An Assessment of the Effectiveness of Surgical Treatment Methods Used for Cervical Spondylosis.

AIM: To evaluate the preoperative and postoperative clinical and radiological findings of patients treated surgically for cervical spondylosis. MATERIAL AND METHODS: The patients included in the study (n=32) were divided into three groups according to their preferred surgical approach. These surgical approaches are posterior cervical laminectomy, posterior cervical laminectomy plus fusion, and anterior approach. Then, pre-and postoperative modified Japanese Orthopaedic Association Myelopathy (mJOA) scores, Torg- Pavlov ratios measured on direct cervical radiography, and pre-and postoperative lordosis angles were recorded. The data obtained were evaluated statistically. RESULTS: The radiological examinations revealed that the average preoperative Torg-Pavlov ratio was < 1 in 29 patients. The average sagittal spinal canal diameter was 9 mm, and myelomalacia was detected in 25 patients. Postoperative mJOA scores in patients who underwent anterior corpectomy and fusion and posterior laminectomy were statistically significant (p < 0.05). The highest symptomatic recovery rate was found in patients with preoperative neck pain. This finding was not statistically significant (p > 0.05). Changes in the postoperative lordosis angles and recovery rates were also observed, depending on the preferred surgical approach. CONCLUSION: If there is no kyphotic deformity or straightening of the cervical lordosis, a posterior laminectomy can be performed to avoid the long-term complications caused by an anterior corpectomy. It should be kept in mind that multi-segment and wide laminectomies may cause instability problems.

Composite Hemangioendothelioma Settled in the Paraspinal Region: A Rare Case Report.

Composite hemangioendothelioma (CHE) is a very rare, low-grade malignant vascular tumor. It is most commonly seen as one or more nodules on both sides of the fingers and toes. This tumor rarely settles in the paraspinal muscles. The age of onset is usually between 21 and 72 years, with an average age of 39.5-41 years. Treatment is with gross total removal of the lesion. We present a case of a 54-year-old male patient with a 2-year history of low back pain. Lumbar spine magnetic resonance imaging revealed CHE in the right paravertebral muscle in the posterior vicinity of the transverse process between the right paraspinal muscle planes. The entire mass was removed grossly. The definitive diagnosis of CHE was made histopathologically. This is a rare case of CHE that had settled in the paraspinal region.

Factors Affecting Prognosis in Patients With Spontaneous Supratentorial Intracerebral Hemorrhage Under Medical and Surgical Treatment.

Spontaneous intracerebral hemorrhage (ICH) is a vascular brain disease that causes very high rates of death and disability. Whether surgical or medical treatment is more appropriate is controversial.The purpose of the study was to examine the morbidity and mortality rates of surgical and medical therapy and their differences in order to determine which patients should be operated.In our study, the authors selected randomly and evaluated retrospectively 49 patients who were operated in Haydarpasa Numune Research and Education Hospital Neurosurgery Clinic and 51 patients who received medical therapy at Neurology Clinic for spontaneous supratentorial ICH between January 2007 and December 2011.The authors documented a detailed history of each patient featuring their neurological examination, Glasgow Coma Scale (GCS), Modified Rankin Disability Scale (MRDS), imaging, age, gender, and history of stroke, hypertension, diabetes mellitus, smoking and alcohol use, aspirin, or coumadin usage.As a result, the mortality rate found in our study was similar to previous studies (49%). Mortality of patients who underwent surgery (63%) found a higher rate of disability. This is because hematoma of the patients who were operated on larger volumes and diameters, GCS lower than and the higher MRDS scores, higher rates of herniation is connected. The authors concluded that very early operation does not create a difference in treatment between mortality rates. The authors observed that the most important factors for the prognosis of ICH patients whether operated or not are the GCS of patients at the time of arrival to the hospital and the nature of the hematoma.

Prognostic Factors in Patients who Underwent Aneurysmal Clipping due to Spontaneous Subarachnoid Hemorrhage.

