Television Tip-Over Related Head Injuries: A Particular Type of Child Neglect.

AIM: To identify, report, and raise awareness of the risk factors for television (TV) tip-over. MATERIAL AND METHODS: In total, 86 children who were brought to the emergency service and hospitalized at the neurosurgery clinic because of TV tip-over-related head trauma between August 2011 and August 2016 were included in the study. RESULTS: The 86 patients consisted of 47 males and 39 females. The mean age was 38.8 ± 19.5 (9â€"102) months. Low education level of the mother was a risk factor for this type of accident (p=0.009). In all the patients, injuries were caused by the tip-over of a cathode ray tube (CRT) TV. In 66 patients (77%), only the TV tipped over onto the child, whereas in 20 cases (23%), the TV tipped over with the TV stand. The TVs were not fixed to the stand or the wall in any of the homes. According to computerized tomography findings, 12 patients (13.9%) had intracranial hemorrhage and 19 patients (22%) had skull fractures. Five patients underwent neurosurgical intervention. Eighty-four patients (97.6%) were discharged with a GCS level of 15. One patient was discharged with a GCS level of 9/15 with a tracheostomy and nasogastric tube. One patient died. CONCLUSION: TV tip-over causes physical injury that may result in serious neurological damage and even death. It is becoming more common and may be prevented by taking simple precautions.

Metastatic Gallbladder Carcinoma in Meningioma: A Case Report.

Metastases from tumors to systemic cancers are rare. The most common intracranial recipient tumor is meningioma. Metastasis from gallbladder cancer has been previously reported from only one patient during autopsy. We present a case of a 72-year-old woman who underwent surgery for right frontal skull base meningioma. The tumor was completely removed. Histological specimens showed gallbladder carcinomatous metastasis with diffuse neuroendocrine differentiation in meningothelial meningioma. The Ki-67 proliferation index of the meningioma was 3%. Further, 60% positive immunoreactivity with the progesterone receptor was observed in meningioma cells. In carcinoma cells, diffuse positive immunoreactivity with chromogranin, CDX2, CEA, panCK, cytokeratin 7, and synaptophysin was observed. A combination of molecular, metabolic, immunological, and/or hormonal factors may contribute to the pathogenesis of this lesion. It cannot be ruled out that it is more common than expected.

Risk Factors and Compression and Kyphosis Rates after 1 Year in Patients with AO type A Thoracic, Thoracolumbar, and Lumbar Fractures Treated Conservatively.

AIM: Conservative treatment is a frequently used treatment modality for traumatic thoracolumbar fractures. However, not many studies evaluating radiological and clinical results of conservative treatment are found. The aim of this study was to determine the risk factors, and compression and kyphosis rates after 1 year in patients with AO type A thoracic, thoracolumbar, and lumbar fractures treated conservatively. MATERIAL AND METHODS: Radiological and clinical results of 79 thoracolumbar fractures in 57 patients, who were treated conservatively, were evaluated one year after trauma. Fractures were classified according to thoracolumbar injury classification and severity (TLICS) score and AO spinal trauma classification system. Compression rate, wedge and kyphosis angles, and sagittal index were calculated in early and late periods after trauma. RESULTS: Female/male ratio was 25/32, and mean age was 41.7±16.7 years. They were followed for 15.2±4.9 months. Mean compression rates were 19.6% and 25.2%; wedge angles were 10.1 and 12.7 degrees; kyphosis angles were 5.82 and 8.9 degrees; and sagittal indexes were 8.01 and 10.13 in all patients just after trauma and after one year, respectively. Fractures in older patients ( > 60 years of age) and in patients with osteopenia or osteoporosis, located in the thoracolumbar junction, AO type A2 and A3 fractures, and solitary fractures had higher compression and kyphosis rates at last follow-up. CONCLUSION: Early mobilization without bed rest for stable thoracolumbar fractures according to the TLICS system is a good treatment option, and radiological and clinical results are usually acceptable. However, fractures in patients older than 60 years, those with osteoporosis or osteopenia, fractures located in the thoracolumbar junction, solitary fractures, and fractures in AO type A2 or A3, are more inclined to increase in compression and kyphosis and may require a closer follow-up.

Rapidly Progressive Spontaneous Spinal Epidural Abscess.

Spinal epidural abscess (SEA) is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI) remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.

Chronic ossified epidural hematoma after ventriculoperitoneal shunt insertion: a case report.

