Ochronosis and lumbar disc herniation.

Alkaptonuria is a rare, autosomal recessive metabolic disorder in which the homogentisic acid oxidase activity is absent. Its incidence is as low as 0.001%. Ochronosis is the pigmentation of connective tissues and this pigmentation leads to degenerative changes in alkaptonuric patients. Alkaptonuria most prominently involves the lumbar region, but lumbar disc herniation as the presenting feature of alkaptonuria is not common. Only a few patients required surgical intervention. Herewith we report an alkaptonuric patient, who was operated on for lumbar disc herniation. His discectomy material was black and the metabolic disorder was diagnosed retrospectively. This metabolic disease is often recognized on physical re-examination after the black disc material was seen during the operation. Therefore urinalysis for homogentisic acid should be performed in all patients with degenerative changes of the vertebral column. The results of disc surgery in this patient group is successful.

Comparison of clinical outcomes between anteroposterior and lateral penetrating craniocerebral gunshot wounds.

OBJECTIVE: To investigate and compare, using a retrospective clinical study, the clinical outcomes of penetrating craniocerebral gunshot wounds (PCGW) with respect to the trajectory of penetration in the axial plane. METHODS: In total, 22 patients with PCGW caused by conflict, suicide attempt, or accidental firing were included in this study. They were divided into two groups: anteroposterior and lateral. All patients underwent surgical treatment following emergency intervention. RESULTS: Of the 22 patients, 16 had anteroposterior and 6 had lateral penetrating injury. Four patients with anteroposterior and five patients with lateral injury died despite surgical treatment. Mortality rate was 25% in the anteroposterior and 83% in the lateral injury group. CONCLUSION: We found that lateral PCGW is the most devastating type of missile injury to the head.

Spinal epidural cavernous angioma: case report.

Epidural cavernous angiomas are apparently rare lesions. We present a case of paraplegia with acute onset secondary to spinal epidural cavernous angioma at levels C7 and T1. Magnetic resonance imaging gave the clinician the opportunity to diagnose the lesion preoperatively. In this article, we present and discuss this rare case with a review of the literature.

Multiple oligodendroglioma: case report.

An 18-year-old female patient was hospitalized with headache and disturbance of consciousness. Magnetic resonance imaging (MRI) revealed a tumor in the left parieto-occipital lobe. The tumor was totally removed, and postoperative radiation therapy was administered locally at 50 Gy. Ten months later, she experienced sudden onset of unconsciousness and headache. Computed tomography (CT) and MRI demonstrated multiple mass lesions in the whole brain. Following the systemic chemotherapy, removal of the largest tumor was performed. Histological examination proved all excised tumors to be oligodendroglioma without evidence of malignant change.

Silicone rubber microangiography of injured acute spinal cord after treatment with methylprednisolone and vitamin E in rats.

STUDY DESIGN: An experimental study of changes in the microvasculature of the injured spinal cord that occur with methylprednisolone and vitamin E treatment. OBJECTIVE: To determine the effect of treatment with the methylprednisolone and vitamin E on the microvasculature of the traumatized spinal cord. SUMMARY OF BACKGROUND DATA: Silicon rubber microangiography provided an excellent three-dimensional method for defining the distribution of vasculature in untreated and treated rats after injury. Therefore, silicone rubber microangiography was helpful for elucidating the pathophysiology of posttraumatic ischemia and hemorrhages in the spinal cord. METHODS: In this study, 30 adult rats underwent laminectomy between C7 and T2 followed by extradural spinal cord clipping to produce the compression injury. A control group of 10 rats was left untreated, and 10 rats were treated with methylprednisolone (30 mg/kg bolus and 5.4 mg per hour for 24 hours). Another 10 rats were treated with methylprednisolone and vitamin E (100 U/kg per day). The animals were killed 4, 24, or 48 hours after injury. Silicon rubber microangiography was performed after injury to assess the vasculature of rats' spinal cord. Spinal cord injury causes rapid elevation of noradrenalin, adrenaline, and dopamine. Venous blood samples were taken from all animals before the silicone rubber microangiography was performed. RESULTS: The compression of the spinal cord followed by postinjury treatment with the methylprednisolone and combination methylprednisolone and vitamin E resulted in a ischemic area smaller than that in the untreated group. Adrenaline, noradrenalin, and dopamine levels were less than those in the untreated group. CONCLUSIONS: Findings showed that the addition of vitamin E to the methylprednisolone treatment made no difference in the extent of the ischemic area as compared with methylprednisolone treatment given alone. However, the statistical analysis did not show a significant difference between the treated and untreated groups.

