Effect of humic acid on oxidative stress and neuroprotection in traumatic spinal cord injury: an experimental study.

Background/aim: Traumatic spinal cord injury (TSCI) is an important health problem, especially in developing countries with additional socioeconomic loss. Humic acid (HA) usually has antioxidant, antiinflammatory, blood circulating, and antiviral effects. Hence, it was aimed herein to show the effect of HA on neuroprotection in a TSCI model. Materials and method: A TSCI model was used, in which 24 Wistar albino rats were divided into 4 groups: control group: subjected to only laminectomy; sham group: subjected to laminectomy + TSCI; HA 5 mg/kg group: subjected to laminectomy + TSCI + intraperitoneal (IP) injection of 5 mg/kg of HA; and HA 10 mg/kg group: subjected to laminectomy + TSCI + IP injection of 10 mg/kg of HA. Intracardiac blood samples were obtained preoperatively (preop), and at 1 and 24 h postoperatively (postop). The total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) levels were evaluated in the serum. The motor functions were evaluated using the Modified Tarlov Score at 24 h postop. Results: There were no significant changes in the TAS values between the sham and HA 5 mg/kg and HA 10 mg/kg groups (p = 0.77/0.21). However there was a significant decrease in the TOS values at 24 h postop when comparing the sham and HA 5 mg/kg groups (p = 0.02). The pathological evaluation showed a significant decrease in the severity of edema, hemorrhage, polymorphonuclear leucocyte (PNL) infiltration, and mononuclear leucocyte (MNL)/macrophage/microglia infiltration when compared with the control group (p < 0.05). There was a significant recovery at the paraplegia level when the HA 5 mg/kg and HA 10 mg/kg groups were compared with the control group (p < 0.001). Conclusion: The effects of HA in the early stages of TSCI on oxidative stress, histopathological changes, and neurological improvement were investigated herein. It is thought to be a potential therapeutic agent in acute TSCI but needs to be further evaluated to determine the extent of its effect on other neuroprotective pathways in larger series.

Postnatal surgery for myelomeningocele in neonates: neurodevelopmental outcomes.

BACKGROUND: The study aims to evaluate the neurodevelopmental outcomes of neonates with myelomeningocele (MMC) operated in the postnatal period. METHODS: This is a prospective follow-up study in a tertiary neonatal intensive care unit. Neurodevelopmental outcomes of term neonates operated for MMC and healthy term newborns were compared with the Bayley Scales of Infant and Toddler Development -Third Edition (BSID III) at 12-18 months. RESULTS: A total of 57 cases were included in the study (patient group = 27; control group = 30). Demographic data between the groups were similar. Cognitive, linguistic, and motor composite scores of the patient group were lower than those of the control group (p < 0.001). In the patient group, those who underwent ventriculoperitoneal shunt had lower cognitive, language and motor scores than those without shunt (p < 0.05). The cognitive, linguistic, and motor composite scores in the patient group who underwent surgery before 72 h were better than those who underwent surgery after 72 h. DISCUSSION: In our study, it was found that the neurodevelopmental prognosis of MMC cases requiring ventriculoperitoneal shunt in the postnatal period was significantly worse than those without shunt. It is the first study in which the neurodevelopment of patients with MMC who were operated in the postnatal period was evaluated with BSID III evaluated and delays in all areas were shown in cases with MMC compared to normal cases. Better neurodevelopmental outcomes in patients operated in the first 72 h suggest that early surgery will improve neurodevelopmental outcomes in patients with MMC.

Effect of Humic Acid on Oxidative Stress and Neuroprotection in Traumatic Spinal Cord Injury: An Experimental Study.

