Intradural Intramedullary Cervicothoracic Tumor With Long-Segmental Localization: A Case Report With Step-by-Step Surgical Treatment Strategy With Neuromonitorization.

Ependymomas are the most common gliomas of the conus and lower cord, with the cervical cord being the second most common location. These tumors can extend upward 3-4 vertebra, and some ependymomas can extend up over 15 segments. Depending on many factors, such as tumor size, lateralization, kyphotic deformity, and lordosis state, there are several posterior surgical options, including laminectomy, laminectomy and lateral mass screw-plate, and laminoplasty. In this study, we discuss a case of intradural intramedullary cervicothoracic ependymoma with long-segmental localization, as well as the general surgical principles of its excision with step-by-step demonstrative figures.

Potential neuroprotective effect of Anakinra in spinal cord injury in an in vivo experimental animal model.

OBJECTIVE: To evaluate the therapeutic effects of inhibiting interleukin-1 beta (IL-1 beta) in vivo using Anakinra in an experimental model of spinal cord injury (SCI). METHODS: All experimental procedures were performed in the animal laboratory of Ankara Education and Research Hospital, Ankara, Turkey between August 2012 and May 2014. The SCI was induced by applying vascular clips to the dura via a 4-level T5-T8 laminectomy. Fifty-four rats were randomized into the following groups: controls (n = 18), SCI + saline (n = 18), and SCI + Anakinra (n = 18). Spinal cord samples were obtained from animals in both SCI groups at one, 6, and 24 hours after surgery (n = 6 for each time point). Spinal cord tissue and serum were extracted, and the levels of IL-1 beta, malondialdehyde, glutathione peroxidase, superoxide dismutase, and catalase were analyzed. Furthermore, histopathological evaluation of the tissues was performed. RESULTS: The SCI in rats caused severe injury characterized by edema, neutrophil infiltration, and cytokine production followed by recruitment of other inflammatory cells, lipid peroxidation, and increased oxidative stress. After SCI, tissue and serum IL-1 beta levels were significantly increased, but were significantly decreased by Anakinra administration. Following trauma, glutathione peroxidase, superoxide dismutase, and catalase levels were decreased; however, Anakinra increased the activity of these antioxidant enzymes. Malondialdehyde levels were increased after trauma, but were unaffected by Anakinra. Histopathological analysis showed that Anakinra effectively protected the spinal cord tissue from injury. CONCLUSION: Treatment with Anakinra reduces inflammation and other tissue injury events associated with SCI.

Incidentally diagnosed giant invasive sacral schwannoma. Its clinical features and surgical management without stability.

Schwannomas are benign encapsulated tumors of Schwan cells that grow slowly along the peripheral myelin nerve fibers. Sacral spinal schwannomas are very rare, and the incidence of sacral schwannoma ranges from 1-5% of all spinal schwannomas, and only around 50 cases are reported in the literature. There are 3 defined types of sacral schwannomas. These are retroperitoneal or presacral, intra osseous, and spinal schwannomas. Patients commonly present with complaints of pain and paresthesia due to the spinal schwannoma extending to extra spinal tissues. Direct x-ray, CT, MRI, and scintigraphy are used for preoperative diagnosis and treatment planning. Local recurrence and transformation to malignancy is very rare. For this reason, the frequently preferred treatments are subtotal removal of the mass or simple enucleation. In our article, we discuss the clinical features and the surgical treatment we performed without the need for stabilization in an incidentally determined giant invasive schwannoma case.

Painful scoliosis due to superposed giant cell bone tumor and aneurysmal bone cyst in a child.

Giant cell bone tumors are the most common precursor lesions of aneurysmal bone cysts (ABCs) developing secondarily. In giant cell bone tumors containing an explicit ABC component, the observation of the solid component of the giant cell bone tumor plays a critical role in the separation of the primary ABC. In general, ABC cases together with giant cell tumors in the bone are diagnosed histopathologically. The combination of giant cell bone tumor with superposed ABC and that of painful scoliosis with backache is rarely seen in children. In this case study, we discussed the diagnosis and the treatment of a giant cell tumor and superposed an ABC present in the fifth lumbar spine in a pediatric patient admitted to our clinic with a complaint of acute scoliotic back pain.

Giant occipitocervical lipomas: evaluation with two cases.

