Retrospective Evaluation of Cases Undergoing Stereotaxic Brain Biopsy.

Objective: The aim of this study is to evaluate the demographic, radiological and histopathological findings, tumoral biomarkers, and survival rates of patients who underwent a stereotactic brain biopsy and those diagnosed with glioblastoma, metastasis, and lymphoma, and the changes in the diagnosis distribution over the years. Materials and Methods: The patients who underwent stereotactic biopsy in our clinic between 2012 and 2020 were evaluated retrospectively. Metastasis, glioblastoma, and lymphoma cases were evaluated as three main groups and the others were excluded. P53 gene expression, isocitrate dehydrogenase (IDH) mutation, and Ki-67 values in glioblastoma cases and Bcl-2, Bcl-6 proteins, and Ki-67 values in lymphomas and their relationship with survival were evaluated. Results: High p53 expression was observed in 27.5% cases diagnosed with glioblastoma. IDH mutation was negative in all glioblastoma cases. Presence of Bcl-2 and Bcl-6 proteins was not associated with survival in lymphomas. Survival rate was significantly higher in cases diagnosed with lymphoma (26.9%) compared to those diagnosed with glioblastoma. A statistically significant increase was determined in patients diagnosed with lymphoma considering the distribution of diseases and incidence and in the distribution of other diagnoses over the years ( p < 0.05). Conclusion: As per the distribution of the disease in recent times, it has been observed that there is an increase in lymphoma cases. Histopathology and biomarkers have great importance in the diagnosis and treatment of cerebral lesions. We think that our findings will be supported by studies in which larger patient population and detailed biomarkers will be studied.

Effects of sodium fluoride on neural tube development in chick embryos.

OBJECTIVE: Various environmental factors encountered in daily life are associated with the development of neural tube defects. This study aims to investigate the effects of fluoride on neural tube development in chick embryos. METHODS: A total of 60 specific pathogen-free, fertile, zero-day Leghorn-type eggs were used in the study. Group 1 was the control group, in which only saline was administered. Group 2 was the low-dose group, in which 0.003 mg of fluoride was administered, and Group 3 was the high-dose group, in which 0.006 mg of fluoride was administered. After 72 h of incubation, the embryonic disc was evaluated microscopically. RESULTS: In the control group, the surface ectoderm of all sections was intact, the neural tube was closed, and the neuroepithelium, the basement membrane surrounding the neuroepithelium, the somites, and the notochord displayed standard structure. Neural tube defects were observed in 3 of the chick embryos, that was given low-dose fluoride. In Group 3, which was administered high doses of fluoride, neural tube defects were observed in 4 embryos. It was observed that the development of neural tube defects was no statistically significantly higher in low and high-dose fluoride group compared to the control group. CONCLUSION: Low and high-dose fluoride exposure was associated with developing neural tube defects, but there was no statisticaly significance.

Effects of Dexamethasone Exposure on Neural Crest Cells and Primary and Secondary Neurulation in Chick Embryos.

AIM: To evaluate the effects of dexamethasone (Dex) treatment on neural crest cells and primary and secondary neurulation in chick embryos. MATERIAL AND METHODS: Sixty fertilized eggs with an average weight of 65 ± 2 g were incubated in 60%?70% humidity at 37.2°C ± 0.1°C. After 26 hours of incubation, the control group (n=12) received 0.1 mg/kg physiologic saline (S), group 1 (n=12) received 0.1 mg/kg Dex, group 2 (n=12) received 1 mg/kg Dex, and group 3 (n=12) received 5 mg/kg Dex into each embryonic disc. The eggs were incubated until Hamburger?Hamilton stage (HH) 15, HH18, and HH20. Then, the embryos were dissected and evaluated both macroscopically and microscopically. RESULTS: The mortality rate in the control group, group 1, and groups 2 and 3 was 27%, 48%, and 100%, respectively. The neural tube thicknesses in group 1 significantly increased in HH 15 and HH20 (p < 0.05). The mitosis number in group 1 significantly decreased in each stage (p < 0.05). Wnt-1 expression was significantly lower in group 1 in HH15 (p < 0.05) and HH18 (p < 0.05), but there was no significant difference in HH20 (p > 0.05). Fibroblast growth factor (FGF) expression was significantly lower in group 1 in HH15 (p < 0.05). The expression of N-cadherin was significantly higher in group 1 in HH20 (p < 0.05). Fibronectin expression decreased in group 1 in HH18 (p < 0.01). CONCLUSION: Although the Dex treatment did not result in neural tube closure defect, the mortality rates and neural tube thicknesses increased, whereas mitotic activation and Wnt-1 and FGF signal pathways reduced in some stages.

