The role of intravenous immunoglobulin in the treatment of cerebral vasospasm induced by subarachnoid haemorrhage: an experimental study.

OBJECTIVES: The aim of this study was to determine whether intravenous immunoglobulin (IVIG) prevents cerebral vasospasm in rabbits with induced subarachnoid haemorrhage (SAH). The effect of IVIG on apoptosis in the endothelial cells of the basilar artery was also evaluated. METHODS: Eighteen New Zealand white rabbits were allocated randomly into three groups. SAH was induced by injecting autologous blood into the cisterna magna. Group 1, the control group, was subjected to sham surgery (no induction of SAH). Group 2 had SAH alone and Group 3 had SAH plus IVIG. Three days after treatment, the animals were sacrificed. The basilar artery tissues were analysed histologically and the malondialdehyde levels in the brain stem tissues were evaluated biochemically. RESULTS: Differences in the histopathological luminal areas and full wall thicknesses in the SAH plus IVIG group and the SAH group were statically insignificant (p > 0.005). The malondialdehyde level was also found to be lower in the IVIG group than in the SAH group, although this difference was not significant (p > 0.005). CONCLUSION: Although the IVIG treatment was revealed to have no vasodilator effect on the SAH-induced spastic basilar artery, it was shown to have a beneficial effect on the apoptosis of endothelial cells, probably via anti-inflammatory mechanisms.

Beneficial effects of levosimendan on cerebral vasospasm induced by subarachnoid haemorrhage: an experimental study.

BACKGROUND: The aim of this study was to investigate the ability of levosimendan to prevent cerebral vasospasm in a rabbit model of subarachnoid haemorrhage (SAH). ANIMALS AND METHODS: Eighteen New Zealand white rabbits were allocated into three groups randomly. SAH was induced by injecting autologous blood into the cisterna magna. (Group 1 = control:sham surgery group, Group 2 = SAH alone group, Group 3 = SAH plus levosimendan group). Histopathological examination was performed on day 3 as described. Intravenous levosimendan dose (initially 12 microg kg(-1) infusion, continuously for at least 10 minutes and then continued with a dose of 0.2 microg kg(-1) min(-1)) treatment was started after the induction of SAH. Three days later, the animals were sacrificed. RESULTS: In pathological investigation; there was statistically significant difference in luminal area and muscular wall thickness of the basilar artery between all groups (p < 0.005). Malondialdehyde level was also found significantly low in the levosimendan group compared with the SAH group. CONCLUSION: Intravenous levosimendan treatment was found effective by increasing the pathological luminal area and reducing muscular wall thickness measurements. This is the first study to show that intravenous administration of levosimendan is effective in preventing cerebral vasospasm induced by SAH in rabbits.

Anatomic and radiologic analysis of the atlantal part of the vertebral artery.

The horizontal third segment (V3h) of the vertebral artery (VA) in 7 cadavers (14 sides) was dissected and the anatomical measurements recorded. Measurements from 24 healthy individuals (48 sides) were taken for comparison using multislice CT scanning. The distance between the medial tip of the VA V3h and the line passing through the mid point of the posterior tuberculum of the atlas was marked as length A. The distance between the medial tip of the VA V3h and the point penetrating the dura mater was classified as length B. The angle between these lines was the alpha (alpha) angle. Measurements were taken when the head was in a neutral position, as well as in maximum right and left rotation, extension and flexion. In cadavers, the mean alpha angle (+/-S.D.) was 82.42+/-10.34 degrees and 83.21+/-10.81 degrees on the right and left side, respectively. On multislice CT scanning, the mean alpha angle was 81.64+/-10.15 degrees on the right and 83.77+/-10.65 degrees on the left. These angles varied with the position of the head.

The lumbar roots and pedicles: a morphometric analysis and anatomical features.

The objective of this study was to conduct a morphometric analysis of the lumbar nerve roots and surrounding structures. In this investigation, the lumbar roots were studied in 14 cadavers (70 lumbar vertebrae). Lumbar pedicle heights and widths were measured at every level of the lumbar vertebrae. The largest mean root diameter was 5.6 mm (L5 root) and the smallest 3.5 mm (L1 root). With regard to the root-dura exit angle, the widest was measured at L1 as 26.2+/-1.6 degrees and the narrowest at L5 as 16.3+/-2.4 degrees. The widest lumbar pedicle was measured at L5 as 17.1+/-4.2 mm and the narrowest at L1 as 8.4+/-1.8 mm. The longest lumbar pedicle was measured at L2 as 15.3+/-2.2 mm and the shortest at L4 as 13.8+/-2.3 mm. Quantitative measurements of lumbar root diameters, their exit angles from the dura, and lumbar pedicle heights and widths in anatomical dissection models may help us to gain a deeper understanding of the pathologies of this region and positively influence the success of surgical interventions.

Primary lumbar vertebral hydatid cyst.

Spinal hydatid cyst is a serious and rare infectious disease. We report a case of spinal hydatid cyst at the second lumbar vertebra, and we discuss the clinical presentation, diagnosis and surgical treatment of vertebral hydatid cyst.

Deoxy-ribonucleic acid repair genes XRCC1 and XPD polymorphisms and brain tumor risk.

