Primary intracranial hydatid cyst in the interpeduncular cistern.

Cerebral involvement in hydatid disease occurs in 1-4% of cases. There are few documented cases in the literature of intracranial hydatid cysts in unusual locations such as pons and thalamus. In this report, a case of 33-year-old male with primary intracranial hydatid cyst in the interpeduncular cistern is reported. This is the first such case in the literature.

Blockade of sodium channels by phenytoin protects ultrastructure and attenuates lipid peroxidation in experimental spinal cord injury.

Spinal cord injury (SCI) involves a series of pathological events. Abnormal sodium influx has been implicated as one of the key events in the pathophysiology of the SCI. Pharmacological blockade of sodium channels can reduce secondary injury and increase recovery from trauma. The aim of the present study was to show the neuroprotective effect of phenytoin, a sodium channel blocker, after experimental SCI. Control and laminectomy-only groups were not injured. 50 g-cm weight drop injury was produced in the trauma group. In the treatment groups, methylprednisolone (30 mg/kg) and phenytoin (1 mg/kg, 10 mg/kg, or 30 mg/kg) were given intraperitoneally immediately after injury. Malondialdehyde (MDA) levels in the spinal cord samples were examined for lipid peroxidation. Spinal cord ultrastructure was evaluated and grading system was used for quantitative evaluation. Trauma increased tissue MDA levels. Treatment with methylprednisolone and phenytoin decreased MDA levels compared to trauma in all doses. Significant ultrastructural neuroprotection was observed with 30 mg/kg of phenytoin treatment according to general neural score. This ultrastructural neuroprotection of phenytoin was not different from methylprednisolone. Phenytoin appears to protect spinal cord against injury by decreasing lipid peroxidation and lessening neuronal damage associated with SCI in rats.

[Acute subdural hematomas: surgical treatment. Retrospective analysis of 73 cases]. / Akut subdural hematomlar: opere edilen. 73 olgunun retrospektif analizi.

The mortality and morbidity of acute subdural hematomas are still high although advanced diagnostic and treatment techniques. We evaluated 73 patients who were operated between 1995 and 2000 for acute subdural hematoma. The relation between mortality and morbidity rates and age, timing of surgery and Glasgow coma scala scores were analyzed. There was not statistically significant relation between age and mortality and morbidity rates. We concluded that Glasgow coma scala score at admission is an important prognostic factor and early surgery decreases mortality rate.

Effect of pinealectomy on immune parameters in rats with Staphylococcus aureus infection.

It is generally accepted that the pineal gland is a neuroendocrine organ. Several recent experiments have shown that the pineal gland has functional and anatomical connections, particularly with the immune system, and therefore the gland is now recognized as an important immunoneuroendocrine organ in both man and animals. The present study investigates the effect of pinealectomy on some immune parameters, including hematological alterations, and the response of the brain tissue against infection caused by Staphylococcus aureus. Experiments were performed on two different age groups of rats (neonatal and young). The results showed a significant reduction of the plasma zinc level in the third week following pinealectomy, impairment of the hematological parameters including lymphocyte, erythrocyte, and leucocyte, and the deficiency of the brain response to the infective agent, particularly in pinealectomized neonatal rats. In view of these data and as described previously, the pineal gland has a main regulatory function in immune physiology, but our study indicates that only neonatal immune functions are significantly affected by pinealectomy.

Pelvic osteosarcomas causing lumbosacral nerve root compression presenting as herniated intervertebral disc: report of two cases.

Osteosarcomas of the pelvic bone are rare. Neurological complication of osteosarcomas in this location is also rare. Diagnosis is not always easy, and misdiagnosis may occur due to pelvic bone destruction and nerve root compression. We present two cases of pelvic osteosarcoma with lumbosacral radicular symptoms who were previously thought to have lumbosacral herniated intervertebral disc.

The effect of pinealectomy on immune parameters in different age groups in rats: results of the weekly alteration of the zinc level and the effect of melatonin administration on wound healing.

