The effects of prophylactic zinc and melatonin application on experimental spinal cord ischemia-reperfusion injury in rabbits: experimental study.

STUDY DESIGN: Experimental study. OBJECTIVES: To determine the neuroprotective effects of zinc and melatonin on spinal cord ischemia-reperfusion (I/R) injuries of rabbits. SETTING: The Experimental Research Centre of Selçuk University, Konya, Turkey. METHODS: Twenty-four male rabbits underwent spinal cord ischemia by clamping the thoraco-abdominal aorta for 20 min. Twenty minutes before the aortic clamping, animals received zinc, melatonin or a combination of both. Neurological examination of the animals was performed three times during reperfusion period. The animals were killed 24 h after reperfusion. Spinal cord samples were taken for biochemical and histopathological evaluation. RESULTS: Pre-treated animals with zinc, melatonin or combination displayed better neurological outcomes than the I/R group (P<0.05). Zinc, melatonin and combined treatment prevented spinal cord injury by reducing apoptosis rate (P<0.05) and preserving intact ganglion cell numbers (P<0.05). Zinc pre-treatment protected spinal cord by preventing malondialdehyde (MDA) formation (P=0.002), increasing glutathione peroxidase (GPx) activity (P=0.002) and decreasing xanthine oxidase enzyme activity (P=0.026) at molecular level. Melatonin treatment also resulted with MDA formation (P=0.002), increased GPx activity (P=0.002) and decreased xanthine oxidase activity (P=0.026). CONCLUSION: The results of the study showed that prophylactic zinc and melatonin use in spinal cord I/R not only suppressed lipid peroxidation by activating antioxidant systems but also had significant neuroprotective effects by specifically improving the neurological and histopathological situation.

Effect of mannitol in experimental spinal cord injury: an ultrastructural and electrophysiological study.

BACKGROUND: Although many experimental and clinical studies were performed on the pathophysiology and treatment of spinal cord injury (SCI), the electrophysiological and ultrastructural changes of the spinal cord were not precisely evaluated. AIMS: To investigate the effect of mannitol on Somatosensory Evoked Potentials (SSEP), postoperative neurological recovery and ultrastructural findings after an experimental SCI. SETTING: The experimental microsurgery laboratory of a university hospital. DESIGN: A prospective, randomized animal study. MATERIAL AND METHODS: Sprague-Dawley rats were used and divided into three groups (Groups I-III) for this study. Those in Group I were control animals who underwent laminectomy only, and non-traumatized spinal cord samples were obtained 2 weeks later. SCI was produced in Groups II and III using clip compression technique, and cord samples were obtained 2 weeks later. The rats in Group II received 2 g/kg of 20% mannitol intraperitoneally, immediately and three hours after trauma was induced; and those in Group III received the same amount of 0,9% NaCl in the same manner. Preoperative and postoperative SSEP records at the end of 2 weeks were obtained. Electron microscopy examination of the cord samples was done at 2 weeks postoperatively. STATISTICAL ANALYSIS USED: Fischer's Exact Test. RESULTS: SSEP records, ultrastructural findings and clinical recovery showed that minor neural damage and significant recovery occurred in Group II. CONCLUSION: This study demonstrates that the administration of 2 g/kg of 20% mannitol produces significant improvement in the neural structures and protects the spinal cord following injury.

Schwannoma of the lateral ventricle: eight-year follow-up and literature review.

