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1.
Childs Nerv Syst ; 36(12): 3119-3122, 2020 12.
Article in English | MEDLINE | ID: mdl-31802192

ABSTRACT

Encephalocele is a congenital anomaly where intracranial neural structures extrude from the cranium through a bony and/or a dural defect. They are generally located at the midline and can be diagnosed via prenatal ultrasonography (USG). A very limited number of cases have been reported in the literature about lateral encephalocele. In this paper, the authors present a case with congenital lateral encephalocele which was subsequently operated.


Subject(s)
Encephalocele , Skull , Encephalocele/diagnostic imaging , Encephalocele/surgery , Female , Head , Humans , Pregnancy , Skull/diagnostic imaging , Ultrasonography, Prenatal
2.
J Craniofac Surg ; 30(7): 2265-2267, 2019 Oct.
Article in English | MEDLINE | ID: mdl-31503117

ABSTRACT

Cerebrospinal fluid rhinorrhea is described as cerebrospinal fluid flow through the nose due to the abnormal connection of the subarachnoid space and sinonasal cavity. Spontaneous idiopathic rhinorrhea is a rarely seen disease. Besides the patient's clinical presentation detailed radiological evaluation and other invasive procedures must be carried out to confirm the diagnosis. Its treatment is compelling due to high recurrence rates. In the treatment algorithm when conservative treatment modalities had been proven inadequate, surgical repair must follow in order. In this paper the authors present the details of 2 cases of spontaneous rhinorrhoea patients.


Subject(s)
Cerebrospinal Fluid Rhinorrhea/surgery , Adult , Cerebrospinal Fluid Rhinorrhea/diagnostic imaging , Female , Humans , Recurrence
3.
Pediatr Neurosurg ; 52(1): 62-66, 2017.
Article in English | MEDLINE | ID: mdl-27427994

ABSTRACT

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.


Subject(s)
Gait Disorders, Neurologic/diagnostic imaging , Gait Disorders, Neurologic/etiology , Head Injuries, Closed/complications , Head Injuries, Closed/diagnostic imaging , Adolescent , Gait Disorders, Neurologic/therapy , Head Injuries, Closed/therapy , Humans , Male
4.
Eur Spine J ; 25(12): 4171-4180, 2016 12.
Article in English | MEDLINE | ID: mdl-27388018

ABSTRACT

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.


Subject(s)
Cervical Vertebrae/surgery , Vascular System Injuries/prevention & control , Vertebral Artery/abnormalities , Adult , Age Factors , Aged , Aged, 80 and over , Female , Humans , Incidence , Magnetic Resonance Angiography , Male , Medical Errors/prevention & control , Middle Aged , Neck Pain/etiology , Radiculopathy/etiology , Retrospective Studies , Sex Factors , Vascular Malformations/complications , Vascular Malformations/diagnostic imaging , Vascular Malformations/epidemiology , Vertebral Artery/diagnostic imaging , Vertebrobasilar Insufficiency/etiology , Young Adult
5.
Eur Spine J ; 25(5): 1608-1613, 2016 05.
Article in English | MEDLINE | ID: mdl-26957102

ABSTRACT

PURPOSE: Pain management following posterior spinal fusion surgeries is a challenging topic. Continuous epidural analgesia (CEA) technique has been invented to resolve some deleterious effects related with conventional intravenous patient-controlled analgesia (IV-PCA) method. However, studies for effectiveness and safety of CEA are scarce in adult population. Our aim was to compare effectiveness and safety of patient-controlled CEA with conventional IV-PCA method in adult patient population. METHODS: Chart review of patients, scheduled for elective posterior spine fusion to treat spinal stenosis, degenerative disc disease, spondylolisthesis or spinal instability from May 2012 to March 2015, was performed. Patients with spinal infection, cancer, inflammatory disease, and ASA higher than class III, allergy to analgesic medications were excluded from the study. One hundred and nine patients were enrolled into the study. 80 out of 109 patients (40 in CEA group, 40 in IV-PCA group) were matched for age, gender, BMI, type of surgery, level of fusions. Visual Analog Scale scores (VAS) and Ramsay Sedation Scale (RSS) scores were evaluated following surgeries until post-operative 24th hour. RESULTS: There were 58 female patients (72.5 %). The mean age of the patients was 59.85 years (range 24-82 years). When VAS and RSS scores were compared between the groups, there were statistically significant differences between the groups in respect of VAS scores at every time point following surgery (lower in CEA group), whereas there was no significant difference between the groups in respect of RSS scores. More additional analgesia medication was needed in IV-PCA group (16 vs. 5 patients), which was significantly higher than CEA group (p = 0.029). CONCLUSIONS: Patient-controlled CEA method is as safe as IV-PCA method and is even more effective than that in controlling immediate post-operative pain in patients treated with posterior spinal fusion.


