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Although rarely reported in the literature, serious occipital and condylar fractures have been diagnosed more often with the widespread use of computed cranial tomography in traumas. In this paper, a 16-year-old female with a left occipital fracture extending from the left occipital condyle anterior of the hypoglossal canal to the inferior part of the clivus is presented. The fracture which had caused a neurological deficit was cured with conservative treatment. For delayed hypoglossal nerve paralysis due to swelling within the canal, methylprednisolone was started, and a complete cure was attained in about 10 days. Traumatic damage of bony structures of the condyle and clivus at the junction of many vital nerves, vessels, and ligaments may lead to traumatic deficit and death.
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Fossa Craniana Posterior/lesões , Osso Occipital/lesões , Traumatismos do Sistema Nervoso/complicações , Adolescente , Anti-Inflamatórios/uso terapêutico , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Traumatismos do Nervo Hipoglosso/etiologia , Metilprednisolona/uso terapêutico , Osso Occipital/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Traumatismos do Sistema Nervoso/diagnóstico por imagemRESUMO
Holoprosencephaly is a rare congenital malformation resulting from an impaired midline division of the prosencephalon into distinct cerebral hemispheres. Hydrocephalus is a frequent problem among the few survivors with alobar holoprosencephaly (aHPE), its most severe form. The literature about neurosurgical management of hydrocephalus in this condition is limited and dispersed, and there are still some points that need to be resolved. We report the case of a newborn with aHPE, hydrocephalus, and central diabetes insipidus. We delineate the complexity of the management of these patients and emphasize the benefits of using an initial programmable shunt valve. Further discussion about management strategies includes reviewing previous reports and the benefits of shunting for hypothalamic osmoreceptor function.
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Holoprosencefalia/complicações , Holoprosencefalia/diagnóstico , Hidrocefalia/diagnóstico , Hidrocefalia/cirurgia , Crânio/cirurgia , Diabetes Insípido/diagnóstico , Diabetes Insípido/genética , Holoprosencefalia/genética , Humanos , Hidrocefalia/etiologia , Recém-Nascido , Imageamento por Ressonância Magnética , Crânio/anormalidades , Derivação VentriculoperitonealRESUMO
OBJECTIVE: This study evaluates the predisposing factors and outcomes of surgical management of encephaloceles at our institution. MATERIALS AND METHODS: A retrospective analysis of 32 occipital encephaloceles managed operatively at the Neurosurgery Department Clinics of the Faculty of Medicine, Adiyaman University, was performed between 2011 and 2015. RESULTS: Among the study population, 19 mothers had been exposed to TORCH infections (toxoplasma, rubella, cytomegalovirus, herpes simplex virus), 18 were in consanguineous marriages, and 3 had regular prenatal screening. Associated congenital anomalies were common. Eight infants required reoperation, and 9 died during follow-up. CONCLUSIONS: The study identified key areas for prevention. Knowledge of the intracranial and associated anomalies can guide management.
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Consanguinidade , Encefalocele/etiologia , Encefalocele/cirurgia , Doenças do Recém-Nascido , Diagnóstico Pré-Natal/estatística & dados numéricos , Encefalocele/mortalidade , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Turquia , Adulto JovemRESUMO
OBJECTIVE/AIM: The aim of this report was to investigate the effect of ventriculoperitoneal shunt insertion for the treatment of hydrocephalus on thyroid hormones in the first 3 months of life. METHODS: Thyroid-stimulating hormone (TSH), free T3 (fT3), and free T4 (fT4) levels were compared at 7 days (preoperatively) and at 30 and 90 days (postoperatively) after birth between 25 ventriculoperitoneal shunt-inserted hydrocephalic newborns and 20 healthy newborns. RESULTS: The TSH level at 7 days was higher in the hydrocephalic patient group (6.33 µIU) compared to the control group (3.76 µIU). This value was significantly decreased at 90 days in the ventriculoperitoneal shunt-inserted newborns (2.35 µIU) compared to the control group (3.33 µIU; p < 0.05). There were no significant differences between time points for fT4 and fT3 values in the patient group or for TSH, fT4, and fT3 values in the control group. CONCLUSION: We propose that a ventriculoperitoneal shunt inserted in the early period of life may have beneficial effects on thyroid hormones.