Effects of Ozone on Injury after Gamma Knife Radiosurgery.

BACKGROUND: At present, gamma knife radiosurgery plays an important role in neurosurgical procedures. Gamma knife radiosurgery has been used to treat many types of brain tumors and as a functional intervention. However, gamma knife treatment has a devastating effect on the normal brain parenchyma surrounding the target point. It causes increased vascular permeability, vasodilation, and swelling in endothelial cells. Ozone has antioxidant, antiapoptotic, and anti-inflammatory effects in the body. Thus, we evaluated the radioprotective effects of ozone in rats undergoing gamma knife radiation. METHODS: In the present study, 24 Sprague-Dawley male rats weighing 250-300 g in 3 groups of 8 rats each were used. The rats were selected randomly. The control group did not receive any gamma knife radiation. The other 2 groups received 50 Gy of radiation, with 1 group given ozone treatment and the other group not given ozone treatment after gamma knife radiosurgery. At 12 weeks after gamma knife radiation, the rats were sacrificed with high-dose anesthetic agents and the tissues prepared for evaluation. The slides were evaluated for necrosis, vacuolization, glial proliferation, and vascular proliferation using hematoxylin-eosin staining. Vascular endothelial growth factor (VEGF) and extracellular matrix metalloproteinase inducer (also known as CD147) were evaluated using immunohistochemical staining. RESULTS: VEGF expression in glial tissue was significantly less in the group receiving ozone (χ2 = 15.00; df = 4; P = 0.005) compared with the group that had not received ozone and was similar to the expression in the control group. CONCLUSIONS: The lower expression of VEGF in the group receiving ozone might cause less edema in the surrounding tissue owing to less degradation of vascular permeability in the rat brain tissue.

Effect of L-Arginine Therapy on Vasospasm: Experimental Study in Rats.

OBJECTIVE: Cerebral vasospasm occurring after subarachnoid hemorrhage is a serious cause of morbidity. Cerebral vasospasm-related studies aim to prevent complications after subarachnoid hemorrhage. Nitric oxide affects brain blood flow and local vascular hemodynamics. L-arginine is used in the synthesis of nitric oxide, and hence we have investigated the efficacy of L-arginine treatment by using femoral artery vasospasm model. METHODS: Twenty-four male Sprague-Dawley rats have been divided into 3 groups as vasospasm, vasospasm + L-arginine, and control. In this study, we have preferred the "Rat Femoral Artery Vasospasm Model" described by Okada et al. Rats in the vasospasm + L-arginine group were given 300 mg/kg L-arginine for 7 days. At the end of the study, all samples of rat femoral arteries have been dissected and examined microscopically for histopathologic analysis. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests, and P < 0.05 value was considered statistically significant. RESULTS: L-arginine treatment reduced the morphometric changes such as irregularity of the elastic lamina, disruption of the endothelial cells, vacuolization, and hemorrhages that are caused by vasospasm. When the wall thickness and lumen diameter measurements were evaluated statistically, significant improvement was observed in the vasospasm + L-arginine group compared with the vasospasm group (P < 0.01). CONCLUSIONS: In our study, the use of L-arginine, as a nitric oxide substrate, improved the experimental vasospasm in rats. Therefore we think that L-arginine therapy can be used in the prevention and treatment of cerebral vasospasm after subarachnoid hemorrhage.

Symptomatic Bilateral Xanthogranuloma of the Choroid Plexus.

Xanthogranulomas (XGRs) of the choroid plexus are rare, asymptomatic, and benign lesions usually found incidentally. Here, we present a case of a 47-year-old male with bilateral XGR of the choroid plexus with periventricular edema and discuss our case in relation to a review of existing literature pertaining to the radiology of XGRs. To the best of our knowledge, this is the first reported case of bilateral trigonal XGR causing brain edema without ventricular dilatation. Despite the fact that they can cause hydrocephalus, XGRs are silent and benign lesions. Although the etiopathology of XGRs remains poorly understood, enhanced imaging analyses may provide additional information regarding edema and focal white matter signal changes.

The Histological Effects of Ozone Therapy on Sciatic Nerve Crush Injury in Rats.