OBJECTIVE: Traumatic spinal cord injury (TSCI) is an important health problem especially in developing countries with additional socio-economic loss. Humic acids (HA) usually have anti-oxidant, anti-inflammatory, blood-circulating and antiviral effects. We aimed to show effect of HA on neuroprotection in TSCI model. METHODS: We performed TSCI model in Twenty-four Wistar-Albino rats in four groups. Control group underwent only laminectomy. Sham group underwent laminectomy followed by TSCI. Low dose HA (5mg/kg) and high dose HA (10mg/kg) groups underwent laminectomy and TSCI followed by peritoneal administration of HA. Preoperative, postoperative 1st hour and postoperative 24th hour cardiac blood samples were obtained. Total Antioxidant Status (TAS), Total Oxidant Status (TOS) and Oxidative Index (OI) levels were evaluated in serum. The 24th hour motor functions were evaluated by Modified Tarlov Score. RESULTS: There were no significant changes in TAS values between sham- low dose and high dose humic acid groups (p:0.77/0.21). However there were a significant decrease of TOS levels in the 24th hour post operative blood samples comparing the sham group with low dose humic acid group (p=0.02). Pathological evaluation showed a significant decrease in the severity of edema, hemorrhage, Polymorphonuclear leucocytes (PNL) and Mononuclearleucocytes (MNL) /macrophage/microglia when we compare with the control group (p<0.05). There is a significant recovery in paraplegia level as we compared the HA groups with control groups (p<0.001). CONCLUSION: In this study, we showed the effects of HA in the early stages of TSCI on oxidative stress, histopathological changes and neurological improvement. It is thought to be a potential therapeutic agent in acute TSCI but needs to be further evaluated by showing proper effect on other neuroprotective pathways in larger series.

Kyphectomy in neonates with meningomyelocele.

PURPOSE: Kyphosis is the most severe spinal deformity associated with meningomyelocele (MMC) and is seen in approximately 15% of neonates. Our purpose is to present our clinical experience, to discuss the technique and deformity correction in kyphectomy in neonates with MMC, and to assess its long-term outcomes. METHOD: In this prospective study, the authors reviewed eight cases submitted to surgery between 2013 and 2015. We evaluated clinical characteristics that were analyzed, as were the operative technique employed, and angle range of the kyphosis deformity postcorrection follow-up. RESULTS: Neonatal kyphectomy was performed of six females and two males. The mean birth weight was 2780 g, and the mean age at the time of surgery was 5.6 days. There were S-shaped type deformity in lumbar region in all neonates. In the correction of the kyphotic deformity, a total vertebrae were removed from four patient, whereas a partial vertebrectomy was done in four. The mean operative time was 116 min. No patients did not require the blood transfusion. There were no serious complications, and wound closure was successful in all patients. The mean follow-up period was 4 years and 3 months (range 36-61 months), except one patient who died 1 week after discharge. The mean preoperative kyphosis of 75.6° (range, 50°-90°) improved at last follow-up to 35° (range 15°-55°). All patients had surgical procedures for hydrocephalus. Three patients had surgery for Chiari type II malformation. The mean hospital stay was 27.7 days. CONCLUSION: Kyphectomy performed at the time of dural sac closure in the neonate is a safe procedure with excellent correction.

Intracranial repair of posttraumatic cerebrospinal fluid rhinorrhea associated with recurrent meningitis.

OBJECTIVE: The purposes of this study are to assess the efficacy of our intracranial surgery and evaluate the association between failure after first surgical repair and the risk factors that have been applied on a group of 13 patients affected by posttraumatic cerebrospinal fluid rhinorrhea associated with recurrent meningitis. METHODS: We retrospectively collected data on 13 patients referred to our institution. All patients had history of head trauma and experienced 2 or more episodes of meningitis. RESULTS: Three of the 13 patients had craniectomy defect due to previous trauma and surgery, 9 patients had linear fracture, and 1 patient had no apparent fracture line on preoperative radiologic evaluation. Ten of the 13 patients had identified frontal bone fracture involving the frontal sinus during surgery. Dural tear was identified intradurally and was repaired using a fascia lata graft with or without fibrin glue. Fibrin glue was applied over the suture in 7 patients. Three of the 13 patients had large dural defects. CONCLUSIONS: The size of bone and dural defect seems to be an important prognostic factor of episodes of meningitis. The use of fibrin glue to fixate fascia lata graft did not benefit the outcome.

Extraosseous, epidural cavernous hemangioma with back pain.

BACKGROUND: Cavernous malformations are characterized by enlarged vascular structures located in benign neural tissues within the cerebellum and spinal cord of the central nervous system. Cavernous hemangiomas (CHs) account for 5% to 12% of all spinal vascular malformations. CASE REPORT: We removed a hemorrhagic thoracic mass in a 40-year-old male patient who presented with progressive neurological deficits. CONCLUSIONS: We found it appropriate to present this case due to its rarity.

Isolated Transverse Clivus Fracture without Neurodeficit: Case Report and Review of Literature.

