Recurrent Osteoma Overlying a Methylmethacrylate Bone Cement Cranioplasty: A Rare Case.

Osteomas are generally benign tumors of the skull that affect all age groups and are diagnosed in the fourth or fifth decade of life, and are rare in childhood. Surgical resection is curative and malignant transformation is very rare. A 12-yearboy who had undergone a craniotomy for resection of a parietal osteoma four years ago, followed by a cranioplasty with methylmethacrylate bone cement, presented to our clinic with an expanding mass overlying the cranioplasty. Upon reoperation, the mass was totally excised, and the parietal cranial defect was repaired using methylmethacrylate bone cement. On histologic examination, the mass was found to be a recurrent osteoma overlying the methylmethacrylate bone cement. In this report, we discuss the etiologies of recurrence of osteoma and treatment options of these rare cases. We believe that this recurrence resulted from contamination of the surgical area and cranioplasty materials with osteoma material. Extensive washing of the cranioplasty materials and perioperative area may prevent recurrence of such tumors.

A Rare History: an Intracranial Nail Present for Over a Half-Century.

We present a rare case of a patient with a persistent headache for many years found to have an intracranial nail present for nearly 65 years. The nail was found entering approximately 1 cm from the midline on the left side, passing below the superior sagittal sinus, with the tip 1.5 mm right of the frontal horn of the lateral ventricle. Treatment strategies designed to optimize outcome for intracranial foreign bodies and possible complications are discussed in this report. We also discuss the decision for surgical intervention for foreign bodies and the relevance of position of the foreign body.

Local Tissue Electrical Resistances in Transpedicular Screw Application in the Thoracolumbar Region.

AIM: To determine local tissue electrical resistance differences generated during a screw pass from the pedicle to another tissue rather than determining all individual electrical tissue resistance values. MATERIAL AND METHODS: We attempted to measure electrical resistance values of regional tissues in addition to fluoroscopic imaging during application of fixation via a transpedicular screw. We also attempted to detect local tissue electrical resistance alterations in case of malposition of the screw inside the pedicle. For this purpose, local tissue electrical resistances of 10 transpedicular tracks opened with standard track openers bilaterally in 5 vertebrae, and of spinal cord accessed by puncturing the medial walls of three vertebrae in a cadaver were measured. These resistance differences were not only measured in human cadaveric tissue but also in 36 pedicles belonging to a total of 18 vertebrae between Th 1-S1 vertebrae of a sheep cadaver. Both medial and lateral walls were drilled to measure local tissue resistance differences in a sheep cadaver. RESULTS: Our results indicated that local tissue electrical resistance changes were statistically significant in both human and sheep cadaver. CONCLUSION: It is possible to prevent screw malposition using a simple and cheap electrical resistance measurement. Local tissue electrical resistance measurement during transpedicular screw insertion is a safe, simple, cheap, and practical method.

Primary spinal epidural Hodgkin's lymphoma.

Primary spinal epidural Hodgkin's lymphoma is very rare. We will discuss the clinical features and treatment of primary spinal epidural Hodgkin's lymphoma. In this paper, a 30-year-old male patient who presented with spinal epidural tumor at the T9-11 level is reported. Subtotal resection of the tumor was performed and the histological examination of the tumor specimen revealed Hodgkin's lymphoma. All other examinations were negative for an occult disease. Six courses of chemotheraphy containing adriamycin, bleomycin, vinblastine and dacarbazine were given to the patient. Surgery is the first therapeutic approach in malignancies compressing the spinal cord. Hodgkin's lymphoma is a very chemo- and radio-sensitive tumor. The indications for surgery were reduced and limited to laminectomy or even biopsy only, leaving the major role to chemo- and radiotheraphy.

Effects of Levetiracetam on neural tube development and closure of the chick embryos in ovo.

PURPOSE: Effects of Levetiracetam (LEV) within its therapeutic range at a 50 mg/kg dose for the chick embryo in ovo has been studied in order to demonstrate whether LEV would effect neural tube closure at the macroscopic morphology or LEV administered embryos still encounter neuroglial detrimental effects at the histological level. METHODS: Embryos were randomly seperated into control (n = 20) and study (n = 20) groups. The eggshell was windowed at specifically 24 h of incubation, and area underlying the membrane was excised to allow injection with 4.5 µl LEV in the study group, while physiologic saline (0.045 ml) were injected in the control group and each egg were re-incubated for 48 h more. Then, histological and immunohistochemical evaluation of the subjects were done. RESULTS: Macroscopic evaluation revealed immaturity of the placental vessel network in number and width for the study group in comparison to the controls. Defects of migration, decrease in the crista neuralis content, delay of the basal plates structures in the formation of the usual configuration, and delay in the cellular proliferation and the delay of development for the central nervous system were determined in the LEV-exposed group. Immunostaining of S100 proteins in this study has clearly demonstrated increased expression patterns of both neuroglial and neuronal cell populations. Toluidine blue stainings revealed mostly bipolar, differentiating neurons and crista neuralis cells which is concordant with active migration and differentiation. CONCLUSIONS: LEV found that delay in the closure of the neural tube and microcephalic fetuses disturb further morphological, biochemical, and functional development.