Chronic calcified/ossified epidural hematoma is an uncommon complication of ventricular shunt surgery. There are only 4 cases related to valve-regulated shunt operations in the literature. It may be seen especially in young patients with chronic hydrocephalus, probably due to craniocerebral disproportion. The precise mechanism of the calcification or ossification of the hematoma is not known, however, the dura mater seems to play a part in this process. A 17-year-old girl with triventricular hydrocephalus was treated with a ventriculoperitoneal shunt system including a medium pressure flow control valve. She was admitted with a complaint of severe headache after three years and a bifrontal calcified/ossified epidural hematoma was seen. The calcifying hematoma was removed and the patient's headache resolved. Although the use of high or medium pressure valves, valves with an antisiphon device, adjustable pressure valves or flow control valves have been recommended to prevent this complication in previous reports, it was seen that our case had been treated with a medium pressure flow control valve.

Pediatric vertebral and spinal epidural tumors: a retrospective review of twelve cases.

OBJECTIVE: Pediatric vertebral tumors are rare, and most of the reported series have limited numbers of cases. Diagnosis of these tumors is difficult because of the patients' age and the rarity of the lesions. We aimed to report the clinical, radiological and pathological characteristics in a small series of pediatric vertebral and spinal epidural tumors and to discuss diagnostic and treatment difficulties. MATERIALS AND METHODS: Twelve consecutive pediatric cases with vertebral or spinal epidural tumors were reviewed retrospectively. RESULTS: The mean age was 12.6 years, and male and female patients were equal in number. The most common symptom was pain. There were some neurological or local findings in all patients, and there were some positive results on plain radiographs in all cases except 2. The tumors were removed totally in 9 cases. There were histologically malignant lesions in 3 and benign lesions in 9 cases. Three patients with malignant tumors were treated by radiotherapy and 2 by chemotherapy. One patient with thoracic hemangioma was also treated by embolization after surgery. One case with cervical Dabska's tumor died due to air embolization. The other patients were followed for 48.3 months. The preoperative neurological deficits were resolved completely in all patients except the one with only biopsy performed at the last follow-up. There were no new spinal deformities on follow-up. CONCLUSION: Children with vertebral tumors and spinal epidural tumors usually present with pain and neurological deficits or local findings, and there are some indications on plain radiographs. Therefore, a careful physical examination and detailed evaluation of radiographs may minimize the rate of misdiagnosis and underestimation. Most of these tumors are benign, therefore, their outcome is good, and cure may be possible for many of the cases.

Clear cell ependymoma of the temporal lobe in a child: a case report.

A 12-year-old boy with a left temporal tumor diagnosed as clear cell ependymoma (CCE) was reported. CCE is an uncommon central variant of ependymomas with a predilection for the supratentorial region in children. Brain tumors with a honeycomb pattern with clear cells having round nuclei and perinuclear halos could pose a problem in the differential diagnosis with the other tumors with clear cells. There were 41 reported cases of CCE in the literature. In 61% of these cases, tumors were located in the supratentorial region, and in the others in the posterior fossa and spinal cord. However, there was none located in the temporal lobe except in the case presented here.

Lumbar extradural infiltrating angiolipoma: a case report and review of 17 previously reported cases with infiltrating spinal angiolipomas.

BACKGROUND CONTEXT: Spinal extradural angiolipomas are rare benign tumors, and most of them are noninfiltrating tumors located in the extradural space. However, there are 17 cases with extradural infiltrating spinal angiolipomas extending into the vertebral bodies or posterior vertebral arches in literature. These 17 tumors are mostly located at the thoracic region, and anterior or in the anterolateral extradural space, and they generally infiltrate only one vertebra. Only two of them are located at the lumbar region, four are mainly located in the posterior extradural space, and three infiltrate more than one vertebra. PURPOSE: To present an exceptional case with infiltrating extradural spinal angiolipoma involving two lumbar segments and mainly located in the posterior extradural space. STUDY DESIGN: A case report. METHODS: A 41-year-old woman with infiltrating spinal angiolipoma was treated by incomplete surgical removal of the tumor. RESULTS: There were no complaints nor recurrence after 18 months follow-up. CONCLUSIONS: Outcome after surgery for spinal angiolipomas is very good overall even in the cases with infiltrating tumors. Although complete removal is certainly preferred, outcomes remained favorable despite incomplete resections.

Cervical spinal brucellosis causing epidural and prevertebral abscesses and spinal cord compression: a case report.

BACKGROUND CONTEXT: Cervical involvement due to spinal brucellosis is quite rare. Although surgery usually is not necessary in spinal brucellosis, most of the patients with cervical involvement require surgical treatment because of the high rate of neurological involvement and spinal cord compression. PURPOSE: To present a unique case with cervical spinal brucellosis with epidural and paravertebral abscesses and to discuss the treatment alternatives of this disease. STUDY DESIGN: A case report. METHODS: A 61-year-old patient with spinal cord compression syndrome due to cervical spinal brucellosis was reported. He was treated by triplet antibiotherapy for 24 weeks. On magnetic resonance imaging, spinal cord compression caused by epidural abscess and granulation tissue, and prevertebral abscess were seen. RESULTS: At the end of the treatment, there were no complaints, neurological findings, or positive infection markers. There was not epidural compression on control magnetic resonance imaging. CONCLUSIONS: Surgery may not be required in all cervical spinal brucellosis cases with epidural compression and neurological involvement. Conservative treatment with close observation may be sufficient in these patients who are usually older people.