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Hidrocefalia/sangue , Hidrocefalia/cirurgia , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina/sangue , Derivação Ventriculoperitoneal/tendências , Feminino , Seguimentos , Humanos , Hidrocefalia/diagnóstico , Lactente , Recém-Nascido , Masculino , Hormônios Tireóideos/sangueRESUMO
BACKGROUND: This study aimed to investigate the protective effect of tacrolimus (FK506), an immunosuppressive agent, on secondary brain damage in rats with experimental head trauma. METHODS: 40 Sprague-Dawley rats, aged 10-12 weeks and weighing 250-350 g, were used without gender selection. The subjects that were divided into five groups of 8 rats per group (sham control, negative control, positive control, vehicle control, and treatment) were sacrificed 1 month after head trauma was induced under appropriate conditions, their brains were then removed en bloc and evaluated histopathologically. Secondary brain injury was evaluated with the immunoreactive score (IRS) after Glial Fibrillary Acid Protein staining of gliosis that would occur in brain tissue. RESULTS: The evaluation of the histopathological IRS values of all groups showed significant statistical differences between all groups. The pairwise group comparison revealed the highest increase in IRS value in the treatment group (p<0.05), with no statistical significance despite the increase in the negative control, positive control, and vehicle control groups. The sham group had the lowest rate of severe histopathological reaction score. CONCLUSION: It was observed that the group treated with FK506 had a statistically significant increase in gliosis in the traumatic area compared to the other control groups. This shows that FK506 cannot prevent and even increase gliosis by a mechanism that has not yet been clarified. In conclusion, it is obvious that the FK506 immunosuppressive agent does not reduce post-traumatic brain injury; on the contrary, it increases gliosis.
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Lesões Encefálicas , Tacrolimo , Ratos , Animais , Tacrolimo/farmacologia , Tacrolimo/uso terapêutico , Ratos Sprague-Dawley , Gliose/tratamento farmacológico , Imunossupressores/uso terapêuticoRESUMO
BACKGROUND: The objective of the study was to investigate the changes in Glasgow Coma Scale (GCS) score, Fisher's grade, and World Federation of Neurological Surgeons (WFNS) grade that occur during transport of patients with aneurysmal subarachnoid hemorrhage (aSAH) from secondary hospitals to a tertiary care center. METHODS: Seventy-five patients with aSAH who were transported through ground ambulance from secondary hospitals to our tertiary care centers between December 1, 2016, and December 1, 2019, were enrolled in this retrospective study. Data regarding GCS, Fisher's grade, and WFNS grade from both hospitals, patient demographics, and duration and distance of transport were analyzed. RESULTS: The female-to-male ratio was 46: 29 and median patient age was 55.0 years. Median transport time was 3.0 h and median distance traveled was 161.0 kilometers. GCS significantly decreased (p=0.004) and Fisher and WFNS grade significantly increased during transport (p=0.003 and p=0.003, respectively). The change in the WFNS grade during transport, but not GCS score or Fisher's grade, was significantly different between non-intubated patients and intubated patients (p=0.036). CONCLUSION: Significant changes in Fisher's grade, GCS, and WFNS grade occurred during ground transport of patients with aSAH from secondary hospitals to tertiary care centers. These changes in the parameters may affect and change patients future prognoses.
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Hemorragia Subaracnóidea , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Hemorragia Subaracnóidea/complicações , Resultado do TratamentoRESUMO
AIM: To investigate the visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores after the removal of the instrumentation system in patients who underwent lumbar instrumentation for lumbar degenerative disease (LDD). MATERIAL AND METHODS: This study included 30 patients (19 female, 11 male) who had undergone posterior lumbar instrumentation for LDD in whom postoperative continuous or recurrent pain led to the removal of the implant system in our clinic between December 2013 and December 2019. The patients had continuous or recurrent low back pain that did not respond to medical treatment, physical therapy, or any type of lumbar block. Nine patients had continuous low back pain in the surgical area, while twenty-one had recurrent low back pain. RESULTS: There was a significant reduction in the number of admissions to the hospital (p < 0.001), and the daily number of analgesics used (p < 0.001) in six months after surgery compared to six months before surgery. There were significant decreases in VAS scores, both at the one-month (p < 0.001) and six-month (p < 0.001) postoperative assessments compared to preoperative measurements. ODI scores were significantly lower than the preoperative scores at both one-month (p < 0.001) and six-month (p < 0.001) postoperative score. CONCLUSION: Our study showed that the instrumentation system removal after fusion for patients with LDD may be beneficial since it alleviates pain and analgesic usage.
