomatic and they can develop anywhere in the brain along the arachnoid membrane. CASE REPORT: Arachnoid cysts form 1% of the non-traumatic lesions which occupy a place and it is thought to be a congenital lesion developed as a result of meningeal development abnormalities or a lesion acquired after trauma and infection. There is a male dominance at a rate of 3/1 in arachnoid cysts which locate mostly in the middle fossa. Our patient was a 2-years-old boy. CONCLUSIONS: As a conclusion, spontaneous subdural hygroma is a rare complication of the arachnoid cysts. Surgical intervention could be required in acute cases.

How frequently external ventricular drainage device should be changed in children with ventriculoperitonel shunt infection?

OBJECTIVE: The purpose of the presenting study was to determine how frequently external ventricular drainage (EVD) device should be changed in children with ventriculopertienal shunt (VPS) infection during prolonged intravenous antimicrobial therapy. METHODS: In this retrospective study, 25 children with VPS infection were evaluated between January 2012 and December 2013. In these children VPS was surgically removed and appropriate antimicrobial therapy was administered according to cerebrospinal culture results. Data noted about how frequently EVD device had been changed, the number of cells on direct observation of cerebrospinal fluid (CSF), glucose and protein levels of CSF, and CSF culture results were obtained from patients' records. RESULTS: Total 25 children were included in the study. The median age was three months (1 and 65 months). In 44% of children, Staphylococcus epidermidis was isolated. During treatment period, EVD catheter has changed one to six times. A total of 68 EVD catheters were changed in these patients. When the duration of ventriculostomy catheter and leukocyte count in CSF were evaluated on daily basis, leukocyte count was decreased 5 units per day in children whose catheter remained less than 10 days. However, in children whose catheter remained more than 10 days leukocyte count was decreased 2.21 units per day. CONCLUSIONS: In children with VPS infection, EVD device should be changed at every 10 days for the rapid resolution of the infection.

The effects of caffeic acid phenethyl ester on inflammatory cytokines after acute spinal cord injury.

BACKGROUND: The purpose of this study was to investigate the effects of Caffeic Acid Phenethyl Ester (CAPE) on proinflammatory cytokines, IL-1ß and TNF-α, and explore its healing effect after acute spinal cord injury. METHODS: Forty-eight male Wistar-Albino rats were used in this study which was planned as three groups. All groups were divided into two sub-groups. Group 1a was the control group, in which only lower segment thoracic laminectomy was performed. In group 1b, spinal cord trauma was performed with aneurysm clip. In the second group, serum physiologic was given systemically thirty minutes after trauma, and rats were sacrificed after the first and sixth hour. In the third group, CAPE was given systemically thirty minutes after trauma, and rats were sacrificed after the first and sixth hour. Serum IL-1ß and TNF-α levels were analyzed by ELISA in the serum. Histopathological analysis was performed in damaged cord tissues. RESULTS: CAPE suppressed TNF-α and IL-1ß levels in the serum. In histopathological evaluation, it was detected that CAPE decreased hemorrhage and necrosis. CONCLUSION: CAPE suppresses the levels of proinflammatory cytokines, TNF-α and IL-1ß, after acute spinal cord injury in the early phase and contributes to the healing process.

Does the removal of spinal implants reduce back pain?

BACKGROUND: The importance of the removal of spinal implants is known in the presence of infection. However, the benefits and/or risks of the removal of spinal implant for the management of back pain are not clear. METHODS: In this retrospective study, we aimed to evaluate the beneficial effects of the removal of spinal implants for back pain. Study included 25 patients with thoracolumbar instrumentation. RESULTS: Seventeen (68%) of them were male. Indications for spinal instrumentation were vertebra fracture (n = 9), iatrogenic instability due to multiple segment laminectomy (n = 12), and instrumentation after recurrent disk herniations (n = 4). Mean visual analog score (VAS) before the removal was 8.08. Mean VAS was 3.36 after the removal. Spinal instruments were removed after the observance of the presence of fusion. All patients were prescribed analgesics and muscle relaxants for 3 weeks before removal. Back pain did not decrease in five (20%) patients in total. Four of them had been instrumented due to recurrent lumbar disk herniation. None of the patients reported the complete relief of pain. CONCLUSION: In conclusion, patients should be cautioned that their back pain might not decrease after a successful removal of their instruments.

