Neuroprotective Effects of Milrinone on Experimental Acute Spinal Cord Injury: Rat Model.

OBJECTIVE: Spinal cord injury (SCI) disrupts nerve axons with devastating neurological consequences, but there is no effective clinical treatment. The secondary damage mechanism is a mainstay process, and it starts within a few minutes after trauma. We aim to investigate the neuroprotective effects of milrinone on the SCI model. MATERIALS AND METHODS: A total of 36 Wistar albino rats, each weighing 300-400 g, were randomly split into 4 groups that received different treatments: in group 1 (sham) (n = 9) control, only a laminectomy was performed; in group 2 (SCI) (n = 9), SCI was imitated after laminectomy; in group 3 (SCI + saline) (n = 9), physiological saline solution was injected intraperitoneally immediately after the SCI; and in group 4 (SCI + milrinone), milrinone was administered intraperitoneally on lateral decubitus position immediately after the SCI. Spinal cord contusion was established by the weight-drop technique after laminectomy. Neurological examination scores were recorded, and rats were killed 72 hours later. Serum and spinal cord tissue glutathione peroxidase, total antioxidant status, total oxidant status, 8-hydroxiguanosine, interleukin-6 and interleukin-10 levels, histopathological spinal cord damage score, and apoptotic index were examined and compared between groups. RESULTS: Neurological examination scores were significantly better in the milrinone-treated group compared with groups 2 and 3. SCI significantly increased serum and spinal cord tissue glutathione peroxidase, total oxidant status, 8-hydroxiguanosine, and interleukin-6 levels that were successfully reduced with milrinone treatment. Interleukin-10 and total antioxidant status levels decreased as a result of SCI increased with milrinone treatment. Increased histopathological spinal cord damage score and apoptotic index in groups 2 and 3 significantly decreased in group 4. CONCLUSIONS: Milrinone could reduce apoptosis and increase anti-inflammatory and antioxidative mediators, thus playing a protective role in secondary nerve injury after SCI in rats.

Beneficial effects of moxonidine on cerebral vasospasm after experimental subarachnoid hemorrhage.

AIM: This study was designed to examine the efficacy of moxonidine, a centrally acting antihypertensive agent that is a selective ligand for I1-imidazoline sites, in a rabbit cerebral vasospasm model. MATERIAL AND METHODS: Twenty-four white, male New-Zealand rabbits weighing 2500-3200 gr. were randomly allocated into three groups as group 1= control group, group 2=subarachnoid hemorrhage (SAH) alone group, and group 3=SAH + moxonidine (treatment) group. Cerebral angiography was performed to all rabbits before (Day=0, basal angiography) and 72 hours after the induction of SAH. Intraperitoneal moxonidine (0.5 mg/kg) treatment was started after the induction of SAH and continued once a day for 72 hours in the treatment group. RESULTS: No statistically significant difference was determined in basal angiographic luminal diameter of the basilar artery between groups (p > 0.005). After SAH, the follow-up angiographic basilar artery luminal diameter significantly changed in treatment group when compared with the SAH alone group (p < 0.001). The pathologically examined basilar artery luminal area was different between these groups (p < 0.005). CONCLUSION: Moxonidine treatment as a centrally acting antihypertensive agent was found to be very beneficial in the treatment of vasospasm by increasing the angiographic diameter and the pathologic luminal area and reducing muscular wall thickness.

CSF hydrothorax after ventriculoperitoneal shunt without catheter migration: a case report.

Ventriculoperitoneal (VP) shunting is the most common procedure performed for the management of hydrocephalus. VP shunt related complications remain a persistent problem in current clinical practice. Five-year-old female patient was admitted to our hospital with persistent dyspnea complaint. The patient was operated at the age of 3 months and a VP shunt established in a different clinic due to hydrocephalus associated with Dandy-Walker malformation. The patient's chest X-ray revealed right sided pleural effusion. Thorasentesis was performed and the effusion was drained with a chest tube. The discharged liquid was consistent with CSF. Scintigraphic radionuclide shunt analyses were performed and CSF passage from abdomen to chest and lower mediastinal region was determined in the late static images. The patient was operated and the incorporated ventriculoperitoneal shunt was removed. Hydrothorax was completely resolved after early postoperative stage. CSF hydrothorax especially without catheter migration is an unusual but potentially serious-clinical complication.

