The Protective Effect of Omeprazole Against Traumatic Brain Injury: An Experimental Study.

BACKGROUND: The development of secondary brain injury via oxidative stress after traumatic brain injury (TBI) is a well-known entity. Consequently, the aim of the present study was to evaluate the role of omeprazole (OM) on rat model of TBI. METHODS: A total of 24 male rats were used and divided into 4 groups as follows; control, trauma, OM, and methylprednisolone (MP). The trauma, OM, and MP groups were subjected to closed-head contusive weight-drop injuries. Rats received treatment with saline, OM, or MP, respectively. All the animals were sacrificed at 24 hours after trauma and brain tissues were extracted. The oxidant/antioxidant parameters (malondialdehyde, glutathione peroxidase, superoxide dismutase, nitric oxide) and caspase-3 in the cerebral tissue were analyzed, and histomorphologic evaluation of the cerebral tissue was performed. RESULTS: Levels of MDA and activity of caspase-3 were significantly reduced in the OM and MP groups compared with the trauma group. Glutathione peroxidase and superoxide dismutase levels were increased both in the OM and MP groups compared with the trauma group. The pathology scores were statistically lower in the OM and MP groups than the trauma group. CONCLUSIONS: The results of the present study showed that OM was as effective as MP in protecting brain from oxidative stress, and apoptosis in the early phase of TBI.

Does Decorin Protect Neuronal Tissue via Its Antioxidant and Antiinflammatory Activity from Traumatic Brain Injury? An Experimental Study.

BACKGROUND: The development of secondary brain injury via oxidative stress after traumatic brain injury (TBI) is well known. Decorin (DC) inactivates transforming growth factor ß1, complement system, and tumor necrosis factor α, which are related to oxidative stress and apoptosis. Consequently, the aim of the present study was to evaluate the role of DC on TBI. METHODS: A total of 24 male rats were used and divided into 4 groups as follows; control, trauma, DC, and methylprednisolone (MP). The trauma, DC, and MP groups were subjected to closed-head contusive weight-drop injuries. Rats received treatment with intraperitoneal saline, DC, or MP, respectively. All the animals were killed at the 24th hour after trauma and brain tissues were extracted. The oxidant/antioxidant parameters (malondialdehyde, glutathione peroxidase, superoxide dismutase, and NO) and caspase 3 in the cerebral tissue were analyzed, and histomorphologic evaluation of the cerebral tissue was performed. RESULTS: Levels of malondialdehyde, NO, and activity of caspase 3 were significantly reduced, and in addition glutathione peroxidase and superoxide dismutase levels were increased in the DC and MP groups compared with the trauma group. The pathology scores and the percentage of degenerated neurons were statistically lower in the DC and MP groups than in the trauma group. CONCLUSIONS: The results of the present study showed that DC inactivates transforming growth factor ß1 and protects the brain tissue and neuronal cells after TBI.

Clinical outcome of adult choroid plexus tumors: retrospective analysis of a single institute.

BACKGROUND: Choroid plexus tumors are rare brain tumors with clinical features that vary according to the histological grade. We reviewed the treatment outcomes of 15 adult patients with choroid plexus tumors, focusing on surgical outcomes and current therapeutic strategies. METHOD: Patient demographic and clinical characteristics, operative findings, adjuvant therapies, disease progression and survival rates were reviewed. RESULTS: The median age at diagnosis was 33.7 ± 10 years (19-59 years) for patients with choroid plexus tumors. Postoperative chemotherapy was given to 26.7 % of patients, and 13.3 % of patients received radiotherapy. The Ki-67 labeling index and mitotic index increased at higher histological grades. All of the choroid plexus papilloma and atypical choroid plexus papilloma patients have survived. The overall survival rate of patients with choroid plexus carcinoma was 50 % in the first year, but none of the patients survived to the second year. Five patients underwent permanent cerebrospinal fluid diversion surgery because of hydrocephalus or subdural effusion. CONCLUSIONS: Choroid plexus papilloma and atypical choroid plexus papilloma patients can be treated with complete surgical resection. Choroid plexus carcinoma has a poor prognosis, and aggressive multi-modal treatments are generally needed for treatment. Chemotherapy and radiotherapy are important adjuvant therapies for choroid plexus carcinoma. If hydrocephalus and/or subdural effusion occur, permanent cerebrospinal fluid (CSF) diversion should be added to the therapeutic strategy.

L'hermitte-Duclos disease in an elderly patient: A case report and review of the literature.

