Retrospective Analysis and Comparison of 48 Intracranial Meningioma Cases As Two Groups According to Their Size.

Objective This study aims to examine the possible demographic, clinical, and surgical differences between giant and smaller meningiomas. Materials and Methods Forty-eight meningioma patients who were operated on in our clinic between 2016-2020 were included in our study. Fourteen meningiomas larger than 5 cm in diameter were defined as giant meningiomas and placed in group 1. Thirty-four remaining meningiomas, with sizes less than 5 cm, were placed in group 2. These patients were evaluated regarding age, sex, localization, symptoms and neurological findings, surgical results, histopathology, and postoperative results. Results The most common localization in group 1 was falcine-parasagittal, whereas in group 2 it was convexity. Simpson's grade I resection rate in group 1 was 35.71%, while in group 2 this rate was 67.65%. In histopathological examination, transitional type meningiomas (35.71%) were the most common in group 1, whereas fibrous type meningiomas (32.35%) were seen the most in group 2. Group 1 Karnofsky Performance Scale score average was 75.71 preoperatively and 85.71 postoperatively. In group 2, the preoperative and postoperative average was 97.35 and 96.76, respectively. The comparative statistical analysis reflects that: A) Resection rates were significantly lower in the giant meningioma group. B) Similarly, Karnofsky Performance Scale scores were also lower than group 2. C) When statistical comparisons were made according to sex, age, localization, histopathological results, postoperative complications, and recurrence rates, no significant differences were observed. Conclusion The term "Giant Meningioma" is a type of distinction that is frequently made in the literature. However, the single major difference we see in our study was the surgical results. The general condition of patients before and after surgery may be more critical than others in giant meningiomas. Although surgical resection is the main form of treatment in giant meningiomas, the risks arising from the size of the tumor should be taken into account, and necessary plans should be made for a successful surgical intervention.

The Role and Contribution of Lumbar Myelography in the Diagnosis and Treatment of Patients With Lumbar Degenerative Disorders: Clinical and Statistical Evaluation of Post-Myelography Treatment of 63 Patients.

Introduction Myelography is a radiological examination method that has been used for the diagnosis of spinal canal pathologies for a long time. More than 90 years of experience has been improved by the development of increasingly less toxic contrast agents. Nowadays, although there are many advanced diagnostic tools, lumbar myelography is a direct imaging technique and so it is a powerful diagnostic method for patients whose treatment has not been decided. The aim of our study is to evaluate the effect of lumbar myelography as a diagnostic method and its contribution to treatment. Materials and methods Between January 2016 and April 2018, 63 patients who were admitted to our neurosurgery clinic due to lumbar degenerative disorders and underwent myelography were included in our study. Patients over 30 years of age with lumbar disc disease, narrow spinal canal, and spinal instability, but for whom a surgical decision could not be made, were included in this study. Results After lumbar myelography, 55 of 63 patients underwent a surgical procedure and 8 were directed to non-surgical treatment options. The results of the patients were evaluated by Roland-Morris Low Back Pain and Disability Questionnaire (RMQ). Results showed that the contribution of selected treatment protocols to the recovery after myelography was statistically significant. Conclusion Nowadays, myelography is not the first choice for the diagnosis of lumbar degenerative disorders. However, according to the results of our study, lumbar myelography is an effective diagnostic tool for specific purposes.

Percutaneous Radiofrequency Thermocoagulation in Trigeminal Neuralgia : Analysis of Early and Late Outcomes of 156 Cases and 209 Interventions.

