Intracranial hemangiopericytoma after radiation treatment: first case in the literature.

BACKGROUND: Radiation exposure is a known risk factor for meningioma but there are no data regarding hemangiopericytoma and radiation exposure. CASE DESCRIPTION: We report a 29-year-old pineoblastoma patient diagnosed with a hemangiopericytoma at a different location, after a successful surgical excision and adjuvant radiotherapy for the original tumor 4-year prior. CONCLUSION: Hemangiopericytoma emergence can be seen after radiotherapy.

Investigating the effects of subthalamic Nucleus-Deep brain stimulation on the voice quality.

Introduction: Deep brain stimulation (DBS) is a standard surgical treatment method which is generally applied to subthalamic nucleus in Parkinson's patients in cases where medical treatment is insufficient in treating the motor symptoms. It is known that Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) treats many motor symptoms. However, the results of studies on speech and voice vary. The aim of the study is analysing the effect of STN-DBS on the characteristics of voice.Materials/methods: A total of 12 patients, (8 male-4 female) with an age average of 58.8 ± 9.6, who have been applied DBS surgery on STN included in the study. The voice recordings of the patients have been done prior to surgery and 6 months after the surgery. The evaluation of voice has been carried out through the instrumental method. The patients' voice recordings of the /a,e,i/ vowels have been done. The obtained recordings were evaluated by the Praat programme and the effects on jhitter, shimmer, fundamental frequency (F0) and noise harmonic rate (NHR) were analysed.Results: Numerical values of F0 of all female participants have been decreased for all of the vowels postoperatively. In the females; jhitter and fraction parameters were found to be significantly different (0.056 and 0.017, perspectively) for the vowel /e/. In addition, p values in the shimmer for vowels /e,i/ were thought to be clinically significant (.087, .079 and .076) respectively. All these changes in second measurements were found to indicate worsening vocal quality after the DBS in females. In males, there is not any significant difference observed between two measures in any of the parameters of any vowels.Conclusions: Acoustic voice quality deteriorated after STN-DBS predominantly for females however this deterioration was not prominent audio-perceptually. This finding commented as a result of the fact that that voice quality deviance of the participants was not severe.

Posterior fossa astroblastoma in a child: a case report and a review of the literature.

A 4-year-old girl presented to the hospital with a progressive headache, difficulty walking, and persistent daily vomiting for 3 weeks. Papilledema was observed on fundoscopic examination. A large left cerebellovermian tumor with "bubbly" appearance was discovered. Total removal of the tumor mass was performed, and a diagnosis of low-grade astroblastoma was made. Adjuvant radiotherapy was performed due to the risk of recurrence. The patient is disease-free and has been kept on close follow-up for 6 months. The occurrence of posterior fossa astroblastoma has been rarely reported in the literature. Thus, when a "bubby" appearance enhancing cystic solid tumor is located on the cerebellar hemisphere in a child, an astroblastoma should also be included in the differential diagnosis.

The Surgical Treatment of a Large Cortical Atherosclerotic Middle Cerebral Artery Aneurysm Presenting With Parietal Lobe Infarction.

Distal MCA aneurysms are rarely seen in daily neurosurgical practice and they are, more commonly associated with infectious processes. Here, the authors present a 65-year-old, patient who had an atherosclerotic M4 segment located aneurysm. It was confirmed, that the aneurysm was not related with any infectious process. The patient had, presented clinically by a parietal infarction and she had been successfully operated. The neuronavigation system for this particular case aided us for a precise localization of the aneurysm and gave a chance for a smaller craniotomy.

Bilateral Central Foot Drop in a Pediatric Patient.

