The unilateral frontotemporal approach for large and giant olfactory groove meningioma: Experience with 18 consecutive patients.

AIM: Although the bifrontal approach used to be recommended for large olfactory groove meningioma (OGM), recent studies showed that large OGMs can also be resected safely via unilateral approaches. The present study aimed to discuss reasons for preferring a unilateral frontotemporal approach (UFTA), and the technical nuances and results of the UFTA, based on 18 cases. MATERIAL AND METHODS: The clinical and surgical data of patients who had been operated on for large (4-6cm) or giant (>6cm) OGM via a UFTA between 2011 and 2018 were retrospectively collected. RESULTS: In all, 18 patients were included. All tumors were compatible with a diagnosis of OGM in the light of peri-operative examinations. 11 cases (61%) were large and 7 (39%) giant OGM; mean diameter was 6.1cm (range, 4-10cm). Resection extent was Simpson grade II in 14 cases (78%), grade III in 1 (5%), and grade IV in 3 (17%). Sixteen cases (89%) had no peri-operative complications, while 2 patients (11%) showed cerebrospinal fluid leakage and hemorrhagic deposition in the surgical area. There were no new neurological deficits nor deaths. CONCLUSION: The UFTA for OGM is a relatively safe and effective approach, ensuring a high total removal rate with low mortality and morbidity. This study, with a reasonable number of patients, is one of the few in the literature on the outcome of this approach.

Retrospective Analysis of 449 Intracranial Meningioma Patients Operated Between 2007 and 2013 at a Single Institute.

AIM: Meningioma literature has many large surgical case series, which have been references of text books and neurosurgical practice. Many of those series were published when stereotactic radiosurgery (SRS) was not so common or these series were in terms of World Health Organization (WHO) 2000 classification. In this study, we aimed to make an update to the current literature using WHO 2007 classification system. MATERIAL AND METHODS: Four hundred eighty-eight intracranial meningioma patients underwent open surgery in 2007-2013 and 449 of them were included in this study. All pathological specimens were re-evaluated in terms of WHO 2007 classification. All demographical and follow-up records and imaging archives were investigated by using our center"s central automation system and National Central Population Management System. If records were not available or not adequate, investigators made phone calls to patients. Pediatric patients were excluded. RESULTS: Three hundred twenty-six female (76.2%) and 123 male (27.4%) patients were analyzed. Their ages ranged from 18 to 84 years (mean=51.6±11.9 years). The most common subtype of meningioma was meningothelial meningioma (51.7%), followed by atypical meningioma (20.3%). WHO Grade I meningiomas had statistically random localization distribution, but WHO Grade II meningiomas were more common in the convexity, parasagittal and middle fossa. Younger age was found to be significantly related with tumor recurrence or progression. Seventy-three (16.2%) patients underwent SRS and 64 (14.2%) patients underwent adjuvant radiotherapy (ART) after surgery. Convexity localization was found to be associated with recurrence, mortality and higher WHO 2007 grade. CONCLUSION: Convexity meningiomas are associated with recurrence, mortality and higher WHO 2007 grade. Convexity meningiomas should be totally resected in order to achieve maximum benefit from surgery.

Neurothekeoma in the middle cranial fossa as a rare location: Case report and literature review.

Neurothekeoma is a benign cutaneous nerve sheath tumor usually located in the head and neck region. To date, only a few cases of intracranial location have been reported in the literature. We report an extremely rare case of intracranial neurothekeoma located in the brain parenchyma of the middle cranial fossa. A 55-year-old female patient was operated on at our clinic for a right temporal cystic mass lesion with heterogenic contrast enhancement. Histologically, the tumor had a multinodular hypercellular appearance with a myxoid matrix, peripheral fibrosis, and sclerosis. It was characterized by spindle and epithelioid mononuclear cells, immunochemically positive with diffuse S-100, vimentin, GFAP, PGP 9.5, and NSE, as characteristics of cellular neurothekeomas. After a total surgical resection, there was no need for further adjuvant chemotherapy or radiotherapy. Because there were still unclear aspects regarding the origin, pathogenesis and management of the intracranial neurothekeomas, we decided to contribute to the literature with this case report.

Comparison of the metabolic and antioxidant effects of diltiazem and vitamin E on streptozotocin-diabetic rats.

