Symptomatic Spinal Seeding Metastasis of a Low-grade Oligodendroglioma.

Extracranial metastases from primary brain tumours are mostly caused by high-grade tumours. Metastases from low-grade intracranial tumours are much rare and usually asymptomatic. We present a case of a symptomatic spinal cord compression with intradural extramedullary and diffuse leptomeningeal infiltration observed approximately 51 months after the first diagnosis of a 52-year male patient with WHO Grade 2 oligodendroglioma with temporoparietal localisation. This patient, who had the complaint of weakness in the lower extremity, was operated on due to a thoracic intradural extramedullary mass. The result of the pathological examination came out as WHO Grade 2 oligodendroglioma, and radiotherapy was planned for this seeding metastasis. The patient who experienced refractory seizures died before his radiotherapy treatment was completed. It should be kept in mind that spinal metastases may also be seen in low-grade intracranial tumours without malignant transformation as in the present case. Key Words: Spinal seeding, Spinal metastases, Low-grade oligodendroglioma.

The preventative effect of of Ro5-4864 (peripheral benzodiazepine receptor agonist) on spinal epidural fibrosis after laminectomy in a rat model.

OBJECTIVE: To investigate the histopathological effects of a peripheral benzodiazepine receptor agonist (Ro5-4864) on epidural fibrosis (EF) in an experimental study model (post-laminectomy) in rats. METHODS: A total of 32 albino Wistar rats were randomly divided into four equal groups (n = 8). In Group 1, no treatment was applied after laminectomy (control group). In Group 2, hemostasis was achieved after Laminectomy, and the surgical procedure was terminated by placing a 2-mm absorbable gelatin sponge dipped in saline into the epidural space. In Group 3, low-dose (4 mg/kg) Ro5-4864 was administered 30 minutes before the surgery. In Group 4, high-dose (8 mg/kg) Ro5-4864 was administered 30 minutes before the surgery. A histopathological examination was performed to evaluate arachnoidal invasion and EF. RESULTS: Our data revealed the EF was significantly reduced in rats treated with high-dose Ro5-4864 (Group 4) compared to the control and saline-soaked Spongostan groups (p = 0.000 and p = 0.006, respectively). There was no significant difference between the groups treated with high- and low-dose Ro5-4864. Arachnoidal invasion was not seen in any of the rats in the high-dose R05-4864 group. However, the arachnoidal invasion results did not significantly differ between the study groups (p = 0.052 = 0.05). CONCLUSIONS: Our study showed that Ro5-4864 could be effective in reducing EF in rats after.

The histopathological effects of reabsorbable polyethylene glycol hydrogel (Coseal) on epidural fibrosis in an experimental postlaminectomy model in rats

Background/aim: To investigate the histopathological effects of reabsorbable polyethylene glycol hydrogel (RPGH, Coseal) on epidural fibrosis (EF) following laminectomy in rats. Materials and methods: A total of 24 rats were equally divided into three groups. In the first group, no treatment was applied after laminectomy (control group, Group 1). In the second group, hemostasis was achieved after laminectomy, and 2 mm absorbable gelatin sponge soaked in saline was placed over the epidural space and the wound was closed (Group 2). In the third group, hemostasis was achieved following laminectomy, and 0.5 mL RPGH (Coseal, Group 3) was squeezed over the dura mater, and the wound was closed. A histopathological examination was undertaken to evaluate arachnoidal invasion and EF. Results: The results of EF in the Group 2 and Group 3 were significantly lower compared to the Group 1 (p = 0.023 and p = 0.002, respectively). No statistically significant difference was found between the Group 2 and Group 3 in terms of EF (p = 0.957). There was also no statistically significant difference between the mean arachnoidal invasion of the three groups (p > 0.171). However, the rate of arachnoidal invasion was the lowest in the Group 3. Conclusion: Intraoperative Coseal, a polyethylene glycol polymer, tends to reduce the risk of epidural fibrosis, although this is not statistically significant.

Rebar-induced transpalatal penetrating head trauma: a case report.

