Surgical vs ultrasound-guided lumbar erector spinae plane block for pain management following lumbar spinal fusion surgery.

PURPOSE: Spinal surgery is associated with severe diffuse pain in the postoperative period. Effective pain management plays an essential role in reducing morbidity and mortality. This study is designed to compare the ultrasound-guided erector spinae plane (ESP) block and surgical infiltrative ESP block for postoperative analgesia management after lumbar spinal fusion surgery. METHODS: The patients who underwent two or three levels of posterior lumbar spinal fusion surgery were randomly allocated into one of three groups with 30 patients each (Group SE = Surgical ESP block; Group UE = ultrasound-guided ESP block; Group C = Controls). The primary aim was to compare postoperative opioid consumption, and the secondary aim was to evaluate postoperative dynamic and static pain scores and the incidence of opioid-related adverse effects. RESULTS: There was a significant difference in terms of opioid consumption, rescue analgesia on demand, and both static and dynamic pain scores between groups at all time periods (p < 0.05). Group SE and Group UE had lower pain scores and consumed fewer opioids than the controls (p < 0.05). However, the Group UE had lower pain scores and opioid consumption than the Group SE. The sedation level of patients was significantly higher in the control group than in the other two groups. Also, nausea was more common in controls than in the other groups. CONCLUSION: While both surgical and ultrasound-guided ESP blocks reduced opioid consumption compared to the controls, the patients who received ultrasound-guided ESP blocks experienced better postsurgical pain relief than those in the other groups (surgical ESP and controls).

Non-Hodgkin lymphoma originating from the frontal sinus.

Primary lymphoma of the paranasal sinuses is a rare entity. Most cases are reported to occur in the maxillary and ethmoid sinuses as well as the nasal cavity. Primary involvement of the frontal sinus is very rare. We report a 68-year-old man with a diagnosis of B-cell lymphoma (non-Hodgkin lymphoma) originating from his frontal sinus.

Diagnosis and treatment of ossified cephalhematoma.

Ossified cephalhematoma is a rare clinical entity. Even though cephalhematoma is frequently encountered, ossified cephalhematoma occurs only sporadically. We report a 13-week-old boy who was admitted to neurosurgery clinic with deformity of the skull. A plain skull radiograph showed radiolucent areas in the right parietal region. CT scan of the head showed thickened right parietal bone and a low-density lesion between bony layers. 3D CT of the skull showed bony protrusion of the right parietal bone. A cosmetic surgical procedure was performed for the patient, and biopsy of the bony lesion confirmed ossified cephalhematoma. We discuss diagnosis, pathogenesis, and treatment of ossified cephalhematoma.

Foreign body granuloma mimicking upper cervical spinal mass after dural repair with Tachocomb [correction of Tachocomp]: a case report.

The common indications of dura mater repair are injuries caused by trauma, neoplasms, surgical complications and congenital spinal dysraphism such as meningomyelocele or encephalocele. Dural grafting is done to recreate the dural barrier and avoid the possible postoperative complications. Autografts derived from periosteum, fascia, muscle and fat. The disadvantages of autografts are their small size and esthetic complaints. To overcome the disadvantages synthetic materials might be used in duroplasty. Here we present a 3-year-old girl who developed muscle weakness in the upper and lower extremities caused by foreign body granuloma mimicking malignancy in the cervical spinal cord after dural repair done via Tachocomb.

Effectiveness of GFAP in Determining Neuronal Damage in Rats with Induced Head Trauma.

AIM: To determine whether the serum level of glial fibrillary acidic protein (GFAP), an important indicator of neuron damage, correlates with the extent of tissue damage in the rat with induced head trauma and to obtain data in order to avoid unnecessary cranial computed tomography analyses. MATERIAL AND METHODS: Three-month-old male Sprague-Dawley rats were used. Rats were divided into 5 groups. The experimental head trauma model was examined in five groups (n=8) as follows: The control group had no intervention; Group 1: Head trauma was induced by dropping a 25 mg ball from a height of 20 cm; Group 2: Head trauma was induced by dropping a 50 mg ball from a height of 20 cm; Group 3: Head trauma was induced by dropping a 50 mg ball from a height of 80 cm; Group 4: Head trauma was induced by dropping a 100 mg ball from a height of 80 cm. Thus, according to the Newton's Law, respectively 0.05, 0.1, 0.2 and 0.4 N trauma was created. Serum GFAP levels were analyzed and the damage to cerebral tissues was evaluated in all groups. RESULTS: We determined that number of apoptotic cells and particularly the number of GFAP (+) protoplasmic astrocytes at the perilesional region of the cortex increased in association with the increased serum GFAP level as long as the severity of the trauma increased. CONCLUSION: Serum GFAP concentration can be used as a marker of the severity of head trauma and traumatic brain injury. However, more animal studies are required to reflect this result in clinical practice.