Lipomas are capsulated benign tumours that are commonly found in all body parts. A lipoma is a well-defined mesenchymal tumour that arises from the adipose tissue. Although giant lipomas are rare in the head and neck regions, when they are located here, they are most commonly found in the subcutaneous posterior neck area. Recurrence as well as invasion is very rare after total surgical excision. In this article, we present two rare cases of giant lipomas in the posterior occipitocervical region, which is an exceptional location.

An evaluation of the effectiveness of pre-ischemic hyperbaric oxygen and post-ischemic aminoguanidine in experimental cerebral ischemia.

OBJECTIVE: To study the effects of pre-ischemic hyperbaric oxygen (HBO) and post-ischemic aminoguanidine (AG) on the infarct volume in permanent middle cerebral artery occlusion. METHODS: This study was approved by the Animal Experiments Ethics Committee of Gulhane Military Medical Academy, Ankara, Turkey and carried out from March 2006 to August 2006. A total of 28 Sprague-Dawley rats (200-320 g) were divided into 4 groups: control (K) group (n = 7); HBO group (n = 7); HBO + AG group (n = 7); and the AG group (n = 7). All rats underwent middle cerebral artery occlusion (MCAO) by subtemporal craniectomy, and permanent ischemia was created. A 2.8 atmospheric pressure of HBO was first applied to the HBO and HBO + AG groups for 45 minutes, and occlusion was created after 2 hours. In the HBO + AG group, intraperitoneal administration of AG hemisulfate (100 mg/kg) was started 6 hours after MCAO, and was continued twice a day for 3 days. RESULTS: The rate of infarction was found to be 22.2+/-3.1% in the control group, 16.1+/-2.7% in the HBO group, 15.2+/-1.9% in the HBO+AG group, and 14.4+/-3.3% in the AG groups. The rate of infarctions (therefore the volume of infarct) in the HBO, HBO + AG, and AG groups were found to be significantly decreased compared with the control group (p=0.002, p=0.001, and p=0.001). CONCLUSION: In permanent MCAO-induced ischemia in rats, HBO and AG were observed to have a lowering effect on the infarct volume, but no additive effect was observed. This situation can be explained by different mechanisms of action.

Chronic subdural hematoma in a child with acute myeloid leukemia after leukocytosis.

Severe complications that develop in the early stages in patients with acute leukemia have a mortal course. Bleeding, leukostasis, and less frequently, infections are responsible for early mortality. Hemorrhage is most common in acute leukemia and usually leads to death. Hemorrhage may occur due to chemotherapy or bone marrow transplantation in patients with acute leukemia. Leukocytosis, thrombocytopenia, sepsis, and coagulopathy increase the risk of bleeding. There may be multiple etiologic factors. Subdural or subarachnoid hemorrhage is less common than an intra-axial hemorrhage. The incidence of spontaneous subdural hematoma is higher in patients with leukemia. Although advances in the treatment of platelet transfusion and disseminated intravascular coagulation have decreased the incidence of hemorrhagic complications in patients receiving chemotherapy for acute leukemia, intracranial hemorrhage-related deaths are a significant problem. We discussed the etiology and management of chronic subdural hematoma detected in a two-year-old male patient with Acute Myeloid Leukemia and hyperleukocytosis.

Giant occipital osteoid osteoma mimicking calcified meningioma.

Osteoid osteoma is a benign bone tumor, which rarely occurs in the skull, and often causes local pain that is worse at night, characteristically relieved by aspirin. Giant osteoid osteoma in the occipital bone is uncommon. We present a case of a 42-year-old female with an osteoid osteoma of the occipital bone that was totally resected. We discuss the clinical presentation, radiographic findings, and differential diagnosis of occipital osteoid osteoma.

Hemangiopericytoma of the pineal region.

We report a unique case of a 37-year-old female suffering from hemangiopericytoma of the pineal region, successfully excised by surgery. Hemangiopericytomas are rare malignant vascular tumors arising from mesenchymal cells with pericytic differentiation. These tumors usually develop in the limbs, pelvis, head, neck, and mostly in the muscle tissue. They are aggressive lesions that tend to occur at an earlier age than other meningeal tumors, recur with high frequency, and metastasize extracranially. Hemangiopericytomas represent less than 1% of all CNS tumors. Surgery remains the mainstay treatment. Radiotherapy and/or chemotherapy are the other treatment options.