Is prophylactic anti-convulsive treatment necessary in subdural hematomas?

BACKGROUND: Subdural hematoma (SDH) is usually an emergent clinical condition in neurosurgery. The relationship between the SDH and epilepsy is not well established. Therefore, the use of anti-convulsive treatment in patients with SDH is controversial. The aim of this study is to analyze the presence of seizures in patients who underwent surgery for SDH. METHODS: Patients who were operated on for SDH in our department between 2016 and 2021 were reviewed retrospectively. Demographic features, Glasgow Coma Scale (GCS) score at admission, type of SDH, location, etiology, type of surgical intervention, presence of seizures, and re-operation were evaluated. RESULTS: There were 175 patients with SDH. There is a statistically significant difference between the frequency of seizures and the type of SDH. More seizures were observed in acute SDH than in the others. There is also a statistically significant difference between the GCS score and the frequency of seizures. Patients with a GCS score <12 at admission had more frequent seizures than patients with a score of 12 or higher. No statistically significant difference was found between factors such as etiology, re-operation, hematoma location, and the development of seizures. CONCLUSION: Anti-convulsive treatment may be recommended in patients with acute SDH and a low GCS score at admission. Further studies with larger series should be performed to determine the most appropriate anti-convulsive agent for patients with SDH.

Comparison of Surgical Techniques for Intracranial Arachnoid Cysts: A Volumetric Analysis.

AIM: To compare the volumetric changes of intracranial arachnoid cysts (IACs) in different surgical techniques. MATERIAL AND METHODS: Sixty-six patients who underwent IAC surgery in our department between 2010 and 2020 were studied retrospectively. Based on the surgical technique, clinical and volumetric changes, postoperative complications, recurrence rates, and length of hospital stay were statistically compared. RESULTS: Microsurgical fenestration (MF) was performed on 32 (48.5%) patients, endoscopic fenestration (EF) on 17 patients, cystoperitoneal shunt (CPS) on 11 patients, and EF + CPS in six patients. The mean IAC volume change rate was 68.54 mL, and the mean cyst volume change rate was 40.68%. The MF technique produces a significantly greater mean cyst volume change than the EF technique. The mean volume change in sylvian IAC is 4.8 times greater than in posterior fossa IAC, a significant difference. The mean cyst volume change is four times greater in patients with skull deformity than in patients with balance loss, and this difference is statistically significant. In patients with cranial deformity, the mean cyst volume change is 2.6 times greater than in patients with neurological dysfunction. This difference is also statistically significant. The volume of IAC decreased more in patients with postoperative complications, with a significant difference between the postoperative complication and the change in IAC volume. CONCLUSION: MF can achieve better volumetric reduction in IAC, particularly in patients with sylvian arachnoid cysts. However, more volumetric reduction increases the risk of postoperative complications.

Meningiomas of the Cerebellopontine Angle: Tips and Pearls for Safe Surgical Resection.

AIM: To present our series of cerebellopontine angle (CPA) meningiomas, and to provide some innovative surgical steps for safe removal of these tumors. MATERIAL AND METHODS: The clinical, radiological, and surgical characteristics of 32 patients with meningioma in the CPA were retrospectively analyzed. A statistical analysis was performed to determine the factors that affect the incidence of complication. RESULTS: The mean age was 49.5 yr, and 87.5% of patients were men had World Health Organization (WHO) grade I meningioma, while the remaining patients had WHO grade II tumors. The mean tumor volume was 33.98 mL, and gross total resection was performed on 65.6% of the patients. Preoperative tumor size/extension and extent of resection were related with the development of complications. CONCLUSION: CPA meningiomas are challenging tumors to remove safely. Important risk factors for the development of postoperative complications include tumor size and extent of resection.

Endoscopic Lavage for the Treatment of Multiple Shunt Failures in Children.

AIM: To compare the efficacy of neuroendoscopic lavage (NEL) and shunt revision (SR) in the treatment of multiple shunt failures in children with hydrocephalus. MATERIAL AND METHODS: The data of 56 pediatric patients who underwent surgeries for the treatment of shunt failure were retrospectively reviewed. Patients were divided into two groups, i.e., the simple SR (Group A) and the NEL+SR (Group B) cohorts. Demographic characteristics, co-morbidities, surgical interventions, cerebrospinal fluid analyzes, and complications were recorded and statistically compared between the groups. RESULTS: Among the 56 enrolled patients, 51 presented with shunt dysfunction caused by infectious debris or clots at different times. Moreover, 28 of these 51 patients (54.9%) were female and 23 (45%) were male. The mean age was 7.3 months. Simple SR was performed in 30 cases (Group A), and NEL and simultaneous SR were performed in 21 patients (Group B). The risk of shunt dysfunction was significantly lower in Group B (p < 0.05).The risk of infection was elevated in Group A; however, this difference was not statistically significant (p > 0.05). CONCLUSION: Simultaneous endoscopic lavage and SR was an effective method for the treatment of shunt dysfunction in children. It was also superior to simple SR regarding the risk of shunt dysfunction. Additional clinical studies are needed to verify this outcome.