AIM: Despite technical and medical advances, aneurysmal subarachnoid hemorrhages (SAH) continue to be a challenging pathology, associated with high rates of morbidity and mortality. In this regard, a definition is required of the various prognostic indicators of an SAH. The aim of the present retrospective study is to examine the various prognostic factors of the clinical outcomes of the patients who underwent a neurosurgical clipping of aneurysms due to aneurysmal SAH. MATERIAL AND METHODS: The data of 104 patients that had suffered an aneurysmal SAH were analyzed. The baseline demographic, clinical and radiological data were all analyzed. The prognostic study was derived from an analysis of these variables. Relationship between prognostic factors and outcome was evaluated by univariate and logistic multivariate regression analysis. RESULTS: This study has identified unfavorable outcomes on the Glasgow Outcome Scale at discharge after the surgical treatment of aneurysmal SAH associated with increased age, poor World Federation of Neurosurgical Societies (WFNS) grade on admission, higher Fisher's grade on admission computed tomography scan, larger aneurysm, and clinical vasospasm. In a multivariate logistic regression analysis, age, high WFNS grade, positive clinical vasospasm and size of aneurysm were found to be independent risk factors for mortality. The presence of hydrocephalus, number of aneurysms, positive risk factors, and the presence of Doppler vasospasm did not reach statistical significance. CONCLUSION: The most important prognostic factors in patients undergoing surgery due to aneurysmal subarachnoid hemorrhage were WFNS grade, age, size of aneurysm and clinical vasospasm.

The Effect of Matrix Metalloproteinase-3 on the Prognosis and Biological Behaviour of Meningiomas.

AIM: To analyse the effect of MMP-3 (Matrix Metalloproteinase Enzyme-3)-one of the extracellular matrix proteins- on the prognosis and biological behaviour of meningiomas. MATERIAL AND METHODS: 79 cases of meningioma that were operated in our clinic between 2005 and 2010 were retrospectively analysed. Age, sex, preoperative peritumoral edema, histological subtype, grade, Ki-67 expression, MMP-3 staining pattern and recurrence rate were analysed. Pathological preparations were graded according to the WHO (World Health Organisation) 2007 grading system. RESULTS: Of the MMP-III positive cases; 24 cases (60%) were grade I, 16 cases were grade II. The MMP-3 staining pattern was significantly positive (80%) in grade II meningioma. 14 of the MMP-3 positive cases were atypical meningiomas. Of the 20 cases with high Ki-67 proliferation index (PI), 12 cases (60%) were MMP-3 positive and 8 cases (40%) were MMP-3 negative. Rates of recurrence and preoperative peritumoral edema were high in cases with MMP-3 positivity. CONCLUSION: In this study it was determined that MMP-3 positivity has a strong relationship with meningiomas having an aggressive character. MMP-3 may be used as a proliferation marker for biological behaviour, recurrence rate and prognosis of meningiomas.

The Association between Sagittal Index, Canal Compromise, Loss of Vertebral Body Height, and Severity of Spinal Cord Injury in Thoracolumbar Burst Fractures.

AIM: Our aim was to determine whether a combination of sagittal index (SI), canal compromise (CC), and loss of vertebral body height (LVBH) is associated with the severity of neurological injury in patients with thoracolumbar burst fractures. MATERIALS AND METHODS: Seventy-four patients with thoracolumbar burst fracture undergoing instrumentation between 2010 and 2015 were analyzed retrospectively. The degree of neurological injury was determined using the American Spinal Injury Association (ASIA) scoring system. The association between the morphology of the fracture and the severity of neurological injury was analyzed. RESULTS: There was a strong association between fracture morphology and the severity of neurological injury. Of the patients, 77.5% with SI ≥20°, 81.6% with CC ≥40%, and 100% with LVBH ≥50% had lesion according to ASIA. All of 7 patients with ASIA A had SI ≥20°, CC ≥40%, and LVBH ≥50%. On the other hand, 79% of the patients with ASIA E had SI <20°, 83.7% of the patients with ASIA E had CC <40%, and all of the patients with ASIA E had LVBH <50%. SI, CC, and LVBH were lower in neurologically intact patients (ASIA E), whereas they were higher in patients with neurological deficits (ASIA A, B, C, D) (P = 0.001; P < 0.01). These measurements had 100% negative predictive values and relatively high positive predictive values. CONCLUSION: SI, CC, and LVBH are significantly associated with the severity of neurological injury in patients with thoracolumbar burst fractures. The patients with SI >25°, the patients with CC >40%, and the patients with LVBH >50% are likely to have a more severe neurological injury.

Foramen Magnum Decompression and Duraplasty is Superior to Only Foramen Magnum Decompression in Chiari Malformation Type 1 Associated with Syringomyelia in Adults.