Methylprednisolone and vitamin E therapy in perinatal hypoxic-ischemic brain damage in rats.

To study the efficacy of methylprednisolone/vitamin E in reducing cerebral edema and improving the ultimate neuropathological outcome in perinatal cerebral hypoxia-ischemia, 40 seven-day postnatal rats were subjected to right common carotid artery ligation followed by exposure to 8% oxygen at 37 degrees C for 3 h. The animals were divided into groups. Twenty rat pups received an intraperitoneal injection of 30 mg/kg body weight methylprednisolone and vitamin E (100 U/kg) immediately following cerebral hypoxia-ischemia. Control animals received either no therapy (n = 10) or an equivalent volume of normal saline (n = 10). After 72 h of recovery from hypoxia-ischemia, the animals were killed and their brains were examined to measure the water contents in the right and left hemispheres (29 rat pups), whereas the others were killed at 21 days for neuropathological examination. Methylprednisolone/vitamin E-treated rats had significantly less water content in the right hemisphere (87.08 +/- 0.28%, mean +/- S.E.M.) than saline-treated animals (89.07 +/- 0.37%, mean +/- S.E.M., P < 0.0001). Methylprednisolone/vitamin E significantly reduced water content in the right hemisphere of the brain. Neuropathological study was performed on nine rat pups. The brains of four methylprednisolone/vitamin E- and five saline-treated pups were examined at the end of the 21-day recovery period. Two groups of the right cerebral cortex included thinning of the cortex. Significantly less damage was seen in the methylprednisolone/vitamin E-treated pups. Our study suggests that trials of methylprednisolone/vitamin E might be effective if they are given to the mother at risk of fetal hypoxia during labor or to the hypoxic infant right after delivery in preventing hypoxic brain damage.

Microangiographic changes following cerebral contusion in rats.

The purpose of this study was to investigate the acute changes due to cerebral contusion in the large vessels and microvasculature in the rat. Thirty adult Sprague-Dawley rats underwent craniectomy performed in the left parietal region, producing a burr hole approximately 8-12 mm in diameter. The dura was left intact and a solid glass rod with a base diameter of 6 mm and weighing 5.2 g was dropped on the brain. Silicone rubber perfusion was performed at 24 h (10 rats) and 48 h (10 rats). Ten rats served as normal controls. The perfused brains were cleared using the alcohol-methylsalicylate technique. The results showed that the arterial and venous systems were clearly visualized by silicone rubber microangiography in the normal rat. Silicone rubber microangiography provided an excellent three-dimensional method for defining the distribution of the vasculature of the normal and contusioned rat brain, and was helpful in elucidating the pathophysiology of post-traumatic ischemia and hemorrhages of the brain. The brain displayed marked ischemia and hemorrhage at the contusion site. The hemorrhages were distributed throughout regions of white and gray matter at the injury site. All contusioned animals of those superficial arteries were irregularly filled or unfilled. The present study suggests that the pathogenesis of the post-traumatic brain may be related to damage of the superficial arteries and their arterial branches. Comparison of the brains from animals killed at 24 and 48 h following contusion revealed that the contusion was more severe 24 h after the vascular damage than after 48 h. Therefore, in the brains that were killed at 48 h, the contusion site was less avascular than those at the earlier times.

Outcome analyses in 1072 surgically treated lumbar disc herniations.

This article reports the outcomes of 1072 consecutive patients surgically treated during a ten-year period. There are many new techniques for the treatment for lumbar disc hernia, but also the conventional standard discectomy procedure is still the most acceptable method today. 1072 consecutive, non-randomized patients with lumbar disc herniation were reviewed for a clinical retrospective study about the surgical outcome according to our functional grading system. The patients reported ruptured disc to be due to lifting (30.13%), trauma (9.42%), and sports (8.11%). Almost all patients had complained of radicular pain in a dermatomal distribution (90.39%) and 86.07% had low-back pain, 5.2% of the patients had complications. Eighty-five patients (7.92%) had a second lumbar disc operation. Thirty of these eighty-five patients underwent the operation at the same level. Patients were also rated to improve the ability. Almost 91% of the patients had excellent, good, and satisfactory outcome; 9% of patients had moderate and poor categories of outcome. Several conclusions can be drawn from this large series of patients who were operated for lumbar disc herniation. 1. Most patients had good-to-excellent surgical outcomes after lumbar discectomy. 2. The results of disc surgery depend not only upon operative technique and skill, the degree of neurological impairment but also upon the correct selection of cases.

