Effects of diclofenac sodium on the hippocampus of rats with acute subdural hematoma: histological, stereological, and molecular approach.

This study was aimed at evaluating the potential effects of acute subdural hematoma (ASDH) and diclofenac sodium (DS) therapy following ASDH on the rat hippocampus. Twenty-four male Sprague Dawley rats were used and divided into four groups. 0.1 ml of non-heparinized autologous blood from the tail vein of the animals in the non-treatment group (NTG) and treatment group (TG) was injected into the subdural space. The TG received intramuscular diclofenac sodium at a 15 mg/kg dose daily from the postoperative second hour to the seventh day after the operation. The control group (CG) and sham group (SG) were used for control and sham operations, respectively. On the postoperative eighth day, all animals were sacrificed, and the hippocampi of all animals were stereologically and histologically evaluated. Also blood samples of the animals were biochemically analyzed. As a result of the study, the mean number of neurons in CA1, CA2, and CA3 regions of the hippocampus and the total number of neurons were decreased in the hippocampus samples of the NTG and especially the TG subjects. When comparing the second blood samples, there was no difference between the levels of adrenaline and serotonin among the groups. However, after the operation, noradrenalin levels in the treatment group were found to be higher than those of the sham and control groups (p < 0.05). In the NTG and TG, histopathological findings were observed such as Nissl condensation as well as completely dead and indistinguishable neurons with abnormally shaped, shrunken cytoplasm and nuclei. Also necrotic areas on the specimens of the TG were seen. In immunohistochemical sections, c-FOS positivity was decreased in the NTG and especially the TG. Otherwise, PGC-1 positive cells were increased in the NTG and especially the TG. In this study, it was shown for the first time by means of stereological techniques that using DS after ASDH caused a decrease in the number of hippocampal neurons (CA1, CA2, and CA3 regions).

Use of 3DFT-CISS sequences and virtual MR endoscopy for the neuroendoscopic treatment of unilateral hydrocephalus: case illustration.

OBJECTIVE: Intraventricular virtual MR endoscopic imaging of the foramen of Monro region by using three-dimensional Fourier transformation constructive interference in steady state (3DFT-CISS) magnetic resonance imaging in a patient with a unilateral congenital obstruction of the foramen of Monro by a transparent membranous septum was performed to enhance the orientation, achieve a better understanding of the pathology, and plan the surgical intervention in an endoscopic approach to the lateral ventricles. METHODS: 3DFT-CISS sequences and virtual MR endoscopic imaging were performed in a patient before and after endoscopic fenestration procedures, to communicate the lateral ventricle to the third ventricle for the treatment of unilateral ventricular enlargement. RESULTS: Preoperative 3DFT-CISS imaging demonstrated unilateral membranous septa in the localization of the left foramen of Monro which were not observed with routine T2-weighted imaging. 3DFT-CISS imaging and T2-weighted imaging were equally useful for monitoring postoperative changes in the size of the ventricles or cysts and the presence of flow voids after fenestration procedures, but only 3DFT-CISS imaging clearly demonstrated the area of fenestration. CONCLUSION: Virtual MR endoscopy by using 3DFT-CISS sequences is a feasible method in the planning of intraventricular real-time endoscopic surgery, for the enhancement of orientation in a surgical field, and to achieve a better understanding of the pathology.

A new minimally invasive experimental spinal cord injury model in rabbits.

The aim of this experimental study was to evaluate the effectivity of epidural microballoon inflation into the unroofed spinal column for the creation of a new experimental spinal cord injury model in rabbits. 10 New Zealand white rabbits were used for this study. Before operation and after anasthesia with 50 mg/kg ketamine and 8 mg/kg xylazine, spinal evoked potentials (SEP) were recorded in all rabbits. A midline skin incision was done on the lomber skin at the level of L1-L4. Paravertebral muscles were dissected bilaterally. A microhemilaminotomy was done in the right L3 lamina close to the midline by using Midas-rex micro-diamond drill instruments. The ligamentum flavum was opened and removed with microscissors. A microballoon was inserted into the spinal column between the bone and dura mater to the level of T12. The microballoon was inflated by using a pressure- and volume-controlled microballoon inflation device. Pre-injury and post-injury SEPs were recorded. The microballoon was deflated 15 minutes later and removed completely from the epidural space. 24 hours later the SEP study was repeated. Following microballoon inflation the SEP waves dropped to the basal level. All rabbits were paraplegic after the operation. In conclusion, this experimental study demonstrated that the microballoon inflation technique is a very successful method for the evaluation of spinal cord injury in rabbits. Unroofing of the spinal column is extremely important because decompression may be an effective treatment in spinal cord injury. Also the traumatic effect of aneurysm clips represents a different type of injury to the spinal cord. This new model may be used in experimental studies of spinal cord injury in rabbits.

