Hemorrhagic presentation of previously silent brain tumors / Presentación hemorrágica de tumores cerebrales anteriormente silenciosos

Introduction and objectives Acute presentation with intracranial hemorrhage owing to a previously silent brain tumor (BT) is rare. Although any BT can bleed, the frequency and type of bleeding varies across tumor types. Materials and methods We aimed to retrospectively review our experience with 55 patients with BTs presenting with ICH. Results Signs of increased intracranial pressure were the most common symptoms. The temporal lobe was the most common lesion site (n=22). Hemorrhages were mainly confined to the tumor margins (HCTs) (n=34). Extensive intraparenchymal hemorrhages (EIHs) were mainly associated with moderately/severely decreased levels of consciousness (LOCs) (n=15/16). High-grade glioma (HGGT) (n=25) was the leading pathological diagnosis followed by metastasis (MBT) (n=16/55). The hemorrhage type was associated with the pathological diagnosis of the tumor. Patients with HGGT (n=19/25) and MBT (n=9/16) mainly presented with HCTs, whereas low-grade gliomas (LGGT) primarily caused EIHs (n=6/7). Conclusions Hemorrhagic presentation is a rare occurrence in BTs. Among all, MBT and HGGT are responsible for majority of the cases. Importantly, despite their relatively benign characteristics, LGGTs mainly result in extensive parenchymal destruction once they bleed. Maximum surgical resection of hemorrhagic BTs and decompression of the affected brain regions followed by histological confirmation of the diagnosis should be the main goals of treatment in cases with hemorrhagic BTs (AU)

Introducción y objetivos La presentación aguda con hemorragia intracraneal debida a un tumor cerebral (BT) anteriormente silencioso es rara. A pesar de que cualquier BT puede sangrar, la frecuencia y el tipo de sangrado varían según el tipo de tumor. Materiales y métodos Nuestro objetivo fue reexaminar retrospectivamente nuestra experiencia con 55 pacientes con los BT que presentaban HIC. Resultados Los síntomas más comunes fueron signos de aumento de la presión intracraneal. El lóbulo temporal fue el sitio de lesión más común (n=22). Las hemorragias se limitaron especialmente a los márgenes tumorales (HCT) (n=34). Las hemorragias intraparenquimatosas extensas (HIE) se asociaron mayormente con niveles de conciencia moderada/severamente disminuidos (LOC) (n=15/16). El glioma de alto grado (HGGT) (n=25) fue el principal diagnóstico patológico después de la metástasis (MBT) (n=16/55). El tipo de hemorragia se asoció con el diagnóstico patológico del tumor. Los pacientes con HGGT (n=19/25) y MBT (n=9/16) presentaron mayormente con HCT, mientras que los gliomas de bajo grado (LGGT) causaron principalmente HIE (n=6/7). Conclusiones La presentación hemorrágica es una ocurrencia rara en los BT. Entre todos, MBT y HGGT son responsables de la mayoría de los casos. Más importante aún, pese a sus características relativamente benignas, los LGGT resultan mayormente una destrucción extensa del parénquima una vez que sangran. La resección quirúrgica máxima de BT hemorrágicos y la descompresión de las regiones cerebrales afectadas con la confirmación histológica del diagnóstico deben ser los objetivos principales del tratamiento en casos con BT hemorrágicos (AU)

Hemorrhagic presentation of previously silent brain tumors.

INTRODUCTION AND OBJECTIVES: Acute presentation with intracranial hemorrhage owing to a previously silent brain tumor (BT) is rare. Although any BT can bleed, the frequency and type of bleeding varies across tumor types. MATERIALS AND METHODS: We aimed to retrospectively review our experience with 55 patients with BTs presenting with ICH. RESULTS: Signs of increased intracranial pressure were the most common symptoms. The temporal lobe was the most common lesion site (n=22). Hemorrhages were mainly confined to the tumor margins (HCTs) (n=34). Extensive intraparenchymal hemorrhages (EIHs) were mainly associated with moderately/severely decreased levels of consciousness (LOCs) (n=15/16). High-grade glioma (HGGT) (n=25) was the leading pathological diagnosis followed by metastasis (MBT) (n=16/55). The hemorrhage type was associated with the pathological diagnosis of the tumor. Patients with HGGT (n=19/25) and MBT (n=9/16) mainly presented with HCTs, whereas low-grade gliomas (LGGT) primarily caused EIHs (n=6/7). CONCLUSIONS: Hemorrhagic presentation is a rare occurrence in BTs. Among all, MBT and HGGT are responsible for majority of the cases. Importantly, despite their relatively benign characteristics, LGGTs mainly result in extensive parenchymal destruction once they bleed. Maximum surgical resection of hemorrhagic BTs and decompression of the affected brain regions followed by histological confirmation of the diagnosis should be the main goals of treatment in cases with hemorrhagic BTs.