STUDY DESIGN: Retrospective cohort study. PURPOSE: To compare surgical results of foramen magnum decompression with and without duraplasty in Chiari malformation type 1 (CM-1) associated syringomyelia (SM). OVERVIEW OF LITERATURE: The optimal surgical treatment of CM-1 associated with SM is unclear. METHODS: Twenty-five cases of CM-1 with SM were included. There were 12 patients (48%) in the non-duraplasty group and 13 patients (52%) in the duraplasty group. The rate of improvement, state of postoperative SM size, amount of tonsillar herniation, preoperative symptom duration, complications and reoperation rates were analysed. RESULTS: The rate of clinical improvement was significantly higher with duraplasty (84.6%) than without (33.3%, p <0.05). The rate of postoperative syrinx regression was significantly higher in the duraplasty group (84.6%) than in the non-duraplasty group (33.3%, p <0.05). One case in the duraplasty group needed a reoperation compared with five cases in the non-duraplasty group (p =0.059). CONCLUSIONS: Duraplasty is superior to non-duraplasty in CM-1 associated with SM despite a slightly higher complication rate.

Atypical pyogenic brain abscess evaluation by diffusion-weighted imaging: diagnosis with multimodality MR imaging.

Whether a brain abscess is apparent by imaging depends on the stage of the abscess at the time of imaging, as well as the etiology of the infection. Because conventional magnetic resonance imaging (MRI) is limited in its ability to distinguish brain abscesses from necrotic tumors, advanced techniques are required. The management of these two disease entities differs and can potentially affect the clinical outcome. We report a case having atypical imaging features of a pyogenic brain abscess on advanced MRI, in particular, on diffusion-weighted and perfusion imaging, in a patient with osteosarcoma undergoing chemotherapy.

Comparison of the Surgical Results for Foramen Magnum Decompression with and without Duraplasty in Chiari Malformation Type 1.

AIM: The surgical results for foramen magnum decompression (FMD) with and without duraplasty in Chiari Malformation type 1 (CM-1) were compared retrospectively. MATERIAL AND METHODS: Thirty-nine cases of CM-1 with and without syringomyelia (SM) were included. There were 18 patients in the nonduraplasty and 21 in the duraplasty group. Syringomyelia, tonsillar herniation (TH), preoperative symptom duration, and postoperative SM size were compared. RESULTS: No significant difference was found between improvement in the duraplasty group (81%) and the non-duraplasty group (61.1%). In cases whose symptom duration was 0-36 months, improvement in the duraplasty group (93%) was significantly better than in the nonduraplasty group (50%) (p < 0.01). The rate of syrinx regression was 92.3% in the duraplasty group and 12.5% in the non-duraplasty group (p < 0.05). In cases with SM, the improvement was 21.4% in the non-duraplasty group compared to 78.6% in the duraplasty group (p=0.056). In cases with TH greater than 10 mm, the improvement was 66.7% in the non-duraplasty group, whereas all six cases (100%) in the duraplasty group had improved. CONCLUSION: In SM associated cases, cases with TH greater than 10 mm, and whose symptom duration is less than 36 months, duraplasty is a more reliable choice despite a slightly higher rate of complications.

Complicated fronto-orbital mucopyocele presenting with proptosis: a case report.

Mucoceles are cystic lesions of the paranasal sinuses which develop as a result of accumulation of mucous secretion due to obstruction of the ostium of the sinuses. Despite their benign behavior, they may enlarge progressively and project into adjacent structures by destructing the bony walls of the sinuses. Frontal mucoceles may get infected and extend towards orbital cavity and compress the orbit by eroding the bony walls of the orbital cavity. Endoscopic and external approaches are performed in the surgical treatment. We report a case of complicated fronto-orbital mucopyocele which eroded the orbital roof and extended into the orbital cavity and discuss the surgical treatment strategy under the light of the current literature.

WITHDRAWN: Riluzole alleviates early neutrophil infiltration, brain oedema and lipid peroxidation in the traumatic brain tissue but does not induce neurotoxicity in non-traumatic brain tissue in rats.

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Long-term disseminated recurrence in spinal hydatid cyst: a case report.

The spinal column is rarely affected by hydatid cyst; however, when involved, it has higher rates of recurrence particularly in case of osseous and paravertebral extensions. We report a 36-year-old patient. The patient was operated previously for hydatid cyst through laminectomy 13 years ago. After 13 years of surgery, the patient was admitted to our clinic with progressive paraparesis. Radiological evaluation revealed multicystic lesions affecting T4 and T5 vertebrae as well as the posterior thoracic wall and paravertebral musculature. Serological findings were also compatible with a hydatid cyst. The patient underwent surgical treatment; the cystic lesions were removed, and vertebral stabilization was provided. The treatment of hydatid cyst in the spine is challenging. Particularly in cases with vertebral involvement, spinal instability and recurrence are the main handicap. Preoperative and postoperative antihelminthic treatment as well as close clinical, radiological and serological follow up in postoperative period is important to avoid recurrence risk.

