Surgery of Cranial Deformity Following Ventricular Shunting: A Multicenter Study.

AIM: To review the cases of craniosynostosis secondary to ventricular shunting procedure. MATERIAL AND METHODS: We retrospectively evaluated the medical records of all pediatric patients with hydrocephalus who were treated with ventriculoperitoneal shunt procedure between the years 2017 and 2021 at the Selcuk University, Ankara University, and Bursa Uludag University. RESULTS: Twenty-one patients were included in the study. The median age at the time of insertion of ventriculoperitoneal shunt for hydrocephalus was 8.1 (range, 1?22) months. Seven patients were shunted because of congenital hydrocephalus. The mean time to development of secondary synostosis was 8.8 (range, 1?36) months. Plagiocephaly was the most common type of secondary synostosis. While shunt revision was performed in 16 patients, cranial vault expansion surgery was performed in 5 patients. CONCLUSION: Slit ventricle syndrome is a frequent condition at shunted patients, but there is no consensus on identifying patients who require treatment. Using programmable or high-pressure valves, performing cranial vault modeling are possible treatment modalities. Increased awareness of this condition in follow-up may allow early diagnosis and intervention and prevent it from evolving into more serious deformities.

Intradural Spinal Arachnoid Cysts in Children: A Collective Experience of 2 Centers.

BACKGROUND: Pediatric intradural spinal arachnoid cysts are rare and can cause spinal cord or nerve root compression. Spinal arachnoid cysts can cause pain, motor/sensory neurological impairments, gait disturbances, spasticity, and bladder problems depending on their location. This study discusses the clinical aspects, management, surgical nuances, and postoperative clinical outcomes of symptomatic congenital intradural spinal arachnoid cysts, which are rarely seen in the pediatric population. METHODS: Our study involves a retrospective evaluation of 8 pediatric patients who underwent surgery for spinal intradural arachnoid cysts at the Department of Neurosurgery, Kocaeli University School of Medicine, and the Department of Neurosurgery, Selros University School of Medicine. The demographic data of all patients, preoperative/postoperative clinical findings, surgical procedures, surgical complications, and radiological imaging were evaluated. RESULTS: The average age of the patients was 8.7 uated. surgicrange:1-17).The female to male ratio was 4:4. The most common complaint was weakness in the lower extremities (87.5%). Urinary problems (50%) and sensory disturbances (50%) were less frequently observed. All patients had dorsal localization of the cysts. Cyst excision was performed in 7 out of 8 patients, and cyst fenestration was performed in 1 patient. Postoperatively, 7 patients showed complete symptom resolution, while one patient had partial improvement. CONCLUSIONS: The success of surgical treatment depends on cyst location, neural tissue compression, and duration of symptoms. Complete removal or fenestration is determined by cyst location and accessibility. Intracystic shunts may be used in certain cases. Timely diagnosis and surgical intervention are crucial for improving neurological function in these rare cases.

A different perspective on the dilemma of durotomy or duraplasty in Chiari type 1 malformation surgery.

PURPOSE: Symptomatic Chiari type 1 malformation (CIM) patients may elect to be treated; however, choosing the optimum surgical method remains problematic: posterior fossa decompression with duraplasty (PFDD) or without duraplasty (PFD). Many studies have compared these surgical methods from several perspectives. We looked at soft tissue density (STD) at the foramen magnum to add another perspective to the comparison of PFD with PFDD. MATERIALS AND METHODS: Eighty-six patients who underwent surgery in our clinic were included in the study. We examined preoperative and postoperative MR images taken in the 1st year. We obtained the foramen magnum area (FMA) and soft tissue at the level of the foramen magnum. The STD within the foramen magnum was calculated as the percentage ratio of soft tissue area (STA) to FMA. Anteroposterior diameters of the syrinx cavities in sagittal T2 sections were measured preoperatively and at 1-year postoperatively. Measurements were double-blind and were performed by the neurosurgeon and by the neuroradiologist. RESULTS: There was no statistically significant difference between the postoperative FMA increases, STA changes, STD changes in patients who underwent PFD and PFDD. In this study, there was no statistically significant difference between PFD and PFDD in terms of syrinx changes. CONCLUSIONS: The medium-term anatomical outcome following craniovertebral decompression for CIM, is no different whether performed PFD or PFDD.