Foot drop is an inability to dorsiflex the ankle and toe. Primary causes of foot drop are compression or lesion of the 5th lumbar nerve and entrapment of the peroneal nerve at the head of the fibula. Rarely, some central nervous system lesions lead to foot drop. A 16-year-old boy was admitted with blunt head trauma that had happened in an assault. The muscle strength of the bilateral tibialis anterior, bilateral extensor digitorum longus and bilateral extensor digitorum brevis were Medical Research Council grade 1. Deep tendon reflexes of both ankles were hyperactive, with bilateral clonus and bilateral Babinski sign. There were cerebral contusions with peripheral edema in both motor strip areas extending anteriorly into the frontal lobes, with right-sided epidural-subdural hematoma. On brain MRI, the superior sagittal sinus was open. The epidural-subdural hematoma did not progress in its dimensions. The patient was treated conservatively. He recovered fully with regression of the contusions and epidural-subdural hematoma 4 months after the trauma. Foot drop due to upper motor neuron pathologies is more spastic in nature, different from what happens following lumbar disc herniation or peroneal nerve dysfunction. Treatment of central foot drop should be planned according to the underlying pathology.

Atretic cephaloceles: a comprehensive analysis of historical cohort.

PURPOSE: This study aims to analyze the historical cohort of patients with atretic cephaloceles (ACs) comprehensively, since the literature regarding ACs is limited by small case series or case reports and to report a new venous anomaly concomitant with a parietal AC in our exemplary case. METHODS: After a PubMed/Medline search with "atretic cephalocele" in April 2016, we retrieved 42 articles, 41 of which were relevant with the topic. Full texts of accessible articles and abstracts of inaccessible articles were read comprehensively. References of retrieved articles were manually searched. Additional 29 articles reporting the cases of atretic, rudimentary, occult, or sequestered cephaloceles were accessed, since these terms have been used interchangeably in the literature. RESULTS: Median age and mean age of the patients were 1 and 6.69 years, respectively. Female/male ratio was 1.03:1. Atretic cephaloceles were located in different regions, in decreasing order of frequency: parietal (55 %; n = 105), occipital (37 %; n = 71), parieto-occipital (n = 8), frontal (n = 4), asterion (n = 1), and sincipital (n = 1). Concomitant central nervous system (CNS) anomalies were present in 73.3 % of patients with parietal atretic cephaloceles and in 32.4 % of patients with occipital atretic cephaloceles (p < 0.0001). We realized that all patients with worse outcomes had concomitant CNS anomalies (100 %), whereas only 48 % of those with good clinical outcomes had concomitant anomalies (p = 0.0248). CONCLUSIONS: Atretic cephaloceles present as nodular extrusions on the parietal and occipital regions. Concomitant CNS anomalies, which impair the clinical outcomes, are more common in patients with parietal ACs. Observation-only approach is enough in patients with asymptomatic ACs. However, life-long follow-ups are required, because of recurrence after the surgery.

Vertebral artery loops in surgical perspective.

PURPOSE: Vertebral artery loop is a congenital or acquired anomaly. Vertebral artery loops are incidentally diagnosed during evaluation of neck problems and trauma. We aimed to present the incidence of VA loops using magnetic resonance angiography in consecutive patients and discuss epidemiological data including the gender, age, location, signs and symptoms, treatment approaches and outcomes of VA loops via analyzing literature. METHODS: In the first leg of our two-legged study, consecutive patients were evaluated using magnetic resonance angiography to detect any medial loop of vertebral arteries. The study period was from October 2015 to March 2016. In the second leg, academic databases about medial loop of vertebral artery were screened. Case reports, case series, abstracts and references of relevant literature were searched manually to avoid any missing cases. RESULTS: We evaluated 239 consecutive patients using magnetic resonance angiography. Twenty-one patients were excluded from the study due to inadequate image acquisition, aplastic vertebral artery and/or concomitant vertebral artery stenosis. Medial loop of V2 vertebral artery was observed in 13 patients (5.9 %): 9 with left, 2 with right and 2 with bilateral medial V2 loop. Patients with medial V2 loop were significantly older than patients with straight vertebral arteries (70.30 vs. 62.36, p = 0.028). In the literature analysis, VA loops were more commonly observed at V2 segment (90.5 %). Vertebral artery loops were mostly diagnosed at the 5th and 6th decades of life predominantly in females. The most common signs and symptoms were radiculopathy and/or neck pain, and signs and symptoms of vertebrobasilar insufficiency. CONCLUSIONS: Concise pre-operative evaluation of the vertebral arteries is essential to avoid the injury of undiagnosed VA loops during surgery, which might result in catastrophic circumstances. Further evaluation of the vertebral arteries using MR angiography is required, especially in elder age, before cervical spine surgeries.