L'hermitte-Duclos disease (LDD) is an extremely rare cerebellar lesion of uncertain etiology. Occasionally, the patients with LDD may even have sudden neurological deterioration due to acute heniation as seen in the present case report. It is also imperative to distinguish this disease from other malignant lesion of the cerebellum and cerebellar malformations with its varied natural course of history and hence better ability to prognosticate such patients. Herein, we reported a successfully treated case of LDD following a long history of vaguely defined neurological complaints in an elderly patient and reviewed the literature.

Clinical outcome of surgically treated low-grade gliomas: a retrospective analysis of a single institute.

OBJECTIVE: Low grade gliomas (LGGs) are slow-growing primary brain tumors with heterogeneous clinical behaviors. The aim of our study is to review the treatment outcome of 63 patients with LGGs focusing on surgical outcome and the current therapeutic strategy. METHODS: We retrospectively enrolled 63 patients surgically treated for LGGs. The gross total resection (GTR) was performed in 35 patients (60.3%), subtotal resection (STR) was performed in 19 patients (31.7%) and partial resection (PR) or biopsy was performed in 9 patients (14.3%). We analyzed their progression-free survival (PFS), overall survival (OS), and malignant transformation with regard to age, gender, Karnofsky performance score (KPS), clinical presentation, tumor location, radiologic pattern, contrast enhancement, extent of removal, pathologic subtype, chemotherapy (CT) and radiotherapy (RT) treatment. RESULTS: Among all LGGs, the 3-year OS rate was 80% and the 5-year OS was 76%. The 3-year PFS rate was 83.6% and the 5-year PFS was 25%. The non-eloquent area location showed a longer PFS than the eloquent area location (p=0.05). Oligodendroglial pathology showed a longer PFS compared to oligoastrocytomas and astrocytomas (p=0.02). Patients older than 60 years had poorer OS than younger patients (p<0.05). Female gender had a shorter OS than male gender (p<0.05), and a KPS of 90 or 100 had a longer OS than a KPS of 80 (p<0.05). Oligodendroglial pathology statistically correlated with a longer OS (p<0.05). CONCLUSION: The findings from our study, which were confirmed by uni- and multivariate analyses, demonstrated that radical tumor resection was associated with better long-term outcomes and tumor progression for patients with LGG.

Effects of raloxifene on cerebral vasospasm after experimental Subarachnoid Hemorrhage in rabbits.

BACKGROUND: The aim of this study was to investigate the ability of a SERM, RLX, to prevent vasospasm in a rabbit model of SAH. METHODS: Thirty-four New Zealand white rabbits were allocated into 3 groups randomly. Subarachnoid hemorrhage was induced by injecting autologous blood into the cisterna magna. The treatment groups were as follows: (1) sham operated (no SAH [n = 12]), (2) SAH only (n = 12), and (3) SAH plus RLX (n = 10). Basilar artery lumen areas and arterial wall thickness were measured to assess vasospams in all groups. RESULTS: There was a statistically significant difference between the mean basilar artery cross-sectional areas and the mean arterial wall thickness measurements of the control and SAH-only groups (P < .05). The difference between the mean basilar artery cross-sectional areas and the mean arterial wall thickness measurements in the RLX-treated group was statistically significant (P < .05). The difference between the SAH group and the SAH + RLX group was also statistically significant (P < .05). CONCLUSIONS: These findings demonstrate that RLX has marked vasodilatatory effect in an experimental model of SAH in rabbits. This observation may have clinical implications suggesting that this SERM drug could be used as possible anti-vasospastic agent in patients without major adverse effects.

Delayed pseudomyelomeningocele: a rare complication after foramen magnum decompression for Chiari malformation.

BACKGROUND: A variety of complications after FMD with or without duraplasty for Chiari malformation have been described. Although cerebellar ptosis through the dural opening and pseudomeningocele are well-known rare complications of this procedure, spinal cord herniation manifesting as pseudomyelomeningocele formation has not previously been cited in the literature. In this report, we present a case of delayed pseudomyleomeningocele after FMD. CASE DESCRIPTION: A 22-year-old man presented with progressive spinal cord compression symptoms 7 years after undergoing FMD for Chiari malformation. Craniocervical MRI of the patient revealed pseudomyelomeningocele at C1 level together with cord distortion. The patient underwent untethering surgery for spinal cord adhesions; neural tissue was freed microsurgically from the adjacent structures and duraplasty was performed with synthetic graft. In the early postoperative period, his symptoms resolved moderately. CONCLUSION: Neural tissue shift including the spinal cord through the dural opening may occur after a large posterior fossa decompression without duraplasty for Chiari malformation. Postoperative inadequate CSF circulation due to arachnoid scarring around the decompression area may facilitate this type condition. Early diagnosis of such a complication is of vital importance to prevent serious neurologic deficits, and release surgery with proper duraplasty and also restoration of CSF circulation is the choice of treatment.