Accuracy of pedicle screw placement for upper and middle thoracic pathologies without coronal plane spinal deformity using conventional methods.

There is a growing interest in the implantation of pedicle screws into the middle and upper thoracic spine. However, usage of the technique is still under debate for these levels because the pedicles in these regions are small and exhibit a high degree of inter- and intraspecimen variability. Twenty-four consecutive patients treated for upper and middle thoracic pathologies by pedicle screw instrumentation under biplanar or uniplanar fluoroscopy were evaluated retrospectively. The rate of screw misplacement on postoperative computerized tomography and complications caused by misplaced screws were determined. In 24 cases, a total of 113 upper-middle thoracic pedicle screws were inserted. Fifty-one of them were inserted between T2 and T5 with guidance of biplanar fluoroscopy, and 62 were inserted between T6 and T8 with uniplanar fluoroscopy. The rate of misplacement was 20.3% for 113 screws (27.4% for T2 to T5 screws, and 14.5% for 62 T6 to T8 screws). Four screws were incorrectly inserted which could have clinical significance (3.5%), and 1 of them required revision. The difference between the upper and middle thoracic screws was not statistically significant (P=0.089). Screw insertion with laminectomy did not cause significant difference in both upper and middle thoracic regions. Only 2 complications were seen because of screw insertion. Pedicle screw insertion with guidance of fluoroscopy may be a reliable and safe method for upper and middle thoracic pathologies.

Non-contiguous multifocal spinal tuberculosis involving cervical, thoracic, lumbar and sacral segments: a case report.

MAIN PROBLEM: There are only a few cases reported with non-contiguous spinal tuberculosis in the literature. Most of these patients have only two non-contiguous lesions, and in almost all of these cases, surgical treatment is required. METHODS: A 17-year-old girl with non-contiguous multifocal spinal tuberculosis involving cervical, thoracic, thoracolumbar, lumbar and sacral segments is reported. The patient presented with systemic tuberculosis symptoms and signs, and progressive paraparesis. RESULTS: The patient was treated with antituberculous drug therapy and was operated twice for thoracolumbar and cervical spinal lesions. She made an excellent neurological recovery. CONCLUSIONS: In the patients with non-contiguous spinal involvement, there is a high percentage of requirement of surgical treatment. This may be due to "fulminant" behaviour of the disease in these patients. Early surgical treatment of the cases with large abscesses and systemic tuberculosis may provide early improvement, and must probably be the first treatment modality after general support to the patient.

Aggressive postoperative lumbar fibromatosis after the placement of instrumentation for treatment of spondylolisthesis. Case report.

This 50-year-old woman presented with a paravertebral lumbar fibromatosis (desmoid tumor) after undergoing the placement of instrumentation for lumbar spondylolisthesis. The tumor developed just cranial to the previous skin incision. Fibromatoses, or desmoid tumors, are uncommon infiltrative lesions that affect musculoaponeurotic structures, most often of the trunk and limbs. They are known to occur in association with surgery-related scars or implants and only rare examples appear in the neurosurgical and spine-related literature. In cases involving well-defined tumors in which radical resection is possible, surgery is the treatment of choice; however, the recurrence rate is high. The patient in the present case was followed for 14 months postoperatively and did not undergo radiotherapy; there was no recurrence. Although rare, this distinctive tumor should be considered in the differential diagnosis of postoperative paravertebral bulgings after neurosurgical and spinal operations.

Thoracic and lumbar tuberculous spondylitis treated by posterior debridement, graft placement, and instrumentation: a retrospective analysis in 19 cases.