Surgical anatomy of the cavernous sinus, superior orbital fissure, and orbital apex via a lateral orbitotomy approach: a cadaveric anatomical study.

BACKGROUND: Tumors of the middle fossa or cavernous sinus (CS), or intraorbital tumors, can penetrate each other through the superior orbital fissure (SOF) or neighboring tissue. These complicated pathologies are often treated with highly invasive surgical procedures. In this article, we demonstrate surgical anatomic dissections of the CS, SOF, orbital apex (OA), and dura mater extending to the periorbita from the middle fossa, by performing an epidural dissection via a lateral orbitotomy approach, and discuss findings that may provide guidance during surgery in these regions. METHODS: Lateral orbitotomy was performed on latex-injected cadaver heads by making a 2-cm skin incision lateral to the lateral canthus, drilling the lesser and greater sphenoid wings that form the SOF borders, and removing the bone section between the middle fossa and orbit. Dura mater from the middle fossa to the periorbita was exposed to perform anterior clinoidectomy. Meningeal dura was dissected from the endosteal dura, which forms the lateral wall of the CS, to expose the CS, SOF, and OA for dissections. RESULTS: Changing the orientation of the microscope from posterior to anterior enabled regional control for dissection from the Gasserian ganglion to the OA. Cranial nerves that pass through the CS, SOF, and OA were dissected and exposed. The annular tendon was opened, revealing the oculomotor nerves and its branches, as well as the abducens and nasociliary nerves, which pass through the oculomotor foramen and course within the OA and orbit. CONCLUSIONS: This approach causes less tissue damage; provides control of the surgical area in spheno-orbital tumors invading the fissure and foramen by changing the orientation of the microscope toward the orbit, OA, SOF, CS, and middle fossa; and expands the indication criteria for lateral orbitotomy surgery. This approach, therefore, represents an alternative surgical method for excising complicated tumors in these regions.

Craniospinal Polyostotic Fibrous Dysplasia, Aneurysmal Bone Cysts, and Chiari Type 1 Malformation Coexistence in a Patient with McCune-Albright Syndrome.

Aneurysmal bone cysts (ABCs) are defined as benign cystic lesions of bone composed of blood-filled spaces. ABCs may be a secondary pathology superimposed on fibrous dysplasia (FD). Concomitant FD and ABC in relation with McCune-Albright syndrome is an extremely rare condition. Here, we report concomitant, double ABCs in bilateral occipital regions and FD from the skull base to the C2 vertebra with Chiari type 1 malformation. A 14-year-old female with a diagnosis of McCune-Albright syndrome presented with swellings at the back of her head. The lesions were consistent with ABCs and were totally resected with reconstruction of the calvarial defects. The coexistence of FD, bilateral occipital ABCs, and Chiari malformation type 1 in a McCune-Albright patient is an extremely rare condition and, to our knowledge, has not been reported to date. Exact diagnosis and appropriate surgical treatment usually lead to a good outcome.

Cerebral venous thrombosis following spinal surgery in a patient with Factor V Leiden mutation.

Cerebral venous thrombosis is a devastating event leading to high mortality and morbidity rates. We present a case of cerebral venous thrombosis that occurred following spinal surgery in a patient with Factor V Leiden mutation and G1691A heterozygosity. Possible prevention and treatment strategies have been discussed.

Trigeminal Neuralgia Caused by Cerebellopontine Angle Arteriovenous Malformation Treated With Gamma Knife Radiosurgery.

Trigeminal neuralgia is a facial pain syndrome characterized as sudden onset and lightening-like sensation over somatosensorial branch(es) of fifth cranial nerve. Rarely, some underlying diseases or disorders could be diagnosed, such as multiple sclerosis, brain tumors, and vascular malformations. The authors present a 47-year-old man with trigeminal neuralgia over left V2 and V3 dermatomes. He had a previous transarterial embolization and long use of carbamazepine with partial response to treatment. Gamma knife radiosurgery (GKR) was planned. A marginal dose of 15 Gy was given to 50% isodose line. His pain was relieved by GKR in 1.5 years. Treatment of posterior fossa arteriovenous malformations causing trigeminal neuralgia, with GKR has a very limited use in the literature. It, however, is obvious that success rate as pain relief, in a very challenging field of functional neurosurgery, is satisfactory. Large series, however, are in need to make a more comprehensive statement about efficacy and safety of the procedure in these pathologies.