Determination of the relationship between respiration rate and ethylene production by fruit sizes of different tomato types.

BACKGROUND: Tomatoes of different types and cultivars are grown in different parts of the world. Accordingly, the phenological, pomological and biochemical characteristics of these types and cultivars may differ from each other, and therefore their ripening behaviours may also differ. The present study aimed to determine the respiration rate and ethylene production of twelve commonly grown cultivars in Turkey at harvest and during the ripening stage. The fruits were harvested at the mature green stage and categorized according to their size as small, medium and large-fruited cultivars. RESULTS: At harvest time, the highest respiration rate was determined from 'Moda' (small-fruited) cultivar and the lowest was from 'Elips' (medium-fruited). The highest ethylene production was determined from 'Sarikiz' (small-fruited) and the lowest was from 'Alberty' (large-fruited). All tomato cultivars examined in the study showed climacteric respiration behavior during the ripening, and it was determined that small-fruited types had a higher respiration rate and ethylene production compared to medium and large-fruited ones. 'Sarikiz' (small-fruited) had the highest climacteric peak and 'Gulpembe' (large-fruited) had the lowest. Moreover, it was determined that the respiration rate of small-fruited cultivars were 5.01-fold higher compared to other cultivars and this type of cultivars produced 4.19-fold higher ethylene compared to big-fruited cultivars at harvest. Medium-fruited tomatoes had 1.90-fold higher respiration rate and 1.64-fold ethylene production compared to big-fruited tomatoes. CONCLUSION: It was determined that fruit size and respiration rate were related independently of the cultivars, although there was no relationship between fruit size and ethylene production. © 2022 Society of Chemical Industry.

Role of early decompressive craniectomy in traumatic brain injury: Our clinical experience.

BACKGROUND: Traumatic brain injury (TBI) is an important cause of death, especially in underdeveloped and developing countries. Diffuse edema in the damaged cerebral tissue as a result of trauma and the subsequent increase in intracranial pressure cause signifi-cant neurological deterioration. Consequently, decompressive craniectomy (DC) is performed as the surgical treatment of TBI. The aim of this study is to evaluate the post-operative mortality and morbidity rates of patients who underwent DC for TBI in our clinic. METHODS: The data of 57 cases of TBI were retrospectively analyzed. Clinical, radiological and surgical features of these cases were reviewed. The rates of mortality and morbidity, as well as main indicators of mortality were investigated. RESULTS: Twenty-five (43.8%) patients were female and 32 (56.1%) were male. The mean age was 54.5 years. Fourteen (24.5%) patients were presented with subdural hematoma, 5 (8.7%) with epidural hematoma, 18 (31.5%) with intracerebral hematoma, 13 (22.8%) with subarachnoid hemorrhage, and 7 (12.2%) with other radiological findings. DC was performed in all cases as soon as pos-sible after admission. Twelve (21.1%) patients died in the first 3 days postoperatively and 7 (12.2%) patients in the postoperative 3-15 days due to progressive cerebral damage and secondary infections. Six (10.5%) patients recovered completely and were discharged. Thirty-two (56.1%) patients were transferred to palliative care clinics and physical therapy clinics after the surgical treatment. CONCLUSION: DC, which is performed in the early period of treatment in TBI, is as important as the degree of intracerebral damage at the time of admission and the high Glasgow coma scale score. Post-operative results are more satisfactory in patients who underwent DC at an earlier stage of treatment.

Treatment of Traumatic Internal Carotid Artery Aneurysm by Flow-Diverter: A Single-Center Experience.

AIM: Traumatic intracranial aneurysm (TICA) is a rare vascular lesion with various etiologies and a high mortality rate when diagnosed late. In this study, we present our cases of TICA, which we treated with flow-diverter stents due to different etiological factors. METHODS: Clinical data were recorded for 8 patients: age, gender, etiological factors, aneurysm location, aneurysm type, rupture, main artery status, and postoperative complications. RESULTS: 75% (n:6) of the patients were male and 25% (n:2) female. Etiologically, there was intracranial tumor surgery in 3 cases (37.5%), fall from height in 2 (25%), road accident in 2 (25%), and blunt trauma in 1 (12.5%). Reconstruction used a flow-diverting stent in all cases. One patient experienced intraoperative iatrogenic rupture of the distal arterioles due to a microwire. Mean angiographic follow-up was 17.8 months (range, 6-32 months). During follow-up, none of the patients required renewed endovascular treatment. CONCLUSION: Traumatic aneurysm is a vascular lesion with high mortality when diagnosed late. In case of suspected vascular injury after trauma or intracranial surgery, further evaluation should be performed without delay. TICA can be safely treated with flow-diverter stents, conserving the main artery.