Lumboperitoneal shunt in a patient with Behçet's disease with medically refractory intracranial hypertension.

A 21-year-old male presented with severe throbbing headache, nausea, vomiting and progressive visual loss. Clinical examination revealed bilateral papilledema and left abducens nerve palsy. MRI showed findings consistent with dural sinus thrombosis. Combinging the clinical findings, MRI and a positive pathergy test, the patient was diagnosed with dural sinus thrombosis associated with Behçet's disease (BD). Despite acetazolamide, prednisone, azathioprine and repeated lumbar punctures, his signs and symptoms of intracranial hypertension gradually worsened. Therefore, lumboperitoneal shunting was planned after which rapid resolution of intracranial hypertension was observed. After reviewing similar reports, we suggest that lumboperitoneal shunt placement can be an effective treatment for patients with BD with medically refractory intracranial hypertension associated with dural sinus thrombosis.

N-acetylcysteine prevents vasospasm after subarachnoid hemorrhage.

BACKGROUND: This study investigated the ability of NAC to prevent cerebral vasospasm in a rabbit model of SAH. METHODS: Twenty-one, male New Zealand white rabbits were randomly divided into 3 groups of 7 rabbits each: group 1 (control), group 2 (SAH only), group 3 (SAH + NAC treatment). NAC (150 mg/kg, single dose, IP) was administered just before SAH and continued until 72 hours after SAH in group 3. Animals were killed 72 hours after SAH. Tissue MDA levels, SOD, and GSH-Px activities were measured, and basilar artery cross-sectional areas, arterial wall thickness, and endothelial apoptosis in a cross section of basillary artery were determined in all groups. RESULTS: Intraperitoneal administration of NAC was found to be markedly effective against developing a cerebral vasospasm following a SAH in rabbits. It could significantly reduce elevated lipid peroxidation and increase the level of tissue GSH-Px and SOD enzymatic activities. Also, NAC treatment was found to be effective in increasing the luminal area and reducing wall thickness of the basilar artery. The morphology of arteries in the NAC treatment group was well protected. NAC markedly reduced apoptotic index and protects the endothelial integrity. CONCLUSIONS: This study demonstrates, for the first time, that NAC treatment attenuates cerebral vasospasm in a rabbit SAH model. NAC treatment has significant neuroprotective effect and markedly prevents cerebral vasospasm after SAH. In conclusion, the NAC treatment might be beneficial in preventing cerebral vasospasm after SAH, thus showing potential for clinical implications.

Preventive effects of intraperitoneal selenium on cerebral vasospasm in experimental subarachnoid hemorrhage.

Vasospasm is an important cause of morbidity and mortality with subarachnoid hemorrhage (SAH). The effect of intraperitoneal administration of selenium, which is an antioxidant on cerebral vasospasm was investigated in an experimental model. By means of intracisternal blood injection model, SAH was induced in 24 rabbits, which were randomly divided into 3 groups (group 1= control group, group 2=SAH alone group, and group 3=SAH plus selenium group). Basilar artery angiography was performed on day 0 and day 3 as described. Intraperitoneal selenium (0.05 mg/kg) treatment was started after the induction of SAH and administered once a day. Three days later, the animals were killed and the basilar artery was examined histologically for the luminal diameter and thickness of the arterial muscular wall. The mean values for the measurements of angiographic luminal diameter, pathologic luminal area, muscular wall thickness derived from the blind observer were analyzed statistically. There was no statistically significant difference in basal angiographic luminal diameter evaluation between groups 1-2-3 (P>0.005). But in third day angiography; comparison of group 2 and group 1-3 showed statistically significant differences (P<0.001). In pathologic investigation; there was statistically significant difference in luminal area and muscular wall thickness of the basilar artery between groups 1, 2, and 3 (P<0.005). Intraperitoneal selenium treatment was found effective by increasing the angiographic diameter; pathologic luminal area and reducing muscular wall thickness measurements. This is the first study to show that intraperitoneal administration of selenium is effective in preventing vasospasm after SAH in rabbits.