Acquired Encephalocele With Hydrocephalus and Pineal Region Epidermoid Cyst.

A combination of trauma and a missed inflammatory response (nasal operation) concomitant with hydrocephalus and tumor in secondary encephalocele has not been described in the English literature yet. A 38-year-old man was admitted to the clinic with rhinorrhea that started 3 months ago. In his medical history, nothing abnormal was present except a nasal operation performed 1 year ago. Brain magnetic resonance imaging depicted left frontal encephalocele concomitant with obstructive hydrocephalus caused by an epidermoid cyst originated from the pineal region. A 2-staged surgery was planned. In the first stage, a ventriculoperitoneal shunt insertion was conveyed successfully. In the second-stage surgery, the herniated brain tissue was excised, and the frontal sinus was cleansed with serum saline combined with antibiotic. The bony defect and the dura defect were repaired. The patient's presenting complaint recovered fully, and he was discharged to home in a well condition. Acquired encephalocele is a rare entity. In case of rhinorrhea and encephalocele, even in the presence of prior history of nasal surgery, intracranial evaluation should be conveyed to exclude the presence of hydrocephalus and/or tumor. The cranial defect should be repaired to prevent future infections and brain tissue damage.

Delayed Onset Intracranial Subdural Hematoma Following Spinal Surgery.

In this case-based review, the authors analyzed relevant literature with an illustrative patient of theirs about subdural hematoma secondary to dural tear at spinal surgery. Intracranial hypotension is a condition of decreased cerebrospinal fluid volume and pressure. Even though intracranial hypotension is temporary and can be managed conservatively, it may progress and result in subdural fluid collections, hematoma formations, "brain sagging or slumping" states, syringohydromyelia, encephalopathy, coma, and even death. The authors present an 81-year-old man admitted with subdural hematoma 50 days following previous spinal surgery for lumbar spinal stenosis. In his previous spinal surgery he had had dural tear, which had been closed primarily. To the literature, only 21 patients have been reported to develop subdural hematoma following spinal surgery. In patients with subdural hematoma following spinal surgery, the female:male ratio was 3:4 and the median age was 55 years. Surgical diagnoses for previous spinal surgeries were intervertebral disc herniation (5), spinal canal stenosis and spondylolisthesis (6), failed back syndrome (2), tethered cord syndrome and myelodysplastic spine (2), spinal cord tumor, spinal epidural hematoma, vertebral dislocation, vertebral fracture, vertebral tumor, and inflammatory spine. Patients presented with signs and symptoms of subdural hematoma within 6 hours to 50 days following the spinal surgery. Source of cerebrospinal fluid leak was most commonly from lumbar region (13 patients, 62%). Ten of 21 (48%) patients were treated conservatively. Late-onset neurological findings should not prevent the evaluation of cranial vault with computed tomography and magnetic resonance imaging. Spinal dural tear should be more aggressively treated instead of suture alone approach, when recognized in older patients during the spinal surgery.

Recurrent Cranial Chronic Subdural Hematoma due to Cervical Cerebrospinal Fluid Fistula: Repair of Both Entities in the Same Session.

Cranial chronic subdural hematoma (CSH) occurs secondary to trauma or just spontaneously. In this clinical report, the authors presented a 39-year-old male patient who was admitted with cranial CSH. In further assessment of the patient, the authors found an underlying cerebrospinal fluid (CSF) leak at the level of cervical spine. Following evacuation of the CSH, it recurred. In the second session, the hematoma was re-evacuated and the CSF fistula repaired. The CSH did not recur again. In young adult patients with recurrent CSH and prior presence of bilateral CSH, a survey for an underlying spinal CSF leak should be considered in the differential, especially in the background of trauma. Conservative treatment, epidural blood patching, or microsurgical repair of the dural defect should be conceptualized according to the circumstances of the individual patients with spontaneous intracranial hypotension and spinal CSF fistula.

