The efficacy of gamma knife radiosurgery in patients with trigeminal neuralgia: The initial experience of the Bezmialem Vakif University.

BACKGROUND: Gamma knife stereotactic radiosurgery is, compared with surgical treatment, a less invasive treatment option for patients with trigeminal neuralgia (TN). AIM: In this report, we analyzed the effect and safety of gamma knife radiosurgery performed in patients with TN. MATERIALS AND METHODS: We retrospectively reviewed patients who underwent gamma knife radiosurgery for TN between June 2014 and January 2017. All patients were treated with Leksell Gamma Knife Model C (Elekta, Stockholm, Sweden) with a prescription dose of 40 Gy with a 50% isodose line. The follow-up of the patients was performed 1 week after the procedure and after every 3 months. The pain score of the patients was recorded using the visual analog scale (VAS). Complications were also reviewed. STATISTICAL ANALYSIS: Statistical analysis was performed using the Statistical Package for the Social Sciences software for Windows, version 23.0. RESULTS: Twenty-four patients (10 males, 14 females) were included in the study. The median age of the patients was 62.5 years (range, 34-91 years). The pre-gamma knife median VAS was 10 (range, 5-10), and the median VAS was 1 (range, 0-10) during the last follow-up. The pain decreased in 16 (76%) patients. Two patients (9%) had treatment-related complications. One patient developed hypoesthesia along the dermatome of the maxillary branch of the fifth cranial nerve and another patient developed facial paresis, which recovered after the usage of steroids for 3 months. CONCLUSION: Gamma knife radiosurgery is an effective and safe treatment for patients with TN with an acceptable pain control rate.

A Rare Complication of Tuberculosis: Acute Paraplegia.

BACKGROUND: Tuberculous radiculomyelitis(TBRM) is one of the complications of neurological tuberculosis and includes cases of arachnoiditis, intradural spinal tuberculoma or granuloma, and spinal cord complications of tuberculous meningitis (TBM). Here, we report a case of TBRM which presented with acute paraplegia. CASE DETAILS: Neurological examination on admission revealed flaccid paralysis, bilateral extensor plantar responses, and exaggerated deep tendon reflexes. Cerebrospinal fluid analysis showed xanthochromic fluid that contained 600 cells/mm3, 98% lymphocytes, protein 318 mg/dl and glucose 51 mg/dl (blood glucose 118 mg/dl). On thorax CT, calcified lymph nodes that were sequelae of primary tuberculosis infection was detected. Antituberculosis and intravenous corticosteroids treatment was started. Seven weeks from the onset, on-control spinal MRI myelomalacia was determined, and there was no leptomeningeal enhancement. After six weeks of rehabilitation, lower limb total motor score was increased from 0/50 to 15/50. CONCLUSIONS: Tuberculous radiculomyelitis is a complication of TBM. It is rarely seen.

Association between nutritional status and Modic classification in degenerative disc disease.

[Purpose] This study was conducted to examine the association between Modic classification and the eating habits in patients with degenerative disc disease (DDD) and to determine the influence of nutrition on disease severity. [Subjects and Methods] Sixty patients with DDD visiting a low back pain outpatient clinic were enrolled. Through face-to-face interviews, they completed questionnaires regarding their demographics, disease activity, smoking and alcohol use, concomitant diseases, disease duration, and nutritional status.Exclusion criteria were age <20 years or >65 years, other comorbidities, missing MRI data, and inability to speak Turkish. [Results] Forty patients were finally included in the study. The frequency with which they consumed water, salt, fast food, eggs, milk, yogurt, cheese, whole wheat bread, white bread, butter, and margarine was recorded. A weak negative correlation was observed between the Modic types and fish and egg consumption. [Conclusion] Modic changes, which indicate the severity of DDD, seem to be correlated to patients' dietary habits. However, studies with comparison groups and larger samples are needed to confirm our promising results before any cause-and-effect relationship can be proposed.

Choosing the most efficacious scoring method for carpal tunnel syndrome.

OBJECTIVE: The aim of this study was to determine the most efficacious hand-specific questionnaire to determine functionality in patients with carpal tunnel syndrome. METHODS: The study included 89 patients who underwent open carpal tunnel release surgery within three years prior to the study. A visual analog scale was used to assess the intensity of pain and paresthesia symptoms. Each participant completed the Boston Carpal Tunnel Questionnaire (BCTQ), the Michigan Hand Outcome Questionnaire (MHQ), the quick form of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and the Duruoz Hand Index (DHI). The BCTQ, pain and paresthesia results were assumed as gold standards. Correlations between the MHQ, QuickDASH, and the DHI were analyzed. A correlation analysis between the variables was tested using Spearman's rho test or Pearson's test for variables. RESULTS: The QuickDASH was well correlated with pain, paresthesia and the BCTQ (p<0.001). The questionnaires complied with each other. CONCLUSION: In addition to its complicated scoring, the MHQ contained detailed subparameters with similar questions and takes a long time to complete. Further studies may confirm the effective usage of the DHI. The easier QuickDASH questionnaire appears to be more practical for carpal tunnel release patients.