BACKGROUND: Clivus is a bony surface in the posterior cranial fossa, serving as the support of the brainstem and thus neighboring important structures because of its location. Skull base fractures that cannot be shown by conventional radiography can be clearly imaged by high-resolution bone window computed tomography. CASE REPORT: A 44 years-old male referred to the emergency department because of a traffic accident in the car. His only complaint was a severe neckache. His X-ray examination showed no pathology. The computed tomographic examination showed no parenchymal pathology, but a isolated transverse fracture in the clivus. CONCLUSIONS: The computed tomographic examination showed isolated transverse fracture in the clivus our case presented in this paper is the first case of transverse clivus fracture without additional cranial bone fracture and neurologic deficit in the literature.

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.

Effect of humic acid on oxidative stress and neuroprotection in hypoxic-ischemic brain injury: part 1.

BACKGROUND: Aimed to investigate in an animal model the efficacy of humic acid by showing its antioxidant and anti-apoptotic effect comparing with the histopathological and neurological outcomes for the hypoxic-ischemic brain injury. METHODS: 28 Wistar-Albino rats who were on the 7th postnatal day and weighting between 9 and 19 g randomly divided into four groups with developed HIE model under the gas anesthesia. 20 mg/kg and 10 mg/kg intraperitoneal HA were given to Group I and II respectively. Saline was given to Group III and the sham group was Group IV. The brain tissues were stained with cresyl-violet histochemistry for grading neuronal cell injury and caspase immunohistochemistry. RESULTS: The neuronal cell injury was statistically lower in all neuroanatomical lands in HA treatment groups. The degree of ischemia was significantly smaller in HA groups. Caspase-3 immunoreactivity was decreased in the HA groups compared with the saline group. When the groups were compared, there were no serious neuronal injury in Group I. CONCLUSIONS: This is the first study which investigates the role of HA in HIE model. HA reduces apoptosis and neuronal injury in cerebral tissue of the rats. This findings suggest that HA may be viable protective agent against HIE.

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.

Reactive changes of disc space and foreign body granuloma due to bone wax in lumbar spine.

Bone wax is a well-known agent used to prevent bleeding from the bone that can be used in different surgical procedures. Bone wax is a safe agent, but it may rarely lead to significant foreign body reactions. In this report, we present a patient who developed bone wax-related disc space foreign body granuloma following L4 total laminectomy, extremely rare complication.

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.

Unilateral acute foot drop due to diffuse axonal injury after head trauma.

Acute foot drop due to diffuse axonal injury (DAI) has not been previously described in the literature. In this report, we present a patient with unilateral acute foot drop caused by a DAI lesion after head trauma.

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.

Can Right-Handed Surgeons Insert Upper Thoracic Pedicle Screws in much Comfortable Position? Right-Handedness Problem on the Left Side.

OBJECTIVE: Thoracic pedicles have special and specific properties. In particular, upper thoracic pedicles are positioned in craniocaudal plane. Therefore, manipulation of thoracic pedicle screws on the left side is difficult for right-handed surgeons. We recommend a new position to insert thoracic pedicle screw that will be much comfortable for spine surgeons. METHODS: We retrospectively reviewed 33 patients who underwent upper thoracic pedicle screw instrumentation. In 15 patients, a total of 110 thoracic pedicle screws were inserted to the upper thoracic spine (T1-6) with classical position (anesthesiologist and monitor were placed near to patient's head. Surgeons were standing classically near to patient's body while patients were lying in prone position). In 18 patients, a total of 88 thoracic pedicle screws were inserted to the upper thoracic spine with the new standing position-surgeons stand by the head of the patient and the anesthesia monitor laterally and under patient's belt level. All the operations performed by the same senior spine surgeons with the help of C-arm. Postoperative computed tomography scans were obtained to assess the screw placement. The screw malposition and pedicle wall violations were divided and evaluated separately. Cortical penetration were measured and graded at either : 1-2 mm penetration, 2-4 mm penetration and >4 mm penetration. RESULTS: Total 198 screws were inserted with two different standing positions. Of 198 screws 110 were in the classical positioning group and 88 were in the new positioning group. Incorrect screw placement was found in 33 screws (16.6%). The difference between total screw malposition by both standing positions were found to be statistically significant (p=0.011). The difference between total pedicle wall violations by both standing positions were found to be statistically significant (p=0.003). CONCLUSION: Right-handedness is a problem during the upper thoracic pedicle screw placement on the left side. Changing the surgeon's position standing near to patient's head could provide a much comfortable position to orient the craniocaudal plane of the thoracic pedicles.

