Treatment of intracranial foreign body.

Craniospinal penetrating foreign body (FB) injuries are interesting, but rarely observed, cases. They are important in terms of the complications that they may cause. The etiologies of craniospinal penetrating injuries and intracranial FB are also different. Though a sewing needle is more rarely seen in an intracranial FB, it may occur as atttempted infanticide or as a result of an accident especially in early childhood before the closure of fontanels. We detected an intracranial sewing needle in the head radiograph of a case admitted to the emergency department for another reason. We present this case since this is a rare injury and the etiologies of craniospinal penetrating foreign body have different characteristics.

Study of the neuroprotective effect of ginseng on superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels in experimental diffuse head trauma.

BACKGROUND: The purpose of our study was to investigate the effect of ginseng on antioxidant enzyme levels in brain damage following experimental diffuse head trauma in rats. The neuroprotective effect of ginseng was also studied. METHODS: In this study, rats were divided into four groups, and the rats in group 1 received no intervention. In group 2, the rats were administered 50 mg/kg ginseng, injected intraperitoneally at 1, 24 and 48 h, and the effect of ginseng on normal tissues was studied. No drugs were administered to the rats in group 3 who had previously experienced diffuse head trauma using Feeney's falling weight method. In group 4, rats underwent Feeney's falling weight method, leading to diffuse head trauma, and they were given 50 mg/kg ginseng intraperitoneally 1, 24 and 48 h after head trauma. Rats were killed 72 h after head trauma and their brain tissues extracted for histopathological and biochemical studies. RESULTS: Histopathological study of brain cross sections in the trauma group demonstrated neurons in the trauma region and surrounding area, which generally had a dark-colored eosinophilic cytoplasm and a pyknotic nucleus, while the nuclei of neurons were located peripherally. However, brain cross sections in group 4 from rats given ginseng after head trauma showed fewer neurons with eosinophilic cytoplasm, pyknotic and peripheral nuclei in the trauma region and surrounding area. No statistically significant difference in the tissue SOD level was observed; however, the GSH Px level in group 4 was significantly reduced compared to that in group 3. CONCLUSIONS: After affecting the GSH Px level and reducing histopathological scores, ginseng was found to display antioxidant and neuroprotective activity.

Spontaneous rapid resolution of acute epidural hematoma in childhood.

Acute epidural hematoma is a critical emergency all around the world, and its aggressive diagnosis and treatment are of vital importance. Emergent surgical evacuation of the hematoma is known as standard management; however, conservative procedures are also used for small ones. Spontaneous rapid resolution of these hematomas has also been reported in eight pediatric cases. Various theories have been proposed to explain the underlying pathophysiology of this resolution. Herein, we are reporting a new pediatric case with spontaneously resolving acute epidural hematoma 12 hours after admission to the emergency room.

A craniocervical teratoma with an encephalocele-like appearance.

Teratomas are rare congenital tumors. Teratomas frequently occur in adult ovaries, but can be located primarily in the sacrococcygeal zone and intracranial compartment in newborns. Teratomas are rare in the head and neck region. Teratomas arise following a sequence of cells derived from more than one germ layer at different regions of the body due to a change in location of germ cells, and contain ectodermic, endodermic, and mesodermic tissues. Herein we detail the follow-up and treatment of a newborn with a mass that was located at the back of the head and was referred to our Neurosurgery Clinic with a pathologic diagnosis of a grade II-III immature teratoma resembling an encephalocele.

Comparison of simultaneous shunting to delayed shunting in infants with myelomeningocele in terms of shunt infection rate.

AIM: Timing of shunt insertion in infants with myelomeningocele (MM) and hydrocephalus (HCP) has been debated. Many authors have suggested to perform the repair of MM and shunt insertion during same operation. However, there is also an opposite view. MATERIAL AND METHODS: We analyzed retrospectively 166 patients who underwent MM Sac repair to evaluate whether there are difference between these two methods in terms of shunt infection rate. RESULTS: In the same session, V-P (ventriculoperitoneal) shunt placement was performed onto 65 infants within the first 48 hours of postnatal and 36 infants were operated 48 hours after birth. In separate sessions, repair of MM were performed onto 29 infants within the first 48 hours of postnatal and shunting was peformed 7 days after sac repair. 14 infants were performed MM sac repair 48 hours after birth, then shunt was applied 7 days after closure of MM. Shunt infection rate in concurrently operated groups was markedly high (12.3 % in early surgery, 33.3% in late surgery); in separatedly operated groups' shunt infection rate was lower (3.44% in early surgery, 14.29% in late surgery). CONCLUSION: We propose to perform V-P shunt placement and MM repair in separate sessions.

