Dual stenting using low-profile LEO baby stents for the endovascular management of challenging intracranial aneurysms.

BACKGROUND AND PURPOSE: Endovascular treatment of wide-neck, complex, and distally located cerebral aneurysms is a challenging issue. This study evaluated the safety and efficacy of dual stent placement by using a low-profile stent system (LEO Baby) for the treatment of challenging distal intracranial aneurysms. MATERIALS AND METHODS: We retrospectively reviewed patients in whom at least 1 LEO Baby stent was used in the context of dual stent placement for the treatment of intracranial aneurysms. Patients who were treated with dual stent-assisted coil embolization and telescopic implantation of LEO Baby stents were included in the study. Clinical and angiographic findings, procedural data, and follow-up are reported. RESULTS: Twelve patients were included in this study. Three patients presented with subarachnoid hemorrhage in the subacute-chronic phase, and the remaining patients had unruptured aneurysms. Nine patients were treated by using the dual stent-assisted coiling method. X- (nonintersecting), Y- (intersecting and reversible), T-, and parallel-stent configurations were performed for the dual stent-assisted coiling procedures. Three patients were treated by using telescopic stent placement for a flow diverter-like effect. The procedures were successful in all cases. Technical complications without a significant clinical adverse event developed in 2 patients. The 3- and 6-month control MRAs and DSAs demonstrated complete occlusion of the aneurysms in all patients except 1. All patients had good clinical outcomes on follow-up (mRS ≤1). CONCLUSIONS: The results of this small study showed the feasibility of dual stent placement by using low-profile LEO Baby stents to treat distally located complex intracranial aneurysms.

Comparison of unilateral hemilaminotomy and bilateral hemilaminotomy according to dural sac area in lumbar spinal stenosis.

INTRODUCTION: Unilateral hemilaminotomy (ULH) and/or bilateral hemilaminotomy (BLH) with limited facetectomy are defined approaches to decompress the thecal sac and exiting lumbar nerve roots without increasing the risk of subsequent spinal instability. METHODS: We retrospectively analyzed 18 cases with degenerative lumbar spinal stenosis (LSS) with BLH or ULH that was performed in 11 and 7 cases, respectively. Magnetic resonance imaging (MRI) was performed at the follow-up examination and dural sac area (DSA) was calculated on T(2)-weighted MRI images and then compared statistically. In addition, the economic and functional status of the patients were evaluated with the Prolo scale. RESULTS: The mean preoperative values on the visual analogue scale (VAS) were 7.1 for lumbalgia and 7.0 for leg pain, respectively. These values were calculated as 4.8 and 4.4 at the follow-up, respectively. The VAS was significantly improved after operation compared to preoperative values (p=0.001). The mean value of the DSA was 84 (+/-32) mm(2) before the operation and 126 (+/-35) mm(2) at the follow-up and the comparison was statistically significant (p=0.001). No statistical correlation was found between VAS and DSA or between VAS and ULH-BLH groups, however, DSA of the BLH cases was significantly higher than in the ULH group (p=0.035). There was a significant negative correlation between VAS scores (back and leg pain) and Prolo status. However, there was no significant difference between DSA and Prolo scores, and between ULH or BLH groups in terms of Prolo scores. CONCLUSION: A unilateral approach with bilateral decompression and bilateral approach with bilateral hemilaminotomy are both minimal invasive, adequate and safe approaches with excellent prognosis. However, BLH leads to a bigger expansion of DSA.

Orbitocerebral injury by a knife: case report.

Orbital penetrating injuries may cause significant harm to the optic nerves and eyeball as well as to the brain and cerebral vessels. Management of orbital foreign bodies should include prompt recognition of the extent of the injury, broad-spectrum parenteral antibiotics, tetanus prophylaxis, anticonvulsant medication and early surgical intervention under direct vision to remove the foreign body and to avoid immediate and long-term complications. We report a penetrating orbital injury caused by a bread knife that extended from the orbit to the tegmental dura mater of the temporal bone. The knife's main trajectory coursed through the temporal lobe. Adjacent cerebral structures were explored before removal of the knife.

Neuroprotective effect of melatonin on experimental peripheral nerve injury: an electron microscopic and biochemical study.