Intracerebral and intramedullary schwannomas are uncommon; but, in general, spinal intramedullary schwannomas are more frequent than intracerebral schwanomas. We present a case of right lateral ventricle schwannoma in a 21-year-old man and review the associated literature. The 21-year-old right-handed man presented with loss of the left-eye vision approximately 8 months before referral to an ophthalmologist. The patient was immediately subjected to computed tomography (CT) scan, which showed an enhanced lesion with cystic component in the right occipital horn of the lateral ventricle. And consecutively, he was admitted to our department. The tumor was evacuated via craniotomy with marked improvement in his clinical state. The postoperative course was uneventful and postoperative CT control showed no residue. On MRI control no recurrence was noted after a follow-up period of 8 years. Intracerebral schwannoma is a rare, benign neoplasm. It is usually located superficially or adjacent to a ventricle. Characteristic imaging features include cyst formation, calcification, and evidence of peritumoral edema or gliosis. The recognition of this benign and potentially curable neoplasm and its differentiation from other neoplasms, some of which have less favourable outcomes, is of obvious importance.

Lateral intrathoracic meningocele associated with a spinal intradural arachnoid cyst.

A case of lateral intrathoracic meningocele associated with a spinal intradural arachnoid cyst is reported and the cases from the literature are reviewed. Both of these lesions were detected by magnetic resonance imaging and treated surgically. Intrathoracic meningoceles are often asymptomatic and diagnosed incidentally during the evaluation of an unrelated pathology. A patient with a spinal intradural arachnoid cyst may present with paraparesis mimicking an intradural tumor, and lateral intrathoracic meningocele may seldom accompany this lesion. A comprehensive radiological examination must be conducted and a higher index of suspicion by neurosurgeons is necessary.

Multiple sclerosis with mass effect: case report.

Multiple sclerosis (MS) may rarely present as a cerebral mass with the clinical features and computed tomography (CT) scan appearance of a cerebral tumor. We report a case of MS with large cranial involvement showing a mass effect. We carried out a complete examination, including contrast enhancement, with neuroimaging studies. The operative procedure associated with medical treatment was performed and we obtained a good result.

Subdural and intraventricular traumatic tension pneumocephalus: case report.

Simple pneumocephalus most frequently arises as a complication of a head injury in which a compound basal skull fracture with tearing of the meninges allows entry of air into the cranial cavity. It can also follow a neurosurgical operation. Tension traumatic pneumocephalus with intraventricular extension is an extremely rare, potentially lethal condition that requires prompt diagnosis and treatment. We report the case of subdural and intraventricular accidental tension pneumocephalus occurring in a 26-year-old man as a result of skull fracture. This case is combined with rhinorrhea and meningitis that suggest some difficulties to treat. The operative procedure associated with medical treatment was performed and a good result was obtained.

Multiple oligodendroglioma: case report.

An 18-year-old female patient was hospitalized with headache and disturbance of consciousness. Magnetic resonance imaging (MRI) revealed a tumor in the left parieto-occipital lobe. The tumor was totally removed, and postoperative radiation therapy was administered locally at 50 Gy. Ten months later, she experienced sudden onset of unconsciousness and headache. Computed tomography (CT) and MRI demonstrated multiple mass lesions in the whole brain. Following the systemic chemotherapy, removal of the largest tumor was performed. Histological examination proved all excised tumors to be oligodendroglioma without evidence of malignant change.

Calvarial metastasis of a paraganglioma. Case report and review of the literature.

BACKGROUND: Metastasis of a paraganglioma (PRG) to the calvarium is very rare. In this paper, the case of a 25-year-old male with metastasis of a PRG to the frontoparietal bone is described. CASE DESCRIPTION: The patient presented with bulging on the left side of the head, headache, and weight loss. Magnetic resonance imaging (MRI) revealed a mass lesion in the left frontoparietal region that had destroyed both the external and internal table of the bone, extending under the skin and above the dura mater. After a frontoparietal craniotomy the tumor was removed totally. Histopathological examination revealed the "Zellballen," which are pathognomonic for a PRG. Systemic examination and radiological investigation revealed no primary tumor source. CONCLUSION: Metastasis of a PRG to the calvarium is possible; radical removal of the tumor will provide a cure.

Nerve entrapment by a firmly wrapped Baker cyst.