Prognostic factors in patients with occipital encephalocele.

BACKGROUND: An encephalocele is a herniation of the brain and the meninges through a skull defect protruding towards the exterior. The condition is not rare when compared to spinal dysraphisms, but the worldwide incidence is not precisely known. The cases involving occipital encephaloceles which we have diagnosed in our clinic and the surgical approaches for this rare condition are presented herein. METHODS: Thirty patients who were diagnosed with occipital encephaloceles and referred to our Neurosurgery Clinic at the Yuzuncu Yil University, Faculty of Medicine Research Hospital between 2000 and 2009 were enrolled in this study. The age of the patient, size of the sac, pathologies that accompanied the condition, and treatments applied were assessed. RESULTS: In the present study, 30 patients (22 girls and 8 boys), whose ages varied between newborn and 14 months, were evaluated. The encephalocele sac was located in the occipital region in 27 patients (90%) and in the occipitocervical region in 3 patients (3%). Nine (30%) of the 30 patients died; 2 in the preoperative period, 2 in the postoperative early period (0-7 days) and 5 in the late postoperative period (first week to 3 months). With the exception of the 2 patients who died preoperatively, surgery was performed on all of the patients. The mortality rate in our study was 29%. CONCLUSIONS: Our study demonstrated that factors which determine the prognosis of patients diagnosed with occipital encephaloceles include the size of the sac, the contents of the neural tissue, hydrocephaly, infections, and pathologies that accompany the condition. An occipital encephalocele is a congenital neurologic condition with an extremely high morbidity and mortality in spite of the treatments rendered pre- and postoperatively.

Cavernous hemangioma presenting as a giant cervical mass: a case report.

Intramuscular hemangiomas of the head and neck are rare congenital vascular tumors and are sparsely reported. Hemangiomas account for approximately 7% of benign tumors and usually present as a mass that suddenly enlarges. Hemangiomas are mostly seen on the trunk and extremities, but can also appear on the head and neck region. A10-year-old boy was referred to our clinic for puffiness and swelling on the right side of his neck. Neurological examination was normal, but we observed an advanced degree of restriction in neck movement. An MRI study showed a soft tissue mass 9 x 8 x 5 in size. The mass was totally extracted by surgical intervention and pathological analysis revealed that it was a cavernous hemangioma. The patient's neck movement returned to normal after surgery. No relapse occurred during 1-year follow-up.

Cervical spinal dysraphism.

OBJECTIVE: Cervical spinal dysraphism is a rare congenital spinal pathology. The results obtained from our series are compared with the results obtained from other series of studies in the literature. METHODS: Seven patients with cervical myelomeningocele and meningocele who underwent surgery between January 1996 and March 2009 at the YYU Faculty of Medicine in the Department of Neurosurgery were retrospectively studied. RESULTS: The referral ages of the patients (6 females and 1 male) varied between 4 days and 4 months (median 1 month). A stalk lesion covered with a dysplastic skin formed as a sac and located at the cervical midline was demonstrated in all of the patients. Cervical myelomeningocele was present in 4 patients, while cervical meningocele was present in 3 patients; however, Chiari type II malformation and hydrocephaly were present in 3 patients with myelomeningoceles. Diastematomyelia and a filum terminal lipoma were present in 1 of the patients. CONCLUSION: In this series, in contrast to the literature, we noted that the number of girls with spinal dysraphism with a cervical myelomeningocele and meningocele was greater than the number of boys. Chiari type II malformation, hydrocephaly and motor weakness in patients with cervical spinal dysraphism are less frequent when compared to patients with caudal spinal dysraphism. The structure of the sac is also more durable and, accordingly, a cerebrospinal fluid leakage is uncommon.

Penetrating spinal injury: reports of two cases.

