Outcomes and Complications of Endoscopic Versus Microscopic Transsphenoidal Surgery in Pituitary Adenoma.

This retrospective study aimed to define outcomes and complications of endoscopic versus microscopic transsphenoidal surgery in pituitary adenoma. Data of 94 patients who underwent transsphenoidal endoscopic (n = 45) or microscopic surgery (n = 49) between June 2000 and June 2014 for pituitary adenoma, performed at Katip Çelebi University Hospital, were retrospectively analyzed. The patients' symptomatology, type of adenoma, radiologic findings, surgical outcomes, and preoperative and postoperative complications were investigated. The total subtotal resection rate was 73.4% (69 patients) and partial resection rate was 26.6% (25 patients). Total subtotal resection rate was 77.6% (38 patients) in the microscopic group and 68.9% (31 patients) in the endoscopic group. Total resection was seen more often in the endoscopic group than in the microscopic group, with no significant difference between the groups. Four patients (8.2%) in the microscopic group had postoperative cerebrospinal fluid leak compared with 3 patients (6.7%) in the endoscopic group. Two patients (2.1%) had hematoma, with 1 patient each in the endoscopic and microscopic group. Panhypopituitarism development rate was higher in the endoscopic group (no significant difference between the 2 groups). One patient (2%) developed blindness in the microscopic group and 1 (2.2%) had meningitis in the endoscopic group. Based on this study, the total resection rate was higher in the microscopic group than in the endoscopic group. However, outcomes and complication rate did not differ significantly between the 2 surgical techniques. Both techniques have advantages and disadvantages. Prospective randomized controlled trials should be conducted to compare the 2 surgical methods.

Intraventricular glioblastoma multiforme: a pediatric case report.

SUMMARY: Glioblastoma multiforme (GBM) is the most common lethal primary central nervous system tumor in adults. GBM is rarely seen in childhood and adolescence as primary intraventricular tumors. Few cases of solitary intraventricular GBM in adolescence have been reported to date. We report a 16-year-old boy with progressive disorientation, diffuse headache, vomiting, and increased intracranial pressure. Computed tomography and magnetic resonance imaging confirmed that the tumor filled posterior body and occipital horn of the left lateral ventricle and also invaded the surrounding parenchyma. Incomplete removal of the lesion was achieved and a pathologic diagnosis of GBM was carried out. We present a case with an uncommon subtype of glial tumor (GBM) in childhood located in a very rare site. The clinical course, radiologic findings, and possible treatment regimens are reviewed.

Giant erosive spinal schwannomas: surgical management.

Giant erosive spinal schwannomas can be distinguished from other spinal schwannomas by its growth in myofascial planes and vertebral body erosion. Therapeutic radical tumour excision without neurologic deterioration is possible in the management. Prognosis is good after total tumour removal. In this article, it is aimed to report six patients who were diagnosed as giant erosive spinal schwannomas between 2001 and 2004 according to the criteria of Sridhar et al. Three of the patients were male and three female with the age range of 16-63 (mean age 39.7). Three of the tumours were located in the cervical region, one in the lumbar region, one in the thoracic region and one in the sacral region. Total excision of the tumours was achieved in four patients. However, one additional operation was required in two patients. Follow-up periods ranged from 6 weeks to 7 years (mean follow-up 51 months). Four patients had a good clinical outcome and there were no radiologic signs of instability or recurrence. Our experience and other published literature suggest that giant erosive spinal schwannoma has significant features such as local invasive nature together with vertebral body erosion and large size but benign histology, long duration for clinical presentation, common preoperative misdiagnosis and good prognosis after total excision. These tumours rarely need spinal instrumentation because the disc capsule and ligaments remain intact even if the pedicle and posterior elements are compromised.

Intracranial chronic subdural haematoma as a complication of epidural anesthesia.

We report the case of a 39-year-old woman with unilateral intracranial chronic subdural haematoma that occurred after epidural anesthesia for excision of a skin scar, complicated by postdural puncture headache. The patient had no history of trauma, headache, coagulation abnormalities, or neurological disorders. Most physicians encountering a case of headache after epidural or spinal anesthesia first think of a postdural puncture headache. Nonetheless, the symptoms subside within 7 days when treated with analgesics and bed rest in the majority of cases. The presence of a continued postdural puncture headache without neurological deterioration, as in this case, should prompt a search for an intracranial lesion.

Nasal-subfrontal giant schwannoma.

Subfrontal schwannomas are rare lesions. They can be misdiagnosed as olfactory meningiomas or neuroblastomas. We report a case of giant schwannoma involving the anterior cranial fossa; the frontal and ethmoid sinuses and nasal cavities. The patient presented with a year-long history of increasingly severe headache associated with insomnia. Examination revealed no neurological deficit except for the anosmia. Magnetic Resonance Imaging revealed a 9x5x3 cm intranasal-subfrontal extraaxial mass. Nasal biopsy indicated the presence of a schwannoma. The lesion was totally removed through a bifrontal craniotomy and the skull base was repaired with periosteal flap, fibrin glue and a split craniotomy graft. In addition to the cosmetic advantages over standard transfacial approaches, the extended subfrontal approach also provides early dissection of neural tissues, avoiding an inadvertent cerebrospinal fluid leak.

Cervical vertebral osteomyelitis and epidural abscess caused by Candida albicans in a patient with chronic renal failure.