Can The Fracture Line of Type II Odontoid Fractures Come to A Neutral Position After Anterior Odontoid Screw Fixation without a Manipulation?

AIM: To examine whether there was an improvement in the displaced fracture line in the follow-up, in which Anterior odontoid screw fixation (AOSF) was performed without manipulation and to determine the "displacement angle range" in which AOSF was possible. MATERIAL AND METHODS: A total of 11 patients with the diagnosis of type II odontoid fracture who underwent AOSF without manipulation were analyzed retrospectively. A control group of 30 cases was formed and odontoid related angle measurements were performed on cervical computed tomographies (CT) of the control group and the patients who were operated. RESULTS: In 6 of 7 cases in the posterior-displaced group along with all cases in the anterior-displaced group, it was determined that the displacement angles returned to the normal range in the 1st year follow-up. In 1 case having posterior displacement with posterior longitudinal ligament (PLL) damage, it was observed that the displacement angle improved to the normal range significantly, but the displacement continued. CONCLUSION: AOSF is a minimally invasive, safe and effective method in patients with displaced type II odontoid fracture, which is between the median odontoidobasal angle range of 100°-134°, whose PLL is preserved, and which cannot be manipulated.

Variations of perforating arteries of anterior communicating artery in cases with anterior communicating artery aneurysms: a cadaveric anatomical study.

PURPOSE: In terms of postoperative morbidity and mortality, preservation of the perforating arteries branching from the anterior communicating artery (ACoA) during clipping is particularly imperative in patients with ACoA aneurysm. In the present study, we aimed to investigate whether perforating arteries originated from ACoA were pushed away in a different location in patients with ACoA aneurysm. Furthermore, if they did so, we aimed to identify the direction in which they were dislocated and how the perforating arteries could be preserved during clipping. METHODS: Herein, we categorized 40 brains obtained from cadavers into two groups. The first (n = 26) and second (n = 14) groups included cases without and with ACoA aneurysms, respectively. After completing the preparation procedure, the brains were dissected using surgical microscope and the relevant anatomical region was examined and photographed. Finally, statistical analyses were performed on the data and the results were documented. RESULTS: In the aneurysms with posterior and superior projections, the perforators appeared to be pushed away inferiorly and were frequently noted at the anteroinferior part of the aneurysm neck. Most of the cases, where one of the A1s was larger at one side, the perforating arteries arose from the larger A1 side. CONCLUSION: The mortality and morbidity associated with damage to the perforators can be reduced by approaching the patient from the dominant A1 side and pursuing the perforators primarily at the anteroinferior part of the aneurysm neck in the aneurysms with superior and posterior projections.

The Efficacy and Safety of Microvascular Decompression for Hemifacial Spasm: A Retrospective Analysis of Surgical Outcomes and Complications.

AIM: To determine the efficacy and safety of microvascular decompression (MVD) for hemifacial spasm (HFS) by retrospectively reviewing our results. MATERIAL AND METHODS: A total of 55 patients who underwent MVD in our clinic between 2003 and 2017 were retrospectively analyzed. Clinical outcome results, recurrence rates, and surgical complications were noted. RESULTS: Thirty-six patients were female (65%). The mean age of the patients was 51.3 years. The mean duration of the complaint was 46.4 months. In 45 patients (82%), HFS was completely resolved within the first 6 months after the surgery. Five patients (9%) with recurrent symptoms were reoperated within the first year of the surgery. HFS symptoms of five patients (9%) completely ceased initially, but started again and reoperation was required due to failure of alternative treatments. Delayed facial nerve palsy and hearing loss were noted in one patient for each (2%). Cerebrospinal fluid leak was observed in two patients (4%). No mortality was observed in this series. CONCLUSION: MVD is a safe and effective option for patients with HFS that is resistant to medical treatment.

Nuances to provide ideas for radiologic diagnosis in primary spinal paragangliomas: report of two cases.

Spinal paragangliomas are rarely-observed neuroendocrine benign tumors in the extra-adrenal paraganglionic system. Primary spinal involvement is even rarer. Radiologic differential diagnosis is not easy. This paper presents 2 lumbar paraganglioma cases and focuses on nuances to provide ideas for radiological differential diagnosis.