It is generally accepted that the pineal gland is a neuroendocrine organ. Several recent experiments have shown that the pineal gland has functional and anatomic connections with many organs and systems, particularly with the immune system, and, therefore, the gland is now recognised as an important immunoneuroendocrine organ both in man and animals. The present study investigates the effect of pinealectomy on some immune parameters including zinc pool alterations and wound healing process in different age group in rats and also investigates the effect of melatonin administration on wound healing in different age groups. Experiments were performed on two different age groups of rats (neonatal and young). We have experimentally shown the induction of immune depression by pinealectomy and the restorative competence of melatonin administration in the present study. The results also showed that the plasma zinc level was significantly reduced in the third week after the pinealectomy particularly in pinealectomised neonatal rats and the wound healing process affected only in pinealectomised neonatal rats but restored to normal by melatonin administration. In view of these data, as described previously, the pineal gland has a main regulatory function in immune physiology, but our study indicates that only neonatal immune functions are significantly affected by pinealectomy.

Surgical management of syringomyelia-Chiari complex.

Great variety exists in the indications and techniques recommended for the surgical treatment of syringomyelia-Chiari complex. More recently, magnetic resonance (MR) imaging has increased the frequency of diagnosis of this pathology and offered a unique opportunity to visualize cavities inside the spinal cord as well as their relationship to the cranio-cervical junction. This report presents 18 consecutive adult symptomatic syringomyelia patients with Chiari malformation who underwent foramen magnum decompression and syringosubarachnoid shunting. The principal indication for the surgery was significant progressive neurological deterioration. All patients underwent preoperative and postoperative MRI scans and were studied clinically and radiologically to assess the changes in the syrinx and their neurological picture after surgical intervention. All patients have been followed up for at least 36 months. No operative mortality was encountered; 88.9% of the patients showed improvement of neurological deficits together with radiological improvement and 11.1% of them revealed collapse of the syrinx cavity but no change in neurological status. None of the patients showed further deterioration of neurological function. The experience obtained from this study demonstrates that foramen magnum decompression to free the cerebro-spinal fluid (CSF) pathways combined with a syringosubarachnoid shunt performed at the same operation succeeds in effectively decompressing the syrinx cavity, and follow-up MR images reveal that this collapse is maintained. In view of these facts, we strongly recommend this technique, which seems to be the most rational surgical procedure in the treatment of syringomyelia-Chiari complex.

First experience with transnasal and transseptal endoscopic and microscopic repair of anterior skull base CSF fistulae.

Currently, endoscopic endonasal surgery is a valuable and safe procedure routinely performed for treatment of paranasal sinus disorders. Since the endoscopic technique has become popular in this area, interest has been increased in its possible use for some other indications such as transsphenoidal pituitary and anterior skull base surgery. In this paper, we present our experience in using the nasal endoscope for repair of anterior skull base cerebrospinal fluid (CSF) fistulae. Between 1994-1999, we observed 44 patients with CSF rhinorrhea. Out of 44 patients, 34 had improved with the conservative treatment in two weeks, in 10 patients endoscopic surgery was performed and in one patient endoscopic surgery failed and the defect was repaired with transsphenoidal microscopic surgery. The remaining 9 patients were doing well and no problem was encountered concerning the surgery.

Choroid plexus papillomas of the posterior fossa: extraventricular extension, intraventricular and primary extraventricular location. Report of four cases.

Four cases of Choroid Plexus Papilloma (CPP) of the posterior fossa are presented. Two cases had extraventricular extension from the fourth ventricle to the Cerebellopontine Angle (CPA) through the foramen of Luschka, in one the CPP was located primarily in the CPA and the fourth case was only in the fourth ventricle. CPP are rare tumours of the Central Nervous System and primary extraventricular location is extremely rare. We know that primary location in the extraventricular and intraventricular regions and extraventricular extension have different pathological mechanisms. The main purpose of this paper is to discuss and review some possible explanations for these mechanisms.

Lipoma of the interpeduncular fossa: demonstration by CT and MRI.

A case of intracranial lipoma located in the interpeduncular fossa of a young woman is presented. Since the patient suffers only nonspecific headache, no treatment was performed. To our knowledge this is the only which was demonstrated by magnetic resonance images (MRI) in the English language literature.

Prognostic value of serum neuron-specific enolase levels after head injury.

