The effect of the sildenafil citrate on cerebral vasospasm and apoptosis following experimental subarachnoid hemorrhage in rats.

AIM: The therapeutic effect of sildenafil citrate on cerebral vasospasm after experimental subarachnoid hemorrhage (SAH) was studied in a rat model. METHODS: We used four groups of seven rats were as follows: no SAH, no treatment; SAH only; SAH plus 2 days of peroral sildenafil citrate 5mg/kg treatment and SAH plus 2 days of peroral sildenafil citrate 15 mg/kg treatment. Three different parameters were evaluated including the diameter of the basilar artery, the level of lipid peroxidation and the degree of the apoptosis 48 hours following SAH. RESULTS: The results showed that sildenafil citrate attenuated SAH-induced cerebral vasospasm in the treatment groups in terms of the diameter of the basilar artery and lipid peroxidation in the two treatment groups, but there was no difference in terms of the level of apoptosis. CONCLUSION: This study indicates that further research on the therapeutic effect of sildenafil citrate can be combined with the use of any apoptosis-blocking agent for the treatment of cerebral vasospasm following experimental subarachnoid hemorrhage.

Ulnar nerve entrapment in Guyon's canal due to a lipoma.

Guyon's canal syndrome is an ulnar nerve entrapment at the wrist or palm that can cause motor, sensory or combined motor and sensory loss due to various factors . In this report, we presented a 66-year-old man admitted to our clinic with a history of intermittent pain in the left palm and numbness in 4th and 5th finger for two years. His neurological examination revealed a sensory impairment in the right fifth finger. Also, physical examination displayed a subcutaneous mobile soft tissue in ulnar side of the wrist. Electromyographic examination confirmed the diagnosis of type-1 Guyon's canal syndrome. Under axillary blockage, a lipoma compressing the ulnar nerve was excised totally and ulnar nerve was decompressed. The symptoms were improved after the surgery and patient was symptom free on 3rd postoperative week.

Atypical presentation of Guillain-Barre syndrome with acute hydrocephalus.

A 32-year-old man was treated with a ventriculo-peritoneal shunt for acute panventricular hydrocephalus. On the third postoperative day, an ascending tetraparesis and subsequent respiratory failure developed. Based on the clinical findings, cerebrospinal fluid study and electrophysiological results, a diagnosis of Guillain-Barre syndrome (GBS) was made. Despite plasmaphoresis and immunoglobulin infusion, the patient was ventilator dependent and bed-bound for 4 months. One year later, he was able to walk without assistance and had only slightly wasting of the intrinsic hand muscles. This is the first report of acute hydrocephalus preceding the symptoms of GBS.

Dissapearance of arachnoid cyst after rupturing into subdural space.

Arachnoid cysts are developmental anomalies usually diagnosed in childhood. The most important complications of arachnoid cysts are subdural haematomas and hygromas and intracystic haemorrhage. In our case we present a 7-year-old boy whose arachnoid cyst ruptured into the subdural space following a mild head injury and disappeared after draining the subdural haematoma by burr-holes.

Six months post-operative clinical and 24 hour post-operative MRI examinations after nucleoplasty with radiofrequency energy.