Maintaining microneurosurgical ability via staying active in microneurosurgery.

The aim of this study was to evaluate the effect of staying inactive for well-trained microneurosurgical hand and to determine the critical time period in the decreasing of this special ability (microneurosurgery). For this purpose we planned a case-based and time-dependent study. This study was done on a microneurosurgeon who previously worked very actively in a department of neurosurgery (at least one operation in a day). He received a new appointment which included staying inactive in another department for a certain period of time, like a medical doctor. He did hand practice everyday and scored his ability in the aspect of total beauty and harmony of the work. The total performance of work was graded as bad, good and excellent. A bad grade was scored as 1 point, a good grade as 2 points, and an excellent grade as 3 points. The inactive time period was divided into three equal periods of 30 days. The total numerical values were calculated and a mean score was estimated for each 30-day period. The differences among the first, second, and third periods were enumerated based on the mean scores. The mean score in the first 30 days was estimated as 2.56+/-0.49, in the second 30 days as 2.16+/-0.37, and in the third 30 days 1.66+/-0.47. The differences between these values were statistically significant. The result of this study revealed that neurosurgeons may gradually lose their well trained microneurosurgical ability through staying inactive from daily practice. The maintenance of trained microneurosurgical ability should be preserved by staying active in neurosurgical operative practice.

Using the magnetic resonance three-dimensional volume rendering for tissues technique in the planning of craniotomy flaps with linear scalp incision.

Preoperative three-dimensional images with surface venous anatomy may be used in the planning of a linear scalp incision and the opening site of the dura mater for protection of surface veins during surgical dissection, and to find the splitting site of the brain according to the lesion. In 45 patients who had a brain tumor, linear scalp incision planning was done by regarding the three-dimensional images derived from post-contrast time-of-flight (TOF) sequence raw data. The findings of correspondence and the quality of routine contrast-enhanced magnetic resonance imaging (MRI) and three-dimensional volume rendering for tissues (VRT) images were analyzed separately with the surgical findings according to a visual grading system. Our experience revealed that the surgical findings correlated well with the three-dimensional VRT images. According to a visual surgical grading system, a grade III correlation was found in 20 (45%), grade II in 15 (33%), grade I in 7 (15%), and grade 0 in 3 (7%) patients in our study population. At the end of our research we conclude that this method is useful in terms of the preoperative determination of brain surface anatomy and may be used in the determination of the site of a linear scalp incision according to the localization of an intracranial lesion.

A model of unilateral frontal focal cerebral venous occlusion in the rat.

OBJECTIVE: The aim of this experimental study was to create a new focal venous infarction model in rats. METHOD: 20-male Sprague-Dawley rats were used in this experiment. Unilateral frontal strip craniectomy was done in front of the coronal suture. Frontal veins were observed by using the operative microscope. In this study we used the bipolar coagulation method over the transparent dura mater for occlusion of the bridging veins for venous infarction. Specimens were evaluated by histopathological techniques. RESULTS: Unilateral frontal hemispheric swelling, midline shift, brain edema, subcortical petechial hemorrhage, hemorrhagic infarction and necrosis were the histopathological findings on microscopic examination. CONCLUSION: Our results revealed that the bipolar coagulation method over the transparent dura mater for occlusion of the unilateral frontal cortical veins for venous infarction might be a new experimental model in the evaluation of brain damage after disturbance to the venous circulation.

Stevens-Johnson syndrome in two patients treated with cranial irradiation and phenytoin.

Stevens-Johnson syndrome (SJS) is a severe cutaneous eruption that most often appears as an adverse reaction to medication. In this report, we present two patients diagnosed with SJS, which developed in patients with brain tumour, after receiving cranial irradiation and phenytoin. Concomitant application of these two therapies may play an important role in the occurrence of the disease.