Anatomic and radiologic analysis of the atlantal part of the vertebral artery.

The horizontal third segment (V3h) of the vertebral artery (VA) in 7 cadavers (14 sides) was dissected and the anatomical measurements recorded. Measurements from 24 healthy individuals (48 sides) were taken for comparison using multislice CT scanning. The distance between the medial tip of the VA V3h and the line passing through the mid point of the posterior tuberculum of the atlas was marked as length A. The distance between the medial tip of the VA V3h and the point penetrating the dura mater was classified as length B. The angle between these lines was the alpha (alpha) angle. Measurements were taken when the head was in a neutral position, as well as in maximum right and left rotation, extension and flexion. In cadavers, the mean alpha angle (+/-S.D.) was 82.42+/-10.34 degrees and 83.21+/-10.81 degrees on the right and left side, respectively. On multislice CT scanning, the mean alpha angle was 81.64+/-10.15 degrees on the right and 83.77+/-10.65 degrees on the left. These angles varied with the position of the head.

A case with prepontine (clival) arachnoid cyst manifested as trigeminal neuralgia.

Most cases of "idiopathic" trigeminal neuralgia are thought to originate from vascular compression of the trigeminal root entry zone. In this case, we describe a young man presenting with the symptoms of trigeminal neuralgia associated with a prepontine (clival) arachnoid cyst.

Astroblastoma in a child.

BACKGROUND: Astroblastoma, an uncommon neuroepithelial tumor, typically presents in young adults as a well-circumscribed cortical or subcortical spherical mass. Astroblastoma may cause a diagnostic problem to anyone unfamiliar with its architectural and histological features. CASE HISTORY: We report the case of a 4-year-old boy who was referred for complaints of progressive deficits of balance and difficulty with walking during the previous 3 months. A large fronto-parietal cystic mass with solid mural nodule was discovered. Total removal of the tumor mass was performed, and a diagnosis of high grade (malignant) variant of astroblastoma was made. Postoperatively, the patient received radiation therapy, for a period of 11 weeks, followed by chemotherapy. He is in a good neurological recovery without any evidence of recurrence for 8 months. PROGNOSIS: The best treatment modality for astroblastoma is surgical resection if possible, whereas adjuvant therapy (radiotherapy and/or chemotherapy) can be considered in high-grade astroblastomas, with a close follow-up for all cases.

Iatrogenic epidermal inclusion cyst of the parapharyngeal space: unusual complication of ear surgery.

A 46-year-old man presented with a 12-month history of a slow-growing mass at the right anterior temporal and superior parotid region. He had a history of chronic otitis media and had undergone a modified radical mastoidectomy for cholesteatoma 5 years earlier. Physical examination revealed a sinus tract and diffuse soft tissue mass measuring 4 cm in diameter spread throughout the region of the right anterior temporal and superior parotid areas. Magnetic resonance imaging (MRI) showed three separate masses, including contrast material in the right superior parotid region and lateral skull base. The patient underwent a preauricular infratemporal approach. Six months later, a sinus tract recurred at the inferior border of the right zygomatic arch. MRI showed multiple masses in the right prestyloid parapharyngeal space, which were resected through a transparotid approach. The histopathologic diagnosis was an epidermal inclusion cyst (EIC). One year after the operation the patient was in good health and there was no sign of disease. EICs are rare tumors that are seen when epidermal elements are included in the dermis, which can follow trauma. EICs are unusual in the parapharyngeal space. Thus, until they become clinically observable, primary benign growths may not be recognized in this region. EICs must be considered in the differential diagnosis of growths in the parapharyngeal space, particularly among patients with a prior history of tympanomastoid surgery on the tumor side.

The role of hyperbaric oxygen in the management of subarachnoid hemorrhage.

