Analysis of Cavernous Malformations: Experience with 18 Cases.

AIM: To analyze the results of stereotactic radiosurgery (SRS) or surgical treatment of 18 cases with cavernous malformation and report 2 cases with unusual localization and size. MATERIAL AND METHODS: We present 11 and 8 patients who underwent surgery and SRS between 2010 and 2018 respectively. The operated group comprised six men and five women (mean age, 33.6 years). SRS was performed in five men and three women (mean age, 33.3 years). All patients were diagnosed and followed-up with magnetic resonance imaging. Stereotactic navigation was not used for lesion localization. The lesion, including the area with hemosiderin, was easily excised using microsurgical approach. RESULTS: Except for recurrent headache, all symptoms of patients who underwent surgery resolved rapidly. Hemorrhage developed in two of our patients after SRS. One of them refused to undergo surgery and recovered completely with steroid therapy, whereas the other underwent surgery after detection of cavernous malformation at the posterior fossa, with a dimension of 26.8x26.2 mm and occluding the fourth ventricle. CONCLUSION: In patients without significant preoperative morbidity risk, surgical excision is the gold standard of treatment. SRS is performed in surgically inaccessible, deeply located, multiple cavernous malformations in the brain stem and eloquent area. Of note, giant aneurysm is defined as an aneurysm with a diameter of at least 25 mm; however, there is no dimension threshold defined for giant CM, and the size of giant aneurysm can be accepted as a valid criterion for giant CM. Our 2 cases had giant CM and up to our knowledge the case with giant CM at the posterior fossa is the first giant CM at the posterior fossa in the English literature.

Recurrent Chronic Subdural Hematoma: Report of 13 Cases.

Chronic subdural hematoma is a frequent type of hemorrhage, which terminates with mortality if not diagnosed and treated early. The aim of this clinical study is to evaluate the patients with unilateral and bilateral recurrent chronic subdural hematoma. The study group consisted of 13 cases with unilateral and bilateral recurrent chronic subdural hematomas who underwent aggressive wide craniotomy, duraectomy, inner and outer membranectomy, dural border coagulation, incision through cortical vein trace and hang up of dural edge, between 2009 - 2016. All of our patients were diagnosed by preoperative Magnetic Resonance Imaging. We evaluated the age, gender, complaints and neurologic signs, localization and thickness of the hematoma. We can estimate that wide craniotomy, duraectomy and membranectomy is a good option in preventing recurrent chronic subdural hematoma and complications.

Effects of Arginine Vasopressin and V1 Receptor Antagonist on Cerebral Vasospasm Secondary to Subarachnoid Hemorrhage: An Experimental Study.

AIM: To examine morphological, radiological and biochemical effects of arginine vasopressin (AV) and V1 receptor antagonist on cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) in rabbits. MATERIAL AND METHODS: Forty male New Zealand white rabbits were randomly divided into four groups comprising 10 rabbits each. The groups were; 1) Control group, 2) SAH group, 3) SAH+AV group, 4) SAH+V1 antagonist group. Diameters of the basilar artery in all groups were measured on angiograms. All animals were sacrificed two days following basilar angiography and tissue samples of basilar artery were obtained under microscope immediate after craniectomy for ultrastructural and biochemical examinations. RESULTS: The artery diameters were found to be 50% and 50% at the 30th minute in the groups 2 and 3 respectively. In group 3, CVS was 13% more in comparison with the 2nd group. In group 4, vascular constriction was 34.5% at the 30th minute and about 30.9% at the 300th minute. Despite the increase in regional blood flow, AV did not provide morphological change. Histological appearance was related to vascular stenosis due to CVS. Histological outcome was the best in group 4 because of less CVS. CONCLUSION: Arginine vasopressin plays an important role in CVS. We detected morphological and radiological recovery in basilar artery, besides moderate improvement due to AV receptor antagonist in CVS.

Immunohistochemical Evaluation of Hemostatic Changes in Glioblastoma Multiforme and Low-Grade Astrocytoma.

AIM: In glioblastoma multiforme, the balance between the procoagulant system, anticoagulant system and fibrinolytic system is impaired in favour of hypercoagulability. The aim of this study was to compare glioblastoma multiforme with astrocytoma grade II by subjectively evaluating the levels of prothrombin and biotinylation thrombin, and G protein serum protease activatin receptors, as tissue factors causing hypercoagulation and affecting coagulation. MATERIAL AND METHODS: Specimens from 35 cases with glioblastoma multiforme and 23 cases with astrocytoma grade II were evaluated immunohistochemically. The specimens were stained with hematoxylen-eosin and immunohistochemically for prothrombin, biotinylation thrombin and protease activating factor receptors to determine the correlation between the tumor malignancy and coagulation factor receptors. RESULTS: An increase in malignancy was seen to result in an increase in prothrombin, biotinylation thrombin, protein activator receptor 1, protein activator receptor 3, and protein activator receptor 4 levels, and a decrease in protein activator receptor 2 level. These data showedthat there was hypercoagulability in glioblastoma multiforme. Descriptive statistics and Mann-Whitney U analysis were used to evaluate the results. CONCLUSION: In glioblastoma multiforme, if there is no radiologicalevidence of hemorrhage, low molecular weight heparin should be administered peroperatively and continued for 3 months postoperatively to prevent the development of deep venous thrombosis. This will also be useful in the prevention of invasion, angiogenesis, metastasis and tumour progression.