OBJECTIVE: Peripheral nerve injury is a common, important problem that lacks a definitive, effective treatment. It can cause neurologic deficits ranging from paresthesia to paralysis. This study evaluated the effect of ozone therapy on sciatic nerve crush injury in rats. MATERIALS AND METHODS: Twenty-four male rats were divided into control sham surgery, sciatic nerve injury, and sciatic nerve injury with ozone groups (each n = 8). The sciatic nerve injury was inflicted via De Koning's crush-force method. The sciatic nerve injury group received medical air and the sciatic nerve injury ozone group received 0.7 mg/kg ozone. Sciatic nerve samples were obtained 4 weeks after injury. Vascular congestion, vacuolization, edema formation, S100 expression, and the thicknesses of the perineurium and endoneurium and diameter of the injured sciatic nerves were evaluated. RESULTS: The diameter of the sciatic nerve and thicknesses of the perineurium and epineurium were significantly greater in the sciatic nerve injury group (P < 0.05) and significantly less in the sciatic nerve injury with ozone group (P < 0.001). High S100 immunoreactivity was seen in the sciatic nerve injury group compared with the other 2 groups (P < 0.05). The distributions of vascular congestion and vacuolization were significantly less in the sciatic nerve injury with ozone group (P < 0.05). CONCLUSIONS: Ozone therapy improved sciatic nerve injury recovery without causing an increase in fibrotic tissue. Ozone reduced fibrosis, vascular congestion, vacuolization, and edema in rodents. Ozone treatment might be used to assist in sciatic nerve injury.

Vascular Variations Associated with Intracranial Aneurysms.

AIM: To investigate the vascular variations in patients with intracranial aneurysm in circle of Willis. MATERIAL AND METHODS: We used the data on 128 consecutive intracranial aneurysm cases. Cerebral angiography images were analyzed retrospectively. Arteries were grouped as anterior cerebral arterial system (ACS), posterior cerebral arterial system (PCS) and middle cerebral arterial system (MCS) for grouping vascular variations. Lateralization, being single/multiple, gender; and also any connection with accompanying aneurysms" number, localization, dimension, whether bleeding/incidental aneurysm has been inspected. RESULTS: Variations were demonstrated in 57.8% of the cases. The most common variation was A1 variation (34.4%). The rate of variations was 36.7%, 24.2% and 10.2% respectively in ACS, PCS and MCS. MCS variations were significantly higher in males. Anterior communicating artery (ACoA) aneurysm observance rates were significantly higher and posterior communicating artery (PCoA) aneurysm and middle cerebral artery (MCA) aneurysm observance rates were significantly lower when compared to "no ACS variation detected" cases. In "PCS variation detected" cases, PCoA aneurysm observance rates and coexistence of multiple variations were significantly higher. CONCLUSION: The rate of vascular variations in patients with aneurysms was 57.8%. Arterial hypoplasia and aplasia were the most common variations. ACS was the most common region that variations were located in; they were mostly detected on the right side. Coexistence of ACoA aneurysm was higher than PCoA and MCA aneurysms. In the PCS variations group, PCoA aneurysms were the most common aneurysms that accompanying the variation and multiple variations were more common than in the other two groups. The variations in MCS were most common in males.

Effects of Ozone on Spinal Cord Recovery via the Wnt/ Β-Catenin Pathway Following Spinal Cord Injury in Rats.

AIM: At the cellular level, spinal cord injury (SCI) provokes an inflammatory response that generates substantial secondary damage within the spinal cord but may also contribute to its repair. Besides intracellular antioxydant increase after exactly estimated oxidative stress; oxygen formation and transport is also advanced by ozone. The Wnt family of proteins contributes to the development of the nervous system, influencing cell proliferation. In the present study we evaluated the effect of ozone on spinal cord injury in rats. MATERIAL AND METHODS: Twenty-one male Sprague-Dawley rats were used. The rats were randomly allocated into three groups (control, trauma and trauma+ozone). SCI was inflicted using Allen"s spinal cord trauma method. The study was performed to determine the effects of ozone therapy on rats with SCI in terms of locomotor strength clinically and neuronal injury, white matter cavitation, edema, number of blood vessels, and expression of ß-catenin immunohistochemically. RESULTS: Comparison of the locomotor strength scores revealed a significant improvement on day 7 in trauma+ozone group. The groups were compared with regard to edema, neuronal injury, and white matter cavitation. Average ß-catenin levels were significantly different between the control group (68.11 ± 0.43), trauma+ozone group (37.96 ± 2.16), and trauma group (25.46 ± 1.07) (F = 1677.74, df = 2, p < 0.0005). CONCLUSION: The results of this study indicated that ozone therapy accelerates the healing process, increases vascularity, and reduces neuronal damage in rodents, suggesting that ozone therapy may be an adjuvant treatment in patients with SCI.

The Effect of Ozone Therapy on Experimental Vasospasm in the Rat Femoral Artery.