Subject(s)
Analgesia, Epidural , Analgesia, Patient-Controlled , Catheters, Indwelling , Pain, Postoperative/prevention & control , Spinal Fusion , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Visual Analog Scale , Young Adult
6.
Pediatr Neurosurg ; 51(5): 253-6, 2016.
Article in English | MEDLINE | ID: mdl-27161212

ABSTRACT

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.


Subject(s)
Arnold-Chiari Malformation/diagnostic imaging , Bone Cysts, Aneurysmal/diagnostic imaging , Fibrous Dysplasia, Polyostotic/diagnostic imaging , Skull/diagnostic imaging , Adolescent , Arnold-Chiari Malformation/complications , Arnold-Chiari Malformation/surgery , Bone Cysts, Aneurysmal/complications , Bone Cysts, Aneurysmal/surgery , Female , Fibrous Dysplasia, Polyostotic/complications , Fibrous Dysplasia, Polyostotic/surgery , Humans , Skull/surgery
7.
Pediatr Neurosurg ; 51(6): 292-296, 2016.
Article in English | MEDLINE | ID: mdl-27497928

ABSTRACT

PURPOSE: The magnetically controlled growing rod technique decreases complications, costs, and loss of functionality by avoiding successive surgical corrections every 6 months in patients with early-onset scoliosis. However, only a few studies have presented clinical experience with the magnetically controlled growing rod. In this study we aimed to present our single-center experience in patients with early-onset scoliosis who underwent the magnetically controlled growing rod technique and follow-up for at least 2 years. MATERIALS AND METHODS: We made an observational study by evaluating patients with early-onset scoliosis who underwent the magnetically controlled growing rod technique between February 2012 and December 2013. Demographic and clinical data were obtained from the patients charts. We included patients who were followed up for at least 2 years. Radiological data were obtained from plain anterior-posterior and lateral scoliosis X-rays. RESULTS: Eight patients with early-onset scoliosis who underwent surgery using the magnetic system were treated with dual rods. None of the spines were fused to the sacrum. We observed no intra- and/or postsurgical complications. The average number of external rod lengthenings was 7.6. The average amount of lengthening was 30.6 mm on the right side and 27.8 mm on the left side by the time of last clinical follow-up. The average coronal and sagittal Cobb values at the final clinical evaluation were 10.5° (thoracic coronal), 13.75° (lumbar coronal), 6.25° (lumbosacral coronal), 24.5° (thoracic sagittal), and 40° (lumbar sagittal), respectively. CONCLUSIONS: The magnetically controlled growing rod is beneficial in early-onset scoliosis, since it enables spinal growth and decreases additional surgeries, complications, and costs. Even though we had a small sample size, our follow-up period was enough to declare long-term outcomes of our patients. Multicenter and large sample-sized studies are needed to make more conclusive statements regarding this promising scoliosis treatment approach.


Subject(s)
Bone Nails , Magnetics/methods , Scoliosis/diagnostic imaging , Scoliosis/surgery , Child , Female , Follow-Up Studies , Humans , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/surgery , Magnetics/instrumentation , Male , Thoracic Vertebrae/diagnostic imaging , Thoracic Vertebrae/surgery , Time Factors
8.
Br J Neurosurg ; 30(4): 456-8, 2016 Aug.
Article in English | MEDLINE | ID: mdl-26414646

ABSTRACT

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.


Subject(s)
Factor V/genetics , Intracranial Thrombosis/surgery , Mutation/genetics , Thrombophilia/surgery , Venous Thrombosis/surgery , Female , Heterozygote , Humans , Intracranial Thrombosis/diagnosis , Intracranial Thrombosis/genetics , Middle Aged , Risk Factors , Thrombophilia/diagnosis , Thrombophilia/genetics , Venous Thrombosis/diagnosis , Venous Thrombosis/genetics
9.
J Craniofac Surg ; 27(1): e55-7, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26674920

ABSTRACT

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.