Penetrating spinal cord injuries caused by stab wounds are rare. Such injuries may result from a direct lesion of the neural elements of the spinal cord, cord infarcts or, more rarely, intradural or epidural hematoma. In the present study, two cases with spinal cord and L4 root injuries caused by a knife are presented. The first case, a 22-year-old male, referred to our emergency outpatient clinic with a stab wound injury at the mid-section of his back. Neurological examination of this patient showed paraplegia, and spinal MRI displayed a total spinal cord lesion at the T7-T8 level. The wound was primarily sutured; however, during follow-up, CSF (cerebrospinal fluid) leakage continued and the patient was operated. The ruptured dura mater was primarily sutured in a surgical intervention that involved T7-T8 total laminectomy. The second patient referred to our emergency outpatient clinic with a torso injury caused by a sharp knife. The knife was embedded 2-3 cm deep at the wound site at the L3 level and the handle was broken. The patient was immediately operated and the broken and embedded metallic part of the knife was extracted.

Skin perforators of back region: anatomical study and clinical applications.

BACKGROUND: Despite widespread studies that have been commonly performed recently on skin perforators and perforator flaps of various regions of the body, investigations on the back region of the body are still insufficient. This study investigates the anatomical characteristics and clinical applications of perforating vessels in the back region. MATERIALS AND METHODS: The skin on the back region between the right and left, 7th to 11th thoracic vertebrae of 10 fresh cadavers were raised as flaps. Perforating vessels perfusing the skin with pedicle diameters of over 1 mm were included in the study. The anatomical localization, diameter, pedicle size, and the supplying vessels of these pedicles were determined. Utilizing this information, the defects of 8 patients with large meningomyeloceles included in the study were closed with prepared intercostal artery perforating flap. RESULTS: Perforators of the back region were seen to originate from the posterior intercostal vessels. There were a higher number of perforators on the right side of the body. The most commonly observed perforators were the 7th and 9th posterior intercostal perforators, and their diameters were larger. All flaps were viable following perforator flap closure for defects in 8 patients with large meningomyelocele included in the clinical study. No problems were encountered in the postoperative 3-month follow-up of cases. CONCLUSION: Owing to the low donor area morbidity and wide motion capabilities, the perforator flap is a new choice of flap for the back region. Perforator pedicle flaps supplied by the posterior intercostal vessels may be safely used in congenital tissue defects, such as meningomyelocele, tumors, and traumatic defects.

Protective effect of sildenafil (Viagra) in transient spinal cord ischemia.

Prospective study of the neuroprotective activity of sildenafil in a rat spinal ischemia model. The present study involved 21 male Sprague-Dawley rats. The animals were divided into 3 groups. Physiological serum was administered intraperitoneally to the 8 rats in the control group at the beginning of reperfusion for a period of 20 min after abdominal aortal occlusion. Sildenafil (Viagra) was administered as a single 10-mg/kg/day intraperitoneal dose to the 8 rats in the sildenafil group at the beginning of reperfusion after 20 min of abdominal aortal occlusion. No occlusion was performed and no agent was administered to the 5 rats in the sham group, but the abdominal aorta was reached by means of surgical intervention. Before the animals were sacrificed, several physiological and biochemical parameters were investigated, preoperative and postoperative motor functions were also assessed, and somatosensory evoked potential (SEP) monitoring and histopathological examinations were carried out. No differences were found between the physiological and biochemical parameters in each of the 3 groups. Neurological scoring performed after reperfusion demonstrated a significant improvement in the neurological results relative to those of the control group over 48 h in subjects that received sildenafil. These animals also showed better 24-hour SEP results, measured in terms of extended latency and decreased amplitude, than the control animals. A histopathological study showed reduced ischemic symptoms in rats that received sildenafil compared with those in the control group. However, no anomalies were observed in the sham group with respect to the histopathological and neurological findings. These results indicate that neurological damage due to spinal-cord ischemia-reperfusion injury can be reduced by sildenafil.

Investigation of neuroprotective effect of dexamethasone by using nitric oxide and leukocyte levels in experimental head trauma.

