Multiple (Concomitant) Traumatic Pseudoaneurysms of the Superficial Temporal Artery.

The authors present a case with a 22-year-old man suffering from a 2 pseudoaneurysms at the temporal region following trauma. The second pseudoaneurysm was diagnosed through an astute use of digital subtraction angiography along with ultrasound to the right external carotid artery which was preferred due to the presence of a vascular pathology at the region of the trauma. During surgery, the distal and proximal ends of both aneurysms were ligated and resected. The concomitant pseudoaneurysms and the use of digital subtraction angiography should be kept in mind in such trauma patients to prevent additional surgical interventions.

Congenital cavernous hemangioma of the skull.

Calvarial cavernous hemangiomas (CHs) comprise 0.2% of benign neoplasms of the skull and frequently occur in the second and fourth decades. Their occurrence in infancy is extremely rare and they can initially be misdiagnosed as cephal hematoma or caput succadeneum that can occur due to the birth trauma, but trauma is not a predisposing factor. CT scan is more helpful than other neuro-imaging studies and untreated CHs of the skull may show progression. Only two cases of congenital primary CH of the skull without intracranial invasion have been reported in the literature. Herewith we reported a 4-month-old infant operated on due to a CH of the parietal bone and discussed the diagnostic and therapeutic modalities.

Spontaneous supratentorial intracerebral hemorrhage: Does surgery benefit comatose patients?

INTRODUCTION: Treatment of spontaneous supratentorial intracerebral hemorrhage (SICH) is still controversial. We therefore analyzed the comatose patients diagnosed as having spontaneous SICH and treated by surgery. MATERIALS AND METHODS: We retrospectively analyzed the collected data of 25 comatose patients with initial Glasgow Coma Scale (GCS) ≤ 8 diagnosed as having spontaneous SICH and they had been treated by surgical evacuation between 1996 and 2008. The outcome was assessed using Glasgow outcome scale (GOS). The side and location of the hematoma and ventricular extension of the hematoma were recorded. The hematoma volume was graded as mild (<30 cc), moderate (30-60 cc) and massive (>60 cc). RESULTS: Age of the patients ranged from 25 to 78 years (mean: 59.6 ± 15.14 years). Among the 25 patients studied, 11 (44%) were females and 14 (56%) were males. GCS before surgery was <5 in 8 (32%) patients and between 5 and 8 in 17 (68%) patients. The hematoma volume was less than 30 cc in 2 patients, between 30 and 60 cc in 9 patients and more than 60 cc in 14 patients. Fourteen of the patients had no ventricular connection and 11 of the hematomas were connected to ventricle. All the 25 patients were treated with craniotomy and evacuation of the hematoma was done within an average of 2 hours on admission to the emergency department. Postoperatively, no rebleeding occurred in our patients. The most important complication was infection in 14 of the patients. The mortality of our surgical series was 56%. GCS before surgery was one of the strongest factors affecting outcome GCS (oGCS) (P = 0.017). Income GCS (iGCS), however, did not affect GOS (P = 0.64). The volume of the hematoma also affected the outcome (P = 0.037). Ventricular extension of the hematoma did affect the oGCS and GOS (P = 0.002), but not the iGCS of the patients (P = 0.139). CONCLUSION: Our data suggest that being surgically oriented is very important to achieve successful outcomes in a select group of patients with SICH.

The effect of repetitious concussions on cognitive functions in rats.

AIM: In this study, we aimed to investigate the effect of repetitious concussions on the spatial learning and memory function in rats. MATERIAL AND METHODS: 46 adult, male Sprague-Dawley rats were assigned to three homogenous groups by stratified random sampling according to their basal performance during the first four days of the Morris water maze (MWM), as Control (n=10), Sham (n=10) and Concussion (n=26) groups. On the 12th day, the MWM experiment was repeated to evaluate the memory function. Rats in the concussion group were then subjected to the first head trauma. Some of the trauma-applied rats were sacrificed for histopathological examination 4 hours (n=4) and 24 hours (n=3) after the trauma. The spatial memory function of the rest of the rats was re-evaluated by MWM on the 20th day. Some of the rats were then subjected to the second head trauma (n=13), four of which were then sacrificed at the 4th hour, and three of which were sacrificed at the 24th hour. On the 27th day, six rats that had received single concussion and the remaining six that had received two concussions were re-evaluated for retention development by the third MWM experiment. RESULTS: Escape latency curves showed a decrease in Sham and Control groups on the 20th and 27th days, and an increase in concussion group on the 20th day but no statistical significance was found between the groups. CONCLUSION: Repetitious concussions did not significantly affect spatial learning-memory functions in rats, and may lead to a counter-adaptive mechanism against concussive injury.