OBJECTIVE: To determine the role of hyperoxic and hyperbaric therapy following experimental subarachnoid hemorrhage (SAH). DESIGN: Prospective, randomized, controlled animal study. SUBJECTS: Thirty male Wistar rats. INTERVENTIONS: Thirty rats were assessed for an initial neurologic status as double-blinded by two different neurosurgeons using a neurologic severity score (NSS) and then underwent an initial angiographic examination. Two days later, 0.3 ml of homologous blood was injected into the cisterna magna to produce a SAH-induced cerebral vasospasm. The NSS and angiographic examination were then repeated. The rats having no spasm or a spasm under 50% (n=8) and 50% or over 50% (n=22) were grouped separately, as groups 1 and 2, respectively. The rats having 50% or more spasm were further divided randomly into group 2A and 2B. The rats in groups 1 and 2A (n=11) underwent a 60-min course of 100% oxygen at the atmospheric pressure 1 atmosphere absolute (ata), and group 2B (n=11) received 100% oxygen at 3 ata for 1 h. Neurologic assessment was repeated on the next day and 7 days later. MEASUREMENTS AND MAIN RESULTS: The animals having no spasm or less than 50% spasm had a better NSS and outcome when compared with the animals having 50% or more spasm. But the animals with 50% or more spasm which underwent hyperbaric therapy were shown to have a better outcome compared to the animals having hyperoxic therapy. CONCLUSION: Exposure to hyperbaric oxygen therapy seemed to accelerate the recovery of neurologic deficits secondary to experimental SAH.

Lateral posterior fossa venous sinus relationships to surface landmarks.

BACKGROUND: Knowing the location of the venous sinuses in the combined lateral posterior fossa and lateral cranial base approach is important to prevent their inadvertent injury. The identification of surface landmarks related to these structures is useful in planning such surgical approaches. METHODS: Twelve injected adult cadaver specimens and 10 dried skulls were used to study the relationship of the venous sinuses to various surface anatomic structures. RESULTS: The asterion was not clearly seen in 60% of the studied cadaver sides. The asterion was always clearly seen in the dry skull preparations. The upper margin of the superior nuchal line was found to range from 1.5 mm to 14 mm inferior to the lower margin of the lateral transverse sinus. In 85% of our specimens, the mastoid groove was found to completely overlie the sigmoid sinus. CONCLUSIONS: The asterion was found to be variable in its anatomic relations to other identifiable structures. This variability in relation to other posterior fossa bony landmarks limits its overall usefulness as a consistently stable marker for intracranial structures. The first and most superolateral burr hole for lateral posterior fossa procedures can be safely placed 1 cm below the superior nuchal line and 1 cm medial to the top of the mastoid groove. A burr hole in this location will avoid the transverse and sigmoid sinuses, as well as the transverse-sigmoid junction, yet will be high enough and lateral enough to provide easy exposure of these venous sinuses for all lateral posterior fossa procedures.

Arachnoid cyst within the fourth ventricle: a case report.

The authors report a case of fourth ventricular arachnoid cyst that presented clinically with the criteria of normal pressure hydrocephalus. Only a few cases of intraventricular arachnoid cyst have been recorded in the literature. In our case, a posterior approach was used via a midline suboccipital craniectomy and the cyst was excised.

Submandibular and intracranial hydatid cyst in an adolescent.

OBJECTIVES: An unusual case of hydatid disease is reported. Review of the pertinent literature did not reveal any hydatid disease located simultaneously in both the intracranial and submandibular glands. This is the first case with hydatid disease occurring in both locations at the same time. STUDY DESIGN: The case of an 18-year-old is presented; the symptoms, findings, methods of diagnosis, and our approach for treatment are discussed; and the literature is reviewed. RESULTS: The intracranial lesion was completely excised by left-sided frontoparietal craniotomy, and the mass in the right side of the submandibular gland was removed through a submandibular approach at the same session. The intact cyst was completely excised. Histological examination of both lesions confirmed the diagnosis of hydatid cyst by. Postoperative recovery was uneventful, and the patient was discharged on the seventh day. CONCLUSIONS: Hydatid cyst should be suspected during the evaluation of cervical masses, particularly in endemic regions. Hydatid disease infestations are best treated with complete excision of the intact cyst.