A new described mechanisms of intestinal glandular atrophy induced by vagal nerve/Auerbach network degeneration following subarachnoid hemorrhage: The first experimental study.

Stress ulcers is a trouble complication of subarachnoid hemorrhage (SAH). Although gastrointestinal ulcerations may be attributed to increased HCL secretion in SAH; the exact mechanism of that complication has not been investigated definitively. We studied if vagal network degeneration may cause intestinal atrophy following SAH. Study was conducted on 25 rabbits, with 5 control group (Group-A), 5 SHAM group (Group-B), and 15 SAH group via injection of autologue blood to cisterna magna. Seven animals followed for seven days (Early Decapitated-Group-C) and eight animals followed 21 days (Late Decapitated-Group-D). The vagal nodosal ganglia (NGs), Auerbach plexuses and goblet cells of duodenums were examined by current stereological methods and compared statistically. The mean numbers of degenerated axon density/mm2 of gastric branches of vagal nerves was 8 ±â€¯2, 34 ±â€¯11, 189 ±â€¯49 and 322 ±â€¯81 in the Group A, B, C, and D respectively. The mean numbers of degenerated neuron density/mm3 of NGs was 5 ±â€¯2, 54 ±â€¯7, 691 ±â€¯87 and 2930 ±â€¯410 in the Group A, B, C, and D respectively. The mean numbers of degenerated Auerbach neurons 2 ±â€¯1, 4 ±â€¯1, 12 ±â€¯3 and 27 ±â€¯5/mm3 in the Group A, B, C, and D respectively. The mean numbers of degenerated goblet cells/mm3 were 4.3 ±â€¯1.02, 11.5 ±â€¯0.26, 143 ±â€¯26 and 937 ±â€¯65 Group A, B, C, and D respectively. Statistical analysis showed that vagal network ischemia could cause intestinal bleeding and so atrophy in SAH progression. Statistical analyses of groups were; Group-D/Group-A < 0.001, Group-D/Group-B < 0.005, Group-C/Group-A < 0.005. Undiscovered effect of ischemic vagal network injuries should be regarded as a major cause of stress ulcerations following SAH which has not been mentioned in the literature.

Hydatidosis Following Giant Cerebral Hydatid Cyst Operation.

BACKGROUND: Hydatid cysts (HCs) are caused by parasites, the larvae of Echinococcus granulosus. They usually affect the liver and lung, but primary brain involvement is rarely seen. HCs may cause a mass effect in the brain. For this reason, surgical excision must be performed. Complications may rarely occur after surgery. Recognition of complications is of vital importance. CASE DESCRIPTION: A 45-year-old man presented with complaints of personality disorder and severe, long-standing headache. The patient had no neurologic deficit. However, there were symptoms associated with increased intracranial pressure. Radiologic examination revealed intracranial HCs. Complications did not develop during the operation. Six months following the surgery, the patient came back after experiencing unconsciousness. Control cerebral magnetic resonance imaging showed multiple cerebral cysts. CONCLUSIONS: Surgical resection should be applied carefully in the treatment of cerebral cysts. Complications may occur later in patients who do not develop complications at the time of operation. For this reason, follow-up of the patients should definitely be done by magnetic resonance imaging.

Magnetic resonance spectroscopy and magnetic resonance imaging findings of the intracerebral alveolar echinococcosis.

Alveolar echinococcosis (AE) is a parasitic infestation produced by Echinococcus multilocularis. The parasite is a rare human infestation with a wide geographic distribution. It primarily affects the liver, and may spread hematogenously to produce metastatic foci in the distant organs. AE can metastise to the lungs, brain and bones. Cerebral involvement is rare but may be lethal. Cerebral AE is a rare but life-threatening parasitic disease. Here we report a 52-year-old man with cerebellar involvement of Echinococcus multilocularis.

Neuroprotective effect of acute interferon-beta 1B treatment after spinal cord injury.