Subject(s)
Arteriovenous Fistula/complications , Cerebellopontine Angle/blood supply , Intracranial Arteriovenous Malformations/complications , Radiosurgery/methods , Trigeminal Neuralgia/etiology , Analgesics, Non-Narcotic/therapeutic use , Arteriovenous Fistula/surgery , Carbamazepine/therapeutic use , Cerebellopontine Angle/surgery , Embolization, Therapeutic/methods , Follow-Up Studies , Humans , Intracranial Arteriovenous Malformations/surgery , Male , Middle Aged , Neurosurgery/methods , Trigeminal Nerve/surgery , Trigeminal Neuralgia/surgery
10.
J Craniofac Surg ; 27(5): e459-61, 2016 Jul.
Article in English | MEDLINE | ID: mdl-27315314

ABSTRACT

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.


Subject(s)
Central Nervous System Cysts/complications , Encephalocele/diagnosis , Epidermal Cyst/complications , Pineal Gland , Adult , Central Nervous System Cysts/diagnosis , Encephalocele/complications , Epidermal Cyst/diagnosis , Humans , Magnetic Resonance Imaging , Male , Tomography, X-Ray Computed
11.
J Craniofac Surg ; 27(4): e370-3, 2016 Jun.
Article in English | MEDLINE | ID: mdl-27192649

ABSTRACT

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.


Subject(s)
Hematoma, Subdural, Intracranial/etiology , Neurosurgical Procedures/adverse effects , Postoperative Complications , Spinal Stenosis/surgery , Aged, 80 and over , Hematoma, Subdural, Intracranial/diagnosis , Hematoma, Subdural, Intracranial/surgery , Humans , Lumbar Vertebrae , Magnetic Resonance Imaging , Male , Sacrum , Spinal Stenosis/diagnosis , Tomography, X-Ray Computed
12.
J Craniofac Surg ; 27(6): e578-80, 2016 Sep.
Article in English | MEDLINE | ID: mdl-27526247

ABSTRACT

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.


Subject(s)
Cerebrospinal Fluid Leak/complications , Fistula/complications , Hematoma, Subdural, Chronic/surgery , Neurosurgical Procedures/methods , Adult , Cerebrospinal Fluid Leak/diagnosis , Cerebrospinal Fluid Leak/surgery , Cervical Vertebrae , Fistula/diagnosis , Fistula/surgery , Hematoma, Subdural, Chronic/diagnosis , Hematoma, Subdural, Chronic/etiology , Humans , Magnetic Resonance Imaging , Male , Recurrence
13.
Childs Nerv Syst ; 31(11): 2015-23, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26174619

ABSTRACT

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.


Subject(s)
Brain Neoplasms/surgery , Glioma/surgery , Radiosurgery/methods , Brain Neoplasms/diagnosis , Brain Neoplasms/epidemiology , Child , Databases, Bibliographic/statistics & numerical data , Glioma/diagnosis , Glioma/epidemiology , Humans , Magnetic Resonance Imaging , Male , Tomography, X-Ray Computed , Treatment Outcome
14.
Eur Spine J ; 24(11): 2432-41, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26342701

ABSTRACT

PURPOSE: Several genomic loci have been previously found to be associated with intervertebral disc degeneration, so far. Data are mostly derived from northern European countries whereas data derived from Southern European Ancestor are limited. This study aimed to evaluate the association between radiological disease severity of lumbar disc degeneration and certain genetic loci in a sample of participants from Southern Europe. METHODS: Seventy-five patients with mild to severe lumbar disc degeneration and 25 healthy controls were enrolled into the study. In each subject, each lumbar intervertebral disc was separately examined to obtain a total radiological score for disease severity. In addition, single-nucleotide polymorphisms of predefined genetic samples were analyzed in all participants: COL1A1 Sp1, COL9a2 Trp2, COL9a3 Trp3, and VDR TaqI. RESULTS: Degeneration scores were significantly worse in cases with COL1A1 Sp1, COL9a3 Trp3, and VDR TaqI mutations; however, COL9a2 Trp2 mutation was not associated with a difference in the severity of disc degeneration. In addition, subjects with mutation in more than one gene sample (n = 20) had significantly worse degeneration scores than the remaining study participants (n = 80) (17.70 ± 2.72 vs. 21.81 ± 1.81, p < 0.001). CONCLUSION: Single-nucleotide polymorphisms occurring in COL1A1, COL9a3 and VDR genes seem to be associated with the development of lumbar disc degeneration in this cohort, possibly with even more pronounced association when multiple mutations are present in the same individual. By further prospective twin studies in associated genes and analyses of their relationship with environmental factors in an internationally sampled large cohort will make a more clear-minded conclusion about their association with disc degeneration, which would yield better appreciation and clinical planning of some predisposed people for these pathologies.