In this study, solitary and combined effects of vitamin E and the calcium-channel blocker diltiazem were investigated in streptozotocin (STZ)-induced diabetic rats. Thirty male Wistar albino rats, weighing approximately 200 g were used. Diabetes mellitus was induced by a single intravenous injection of STZ at a dose of 65 mg/kg body weight. Five experimental groups were established as STZ-diabetic, STZ-diabetic + vitamin E, STZ-diabetic + diltiazem and STZ-diabetic + vitamin E + diltiazem. Vitamin E was injected intraperitoneally three times a week at a dose of 500 mg/kg body weight. Diltiazem was given orally every day at a dose of 25 mg/kg body weight. At the end of the study (10 weeks) blood glucose levels of diabetic rats, which had received vitamin E and diltiazem, had significantly decreased when compared with untreated diabetic rats (P < 0.02). Similarly, HbA1c levels had significantly decreased in diabetic rats which had received vitamin E (P < 0.05), diltiazem (P < 0.01) and vitamin E + diltiazem (P < 0.02) when compared with untreated diabetic rats. Liver glutathione levels of diabetic rats, which had received vitamin E (P < 0.01) and vitamin E + diltiazem (P < 0.05) had significantly increased when compared with untreated diabetic rats. Liver lipid peroxide levels had significantly decreased in diabetic rats, which had received vitamin E (P < 0.001) and diltiazem (P < 0.01). With respect to their metabolic and antioxidant effects, vitamin E proved superior to diltiazem.

Reflex occipital lobe epilepsy.

Photosensitivity is a typical feature of photosensitive epilepsy which is usually considered a form of idiopathic generalized epilepsy. Partial seizures featuring visual symptoms are rarely reported in photosensitive epilepsy. In this study, we describe 13 neurologically normal patients in whom daytime seizures were always induced by television and began with elementary visual hallucinations, followed frequently by vomiting, headache and then secondary generalization. Three patients additionally reported nocturnal seizures, which have not been described in previous studies. Two of these latter patients had generalized tonic-clonic seizures, the other always awoke from sleep and could describe typical visual hallucinations at the beginning of the seizure. EEG features included normal background activity and occipital spikes or spike-waves in all but two patients. Eight patients also showed generalized epileptiform activity during intermittent photic stimulation. Seizure frequency was low in all. Apart from two patients, who refused treatment, all patients received antiepileptic drugs. Only one patient continued to have rare seizures after treatment; in the others seizure control was achieved with monotherapy. We conclude that reflex occipital lobe epilepsy is an idiopathic form of the benign partial epilepsies, which may overlap with one another.

Childhood occipital epilepsy: seizure manifestations and electroencephalographic features.

Childhood epilepsy with occipital paroxysms (CEOP) is an idiopathic localization-related epilepsy. A typical seizure in CEOP begins with visual symptoms, followed by hemiclonic seizures, complex partial seizures or generalized tonic-clonic seizures. Benign nocturnal childhood occipital epilepsy (BNCOE), characterized by nocturnal seizures with tonic deviation of the eyes followed by vomiting, has the same electroencephalographic features as CEOP. In this study, we report the seizure symptoms and electroencephalographic features of 21 cases with CEOP or BNCOE. Out of these patients, nine had BNCOE, six had CEOP, four had CEOP and BNCOE and the remaining two belonged to the incomplete syndrome because of no paroxysmal discharges in EEG. When the patients with BNCOE awoke from sleep, they had tonic deviation of the eyes and could describe visual symptoms. Patients with CEOP had seizures beginning with visual symptoms followed by loss of consciousness but no generalized convulsions. In three cases, in addition to the occipital spikes, independent centro-temporal spikes were recorded and in another three cases generalized spike-wave discharges were recorded. Such a combination suggests the idiopathic nature of these epilepsies. We concluded that in the diagnosis of CEOP and BNCOE, the seizure symptomatology is important even if the EEG can be considered normal.

The effects of calcium channel blockers, verapamil, nifedipine and diltiazem, on metabolic control in diabetic rats.

The effects of calcium channel blockers (CCB)-verapamil, nifedipine, diltiazem on metabolic control in streptozotocin-induced long-term diabetes in rats were investigated. Diabetes mellitus was induced by single intravenous injection of streptozotocin (65 mg/kg body wt.). The animals were divided into five groups: a healthy control group, a diabetic group and three diabetic groups treated with one of the calcium channel blockers (verapamil, 25 mg/kg/day, nifedipine, 20 mg/kg/day, and diltiazem, 30 mg/kg/day, respectively). Body weight, glycemia, glycated hemoglobin and total serum protein levels of these animals were measured at the beginning and at the end (after 13 weeks) of the experiment. It was observed that diabetic animals who were not treated with CCB had lost weight at the end of the experiment (P < 0.01). The blood glucose and glycated hemoglobin levels were increased in the diabetic group in comparison to the healthy control group (P < 0.001). However, the calcium channel blockers seem to have beneficial effects on body weight, glycated hemoglobin and blood glucose levels.