AIM: The purpose of this trial was to investigate the effect of a well known immunomodulator -interferon beta- on traumatized spinal cord in terms of biochemical and histopathological features. MATERIAL AND METHODS: Twenty-four rats were used in this trial. The rats were divided into 3 groups. In the first group of rats, spinal cord injury was created by the weight drop method and interferon beta was administered. In the second group, physiological saline was administered. Third group was used as control. Rats were sacrificed 24 hours following trauma. Heat shock protein 70 levels were measured in the spinal cord samples and the samples were examined histopathologically. RESULTS: When the rats in the physiological saline and control groups were compared to rats treated with interferon beta 1b, those treated with interferon beta 1b revealed significant increases in the heat shock protein 70 levels in tissues, and histopathological examination revealed decreases in polymorphonuclear leucocyte infiltration, haemorrhage, oedema and necrosis. CONCLUSION: Although, the results of the study indicated that interferon beta might have some healing effects via increasing the cellular heat shock protein 70 on spinal cord injuries, more studies are needed.

Neuroendoscopic approach to quadrigeminal cistern arachnoid cysts.

OBJECTIVE: The introduction of neuroendoscopy has provided a minimally invasive modality for the surgical treatment of quadrigeminal arachnoid cysts. Three pediatric patients with arachnoid cyst of the quadrigeminal cistern treated by endoscopic fenestration are reported. MATERIALS AND METHODS: The hospital records of patients were retrospectively rewieved. All patients had hydrocephalus. A lateral ventricle-cystostomy and endoscopic third ventriculostomy were performed by using rigid neuroendoscopes. RESULTS: There were one boy and two girls with ages 7 months, 9 months and 14 years, respectively. One patient had undergone shunting prior to neuroendoscopic surgery. The postoperative course was uneventful in all cases, with no complications. They showed disappearance of intracranial hypertension symptoms and significant reduction of the cyst size. CONCLUSION: Neuroendoscopic technique is an effective and suitable method for the treatment of quadrigeminal cistern arachnoid cysts and accompanying hydrocephalus.

Tethered cord syndrome in childhood: special emphasis on the surgical technique and review of the literature with our experience.

AIM: Surgery is the treatment of choice for children who had tethered cord syndrome (TCS). However, a detailed technique for the release of spinal cord is not described yet. The aims of this study are to present our series of TCS in children and to focus on the details of surgical technique. MATERIAL and METHODS: Forty-nine children with tethered cord syndrome underwent surgical treatment for the release of spinal cord between 2004 and 2009. The mean age was 4.6 years (2 days-13 years). Twenty (40.8%) patients were female and 29 (59.2%) were male. Among the 49 children, 41 (83.7%) had different spinal malformations and 8 (16.3%) had no associated lesion. Sectioning of the filum terminale, cutting the arachnoid and fibrous bands, protection of the rootlets and correction of the associated malformations was the standard surgical method to release the spinal cord. RESULTS: Neurological improvement was observed in 4 (8.2%) patients, while the neurological status was unchanged in the others. Cerebrospinal fluid fistula was the main complication and was observed in 3 patients. No mortality or neurological deterioration was encountered. CONCLUSION: Spinal cord release with appropriate technique seems to be beneficial in maintaining neurological functioning in children with TCS.

Neuroprotective effect of ACE inhibitors in glutamate - induced neurotoxicity: rat neuron culture study.

AIM: Glutamate is known to be neurotoxic at concentrations of 10-6M and 10-7M. Angiotensin converting enzyme (ACE) inhibitors can be assumed to be neuroprotective as they open the mitochondrial adenosine triphosphate-sensitive potassium channels by inhibiting the degradation of bradykinin. In this study, we investigated whether the ACE inhibitors captopril, ramipril and perindopril have protective effects in glutamate-induced neurotoxicity in newborn rat cerebral cortex cell cultures. MATERIAL AND METHODS: Viability tests were performed among ACE inhibitors by constituting groups of control and 10-7M and 10-6M glutamate doses in newborn rat cortex cultures. RESULTS: While the mean viable cell number was 0.47±0.06 in the control group, it was 0.37±0.03 in the group exposed to 10-7M glutamate (p < 0.05) and 0.37±0.01 in the group exposed to 10-6M glutamate (p < 0.05). Captopril was used at a dose of 10 µM, perindopril was used at a dose of 1 µM, and ramipril was used at a dose of 30 µM against 10-7M and 10-6M glutamate. Ramipril and perindopril reversed the toxicity against 10-6M glutamate (p < 0.05). The neuroprotective properties of captopril, perindopril and ramipril were not found to be statistically significant against 10-7M glutamate at the doses mentioned above. CONCLUSION: Data obtained from this study indicate that ramipril and perindopril can prevent 10-6M glutamate-induced neurotoxicity.