Subject(s)
Collagen Type IX/genetics , Collagen Type I/genetics , Intervertebral Disc Degeneration , Receptors, Calcitriol/genetics , Case-Control Studies , Europe/epidemiology , Genetic Association Studies , Humans , Intervertebral Disc Degeneration/diagnostic imaging , Intervertebral Disc Degeneration/epidemiology , Intervertebral Disc Degeneration/genetics , Intervertebral Disc Degeneration/pathology , Radiography
15.
Pediatr Neurosurg ; 50(3): 133-44, 2015.
Article in English | MEDLINE | ID: mdl-26067202

ABSTRACT

PURPOSE: Defective posterior spinal arch and paraspinal musculature lead to progressive kyphosis in patients with myelomeningocele. Kyphosis decreases the patients' functional status and quality of life. To correct or prevent further deterioration, different surgical techniques have been introduced. Our aim is to present our clinical experience in kyphectomy and pedicle screw fixation with a posterior-only approach in pediatric patients with myelomeningocele and to discuss the technique with a review of the literature. MATERIALS AND METHODS: Four patients with lumbar and 2 patients with thoracolumbar kyphosis (female:male ratio = 1:5) secondary to myelomeningocele were operated between January 2009 and October 2012. The median age was 5.5 years (range = 3-10 years). The criteria of the patient selection for the procedure were progression of kyphosis angle, impaired truncal balance and cosmetic deformity. In this retrospective study, we performed chart reviews for demographic and clinical data. We measured the pre- and postoperative kyphosis angles by using the Cobb method on lateral x-rays. RESULTS: The mean preoperative kyphosis angle was 114.3° (range = 91-136°). The mean operative time was 171.7 min (range = 110-220 min). The mean intraoperative blood loss was 450 cc (range = 300-700 cc). The postoperative mean kyphosis angle was 28.2° (range = 13-33°). Five patients had skin breakdown. After osteofusion was established, those 5 patients' instrumentations were explanted. No acute or immediate postoperative complications occurred. Other complications were pneumonia and urinary tract infection. In the long term, 2 patients died due to pneumonia and slit-ventricle syndrome, respectively. CONCLUSIONS: Kyphectomy and pedicle screw instrumentation with the posterior-only approach dramatically reduces the kyphosis angle that develops in patients with myelomeningocele. The method itself is less time-consuming and leads to less intraoperative blood loss compared to other methods used for this patient population. Skin breakdown is the most common short-term complication.


Subject(s)
Internal Fixators , Kyphosis/surgery , Meningomyelocele/surgery , Pedicle Screws , Spinal Fusion/methods , Child , Child, Preschool , Female , Humans , Kyphosis/complications , Kyphosis/diagnosis , Male , Meningomyelocele/complications , Meningomyelocele/diagnosis , Retrospective Studies
16.
Pediatr Neurosurg ; 50(6): 330-5, 2015.
Article in English | MEDLINE | ID: mdl-26461185

ABSTRACT

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.


Subject(s)
Ganglioneuroma/diagnosis , Spinal Cord Neoplasms/diagnosis , Spinal Neoplasms/diagnosis , Child , Female , Ganglioneuroma/surgery , Humans , Lumbar Vertebrae/pathology , Lumbar Vertebrae/surgery , Spinal Cord Neoplasms/surgery , Spinal Neoplasms/surgery
17.
Turk Neurosurg ; 34(2): 283-288, 2024.
Article in English | MEDLINE | ID: mdl-38497181

ABSTRACT

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.


Subject(s)
Hydrocephalus , Premature Birth , Humans , Infant, Newborn , Pregnancy , Female , Intensive Care Units, Neonatal , Retrospective Studies , Cesarean Section , Hydrocephalus/epidemiology , Hydrocephalus/surgery , Cerebral Hemorrhage/epidemiology , Cerebral Hemorrhage/surgery , Hospitals, University , Demography
18.
Neurospine ; 20(3): 947-958, 2023 Sep.
Article in English | MEDLINE | ID: mdl-37798989