Baker's cysts as a clinical entity are among the most infrequent cause of peripheral nerve entrapment and usually produce a strong positive pressure within the knee resulting in the rupture of the joint capsule. An unusual case with muscular and sensorial weakness due to compression of the peroneal nerve around the fibular head by a Baker cyst is presented in this article. Clinical and electromyographical findings shown peroneal nerve entrapments in the popliteal fossa. Peroneal nerve decompression by synevectomy resulted in clinical and electromyographical improvement.

Foot drop following brain tumors: case reports.

Three cases with foot drop following brain tumors in patients suffering from parasagittal pathology are reported. Foot drop was the first complaint in the patients in our series. We generally notice foot drop as a sign of lumbar disc herniation or peroneal nerve lesions but rarely foot drop may also occur with brain lesions.

Primary multiple cerebral hydatid cysts: case report with CT and MRI study.

We present a case of a patient with multiple cerebral hydatidosis. We could not find any other origin of hydatidosis. In the light of the radiodiagnostic and biochemical findings, we assessed this case as a primary cerebral hydatidosis. The cysts were delivered completely. Two months after operation, the patient's neurological examination and control MRI were normal.

Intrasellar gangliocytoma resembling pituitary adenoma.

Cushing's disease resulting from intrasellar gangliocytomas is very rare and only three cases have been reported to date. All of the cases were female. We present a fourth case of Cushing's disease resulting from intrasellar gangliocytoma. Computed tomography and magnetic resonance imaging scans showed a pituitary macrotumor with suprasellar extension. A greenish-gray colored homogenous tumor was subtotally removed by a transcranial approach. Histological diagnosis was gangliocytoma. To the best of our knowledge, this is the first reported instance of a tumor causing Cushing's disease in a man in the absence of a pituitary adenoma component.

Causes of infections and management results in penetrating craniocerebral injuries.

From February 1992 to December 1994, 148 patients with penetrating craniocerebral injuries were treated surgically with primary and secondary debridement including repair of dural defects and removal of retained intracranial bone and metal fragments. Dural defects were closed primarily or with temporalis fascia, pericranium, and cadaver graft. Cerebrospinal fluid fistulas were observed in 11 (7.3%) patients; 7 of these were infected. Central nervous system (CNS) infection was seen in 2 patients without CSF fistula. Excluding those 11 patients with CSF fistula CNS infection was shown in 2 of the 137 cases (1.5%). All patients underwent CT scans periodically. In 51 (34%) of 148 patients, bone and metal fragments were determined on control CT scans. During this time, 12 patients died (8%). Most of deaths were caused by the direct effect of brain injury and occurred within the first month after injury. Fragments retained after first debridement were followed periodically by CT scan. Surgery was not performed until infection developed. Retained fragments did not increase the infection risk, but high rates of infection did occur in cases with CSF fistula.

Cyst of the mesencephalon (neuroepithelial cyst?): review and case report.

A case of a mesencephalic region cyst is reported. Neuroepithelial cysts are rare benign lesions that may be asymptomatic or may appear as space-occupying mass lesion. The pathogenesis and principles of diagnosis and management of these rare lesions are reviewed.

Hydatid disease of the spine.

Spinal hydatid cyst was diagnosed in four patients, aged between 21 and 35 years, three male and one female between 1983 and 1993. In three patients, the cysts were epidural and in one intra-vertebral. All patients presented with symptoms of spinal cord compression. Surgical treatment was performed in all of the patients. One patient who relapsed showed evidence of cure after a second operation, and was given mebendazole (Vermox). Histological examination was performed in all of the patients.

Hydatid cysts of the brain.

Intracranial hydatid cysts, although still rare, are being seen with increasing frequency. We report 12 cases of intracerebral hydatid cysts diagnosed with the use of computed tomography. We also review the methods recently available for diagnosis and therapy of this disease. Excellent therapeutic results can be achieved through surgical removal of the hydatid cyst; however, it is important to avoid rupturing the cyst.