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Remoção de Dispositivo , Síndrome Pós-Laminectomia/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Idoso , Descompressão Cirúrgica/efeitos adversos , Feminino , Humanos , Dor Lombar/etiologia , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Próteses e Implantes/efeitos adversos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Alkaptonuria is a rare metabolic disease caused by deficiency of homogentisic acid oxidase and characterized by bluish-black discoloration of cartilages and skin (ochronosis). Defective production of this enzyme results in the accumulation of homogentisic acid (HGA), a tyrosine degradation product, in the bloodstream. Accumulation of HGA and its metabolites in tissues causes ochronosis. The word ochronosis refers to the dark bluish-black discoloration of connective tissues including the sclera, cornea, auricular cartilage, heart valves, articular cartilage, tendons, and ligaments. Neurogenic claudication resulting from focal hypertrophy of the ligamentum flavum in the lumbar spine due to ochronotic deposits has only been previously reported once in the literature. In this article, we present a 71-year-old male patient with alkaptonuria-associated degenerative L3-L4-L5 stenosis, diagnosed after lumbar decompressive laminectomy.
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Alcaptonúria/complicações , Ligamento Amarelo/patologia , Vértebras Lombares , Ocronose/etiologia , Idoso , Alcaptonúria/patologia , Humanos , Masculino , Ocronose/patologiaRESUMO
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause.
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AIM: To evaluate the effects of agomelatine on the biochemical and pathological features of cisplatin-induced peripheral neuropathy. MATERIAL AND METHODS: This study included a total of 30 male Wistar albino rats that weighed 285â"300 grams and were divided into three groups: healthy controls (HC, n=10); cisplatin group (CIS, n=10) and agomelatine plus cisplatin group (AC, n=10). The CIS group received only cisplatin (EbeweLiba, Turkey) at a dose of 2.5 mg/kg, whereas the AC group received both agomelatine (25 mg/kg, Les Laboratoires Servier, France) and cisplatin (2.5 mg/kg). The animals were sacrificed by thiopental anaesthesia (50 mg/ kg, IE Ulagay, Turkey) and sciatic nerves were dissected. The sciatic nerve tissue was analysed for the levels of malondialdehyde (MDA), myeloperoxidase (MPO), total glutathione (tGSH) and superoxide dismutase (SOD) and was examined histopathologically. RESULTS: The mean levels of MDA, MPO, tGSH and SOD were 34.90 ± 13.83, 41.30 ± 18.03, 15.40 ± 6.06 and 48.60 ± 18.19, respectively. MDA and MPO were significantly lower in the AC group than in the CIS group (p < 0.001 for both). However, the antioxidative parameters tGSH and SOD were significantly higher in the AC group than in the CIS group (p < 0.001 for both). Pathological examinations revealed swollen myelinated nerve fibres and evident myelin sheath degeneration in the CIS group; in the AC group, the myelin sheath degeneration was less and the blood vessels were normal. CONCLUSION: Agomelatine decreased the oxidative status in an experimental rat model of cisplatin-induced peripheral neuropathy. Myelin sheath degeneration was less in the AC group than in the CIS group. To our knowledge, this was the first study that showed the positive effects of agomelatine on cisplatin-induced neuropathy in rats.