OBJECTIVE: Trigeminal neuralgia is one of the most common causes of facial pain. Our aim is to investigate the efficacy and borders of percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia. METHODS: Between May 2007 and April 2017, 156 patients with trigeminal neuralgia were treated with radiofrequency thermocoagulation. These 156 patients underwent 209 procedures. In our study, we investigated the early and late results of percutaneous radiofrequency thermocoagulation under guiding fluoroscopic imaging in the treatment of trigeminal neuralgia. Barrow Neurological Institute (BNI) pain scale was used for grading the early results. In addition, Kaplan-Meier survival analysis was used to assess long-term outcomes. Of the 156 patients who underwent radiofrequency thermocoagulation for trigeminal neuralgia, 45 had additional disease. Patients with this condition were evaluated with their comorbidities. Early and late results were compared with those without comorbidity. RESULTS: In 193 of 209 interventions BNI pain scale I to III results were obtained. Out of the 193 successful operation 136 patients (65.07%) were discharged as BNI I, 14 (6.70%) as BNI II, 43 (20.58%) as BNI III. Sixteen patients (7.65%) remained uncontrolled (BNI IV and V). While the treatment results of trigeminal neuralgia patients with comorbidity seem more successful in the early period, this difference was not observed in follow-up examinations. CONCLUSION: Finally, we concluded that percutaneous radiofrequency thermocoagulation of the Gasserian ganglion is a safe and effective method in the treatment of trigeminal neuralgia. However, over time, the effectiveness of the treatment decreases. Neverthless, the reapprability of this intervention gives it a distinct advantage.

Clinical and radiological evaluation of treated Chiari I adult patients: retrospective study from two neurosurgical centers.

Chiari malformation type I (CM1) is a common neurosurgical disorder. It often causes debilitation in the affected patients. CM1 is a herniation of the caudal cerebellum into the spinal canal. This study aimed to evaluate the clinical and radiological outcomes of posterior fossa decompression and duraplasty (PFDD) in treated CM1 patients. In retrospective design, we reviewed the medical records of diagnosed patients with CM1 at two neurosurgical centers spanning 8 years from 2010 to 2017. We selected all CM1 patients who underwent PFDD surgery (n = 72) as the core sample for this study. We used the Chicago Chiari Outcome Scale (CCOS) to evaluate clinical outcomes. Pre- and postoperatively, we assessed the syrinx/cord ratio, the syrinx length, and the improvement of aqueductal stroke volume (ASV) on CSF flow MRIs. The mean value of CCOS was 14.1 ± 2.1. On midsagittal MRIs, the mean regression in ectopia tonsils was 9.4 ± 1.9 mm (i.e., mean pre- and postoperative tonsil herniation was 13.1 ± 3.1 mm and 4.0 ± 1.6 mm, respectively; p < 0.001). On coronal MRIs, the mean regression in ectopia tonsils was 8.4 ± 1.5 mm (i.e., mean pre- and postoperative tonsil herniation was 13.9 ± 2.4 mm and 5.8 ± 1.0 mm, respectively; p < 0.001). A strong positive correlation was observed between clinical improvement and the increase in ASV values. CSF flow MRIs can help in the surgical decision and follow-up of CM1 patients. ASV ≤ 12 µl is a significant predictor for surgical intervention. Full clinical and radiological evaluation utilizing CSF flow MRI are essential. Most syrinx cavities have regressed following PFDD.

Radiologic-Histopathologic Correlation of Adult Spinal Tumors: A Retrospective Study.