Penetrating head injuries caused by blunt or piercing objects are rare. In this paper, we present the case of a 9-year-old boy referred to our hospital with rebar-induced injury. The patient's neurological examination findings were normal. Computed tomography undertaken revealed that the rebar had entered through the oral cavity transorally-transpalatally, passing the frontal bone, and then exited the body by piercing the skin. The patient was taken to emergency surgery, and first, tracheostomy was performed. The rebar had been cut and shortened by the emergency rescue unit, which resulted in shortening the part of the foreign body that would pass through the brain parenchyma. During surgery, the rebar was carefully removed by following the route of the entry. All the defects caused by the foreign body were surgically repaired using a multidisciplinary approach, including neurosurgery and plastic and reconstructive surgery, by otolaryngology teams.

Repair of small abdominal wall hernias. The comparison of open in-lay and on-lay techniques.

BACKGROUND: Our aim was to report the results of open in-lay placement of a composite mesh for repair of small abdominal wall hernias compared to a control group of on-lay polypropylene mesh placement. MATERIALS AND METHODS: The patients were divided into two groups in which group-1 (n=27) included patients who underwent a repair with composite mesh, Ventralex Patch, which was fixed in-lay to the abdominal wall and group-2 (n=34) included patients with a repair with simple polypropylene mesh fixed on-lay to the abdominal wall. Due to the limited dimensions of the Ventralex Patch, in order to match the defects in both groups no randomization was done prior to the operation and patients were divided into groups consequently. All the patients were explored under general or spinal anesthesia. No further subcutaneous dissection was performed in order not to increase the seroma during onlay mesh placement. RESULTS: The demographic data between study groups were similar. The postoperative complication rate was significantly low in group 1 (0%), compared to group 2 (23.5%) which included seroma (n=3) and wound infection (n=5), however, the mean operative time was significantly high in group l (61 minutes) compared to group 2 (39 minutes). There were no recurrences occurred in both group. CONCLUSION: Although, the patch itself has tendency to make a dome formation when placed intra-abdominally, a composite polypropylene and ePTFE hernia patch has better outcomes if placed precisely with minimal extra-peritoneal and extensive intra-peritoneal dissection. We assume that inadequate liberation of omental attachments around the defect enhances the prior reported failures of the product. KEY WORDS: Composite mesh, Hernia, Ventralex patch.

Is the recurrence rate of chronic subdural hematomas dependent on the duration of drainage?

OBJECTIVES: Chronic subdural hematoma (CSDH) is the most frequent type of intracranial hemorrhage which especially affects the elderly. Various surgical techniques have been reported for CSDH treatment; optimal treatment methods are still controversial. In this study, the effects of long drainage durations on results and recurrences were investigated in patients on whom closed system drainage with burr hole craniotomy was applied due to CSDH. METHODS: 90 patients with 105 CSDH were operated between 2008 and 2016. Patients were divided into two groups based on the duration of drainage. Group A (n = 40) was determined as 2-4 days of closed-system drainage, while Group B (n = 50) was recorded as 5-7 days of closed-system drainage. Recurrence was defined as accumulation of blood in the operation area and recurrence of symptoms within the monitoring period of six months. RESULTS: Recurrence was observed in 7 (15.6) of the Group A patients and 2 (3.3%) of the Group B patients. There was a statistically significant difference between groups in terms of recurrence rate (p = 0.04). Postoperative thickness of hematoma was measured in the first month follow-up computerized tomography. There was a statistically significant difference between groups in terms of postoperative thickness of residual hematoma (p = 0.05). CONCLUSION: 2-4 days of closed system drainage following burr hole craniotomy is an effective and reliable choice of treatment in CSDH. Nevertheless, increasing the duration of drainage to 5-7 days provided better results without increasing the risk of complication.

Unilaterally posterior lumbar interbody fusion with double expandable peek cages without pedicle screw support for lumbar disc herniation.