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Acetamidas/uso terapêutico , Antineoplásicos/toxicidade , Antioxidantes/uso terapêutico , Cisplatino/toxicidade , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Acetamidas/farmacologia , Animais , Antioxidantes/farmacologia , Hipnóticos e Sedativos/farmacologia , Hipnóticos e Sedativos/uso terapêutico , Masculino , Estresse Oxidativo/efeitos dos fármacos , Estresse Oxidativo/fisiologia , Doenças do Sistema Nervoso Periférico/metabolismo , Ratos , Ratos Wistar , Nervo Isquiático/efeitos dos fármacos , Nervo Isquiático/metabolismoRESUMO
Steel rod impalements, mostly experienced by construction workers due to falls from heights, are known entities, but only some individuals unfortunately suffer spinal cord injury. The management of the spine involved injuries is challenging due to the lack of guidelines, various clinical presentations resulting from different trajectories, and high risk of infection. We report a case of steel rod impalement involving the spinal canal and review the literature to enhance the management strategies and to identify the risk factors for possible complications, particularly infection. A 37-year-old male construction worker presented to our emergency department due to falling onto a concrete reinforcing steel rod that penetrated through his perineum to the L4 vertebra. Examination revealed paralysis and sensory loss of the left foot. The rod was removed in the operating room (closed removal) under general anesthesia, followed by laparotomy. Rectal laceration was primarily repaired, and colostomy was performed. In a separate session, laminectomy was performed. At 3 months post-discharge, the patient was ambulatory with armrest based on the same motor examination performed on presentation This case is a good example of careful preoperative planning, multidisciplinary involvement, and appropriately sequenced interventions resulting in an acceptable outcome for an injury with high morbidity and mortality and demonstrates the feasibility and potential benefits of closed removal of the rod in an operating room just before laparotomy. The presence of an intestinal perforation increases the infection risk, but infections can still be prevented in this setting. Shorter time intervals between the incidence and surgery may reduce the infection rate.
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Acidentes por Quedas , Vértebras Lombares/lesões , Traumatismos da Medula Espinal/etiologia , Traumatismos da Coluna Vertebral/etiologia , Ferimentos Penetrantes/etiologia , Adulto , Colonografia Tomográfica Computadorizada , Colostomia , Humanos , Lacerações , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Períneo/lesões , Fatores de Risco , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Aço , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/cirurgiaRESUMO
Periosteal enchondromas located in the spine are rare. We reported an even more infrequent occurrence of a periosteal enchondroma in the cervical spine of a 19-year-old girl. During the operation, a giant (>8 cm × 5.5 cm × 5 cm) ossified periosteal enchondroma with involvement of posterior structures and muscles of the axis was resected. The pathological examination revealed that the tumor consisted of enchondroid tissue with typical chondrocytes, confirming the diagnosis of periosteal enchondroma. Early identification of the initial lesion should be coupled with total surgical resection, as a definitive treatment, to prevent malignant transformation. Enchondromas grow in an expanding manner which makes easy total resection.
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AIM: To evaluate postoperative clinical outcome and recurrence rates in cases with ventrally located spinal meningiomas who underwent Simpson grade 2 resection. MATERIAL AND METHODS: We evaluated eight cases (six females and two males; age, 28?86 years; mean age, 60 years) with ventrally located spinal meningioma that underwent surgical treatment in our clinic. The tumors were located in the thoracic region in seven cases and in the cervical region in one case. All cases underwent surgery, which was performed using a traditional posterior midline approach. Laminectomy was unilaterally extended. The case with cervically located tumor differed from the other cases in that a skull clamp was used and laminoplasty was performed. RESULTS: The tumor was completely resected in all cases. Furthermore, in all cases, the tumor nidus that caused the thickening of the dura was cauterized using bipolar cautery and peeled off (Simpson grade 2). The pathological examination of the tumor specimens revealed typical grade 1 meningioma in all cases (fibropsammomatous type, n=1; meningothelial type, n=3; and psammomatous type, n=4). Recurrence was not observed in any of the cases during the follow-up. None of the cases demonstrated postoperative neurological deterioration. At 1 month postoperatively, pain and motor deficit completely improved in all cases, with remarkable improvements of motor deficits in the early postoperative period. CONCLUSION: Simpson grade 2 resection in ventrally located spinal meningiomas results in low complication rates and is satisfactory in terms of recurrence.