Can using a peel-away sheath in shunt implantation prevent ventricular catheter obstruction?

PURPOSE: Shunt obstruction is the most common shunt complication. In 2003, Kehler et al. used peel-away sheath while implanting the ventricular catheter in 20 patients. They found less revision rate in the peel-away sheath group. We aimed to test the efficacy of this technique in cadavers. METHODS: We used 100 fresh brains obtained from medicolegal autopsies. Posterior parietal and frontal approaches were used to puncture the lateral ventricle in each cerebral hemisphere. The ventricle is punctured with a peel-away sheath system. After the ventricle is reached, the mandarin is retracted and the ventricular catheter is introduced through the opening. The ventricular catheter was removed from the ventricle, the opening at the tip of the ventricular catheter was checked out for obstruction, and the number of patent and plugged openings was recorded. This procedure was repeated four times for each location with and without using peel-away sheath. The control group consisted of the procedures done without using peel-away sheath. RESULTS: The number of the plugged openings in the peel-away sheath group was significantly smaller than the control group. There was no significant difference between the two groups in terms of gender and left and right cerebral hemispheres. The obstruction rate was significantly lower in the posterior parietal approach. Pearson's correlation showed that increasing age was associated with less obstruction rate. CONCLUSION: Peel-away sheath decreases the number of plugged openings of the ventricular catheter. A clinical cooperative study is needed to prove that a peel-away sheath should be included in the ventricular shunt systems in the market.

Atypic geniculate neuralgia: atypic anatomic correlation of cranial nerve roots and AICA.

Geniculate neuralgia is a rare cause of craniofacial pains. The anterior inferior cerebellar artery is the offending vessel which compress nervus intermedius in the patients with typical geniculate neuralgia. We report a patient whose pain was atypical for either geniculate neuralgia and trigeminal neuralgia. At operation the anterior inferior cerebellar artery was coursing with the nerves and was separated. After the decompression the pain resolved immediately.

Can midline brain shift be used as a prognostic factor to predict postoperative restoration of consciousness in patients with chronic subdural hematoma?

BACKGROUND AND PURPOSE: Our aim was to determine if midline brain shift could be used as a prognostic factor to predict postoperative restoration of consciousness in patients with CSDH. In these patients, we evaluated the relation (1) between midline brain shift as measured on CT and alteration of level of consciousness, and (2) between midline brain shift and restoration of consciousness after the operation. METHODS: Prospectively recorded data of 45 patients with CSDH were evaluated. We compared level of consciousness of patients measured by GCS score, brain displacement at PG and SP both in the preoperative and early postoperative period. RESULTS: Preoperatively, PG and SP shifts of the patients who were alert (GCS = 15) were significantly less than those of patients who had diminished consciousness. However, in patients with diminished consciousness (GCS < 15), the amount of lateral brain displacement and the degree of diminution of consciousness did not correlate. Those patients who had a preoperative SP shift of less than 10 mm had a significantly lesser chance to become alert after operation (2 of 5 patients) when compared with those patients who had a preoperative SP shift of 10 mm or more (21 of 23 patients). CONCLUSIONS: We conclude that preoperative SP shift may be used as a factor to predict restoration of consciousness in patients with CSDH; the likelihood of becoming alert after operation is increased if SP shift is 10 mm or greater, and is decreased if SP shift is less than 10 mm.

Depressed fractures over cranial venous sinus.

Seventeen patients with depressed fractures over cranial venous sinus who had undergone operations between 1993 and 1998 were reviewed retrospectively. There were 15 male and two female patients. Their ages ranged from 7 to 48 years. The most frequent causes of trauma were motor vehicle accident (in eight cases) followed by assault (in six cases). In the majority of cases, depressed fractures were localized over the superior sagittal sinus, and half of them were over the medial third of the sinus. In 11 cases, massive blood loss occurred intraoperatively that could be controlled by digital pressure with gelfoam or with a free muscle flap. Postoperative infection developed in one case and was treated successfully with antibiotic medication alone. Two patients died due to associated intracerebral lesions. The remaining 15 patients returned to daily living activity in the follow-up period.