Pituitary apoplexy: An emergent and potential life-threatening complication of pituitary adenomas.

BACKGROUND: Pituitary apoplexy is an emergent and potential life-threatening complication of pituitary adenomas if not managed properly. The aim of our study is to present our series of pituitary adenomas and to focus on the clinical, radiological, and surgical characteristics of this rare complication. METHODS: In this study, a total of 143 patients with pituitary adenoma underwent surgical treatment between 2016 and 2018. All patients were operated using endoscopic endonasal transsphenoidal (EET) technique. The data of pituitary apoplexy cases were recorded. Resection rates, hormonal results, and visual outcomes of patients with pituitary apoplexy were evaluated. RESULTS: Of the 143 patients, 8 (5.59%) were presented with the symptoms and radiological findings of pituitary apoplexy. The mean age was 26.75 years, and 4 (50%) of them were male and 4 were female. Pre-operative mean Knosp grading score was 2.1 All of eight patients underwent emergent surgical intervention and total resection was achieved in 75% of patients with apoplexy. Hormone levels were significantly decreased after surgery (p<0.05), except prolactin (p>0.05). Cerebrospinal fluid leakage occurred in one pa-tient. None of the patient with pituitary apoplexy died in our series. CONCLUSION: Pituitary apoplexy is an important complication of pituitary adenomas. Early diagnosis and surgical intervention provide excellent ophthalmological and hormonal outcomes. Emergent EET approach is crucial for patients with ophthalmological findings and macroadenomas.

Comparison of Different Endoscopic Techniques for the Treatment of Hydrocephalus in Children.

AIM: To present a series of hydrocephalus cases treated with different endoscopic techniques, and to compare their surgical outcomes. MATERIAL AND METHODS: Sixty-one patients underwent endoscopic approach for treating hydrocephalus over a 5-year period. Forty-six patients were children. Three surgical techniques [i.e., endoscopic third ventriculostomy (ETV), ETV plus shunting, and simultaneous ETV plus aqueductoplasty] were used in these patients. Surgical results were statistically analyzed based on age, gender, and type of surgery. RESULTS: Of the 46 children, 24 (52.17%) were female with a mean age of 25.33 months. Twenty-one (45.65%) children underwent ETV alone, 19 underwent ETV plus ventriculoperitoneal shunting, and six underwent simultaneous ETV plus aqueductoplasty. Five (10.87%) children died during the follow-up period. No correlation was observed between surgery type and patient age. No statistically significant differences in sex and complications were found between the surgical techniques. CONCLUSION: ETV alone is the safest method for treating hydrocephalus in children. Mortality is higher in patients younger than 12 months who underwent combined surgical methods, instead of ETV alone.

Endoscopic endonasal approach to the cavernous sinus Epstein-Barr virus-positive B cell non-Hodgkin lymphoma in a child: case report.

Cavernous sinus (CS) lymphoma without paranasal sinuses involvement is extremely rare in pediatric population and remains a diagnostic challenge due to its similarity to other tumors located in this area. An 8-year-old boy presented with a 6-day history of gradually developing ptosis in the right eyelid. After admission, his symptoms progressed within 24 h to include right-sided ophthalmoplegia consisting of oculomotor and abducens nerve palsies. Endoscopic endonasal approach (EEA) was performed urgently to decompress the CS and to obtain a diagnosis. The postoperative course was uneventful, and there was no complication related to the surgical approach. No immunodeficiency was identified. The histopathological diagnosis was an Epstein-Barr virus (EBV)-positive high-grade mature B cell non-Hodgkin lymphoma. He was initiated chemotherapy according to COG ANHL01P1 protocol. Two months after surgery, the third and sixth nerve palsies had resolved completely. Currently, he is well and has no clinical or radiological recurrence. This is the first pediatric case with EBV-positive CS lymphoma that underwent EEA for the diagnosis and decompression. In the pediatric population, EEA enables minimally invasive access to the CS and can play an alternative role in the management of CS lesions, either through biopsy or debulking.

Radial nerve injuries and outcomes: Our surgical experience.