The complications of cerebral hydatid cyst surgery in children.

PURPOSE: Complications related to cerebral hydatid cyst surgery are not uncommon but require prompt diagnosis and treatment. The aim of this study is to demonstrate the radiological findings that would indicate complications after cerebral hydatid cyst surgery in children and to report our results. METHOD: The data of 25 pediatric patients who underwent surgery for cerebral hydatid cysts over a 16-year period were analyzed retrospectively. The complications related to surgical technique and cyst location were recorded. Postoperative radiological findings of the patients were documented. RESULTS: Intraoperative cyst rupture occured in three patients. Subdural effusion developed in five patients, porencephalic cyst in four, subdural effusion associated with porencephalic cyst in two, hemorrhage in two, epidural hematoma in one, and pneumocephalus in three patients. Subdural-peritoneal shunt was placed in two patients. Recurrence of cerebral hydatid cyst was observed in only one patient who experienced intraoperative cyst rupture. There was no surgery-related death. CONCLUSIONS: The complications following cerebral hydatid cyst surgery in children are various and usually not fatal. When appropriate surgical procedures are planned and carefully applied, the results will be excellent with no mortality.

The variations of the anterior choroidal artery: an intraoperative study.

AIM: Increasing use of surgical magnification for operations in the territory of the anterior choroidal artery (AChA) has created a need for detailed knowledge of their anatomical variations. The aim of the present study is to examine the anatomical variations of the AChAin patients operated via pterional approach. MATERIAL AND METHODS: The origin and branching pattern of AChAs were observed intraoperatively in 130 patients who were operated via a pterional approach at our center. RESULTS: AChAs arose from the internal carotid artery (ICA) and distal to the posterior communicating artery (PCoA) at a ratio of 70%, from just distal to the original point of the PCoA in 20%, and from just proximal to the ICA bifurcation in 10% of the patients. In 95 cases, AChAs arose from the inferolateral aspect of the ICA in the posterolateral aspect in 27 and from its lateral part in 8 cases. AChAs were found as a single branch at the origins from ICA in 110 patients, as double in 17 cases and as triple in 3 patients. CONCLUSION: Recognition of anatomical variations and microvascular relationships of AChA will allow neurosurgeons to construct a better and safer microdissection plan, to save time and can prevent postoperative neurological deficits.

Infratentorial subdural empyema.

Infratentorial subdural empyema is a life-threatening rare complication of bacterial meningitis. Infratentorial subdural empyemas constitute only a small portion of all cases with intracranial infectious diseases. We present a 15-year-old boy with infratentorial subdural empyema. Empyema was diagnosed with serial follow-up computed tomography and magnetic resonance imaging while he was being treated for bacterial meningitis secondary to neglected mastoiditis. The patient was successfully treated with emergent surgery and appropriate antibiotics. Empyema should be considered in patients with suspected or proven bacterial menengitis and associated ear nose throat infection with neurological signs that suggest a posterior fossa lesion.

Primary hemangiopericytoma of the parietal bone: a case report.

UNLABELLED: Hemangiopericytomas are rare hypervascular tumors arising from Zimmerman's pericytes. They usually occur in the soft tissue, and intraosseous lesions are very rare. Surgical excision is the first choice for treatment. Many studies show that patients should be monitored for some time following treatment because of a high rate of recurrence and metastasis after radical resection. This report introduces a 56-year-old patient with a hemangiopericytoma in his parietal bone. KEYWORDS: Parietal bone, Hemangiopericytoma.

Nonsurgically treated cervical brucellar epidural abscess causing spinal cord compression.

Cervical spinal cord compression due to brucellar epidural abscess is extremely rare, with only 13 previously reported cases. We present another case of cervical spinal epidural abscess causing spinal cord compression. Diagnostic tools and treatment options are discussed.

Alveolar echinococcosis of the brain in five patients.