Post-traumatic C7-T1 Spondyloptosis in a patient without neurological deficit: a case report.

Traumatic cervical spondyloptosis has almost always been associated with disabling neurological deficit and we could only find one case without a neurological deficit reported in the literature. A 42 year old man suffering from severe neck pain following a high speed motor vehicle accident was admitted to our hospital. Magnetic resonance imaging (MRI) and computerized tomography (CT) of the cervical spine and neurologic examination of the patient were performed. The patient was treated with three-column fixation of the traumatic level. We aimed to report a unique case of traumatic C7-T1 total spondyloptosis without a neurological deficit and discuss possible mechanisms and treatment modalities.

Multilevel primary intraspinal PNETs in an infant associated with hydrocephalus.

PNETs of the spinal cord are aggressive and local recurrence and/or leptomeningeal spread is common. Primary spinal PNETs are extremely rare and most cases involving the spinal cord are drop metastases from primary intracranial tumors by cerebrospinal fluid. Herewith, we present a 40-day-old infant with multilevel primary spinal PNET at Th12-L1 and L5-S1 levels associated with hydrocephalus occurring nearly 15 days after the operation. According to our knowledge this is probably the first case harboring all these pathologies. Multilevel primary intraspinal PNET in an infant is even rarer and can be associated with hydrocephalus that occurs during the postoperative period.

Predictive value of leucocytosis in head trauma.

AIM: Head trauma is associated with an acute phase response which is characterized by leucocytosis due to increased levels of catecholamine and cortisol. Early edema formation following severe head injury may also be associated with microglia activation. Therefore, increased white blood cell (WBC) count after head trauma may be a predictive parameter of the severity of craniocerebral trauma. MATERIAL AND METHODS: We retrospectively studied 59 patients with severe, moderate and minor injury between February 2007 and March 2009. WBC counts of all patients were obtained within the first day of their admission. All patients were divided into separate groups according to their Glasgow Coma Scale (GCS) scores and hospital stay durations. Their CT progressions and Glasgow Outcome Scale (GOS) scores were also assessed. The relationship between these parameters and WBC counts were evaluated by statistical methods. RESULTS: There was a favorable correlation between WBC counts of the patients and GCS scores (pI0.01), hospital stay (p=0.006), CT progression (p < 0.01) and GOS scores (p < 0.01). CONCLUSION: AWBC count exceeding 17.5 x 106/l has a predictive value for poor GCS score, and long hospital stay. CT progression tends to be seen in patients with moderate and severe head injury.

Antiepileptic activity of melatonin in guinea pigs with pentylenetetrazol-induced seizures.

BACKGROUND: Antiepileptic and neuroprotective effects of melatonin (N-acetyl-5-methoxytryptamine) have been shown at higher doses (50-160 mg/kg). We aimed to investigate the antiepileptic effects of low-dose melatonin (10 mg/kg) on pentylenetetrazol (PTZ)-induced experimental epilepsy model. MATERIALS AND METHODS: Twelve male albino guinea pigs weighing 500-800 g were used in our work. Initially, latent period, seizure intensity and mortality parameters were evaluated during the epileptic seizure induced by PTZ. After a recovery period of 7 days, effects of the neuroprotective agent, melatonin (which is dissolved in 2.5% ethanol-saline solution), on epileptic seizures induced by PTZ were evaluated. Effects of 2.5% ethanol, which is an anticonvulsant agent when administered acutely in high concentrations, on PTZ-induced seizures were also evaluated. RESULTS: Data obtained from the study groups (PTZ, PTZ + melatonin and PTZ + ethanol) were evaluated by paired t-test, and p<0.005 was considered statistically significant. The differences of latent periods between the PTZ and PTZ + melatonin groups were found to be statistically significant (p<0.001). CONCLUSION: Although melatonin does not have a primary anticonvulsant effect at low doses (10 mg/kg), it lowers the mortality rates and attenuates seizure severity while increasing the latent period.

CSF rhinorrhea from a transclival meningocele: a case report.