OBJECT: Surgical treatment of thoracic and lumbar tuberculous spondylitis is controversial. An anterior approach is usually recommended. The aim of the present study was to assess the efficacy of posterior debridement and the placement of posterior instrumentation for the treatment of patients with thoracic and lumbar tuberculous spondylitis. METHODS: Nineteen patients with thoracic and lumbar tuberculous spondylitis underwent single-stage posterior decompression and debridement as well as the placement of posterior interbody grafts if necessary, instrumentation and posterior or posterolateral grafts. No postoperative neurological deterioration was noted. One patient died of myocardial infarction on Day 10. The mean follow-up duration, excluding the one death, was 52.7 months (range 16-125 months). In a 70-year-old patient, a single pedicle screw broke after 3 months. All patients were in better neurological condition after surgery and at the last follow-up examination. Neurological deficits were present in only two patients at the last follow up (one American Spinal Injury Association Grade B and one Grade C deficit preoperatively). Three other patients suffered intermittent back or low-back pain. The mean angulation measured in 13 patients with kyphotic deformity was 18.2 degrees (range 5-42 degrees) preoperatively; this was reduced to 17.3 degrees (range 0-42 degrees) after surgery. There was a 2.8 degrees loss of correction (range 2-5 degrees) after 44.3 months (16-64 months). Kyphosis did not progress beyond 15 months in any patient. CONCLUSIONS: A posterior approach in combination with internal fixation and posterior or posterolateral fusion (with or without placement of posterior interbody grafts) may be sufficient for the debridement of the infection and to allow spinal stabilization in patients with thoracic and lumbar tuberculous spondylitis. This procedure is associated with easy access to the spinal canal for neural decompression, prevention of loss of corrected vertebral alignment in the long term, and facilitation of early mobilization.

A solitary calvarial lytic lesion with typical histopathological findings of juvenile hyaline fibromatosis.

Juvenile hyaline fibromatosis (JHF) is a rare systemic disease characterized by papulonodular skin lesions, gingival hyperplasia, joint contractures, and osteolytic lesions on long bones and the skull. It has recently been reported that the disease is caused by mutations in the gene encoding capillary morphogenesis protein-2 (CMG-2). To date, fewer than 60 cases have been published in the literature. Partial disease expression is common, but no cases featuring a solitary calvarial lesion have been reported. The authors discuss this 4-year-old boy with a solitary calvarial osteolytic lesion whose histopathological examination exhibited findings characteristic of JHF. Mutational analysis, however, revealed that there were no mutations in the CMG-2 gene. Two years after surgery, he was free of any complaints as well as gingival hyperplasia, joint contractures, and new skull or skin lesions. This patient's condition may represent clinical or genetic heterogeneity associated with JHF. Whether solitary lesions mimicking JHF can arise from somatic mutation of the CMG-2 gene remains to be proven.

Paradoxical intracranial tuberculoma requiring surgical treatment.

Paradoxical enlargement of intracranial tuberculomas or development of new ones during adequate antituberculous chemotherapy is an uncommon event. Treatment of such cases is controversial. Steroid therapy is usually advocated without change in the antituberculous drug program. However, in some patients whose lesions fail medical treatment, or who have superficially located large lesions, surgical therapy may be required. A 15-year-old girl with pulmonary miliary tuberculosis, tuberculous meningitis and multiple intracranial tuberculomas is presented. While her pulmonary lesions and intracranial tuberculomas except one were healed with chemotherapy, one tuberculoma increased in size 1 month after starting chemotherapy. She was followed with dexamethasone treatment in addition to antituberculous therapy for 2 months. Then, the lesion was removed because it had increased in size in spite of appropriate chemotherapy.

Vertebral osteoid osteoma associated with paravertebral soft-tissue changes on magnetic resonance imaging. Report of two cases.

Soft-tissue changes associated with osteoid osteoma have been described in the digits of the hands and feet as well as the long bones. Only six cases in which such changes occurred in the spine have been reported. Magnetic resonance (MR) imaging facilitates the determination of such changes. Establishing a diagnosis, however, is especially difficult in spinal osteoid osteoma when using MR imaging. Therefore, osteoid osteoma-related soft-tissue changes demonstrated on MR imaging raise the question of malignancy and may lead to unnecessary long-term treatment or biopsy sampling. The authors report two cases of spinal osteoid osteoma in which paravertebral soft-tissue changes were observed on MR imaging to mimic malignant soft-tissue tumors.

Tissue and serum sialic acid levels in an animal head injury model.

BACKGROUND: Significant elevations of serum sialic acid level have been documented in various diseases including in a variety of central nervous system disorders. But, in head injury, there is no any study on the serum and brain tissue sialic acid levels. So, we planned an experimental study to evaluate serum and brain tissue sialic acid levels in head injury. METHODS: Marmarou's impact-acceleration model was used in rats to produce diffuse brain injury. Rats were divided into equal three groups. In Group I, 450 g weight was fell from 1 m height to heads of subjects, and from 2 m in Group II. Group III was control group. Sialic acid levels were measured in both sera and brain tissue supernatants after trauma. RESULTS: It was observed that serum sialic acid level was decreased according to the severity and period of trauma increased; and there was no change in brain tissue sialic acid levels. CONCLUSION: Serum sialic acid level might be used as a marker to show the degree of diffuse brain injury.