AIM: Oxidation products following subarachnoid hemorrhage (SAH) are among the causative substances of cerebral vasospasm and poor outcome. Ozone (O3) is a gas that contains three atoms of oxygen with a cyclic structure. It has been suggested that application of low-dose ozone has an antioxidant effect and provides resistance to oxidative stress. We investigated the effect of oxygen-ozone therapy on rat femoral artery vasospasm. MATERIAL AND METHODS: Twenty-four male Sprague-Dawley rats were randomly separated into vasospasm, vasospasm + ozone and control groups. The femoral artery vasospasm model was used. Rats in the vasospasm + ozone group were given 4 mL of ozone (20 µ/mL) daily for 7 days. Femoral arteries were examined by light microscopy for histological changes and morphometric analysis. Kruskal Wallis test and Mann Whitney U tests were used for the statistical analysis. The values of p < 0.01 and p < 0.05 were recognized as statistically significant. RESULTS: Ozone treatment reduced the morphometric changes as irregularity of the elastic lamina, disruption of the endothelial cells, vacuolization and hemorrhages that caused by vasospasm. The measurements of the wall thickness (p=0.003; p < 0.01) and lumen diameter (p=0.001; p < 0.01) showed statistically significant difference (p < 0.01) between the vasospasm and vasospasm+ozone groups. CONCLUSION: Ozone therapy may be useful in the treatment of post-hemorrhagic vasospasm.

Prognostic Factors in Patients who Underwent Aneurysmal Clipping due to Spontaneous Subarachnoid Hemorrhage.

AIM: Despite technical and medical advances, aneurysmal subarachnoid hemorrhages (SAH) continue to be a challenging pathology, associated with high rates of morbidity and mortality. In this regard, a definition is required of the various prognostic indicators of an SAH. The aim of the present retrospective study is to examine the various prognostic factors of the clinical outcomes of the patients who underwent a neurosurgical clipping of aneurysms due to aneurysmal SAH. MATERIAL AND METHODS: The data of 104 patients that had suffered an aneurysmal SAH were analyzed. The baseline demographic, clinical and radiological data were all analyzed. The prognostic study was derived from an analysis of these variables. Relationship between prognostic factors and outcome was evaluated by univariate and logistic multivariate regression analysis. RESULTS: This study has identified unfavorable outcomes on the Glasgow Outcome Scale at discharge after the surgical treatment of aneurysmal SAH associated with increased age, poor World Federation of Neurosurgical Societies (WFNS) grade on admission, higher Fisher's grade on admission computed tomography scan, larger aneurysm, and clinical vasospasm. In a multivariate logistic regression analysis, age, high WFNS grade, positive clinical vasospasm and size of aneurysm were found to be independent risk factors for mortality. The presence of hydrocephalus, number of aneurysms, positive risk factors, and the presence of Doppler vasospasm did not reach statistical significance. CONCLUSION: The most important prognostic factors in patients undergoing surgery due to aneurysmal subarachnoid hemorrhage were WFNS grade, age, size of aneurysm and clinical vasospasm.

Effects of the popular food additive sodium benzoate on neural tube development in the chicken embryo.

AIM: Many more additives have been introduced with the development of processed foods. Neural tube defects are congenital malformations of the central nervous system. More than 300 000 children are born with neural tube defects every year and surviving children remain disabled for life. Sodium benzoate is used intensively in our daily lives. We therefore aimed to evaluate the effects of sodium benzoate on neural tube defects in chicken embryos. MATERIAL AND METHODS: Fertile, specific pathogen-free eggs were used. The study was conducted on five groups. After 30 hours of incubation, the eggs were opened under 4x optical magnification. The embryonic disc was identified and sodium benzoate solution was injected. Eggs were closed with sterile adhesive strips and incubation was continued till the end of the 72nd hour. All eggs were then reopened and embryos were dissected from embryonic membranes and evaluated histopathologically. RESULTS: We found that the development of all embryos was consistent with the stage. We detected neural tube obstruction in one embryo. Neural tube defects were not detected in any embryos. CONCLUSION: This study showed that sodium benzoate as one of the widely used food preservatives has no effect to neural tube defect development in chicken embryos even at high doses.

Fourth Ventriculostomy in Occlusion of the Foramen of Magendie Associated with Chiari Malformation and Syringomyelia.