BACKGROUND: Minimally invasive techniques are gaining popularity for the treatment of discogenic low-back pain. Nucleoplasty is a relatively new procedure that uses radiofrequency energy to disintegrate and evacuate the disc material. The purpose of this study is to examine the early post-operative radiological changes after lumbar nucleoplasty and to assess the short-term effects of this procedure on discogenic lower back pain and leg pain. METHODS: Twenty nine patients between the ages of 32 and 59 years (mean 44.14, SD 7.11 years) were included in the study. Visual Analogue Scale (VAS) scores of the patients were recorded in the pre-operative period and 24 hours, 3 months and 6 months after the procedure. Additionally, pre-operative and post-operative lumbar magnetic resonance imaging (MRI) examinations of these patients were compared. FINDINGS: The mean pre-operative VAS score was 6.95 (range 3.0-10.0, SD 1.87) and the mean post-operative VAS scores at 24 hours, 3 months and 6 months were 2.46 (range 0-8.0, SD 2.07), 4.0 (range 0-10.0, SD 3.09) and 4.53 (range 0-10.0, SD 3.6), respectively. There were statistically significant reductions (p < 0.001) in VAS scores for all post-operative time points when compared to pre-operative values. Nucleoplasty did not produce obvious changes at least on the early post-operative MRI examination. CONCLUSIONS: Although, nucleoplasty appeared to be a safe minimally invasive procedure, the value of this new technique for the treatment of discogenic low-back pain remains as yet unproven. Further randomised placebo-controlled studies with longer follow-up are needed to elucidate the effects of nucleoplasty on discogenic low back and leg pain.

Fusiform aneurysm of the superior cerebellar artery: short review article.

Fusiform superior cerebellar artery (SCA) aneurysms are quite rare and only 9 cases have been reported in the literature. Fusiform aneurysms are a small group of cerebral aneurysms among the most difficult to treat. The therapeutic approaches in the limited number cited in the literature include surgery and endovascular occlusion. Surgical techniques which have been used are parent artery occlusion, trapping or body clipping of the bleeding site, and wrapping for fusiform aneurysms. Neurological condition, presence of collateral circulation, type and configuration of the aneurysm, and type of the dissection are important factors that predict the course of fusiform SCA aneurysms. We reviewed the literature on fusiform aneurysm of the SCA and report a further case treated surgically.

Neurosurgical practice at Baskent University, Turkey: a new model.

BACKGROUND: The Turkish Organ Transplantation and Burn Foundation was established in 1980. This was followed by the founding of the Turkish Transplantation and Burn Foundation Hospital in 1985. Under the aegis of this foundation and the Haberal Educational Foundation, Baskent University (BU) was founded in 1993 by Professor Mehmet Haberal, general surgeon and pioneer of organ transplantation in Turkey, and the President of the university since then. METHODS AND FINDINGS: The BU Neurosurgery Department began functioning in January of 1995, with the advancement of the department and with contributions from the other hospitals in cities of Adana, Konya and Alanya. Just 13 years after its foundation, BU became one of the most prestigious universities of the country. While establishing new neurosurgery units within BU health care facilities, the neurosurgeons appointed to the new center spend few months in the neurosurgery department at the BU Ankara Hospital, central hospital, at first in order to get acquainted with the BU medical system. After the new neurosurgery unit begins to operate, senior neurosurgeons from Ankara are called to supervise junior colleagues during major surgical procedures. In addition to these exchanges, residents are sent routinely to these centers as part of the neurosurgical residency programme. As the system is very integrated, neurosurgeons from other centers of the BU also routinely come to Ankara Hospital and Research Center for educational purposes. CONCLUSION: BU as a whole and its health system model in particular are certainly unique in Turkey. The statistical data from all hospitals of the BU reveal growing patient demand and consumer satisfaction.

Treatment of hydrocephalus with functionally isolated ventricles.

Rapid therapeutic drainage of one lateral ventricle may lead to ipsilateral slit ventricle, and the resultant functional obstruction of cerebrospinal fluid flow through the foramen of Monro may cause dilatation of the contralateral ventricle. Drainage of the lateral ventricle with a low-pressure shunt led to functionally isolated contralateral ventriculomegaly in this report. The patient's condition was complicated by a Candida albicans shunt infection. Following effective treatment of the infection by chemotherapy and removal of the shunt system, the patient was treated by bridging two lateral ventricles with ventricular catheters connected to an Ommaya reservoir. An occipital ventricular catheter was then inserted and connected to a programmable valve to drain the bridged lateral ventricles. Modern centers, caring for patients with infantile hydrocephalus, should have endoscopic facilities available but in cases with extensive ventricular adhesions and in asymmetric hydrocephalus where endoscopic septostomy between the ventricles is impossible our described technique may be used.