Effects of sodium selenite and amiloride on calvarial calcification in closing small cranial defects.

OBJECT: Fresh autogenous bone graft is the most preferred osteoplastic material, whether the purpose is cosmetic, psychological, or for the protection of the brain. These grafts are not rejected and do not react immunologically. The aim of this study was to evaluate the efficacy of autogenous fat rolled with bone dust derived from the bur hole in closing small cranial defects. Additionally, the authors examined the morphological and biochemical effects of Na selenite and amiloride on calvarial calcification. METHODS: The study group consisted of 20 domestic pigs. These animals were randomly divided into 4 groups. A bur hole with a diameter of 10 mm was made at the right parietal region in all animals, and then the periosteum around the bur hole was cauterized following exposure of the dura mater. The dura was coagulated with bipolar cautery. Group 1 (controls): only a bur hole was opened, and it was then closed with a mixture of the bone dust that had been created during the opening of the bur hole and fat tissue that was taken from the animal's neck. Group 2 (amiloride): 1 nmol/g body weight of amiloride was applied subcutaneously within 15 minutes after closure of the bur hole with bone dust and fat, and then amiloride was applied once a day for 4 weeks. Group 3 (Na selenite): 30 nmol/g body weight of Na selenite was applied subcutaneously within 30 minutes after closure of the bur hole with bone dust and fat, and then Na selenite was applied once a day for 4 weeks. Group 4 (amiloride and Na selenite): 1 nmol/g body weight of amiloride was applied subcutaneously at 15 minutes, and 30 nmol/g body weight of Na selenite was applied subcutaneously at 30 minutes after closure of the bur hole with bone dust and fat, and these 2 injections were repeated once a day for 4 weeks. At the end of 4 weeks, the animals were anesthetized to evaluate the closure of the bur hole. Tissue samples were obtained for ultrastructural and biochemical examination. RESULTS: The defect was covered with diffuse connective tissue in the control group. Although multiple capillary vessels were present, the authors did not observe osteogenic differentiation. Histological examination of the second group revealed osteogenic changes. Although new matrix was formed, calcification was not detected. The authors observed fibroblast, collagen fibers, and dense connective tissue filled with capillary in the third group of pigs, which had undergone Na selenite application. Calcification was not detected in this group. Both connective and osteogenic tissue were observed in specimens obtained in the fourth group, which had undergone amiloride and Na selenite application. CONCLUSIONS: The authors experimentally evaluated the supplementary osteogenic effects of Na selenite and amiloride by using them separately and together. The findings seem promising as a lead-in to new studies in restoring cranial defects.

Huge bilateral pulmonary and pleural metastasis from intracranial meningioma: a case report and review of the literature.

A case of recurrent meningioma with atypical features and extracranial metastases is reported. A 34-year-old female was operated in 1996, 2000, and 2002, and frontal parasagittal meningioma was extirpated. Histological diagnoses of all the resected tumors were meningotheliomatous meningioma, WHO Grade I. However, 2 years later, the tumor recurred in the frontal scalp and was removed again totally. Histological diagnosis was reported as an atypical meningioma; meningotheliomatous type; WHO Grade II. She received radiation therapy. But the tumor had metastasized to the lung and pleura. Transthoracic tru-cut biopsy was performed from large mass of the left lung. Cytopathology was consistent with malignant meningioma, metastasis from the patient's known intracranial meningioma. Ki-67 staining index at the primary and metastatic sites of the present cases were 7 and 5%, respectively. We reviewed and discussed the histopathological features and mechanisms of metastasizing meningioma.

The relationships among ultrastructural angiogenic features, Na+ K+, Ca+2, Mg+2 ATP-ase activities and SOD concentration in the microvasculature of intracranial meningiomas and glial tumors.

The purpose of this study was to investigate the relationship among ultrastructural angiogenic features, adenosine-5'-triphosphatase (ATP-ase) activities and superoxide dismutase (SOD) concentration in the microvasculature of intracranial meningiomas and glial tumors. We examined 20 tumor materials from 20 adult patients with intracranial meningioma or glial tumor who underwent selective surgery, dividing them into two groups based on the type of the tumors. Group I consisted of 10 meningioma-materials, and Group II of 10 glial tumor-materials. Na+-K+, Mg+2 and Ca+2 ATP-ase activities in Group I were significantly higher than those in Group II (p < 0.01). The SOD activity in Group I was significantly lower than that in Group II (p < 0.01). According to electron microscopic findings, vascular endothelial proliferation and ultrastructural cytoplasmic changes in the glial tumors were more prominent than those in the meningiomas. Our results show that there is a meaningful correlation among an increased endothelial proliferation, a decreased ATP-ase level and an increased SOD activity in the meningiomas and glial tumors.