Osteopetrosis and Chiari type I malformation: a rare association.

Osteopetrosis (OP) is hereditary X-linked, autosomal recessive (ARO), or autosomal dominant (ADO) skeletal disease. ARO has two subtypes, which are infantile malignant and intermediate type. ARO and X-linked OP have poor clinical outcome. ADO is called adult benign type because of the normal life expectancy, which has type I and type II. Here, the authors present an ADO patient with Chiari type I. Concomitant ADO with Chiari type I malformation is an extremely rare condition. Literature research yielded only one case report to date.

The effects of erythropoietin, dextran and saline on brain edema and lipid peroxidation in experimental head trauma.

BACKGROUND: The aim of this study was to investigate the protective effects of erythropoietin, dextran/saline and erythropoietin in combination with dextran/saline on brain edema and lipid peroxidation following traumatic brain injury in rats. METHODS: In the study, 40 male 3-month-old albino Wistar rats, weighing 250-340 g, were divided into four groups, each consisting of ten rats. Traumatic brain injury was induced in all rats by the weight-drop method, and erythropoietin (5,000 U/kg) and/or dextran and saline (8 ml/kg) solutions were injected intraperitoneally ten minutes after trauma. Control animals received an equal volume of serum physiologic. All rats were sacrificed 24 hours later. Glutathione peroxidase activity and malondialdehyde levels were measured in the left hemisphere, and edema was quantitated by the wet-dry method. RESULTS: Brain edema and the levels of malondialdehyde, the last product of lipid peroxidation in tissues, were decreased variably, and the activity of glutathione peroxidase, an antioxidant enzyme, was increased in others compared with the control group. CONCLUSION: In this study, it was concluded that the brain edema that developed in rats on which head trauma was induced and the secondary brain damage caused by oxidative stress could be deceased using a combination of erythropoietin, dextran, and saline.

Collapsed L4 vertebral body caused by brucellosis.

Brucellosis is caused by gram-negative, aerobic, non-motile, facultative, intracellular coccobacilli belonging to the genus Brucella. A 50-year-old man working as an employee was admitted to neurosurgery clinic with severe low back, radicular right leg pain and hypoesthesia in right L4-5 dermatomes for 2 months. Brucella tube agglutination (Wright) test was positive in serum sample of the patient with a titer of 1/640. Brucella melitensis was isolated from blood culture. X-ray and MRI of the lomber spine showed massive collapse of L4 vertebral body. Neural tissue was decompressed and then posterior L3-5 short segment transpedicular screw fixation and stabilization was performed. Brucella melitensis was isolated from microbiologic culture of pathologic specimen. Antibiotic therapy was given as doxycycline 200 mg/day and rifampicin 600 mg/day for 6 months. Brucellosis is a systemic zoonotic infection and still an important public health problem in many geographical parts of the world. Vertebral body collapse caused by brucellosis occurs very rarely but represents a neurosurgical emergency because of its potential for causing rapidly progressive spinal cord compression and permanent paralysis. Neurosurgeons, emergency department personnel as well as infectious disease specialists should always keep a high index of suspicion and include brucellosis in the differential diagnosis of vertebral body collapse.

Spinal arachnoid cysts associated with syringomyelia: a review of the literature and report of a case.

Syringomyelia is a not infrequent pathology that develops related to changes in cerebrospinal fluid dynamics due to many etiological factors. The development of syringomyelia through a spinal arachnoid cyst is quite rare and has been defined in only 31 cases in the literature. A case due to thoracic epidural lipomatosis has also been reported. There have been no previous reports of thoracic region epidural lipomatosis with underlying arachnoid cyst and syringomyelia as in our case. We present a 27-year-old patient who developed thoracic arachnoid cyst and underlying syringomyelia because of the pressure of the thoracic epidural fat tissue and also evaluate the characteristics of patients with syringomyelia by virtue of an arachnoid cyst previously reported in the literature.

Hemangioblastoma of the filum terminale associated with von Hippel-Lindau disease: a case report.