Gamma Knife treatment of low-grade gliomas in children.

BACKGROUND: Low-grade gliomas have good overall survival rates in pediatric patients compared to adults. There are some case series that reported the effectiveness and safety of Gamma Knife radiosurgery, yet they are limited in number of patients. We aimed to review the relevant literature for pediatric low-grade glial tumors treated with stereotactic radiosurgery, specifically Gamma Knife radiosurgery, and to present an exemplary case. CASE DESCRIPTION: A 6-year-old boy was admitted to clinic due to head trauma. He was alert, cooperative, and had no obvious motor or sensorial deficit. A head CT scan depicted a hypodense zone at the right caudate nucleus. The brain magnetic resonance imaging (MRI) depicted a mass lesion at the same location. A stereotactic biopsy was performed. Histopathological diagnosis was low-grade astrocytoma (grade II, World Health Organization (WHO) classification, 2007). Gamma Knife radiosurgery was applied to the tumor bed. Tumor volume was 21.85 cm(3). Fourteen gray was given to 50% isodose segment of the lesion (maximal dose of 28 Gy). The tumor has disappeared totally in 4 months, and the patient was tumor-free 21 months after the initial treatment. DISCUSSION AND CONCLUSION: The presented literature review represents mostly single-center experiences with different patient and treatment characteristics. Accordingly, a mean/median margin dose of 11.3-15 Gy with Gamma Knife radiosurgery (GKRS) is successful in treatment of pediatric and adult low-grade glial tumor patients. However, prospective studies with a large cohort of pediatric patients should be conducted to make a more comprehensive conclusion for effectiveness and safety of GKRS in pediatric low-grade glial tumors.

Lumbar Spinal Immature Ganglioneuroma with Conus Medullaris Invasion: Case Report.

Ganglioneuroma (GN) is a benign rare tumor that originates from neural crest cells. It shares a common histogenic family with ganglioneuroblastoma and neuroblastoma and represents the most benign and differentiated form of the group. The most common locations of the GNs are the mediastinum and retroperitoneum. We report an extremely rare case of lumbar spinal GN with conus medullaris invasion and extradural paraspinal extension. A 10-year-old girl presented with a history of worsening lower-back pain and an intermittent tingling sensation in the left leg. Neurological examination revealed reduced sensation in the left L2-L5 dermatomes. Magnetic resonance imaging revealed an intra- and extradural mass extending from the D11 to L5 vertebral body level. There was conus medullaris invasion by the tumor. After L1-L5 laminotomies, the patient underwent tumor resection. Histopathological diagnosis was immature GN. GNs occurring within the spinal column are rare and may grow to a large size. Despite the size and the common involvement of both intra- and extraspinal compartments, the prognosis is usually excellent after complete excision using microsurgical techniques.

Intraventricular Hemorrhage and Related Hydrocephalus Patients Demographics in a University Hospital NICU: Single-Center Data.

AIM: To analyze the demographic and clinical data of preterm or low birth weight newborns with periventricular hemorrhage. MATERIAL AND METHODS: This retrospective study analyzed patients admitted to the neonatal intensive care unit of a Bahcesehir University School of Medicine-Affiliated Hospital due to preterm birth or low birth weight between June 1, 2012, and April 30, 2021. Categorical values were evaluated by Pearson chi-square or Fisher's exact test. The Mann-Whitney U test compared continuous values between the groups. Logistic regression was used to evaluate the factors that affected permanent cerebrospinal fluid (CSF) diversion. RESULTS: The study finally evaluated 180 newborns. Ninety-one newborns (50.5%) had grade I, 18 (10%) had grade II, 22 (12.2%) had grade III, and 49 (27.2%) had grade IV hemorrhage. One hundred and forty-nine patients (82.8%) were delivered by cesarean section, and 31 (17.2%) were delivered vaginally. All patients with low-grade hemorrhage who needed temporary CSF diversion eventually required permanent CSF diversion. For high-grade hemorrhage, 15 (grade III, 1; grade IV, 14) of 51 (29.4%) patients with ventricular access device (VAD) insertion required permanent CSF diversion. Fifteen (grade III, 6; grade IV, 9) of these 51 (29.4%) patients did not need permanent CSF diversion; thus, their VADs were removed. CONCLUSION: The permanent CSF diversion rate was significantly higher in the high-grade hemorrhage group, which had significantly lower weight and gestational age at birth. Moreover, only weight at VAD insertion had minimal effect on the need for permanent CSF diversion.