We present four cases of hydrocephalus caused by occlusion of foramen of Magendie associated with Chiari Type I malformation and syringomyelia. The aim of this study is to evaluate the results of surgical treatment via fourth ventriculostomy with catheter from the fourth ventricle to the upper cervical subarachnoid space. Obstructive tetraventricular hydrocephalus due to occlusion of the foramina of Luschka and Magendie can be treated with cerebrospinal fluid shunting, opening the membranes with suboccipital craniotomy, placement of a catheter, endoscopic third ventriculostomy, and endoscopic fourth ventriculostomy. Our aim was to solve all the pathologies such as Chiari malformation, hydrocephalus, and syringomyelia in one approach. Thus, the treatment consisted of posterior fossa decompression and exploration. All the patients were treated with suboccipital craniectomy and C1 laminectomy with excision of the membrane obstructing the foramen of Magendie. Fourth ventriculostomy with cathetering from fourth ventricle to upper cervical subarachnoid space was performed. The postoperative period was uneventful in all the patients. Neurological status of all the patients improved. Tetraventricular hydrocephalus and syrinx were reduced in the control cranial magnetic resonance imaging. Complications such as infection and catheter migration were not observed during the follow-up period. Treatment with fourth ventriculostomy using a catheter from fourth ventricle to upper cervical subarachnoid space could be a treatment of choice in cases with hydrocephalus caused by occlusion of the foramina of Magendie, with associated Chiari Type I malformation and syringomyelia.

Long-term disseminated recurrence in spinal hydatid cyst: a case report.

The spinal column is rarely affected by hydatid cyst; however, when involved, it has higher rates of recurrence particularly in case of osseous and paravertebral extensions. We report a 36-year-old patient. The patient was operated previously for hydatid cyst through laminectomy 13 years ago. After 13 years of surgery, the patient was admitted to our clinic with progressive paraparesis. Radiological evaluation revealed multicystic lesions affecting T4 and T5 vertebrae as well as the posterior thoracic wall and paravertebral musculature. Serological findings were also compatible with a hydatid cyst. The patient underwent surgical treatment; the cystic lesions were removed, and vertebral stabilization was provided. The treatment of hydatid cyst in the spine is challenging. Particularly in cases with vertebral involvement, spinal instability and recurrence are the main handicap. Preoperative and postoperative antihelminthic treatment as well as close clinical, radiological and serological follow up in postoperative period is important to avoid recurrence risk.

A primary orbital hydatid cyst.

Echinococcosis, caused by the tapeworm Echinococcus granulosus, is an endemic zoonosis in which humans act as accidental intermediate hosts. Orbital hydatid cysts comprise 1% to 2% of all hydatid lesions. We describe a 10-year-old boy with an orbital hydatid cyst. The orbital cyst was removed totally by frontal craniotomy and orbitotomy. It should be noted that unilateral painless proptosis in patients from countries endemic for echinococcosis could be caused by an orbital hydatid cyst.

Effects of parenteral nutritional support with fish-oil emulsion on spinal cord recovery in rats with traumatic spinal cord injury.

AIM: Aim of this study is to assess effects of parenteral nutritional support with fish-oil emulsion on spinal cord recovery in rats with traumatic spinal cord injury. MATERIAL AND METHODS: For 5 days after SCI rats were received saline in group C and Omegaven in group O. Locomotor strengths (BBB scale)of animals were rated at Day 0,7,14,21,28, and 35. At Day 35 spinal cord sampling was evaluated immunohistochemically. RESULTS: BBB scores were 0 in early period after SCI was inflicted in both groups. BBB scores were progressively increased after Day 7 in both groups (p < .005). BBB scores were significantly higher in group O when compared with control group after Day 7 in all times (p < .005). Neuronal injury (p < .002) and edema was much more in control group when compared with in group O (p < .005). Scores for white mater cavitation, demyelinization and vessel in growth were similar in both groups. VEGF expression in control group was higher (p=.019). CONCLUSION: At the early period of SCI fish-oil emulsion treatment in rats, its anti-inflammatory effects leaded to decrease in edema and had positive effect at the prevention of neuronal injury. We believe that nutritional support with fish-oil emulsion in patients with SCI will result in patient's better clinical outcome and increase in quality of the patient's life.

Tumoral calcinosis and epidural lipomatosis of the lumbar spine.

Lumbar spinal tumoral calcinosis and spinal epidural lipomatosis are rare conditions. We present a 70-year-old female patient with serology negative spondyloarthropathy who developed paresis due to tumoral calcinosis in the left facet joint between L5 and S1 levels and spinal epidural lipomatosis at L5 and S1 levels. Surgery was performed to excise the lesions en bloc. Neural decompression was provided. Neurological symptoms improved after surgery. Here, we report the first serology negative spondyloarthropathy case that had concomitant development of tumoral calcinosis and spinal epidural lipomatosis.