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Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias da Medula Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Período Pós-OperatórioRESUMO
OBJECTIVE: Among the various neurosurgical techniques currently being used in chronic subdural hematoma (CSDH) surgery, bur hole craniostomy is the most popular worldwide. Recent studies have strongly recommended that a drain be placed after surgical evacuation of a hematoma, and a broad spectrum of preformed surgical drains is widely available for this purpose. If preformed drains are unavailable, a surgeon-made drain can be used and various methods are available to develop a drain in the operating room. METHODS: Using a case report, we demonstrate how to develop a surgeon-made drain. Next, we retrospectively screened for subdural drain usage in consecutive patients undergoing bur hole drainage for CSDH at Adiyaman University Hospital between January 2017 and April 2017, and data from only those patients in whom a surgeon-made drain was used were included for analyses. RESULTS: A 74-year-old male was operated with the diagnosis of CSDH. Assembly of a surgeon-made drain was explained step by step. Our review identified 6 unilateral and 2 bilateral cases in which 10 surgeon-made drains were used. Mean age of the patients was 72, and mean follow-up period was 7 months, 23 days. No instances of infection or drain-related complications had been recorded. The recurrence rate was 0%, and the average drainage period was 3.4 days. CONCLUSIONS: In case of unavailability of a preformed drain, a surgeon-made drain can be used during CSDH surgery. Different methods are available and can be further diversified using various combinations of simple medical materials.
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Drenagem/economia , Drenagem/instrumentação , Hematoma Subdural Crônico/cirurgia , Procedimentos Neurocirúrgicos/economia , Custos de Cuidados de Saúde , HumanosRESUMO
STUDY DESIGN: A multicenter retrospective study of patients who underwent unilateral and bilateral balloon kyphoplasty. OBJECTIVE: The aim of this study was to compare the radiographic and clinical results of unilateral and bilateral balloon kyphoplasty to treat osteoporotic vertebral compression fractures. SUMMARY OF BACKGROUND DATA: Percutaneous kyphoplasty has long been used as a successful method in the treatment of osteoporotic vertebral compression fractures. Although the bilateral approach is considered to be the mainstay application of percutaneous kyphoplasty, the unilateral approach has also been shown to be sufficient and even more effective in some cases. METHODS: A total of 87 patients who underwent percutaneous kyphoplasty due to osteoporotic vertebral compression fractures between 2009 and 2016 were retrospectively evaluated and divided into two groups as patients who underwent unilateral or bilateral percutaneous kyphoplasty. Unilateral percutaneous kyphoplasty was performed in 36 and bilateral percutaneous kyphoplasty in 51 patients. The groups were compared in terms of clinical outcomes, radiological findings, and complications. Clinical outcomes were evaluated using Visual Analogue Scale and Oswestry Disability Index and the radiological findings were evaluated by comparing the preoperative and postoperative day 1 and year 1 values of anterior, middle, and posterior vertebral heights and kyphosis angle. RESULTS: Clinical improvement occurred in both groups but no significant difference was observed. In radiological workup, no significant difference was found between the groups in terms of improvements in vertebral heights and kyphosis angle. Operative time and the amount of cement used for the surgery were significantly lower in the patients that underwent unilateral kyphoplasty. CONCLUSION: Unilateral percutaneous kyphoplasty is as effective as bilateral percutaneous kyphoplasty both radiologically and clinically. Operative time and the amount of cement used for the surgery are significantly lower in unilateral kyphoplasty, which may play a role in decreasing complication rates. LEVEL OF EVIDENCE: 3.
