Composite type of split cord malformation: two different types at three different levels: case report.

The authors report on a child with a composite type of split cord malformation (SCM). The patient presented with symptoms of a common cold. The diagnosis of SCM was made based on computerized tomography and magnetic resonance (MR) imaging of whole spinal axis. The SCM was Type I at T-4 and T-5 and Type II at T-12, according to the classification developed by Pang. The child underwent resection of the splitting lesions and terminal filum release. No case of composite-type SCM reported to date contains documentation of such a malformation. Because of the possible neurological and urological problems, the authors recommend MR imaging of the whole spine be performed during/an evaluation for SCM.

Desmoplastic fibroma of the cervical spine.

There have been only a few cases of desmoplastic fibroma of the spine in the literature and only one of them was purely located on the cervical spine. We report a new patient with the diagnosis of desmoplastic fibroma of the fourth cervical spine. The patient had the complaints of left arm and neck pain. After his radiological evaluation, a mass lesion was found on the left lamina of the fourth cervical spine. Surgical treatment was performed, and the histopathological examination revealed the diagnosis of desmoplastic fibroma. Patients with desmoplastic fibroma of the cervical spine may present with the arm and neck pain mimicking cervical disc disease. Higher index of suspicion by the clinicians must be practiced to make the appropriate diagnosis. Successful surgical outcome may be achieved in these patients.

The clinical and surgical aspects of spinal tumors in children.

A series of 20 pediatric patients underwent surgery for spinal tumor at the Department of Neurosurgery, Gulhane Military Medical Academy between 1995 and 2003. Motor weakness and reflex changes were the main initial signs in these patients. Epidural tumors and intradural-extramedullary tumors were in equal number, and total tumor removal was achieved in most of the patients without adjuvant treatment. Laminotomy was the main surgical method in 60% of the patients with spinal tumor, especially in children younger than 3 years of age.

Surgical outcomes of ulnar nerve lesions in children. A retrospective clinical study.

The ulnar nerve provides the major motor innervation of the interosseous muscles of the hand and the flexor muscles of the wrist and the fourth and fifth digits. Injury is most common at the wrist, forearm or elbow, secondary to trauma or entrapment. Pediatric ulnar nerve lesions differ from adult lesions by their quicker axonal regeneration. Neural plasticity is also greater in children. We analyzed 21 pediatric patients with ulnar nerve lesion who underwent surgical treatment between 1995 and 2002 to determine if there were differences in the neurological outcome in terms of the type of lesion and surgery. Data showed that excellent results were found in 100% of the lesions treated by simple decompression and nearly 58% of the lesions treated by neurolysis. Good results were obtained in 33% of lesions treated by neurolysis. There were fair results for surgery performed in discontinuous lesions.

Association of paranasal sinus osteoma and intracranial mucocele--two case reports.

Two young adult males presented with paranasal sinus osteoma associated with mucocele. A 20-year-old man presented with headache and seizure, and another 20-year-old man presented with headache, frontal deformity, and visual disturbances. Both patients underwent surgery and satisfactory results were obtained. Isolated paranasal sinus osteomas are benign and slow-growing tumors, but may become more aggressive in association with mucoceles. The higher aggressiveness of the lesions may be due to the presence of the mucocele. Calcification and ossification of the mucocele probably contributes to the unexpected enlargement of the osteoma.

Surgical outcomes of cerebellar tumors in children.

Cerebellar tumors in childhood are generally associated with a favorable outcome if they are managed appropriately. 27 cases of pediatric cerebellar tumors, operated over a 7-year period, are presented. Histopathological diagnoses were as follows: pilocytic astrocytoma (48.2%); medulloblastoma (22.2%); ependymoma (18.5%); fibrillary astrocytoma grade III (3.7%); cystic oligodendroglioma (3.7%), and hemangioblastoma (3.7%). Microscopic gross total resection was achieved in 16 (59.3%) of 27 cases. The total removal of pediatric cerebellar tumors without neurological deficit is possible with appropriate microsurgical techniques excluding brain stem invasion. The follow-up periods must be shorter if brain stem invasion exists. Radiotherapy and chemotherapy are the adjuvant therapies according to the pathological diagnosis and the patient's age.

Split cord malformation in adults.

Although split cord malformations have been well documented in children, there is no consensus about their surgical indications and clinical course in adults because of their rarity. Medical records of nine young adult patients with split cord malformations were reviewed retrospectively. The most common complaint was radicular low back pain persisting more than 1 year, and the most common finding was hypertrichosis. Adult split cord malformation patients in our series had neither scoliosis nor foot deformities. Radiologically, all had low-situated conus medullaris. Eight of them underwent surgery. The radicular low back pain decreased in all the surgically treated patients at short-term follow-up but had not disappeared. Although pain originating from split cord malformations seems to be the most common surgical indication in adult patients and shows good short-term results, in our opinion long-term pain improvement is necessary for confirmation. According to our results, it seems that symptomatic young adults with split cord malformations are good candidates for complaint and deficit stabilization surgery.