BACKGROUND AND STUDY AIMS: Melatonin is an important antioxidant agent with a protective role in the prevention of oxidative stress. We designed an experimental study which focused on the potential neuroprotective effect of melatonin on peripheral nerve injury. MATERIALS AND METHODS: Sciatic nerve injury was induced in the mid thigh region of 30 male Wistar rats by clip compression. Melantonin was injected intraperitoneally in 15 of the 30 rats. Electron microscope and biochemical studies were performed to assess the potential beneficial effect of melatonin on peripheral nerve regeneration. Changes to cellular organelles, myelin lamellae and axons were studied. RESULTS: There was a significant difference between the melatonin and nerve injury groups. Rats treated with melatonin demonstrated significant structural protection of the myelin lamellae compared to the nerve injury group. Axonal shrinkage and myelin changes were not prominent histopathologically in melatonin-treated group. Biochemical analysis confirmed the neuroprotective effects of melatonin with significantly lower lipid peroxidation and myeloperoxidase activity measurements in the melatonin-treated group compared to the neural injury group. The results indicate that melatonin can improve neural healing. CONCLUSION: With its neuroprotective effect, as demonstrated in this experimental peripheral nerve injury, melatonin might be used successfully in clinical practice. Further studies on the correct dosage and possible side effects are necessary.

Lumbar epidural abscess caused by brucella species: report of two cases

Spinal epidural abscess due to Brucella species isusually associated with spondylodiscitis. Urgent surgicaldecompression should be performed in cases withmoderate to severe neurological deficits particularlyif progressive. We report clinical features of two casesoperated for lumbar epidural abscess caused by Brucellaspecies. Early surgical decompression combinedwith medical treatment could decrease progression ofneurological findings or the severity of complications.Iatrogenic dural tear at the operation should be repairedimmediately with fine sutures and fibrin tissue glueto prevent further innoculation into the cerebrospinalaxis. These cases should be cautiously followed for anyrecurrence or neurobrucellosis (AU)

Los abscesos epidurales espinales debidos a Brucellase asocian habitualmente a espondilodiscitis. Ladescompresión quirúrgica urgente debe ser realizadaen casos con déficit neurológico moderado o graveparticularmente si este es progresivo. Describimos losaspectos clínicos de dos casos operados por abscesosepidurales causados por Brucella. El tratamiento quirúrgicotemprano asociado con tratamiento médicopuede disminuir la progresión de la sintomatologíaneurológica y la gravedad de las complicaciones. Laaparición de desgarros durales durante la cirugía debeser reparada de forma inmediata con sutura o pegamentosde fibrina para prevenir la inoculación dentrodel neuroeje. Estos casos deben ser seguidos de formacuidadosa para evitar la recurrencia de la neurobrucelosis (AU)

Cystic olfactory schwannoma of the anterior cranial base.

Olfactory groove schwannomas are extremely uncommon and less than 30 cases are reported in the literature. We report a 21-year-old developmentally-retarded boy who experienced severe headache and aggressive behaviour for 5 months. Imaging showed a cystic mass in the subfrontal region, which was removed by craniotomy. The lesion had a vascular supply from the anterior ethmoidal arteries and it was noted to be attached to the right olfactory nerve. It was removed completely and histology showed it to be a schwannoma. Olfactory groove schwannomas are rare lesions and should be differentiated from meningiomas, neuroblastomas and dural-based metastatic lesions of the anterior cranial base.

An effective and less invasive treatment of post-traumatic cerebrospinal fluid fistula: closed lumbar drainage system.

Cerebrospinal fluid (CSF) leakage may develop when a defect is formed in dural layers by traumatic or iatrogenic processes. Traumatic CSF leakage was encountered in 2% of head injuries. CSF leakage is an associated feature of 12-30% of skull base fractures. Numerous treatment modalities are proposed for the management of CSF leaks. A closed lumbar drainage system (CLDS) is recommended as an alternative method to surgery for preventing complications related to leakage. In the present study, we report the clinical details of 46 patients who suffered from rhinorrhea/otorrhea (R/O), three of whom were urgently operated due to other causes like subdural hematoma and tension pneumocephalus. Leakage spontaneously ceased in 26 (60.4%) patients whereas CLDS insertion was found to be necessary in 17 patients. A prophylactic antibiotic regimen was started in the CLDS group and these patients were followed with daily CSF cell counts. Fifteen patients (88.2%) were successfully treated by CLDS, however meningitis developed in 2 patients (11.7%). Severe complications like meningitis could be avoided by a simple daily microbiological analysis of CSF.

Rare intracranial manifestations of frontal osteomas.

Osteomas of the paranasal sinuses are usually asymptomatic. When enlarged, they could give rise to intracranial manifestations and serious complications. Osteomas most commonly affect the fronto-ethmoid sinuses. They rarely show intra-orbital extension or cause intracranial complications such as CSF rhinorrhea, pneumocephalus and intracranial infection. We report two unusual cases of frontal osteomas complicated by rare manifestations such as intracranial mucocele, CSF leak, pneumocephalus and bacterial meningitis. We demonstrate the importance of these intracranial manifestations when these lesions are accompanied by neurological symptoms and signs with special emphasis on the importance of early treatment.