Meningiomas of the Cerebellopontine Angle: Tips and Pearls for Safe Surgical Resection.

AIM: To present our series of cerebellopontine angle (CPA) meningiomas, and to provide some innovative surgical steps for safe removal of these tumors. MATERIAL AND METHODS: The clinical, radiological, and surgical characteristics of 32 patients with meningioma in the CPA were retrospectively analyzed. A statistical analysis was performed to determine the factors that affect the incidence of complication. RESULTS: The mean age was 49.5 yr, and 87.5% of patients were men had World Health Organization (WHO) grade I meningioma, while the remaining patients had WHO grade II tumors. The mean tumor volume was 33.98 mL, and gross total resection was performed on 65.6% of the patients. Preoperative tumor size/extension and extent of resection were related with the development of complications. CONCLUSION: CPA meningiomas are challenging tumors to remove safely. Important risk factors for the development of postoperative complications include tumor size and extent of resection.

Endoscopic Lavage for the Treatment of Multiple Shunt Failures in Children.

AIM: To compare the efficacy of neuroendoscopic lavage (NEL) and shunt revision (SR) in the treatment of multiple shunt failures in children with hydrocephalus. MATERIAL AND METHODS: The data of 56 pediatric patients who underwent surgeries for the treatment of shunt failure were retrospectively reviewed. Patients were divided into two groups, i.e., the simple SR (Group A) and the NEL+SR (Group B) cohorts. Demographic characteristics, co-morbidities, surgical interventions, cerebrospinal fluid analyzes, and complications were recorded and statistically compared between the groups. RESULTS: Among the 56 enrolled patients, 51 presented with shunt dysfunction caused by infectious debris or clots at different times. Moreover, 28 of these 51 patients (54.9%) were female and 23 (45%) were male. The mean age was 7.3 months. Simple SR was performed in 30 cases (Group A), and NEL and simultaneous SR were performed in 21 patients (Group B). The risk of shunt dysfunction was significantly lower in Group B (p < 0.05).The risk of infection was elevated in Group A; however, this difference was not statistically significant (p > 0.05). CONCLUSION: Simultaneous endoscopic lavage and SR was an effective method for the treatment of shunt dysfunction in children. It was also superior to simple SR regarding the risk of shunt dysfunction. Additional clinical studies are needed to verify this outcome.

Spontaneous migration of a bullet in the cerebrum.

Herein, we report the case of a 32-year-old man who experienced spontaneous migration of a bullet within the brain following a gunshot injury. Emergent computed tomography revealed the bullet located in the posterosuperior side of mesencephalon. During follow-up after 10 days, the neurological status of the patient had worsened. Computed tomography revealed that the bullet had migrated posteriorly and lodged in the occipital lobe. Although a few studies have reported on the spontaneous migration of a bullet within the brain, the present case is unique as the patient examination changed with migration. We recommend serial imaging and surgery in cases of bullet migration in the brain.

Effects of Zinc Oxide on mRNA Expression of Genes in Brain Tissue of Rats.

AIM: To investigate the expression of the DR4, DR5, OPG, DcR1, and DcR2 in rat brain tissue. MATERIAL AND METHODS: Thirty rats were used in this study. The rats were divided into three groups as the control group (n=10), tumor group (n=10), and zincoxide (ZnO) nanoparticles (NP) treatment group (n=10). The reverse transcription polymerase chain reaction (RT-PCR) and Western Blotting methods were used to measure the expression of DR4, DR5, OPG, DcR1, DcR2 and β-actin in the brain tissues of all the three groups. RESULTS: Expression of DR4, DR5, OPG, DcR1, and DcR2 genes were decreased in the tumor group. Overexpression of DR4, DR5, OPG, DcR1, and DcR2 was observed in brain tissues of the ZnO-NP group. CONCLUSION: Increased expression of the DR4, DR5, OPG, DcR1, and DcR2 genes may play an important role in ZnO-NP treatment of brain tumors.

Parieto-Occipital Interhemispheric Precuneal Approach to the Lesions of the Atrium: Experience with 66 patients.