Sublabial transseptal approach to pituitary adenomas with special emphasis on rhinological complications.

OBJECTIVE: The aim of this presentation is to show that the sublabial transseptal transsphenoidal approach to pituitary adenomas is the least invasive anatomic route with the lowest postoperative complication rates. PATIENTS AND METHOD: This study was based on a retrospective analysis of 276 patients with a diagnosis of pituitary adenoma who were surgically treated via the sublabial transsphenoidal route. RESULTS: The overall complication rate of the presented series was 14.8%. The recurrence rate was 14.1%; there were no deaths or intranasal complications in this series. Postoperative rhinological complications, such as septal perforation, synechiae, and mucosal tear which impaired nasal function, occur rarely with this approach compared to other approaches. CONCLUSION: Besides the technical advantages of this approach, performance of the initial phase of the operation by an otorhinolaryngologic surgeon is the basis of the low intranasal complication rate in our series.

Magnetic resonance imaging abnormalities of neural axis in Lenke type 1 idiopathic scoliosis.

STUDY DESIGN: Patients with Lenke type 1 single thoracic idiopathic scoliosis were included in this prospective study. All patients had preoperative magnetic resonance imaging (MRI). OBJECTIVE: To examine the frequency of neural axis abnormalities and the need for preoperative MRI in this group of patients. SUMMARY OF BACKGROUND DATA: Because of the increasing use of MRI, neural axis abnormalities have been reported in association with certain clinical and radiologic findings in idiopathic scoliosis cases. METHODS: A total of 104 patients (49 juvenile onset and 55 adolescent onset), older than 10 years, were included in the study. The association of neural axis abnormalities with pes cavus, abnormal deep tendon reflexes, age of onset, presence of pain, severity of the frontal plane deformity, and sagittal contours were investigated. RESULTS: All 7 patients with a neural axis abnormality on MRI had an early onset disease, and 6 of them had back pain. Thus, age of onset and back pain seem to be predictive of these abnormalities. Frequency of MRI abnormalities was as high as 45% for patients with back pain in addition to a type IC curve. CONCLUSION: In patients with juvenile idiopathic scoliosis and back pain, preoperative MRI should be performed to eliminate the risk of postoperative neurologic deficits, even if the scoliosis is Lenke type 1. However, in patients with Lenke type 1 idiopathic scoliosis, preoperative MRI studies seem unnecessary if intraoperative neural monitoring is to be performed.

[Neural axis abnormalities detected by preoperative magnetic resonance imaging in patients with type III idiopathic scoliosis]. / Tip III idiyopatik skolyoz hastalarinda manyetik rezonans görüntüleme ile saptanan nöral aks anomalileri.

OBJECTIVES: We investigated the presence of neural axis abnormalities by magnetic resonance imaging (MRI) in patients with clinically and radiologically confirmed absolute flexible thoracic curves (King-Moe type III). METHODS: Preoperative MRI scans of 84 patients (34 males, 50 females; mean age 14.1 years; range 11 to 17 years) with adolescent idiopathic scoliosis and a flexible thoracic curve (King-Moe type III) were prospectively evaluated to determine neural axis abnormalities. Clinical and radiologic indications for preoperative MRI examination were sought. All patients were treated with posterior fusion. All patients were intraoperatively monitored by means of motor evoked potentials by magnetic transcortical stimulation and somatosensory evoked potentials. The mean follow-up was 50.1 months (range 24 to 105 months). RESULTS: Neural axis abnormalities were detected in six patients (7.1%), including syringomyelia in five patients (5.9%) and diastometamyelia in one patient (1.2%). Of 84 patients, 51 patients (60.7%) had a relatively decreased spinal cord diameter, and an increased epidural distance. No clinical or radiologic indicators were found for preoperative MRI examination. No neurologic deficits developed during operation and in the postoperative period. CONCLUSION: The detection of neural axis abnormalities implies the necessity of intraoperative neurologic monitoring to minimize the risks for neurologic deficits. Where this is not available, preoperative MRI seems to be an essential tool in the prevention of surgery-associated neurologic risks.