Posttraumatic acute bilateral abducens nerve palsy in a child.

INTRODUCTION: Acute bilateral abducens nerve palsy after traumatic clivus epidural haematoma is a rare condition in trauma patients. CASE REPORT: In this report, we present a case with this rare neurological complication of head trauma and discuss the possible mechanisms for abducens nerve palsy and clival epidural haematoma.

Spontaneous acute subdural hematoma following contralateral calcified chronic subdural hematoma surgery: an unusual case.

Calcified chronic subdural hematoma (CCSDH) is a well-known disease to many neurosurgeons but only few cases have been reported regarding its surgical complications. We report a spontaneous acute subdural hematoma following contralateral CCSDH surgery in a 16-year-old boy and discuss its possible mechanisms. The first few days of the postoperative period, especially for the cerebral atrophy cases, should be monitored carefully and a control computerized tomography scan should be performed early for possible complications. To our knowledge, spontaneous acute subdural hematoma following contralateral CCSDH surgery has not been reported previously.

Sacral kyphoplasty for relieving pain caused by sacral hemangioma.

STUDY DESIGN: Case report describing sacral kyphoplasty in a patient with sacral hemangioma; the first account of this procedure in a sacral hemangioma. OBJECTIVES: To highlight the advantages of sacral kyphoplasty in the treatment of sacral tumors. SETTING: This study is made in Baskent University in Turkey. SUMMARY OF BACKGROUND DATA: Kyphoplasty and sacroplasty are new, minimally invasive techniques that are mostly used for treating osteoporotic vertebral body fractures. These techniques are very effective for achieving rapid pain relief and stabilizing the vertebra, and biopsy collection can be included in the procedure. The latter allows for informed treatment planning in patients with metastatic tumors. METHOD: A 74-year-old woman with known metastatic renal cell carcinoma was investigated for pain in the left sacral region. A tumoral lesion was detected, and sacroplasty was performed at S1. RESULTS: The sacral pain resolved completely after the procedure, and the patient was able to walk without assistance. The pathological diagnosis for the vertebral lesion was hemangioma. CONCLUSIONS: Sacral kyphoplasty is a very effective, minimally invasive surgical procedure. Patients with debilitating diseases such as primary sacral tumors or metastases can be treated by this technique with no significant complications.

Correlation between histological grade and MIB-1 and p53 immunoreactivity in meningiomas.

OBJECTIVE: Meningiomas for the most part are slow-growing benign tumors, but complete removal can be difficult and recurrence is an issue. The aim of this study was to re-evaluate tumors diagnosed as meningioma previously in our hospital, according to the latest World Health Organization classification. We also examined the relationships among parameters such as brain invasion, histological grade and Ki-67 and p53 expression in these tumors. MATERIALS AND METHODS: Meningioma biopsy specimens numbering 60 (48 grade I, 11 grade II, and 1 grade III tumors) were examined immunohistochemically using monoclonal antibodies for Ki-67 (MIB-1) and p53 protein. The MIB-1 labeling index (LI) for each tumor was calculated as a percentage based on the number of stained cells per total cells counted. The level of p53 expression in each sample was semiquantatively evaluated as < 1%, 1 - 10%, 10 - 70%, or > 70%. Any value > 1% was accepted as presence of p53 expression. RESULTS: Of the 60 meningiomas, 7 (11.7%) exhibited brain invasion. The mean MIB-1 LI values for the grade I and grade II tumors were 1.1% and 2.3%, respectively. The corresponding levels of p53 protein expression in these groups were 54.1% and 72.7%. The MIB-1 LI and the level of p53 expression in the one grade III meningioma were 6.7% and 10 - 70%, respectively. Histological grade was significantly correlated with MIB-1 LI and with p53 expression (p < 0.01 for both). Brain invasion was not correlated with histological grade, MIB-1 LI, or p53 expression. CONCLUSION: The results indicate that MIB-1 LI and p53 protein expression are good indicators of histological grade in meningioma and may be particularly valuable for distinguishing borderline atypical meningiomas. The number of cases was limited, but the findings also suggest that brain invasion is a prognostic parameter independent of grade, MIB-1 LI and p53 expression.