ABSTRACT

OBJECTIVE: The aim of this study was to emphasize on the interaction of spatial and temporal gait parameters and analyse the gait asymmetry in the patients with lumbar disc herniation (LDH) before and after microdiscectomy. METHODS: This was a prospective, observational study conducted on 59 cases of LDH planned for lumbar microdiscectomy, and healthy control group with 54 participants for analysis was performed prior to surgery and 15 days after surgery. The spatiotemporal gait parameters were measured using a "Win-Track" gait analysis platform system. All the participants walked barefoot for 10 times with their normal walking speed in the same day. The 3 flawless walking data were recorded and the arithmetic means were computed. The gait symmetry index was used to calculate the walking asymmetry. The pain intensity of the patients was recorded shortly before performing the analysis by a visual analogue scale. RESULTS: In the postoperative assessment LDH patients had significantly shorter temporal parameters, longer spatial parameters, faster walking speed, and more cadence than the preoperative assessment (p < 0.05). There were improvements in the asymmetry values of the postoperative gait parameters compared to the preoperative values, but these differences were not significant (p > 0.05). In addition, there was a significant difference in all parameters in terms of gait asymmetry between the postoperative assessment and the healthy controls (p < 0.05). CONCLUSION: These results can guide the patient-specific evaluating and implementation of gait rehabilitation programs, and design protocols before or after surgery in the LDH patients.

19.
Neurospine ; 17(1): 215-220, 2020 Mar.
Article in English | MEDLINE | ID: mdl-32252171

ABSTRACT

OBJECTIVE: Low back pain is the most common reason for physician visit in Western population. It's one of the factors that affect health-related quality of life. Intervertebral disc degeneration is one of the leading factors for low back pain and disc degeneration needs serious attention. In this article, we try to summarize biomechanical factors on the degenerative process. METHODS: Patients with low back pain in Neurosurgery Department between January 2012 and June 2019 are searched for this study. The patients were gathered under 2 groups; surgical intervention and conservative treatment groups. Intervertebral disc degeneration was assessed by Pfirrmann grading system. All spinopelvic parameters were measured by using standardized lateral plain standing lumbar radiographs. RESULTS: There were 165 patients in the surgical group (60 females, 105 males) and 84 patients in the conservative group (57 females, 27 males) after randomization. One hundred fifty patients had microdiscectomy and 15 patients had spinal instrumentation with transforaminal lumbar interbody fusion. There was not a statistically significant difference between surgical intervention and conservative treatment groups when comparing disc degeneration status. There was a statistically significant difference in parameters lumbar lordosis (LL), L4-S1, and pelvic incidence-LL (PI-LL) between the 2 treatment groups. In the surgical group when we further analyze the spinopelvic parameters in between the 2 different surgical techniques; L4-S1, pelvic tilt, and PI-LL showed a statistically significant difference. CONCLUSION: Degenerative disc disease is related with multiple factors which can be detailed under the mechanic components and the genetic components. Of these factors, spinopelvic parameters seem highly penetrating to patients' surgery needs with degenerative disc disease independently.

20.
Turk Neurosurg ; 30(2): 277-284, 2020.
Article in English | MEDLINE | ID: mdl-32091127

ABSTRACT

AIM: To assess spatiotemporal gait parameters in patients with lumbar disc herniation (LDH) and chronic mechanical low back pain (CMLBP), and compare with healthy control group. MATERIAL AND METHODS: A total of 70 patients was enrolled in this prospective, controlled cross-sectional study, of which 25 with LDH, 25 with CMLBP and 20 healthy individuals as the control group. Participants completed 10 passes on the "WIN-TRACK" Gait Analysis Platform at their self-selected walking speed. The arithmetic mean of the five flawless walking data was used for analysis. Pain intensity is assessed by the Visual Analog Scale (VAS). RESULTS: The spatiotemporal gait parameters were significantly decreased in LDH and CMLBP groups than the healthy control group, particularly in LDH groups (p≥0.001). It was found that pain intensity is negatively correlated to step and stride length, cadence and velocity (p < 0.001). Results of linear regression analysis showed that 10% of the changes in gait cycle duration of the left extremity and 74% of the changes in the velocity were associated with pain intensity. CONCLUSION: Pain intensity can affect the spatiotemporal gait parameters in patients with Low Back Pain (LBP). Rehabilitation programs with gait optimization should be considered in the management of patients with LDH and CMLBP.


Subject(s)
Gait , Intervertebral Disc Degeneration/complications , Intervertebral Disc Displacement/complications , Low Back Pain/complications , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pain/etiology , Prospective Studies , Walking
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