Neuroendoscopic approach to quadrigeminal cistern arachnoid cysts.

OBJECTIVE: The introduction of neuroendoscopy has provided a minimally invasive modality for the surgical treatment of quadrigeminal arachnoid cysts. Three pediatric patients with arachnoid cyst of the quadrigeminal cistern treated by endoscopic fenestration are reported. MATERIALS AND METHODS: The hospital records of patients were retrospectively rewieved. All patients had hydrocephalus. A lateral ventricle-cystostomy and endoscopic third ventriculostomy were performed by using rigid neuroendoscopes. RESULTS: There were one boy and two girls with ages 7 months, 9 months and 14 years, respectively. One patient had undergone shunting prior to neuroendoscopic surgery. The postoperative course was uneventful in all cases, with no complications. They showed disappearance of intracranial hypertension symptoms and significant reduction of the cyst size. CONCLUSION: Neuroendoscopic technique is an effective and suitable method for the treatment of quadrigeminal cistern arachnoid cysts and accompanying hydrocephalus.

The variations of the anterior choroidal artery: an intraoperative study.

AIM: Increasing use of surgical magnification for operations in the territory of the anterior choroidal artery (AChA) has created a need for detailed knowledge of their anatomical variations. The aim of the present study is to examine the anatomical variations of the AChAin patients operated via pterional approach. MATERIAL AND METHODS: The origin and branching pattern of AChAs were observed intraoperatively in 130 patients who were operated via a pterional approach at our center. RESULTS: AChAs arose from the internal carotid artery (ICA) and distal to the posterior communicating artery (PCoA) at a ratio of 70%, from just distal to the original point of the PCoA in 20%, and from just proximal to the ICA bifurcation in 10% of the patients. In 95 cases, AChAs arose from the inferolateral aspect of the ICA in the posterolateral aspect in 27 and from its lateral part in 8 cases. AChAs were found as a single branch at the origins from ICA in 110 patients, as double in 17 cases and as triple in 3 patients. CONCLUSION: Recognition of anatomical variations and microvascular relationships of AChA will allow neurosurgeons to construct a better and safer microdissection plan, to save time and can prevent postoperative neurological deficits.

A preliminary histopathological study of the effect of agmatine on diffuse brain injury in rats.

The present study evaluates the effects of agmatine on histopathological damage following traumatic injury using a clinically relevant model of diffuse brain injury. A total of 27 male Sprague-Dawley rats weighing 200-225 g were anaesthetised and subjected to head trauma using Marmarou's impact-acceleration model. The rats were then separated into two main groups: one was treated with agmatine and the other with saline for up to 4 days immediately after head trauma. Rats from both groups were killed 1, 3 or 8 days post-injury. The brains were examined histopathologically and scored according to the axonal, neuronal and vascular changes associated with diffuse brain injury. There were no significant differences between the groups at 1 day or 3 days after trauma, but evaluation after 8 days revealed a significant improvement in the group treated with agmatine. Our data indicate that agmatine has a beneficial effect in diffuse brain injury and should be trialled for therapeutic use in the management of this condition.

Treatment of spinal hydatid disease: a single center experience.

In Turkey, spinal hydatidosis remains a serious health problem that is associated with high morbidity and mortality. This study was undertaken to analyze the clinical, radiological, and surgical aspects and outcomes for five patients with spinal hydatidosis who were treated surgically at the Department of Neurosurgery of Ataturk University, Turkey. Despite the introduction of modern surgical and pharmacological therapy the disease remains difficult to cure, and patient outcomes are not satisfactory because of the high incidence of recurrence.

Acute interhemispheric subdural hematoma due to hemodialysis: case report.

BACKGROUND: Acute interhemispheric subdural hematoma (AISH) is an extremely limited complication in patients on maintenance hemodialysis. Diagnostic difficulties result from a fact that symptoms of acute hematoma such as headache, nausea, vomiting, apathy, sleepiness, paresthesia and seizures may also suggest dysequilibrium syndrome, dialytic dementia as well as hypertensive encephalopathy. CASE DESCRIPTION: A case of acute interhemispheric subdural hematoma during long-term dialysis is presented. CONCLUSION: AISH caused by hemodialysis is a very important complication. It is sometimes difficult to differentiate from dysequilibrium or dialysis dementia. Clinicians must pay closer attention on neurological examination of hemodialyzed patient. Surgical treatment must be as prompt as possible because of the possible sudden worsening of the patient's clinical condition.

The clinical, radiological and surgical aspects of cerebral hydatid cysts in children.

A series of 13 pediatric patients underwent surgery for cerebral hydatid cysts at the Department of Pediatric Neurosurgery between 1993 and 2003. Headache and motor weakness were the main initial signs of these patients. A round cystic lesion was the characteristic appearance on computed tomography of each patient. Different cyst locations such as the liver, kidney or spleen were detected in 5 patients. Surgery using Dowling's technique was performed in all patients as the main treatment. Intraoperative rupture and cyst recurrence were observed in only 1 patient. Subdural effusion, intraparenchymal air and hemorrhage were the main complications observed after surgery. None of the patients died after surgery. Because of its efficacy combined with excellent results, surgery is currently the method of choice in the treatment of cerebral hydatid cyst in children.

Effect of nimodipine on histological alterations in basilar artery following the bilateral common carotid artery ligation (preliminary study).

BACKGROUND: The blood supply to tissues is reduced as a result of arterial occlusions. Angiogenesis, collateral circulation and reverse flow mechanisms go into operation to restore a continued adequate supply of blood. Ca++ channels undertake the major part of this function. As a result of the increasing tension on the arterial walls, vascular autonomy is affected, and ischemia and even necrosis are observed. METHOD: Adult 100 male hybrid rabbits were used in this study. The bilateral carotid arteries were ligated at the carotid bifurcation. The rabbits were divided into 2 main groups: treatment and control, and then both groups were further divided into 5 subgroups consisting of 10 rabbits each. The rabbits were sacrificed between the first day and the end of 8 weeks for histopathological examination of the basilar artery in two groups. RESULTS: In control groups, after 24 hours of the occlusion partial swelling and minor endothelial damage were observed in histopathological sections of the basilar artery. Luminal flattening started to decrease, and expanding of the diameter continued. The increase in the diameters of the basilar artery was higher in animals treated by nimodipine, and that difference was statistically significant (P=0,000). CONCLUSION: This study revealed that the intimal and medial alterations arising from the increased blood flow rate in the basilar artery might be lessened and even partially prevented by the use of nimodipine.