Spontaneous corynebacterium discitis in a patient with chronic renal failure.

STUDY DESIGN: Case report describing spontaneous Corynebacterium diptheria discitis in a patient with chronic renal failure. OBJECTIVES: To describe this very rare form of discitis and the results of surgical and antibiotic therapy. SETTING: University Department of Neurosurgery, Turkey. CASE REPORT: A 55-year-old man with chronic renal failure presented with acute low-back pain. Lumbar magnetic resonance imaging (MRI) suggested discitis and osteomyelitis at the L5-S1 level. The L5-S1 disc was operated upon and the discectomy material was sent for pathological and microbiological analysis. RESULTS: Pathological examination revealed infection and bacterial culture grew C. diptheria. The patient was prescribed combination antibiotic therapy with vancomycin, a third-generation cephalosporin, and rifampicin. Clinical status improved after 8 weeks of therapy. Lumbar MRI revealed remission of the discitis and osteomyelitis after 10 months of follow-up. CONCLUSION: Chronic renal failure patients with low-back pain should be investigated for spinal infection. These individuals are prone to low-grade infection in the form of discitis or osteomyelitis. Corynebacterium subspecies rarely cause spontaneous discitis. This case is interesting because of the unusual causal organism and the occurrence of discitis in the setting of chronic renal failure.

Early effects of mild brain trauma on the cytoskeletal proteins neurofilament160 and MAP2, and the preventive effects of mexilitine.

OBJECTIVE: The aims were to investigate the early effects of graded, closed, mild head injury on neurofilament protein (NF160) and microtubule-associated protein-2 (MAP2) and to examine the levels of lipid peroxidation and the impact of mexilitine, inhibitor of lipid peroxidation, pretreatment on tissue damage. MATERIAL AND METHOD: One hundred and twenty-six rats were divided into groups as follows: Group 1 (n = 14) were controls; group 2 (n = 56) sustained trauma alone; and group 3 (n = 56) were pretreated with mexilitine (50 mg/kg). Groups 2 and 3 were subdivided into subgroups (n = 14 each), which were subjected to 100 g/cm2, 125 g/cm2, 150 g/cm2, and 175 g/cm2 trauma forces, respectively. Two hours after trauma, the frontal lobes from all groups were removed and processed for lipid peroxidation H&E staining, immunofluorescent labelling of neurofilaments and microtubules with anti-NF160 and anti-MAP2 antibodies. RESULTS: Compared to control findings, all the trauma-only animals showed increased lipid peroxidation levels and the elevations paralleled the amount of force applied. Administration of mexilitine significantly reduced the level of lipid peroxidation. In NF160 stainings, in group 2, the degree of impairment in axonal organization paralleled the different levels of force that were applied. Groups 3C and 3D (mexilitine pretreated) showed well-preserved axons and intact perikarya. In MAP2 stainings group 2 animals showed remarkably less MAP2 staining throughout the sections. There were no significant differences in MAP2 staining intensity or pattern among the group 2 subgroups. In contrast, in the sections from the group 3 animals, the level of MAP2 positivity was markedly preserved. CONCLUSION: In conclusion, our results show that the cytoskeletal proteins we investigated have different capacities for resisting injury, and that MAP2 is more vulnerable to injury than NF160. One of the reason for this cytoskeletal disruption may be increased lipid peroxidation. Inhibition of lipid peroxidation by pre-treatment with 50-mg/kg mexilitine significantly reduces the level of lipid peroxidation and may protect MAP2 and NF160 integrity in closed mild head injury. This protection is inversely proportional to the magnitude of the applied force.