BACKGROUND: The aim of this study was to retrospectively evaluate patients who underwent surgery in our department for radial nerve lesions in terms of surgical outcomes. METHODS: Thirty-eight patients were admitted to our department with radial nerve lesion. Twenty-seven of the patients had entrapment neuropathy and 11 had radial nerve injury secondary to other traumas. Various factors such as surgical results, time to surgical intervention, injury mechanism, and reconstruction technique were analyzed. RESULTS: In all of 27 patients who were operated for radial nerve entrapment neuropathy, a complete improvement in wrist dorsal flexion was detected at postoperative 3rd month. Seven of the 11 patients who were operated for radial nerve lesion had different degrees of improvement in wrist dorsal flexion at the postoperative 3rd month. Two of the seven patients underwent anastomosis using a sural nerve graft. The recovery rate in our series was 89%. Three of the 4 patients who did not recover after the radial nerve injury were the patients who were operated within the 1st month after the trauma. CONCLUSION: Better functional results were obtained in the postoperative period in patients who were operated after the 1st month, underwent internal neurolysis and used a short nerve graft for anastomosis in the radial nerve lesions. In patients with entrapment neuropathy, the earliest surgery revealed satisfactory results in the postoperative period.

Comparison of organically and conventionally produced Batavia type lettuce stored in modified atmosphere packaging for postharvest quality and nutritional parameters.

BACKGROUND: The impacts of organic and conventional production systems on postharvest life and quality parameters of Batavia type 'Caipira' lettuce heads (Lactuca sativa L.) were investigated. Harvested lettuce heads grown in two different production systems were stored at 0 °C temperature and 95-98% relative humidity for 20 days in modified atmosphere packaging. RESULTS: The lowest weight loss, the highest ascorbic acid content and antioxidant activity were obtained from the organic production system (Org-2). The conventional production system had higher total soluble solids, titratable acidity, and total phenolic contents. During the shelf-life period at 20 °C, the weight losses of lettuce heads grown conventionally were higher than with the other production system. Conventionally grown heads had higher titratable acidity and total phenolic contents than organically grown heads. The highest titratable acidity and h° values were obtained from the plants grown under conventional and organic production systems (Org-2), while the highest chroma value and antioxidant activity were detected from the control treatment. The highest ascorbic acid content was detected in the control treatment, but the effects of control, organic (Org-2) and conventional production systems on ascorbic acid content were not statistically significant. CONCLUSION: The results indicated that the organic production system (Org-2) was the most effective treatment in prolonging postharvest life and protecting the quality of Batavia type 'Caipira' lettuce heads stored in modified atmosphere packaging. © 2018 Society of Chemical Industry.

Lhermitte-Duclos Disease in a Six-Year Old Child: A Rare Presentation.

Lhermitte-Duclos disease (LDD) is a rare, slow-growing, benign lesion of the cerebellum. It is often seen in the second and fourth decades. This disease is extremely rare in childhood. A 6-year-old girl presented with loss of balance. A mass lesion in the right cerebellum was detected by magnetic resonance imaging. The patient underwent surgical removal of the lesion, and the histological diagnosis was dysplastic gangliocytoma (LDD). The patient was discharged without complication, and her balance improved in the follow-up period. In this report, we present this rare occurrence in childhood and discuss the clinical course and management. LDD is very rare in early childhood and should be considered in the differential diagnosis of posterior fossa lesions.

The effects of UV radiation during the vegetative period on antioxidant compounds and postharvest quality of broccoli (Brassica oleracea L.).

In this study, the effects of supplementary UV radiation during the vegetative period on antioxidant compounds, antioxidant activity and postharvest quality of broccoli heads during long term storage was studied. The broccolis were grown under three different doses of supplementary UV radiation (2.2, 8.8 and 16.4 kJ/m(2)/day) in a soilless system in a glasshouse. Harvested broccoli heads were stored at 0 °C in modified atmosphere packaging for 60 days. The supplementary UV radiation (280-315 nm) during the vegetative period significantly decreased total carotenoid, the chlorophyll a and chlorophyll b content but increased the ascorbic acid, total phenolic and flavonoid contents of broccolis. All supplementary UV treatments slightly reduced the antioxidant activity of the broccolis, however, no remarkable change was observed between 2.2 and 8.8 kJ/m(2) radiation levels. The sinigrin and glucotropaeolin contents of the broccolis were substantially increased by UV treatments. The prolonged storage period resulted in decreased ascorbic acid, total phenolic and flavonoid contents, as well as antioxidant activity. Discoloration of the heads, due to decreased chlorophyll and carotenoid contents, was also observed with prolonged storage duration. Glucosinolates levels showed an increasing tendency till the 45th day of storage, and then their levels started to decline. The weight loss of broccoli heads during storage progressively increased with storage time in all treatments. Total soluble solids, solids content and titratable acidity decreased continuously during storage. Titratable acidity was not affected by UV radiation doses during the storage time whereas soluble solids and solids content (dry matter) were significantly affected by UV doses. Supplementary UV radiation increased the lightness (L*) and chroma (C*) values of the broccoli heads. Pre-harvest UV radiation during vegetative period seems to be a promising tool for increasing the beneficial health components of broccolis.