Acute epiglottitis is a rare clinical presentation of coronavirus disease 2019: a case report.

BACKGROUND: In humans, coronavirus disease 2019 (COVID-19) has a variable presentation ranging from mild self-limiting respiratory tract infections to severe acute respiratory distress syndrome. Methods: We present the case of a patient who developed acute epiglottitis after surgery for an intracranial tumour and was subsequently diagnosed with COVID-19. RESULTS: A 58-year-old female patient developed acute-onset respiratory distress on day 6 after intracranial surgery. Neck computed tomography revealed near-total airway obstruction due to severe edoema of the epiglottis and periepiglottis. The patient's SARS-CoV-2 polymerase chain reaction test was positive. Viral respiratory tract panel and sputum and blood cultures were negative. She completed the antiviral and antibacterial treatment regimens recommended by the chest disease department. CONCLUSIONS: We conclude that epiglottitis can be an unusual manifestation of COVID-19.

Corpus Callosum Lipomas in Children.

AIM: To determine the clinical and radiographical aspects of six patients diagnosed with pericallosal lipomas (PCL). MATERIAL AND METHODS: A retrospective analysis of patients who presented to the neurosurgery outpatient clinics of Selcuk Faculty of Medicine between 2009 and 2019, revealed that six patients were diagnosed with PCL. The clinical and magnetic resonance imaging (MRI) data were obtained by reviewing patients? records. RESULTS: A total of six patients (two girls and four boys), with a mean age of 53.8 months (38?72 months), were included in this study. They were followed up for a mean period of 36.5 months (32?41 months). PCL were detected on MRIs, which were obtained to investigate headache in two patients, epilepsy in one patient, frontal dermal sinus tract and left frontal epidermoid tumor in one patient, and subcutaneous lipoma associated with PCL in one patient. Five patients displayed tubulonodular lipomas and one patient displayed curvilinear lipomas. Agenesis or dysgenesis of the corpus callosum (CC) was observed in four (66%) patients. Two patients received surgical treatment for cosmetic skin problem. CONCLUSION: Because of the benign course of PCL, i.e. no growth or very slow growth, and close proximity to the surrounding neurovascular structures, surgical removal should be considered only in symptomatic PCL. Furthermore, other malformations and anomalies may accompany PCL.

Comparison of Immunogenetic Properties of Glial Tumors with Advanced Magnetic Resonance Imaging Findings.

AIM: To investigate the immunogenetic properties of glial tumors according to the World Health Organization 2016 glial tumor classification and develop an accurate diagnosis and treatment strategy by comparing preoperative advanced magnetic resonance (aMRI) technique findings of these results. MATERIAL AND METHODS: This study was conducted at the Department of Neurosurgery at the Medical Faculty Hospital of Selcuk University between January 1, 2010 and January 4, 2017 and included 50 patients. MR spectroscopy (MRS), MR perfusion (PWI), and MR diffusion (DWI) were performed in 50 patients preoperatively. Patient data were obtained from the hospital’s information system. Pathological diagnosis of all patients was taken from the department of pathology at the same medical faculty. RESULTS: Among the patients included in the study, 11 were grade II (22%), 7 were grade III (14%), and 32 were grade IV (64%). All patients were IDH1 stained: 22 were IDH mutant (44%) and 28 were IDH wild-type (56%). A statistically significant difference in the survival time was observed between IDH mutant and wild-type. IDH-mutant tumors were commonly located in the frontal lobe and IDH wild-type tumors in the parietal and temporal lobes. A significant difference in PWI relative cerebral blood volume (rCBV) and DWI apparent diffusion coefficients (ADC) was noted among grade II, III, and IV tumor groups. The PWI rCBV cut-off value for grade IV tumors was 2.05 (90% sensitivity, 78% specificity). No difference in the Cho/Cr ratio among grade II, III, and IV tumor groups was noted. A significant difference was noted between the IDH mutant and wild type in terms of PWI rCBV. The PWI rCBV cut-off value of IDH mutantâ€"wild type was 2.15. No difference in the Cho/Cr, Cho/NAA, and DWI apparent diffusion coefficients (p > 0.05) was noted between the IDH mutant and wild type. CONCLUSION: PWI rCBV is the most important prognostic value of aMRI used in tumor grading. PWI rCBV values could be significant in distinguishing IDH wild and mutant.