Factors affecting infection development after meningomyelocele repair in newborns and the efficacy of antibiotic prophylaxis.

AIM: The purpose of this study was to evaluate the clinical and surgical variables that may be associated with wound infection and meningitis/ventriculoperitoneal (VP) shunt infection in newborns diagnosed with meningomyelocele (MMC), as well as the efficacy of antibiotic prophylaxis in reducing these complications. MATERIAL AND METHODS: The data of 91 neonates diagnosed with MMC, who underwent surgical intervention between May 2012 and December 2014, were retrospectively evaluated. Multivariant logistic regression analysis was used to determine the possible clinical and neurosurgical variables associated with meningitis/VP shunt infection and surgical wound infection. Spearman's test was performed for the correlation analysis. RESULTS: Following MMC closure, of the 91 neonates, 18 (16.4%) developed meningitis/shunt infection and 12 (11%) developed surgical wound infection. The operation time was not a significant independent risk factor for the development of meningitis (RR 0.618 [0.199-1.922], p = 0.406). Open neural placodes that were not covered by any pseudomembrane (myeloschisis), external ventricular drainage (EVD) use, and flap transposition were determined as significant relative risk factors for the development of meningitis (RR 8.655 [2.329-32.157], p = 0.001; RR 9.404 [1.183-74.743], p = 0.034; RR 8.125 [2.496-26.448], p = 0.001; and RR 3.150 [1.963-10.308], p = 0.048, respectively). Deep surgical wound infection was not correlated with the operation time or wound surface area. However, there was an intermediate but very significant positive correlation between meningitis and cerebrospinal fluid (CSF) leakage, length of hospitalization, and flap transposition (r = 0.377, 0.420, 0.357, and 0.503, respectively; for all values, p < 0.001). CONCLUSIONS: There was no association between MMC closure and development of infection. Since it carries a high risk for the development of meningitis, the EVD system should be avoided unless necessary. Routine prophylactic antibiotic use did not reduce the infection risk in MMC repair surgery. Thus, antibiotics should not be used if there are no risk factors predisposing to infection.

Intracranial Meningioma Diagnosed during Pregnancy Caused Maternal Death.

Brain tumors are rarely diagnosed during pregnancy. Accelerated growth of intracranial meningiomas during pregnancy sometimes requires urgent surgical intervention. We describe a 41-year-old pregnant woman with severe neurological decompensation requiring immediate neurosurgery. Cesarean section resulted in maternal death. Meningioma diagnosed during a viable pregnancy should be managed according to the severity of maternal neurological symptoms and gestational age of pregnancy. Early intervention for intracranial tumors during pregnancy may save maternal and fetal lives.

Co-occurrence of lumbar spondylolysis and lumbar disc herniation with lumbosacral nerve root anomaly.

Lumbosacral nerve root anomalies are the leading cause of lumbar surgery failures. Although co-occurrence of lumbar spondylolysis and disc herniation is common, it is very rare to observe that a nerve root anomaly accompanies these lesions. A 49-year-old male patient presented with sudden-onset right leg pain. Examinations revealed L5/S1 lumbar spondylolysis and disc herniation. At preoperative period, he was also diagnosed with lumbosacral root anomaly. Following discectomy and root decompression, stabilization was performed. The complaints of the patient diagnosed with lumbosacral root anomaly at intraoperative period were improved at postoperative period. It should be remembered that in patients with lumbar disc herniation and spondylolysis, lumbar root anomalies may coexist when clinical and neurological picture is severe. Preoperative and perioperative assessments should be made meticulously to prevent neurological injury.