The objective of the present study was to determine the levels of nitric oxide (NO) and white blood cells (WBCs), which are assumed to play a role in secondary cerebral damage by increasing to pathological levels during cranial trauma, and to investigate the neuroprotective effect of dexamethasone on NO and WBC levels in experimental cranial trauma. For this purpose, adult Sprague-Dawley male rats were used. Blood NO and WBC levels were investigated in one group of non-trauma rats (control group, n = 10) after 6 h; in a group of rats with experimental post-cranial trauma (trauma group, n = 10) after 6 and 24 h; and in a third group of rats with experimental cranial trauma, intraperitoneally injected with 10 mg/kg dexamethasone after 1 and 12 h (trauma + dexamethasone group, n = 10), WBC and NO levels were measured after 6 and 24 h. Determination of NO levels was carried out by assaying serum nitrite and nitrate levels. The increases in post-trauma serum NO (nitrite and nitrate) and WBC levels were statistically significant for the trauma and trauma + dexamethasone groups compared to controls. There was no significant difference between serum NO and WBC levels in rats in the trauma + dexamethasone and those in the trauma group. The study demonstrated no significant inhibition of NO and WBC levels by dexamethasone, a drug used for its anti-edema and anti-inflammatory effects and its influence on membrane stabilization and in avoiding oscillation stress. In the present study, dexamethasone was found to be ineffective in decreasing NO and WBC levels to avoid secondary cerebral damage after cranial trauma.

Activity of mannitol and hypertonic saline therapy on the oxidant and antioxidant system during the acute term after traumatic brain injury in the rats.

In this study, our objective is to investigate the effects of mannitol and 7.5% hypertonic saline (HS) therapy on the levels of malondialdehyde (MDA), catalase and glutathione peroxidase (GSH-Px) in the early stages of experimental head traumas in rats. Rats included in the study were divided into four groups: Group I Control, Group II Trauma, Group III Mannitol, and Group IV 7.5% Hypertonic Saline. Rats in Group II were subject to head trauma only. Mannitol was injected intraperitoneally to rats in Group III after head trauma and 7.5% HS was injected intraperitoneally to rats in Group IV after head trauma. Rats were sacrificed 4 h after administration of mannitol or 7.5% HS, and the levels of MDA catalase and GSH-Px in brain tissues extracted from rats were determined. MDA levels in the trauma group were significantly increased compared with the control group (p<0.01), whereas there was a reduction in catalase and GSH-Px levels, although these differences were not significant. By contrast, in the mannitol group, MDA, catalase and GSH-Px levels were lower than the levels in the trauma group, and these reductions were statistically significant (p<0.05). The MDA, catalase and GSH-Px levels of the 7.5% HS group were lower than those of the trauma group; however, this reduction was not statistically significant. It was concluded that mannitol and 7.5% HS therapies that are used to reduce intracranial pressure and to increase the use of catalase, an antioxidant enzyme, and GSH-Px, are likely to reduce cellular damage by reducing the formation of MDA, the levels of which are known to be indicative of cellular level oxidant damage.

Plasma vitamin E and selenium levels in rats with head trauma.

BACKGROUND: Free radicals play an important role in brain damage induced by a head trauma. In this study, we examined the prevention of brain damage that occurs after oxidative stress in rats that had undergone an experimental head trauma and the determination of plasma levels of vitamin E and selenium, which are recognized as antioxidant agents. METHODS: In this study, adult male Sprague-Dawley rats were used. Rats were divided into 2 groups. In the first group (control group, n = 10), pretraumatic plasma selenium and vitamin E levels were investigated and rats were not traumatized. In the second group (trauma group, n = 10), posttraumatic plasma selenium and vitamin E levels were investigated at the 6th and 24th hours in traumatized rats. RESULTS: In the control group, the plasma selenium level was 107 +/- 8.113 microg/L, whereas vitamin E level was 1.310 +/- 0.048 mg/dL. In the trauma group, the plasma selenium level was 79.93 +/- 3.130 microg/L at the 6th hour and 74.74 +/- 2.947 microg/L at the 24th hour, whereas the vitamin E level was 1.211 +/- 0.056 mg/dL at the 6th hour and 1.136 +/- 0.044 mg/dL at the 24th hour. Normal plasma selenium and vitamin E levels were significantly reduced in the early period after trauma. CONCLUSION: Because of oxidative stress that occurs directly after a head trauma, vitamin E and selenium depletion occurs in the early period. This condition supports the idea that brain damage can be reduced if decreased antioxidants are replaced when a head trauma occurs. We believe that these findings will guide and assist in future studies to develop clinical management strategies to prevent brain damage induced by head trauma.