Cervical spine injuries and management: experience with 235 patients in 10 years.

During the past 10-year period 235 patients with cervical injury were included in this study. In this paper we present our clinical experiences in patients with cervical spine injury treated surgically and conservatively and their outcome. Only few data exist on the treatment of cervical spine injuries. The principles of the management are still controversial. The 235 patients with cervical spine injury admitted to our department were assessed with Frankel's grading scale and treated surgically and conservatively according to the type and level of the injury; 172 patients were treated surgically, and 63 patients were managed conservatively. The neurological state of the patients and the treatment modality are summarized in Table 1 and Table 2. In the upper cervical injury, except type II odontoid fracture with a dislocation of more than 6 mm, conservative treatment modalities were performed. In the lower cervical injury, an anterior approach with discectomy and anterior fusion were performed if there was spinal cord compression anteriorly. Otherwise a posterior approach with decompression and a variety of posterior fusion techniques were used.

The tanycytic ependymoma of the lateral ventricle: case report.

The tanycytic ependymoma is an extremely rare, primitive neuroectodermal tumor, arising from the ependymoglial cells or tanycytes. Such cells are generally seen in the primitive nervous system instead of the mature ependymal cells. The tanycytic ependymoma described in this report was found in a 42-year-old man. Histological analysis strongly suggested that this tumor originated from a primitive progenitor cell, the ependymoglia or the tanycyte in the lateral ventricle.

Presentation and management of supratentorial and infratentorial arachnoid cysts. Review of 25 cases.

BACKGROUND: To discuss the presentation, diagnosis, management modalities and outcomes of the arachnoid cysts. EXPERIMENTAL DESIGN: Retrospective study with a mean follow-up period of 31 months (ranging between 9 months and 5 years). SETTING: Institutional practice (The Military Medical Faculty Hospital). Patients and the participants: 25 patients with arachnoid cysts treated surgically. INTERVENTION: Fenestration and drainage of the cyst into cisterns in 13 cases, cyst-peritoneal shunting in 8 cases and cyst excision in 4 cases. MEASURE: The arachnoid cysts were followed-up by Computed Tomography or/and Magnetic Resonance Imaging. RESULTS: The results are excellent in 21 cases, moderate in 2 cases and poor in 2 cases. CONCLUSIONS: Regardless of the procedure used for arachnoid cyst treatment, the outcomes are somewhat similar if the surgical indications and techniques are properly selected.

Nerve entrapment by a firmly wrapped Baker cyst.

Baker's cysts as a clinical entity are among the most infrequent cause of peripheral nerve entrapment and usually produce a strong positive pressure within the knee resulting in the rupture of the joint capsule. An unusual case with muscular and sensorial weakness due to compression of the peroneal nerve around the fibular head by a Baker cyst is presented in this article. Clinical and electromyographical findings shown peroneal nerve entrapments in the popliteal fossa. Peroneal nerve decompression by synevectomy resulted in clinical and electromyographical improvement.

Radical surgery and reoperation in supratentorial malignant glial tumors.

The treatment modalities for gliomas are still questioning and searching. We reviewed the effect of the extent of surgical resection and reoperation on the length and quality of survival in 152 consecutive patients who underwent operation for supratentorial gliomas at GATA Neurosurgery clinic between 1985 to 1995. Seventy-two patients (50%) had glioblastoma multiforme (GBM), and 48 patients (33%) had anaplastic astrocytoma (AA). Gross total resection was achieved in 70 cases (49%), subtotal resection was performed in 60 cases (42%), and biopsy was carried out in 14 cases (9%). Thirty-two patients were reoperated for recurrency and the median interval between the first operation and reoperation was 9.5 months in glioblastoma multiforme, and 11.7 months in anaplastic astrocytoma. The resection groups were compared for age, sex, preoperative and postoperative Karnofsky rating, tumor location, postoperative radiation therapy, and chemotherapy, and survival according to multivariate analysis. Preoperative Karnofsky rating and surgical resection type were the most important factors related to survival after operation or reoperation. The gross total resection group lived longer than the subtotal resection group by life table analysis. Median survival of GBM was 76 weeks in gross total resection group, and 33 months in AA group with total resection (p < 0.001). Preoperative Karnofsky scores had a statistically significant effect on the quality of life and survival after operation and reoperation in all cases (p = 0.005). Radical surgery and reoperation also improve quality and length of life in selective malignant supratentorial gliomas.