Use of intraoperative ultrasonography during the surgical repair of pediatric cystic spinal dysraphism--technical note.

The present study investigated the benefits of intraoperative ultrasonographic guidance during the surgical repair of congenital cystic spinal dysraphic lesions. Twenty-one children with cystic spinal dysraphism who underwent surgical repair were examined by real-time ultrasonography during the surgical intervention. Five children had meningoceles, six had myelomeningoceles, four had open neural plaques, three had lipomyelomeningoceles, and three had diastematomyelia. Visualization of the cystic compartments, identification of the neural structures, and identification and localization of the associated lesions were all reliably achieved in all cases. Intraoperative ultrasonographic guidance could determine the type of lesion and the associated lipomas, ectopic tissues, dermoid and epidermoid cysts, and doubling of the spinal cord, and locate diastematomyelic spurs, bands, and adhesions. Components filled with cerebrospinal fluid appeared as anechoic areas, and lipomas as hyperechoic. Intraoperative ultrasonographic guidance allowed the surgeon to correlate the complex anatomy identified on preoperative computed tomography and magnetic resonance imaging to the surgical site during the operation. Better orientation to the defect allows appropriate repair of the lesion with optimal preservation of neural tissues.

Open median nerve release using double mini skin incision in patients with carpal tunnel syndrome: technique and clinical results.

Patients who undergo open carpal tunnel surgery frequently complain of the postoperative cosmetic appearance at the site of the incision on the palm. This problem occurs as a result of excessive scar formation, and the long incision. A double mini skin incision, each 1 cm long, was used in the surgical treatment of carpal tunnel syndrome. The transverse carpal ligament was easily sectioned. Postoperatively healing was good with no excessive scar formation.

Restless leg syndrome and sleep quality in lumbar radiculopathy patients.

BACKGROUND: To investigate the frequency of restless leg syndrome (RLS), sleep quality impairment, depression, fatigue, and sleep behavior disorder and to determine the effects of surgery on these parameters in radiculopathy patients resistant to conservative treatment. METHODS: The present study included 66 lumbar radiculopathy patients, who were resistant to conservative treatment and had indication of surgery. Five different questionnaires were performed to assess depression (the Beck Depression Inventory (BDI)), sleep quality (the Pittsburgh Sleep Quality Index (PSQI)), fatigue (the Fatigue Severity Scale (FSS)), and presence of RLS and rapid eye movement sleep behavior disorder (RBD). The same questionnaires were also performed on a control group (n = 61). RESULTS: Of the radiculopathy patients, 68.1% had RLS and 92.4% had fatigue. Of the controls, 16.4% had RLS and 59% had fatigue. RBD was present in 8 (12.1%) patients and 3 (4.9%) controls. The PSQI revealed that sleep quality was impaired in 46 (69.7%) patients and 35 (57.4%) controls (P > 0.05). The number of individuals having substantial depression according to the BDI was significantly higher in the patients than in the controls. CONCLUSIONS: There was a significant increase in the frequency of RLS, which was significantly decreased in the postoperative period in the radiculopathy patients.

There are no estrogen and progesterone receptors in cerebral cavernomas: a preliminary immunohistochemical study.

BACKGROUND: Literature consistently mentions that pregnancy and hormonal therapy probably increase the bleeding rate and seizure expression of cerebral cavernomas. Either increased hormonal activity or embryogenesis related abundant expression of some growth factors such as VEGF, bFGF, and placental growth factor during pregnancy were proposed to initiate angiogenic process and vascular proliferation in cavernomas, thereby increasing their bleeding rate and seizure expression. METHODS: To reveal whether estrogen and/or progesterone have direct effect on cerebral cavernomas, their receptor expressions were studied immunohistochemically in recently excised 12 cerebral cavernomas. RESULTS: Study showed no expression of either estrogen or progesterone receptors in cerebral cavernomas even the staining worked well in positive control tissues of infiltrative ductal carcinoma. CONCLUSIONS: Aggressive behavior of cerebral cavernomas during pregnancy is a commonly proven observation and attributed to some hormonal effects. However, this effect seems not related to effect of estrogen or progesterone on cavernoma tissue via receptor binding.

The borders of the odontoid process of C2 in adults and in children including the estimation of odontoid/body ratio.

The odontoid process of C2 projects upward from the superior roof of the body of C2. There is a confusion about the inferior border of the odontoid. The aims of this clinical study were to describe the inferior border of the odontoid process based on the remnant of dentocentral synchondrosis in adults, and the estimation of the odontoid/body ratio in pediatric and adult ages. Sixty-six cases were included for this study. Forty-four of them were in adult ages and the remaining 22 of them were in pediatric ages. The region of occiput, C1, C2, and C3, was examined with the magnetic resonance imaging (MRI) in all cases. The length of the odontoid process was estimated by using radiological images of MR from the tip of the odontoid to the remnant of dentocentral synchondrosis. The portion located under the level of synchondrosis was considered as the body of C2. The average length of the odontoid was 18. 6 mm in pediatric and 21. 3 mm in adult cases. In adult females, the length of the odontoid process (19. 1 mm in length) was smaller than those of adult males (23. 6 mm in length). The average ratio of odontoid/body was two in pediatric and 1.8 in adult cases. This study demonstrated that the neck of the odontoid segment at the level of superior articulating facets is not the synchondrosis between the odontoid process and the body of C2. The synchondrosis is located well below the level of superior articulating facets. It can be demonstrated with sagittal and coronal images of MR in both of pediatric and adult individuals.

Multiple organ involvement hydatid cysts in a 2-year-old boy.

The cerebral hydatid cysts caused by Echinococcus granulosus are rare and occur mostly during childhood in endemic areas. A 2-year-old boy was admitted with focal neurological signs in the left extremities. Magnetic resonance imaging of the brain showed a cyst lying from right parietooccipital region to the lateral ventricle. There were also multiple cysts in his lung and liver. The cerebral hydatid cyst was surgically extracted without complications. We suggest that a differential diagnosis of hydatid cyst should be considered when a brain mass is found in a patient, even 2 years old, from an endemic area of echinococcosis.