The most common site of cerebrospinal fluid (CSF) leakage is through the floor of the anterior fossa, which communicates with the ethmoid or frontal sinuses or with the nasal fossa. The sphenoid sinus is rarely implicated as a source of spontaneous CSF fistula. Transclival meningocele is an extremely rare lesion. A 36-year-old woman with a 1-year history of intermittent CSF rhinorrhea was found to have a transclival meningocele. The diagnosis of transclival meningocele was made by magnetic resonance (MR), 3-dimension-computerized tomography (CT). At operation, by a transsphenoidal approach, the transclival meningocele was packed with fasia lata graft, fat tissue, and bio-glue. This is the third case of transsphenoidal transclival meningocele producing rhinorrhea in an adult. Transclival meningocele should be taken into consideration in patients with spontaneous CSF rhinorrhea.

Angiographically occult vascular malformation of the third ventricle.

Angiographically occult vascular malformations (AOVM) are cerebrovascular malformations that are not demonstrable on cerebral angiography. The majority of AOVMs located in the third ventricle are cavernous malformations. To the best of our knowledge an angiographically occult arteriovenous malformation (AOAVM) of the third ventricle has not been previously reported. We report an unusual vascular malformation of the third ventricle presenting with hydrocephalus due to mass effect, verified histopathologically as an AOAVM.

An unusual type of split cord malformation.

A 4-year-old girl with an unusual type of split cord malformation (SCM) is reported. She presented with a capillary hemangioma in the lumbosacral region. Computed tomography and magnetic resonance imaging studies of the whole spinal axis revealed SCM. There was a Type II SCM at the L1 level and a dorsal bony septum at the S2 level. The conus medullaris terminated at the upper end of the L2 vertebral body. There was no tethered cord syndrome. There is no reported case to date of SCM with this malformation. She did not undergo surgical treatment due to the absence of tethered cord syndrome. Her neurological examination was unremarkable and she is still being followed up without any neurological abnormalities.

Cirsoid aneurysms of the scalp.

This study reviewed the surgical management of cirsoid aneurysms of the scalp, which are rarely encountered in the neurosurgical practice, and compares the results with embolization. 21 patients with cirsoid aneurysm underwent surgery. There were 1 female and 20 male patients. Trauma was present in four patients. Selective internal and external carotid artery angiograms and cranial magnetic resonance imaging studies were performed on all patients. All angiograms were staged according to published procedures. There were 15 (71.4%) Stage 1a, 4 (19.1%) Stage 1b, and 2 (9.5%) Stage 3 patients. Total excision of the lesion was achieved in 19 patients (90.5%). We operated on only one patient for a second time, because of a residual lesion, and we resected the lesion totally. Only two patients developed necrosis of the scalp (button hole). Both scalp necroses were on the frontal area. Other patients all had good cosmetic results. Surgical resection of cirsoid aneurysms seems to be the most effective treatment with good results. There may be a tendency for the occurrence of necrosis on the frontal area. Staging of the scalp aneurysms has no effect on surgical outcome.

Peritumoral brain edema in intracranial meningiomas.

OBJECTIVE: The goal of this study was to determine the relationship between patient age and gender and meningioma location, histological subtype, size, lobulation and peritumoral brain edema (PTBE). PATIENTS AND METHODS: In a series of 55 patients with intracranial meningiomas, factors possibly related to the development of PTBE were analyzed. We used an EI (edema index) as the indicator of PTBE. EI was calculated by dividing the area of PTBE by that of the tumor. Thus if EI = 1, there is no PTBE. Univariate analysis was used to evaluate the relationship between EI and related factors. The MEI (mean edema index) difference between age groups was calculated using the Duncan Test. RESULTS: We found that none of the factors analyzed influenced PTBE except patient age 61-70 years, which correlated with PTBE (p = 0.022). The difference between MEI in the 41-50 years and 61-70 years age groups was significant, with that in the 61-70 years age group being significantly higher. CONCLUSION: We conclude that these findings in the 61-70 years age group may constitute an increased risk of perioperative mortality and morbidity.

Solitary intraspinal lumbar vertebral osteochondroma: a case report.

1-4% of osteochondromas involve the spine. They are commonly found in the posterior elements of the vertebra and can cause radicular symptoms. We report a 35 year-old man, suffering from right leg pain, which became worse over five years. His neurological examination revealed a positive right straight leg raising test and L4-L5 hypoesthesia. Lumbar computerised tomography (CT) and magnetic resonance imaging (MRI) studies revealed an exophytic, pedunculated bony projection. Osteochondroma should be considered while evaluating a patient with low back pain or radiculopathy without a CT or MRI appearance of a herniated lumbar disc.