Neuron-specific enolase (NSE) is a dimeric cytoplasmic enzyme detected in high levels in neurons and acts in the glycolytic pathway. It is known that there is a quantitative relationship between the concentration of serum NSE and the degree of cell damage in the central nervous system. We examined serum levels of NSE by enzyme immunoassay in 89 patients with head injury and aimed to evaluate its relationship with neurological status and prognosis of the patients.

Osteoid osteoma of the frontal bone. Case report.

A case of osteoid osteoma of the frontal bone is presented. It is a benign bone tumour which rarely involves the cranium. Local pain that is worse at night and improves following salicylate administration is characteristic for osteoid osteoma. This report describes cranial osteoid osteoma, a rare pathologic entity for the cranium, with pain only on palpation.

Metastatic choriocarcinoma in the thoracic extradural space: case report.

A case is reported of a 44-year old woman with metastatic choriocarcinoma of the thoracic extradural space causing paraplegia. Spinal cord compression due to an extradural deposit is an emergency in neurosurgical practice. The majority of these lesions are metastatic. To our knowledge choriocarcinoma metastases and extradural cord compression in the spinal canal is the first case reported in the neurosurgical literature.

Primary giant granulomatous basal meningitis: an unusual presentation of tuberculosis.

A case of granulomatous tuberculous meningitis in a 3-year-old child without any known primary disease in any other organ is presented. Tuberculous meningitis is an uncommon presentation of tuberculosis and is characterized by diffuse or circumscribed granulomatous involvement of the meninges, particularly at the base of the brain. Early diagnosis and treatment are essential to prevent the worst events it can bring and to improve the chances of survival. Diagnosis remains difficult because of the lack of reliable clinical diagnostic criteria.

Asymptomatic or minimally symptomatic traumatic epidural haematomas: comparison of the results of surgical and conservative management related to SPECT and neuropsychological tests. Preliminary results.

One hundred and thirteen patients with asymptomatic or minimally symptomatic epidural heamatomas treated surgically or conservatively in our department were collected prospectively. Between 3 and 6 months after the head injury a SPECT (single photon emission computed tomography) study for evaluation of the three-dimensional cerebral blood flow distribution and extensive neuropsychological tests were performed in 22 patients. The preliminary results of this prospective study have demonstrated that minimally symptomatic or asymptomatic EDHs cause no pathologic SPECT findings and that neuropsychological impairment and duration of the haematoma do not affect the results of conservative management.

Cranio-cerebral erosion: delayed diagnosis and treatment.

Cranio-cerebral erosion is a well-known complication of calvarian fracture with underlying dural tear and cerebral injury in infancy and early childhood. The anatomy, pathogenesis and natural evolution of these lesions remain obscure. The common clinical symptoms are seizures, focal neurological deficits, impairment of consciousness and a soft subgaleal mass. Three patients of cranio-cerebral erosion who underwent delayed surgery in their adult lives are presented to illustrate the common and uncommon features, and their long-term outcome is discussed.

Sacral hydatid cysts with intrapelvic extension presenting as herniated intervertebral disc.

Hydatid disease of bone is a rare condition. Although the bones most often involved are the vertebrae, sacral vertebral involvement is extremely rare. Prognosis is poor despite extensive medical and surgical treatment. In this paper we present two unusual cases of hydatid disease located in the sacral vertebrae with extension into the pelvic cavity causing radicular symptoms.

The value of MR imaging in prevention of unsuccessful back surgery. A case report.

MR imaging helped in diagnosing a spinal schwannoma, and intradural space surgery was thus avoided.

Cervical laminar exostosis in multiple hereditary osteochondromatosis: anterior stabilization and fusion technique for preventing instability.

Multiple hereditary osteochondromatosis is a genetically transmitted disorder consisting of multiple projections of bone capped by cartilage, which are called exostoses. Spinal cord compression due to expansion of a laminar osteochondroma is rare but well recognized. Surgical decompression usually improves the patient's neurological status but, in cervical exostosis, post-laminectomy kyphosis and instability problems, especially in the high-risk adolescent group, form the most significant potential difficulties in the postoperative period. We report a case of cervical laminar exostosis that was treated by anterior stabilization and fusion and discuss the benefits of this technique.