Soft micro-balloon paddy for brain retraction in the protection of neuronal tissue.

UNLABELLED: Brain protection is extremely important during arachnoidal dissection and brain separation with a metallic retractor to create a surgical corridor. We have designed a new type of paddy containing air-filled micro-balloons and cotton for use between the metallic retractor and the brain surface for maximal protection of the neuronal tissues from the pressure of the retractor. In neurosurgical operations, cotton paddies are commonly and generally used during the retraction of brain tissue. We hypothesized that air-filled micro-balloon paddies covered with cotton could be helpful in the gentle separation of brain tissue with metallic retractors for minimizing cerebral damage, and for separating sulcal and cisternal walls during brain operations. These paddies are 2 cm in width and 4 cm in length. Multiple air-filled silicon micro-balloons are located in a sheet with 1-2 mm separation from each other. These silicon micro-balloonoid sheets are covered with a cotton sheath. The thickness of this type of paddy is 2-3 mm from the anterior surface to the posterior surface. We used paddies in 86 brain operations where brain retraction was necessary to create a surgical corridor. There was no complication or unwanted events related with the use of these paddies. IN CONCLUSION: air-filled silicon micro-balloon paddies are useful materials for the gentle separation of brain tissue with a metallic retractor in order to minimize cerebral damage, and for the separation of sulcal and cisternal walls during the surgical intervention.

Experimental rabbit hemilaminotomy model in the evaluation of peridural fibrosis: a minimally invasive peridural fibrosis model.

The neuronal adhesions of newly synthesized scar tissue to dura mater after spinal peridural operations represent an unsolved problem in neurosurgical practice. This experimental study was planned to compare the success of a rabbit hemilaminotomy procedure with the total laminectomy model in the evaluation of peridural fibrosis in terms of proposing a lesser invasive peridural adhesion model. Fourteen New Zealand white rabbits were used in this experiment. Laminectomy was performed in one level, and hemilaminotomy was done in another level. Four weeks after operation the rabbits were sacrificed by perfusion with 10 % neutral buffered formalin solution. The lumbar spines were removed and immersed in 10 % neutral buffered formalin for approximately 24 hours. Then each specimen was decalcified in 5 % formic acid for approximately 3 weeks. Specimens were cut coronally for gross inspection. Two blocks of tissue were taken from each laminectomy site to be processed and embedded in paraffin. In seven (50 %) of the laminectomy sites of the rabbits, fibrous tissue penetrated the spinal canal through the laminectomy defect and produced neural compression (Grade III). Eight (57 %) hemilaminotomy sites were in Grade III fibrosis. There was no difference between laminectomy and hemilaminotomy in regard to the dural adhesions. In this experimental study, we modified the rabbit total laminectomy model by using a hemilaminotomy procedure in the study of peridural scar formation. The authors conclude that this procedure is more simple, reliable, and lesser invasive than the total laminectomy model.

A model of unilateral cerebral anterior and posterior anastomotic vein occlusion in the rat.

A new rat model of the sacrifice of the anterior and posterior cortical anastomotic veins by the microsurgical technique was used to evaluate venous infarction. 20 male Sprague-Dawley rats were used in this experiment. Small burr-holes were done over the anterior and posterior anastomotic veins. After the precise description of these vessels, bipolar coagulation and micro-scissor was used for sacrifice. Specimens were evaluated by histopathological techniques. Hemispheric swelling, midline shift, brain edema, subcortical petechial hemorrhage, infarction and necrosis were histopathological findings on the microscopic examination. Our results revealed that the sacrifice of the anterior and posterior anastomotic veins was a very successful model in the evaluation of brain damage after the disturbance to the venous circulation.

The effects of venous ischaemia on the subependymal and choroid plexus morphology in rat.

Morphological changes of ependyma, subependyma and choroids plexus regions were evaluated after experimental anastomotic venous occlusion in twenty male Sprague-Dawley rats. In this model, small burr holes were made over the anterior and posterior anastomotic veins and after precisely locating these vessels, bipolar coagulation and microscissors were used to perform permanent occlusion. Three days later, rats were sacrificed by perfusion and fixation and specimens were evaluated by histopathological techniques. Morphological changes of ependymal, subependymal and choroids plexus cells were evaluated in operated and intact hemispheres and revealed cell proliferation in the subventricular zone adjacent to the territory of venous occlusion in the operated hemisphere as well as midline shift, brain oedema, subcortical petechial haemorrhage, brain infarction and hemispheric swelling. In conclusion, following anterior (the vein of Throlard) and posterior (the vein of Labbé) anastomotic vein occlusion, cell proliferation can be seen in the choroids plexus, ependymal and subependymal regions in rats. We conclude that these morphological changes might be part of a self-repairing mechanism in the brain.