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Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Cifoplastia/tendências , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Medição da Dor/tendências , Estudos RetrospectivosRESUMO
AIM: To show causes of dural tear in isolated lumbar disc surgery, and to investigate the risk factors. MATERIAL AND METHODS: We retrospectively reviewed 1159 cases (532 females and 627 males) involving patients who underwent a surgery for the treatment of lumbar disc herniation between 2006 and 2013. We have analysed the side of the surgery, level of the operation, first or revision surgery, type of anesthesia and type of surgical procedure for the risk of dural tear. To examine differences between disc levels, we used Chi-square testing for categorical variables and the student's t test for continuous variables. To analyze our data, we used STATA version 12. A "p value" less than 0.05 was considered as statistically significant. RESULTS: A total of 1047 (90.3%) cases were treated with microdiscectomy, and 112 (9.7%) required open discectomy. Overall, 820 (70.7%) and 339 (29.3%) surgeries were performed under epidural and general anesthesia, respectively. Dural tear ratio was 1.20%. In dural tear ratio, there was a significant difference in gender (Female: 1.6%, Male: 0.79%) (p < 0.05). Dural tear ratios at primary disc surgery and at recurrent disc surgery were respectively 0.82% and 7.14% (p < 0.05). Most of the tears were on the right side (11/14) (p < 0.05). 13 dural tear cases (1.58%) were noted in patients who operated under epidural anesthesia (820 cases) compared to 1 (0.29%) under general anesthesia (339 cases) (p < 0.05). CONCLUSION: Recurrent disc surgery, female sex, epidural anesthesia, open discectomy, non-dominant hand usage of surgeon, and upper-level affected lumbar discs were risk factors for intraoperative dural tear during lumbar disc surgery.
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Discotomia/efeitos adversos , Dura-Máter/lesões , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Epidural , Anestesia Geral , Discotomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVES: Far lateral lumbar disc herniations (FLLDHs) can cause difficulty and differences in diagnosis and treatment compared with intraspinal herniation. We have aimed to analyze the efficacy of gabapentin as a noninvasive treatment of pain in patients with isolated FLLDH. METHODS: Thirteen patients with isolated FLLDH were evaluated for the study prospectively. All of the cases were diagnosed by lumbar magnetic resonance imaging. The previously prescribed medical therapy of the patients was not changed and gabapentin (3 × 600 mg/d) was added. For each patient, visual analog scale and Odom criteria were administered and recorded at 4 time points as follows: pretreatment and days 1, 7, and 30 posttreatment. Paired t test was used to examine scores of the cases before and after gabapentin treatment. Results were considered significant at P < 0.05, and 95% confidence interval was calculated. RESULTS: Mean visual analog scale score was 9.3 in the pretreatment period, and reduced to 5, 2.6, and 1.3 on posttreatment days 1, 7, and 30, respectively (P < 0.05). Mean Odom criteria score was 4 before gabapentin treatment. It decreased to 2.3 at posttreatment day 1 and 1.5 at day 7. At the end of 1 month, symptoms had resolved completely in all cases (P < 0.05). CONCLUSIONS: Gabapentin provided fast and effective relief of pain caused by FLLDH. We advise that the gabapentin should be kept in mind in the first-step medication of pain for such patients. Direct compression of the dorsal root ganglion or its distal part may be related to the intense pain-relief effect provided by gabapentin.
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Aminas/uso terapêutico , Analgésicos/uso terapêutico , Ácidos Cicloexanocarboxílicos/uso terapêutico , Deslocamento do Disco Intervertebral/complicações , Dor/tratamento farmacológico , Dor/etiologia , Resultado do Tratamento , Ácido gama-Aminobutírico/uso terapêutico , Adulto , Idoso , Feminino , Seguimentos , Gabapentina , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Medula Espinal/patologiaRESUMO
AIM: Lumbar disc surgery can be performed under general anesthesia or regional anesthesia methods. There are long-standing discussions between neurosurgeons, orthopedic surgeons and anesthesiologists concerning the use of epidural anesthesia in lumbar surgery. The results of this study's 700 lumbar disc surgery cases operated with epidural anesthesia in our clinic between September 2006 and December 2011 will contribute to these discussions. MATERIAL AND METHODS: This study included 700 patients underwent lumbar disc surgery with epidural anesthesia, which consisted of 388 males (55%) and 312 females (45%). Forty-two of these cases had recurrence disc herniation and only 11 of 42 cases were operated in our department. RESULTS: Eleven of 700 cases had dural injury and were repaired intraoperatively by primary sutures and tissue sealants. Infection of the incision site developed in six patients, who healed with appropriate antibiotic treatment with no problems. In addition to those 700 cases, 22 patients received general anesthesia in which we started with epidural anesthesia. Microdiscectomies were performed in 578 of 700 cases, and open surgery in 122 cases. CONCLUSION: This study showed that epidural anesthesia seems more advantageous for some patients since it does not have some of the risks that general anesthesia bears.