Cerebral alveolar echinococcis is a biologically aggressive infestation that mimics a malignant neoplasm radiologically and macroscopically. This paper describes the clinical and radiological aspects of the disease, with new diagnostic studies, and discusses the surgical treatment of this infestation. The records of five patients with cerebral alveolar echinococcis treated at our center between 2000 and 2004 were reviewed. Three patients underwent radical surgical treatment and received antihelminthic therapy post-operatively, two of whom experienced asymptomatic recurrence. Two patients with multiple lesions were treated with antihelminthic therapy alone. The prognosis was poor for these patients. Radical surgery combined with antihelminthic therapy of sufficient duration are mandatory to prevent the progression of symptoms but the disease continues to be difficult to cure.

A preliminary histopathological study of the effect of agmatine on diffuse brain injury in rats.

The present study evaluates the effects of agmatine on histopathological damage following traumatic injury using a clinically relevant model of diffuse brain injury. A total of 27 male Sprague-Dawley rats weighing 200-225 g were anaesthetised and subjected to head trauma using Marmarou's impact-acceleration model. The rats were then separated into two main groups: one was treated with agmatine and the other with saline for up to 4 days immediately after head trauma. Rats from both groups were killed 1, 3 or 8 days post-injury. The brains were examined histopathologically and scored according to the axonal, neuronal and vascular changes associated with diffuse brain injury. There were no significant differences between the groups at 1 day or 3 days after trauma, but evaluation after 8 days revealed a significant improvement in the group treated with agmatine. Our data indicate that agmatine has a beneficial effect in diffuse brain injury and should be trialled for therapeutic use in the management of this condition.

Treatment of spinal hydatid disease: a single center experience.

In Turkey, spinal hydatidosis remains a serious health problem that is associated with high morbidity and mortality. This study was undertaken to analyze the clinical, radiological, and surgical aspects and outcomes for five patients with spinal hydatidosis who were treated surgically at the Department of Neurosurgery of Ataturk University, Turkey. Despite the introduction of modern surgical and pharmacological therapy the disease remains difficult to cure, and patient outcomes are not satisfactory because of the high incidence of recurrence.

Transanal prolapse of a ventriculoperitoneal shunt.

Ventriculoperitoneal shunt application is among the most frequently performed procedure in the treatment of hydrocephalus. Despite the peritoneal cavity being convenient for absorption of cerebrospinal fluid, multiple complications related to the shunt tend to develop in this area. Anal migration of ventriculoperitoneal shunt catheter is seen as a rare complication due to the intestinal perforation caused by peritoneal shunt catheters. The diagnosis of this condition is self-evident. In this report, an infant whose shunt catheter protrudes through the anus with no abdominal or CNS signs is presented.

Coexistence of subdural and intracerebral hematoma in a shunted infant not related to ventricular catheter.

We have here, a case report of an infant who presented with subdural and intracerebral hematoma distantly from the site of insertion of a ventriculoperitoneal shunt 6 days after operation. Though this complication has been previously reported, it remains a rare event. Both pathogenesis and treatment still represent a problem.

Multiple schwannomas of cauda equina in the absence of von Recklinghausen's disease.

Multiple schwannomas in the absence of neurofibromatosis is rarely reported in the literature. We present a 56-year-old female with a history of severe leg and back pain on the left side for one year. Magnetic resonance imaging revealed 4 schwannomas located in the cauda equina in the absence of von Recklinghausen's disease.

Triple occipital meningoceles in a newborn. Case report.

The coexistence of three cranial meningoceles in a single patient is an extremely rare event. Multiple cranial meningoceles have not been reported in the literature. The rare case of a newborn with three distinct occipital meningoceles, of which one was rudimentary, is presented. Diagnostic tools and treatment options are also reviewed.

Spinal intramedullary ependymal cyst and tethered cord in an adult. Case report.

Spinal intramedullary ependymal cysts are extremely rare. Fourteen cases have been reported in the literature, and only one was associated with another congenital lesion. The authors describe the case of a 33-year-old man in whom an intramedullary ependymal cyst and filar lipoma were present. These lesions were diagnosed using magnetic resonance imaging and were treated surgically. Pathological examination confirmed the diagnosis. At 6 months postsurgery, there was no evidence of recurrence.