The initial treatment of meningocele and myelomeningocele lesions in adulthood: experiences with seven patients.

This is a retrospective study of patients having undergone surgical treatment of spina bifida cystica (SBC) lesions in adulthood. The objectives were to assess the clinical, radiological, and surgical characteristics of SBC lesions in adults. There is almost no study assessing these characteristics. Seven adult male patients with SBC lesions, ages between 20 and 23 (mean 21.1), had their primary evaluations between 1995 and 1999 in the Military Hospital, Yzmir, and Gülhane Military Medical Academy, Ankara. A temporary cerebrospinal fluid leak in the patient with the thoracic lesion and a temporary partial urinary incontinence in the patient with the lumbosacral lesion occurred. The most common preoperative complaint was low back pain. This improved in three of four patients (75%) but did not disappear. Although it is rare, an adult with an untreated SBC is a possible entity. These lesions should be included in the differential diagnosis of dorsal midline lesions in adults. Even though they appear as a simple spinal meningocele clinically, preoperative MR imaging and CT are necessary and helpful in the precise diagnosis and surgical planning.

Fracture and lateral dislocation of the T12-L1 vertebrae without neurological deficit--case report.

A 21-year-old man suffered T12-L1 vertebrae fracture and lateral dislocation without neurological deficit. Computed tomography and magnetic resonance imaging demonstrated the fracture and lateral dislocation of the thoracolumbar spine. The injured spine was realigned with rods and screws, and bony fusion of the affected vertebrae was performed. Patients with thoracolumbar fracture-dislocation without neurological deficit may suffer unintended neurological injury secondary to maneuvers that cause further dislocation of the spine. Severe spinal injury without neurological deficit should be evaluated in detail, especially with spinal computed tomography. Internal fixation and reduction are recommended if the patient's condition is suitable for surgery.

[Traumatic dissection of bilateral vertebral arteries]. / Travmatik bilateral vertebral arter diseksiyonu.

58-year-old male comatose patient following a motor vehicle accident with a history of coronary bypass surgery 5 years ago has been presented. The patient was awake after the accident and he became comatose 30 minutes after the accident. The early diagnostic investigations showed no responsible cranial or spinal lesion. At the 2nd day of the accident, diffusion weighted magnetic resonance scans, magnetic resonance arteriography and digital subtraction arteriography revealed bilateral vertebral artery dissection at the second part of the vertebral arteries. Clinical, radiological features and treatment options of the vertebral artery dissection has been discussed with the ertinent literature.

Medulloblastoma of the cerebellopontine angle--case report.

A 21-year-old male patient presented with a rare cerebellopontine angle medulloblastoma manifesting as cerebellar and long tract involvement signs and symptoms. The clinical and radiological characteristics of the lesion were similar to extraaxial lesions of cerebellopontine angle. The histological diagnosis of the lesion was medulloblastoma. Surgery achieved partial removal and was followed by radiotherapy and chemotherapy. The patient remained well after 18 months. Medulloblastoma of the cerebellopontine angle is a relatively rare clinical entity and may occur as a dural-based extraaxial mass.

Congenital absence of internal carotid artery associated with hypogonadotropic hypogonadism--a case report.

Congenital absence of internal carotid artery is a relatively rare disorder. It may be an isolated entity or combined with other organ or system anomalies. Investigations of a 19-year-old male patient with hypogonadotropic hypogonadism and hypothyroidism suffering from intracerebral and subarachnoid hemorrhages showed absence of the left internal carotid artery. The association of endocrinologic disorders and congenital absence of internal carotid artery is discussed with the pertinent literature. In conclusion, association of the absence of internal carotid artery and hypogonadism is extremely rare. Patients with absence of internal carotid artery may also have intracerebral and subarachnoid hemorrhages and should be followed up closely.

Dorsal bony septum: a split cord malformation variant.

Split cord malformations (SCMs) are rare spinal anomalies and their classification is still a matter of debate. There is no widespread consensus on the embryological basis of this entity. The unified theory, proposed by Pang et al. [Neurosurgery 1992;31:451-480], was an attempt to explain the embryogenetic mechanism as a basic error occurring around the time when the primitive neuroenteric canal closes. We report two unusual cases of SCMs with a dorsally situated bony spur. We analyzed the radiological, clinical and surgical features of the lesions and were not able to classify these cases according to the unified theory. Further embryological studies should be conducted to elucidate the mechanisms of occurrence of these lesions, and the dorsal bony septum variant should be considered in SCM surgery.