Magnetic Resonance Imaging of Unusual Neoplasms Related to Foramen of Luschka: A Review for Differential Diagnosis.

There are many types of neoplasms in or around the foramen of Luschka (FL), and definitive diagnosis in some cases requires knowledge of imaging findings. The uncommon and challenging neoplasms with FL involvement considered in this study are exophytic brainstem glioma, primary glioblastoma of the cerebellopontine angle (CPA), primary anaplastic ependymoma of the CPA, choroid plexus papilloma of the FL, solitary FL choroid plexus metastasis, extraskeletal myxoid chondrosarcoma of the jugular foramen, paraganglioma of the jugular foramen, exostosis of the jugular foramen, psammomatous meningioma in the lateral cerebellar medullary cistern, epidermoid tumor of the fourth ventricle, and a hypoglossal schwannoma. These neoplasms may have overlapping clinical and imaging features, but some have relatively distinct imaging features. Knowledge of the key clinical and magnetic resonance imaging features of these unusual lesions with FL involvement is important for radiologists to improve diagnostic ability and to assist the referring physician in the appropriate management of the patient.

Cervical Venous Vascular Anatomy for Ventriculoatrial Shunt Applications: Anatomical Study and Surgical Approach Recommendation.

AIM: To develop an approach for atrial application of ventriculoatrial (VA) shunts after revealing the venous anatomy with facial and cervical anatomical dissections. MATERIAL AND METHODS: Five cephalic cadavers were used in the study. Facial and cervical regions of the cephalic cadavers were examined with layer by layer anatomical dissection. Venous angiography and ultrasonography were performed to obtain additional data on the cervical venous vascular anatomy. Subsequently, we developed an approach for atrial catheter applications. RESULTS: No anatomical variations were detected in the dissections. The common facial vein, which was formed by the facial vein and retromandibular vein, was observed to drain into the internal jugular vein. As a result of dissections and examinations, an incision approximately 2 cm below the mandible, extending from the projection of the submandibular notch to the trace of the angulus mandible, was considered adequate to expose the common facial vein for atrial catheter insertion. CONCLUSION: The approach described in our study is appropriate for the application of an atrial catheter for VA shunts. Revealing the venous anatomy with examinations contributes to the success of the operation.

Electromagnetic Waves from Mobile Phones may Affect Rat Brain During Development.

AIM: To investigate the effects of electromagnetic waves (EMWs) from mobile phones (MPs) on rat brains of rats by morphological and biochemical analysis. MATERIAL AND METHODS: EMW was applied for two hours/day until birth in stand-by fetal and EMW fetal groups and postnatal 60 < sup > th < /sup > day in stand-by and EMW groups. The control group was not exposed to MP. On postnatal 60 < sup > th < /sup > day, brain malondialdehyde (MDA) and glutathione (GSH) levels were measured, and western blot analysis was performed to determine glial fibrillary acidic protein (GFAP) content. Hematoxylin and eosin staining and GFAP immunohistochemistry were applied. Trigeminal nerves were examined using the transmission electron microscope. RESULTS: In comparison to controls, rats exposed to MP in stand-by or talk modes had significantly increased neuronal damage in the cortex and hippocampus. Increased MDA levels in the EMW group and decreased GSH levels in the stand-by, EMW fetal and EMW groups were found compared with controls. Increased GFAP content in the EMW group and increased GFAP staining in the EMW fetal and EMW groups compared to controls were observed. EMW group had a significantly decreased number of myelinated axons than control animals. CONCLUSION: The results of this study suggests that 1800 MHz EMWs (SAR=1.79 W/kg) exposure in the prenatal and early postnatal life may lead to trigeminal nerve damage in addition to oxidative stress-induced neuronal degeneration and astroglial activation in the rat brain. Effects seem to be mode related, being more detrimental in groups exposed to MP during talk mode.