Imatinib mesylate decreases the cytotoxic effect of roscovitine on human glioblastoma cells in vitro and the role of midkine.

The purpose of the present study was to overcome resistance to imatinib (IM) by combining it with roscovitine (ROSC) and to investigate whether or not midkine (MK) had an effect on this combination in the treatment of glioblastoma (GBL). Human T98 GBL cells were used to evaluate the effects of IM (10 µM), ROSC (200 µM) and their combination on the cell proliferation index, apoptotic index, the apoptotic protein and anti-apoptotic protein levels, and ultrastructure. All applications decreased the cell proliferation index and increased the apoptotic index, but ROSC was the most efficient drug and the second most efficient drug was IM. Notably, ROSC increased anti-apoptotic proteins levels (PDGFR-α, AQP-4, hTERT), COX-1 activity and ribosome numbers. The effects of ROSC on hTERT, MK, AQP-4 and MRP-1 levels and COX-1 activity were reported for the first time. ROSC induced the highest increase in caspase-3 levels. Autophagy was not involved in the activity of ROSC in GBL spheroids. The combination of IM with ROSC showed an antagonist effect in the treatment of human GBL cells. The combination group decreased certain anti-apoptotic protein levels (PDGFR-α, EGFR, p-gp, MRP-1 and MK), cAMP levels, COX-1 activity and apoptotic protein levels (caspase-3). However, it induced the highest increase in hTERT levels and COX-2 activity. Ribosome numbers were much lower than those in the ROSC group and no autophagic vacuole was observed. In conclusion, more investigations are required to identify the key regulatory components that are responsible for this antagonism; however, the determination of this combination therapy as a failure therapy may be precautionary for oncologists in the treatment of GBL patients and potentially may contribute to the efficacy of new therapeutic regimens.

Chronic ossified epidural hematoma after ventriculoperitoneal shunt insertion: a case report.

Chronic calcified/ossified epidural hematoma is an uncommon complication of ventricular shunt surgery. There are only 4 cases related to valve-regulated shunt operations in the literature. It may be seen especially in young patients with chronic hydrocephalus, probably due to craniocerebral disproportion. The precise mechanism of the calcification or ossification of the hematoma is not known, however, the dura mater seems to play a part in this process. A 17-year-old girl with triventricular hydrocephalus was treated with a ventriculoperitoneal shunt system including a medium pressure flow control valve. She was admitted with a complaint of severe headache after three years and a bifrontal calcified/ossified epidural hematoma was seen. The calcifying hematoma was removed and the patient's headache resolved. Although the use of high or medium pressure valves, valves with an antisiphon device, adjustable pressure valves or flow control valves have been recommended to prevent this complication in previous reports, it was seen that our case had been treated with a medium pressure flow control valve.

Clear cell ependymoma of the temporal lobe in a child: a case report.

A 12-year-old boy with a left temporal tumor diagnosed as clear cell ependymoma (CCE) was reported. CCE is an uncommon central variant of ependymomas with a predilection for the supratentorial region in children. Brain tumors with a honeycomb pattern with clear cells having round nuclei and perinuclear halos could pose a problem in the differential diagnosis with the other tumors with clear cells. There were 41 reported cases of CCE in the literature. In 61% of these cases, tumors were located in the supratentorial region, and in the others in the posterior fossa and spinal cord. However, there was none located in the temporal lobe except in the case presented here.

Delayed infection 6 years after spinal instrumentation: a case report.

Infection is the major and important complication of spinal instrumentation generally requiring removal of the implant. Although findings of infection usually appear within a few months after operation, they may appear even after few years in some cases. A case with delayed postoperative infection 6 years after surgery is reported. A 27-year-old female with purulent flow from her anterolateral skin incision scar was diagnosed as delayed spinal infection 6 years after anterior and posterior combined spinal instrumentation performed for treatment of giant cell tumor of L3 vertebral body. Staphylococcus aureus was detected from purulent flow. Infection was treated by removal of the implant and antibiotherapy. Spinal infection after instrumentation may appear even a few years later. Patients must therefore be carefully followed for a long time. Staphylococcus aureus can stay silent for a long time.

Bilateral suprascapular nerve entrapment.

Bilateral suprascapular nerve entrapment syndrome is very rare. It presents with shoulder pain, weakness and atrophy of the supraspinatus and infraspinatus muscles. We present a twenty-year old man having a history of bilateral shoulder pain associated with weakness. Electromyographic studies revealed signs of a lesion that caused a neupraxic state of the left suprascapular nerve, moderate axonal loss of the right suprascapular nerve and denervation of the right suprascapular muscle. The patient was treated with physical and medical therapy. Due to worsening of the symptoms, a surgical operation was performed by the excision of the transverse scapular ligaments bilaterally. His pain, weakness and atrophy had diminished on examination six weeks later. Suprascapular nerve entrapment should be considered in patients with shoulder pain, particularly those with weakness and atrophy of the supraspinatus and infraspinatus muscles.