OBJECTIVES: To evaluate whether polymorphisms in the deoxy-ribonucleic acid (DNA) repair genes XRCC1 and XPD, have efficacy in the development of brain tumors. METHODS: This is a case-population based study, including 135 cases of brain tumors, and 87 population based age- and gender-matched healthy controls. We examined the role of XRCC1 Arg 399Gln gene and XPD Lys751Gln gene polymorphisms, in the context of brain tumor risk for the Turkish population between 2004 and 2007 at Selcuk University, Konya, Turkey. Patients with brain tumors were subdivided into glial tumors (n=71), meningiomas (n=35), pituitary adenomas (n=21), and metastases to the brain (n=8). The diagnoses of brain tumors in all patients were analyzed by histopathological examination. Genomic DNA of leukocytes for polymerase chain reaction analysis was isolated. RESULTS: Association of genotype of both XRCC1 Arg399Gln and XPD Lys751Gln genotypes with tumor types, tumors according to brain subtypes were, 71 (52.6%) meningiomas, 35 glial (25.9%), 21 (15.55%) pituitary adenomas, and 8 (5.9%) metastases to the brain. Between subtypes of tumors, there was a significant difference in XRCC1 Arg399Gln genotypes, and not in XPD Lys751Gln genotypes. CONCLUSION: The results indicated no elevated risk for brain tumors in individuals with the XRCC1 Arg399Gln and XPD Lys751Gln polymorphism risk.

Primary spinal intradural extramedullary hydatid cyst in a child.

BACKGROUND/OBJECTIVE: Spinal hydatid cyst is a serious form of hydatid disease affecting less than 1% of the total cases of hydatid disease. We present a case of pathologically confirmed primary intradural spinal cyst hydatid in an otherwise healthy patient who showed no other evidence of systemic hydatid cyst disease. CASE REPORT: An 8-year-old boy presented with back pain, left leg pain, and difficulty in walking. The patient had no other signs of systemic hydatid cyst disease. An intradural extramedullary cystic lesion was identified with magnetic resonance imaging and was shown to be a hydatid cyst by histopathologic examination after the surgical removal. CONCLUSION: Although extremely rare, primary intradural extramedullary hydatid cyst pathology might be the cause of leg pain and gait disturbance in children living in endemic areas.

A case report of firearm bullet settling into the thoracic spinal canal without causing neurological deficit or vertebral bone destruction.

OBJECTIVE: The main objective of this study was to present a case of gunshot injury in which a bullet particle settled into the inferior-thoracic epidural canal, which was neurologically intact, without causing any vertebral bone destruction. There has been no previous report in the literature regarding a foreign body settling into the vertebral canal following gunshot injury without causing any bony destruction. CASE REPORT: A 40-year-old male patient was hospitalized in emergency service with the complaints of severe pain in his back and both legs secondary to a gunshot wound. The entrance wound of the traversing projectile was located at the level of the tenth costa at the inferior of the right scapula. Neurological examination revealed no motor deficit. His lung X-ray was normal at radiological examination. Direct radiograph determined a bullet nucleus on the medium line at thoracolumbar level T-12. Intracanalicular bullet nucleus was found at posterior epidural at the T-12 level on thoracic CT, myelography and CT myelography. No vertebral bone destruction was seen in the direct radiograph studies and serial CT. T12 total laminectomy was performed and epidural foreign body removed. The patient, whose pains ameliorated during the postoperative process, was discharged without any neurological deficit. CONCLUSION: We prefer removal of firearm particles settling into the spinal canal in view of possible later complications such as infection and the toxic effect of the metallic particles, unless there appears any risk of neurological detriment to the patient.

An unusual association of optic hydrops and Reiter`s syndrome.

The association of optic hydrops and Reiter`s syndrome in the literature has not been mentioned previously. This syndrome characteristically consists of 3 manifestations: arthritis, urethritis, and conjunctivitis. A 42-year-old woman with a history of Reiter`s syndrome presented with progressive vision disturbance in her left eye and with headache. Orbital MRI demonstrated enlarged perioptic nerve subarachnoidal space on the left side.

Efficacy of Adcon-L gel or Healon-GV in epidural fibrosis after lumbar microdiscectomy.

OBJECTIVE: To evaluate the efficacy of anti-adhesion barrier agents following lumbar microdiscectomy. METHODS: Healon GV or Adcon-L was applied to a laminectomy defect overlying the duramater in 60 patients assigned to 3 randomized groups: Group I - Adcon-L (n=21), Group II - Healon GV (n=21), and Group III - control group, no adhesion barrier used (n=18). We conducted this study between 2004 and 2006 at Selcuk University, Konya, Turkey. RESULTS: No significant difference was found between the 3 groups either in the outcome measurements according to visual analogue score and the Oswestry Disability Index or in the radiological evaluation of epidural fibrosis by application of those anti-adhesion barrier agents. When comparing group III with groups I and II, we could not find a statistically significant difference in the clinical results and in the outcome measures (p>0.01). CONCLUSION: The epidural application of popular anti-adhesion barriers, after lumbar microdiscectomy was not found to be effective regarding outcome measures in human spinal surgery.

Congenital cranial and spinal dermal sinuses: a report of 3 cases.

Three cases of congenital dermal sinus are presented--2 female and 1 male. Frontal, thoracic, and lumbosacral congenital dermal sinuses were explored. All patients presented with skin findings, but no neurologic deficits. The case with frontal localization was associated with a corpus callosum lipoma and dermoid tumor, and the patient presented with recurrent meningitis. The case with sacral localization was associated with an epidermoid tumor. Morphogenetic, clinical, and radiologic aspects of these cases are discussed. The midline should be carefully examined whenever a child suffers from meningitis. Dermal sinus tracts should be excised prophylactically.

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.

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.

Pediatric cerebellar cystic oligodendroglioma: case report and literature review.

Oligodendrogliomas rarely occur in the posterior fossa of childhood and constitute approximately 1% of pediatric brain tumors. Only six pediatric posterior fossa oligodendroglioma cases have been reported to date and none of them were cystic. The authors present a seven-year-old girl with cystic, cerebellar midline localized tumor. A standard suboccipital craniectomy was performed and the tumor was histologically confirmed as oligodendroglioma. After operation the patient underwent radiation therapy and at one the-year follow-up, no recurrence of the tumor was observed.

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.

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.