OBJECTIVES: Posterior lumbar interbody fusion (PLIF) is usually bilateral procedure, and it is combined with posterior by bilateral pedicle screw support or with fixation. The purpose of this retrospective study was to compare the surgical outcomes of simple discectomy and PLIF without pedicle screw support in patients with lumbar disc herniation (LDH). PATIENTS AND METHODS: 60 patients with single segment LDH were operated between February 2010 and June 2013. 40 patients were treated with simple discectomy (Group 1) and 20 patients were treated with PLIF using double expandable polyetheretherketone (PEEK) cages without instrumentation (Group 2) unilaterally. Pain and function were evaluated by the visual analog scale (VAS) and Oswestry disability index (ODI) before and 18 months after surgery. Besides, PLIF patients were evaluated with computerized tomography (CT) scan of lumbar vertebra for the evaluation of the height of the disc, instability and fusion. RESULTS: Both leg and low back pain VAS scores were significantly improved 18 months after surgery in both of the groups (p<0.001). Significant decrease in VAS low back pain scores was seen in group 2 when compared to group 1 (p<0.001). Height of the intervertebral disc space was preserved and no instability was detected in group 2. No recurrence and 80% fusion rate was achieved in group 2. CONCLUSION: This study showed that unilateral PLIF intervention with double expandable PEEK cages without pedicle screw support would be sufficient in the management of single segment lumbar disc herniation in patients whom are thought to have lumbar stabilization.

Comparison of single port and three port laparoscopic splenectomy in patients with immune thrombocytopenic purpura: Clinical comparative study.

AIM: Single-port laparoscopic surgery (SILS) has become increasingly popular during the last decades. This prospective study was undertaken to evaluate the feasibility of single-port laparoscopic splenectomy compared with conventional multiport laparoscopic splenectomy. MATERIALS AND METHODS: Between February 2, 2009 and August 29, 2011, a total of 40 patients with the diagnosis of immune thrombocytopenic purpura were included to study. Patients were alienated into two groups according to the procedure type including SILS and conventional multiport splenectomy. RESULTS: There were 19 patients in group 1, and 21 in group 2. Operative time was significantly shorter in group 1 versus group 2 (112.4 ± 13.56 vs 71.2 ±18.1 minutes, respectively, P < 0.05). One patient in group 1 had converted to laparatomy due to preoperative bleeding. Postoperative pain analyses (VAS Score) revealed superiority of SILS in the early post-operative days (P < 0.05). CONCLUSIONS: SILS splenectomy is a safe and effective alternative to standard laparoscopic splenectomy.

Coexistence of cervico-thoracic extradural en-plaque meningioma with multiple intracranial meningiomas.

Meningioma is one of the most common tumors in the spinal cord. Extradural and en-plaque variety of meningioma occur less frequently. A 47-year-old woman is presented with radiculopathy signs. Magnetic resonance imaging revealed a lesion from C6 through T3 vertebral levels compressing the cord both anteriorly and posteriorly. Subtotally excision was performed and histopathologic signs showed transitional type of meningioma (WHO Grade 1). Post operatively, she had good neurological recovery. Intraoperative findings point out that the en-plaque meningioma was pure extradural. Twelve cases of pure extradural en-plaque meningioma have been reported in the literature. Besides, to the best our knowledge coexistence of "en plaque" spinal epidural meningioma with meningiomas in cranial cavity has not been reported. Complete resection is mandatory to prevent recurrence. Moreover, it is considerably difficult to remove the parts of tumor over anterior of the dura without complication.

A rare pattern of angiogenesis in meningiomas: glomeruloid microvascular proliferation.

Glomeruloid microvascular proliferation (GMP) is a localized proliferation of vascular endothelial cells resembling a renal glomerule. The nature of cells participating in the formation of these structures remains unclear. While it is a characteristic feature of glioblastoma, it is rarely seen in other solid tumors. Presence of diffuse GMP in meningiomas is characterized by peritumoral edema and an atypical contrast uptake in radiological imaging. Due to its rare nature, a case of spinal meningioma comprising distinct GMP was presented in this study in company with literature data. Also provided a discussion on the pathogenesis of this unusual pattern of angiogenesis and its relationship with tumors biological behavior.

Changes in the frequencies of abdominal wall hernias and the preferences for their repair: a multicenter national study from Turkey.