We report a 41-year-old man who presented with low back pain, lower extremity paresthesia, urinary retention and constipation. Magnetic resonance imaging showed a vascular intradural-extramedullary lesion at the second lumbar vertebral level. His medical history revealed that he had undergone surgery for a cerebellar hemangioblastoma 5 years ago. The patient underwent a spinal operation and a vascular tumor was removed from filum terminale. Pathologic examination of the tumor revealed a hemangioblastoma. Hemangioblastomas may occur sporadically or in association with von Hippel-Lindau disease. In the second case, they are often multiple and accompanied by cerebellar and brainstem lesions. The hemangioblastomas reported in the conus medullaris or in the extramedullary compartment adjacent to the conus medullaris are rare, tumors of the cauda equina are uncommon, and lesions of the filum terminale are extremely rare. We report a patient with von Hippel-Lindau disease having filum terminale hemangioblastoma and discuss the diagnosis, pathogenesis and treatment of hemangioblastoma.

Mini transverse versus longitudinal incision in carpal tunnel syndrome.

OBJECTIVE: To evaluate the effectiveness of mini-transverse compared with mini-longitudinal incision for carpal tunnel release (CTR) with reference to postoperative functional capacity, symptom severity and complication rate. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: Cumhuriyet University Medical Faculty, Department of Orthopaedics, Tokat State Hospital, Department of Orthopaedics and Medical Park Tokat Hospital, Department of Neurosurgery, from January 2007 to January 2009. METHODOLOGY: This study included 93 hands of 79 patients with carpal tunnel syndrome (CTS), which were operated between 2007 and 2009. Patients were divided according to incision types into Group-1 (undergoing mini-longitudinal incision) and Group-2 (undergoing mini-transverse incision). Patients were evaluated initially and at 3 weeks after treatment according to symptom severity and functional status of Boston Questionnaire (BQ). Demographic and clinical data were analyzed and compared statistically between two groups. RESULTS: Statistically significant differences were observed in BQ symptom and functional scores between the pre- and postoperative period (p < 0.0001). BQ symptom and functional scores at postoperative period were better in Group-1 than Group-2 (p = 0.044 and p = 0.023 respectively). The scar hypersensitivity (p = 0.258) and tenderness (p = 1.00) associated with the incision sites were not statistically different. CONCLUSION: Longitudinal incision is more effective on symptom and functional conditions than transverse incision. However, there was less scar formation with transverse incision.

Surgical management of symptomatic T8 vertebral hemangioma: case report and review of the literature.

Vertebral hemangiomas are benign vascular lesions of the vertebral column; only 0.9-1.2% of all vertebral hemangiomas cause spinal cord compression. We report a 34-year-old female who was admitted to the neurosurgery clinic with a history of back pain, poor quality of life and easy fatigability for 1.5 years. Her medical history revealed a fall from a height of 2 meters 1.5 years ago. Neurology examination revealed bilateral hypoesthesia below the T8 level and hyperactive deep tendon reflexes in her left leg. Computed tomography scan of the thoracic spine showed T8 vertebral hemangioma, and magnetic resonance imaging showed a T8 hemangioma compressing the spinal cord. Surgical intervention was planned and T8 total laminectomy was performed. The tumor extending into the anterior spinal cord was resected, and T8 vertebroplasty with short segment posterior stabilization and fusion was performed. We aimed to present a new treatment approach for symptomatic vertebral hemangiomas and reviewed the relevant literature.

Surgical management of cervical spinal epidural abscess caused by Brucella melitensis : report of two cases and review of the literature.

Spinal epidural abscess, if especially caused by Brucellosis is a very rare disease which is usually a consequence of spondylodiscitis. The spinal column can be affected at any joint; however, the lumbar spine is the most common region, especially at the level of the L4-5 and L5-S1. The frequency of spinal involvement usually seen at the lumbar, thoracic and cervical spine respectively. As an occupational disease in farmers, veterinaries, butchers, laboratory staff and shepherds, brucellosis can also occur by direct contact to animals and infected materials or ingestion of raw cheese, milk or unpasteurized milk products. In this study, we presented two cases with cervical spinal epidural abscess caused by brucella melitensis, which was successfully treated by surgical approach. Initial treatment was combined with antibiotic therapy after the surgery for 3 months.

Malign transformation in the low grade astrocytomas and related factors.

AIM: Retrospective investigation of prognostic factors in low-grade astrocytomas. MATERIAL AND METHODS: In the study, prognostic factors were prospectively identified and assumed to be effective on prognosis, which were reviewed in 67 cases diagnosed as low-grade astrocytoma with craniotomy between May 1998 to December 2005 at Erciyes University Neurosurgery Department. Assessment of demographic, neurologic, radiological, surgical and clinical features of cases and adjuvant therapies and their relationship with prognosis were evaluated. Post-operative cumulative survival of the cases was estimated by using the Kaplan-Meier method. The Log Rank test was used to compare the survival curve of the sub-groups. Multivariate analysis of survival was analyzed by using the Cox regression method. RESULTS: It was seen that malign transformation occurred in 9 patients of subtotal resection group. The difference was statistically significant (p < 0.01). malign transformation was detected in one female (3.2%) and 8 male patients (22.2%). Difference in favor of men was statistically significant (p < 0.05). Malignant transformation was detected in 7 of the patients given post-operative radiotherapy, only 2 patients displayed malign transformation in the group which received no radiotherapy. Comparison of groups revealed a significant difference (p=0.01). CONCLUSION: Detection of higher malign transformation rate in cases underwent radiotherapy than those did not and the statistical significance in this meaning mandates to revise treatment plan regarding radiotherapy.