Spondylodiscitis occurring after diagnostic lumbar puncture: a case report.

Spondylodiscitis is a rare disease which is generally seen after long-term epidural catheterization. However, spondylidiscitis developing after diagnostic lumbar puncture is very rare. Early diagnosis has a crucial role in the management of the disease and inclines the morbidity rates. However, the diagnosis is often delayed due to the rarity and insidious onset of the disease usually presenting with low back pain which has a high frequency in the society. If it is diagnosed early before development of an abscess requiring surgery or neurological deficit, it responds to antimicrobial therapy quite well. We report 66-year-old male case of spondylodiscitis developing after diagnostic lumbar puncture. The patient was treated with antimicrobial therapy. After antimicrobial therapy, findings of spondylodiscitis were completely resolved and no recurrence was seen in the period of 9-month followup.

A primary orbital hydatid cyst.

Echinococcosis, caused by the tapeworm Echinococcus granulosus, is an endemic zoonosis in which humans act as accidental intermediate hosts. Orbital hydatid cysts comprise 1% to 2% of all hydatid lesions. We describe a 10-year-old boy with an orbital hydatid cyst. The orbital cyst was removed totally by frontal craniotomy and orbitotomy. It should be noted that unilateral painless proptosis in patients from countries endemic for echinococcosis could be caused by an orbital hydatid cyst.

Infection of cranioplasty seen twenty years later.

Cranioplasty is performed using autograft and allograft materials on patients to whom craniectomy was applied previously due to the facts that, this region is open to trauma and the scalp makes irritation and pressure onto the brain paranchyma causing brain atrophy and convulsions. Dramatical improvement of neurological deficits, control of convulsions and partial prevention of cerebral atrophy are achieved after these operations. One of the most important complications of cranioplasty is late infection. Here, we report a 43-year-old male patient admitted with the history of purulant discharge from the right temporal incission site for one year to whom cranioplasty had been performed with allograft material 20 days after craniectomy which had been performed in 1989. Allograft cranioplasty material was removed and cranioplasty was performed using new allograft material with the diagnosis of late cranioplasty infection.

The safety and diagnostic value of frame-based and CT-guided stereotactic brain biopsy technique.

AIM: Histopathological diagnosis is always necessary to make an effective treatment plan for intracranial mass lesions. This study aimed to evaluate the diagnostic efficacy, and associated mortality and morbidity of CT-guided stereotactic biopsy procedures in a large number of patients with intracranial lesions. MATERIAL AND METHODS: A total of 290 cases undergoing CT-guided stereotactic biopsy for intracranial lesions were included in this retrospective study. Clinical, radiological and histological data in patient records were examined. RESULTS: The mean age of the patients was 46.6 years (range: 2-82 y). Pediatric patients comprised 6.3% (n=13) of the total population. Examination of paraffin embedded histological preparations revealed a tumoral mass in 240 (82.8%), a non-tumoral mass in 37 (12.8%), and non-definable lesions in 13 (4.5%). Therefore, the diagnostic value in this series was 95.5%. Postoperative mortality rate was 0.8% (n=2). When histopathological diagnoses made after biopsy and surgical resection were compared in 42 patients with available data, a complete or partial agreement was present in 90.5%. CONCLUSION: Our findings support that frame based-stereotactic biopsy is a safe and valuable technique that allows the neurosurgeon to obtain tissue samples for histopathological diagnosis of intracranial mass lesions in almost any region.

Bacterial brain abscesses: an evaluation of 96 cases.

OBJECTIVES: Although the decline of the morbidity and mortality in recent years, brain abscess is still one of the most important problems in Neurosurgery. METHODS: Ninety-six patients with brain abscess are analysed retrospectively, that treated between 1988 and 2001, according to age, the clinical symptoms, etiologic factors, infecting organisms, prognostic factors, localization, diagnostic and treatment methods and outcome. RESULTS: Seventy-two patients treated with aspiration (streotactic aspiration in 12 cases), 14 patients with excision. Ten patients treated medically alone. Seven patients in the aspiration group and one patient in the excision group were died. Cure without any morbidity obtained in 55 patients. A significant correlation determined with initial neurologic grade, meningismus, high fever (>38.50), leucocytosis (>20.000/mm3) and mortality. There were no significant correlation the age groups and outcome, treatment groups and location of abscess, period of treatment, number of abscess, outcome according to GOS and factor, treatment period and received antibiotic. CONCLUSIONS: In appropriate cases, medical treatment can be successful alone but surgery, aspiration, is gold standard for brain abscesses. In that way, definite diagnosis is obtained and pathogen is identified and cure is obtained in a short time.