AIM: The atrium (trigone) is the most common site for intraventricular lesions. The parieto-occipital interhemispheric precuneal approach (POIPA) is one of the particular ways to reach these lesions. The aim of this study was to draw specific attention to the surgical difficulties of these lesions and to present our experience with this operative approach. MATERIAL AND METHODS: Sixty-six patients with lesions located in the atrium of the lateral ventricles underwent surgical treatment in our institution using POIPA over a 13-year period. The clinical, radiological and surgical characteristics of these patients were retrieved and reviewed retrospectively. The histological diagnosis of the cases and postoperative complications were specifically focused on in this study. RESULTS: Thirty-six (54.5%) patients were male and 30 patients were female with a mean age 37.9 years (range between 8 and 74 years). The lesion was in the right atrium in 25 cases and in the left in 41 (62.1%) patients. POIPA was used in all cases to remove the lesions. The most common tumor was glioblastoma (34.8%), followed by glial tumors grade I, II and III and meningiomas. The other lesions were metastases, ganglioglioma, epidermoid cysts and arteriovenous malformations. Gross total resection of the tumors was achieved in 59 patients (89.4%) while subtotal removal was performed in 7 cases. Five (7.5%) patients died within the first month after surgery. Conclusion: POIPA provides a safe and effective way to reach lesions located in the atrium of the lateral ventricle. Knowledge of precise anatomy associated with the meticulous surgical techniques decreases the surgical morbidity and mortality of the patients.

Anterior Skull Base Defects Reconstructed Using Three-Layer Method: 78 Consecutive Cases with Long-Term Follow-Up.

Objectives Anterior skull base defects are potentially lethal and surgical treatment must be performed as soon as possible. The purpose of this study was to evaluate whether our technique is effective or not in long-term period. Design Retrospective chart review of all patients whose data were entered into the Hospital Registry System between 1995 and 2015. Setting/Participants This study was performed at the Gaziantep University School of Medicine, Gaziantep, Turkey, in 2015 and included 78 patients who in the past 20 years underwent three-layer reconstruction surgery for anterior skull base defects at the same university. Main Outcome Measures Among the patients, defects repaired by transcranial approach had the lowest recurrence rate. Overall, successful repair was achieved in 100% of the patients. Results Pure transbasal approach was used as a single procedure on 71 (91%) patients. Combined approaches were used in seven (9%) cases. The extended transbasal approach was combined with a transfacial approach in four patients and with a pterional approach in three patients. Conclusion We encourage the use of three-layer reconstruction and recommend free fascia lata grafts and galeal flaps with vascularized pedicle as sealing material of choice in all types of cases such as tumor and trauma.

Multicentric Dentigerous Dermoid Cyst with an Unusual Location in the Central Nervous System.

Dermoid cysts are benign and congenital ectodermal inclusions. Their occurrence in an intracranial location is quite rare. They constitute 0.1 to 0.7% of all intracranial tumors. Their occurrence in the fourth ventricle and their multicentric feature are extraordinary. A 12-year-old boy was admitted to our clinic with a dermoid cyst with sixth cranial nerve involvement. He had symptoms of increased intracranial pressure. This case is the first dermoid cyst in the literature at this unusual location; a mature tooth structure was found within the cyst, which extended over the cervical subsegments. There was a second dermoid cyst in the thoracic spine (multicentric). Our aim is to present an atypical dermoid cyst along with radiodiagnostic characteristics and macroscopic findings.

Early cyclosporin A treatment retards axonal degeneration in an experimental peripheral nerve injection injury model.

Injury to peripheral nerves during injections of therapeutic agents such as penicillin G potassium is common in developing countries. It has been shown that cyclosporin A, a powerful immunosuppressive agent, can retard Wallerian degeneration after peripheral nerve crush injury. However, few studies are reported on the effects of cyclosporin A on peripheral nerve drug injection injury. This study aimed to assess the time-dependent efficacy of cyclosporine-A as an immunosuppressant therapy in an experimental rat nerve injection injury model established by penicillin G potassium injection. The rats were randomly divided into three groups based on the length of time after nerve injury induced by cyclosporine-A administration (30 minutes, 8 or 24 hours). The compound muscle action potentials were recorded pre-injury, early post-injury (within 1 hour) and 4 weeks after injury and compared statistically. Tissue samples were taken from each animal for histological analysis. Compared to the control group, a significant improvement of the compound muscle action potential amplitude value was observed only when cyclosporine-A was administered within 30 minutes of the injection injury (P < 0.05); at 8 or 24 hours after cyclosporine-A administration, compound muscle action potential amplitude was not changed compared with the control group. Thus, early immunosuppressant drug therapy may be a good alternative neuroprotective therapy option in experimental nerve injection injury induced by penicillin G potassium injection.