Spinal epidural cavernous hemangioma: case report.

Pure epidural cavernous hemangiomas are quite rare. In this paper, a case of lumbar epidural cavernous hemangioma presenting as a lumbar radiculopathy is presented. The magnetic resonance imaging findings, differential diagnosis and therapy options of this rare case are discussed.

Preemptive wound infiltration in lumbar laminectomy for postoperative pain: comparison of bupivacaine and levobupivacaine.

AIM: Patients usually suffer significant pain after lumbar laminectomy. Wound infiltration with local anesthetics is a useful method for postoperative pain control. Our aim was to compare the efficacies of preemptive wound infiltration with bupivacaine and levobupivacaine. MATERIAL AND METHODS: 60 patients were randomized three groups as follows: Group L wound infiltration with 20 mL 0.25% levobupivacaine and 40 mg methylprednisolone just before wound closure; Group B wound infiltration with 20 mL 0.25% bupivacaine and 40 mg methylprednisolone before closure; Group C had this region infiltrated with 20 ml physiological saline. Demographic data, vital signs, postoperative pain scores and morphine usage were recorded. RESULTS: First analgesic requirement time was significantly shorter in the control group compared to other two groups (p < 0.001). Group B had the lowest cumulative morphine consumption at the end of 24 hours within 0-4, 4-12 and 12-24 hours time intervals and the values were not significant when compared with Group L, however the consumption of both groups was significantly lower compared to the control group (p < 0.001). CONCLUSION: Our data suggest that preoperative infiltration of the wound site with bupivacaine or levobupivacaine provides similarly effective pain control with reduced opiate dose after unilateral lumbar laminectomy.

The artery of Percheron revisited: a cadaveric anatomical study.

BACKGROUND: The artery of Percheron (AOP) is a single thalamoperforating arterial trunk that provides bilateral supply to the paramedian thalami and the rostral midbrain. As this rare anatomical variant artery may be involved in endovascular procedures or encountered surgically during basilar terminus aneurysms, the present study was warranted. METHOD: Thirty-four adult (20 male and 14 female) formalin-fixed cadaveric brains underwent dissection of the 68 posterior cerebral arteries. Observations were made of the presence and the variations of the thalamoperforating arteries as well as the presence of the AOP. FINDINGS: Thalamoperforating arteries arose from the superior or posterior surfaces of the P1 segment at a mean of a 1.87 mm (range, 0.39-5.25 mm) distance from the basilar apex and entered the brain through the posterior perforated substance. The average number was 4.25 (range 1-9), and the mean diameter was 0.73 mm (range 0.46-1.16 mm). Thalamoperforating arteries were classified into four different types according to their origin at the P1 segment: type I (bilateral multiple, n = 19), 55.8 %; type II (unilateral multiple, unilateral single, n = 4), 11.7 %; type III (bilateral single, n = 7), 20.5 %; type IV [one side with a single branch, the other side with no branches (the AOP), n = 4], 11.7 %. In three separate specimens with ruptured basilar artery aneurysms, the origin of the thalamoperforating arteries was incorporated not only into the posterior aspect of the aneurysm neck but also into the fundus. CONCLUSIONS: In about one tenth of cases the possibility of the presence of a single arterial trunk that supplies the two paramedian thalamic territories should be taken into consideration during treatment planning of basilar terminus aneurysms. Furthermore, our data show that the thalamoperforating arteries may take off from both the aneurysm neck and the fundus.

Metastatic gliosarcoma mass extension to a donor fascia lata graft harvest site by tumor cell contamination.

BACKGROUND: Brain glioblastoma multiforme is a malignant and highly aggressive entity that rarely shows extracranial and extraneural invasion. In the past 70 years, only eight cases of subcutaneous metastases have been reported. CASE DESCRIPTION: A case of glioblastoma multiforme with extensive local cutaneous and subcutaneous involvement of previous surgical sites and a metastatic mass, which had developed in the graft donor area of the tensor fascia lata tendon used for the reconstruction of dura. According to the excisional biopsy results, the developed mass was defined as a gliosarcoma carrying the exact characteristics of the primary tumor. CONCLUSIONS: Contaminated surgical tools and instruments can facilitate the distant spread of tumor cells. Therefore, the renewal of the surgical tools and instruments and irrigation of the surgical area after primary tumor resection is emphasized.