Controversies in chronic subdural hematoma: continuous drainage versus one-time drainage.

BACKGROUND: Various surgical methods are recommended for the therapy of chronic subdural hematoma (CSH). In this study, burr-hole continuous drainage (CD) and burr-hole one-time drainage (OTD) methods for the treatment of CSH are retrospectively compared. MATERIAL/METHODS: Fifty patients with CSH referred to this clinic between July 1995 and December 2003 were selected for treatment. Twenty-one patients were treated by the burr-hole OTD method and 29 patients received burr-hole CD therapy. The recurrence rates and the extension of the hematoma were evaluated with respect to the period of postoperative hospitalization to evaluate the most effective RESULTS: The postoperative hospitalization period was 7.9 days in the burr-hole continuous drainage group and 17 days in the burr-hole one-time drainage group. Recurrence developed in two cases (6.8%) in the CD group and in six cases (28.5%) in the OTD group. When the pre- and postoperative hematoma extension in the CD group were compared, a significant degree of decrease was observed on post-op day 1. Extension of the hematoma was found to be minimal in the days following the modification. The width of the hematoma in the OTD group was also reduced at post-op day 1; however, the degree of this decrease was not significant. CONCLUSIONS: Continuous drainage therapy for CSH is superior to the one-time drainage method due to the shorter time of post-op hospitalization and to the reduced rate of recurrence.

Surgical treatment outcome of subdural empyema: A clinical study.

A retrospective study of 28 patients identified with subdural empyema (SE) at the Department of Neurosurgery between the years 1995 and 2005 was carried out. SE occurred in all patients following bacterial meningitis. The six most frequently encountered clinical features included: (1) fever in 22 (79%) patients; (2) disturbed consciousness in 16 (57%) patients; (3) papilledema in 11 (39%) patients; (4) hemiparesis in 4 (14%) patients; (5) meningismus or meningeal signs in 4 (14%) patients, and (6) seizures in 3 (11%) patients. In the majority of cases, the most frequent causative pathogen of SE was Staphylococcus aureus. Surgery was performed on all patients, which included craniotomy in a group of 20 patients and burr hole drainage in a group of 8 patients. In conclusion, we believe that infants and young children should be carefully monitored following meningitis, in case of SE development, and that surgical intervention in patients presenting with meningitis may facilitate the development of SE. Furthermore, from a surgical point of view, our experience has led us to believe that craniotomy in comparison with burr hole surgery is the best surgical modality for management of SE as the recurrence rate of SE associated with burr hole surgery is high.

Primary hydatid cyst of the brain during pregnancy.

A 26-year-old woman in the 28th week of pregnancy presented with a primary cerebral hydatid cyst manifesting as deteriorating consciousness and weakness in the left arm and leg. Cranial computed tomography revealed an intracranial hydatid cyst. The cyst was surgically removed and albendazole was administered. The patient had a spontaneous vaginal term delivery and no problem was observed in the mother or child. No primary focus was found in the lungs, liver, and other organs. Hydatid cyst is still an important disease. Intracranial hydatid cyst without primary foci in organs such as the liver and lungs is very rare. Primary cerebral hydatid cyst during pregnancy can be successfully treated by surgical and medical intervention.

Lipid peroxidation in patients with brain tumor.

Molecular and genetic signatures may predict brain tumor behavior and may soon guide tumor classification, diagnosis, and tumor-specific treatment strategies. Free oxygen radicals (FOR) are thought to take part in oncogenesis and cellular differentiation. This article explored the state of FORs and antioxidant system in patients with cerebral tumor. The serum concentrations of malondialdehyde (MDA), catalase, and glutathione peroxidase (GSH-Px) enzyme activities were measured in the serum of 35 patients with cerebral tumors (21 glioma, 14 meningioma) and 11 controls. MDA measurement was done with fluorometric method and catalase and GSH-Px enzyme activities were done with photometric method. Mean serum MDA levels, catalase, and GSH-Px enzyme activities were significantly higher for both glial and meningiomal tumor cases when compared to controls (p < .05). There is no significant difference between glioma and meningioma groups in terms of the aforementioned parameters (p > .05). In conclusion, lipid peroxidation and antioxidant enzymes as assessed by MDA, catalase, and GSH-Px were increased in patients with brain tumors, for this respect there is no difference between gliomas and meningiomas.