Presurgical ultrasound-assisted neuro-examination in the surgical repair of peripheral nerve injury.

In spite of electrodiagnostic examinations, the determination of the precise localization of the injured site along the involved peripheral nerve may remain obscure or uncertain. Before starting the operation, a surgeon should have knowledge about the type of injury, the position of the proximal and distal nerve stumps, and the presence or absence of a neuroma and excessive perilesional scar tissue formation for orientation and planning of the surgical intervention. We hypothesized that real-time ultrasound could be helpful in the determination of the type of injury, the localisation of proximal and distal nerve stumps, as well as for diagnosing a neuroma. Fourteen patients with traumatic peripheral nerve injuries that were verified by neurological examinations and electrodiagnostic tests underwent surgical repair, and were examined by ultrasound before and during the surgical intervention. Visualisation of the injured site, the type of the injury, the position of the nerve stumps and the diagnosis of the neuroma were reliably feasible in all the patients by using ultrasonography. Axonal swelling of a nerve was diagnosed in 4 (29 %) patients, a stump neuroma was diagnosed in 3 (21 %) patients, a total nerve interruption (neurotmesis in the Seddon classification) was diagnosed in 9 (64 %) patients, and surrounding scar tissue was diagnosed in 5 (35 %) patients. Presurgical and intraoperative ultrasound-assisted neuroexamination is a useful diagnostic method in the determination of the precise localisation of the injured site, the type of injury, the position of stumps, and the diagnosis of a neuroma. The use of preoperative and intraoperative ultrasound can enhance the orientation of the surgeon to the surgical field. The application of our method to our patients shows that presurgical ultrasonographic neuroexamination can be used in the surgical repair of peripheral nerve injury.

Transparent microballoon dissection in the surgical treatment of brain tumors.

In spite of maximal microsurgical efforts, perilesional neural tissue can be injured by surgical instruments in the process of the separation and dissection of tumors. We hypothesized that transparent microballoon dissection could be helpful in the gentle separation of brain tissue from tumor by minimizing cerebral damage, and in separating sulcal and cisternal walls during surgical interventions on brain masses. We used the transparent microballoon dissection technique in 3 primary cases and 4 metastatic brain tumors that were verified with computed tomography (CT) and magnetic resonance imaging (MRI). Gentle separation of tumor from surrounding brain, reduction of cerebral damage, and separation of sulcal and cisternal walls were feasible in all patients. Postoperative CT and MRI showed satisfactory results in reducing perilesional cerebral damage. The transparent microballoon inflation technique is a useful microsurgical method for the gentle separation of tumors from surrounding brain tissue, minimizing cerebral damage, and separating sulcal and cisternal walls during surgical interventions for brain masses. Our conclusion is that using the microballoon dissection method may be suitable in microneurosurgical practice.

The guidance of intraoperative ultrasonography in the surgical treatment of arteriovenous malformation.

In this operative case-based report, we have investigated the ability and benefits of intraoperative grey-scale sonographic examination in the localising of arteriovenous malformations in the brain, the identification of feeding artery or arteries, the description of perilesional changes, and the detection of accompanying hematomas. The surrounding edematous brain tissue was observed as hyperechioc areas. The arteriovenous malformation appeared in two echogenic parts, a hyperechioc thrombotic part and a hypoechoic perfused part. We were able to identify the feeding artery. The sonographic characteristics of this artery are thick vascular wall, the presence of arterial systolic pulsation and a close relation with the nidus. We conclude that intraoperative ultrasonographic examination during the surgical treatment of arteriovenous malformation is a non-invasive, useful, and simple diagnostic tool in the detection of the components and accompanying parts of the lesion.

Spontaneous disappearance of two asymptomatic arachnoid cysts in two different locations.