AIM: Preoperatively performed magnetic resonance images (MRIs) are essential before treating spinal tumors surgically. This study aims to investigate the compatibility of MRI preliminary diagnosis and proven histopathologic diagnosis of consecutively operated 96 spinal tumors. MATERIAL AND METHODS: Medical records were retrospectively reviewed for all spinal tumors operated at our institute during a period of 6 years. One hundred and ten spinal tumors were detected. Fourteen tumors were excluded because they were not met our study criteria. RESULTS: Ninety-six cases of spinal tumors were detected in 46 female and 50 male patients. The mean age was 49.3 ± 22.7 years. The most common symptom was radicular pain (88.6%). Histopathologic diagnoses were metastasis (n = 26), meningioma (n = 16), schwannoma (n = 15), ependymoma (n = 9), astrocytoma (n = 6), chronic nonspecific granulomatous infection (n = 4), lymphoma (n = 3), lipoma (n = 3), epidural tuberculosis abscess (Pott's disease) (n = 3), and other pathologies in 11 cases. Cervical spine was the less spinal region affected with metastases (P < 0.05). Thoracic spine was the most affected spinal region from meningioma (P < 0.05). Preoperatively, preliminary diagnosis on MRIs was proven with histopathologic examinations in 22 metastasis, 14 meningioma, 11 schwannoma, and all epidermoid cyst and lipoma cases. Despite the fact that MRI cannot diagnose all cases of spinal tumors, MRIs had a high accurate rate to diagnose the most common spinal neoplasms (69.8%). CONCLUSIONS: Metastases rarely occurred in cervical spine, whereas meningiomas were most likely to occur in thoracic spine. MRIs can help diagnose metastases and spinal benign lesions, whereas they failed to distinguish astrocytomas and lymphomas. Further prospective studies with large size are needed to support our results.

Long-Term Surgical Resection Outcomes of Pediatric Myxopapillary Ependymoma: Experience of Two Centers and Brief Literature Review.

BACKGROUND: Myxopapillary ependymoma (MPE) is a rarely reported lesion of the spinal cord in the pediatric population. Based on their low mitotic index and slow-growth, MPEs are classified as low-grade glial tumors. However, MPEs have malignant characteristics, such as distant neural axis and extraneural axis dissemination. We present the long-term surgical resection outcomes of 5 consecutive pediatric MPE cases and the results of a literature search for reported cases of pediatric spinal MPE. METHODS: We retrospectively reviewed the medical records of 38 primary spinal MPE cases who underwent surgery at 2 neurosurgical centers over a 16-year period from January 2004 to January 2019. All pediatric cases (age <18 years; n = 5) who were diagnosed with MPE composed the core sample for this study. RESULTS: This series comprised 5 patients (3 females and 2 males), with a mean age at first presentation of 13.6 ± 2.3 years. The mean preoperative course was 8.2 ± 9.3 months. The predominant location was the lumbar spine, for 4 tumors. Gross total resection (GTR) was achieved in 4 patients. All patients were diagnosed histopathologically as MPE, World Health Organization grade I. No adjuvant treatment was provided after the first surgery. Three patients experienced spinal drop metastasis. The mean interval between the first diagnosis and diagnosis of neural dissemination was 44.0 ± 31.5 months. The location of neural dissemination in all patients was the sacral spine; 1 patient experienced distant metastasis in the brain along with her sacral metastasis. The mean duration of follow-up was 75.0 ± 37.6 months. CONCLUSIONS: Even with GTR, pediatric MPE has a high propensity for neural axis dissemination. We recommend close clinical and radiologic follow-up for pediatric patients with MPE.

Radiation-Induced Meningiomas: A Series of Four Consecutive Patients and a Review of Literature.

AIM: To assess the clinical outcomes of treatment for radiation-induced meningiomas. MATERIAL AND METHODS: Medical records were retrospectively reviewed for all cranial meningioma cases that were diagnosed and/or underwent surgery at our hospital from 2009 to 2016. All radiation-associated meningioma patients constituted the core sample for this study. RESULTS: This series included one female and three male patients, with a mean age of 47.3 ± 16.3 years. The mean preoperative course was < 3 months. The most common symptom was headache (100%) and three patients had alopecia and thin scalp skin. The mean of the age at which they underwent radiotherapy was 18.5 ± 13.7 years. The mean latency period was 19.2 ± 7.4 years. Initial malignancies included two patients with desmoplastic medulloblastomas (13-year-old female, 65 Gy), (11-year-old male, 54 Gy) and a patient with grade II oligodendroglioma treated with 30 Gy. A male patient received low-dose radiotherapy for chronic otitis at 10 years old. Histopathological examinations revealed the following: 1) fibroblastic-grade I, Ki-67 2%-3%, 25.5 years latency; cerebellopontine angle, 2) atypical meningioma grade II, Ki-67 8%, 21 years, frontal; and 3) transitional grade I, Ki-67 3%-4%, 11 years, frontal. The fourth patient had three radiation-induced meningiomas and 27 radiation-induced cavernomas, and was treated using a gamma knife. The mean follow-up period was 34.8 ± 39.4 months. One patient had rhinorrhea and another experienced a cerebrospinal fluid fistula. Both underwent an additional operation. The former died because of meningitis on postoperative day 31. CONCLUSION: Most radiation-induced meningiomas are low-grade, but they have a high trend of recurrence. Close follow-up and yearly magnetic resonance imaging would minimize the morbidity rate. To reduce fatal complications, surgery should be planned in conjunction with plastic surgeons.