Abdominal wall hernias are a common problem in the general population. A Western estimate reveals that the lifetime risk of developing a hernia is about 2%. As a result, hernia repairs likely comprise the most frequent general surgery operations. More than 20 million hernias are estimated to be repaired every year around the world. Numerous repair techniques have been described to date however tension-free mesh repairs are widely used today because of their low hernia recurrence rates. Nevertheless, there are some ongoing debates regarding the ideal approach (open or laparoscopic), the ideal anesthesia (general, local, or regional), and the ideal mesh (standard polypropylene or newer meshes).

Decompressive craniectomy for acute subdural haematoma: an overview of current prognostic factors and a discussion about some novel prognostic parametres.

OBJECTIVE: To identify specific factors that can be used to predict functional outcome and to assess the value of decompressive craniectomy in patients with acute subdural haematoma. METHODS: The retrospective study was done at the Zonguldak Karaelwas University Practice and Research Hospital, Turkey, and included 34 trauma patients who had undergone decompressive craniectomy for acute subdural haematoma from 2001 to 2009. At the 30th day of the operation, the patients were grouped as survivors and non-survivors. Besides, based on their Glasgow Outcome Scale, which was calculated 6 months postoperatively, the patients were divided into two functional groups: favourable outcomes (4-5 on the scale), and unfavourable outcomes (1-3 on the scale). The characteristics of the groups were compared using SPSS 15 for statistical analysis. RESULTS: One-month mortality was 38.2% (n = 13) and 6-month total mortality reached 47% (n = 16). Patients with higher pre-operative revised trauma score, Glasgow coma scale, partial anterial pressure of carbon dioxide, arterial oxygen pressure, Charlson co-morbidity index score, blood glucose level, blood urea nitrogen, and lower age had a higher rate of survival and consequently a favourable outcome. Higher platelet values were only found to be a determinant of higher survival at the end of the first month without having any significant effect on the favourable outcome. CONCLUSION: In patients of traumatic acute subdural haematoma whose Glasgow coma scale on arrival was < or = 8, a massive craniectomy along with the evacuation of the haematoma, may be considered as a treatment option for intra-operative and post-operative brain swelling. But in patients with a score of 3 on arrival and bilaterally fixed and dilated pupils, decompressive craniectomy is unnecessary.

Mammae erraticae: a case report and reappraisal of the related theories.

UNLABELLED: Extra nipples and breast tissue outside the orthotopic location of the mammary glands are called polythelia and polymastia, respectively. Although the theory of mammary ridge remnants can explain extra breast tissue along the milk line, other locations such as the dorsum of the body still need further discussion. This report describes a 28-year-old Caucasian woman with a perfectly formed breast together with a meningocele in the lumbar region. Kyphoscoliosis and growth retardation were accompanying pathologies. As far as the authors can discern, this is the first case in the literature showing a well-formed breast and dysraphism occurring together. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.

Route selection for double balloon enteroscopy in patients with obscure gastrointestinal bleeding: experience from a single center.

BACKGROUND/AIMS: This study was performed to clarify the best insertion route of double-balloon enteroscopy and to report the characteristics and proportions of small bowel pathologies detected by double-balloon enteroscopy in our patients with obscure gastrointestinal bleeding. MATERIALS AND METHODS: Between January 2006 and December 2009, 75 patients with obscure gastrointestinal bleeding were enrolled into this study. The procedure was performed by oral route in 60 patients, anal route in 5 patients and both in 10 patients. Mean age of the patients was 50.8 years, and 57.3% of them were male. The main outcome measurements were total length of insertion, total time of double-balloon enteroscopy, diagnostic rates, anatomic location of the lesions, and final diagnosis of lesions detected. RESULTS: Double-balloon enteroscopy was diagnostic in 75% of the patients. This rate was significantly higher in overt bleeding (91.7%). The source of bleeding could not be detected in 19 patients. Mean times of procedures were 119, 144 and 154 minutes for oral route, anal route and both, respectively. The mean insertion length was 310.65 cm (beyond the pylorus)for oral and 166.8 cm (beyond the ileocecal valve) for anal route. The most frequent pathologies were vascular malformations (n=20) and tumors (n=19). All malignant lesions were detected in the proximal part of the small intestine. Vascular malformations were distributed equally through the small intestine. Endoscopic treatment was performed in 30% of patients. CONCLUSIONS: Double-balloon enteroscopy is a safe and feasible examination for obscure gastrointestinal bleeding. Most lesions were localized in the proximal part of the small intestine. The oral route may be preferred as a first choice, if the imaging modalities including capsuleendoscopy cannot detect the lesion.

