Esthesioneuroblastoma located in the thoracic extradural space: Case report.

OBJECTIVE: Esthesioneuroblastoma accounted for only 6% of the malignant nasal cavity neoplasms (ENB) is a rare tumor which originates from the olfactory epithelium. ENB's are locally agresive and can metastasize by lymphatic and hematogenous routes. A patient with the mass on the nasal dorsum was reported in this article. CASE HISTORY: A 52-year-old-man admitted to the hospital with a 3 months history of progressive nasal obstruction, epistaxis and mass on the nasal dorsum. On rhinoscopy, a polypoid mass was seen in the both nasal cavity and intranasal biopsy with local anesthesia was performed. Histopathologic diagnosis of the tumor was Kadish stage B esthesioneuroblastoma. Tumor was excised by using bilateral endoscopic endonasal resection and lateral rhinotomy approach and paranasal radiotherapy performed postoperatively. Ten months after surgery, neck metastasis was occured and patient was underwent neck dissection. Twenteeth months after initial treatment, distant metastasis was identified on the T 10 vertebra and following the cranial and spinal radiotherapy to the neck he was free of local recurrence at follow up 13 months after surgery. CONCLUSION: It has been known that the metastasis of the ENB to the spinal cord is an uncommon event, and it occurs often years after initial diagnosis. MRI scan is helpful for making the diagnosis, and surgery is the treatment of choice for obtaining diagnostic tissue and debulking the tumor. Radiotherapy is also a mainstay of postoperative treatment.

Traumatic intraventricular hemorrhage with a good prognosis.

We report a 10-year-old girl with an isolated traumatic intraventricular hemorrhage following a traffic accident, who had a good prognosis. Her neurological examination upon arrival was normal and she had no complaint other than headache and vomiting. Computed tomography on admission showed a hemorrhage in the lateral and fourth ventricles. She had a Glasgow Coma Score of 15, and she was thus given only antiepileptic drugs for prophylaxis and followed. Computed tomography that was repeated 5 days after admission showed no blood and all ventricles were of normal size. There was no vascular pathology on magnetic resonance imaging and magnetic resonance angiography. The patient remains well 5 months after her accident. Intraventricular hemorrhage does not always have a poor prognosis.

Regional anatomic structures of the elbow that may potentially compress the ulnar nerve.

HYPOTHESIS: Traumatic injuries to the ulnar nerve at the elbow are a frequent problem as it is vulnerable to stretching and compression with motion of the upper limb. The aim of the present study was to explore the course of the ulnar nerve at the elbow and forearm and to determine possible anatomical structures that may cause compression of this structure. MATERIALS AND METHODS: We examined 12 upper limbs from cadavers. The length of any fibrous bands, and if present, their distance to the medial epicondyle was recorded. RESULTS: On 5 sides a fibrous band originating from the medial intermuscular septum was observed to cross over the ulnar nerve. The average length of the fibrous band was 5.7 cm, and it attached to the medial epicondyle. The mean length of the ulnar nerve as it coursed in the cubital tunnel was 3.8 cm. In 4 of the cases, the ulnar nerve was covered by muscle fibers originating from the flexor digitorum superficialis and extending to the flexor carpi ulnaris. On 5 sides we observed fibrous thickenings, and on 8 sides vascular structures were found crossing over the ulnar nerve. DISCUSSION: The cubital tunnel is the most common site of compression of the ulnar nerve. Numerous surgical procedures are recommended for cubital tunnel syndrome. Simple decompression is used most commonly. Although surgical procedures are reported to provide efficient pain relief and functional recovery, residual or recurrent symptoms have been reported. Reasons for such recurrences may be more proximal or distal compression of the ulnar nerve as seen in our study. CONCLUSION: Knowledge of possible compression sites of the ulnar nerve is important to the surgeon so that complications are avoided and postoperative recurrence is decreased. LEVEL OF EVIDENCE: Basic science study.

A 13-year-old girl with a cystic cerebellar lesion: consider the hydatid cyst.