The value of expanded polytetrafluoroethylene in preventing early re-ossification after craniosynostosis surgery: an experimental animal study in the rat.

BACKGROUND: Early re-ossification at the suturectomy site after craniosynostosis surgery remains an important problem. Many surgical methods have been used to address this, including placement of various types of absorbable and non-absorbable material between the bone edges at the site. This experimental study investigated the value of expanded polytetrafluoroethylene (ePTFE) membrane as a barrier to calvarial reclosure after craniosynostosis surgery in rats. METHOD: Thirty-five 2-week-old Sprague-Dawley rats were divided into two groups. In Group A (n = 17), ePTFE membranes were placed in the defect formed by a left coronal suturectomy. The Group B rats (n = 18) underwent left coronal suturectomy only. Animals were sacrificed at 1, 2 and 4 months postoperatively. In each case, the skull was removed and the operative site was examined for fibrosis, new bone formation, bone bridging, neovascularization and inflammatory response. FINDINGS: The two groups were similar with respect to neovascularization and new bone formation. By the end of the fourth postoperative month, 50% of the Group B specimens showed fibrosis and 50% showed bridging between the bone edges at the suturectomy site. In contrast, at the same stage in Group A, only 16.6% of the specimens exhibited a small amount of fibrosis, and none showed bone bridging between the edges. INTERPRETATION: Expanded PTFE is one of the most inert materials used in surgery. The study showed that inserting ePTFE membrane as a barrier between the bone edges at the suturectomy site prevents early re-ossification after craniosynostosis surgery in rats.

Spontaneous resolution of lumbar vertebral eosinophilic granuloma.

Eosinophilic granuloma (EG) is a rare disease but is more common in adults than children. It's often self-limiting. Spinal involvement is rare. It is the localized and most benign form of Langerhans' cell histiocytosis (previously known as histiocytosis X), characterised by lytic lesions in one or more bones. Spontaneous resolution of vertebral body lesions is very rare. In this case, the patient had one EG in a cervical vertebra and a similar lesion in a lumbar vertebra. This case is important because it featured a symptomatic lesion in the cervical spine accompanied by an asymptomatic lesion in a lumbar vertebra. We treated the cervical lesion by surgical fusion and followed the lumbar lesion up conservatively, with the patient in a corset. After 8 years of follow-up, control MRI showed that the lumbar lesion had spontaneously resolved.

Magnetic resonance image findings and surgical considerations in T1-2 disc herniation.

OBJECTIVE: To report a case of disc herniation at T1-2. CLINICAL PRESENTATION: A 57-year-old man presented with hand weakness, Horner's syndrome, and pain radiating along the medial aspect of one upper extremity. Magnetic resonance imaging demonstrated extruded T1-2 disc herniation with upward herniation of a sequestrated fragment. INTERVENTION: An anterior approach was used to excise the disc, that was compressing the spinal cord and the T1 nerve root. All the patient's symptoms resolved completely, including Horner's syndrome. CONCLUSION: Anterior discectomy may be the simplest and most effective method for disc excision and relief of spinal cord and T1 nerve root compression.

The structure of a neurosurgical manuscript.

Preparing publishable manuscripts is an important aspect of professional life in research or clinical neurosurgery, especially for those in academic circles. Scientific writing skills can be developed through a long process of training and experience, starting with the residency program. The first step in developing a manuscript is to focus on a subject or problem that might be of significant interest to colleagues in the field. Next, the prospective writer must do a detailed survey of the relevant literature, the results of which will help him or her decide whether to actually write about the topic. Since the primary goal is to get the manuscript published, the writer should bear a specific journal in mind and write in accordance with the guidelines of that publication. He or she must also consider general ethics and scientific rules during the writing process. Learning how to assess and use scientific sources, how to relate the collected information to the manuscript, and how to write in good scientific form are all important aspects of neurosurgical training.