Pure SILS Floppy Nissen Fundoplication with Hiatal Repair: A Case Report.

Background. Single-incision laparoscopic surgery has recently became popular on behalf of inventing less invasive procedures. In this paper, we present a case of Pure SILS Nissen Fundoplication. Patient and Methods. In February 2010 a 29-year old male patient with a 4 cm sliding hiatus hernia presenting with reflux symptoms had undergone a standard floppy Nissen Fundoplication with a hiatus repair via single 2 cm incision in umbilicus. Results. The procedure had obeyed the standard natural orifice surgery rules, and no needlescopic assistance for any stage of the operation was used so to be a pure single-incision procedure. The operation lasted for 120 minutes without any need of conversion, and the patient was discharged the following day of operation. Conclusion. In the recent time, hybrid single incision laparoscopy techniques have been defined with the use of extra-abdominal supplements for retraction of liver or stomach for Nissen procedure. In addition the main issue in single-incision upper GI and/or hiatus surgery is still the retraction of liver. We succeeded to retract the left lobe of liver through the incision and completed the operation without any need for supplemental access besides the umbilical incision till the end. SILS Hiatus Surgery can be safely and effectively done but the issue needs further clinical studies to state the efficacy when compared to standard laparoscopy.

SILS Incisional Hernia Repair: Is It Feasible in Giant Hernias? A Report of Three Cases.

Aim. Three incisional ventral abdominal wall hernias were repaired by placing a 20 × 30 cm composite mesh via single incision of 2 cm. Methods. All three cases had previous operations and presented with giant incisional defects clinically. The defects were repaired laparoscopically via single incision with the placement of a composite mesh of 20 × 30 cm. Nonabsorbable sutures were needed to hang and fix the mesh only in the first case. Double-crown technique was used in all of the cases to secure the mesh to the anterior abdominal wall. Results. The mean operation time was 120 minutes. The patients were mobilized and led for oral intake at the first postoperative day. No morbidity occurred. Conclusion. Abdominal incisional hernias can be repaired via single incision with a mesh application in experienced centers.

Effect of coenzyme Q10 on ischemia and neuronal damage in an experimental traumatic brain-injury model in rats.

BACKGROUND: Head trauma is one of the most important clinical issues that not only can be fatal and disabling, requiring long-term treatment and care, but also can cause heavy financial burden. Formation or distribution of free oxygen radicals should be decreased to enable fixing of poor neurological outcomes and to prevent neuronal damage secondary to ischemia after trauma. Coenzyme Q10 (CoQ10), a component of the mitochondrial electron transport chain, is a strong antioxidant that plays a role in membrane stabilization. In this study, the role of CoQ10 in the treatment of head trauma is researched by analyzing the histopathological and biochemical effects of CoQ10 administered after experimental traumatic brain injury in rats. A traumatic brain-injury model was created in all rats. Trauma was inflicted on rats by the free fall of an object of 450 g weight from a height of 70 cm on the frontoparietal midline onto a metal disc fixed between the coronal and the lambdoid sutures after a midline incision was carried out. RESULTS: In the biochemical tests, tissue malondialdehyde (MDA) levels were significantly higher in the traumatic brain-injury group compared to the sham group (p < 0.05). Administration of CoQ10 after trauma was shown to be protective because it significantly lowered the increased MDA levels (p < 0.05). Comparing the superoxide dismutase (SOD) levels of the four groups, trauma + CoQ10 group had SOD levels ranging between those of sham group and traumatic brain-injury group, and no statistically significant increase was detected. Histopathological results showed a statistically significant difference between the CoQ10 and the other trauma-subjected groups with reference to vascular congestion, neuronal loss, nuclear pyknosis, nuclear hyperchromasia, cytoplasmic eosinophilia, and axonal edema (p < 0.05). CONCLUSION: Neuronal degenerative findings and the secondary brain damage and ischemia caused by oxidative stress are decreased by CoQ10 use in rats with traumatic brain injury.