We report two children with asymptomatic arachnoid cysts which resolved spontaneously without any surgical intervention and history of major head and body trauma. The first child was a 10-year-old boy with an arachnoid cyst in the right sylvian fissure. The second child was a 1-year-old girl with a right cerebral convexity arachnoid cyst. Both of them were asymptomatic. Arachnoid cysts spontaneously disappeared within 2 years following initial diagnosing. There was no major head and body trauma except usual home, school and sports activity. We speculated that the cysts ruptured into cerebrospinal fluid circulation by the mechanical effects of some forced activities to the brain tissue and cyst, such as excessive breathing, coughing and sport activities. These factors may change the balance between intracystic and pericystic pressure and facilitate the rupturing of the cyst into subdural, subarachnoid and intraventricular spaces. These cases demonstrate that neurosurgical intervention of asymptomatic arachnoid cysts is not absolutely indicated in the paediatric age group. Close follow up with computerized tomography (CT) and magnetic resonance imaging (MRI) is a treatment option in the patient with arachnoid cysts located in the middle cranial fossa and cerebral convexity.

Cerebral aneurysms in Behçet's disease: a case report.

A 42-year-old male patient was surgically treated for two cerebral aneurysms, 18 months later he developed manifestations of Behçet's disease. Lack of clinical manifestations as well as angiographic evidence of vasculitis at the time of the cerebral aneurysmal disease argue against the possibility that the aneurysms were complications of the neural involvement of Behçet's disease.

Reconstruction of burr hole by using autologous button-shaped graft harvested from inner table of craniotomy flap: technique and clinical result.

Patients who underwent craniotomy occasionally complain about the postoperative cosmetic appearance at the site of burr holes on the scalp. This problem occurs as a result of depletion of the skin into the unreconstructed burr holes. Some materials have been developed for reconstruction of craniotomy burr holes. To prevent the postoperative cosmetic deformity, the authors developed a button-shaped autologous bone graft harvested from the inner table of craniotomy flap. Clinical application of this method is described.

Acute interhemispheric subdural hematomas. Report of nine cases.

Nine male patients with acute interhemispheric subdural hematoma (ISH) are presented. The etiologic factor was trauma for all patients (traffic accident and falling down). The young adult cases and one child had bad prognosis due to severe clinical findings and high mortality. The asymptomatic patients were treated conservatively. In this report, we discussed etiologic factors, presentation of age groups, whether an ISH progresses to a chronic convexity subdural hematoma (SH), and real mortality rates for ISH with relevant literature knowledge. As a result, ISHs can present in all age groups including shaken babies, severely injured young adults as well as low velocity trauma striken elderly patients (especially those under anticoagulant medication). We believe that an acute ISH does not change to chronic convexity SH; in fact they present as simultaneous acute thin convexity SH and acute ISH. It is also concluded that in contrast to previous literature ISH and acute SH patients of similar neurological status have similar mortality rates.

The effects of albendazole solution at scolocidal concentration in the rat brain.

Intra-operative cyst rupture is a catastrophic event in the intracranial hydatid cyst disease. Dissemination of the cyst contents may lead to severe anaphylactic reactions and an increased risk of recurrence. Several scolicidal agents have been used to eradicate the infective scolices but recurrences occur and no solution has been evaluated for its adverse effects to the brain tissue. Being a specific scolocidal agent albendazole has been shown to be 100% scolicidal in vitro. In this study, we present the electrophysiological and histopathological effects of intracerebral 2% albendazole injection in the rat brain. Vascular, neuronal and glial as well as inflammatory changes were evaluated in order to detect any adverse pharmacological effects. Electrophysiological and most microscopic parameters showed no significant effects attributable to albendazole but in 25% of the albendazole group cerebral gliosis was detected whereas no gliosis was present in the control group. It is concluded that being a specific scolicidal agent albendazole offers an efficient alternative for ruptured cerebral hydatid disease, but the significance and clinical importance of the gliosis should be further investigated.

Intranasal (transethmoidal) encephalomeningocele. Case report.

Intranasal encephaloceles are rarely encountered in pediatric neurosurgery. The symptoms and clinical features may mimic those of nasal polyp. It is important to know the type of basal encephalomeningocele for appropriate surgical intervention. Computed tomographic examination is helpful for differential diagnosis of the encephalocele sac and localization of the cranial bone defect.