Although rare, the diagnosis of candidal vertebral osteomyelitis of the cervical spine should be considered in cases of quadriparesia occurring in hemodialysis patients. This disease leads to vertebral destruction and spinal cord compression. Candidal vertebral osteomyelitis constitutes a diagnostic problem for all physicians. The insidious progression of disease, the non-specificity of the clinic and laboratory findings, and the failure to recognize candida as a potential pathogen may lead to a diagnostic delay. Early diagnosis and treatment are fundamental points for prognosis. In this report, we present the fifth case of cervical vertebral osteomyelitis caused by Candida species in the literature. Our case is the second case of candidal vertebral osteomyelitis associated with epidural abscess of the cervical spine.

Combined approach for otogenic brain abscess.

Otogenic intracranial infections usually require both neurosurgical and otolaryngological surgery. This prospective, non-randomized study investigated the value of combining both surgical procedures. Thirteen patients with otogenic intracranial abscess were treated by mastoidectomy and abscess removal through the same incision between 1993 and 2002. Another 12 patients underwent abscess removal or mastoidectomy followed by the other procedure within 7 days. The clinical features of the patients were compared. Four patients died in our series. All four patients had Glasgow Coma Scale (GCS) scores of 7 or less. The preoperative GCS score was the main factor in mortality. One patient had recurrence after the combined approach compared to nine patients with recurrence after separate procedures. The surgical procedure was the main factor affecting the recurrence rate. The combined approach and total capsule excision of the abscess may reduce the risk of recurrence of otogenic intracranial abscess.

Computerized tomography-guided percutaneous transforaminodiscal biopsy sampling of vertebral body lesions.

OBJECT: The posterolateral approach is the common route for obtaining percutaneous biopsy samples in lumbar and thoracic vertebral bodies (VBs). This procedure, however, is associated with the risk of complications. Because of this, the authors devised a new method for percutaneous biopsy sampling of VB lesions. METHODS: The percutaneous computerized tomography (CT)-guided transforaminodiscal biopsy procedure was undertaken in 20 patients during a 10-month period. The VBs in 18 cases were successfully accessed using this technique. There were no procedure-related complications. CONCLUSIONS: Transforaminodiscal CT-guided spinal biopsy procedure is a safe and effective method for accessing VB lesions. It is possible to obtain a biopsy sample in the major part of the VB. This technique is a good alternative to the standard posterolateral approach.

Partial spondylectomy for primary leiomyosarcoma of C2 vertebra.

STUDY DESIGN: A primary leiomyosarcoma located on the left side of the C2 is reported. Left-sided partial spondylectomy and anterior reconstruction with posterior stabilization was performed by a two-staged operation. OBJECTIVE: To emphasize the occurrence of primary leiomyosarcoma and the importance of proper stabilization in the upper cervical spine. SUMMARY OF BACKGROUND DATA: Leiomyosarcoma is a rare malignant neoplasm of the bone and the primary leiomyosarcoma of the spine is extremely rare. Radical tumor excision is the goal in case of vertebral leiomyosarcoma, but to both gain surgical access to the upper cervical spine and obtain anterior reconstruction is challenging. METHODS: Leiomyosarcoma of the C2 in a 25-year-old woman with mild neurologic deficits is reported. A left-sided partial spondylectomy of C2 was performed. The defect of the vertebral body was reconstructed by expandable titanium prosthesis, and posterior craniocervical fixation was performed by the polyaxial screws in the lateral masses and rod/plates. RESULTS: The surgical margin was very small. The pathology of the tumor was reported as leiomyosarcoma. No sign of local recurrence or metastasis was evident 1 year after surgery. CONCLUSION: Leiomyosarcoma, although rare, should be kept in mind as one of the possible diagnoses when a patient with an upper cervical tumor is presented and complete tumor removal must be the goal.

Paraganglioma of the cauda equina: a highly vascular tumour.

Paragangliomas uncommonly occur in the cauda equina region. This type of tumour may be misdiagnosed pre-operatively as a neurinoma or an ependymoma. Paragangliomas are highly vascular tumours. We report three patients with paraganglioma of the cauda equina. The first patient had many dilated vessels resembling an arteriovenous malformation, which were seen during surgery. The second patient had a post-operative haemorrhage without any residual tumour. The third patient had a selective angiogram with dense tumour staining.

Primary primitive neuroectodermal tumor of the lumbar extradural space.

Primary spinal primitive neuroectodermal tumors (PNETs) of the extradural space are very rare; only 10 cases have been reported in the English language literature. The histopathological diagnosis of primary spinal PNETs has been discussed for many years. These tumors have a rapidly progressive course, and there is no current consensus on the optimal therapeutic approach for these patients. The authors present a case of primary PNET located in the lumbar extradural space in a 13-year-old girl and report the clinical, radiological, histopathological, and surgical findings. They compare their findings with those from the other 10 cases reported in the literature and review relevant literature.

Percutaneous computed-tomography-guided biopsy of the spine: 229 procedures.

OBJECTIVES: Percutaneous biopsy of the spine is an effective and well-evaluated procedure. Only very few series containing more than a hundred patients have been reported so far and there is no agreement about the factors affecting the diagnostic rate. We aimed to find out if there is any factor influencing the success rate of the spinal biopsy using our biopsy series. METHODS: Two hundred and twenty-nine procedures were performed in 201 patients between November 2001 and August 2005. All procedures were performed under computed tomography guidance. The side was chosen according to the extension of the lesion. When the lesion was in the midline or extended to both sides, we preferred to obtain biopsy from the right side. The puncture point and the needle trajectory were planned on both lateral computed tomography scout scan and axial scans. RESULTS: We found that the diagnostic rate was not affected by the variables such as age, gender, type and diameter of the biopsy needle, diagnosis as well as lesion localization and level. The success rate of the repeat biopsies was considerably lower than the first procedures. CONCLUSIONS: The diagnostic rate is not affected by any of the variables but the approach, chosen can vary with the level, localization, and lesion characteristics.