We report a 13-year-old girl with a hydatid cyst located in the posterior fossa. The pre-operative diagnosis was a cerebellar tumour; the cyst was operated on using puncture, aspiration, irrigation and resection. Sixteen months post-operatively, the patient is in a good health. A hydatid cyst must always be considered in the differential diagnosis of cystic lesions of the cranium, especially for those children living in rural areas.

Thoracic intradural cystic schwannoma: a case report.

Spinal schwannomas are benign tumors arising from spinal nerve root sheaths. These are the most common intradural extramedullary spinal tumors. Schwannomas are mostly solid or heterogeneous solid tumors. Cystic schwannomas are rare lesions. We present a 27-year-old woman with an intradural extramedullary cystic tumor in the lower thoracic region who complained of back pain and walking difficulty. The patient was operated and the tumor was totally removed. The postoperative course was uneventful. The histopathological diagnosis was cystic schwannoma. Differentiation of cystic schwannomas from other cystic mass lesions can be difficult. Magnetic resonance imaging and histopathological findings are important for evaluating these tumors.

The importance of evaluating all seven cervical vertebrae in the trauma patient: a case report.

The cervical spine is injured in approximately 3% of major trauma patients and 10% of patients with serious head injury. We present a patient in whom an unstable cervical spine, without neurological deficit, resulting from a traffic accident was misdiagnosed as normal in the emergency room. Although cervical spine pain or tenderness and neurological deficit have a sensitivity of 93% for cervical spine injury, asymptomatic patients or patients with mild symptoms can have spine injury. All trauma patients with a complaint of mild neck pain require a standard three-view radiological evaluation of the cervical spine demonstrating all seven vertebrae and the top of first thoracic vertebra even if their neurologic examination is normal.

High-sensitivity C-reactive protein levels in cerebrospinal fluid and serum in severe head injury: relationship to tumor necrosis factor-alpha and interleukin-6.

Recent studies have demonstrated the role of high-sensitivity C-reactive protein (hsCRP) in inflammatory diseases; however, it is unclear whether this molecule has a role after severe head injury (SHI). Our aim was to evaluate the levels of hsCRP in both cerebrospinal fluid (CSF) and serum from patients after SHI. The study focused on 11 patients with SHI, and evaluated CSF and serum levels of hsCRP, tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in a 10-day period following the head trauma. The values were compared with those from nine control patients, who had normal pressure hydrocephalus. In the CSF and serum of the patients after SHI, HsCRP was found to be significantly higher, at all times, than in the controls; TNF-alpha and IL-6 levels were also higher in these patients. However, hsCRP levels did not correlate with either TNF-alpha or IL-6. TNF-alpha and IL-6 increased during the period immediately following the SHI, and intrathecal levels were always higher than those of the serum. This study demonstrates for the first time that hsCRP reaches high levels in both CSF and serum in patients with SHI, and it may therefore be used as an inflammatory index. This finding suggests a need for further studies in this area, which are larger in scope than the present study.

Mitomycin C, 5-fluorouracil, and cyclosporin A prevent epidural fibrosis in an experimental laminectomy model.

This study examined the preventive effects of the local application of mitomycin C (MMC), 5-fluorouracil (5-FU), and cyclosporine A (CsA) in minimizing spinal epidural fibrosis in a rat laminectomy model. Thirty-two 2-year-old male Wistar albino rats, each weighing 400 +/- 50 g, were divided into four equal groups: sham, MMC, 5-FU, and CsA. Each rat underwent laminectomy at the L5-L6 lumbar level. Cotton pads (4 x 4 mm2) soaked with MMC (0.5 mg/ml), 5-FU (5 ml/mg), or CsA (5 mg/ml) were placed on the exposed dura for 5 min. Thirty days after surgery, the rats were killed and the epidural fibrosis, fibroblast density, inflammatory cell density, and arachnoid fibrosis were quantified. The epidural and arachnoid fibroses were reduced significantly in the treatment groups compared to the sham group. Fibroblast cell density and inflammatory cell density were decreased significantly in the MMC and 5-FU groups, but were similar in the sham and CsA groups. The decreased rate of epidural fibrosis was promising. Further studies in humans are needed to determine the short- and long-term complications of the agents used here.