Microsurgical training model for residents to approach to the orbit and the optic nerve in fresh cadaveric sheep cranium.

BACKGROUND: Neurosurgery and ophthalmology residents need many years to improve microsurgical skills. Laboratory training models are very important for developing surgical skills before clinical application of microsurgery. A simple simulation model is needed for residents to learn how to handle microsurgical instruments and to perform safe dissection of intracranial or intraorbital nerves, vessels, and other structures. MATERIALS AND METHODS: The simulation material consists of a one-year-old fresh cadaveric sheep cranium. Two parts (Part 1 and Part 2) were designed to approach structures of the orbit. Part 1 consisted of a 2-step approach to dissect intraorbital structures, and Part 2 consisted of a 3-step approach to dissect the optic nerve intracranially. RESULTS: The model simulates standard microsurgical techniques using a variety of approaches to structures in and around the orbit and the optic nerve. CONCLUSIONS: This laboratory training model enables trainees to gain experience with an operating microscope, microsurgical instruments and orbital structures.

[Infection in patients with isolated head injury: risk factors and the impact on treatment cost]. / Izole kafa travmali olgularda enfeksiyon: Risk etkenleri ve tedavi maliyeti üzerine etkisi.

BACKGROUND: We aimed to determine risk factors and the impact on treatment cost of infection in patients with isolated head injury. METHODS: Data acquired from 299 patients (239 males, 60 females; mean age 35,1±23,2 years) with isolated head trauma who were hospitalized for more than 72 hours at Trakya University Training and Research Hospital between 2001-2007 were evaluated retrospectively. Data including age, gender, initial neurological examination, radiological findings, duration of hospitalization, need for surgery, cost of infection treatment, total cost of care, and outcome scores were determined. Two groups divided according to the development of infection were compared for risk factors and the impact of infection on the cost of treatment. RESULTS: In the group of patients with infection, the mean Glasgow Coma Scale score at delivery was lower; anisocoria, light reflex loss, lateralized deficit, skull base fracture, subdural hematoma, and cerebral edema findings were more frequent. A four-times longer hospital stay, 10-times higher total cost and a significantly increased mortality rate were determined in this group. For the patients with light head injury, in the group of patients with infection, the mean age was found to be higher. CONCLUSION: For patients with isolated head injury, there are some risk factors for the development of infection that increase the hospitalization duration, total cost of care and mortality rates.

Pure peroneal intraneural ganglion cyst ascending along the sciatic nerve.

Peroneal nerve entrapment is most commonly seen in the popliteal fossa. It is rarely caused by a ganglion. Intraneural ganglia, although uncommon and seldom cause serious complications, are well recognized and most commonly affect the common peroneal (lateral popliteal) nerve. Ganglionic cysts developing in the sheath of a peripheral nerve or joint capsule may cause compression neuropathy. The differential diagnosis should involve L5 root lesions, posttraumatic intraneural hemorrhage, nerve compression near the tendinous arch located at the fibular insertion of the peroneal longus muscle and nerve-sheath tumors. We present a unique case of a pure intraneural ganglion of the common peroneal nerve ascending along the sciatic nerve. This case underscores the importance of consideration of an intraneural ganglion cyst with sciatic nerve involvement.

Hereditary neuropathy with liability to pressure palsies in a Turkish patient (HNPP): a rare cause of entrapment neuropathies in young adults.

Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal dominant nerve disease usually caused by 1,5 Mb deletion on chromosome 17p11.2.2-p12, the region where the PMP-22 gene is located. The patients with HNPP usually have relapsing and remitting entrapment neuropathies due to compression. We present a 14-year-old male who had acute onset, right-sided ulnar nerve entrapment at the elbow. He had electrophysiological findings of bilateral ulnar nerve entrapments (more severe at the right side) at the elbow and bilateral median nerve entrapment at the wrist. Genetic tests of the patient demonstrated deletions in the 17p11.2 region. The patient underwent decompressive surgery for ulnar nerve entrapment at the elbow and completely recovered two months after the event. Although HNPP is extremely rare, it should be taken into consideration in young adults with entrapment neuropathies.

Giant cervicothoracic extradural arachnoid cyst: case report.

The pathogenesis, etiology, and treatment of the spinal arachnoid cyst have not been well established because of its rarity. A 57-year-old male was presented with spastic quadriparesis predominantly on the left side. His radiological examination showed widening of the cervical spinal canal and left neural foramina due to a cerebrospinal fluid-filled extradural cyst that extended from C2 to T2 level. The cyst was located left anterolaterally, compressing the spinal cord. Through a C4-T2 laminotomy, the cyst was excised totally and the dural defect was repaired. Several features of the reported case, such as cyst size, location, and clinical features make it extremely unusual. The case is discussed in light of the relevant literature.

Reversible postictal MRI change mimicking structural lesion.

A reversible change on magnetic resonance imaging (MRI) following generalised seizure mimicking a tumour-like structural lesion is reported in a 15-year-old patient. MRI revealed a left fronto-parietal cortico-subcortical lesion on T2 weighted images. The control MRI after 5 weeks from the onset revealed no pathological finding. The reversible MRI changes may be the result of a local brain swelling, and a defect of cerebral autoregulation during seizure at the site of activity. The transient nature of such neuroradiological findings have to be taken into consideration in the differential diagnosis because of their similar appearance on imaging to intrinsic brain tumours.