Factors affecting the surgical outcomes of tethered cord syndrome in adults: a retrospective study.

This study aimed to find the factors that may affect the surgical outcomes of congenital tethered cord syndrome (TCS) in adults by evaluating the long-term surgical outcomes of 25 consecutive cases. Medical records of 79 TCS cases which underwent surgery in Bakirköy Research and Training Hospital for Neurology, Neurosurgery and Psychiatry (BRSHH), during an 11-year period from 2005 to 2015, were retrospectively reviewed. All adult cases (patient age > 18 years) were selected as the core sample used for this study. Twenty-five cases of TCSs were surgically treated. The sample consists of 16 female and nine male patients. The mean age of the sample is 30.1 ± 10.3 years. Untethering was carried out in 88% of the patients. Sixty-four percent of the patients had good clinical outcomes at their last follow-up (after 73.8 months on average). The mean length of hospital stay was 4.76 ± 2.88 days. In a multivariate regression model, laminectomy, bladder dysfunction when associated to muscular weakness, and long-term (>6 months) symptoms were selected as the independent risk factors associated with poor or minimally improved (almost unchanged) surgical outcomes. When the urodynamic test showed overactive detrusor muscle, no improvement was recorded in postoperative urodynamic test. Laminoplasty (or hemilaminectomy), short-term (<6 months) symptoms, patients without lipomas, and presentation with moderate or mild symptoms seem to be proper predictors for good surgical outcomes. Further prospective studies are necessary to investigate these findings systematically. Urodynamic study can be used as a predictive tool for close follow-up of asymptomatic adult patients involved with TCS.

Clinical outcomes of multiple aneurysms microsurgical clipping: Evaluation of 90 patients.

BACKGROUND: The incidence of multiple intracranial aneurysms (MIAs) among patients who are diagnosed with aneurysm is 15-45% in the literature. Treatment options depend on the patient's status, age, aneurysm location and neurosurgeon's experience. In this study outcomes of micro-surgically clipped 90 patients have been evaluated. MATERIALS AND METHODS: Medical records of 90 (49 women and 41 men) patients of MIAs who underwent surgery by the authors, during a 3-year period from 2011 to 2013 were retrospectively reviewed of prospectively collected patients' data. Surgically treated patients underwent a lateral supraorbital craniotomy followed by microsurgical clipping of all reachable aneurysms. RESULTS: The mean age of the sample is 50.8±11.9 (25-82) years. There were 67 patients presented with SAH. The most common complaint was severe headache of sudden onset (94%) in SAH group and migraine type headache (60.8%) in incidentally diagnosed group. According to location of the arteries; ACoA (50), MCA (R:49,L:45), ICA (R:34,L:15), PCoA (R:9,L:4), ACA (R:6,L:4), basilar artery (3) and SCA (2). Mortality rate was 13.3% (n=12), morbidity rate (new deficit was developed) was 18.8% (n=17) [7 out of them were partially/completely dependent on others for daily living activities before surgery (i.e. GOS<3)] and 67.8% (n=61) of the patients returned to their normal jobs and daily activities. CONCLUSIONS: Multiple cerebral aneurysms are not associated with a less favorable outcome than are single aneurysm cases. Authors prefer microsurgical clipping of all the aneurysms, be it on the reverse side, if the aneurysm location is reachable and that includes bilaterally presenting MIAs.