Microvascular decompression for primary trigeminal neuralgia : short-term follow-up results and prognostic factors.

OBJECTIVE: The aim of this prospective study was to demonstrate the influence of some factors on the prognosis of microvascular decompression in 37 patients with trigeminal neuralgia. METHODS: The results of microvascular decompression (MVD) in 37 patients with trigeminal neuralgia were evaluated at 6 months after surgery and were compared with clinical and operative findings. RESULTS: The sex of the patient, the patient's age at surgery, the side of the pain, and the duration of symptoms before surgery did not play any significant roles in prognosis. Also, the visual analogue scale (VAS) of the patient, the duration of each pain attack, and the frequency of pain over 24 hours did not play any significant roles in prognosis. In addition, intraoperative detection of the type of conflicting vessel, the degree of severity of conflict, and the location of the conflict around the circumference of the root did not play any roles in prognosis. The only factors affecting the prognosis in MVD surgery were intraoperative detection of the site of the conflict along the root and neuroradiological compression signs on preoperative magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA). CONCLUSION: These findings demonstrated that if neurovascular compression is seen on preoperative MRI/MRA and/or compression is found intraoperative at the root entry zone, then the patient will most likely benefit from MVD surgery.

Analysis of the mortality probability of preoperative MRI features in malignant astrocytomas.

AIM: The aim of the present study is to analyze the effects of the MRI features on the recurrence time and prognosis, and to emphasize the analyses of mortality risks in malignant astrocytomas. MATERIAL AND METHODS: The effects of preoperative MRI features on prognosis were studied for follow-up period of 45 months, from November 1999 to August 2003, on a total of 79 patients' 41 cases of total resection and 38 cases of subtotal resection diagnosed to have malignant astrocytoma subsequent to craniotomy. RESULTS: The cases of gross total resection had 2.2 times as high survival rate as those in the subtotal resection group (p < 0.01). The comparison of the cases in the groups in relation to their ages revealed that mortality rate rose 4.35 times (p < 0.01) in the age group of 60 years and above, and 2.1 times in the age group of 45-59 years. When cases without necrosis were compared with the group containing necrosis of grade 1, 2, 3, it was observed that the probability of mortality increased 3.84 (p < 0.01), 4.15 times (p < 0.01) in the case of necrosis of grade 2 and 3, respectively by means of Cox regression model. CONCLUSION: Necrosis in preoperative MRI of malignant astrocytomas seems to be an important clinical marker of the prognosis.

Surgical timing of the subependymal giant cell astrocytoma (SEGA) with the patients of tuberous sclerosis complex.

AIM: Tuberous sclerosis complex has shown a wide variety of clinical, pathologic and radiologic manifestations. Many tumor types are found in tuberous sclerosis, which includes subependimal giant cell astrositoma. The aim of this study is to focus on surgical timing of the tumor. MATERIAL AND METHODS: This study included 37 children with tuberous sclerosis presenting to Erciyes Univercity Medical School, whose hospital record were retrospectively evaluated between 1995 and 2010. Of the 5 patients had diagnosed with the subependymal giant cell astrocytoma and three patients were opereted on. RESULTS: In the 27 of the patients had subependimal nodules (73%), cortical tubers were in the 19 patients (51,4%), giant cell astrositoma (SEGA) were in the 5 patients (13,5%). Mental retardation in different level was detected in the 18 patients (48.6%). The other clinical findings of the patients were angiomyolipomas (37.8%), hypomelanotic macules (91.9%), Convulsion (54.1%), adenoma sebaceum (32.4%) , West syndrome (16.22%), shagreeen patch (16.2%), intracardiac tumor (37.8%), subungual fibroma (2.7%), fibroadenom in the neck (2.7%). CONCLUSION: A multidisciplinary approach is essential for an early, accurate diagnosis and proper management of affected individuals. The early surgical menagement for subependimal giant cell astrocytoma are recommended, and also periodic monitoring even for asymptomatic patients with subependymal nodules.