Spontaneous expulsion of a bullet, in the body of second cervical vertebrae, via the mouth.

Gunshot wounds to the upper cervical spine without neurological deficit occur infrequently. In this report, we describe a case with spontaneous expulsion of a bullet located in the body of second cervical vertebrae (C2) via mouth.

Primary Sacral Hydatid Cyst Causing Cutaneous Fistula.

Echinococcus granulosus and Echinococcus multilocularis are the causes of hydatid disease and the main characteristic is endemic. Generally, it affects the liver and lungs. Spinal hydatidosis accounts for less than 1% of the cases. Vertebral hydatidosis is usually silent and a slowly progressive disease with a long latent period. Another rare form is the primary sacral hydatid cyst. Generally, patients suffer from back pain and neural compression symptoms. A 43-year woman was admitted with left leg pain and a fluid leakage from a cutaneous fistula on the left hip. It was diagnosed on MRI as a bilateral cystic lesion which eroded the first sacral wing, extending to the paravertebral region and left intervertebral for a men. We present a case with fluid leakage from cutaneous fistula.

Protective effect of melatonin against head trauma-induced hippocampal damage and spatial memory deficits in immature rats.

It is well known that head trauma induces the cognitive dysfunction resulted from hippocampal damage. In the present study, we aimed to demonstrate the effect of melatonin on hippocampal damage and spatial memory deficits in 7-day-old rat pups subjected to contusion injury. Melatonin was injected intraperitoneally at the doses of 5 or 20 mg/kg of body weight immediately after induction of traumatic injury. Hippocampal damage was examined by cresyl violet staining and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. Spatial memory performance was assessed in the Morris water maze. Melatonin significantly attenuated trauma-induced neuronal death in hippocampal CA1, CA3 regions and dentate gyrus, and improved spatial memory deficits, which was equally effective at doses of 5-20 mg/kg. The present results suggest that melatonin is a highly promising agent for preventing the unfavorable outcomes of traumatic brain injury in young children.

QTc dispersion in children with severe head trauma.

OBJECTIVE: Corrected QT (QTc) interval prolongation has been described after subarachnoid hemorrhage and head injury in adults. Abnormal QTc prolongation is associated with a higher risk of ventricular arrhythmias. The aim of this study was to analyze QTc interval and QTc dispersion in children with severe head trauma. METHODS: Forty-three patients with severe head trauma and 49 children with no or only mild head injury as controls were enrolled in the study. QT interval from standard 12-lead electrocardiogram immediately after admission was calculated. QT interval was corrected by heart rate according to Bazett formula, and then QTc dispersion was calculated. At the same time, levels of serum electrolytes were measured. RESULTS: Although no significant difference in terms of age, sex, and R-R interval was found, QTc interval and QTc dispersion values were significantly increased in the patients with severe head trauma compared with those with no or only mild head injury (QTc, 447 +/- 31 vs. 409 +/- 27 milliseconds; QTc dispersion, 77 +/- 22 vs. 52 +/- 16 milliseconds, respectively). When the patients with severe head trauma were categorized as those with or without intracranial hemorrhage, both QTc interval and QTc dispersion were significantly greater in those with intracranial hemorrhage. These electrocardiographic parameters were inversely associated with Glasgow Coma Scale score, serum calcium levels, and, at a lesser degree, potassium levels. CONCLUSIONS: Children with severe head trauma, especially those with intracranial hemorrhage have longer QTc interval and greater QTc dispersion.

Bilateral Internal Carotid Artery Occlusion as a Cause of Intraventricular Hemorrhage due to Pial Collateral Vessels.

In patients with high-grade atherosclerotic stenosis or occlusion of the extracranial cerebral arteries, subarachnoid hemorrhage (SAH) may occur, potentially due to rupture of fragile dilated pial collateral vessels. This association has been well described in Moyamoya disease. There are only few cases in the literature that reported SAH due to bilateral carotid artery stenosis but intraventricular hemorrhage caused by dilated pial collateral has not been reported yet. We present a case of bilateral carotid artery occlusion presented with intraventricular hemorrhage. Based on the findings in the present case, carotid artery stenosis or occlusion may present with intraventricular hemorrhage due to rupture of the dilated, fragile collateral vessels.