Primary Intracranial Germinomas: Retrospective Analysis of Five Cases.

AIM: Primary intracranial germinomas (PIGs) are rare malignant brain tumors that represent approximately 0.2% to 1.7% of all primary intracranial tumors. PIGs have infrequent, but there is a possibility of spinal cord metastases. In this study, clinical outcomes of five consecutive PIGs have been presented. MATERIAL AND METHODS: Medical records were retrospectively reviewed in 1,849 cases of intracranial tumors who underwent surgery between the years 2005 and 2015 and cases confirmed as germinoma histopathologically were included in this study. RESULTS: Five cases of PIGs were detected in two female (40%) and 3 male (60%) patients. The mean age was 15.2±5.6 (8-23) years. The mean follow-up period was 52.3±56.4 (9-135) months. The most common complaint was headache (60%), followed by nausea±vomiting (40%). Four cases (80%) affected the suprasellar region while the fifth patient"s tumor was localized in the pineal region. The duration between the initial symptom and time of surgical intervention ranged between 15 days and 2 months. Twelve months after the first operation, one patient presented with drop seeding metastasis. Four-year survival (with exception of the case that died as a early surgical complication) was 100%. Gross total resection (GTR) was achieved in one patient. Surgical mortality rate was 20%. PIGs" morbidity rate was 60%. CONCLUSION: PIG is a mostly malignant tumor that generally affects the pediatric age group. They are radiosensitive tumors. Subtotal or near-total resection using stereotactic guide or direct surgery to confirm the histopathological diagnosis followed by chemotherapy and whole brain or in some cases craniospinal radiotherapy rather than GTR is therefore the treatment of choice.

Late Postoperative Rhinological Complications After Microscopic Transnasal Hypophysectomy.

AIM: Major complications of microscopic transnasal hypophyseal surgery (MTHS), such as cerebrospinal fluid rhinorrhea, carotid injury, and optic nerve injury, are very rare. However, late rhinological complications can be ignored because they are a minor cause of morbidity compared with major complications. In this study, we extensively examined postoperative rhinological complications in patients who underwent MTHS for pituitary adenoma. MATERIAL AND METHODS: Thirty-one patients diagnosed with pituitary adenoma, who underwent MTHS and whose preoperative nasal examinations were recorded between January 2007 and January 2014, were included in the study. A detailed rhinological examination of the patients was performed. RESULTS: A total of 12 of 31 patients (38.7%) had a perforated nasal septum, and synechiae were detected in the nasal cavities of 13 patients (42%). Anosmia occurred in three patients, hyposmia in two, and a nasal tip deflection and saddle nose deformity were detected in one patient with a perforated nasal septum. No perinasal loss of sense, oronasal fistula, or purulent secretion in the nasal cavity was found in any patient. CONCLUSION: The nasal structures, particularly the nasal septum mucosa, should be treated gently during MTHS. The nasal stages of the operation should be performed with the help of an otolaryngologist until adequate experience is gained.

Two cases of arachnoid cyst complicated by spontaneous intracystic hemorrhage.

Arachnoid cysts are developmental anomalies which are usually asymptomatic. Intracystic hemorrhage after trauma is a well known complication; however, spontaneous intracystic hemorrhage is rare. This report presents two rare cases of arachnoid cyst complicated by spontaneous intracystic hemorrhage. The first patient was admitted following transient loss of consciousness and speech disturbance, and a subacute subdural hematoma at the left temporal region was diagnosed. The second patient presented with severe headache of four days duration and a subdural hematoma at the left temporoparietal region was diagnosed. In both the patients, both on radiological examination and during surgical intervention, hematomas were found to be intracystic.