Intramedullary pancreatic adenocarcinoma metastasis: The first case in literature / Metástasis de adenocarcinoma de páncreas intramedular: primer caso en la literatura

Background Pancreatic cancer is a common gastrointestinal malignancy, and is often associated with a poor prognosis. Although liver is generally seen as a distant metastasis point, it has been shown that it can metastasize to any organ, especially the gastrointestinal tract, and approximately 0.3% of metastases are observed in spinal cord. Case description We report a 36-year-old woman with a prior history of pancreatic adenocarcinoma who presented to us with a thoracic intramedullary lesion and recent onset of neurological deficits. She underwent surgery with histological confirmation of a diagnosis of metastatic adenocarcinoma. Conclusion To our knowledge there is no prior report of pure intramedullary spinal cord metastasis from a pancreatic adenocarcinoma in the literature. We report the present patient in view of the rarity of intramedullary spinal cord metastasis and its clinical significance. Although intramedullary metastases are rare, they should be investigated in every patient with malignancy and progressive neurological deficit. While its general prognosis is poor regardless of the type of treatment, early diagnosis and treatment is important in terms of quality of life and survival (AU)

Antecedentes El cáncer de páncreas es una neoplasia maligna gastrointestinal común y, a menudo, se asocia con un mal pronóstico. Aunque el hígado generalmente se ve como un punto de metástasis distante, se ha demostrado que puede hacer metástasis a cualquier órgano, especialmente al tracto gastrointestinal, y aproximadamente el 0,3% de las metástasis se observan en la médula espinal. Descripción del caso Presentamos una mujer de 36 años con antecedentes de adenocarcinoma de páncreas que se presentó con una lesión intramedular torácica y de reciente aparición de déficits neurológicos. Fue intervenida quirúrgicamente con confirmación histológica de diagnóstico de adenocarcinoma metastásico. Conclusión Hasta donde sabemos, no existe en la literatura ningún informe previo de metástasis intramedular pura de la médula espinal de un adenocarcinoma pancreático. Presentamos el presente paciente en vista de la rareza de la metástasis intramedular de la médula espinal y su importancia clínica. Aunque las metástasis intramedulares son raras, deben investigarse en todo paciente con neoplasia maligna y déficit neurológico progresivo. Si bien su pronóstico general es malo independientemente del tipo de tratamiento, el diagnóstico y el tratamiento precoces son importantes en términos de calidad de vida y supervivencia (AU)

Intramedullary pancreatic adenocarcinoma metastasis: The first case in literature.

BACKGROUND: Pancreatic cancer is a common gastrointestinal malignancy, and is often associated with a poor prognosis. Although liver is generally seen as a distant metastasis point, it has been shown that it can metastasize to any organ, especially the gastrointestinal tract, and approximately 0.3% of metastases are observed in spinal cord. CASE DESCRIPTION: We report a 36-year-old woman with a prior history of pancreatic adenocarcinoma who presented to us with a thoracic intramedullary lesion and recent onset of neurological deficits. She underwent surgery with histological confirmation of a diagnosis of metastatic adenocarcinoma. CONCLUSION: To our knowledge there is no prior report of pure intramedullary spinal cord metastasis from a pancreatic adenocarcinoma in the literature. We report the present patient in view of the rarity of intramedullary spinal cord metastasis and its clinical significance. Although intramedullary metastases are rare, they should be investigated in every patient with malignancy and progressive neurological deficit. While its general prognosis is poor regardless of the type of treatment, early diagnosis and treatment is important in terms of quality of life and survival.

Intramedullary pancreatic adenocarcinoma metastasis: The first case in literature.

BACKGROUND: Pancreatic cancer is a common gastrointestinal malignancy, and is often associated with a poor prognosis. Although liver is generally seen as a distant metastasis point, it has been shown that it can metastasize to any organ, especially the gastrointestinal tract, and approximately 0.3% of metastases are observed in spinal cord. CASE DESCRIPTION: We report a 36-year-old woman with a prior history of pancreatic adenocarcinoma who presented to us with a thoracic intramedullary lesion and recent onset of neurological deficits. She underwent surgery with histological confirmation of a diagnosis of metastatic adenocarcinoma. CONCLUSION: To our knowledge there is no prior report of pure intramedullary spinal cord metastasis from a pancreatic adenocarcinoma in the literature. We report the present patient in view of the rarity of intramedullary spinal cord metastasis and its clinical significance. Although intramedullary metastases are rare, they should be investigated in every patient with malignancy and progressive neurological deficit. While its general prognosis is poor regardless of the type of treatment, early diagnosis and treatment is important in terms of quality of life and survival.

Giant Sacral Schwannoma Causing Bilateral Hydronephrosis: Case Report and Review of the Literature.

BACKGROUND: Giant sacral schwannomas are very rare, and less than 1%-5% of spinal schwannomas are found in the sacral region. These frequently grow to considerable size because of permissive anatomic location and benign, slow growth of tumor. They can be unnoticed before reaching a huge size. CASE DESCRIPTION: We report a rare case of a giant sacral schwannoma in a 46-year-old man. The patient presented with difficulty in passing urine, episodic constipation, and swelling of the right lower extremity for 6 months. Magnetic resonance imaging revealed 160 x 110 x 110 mm encapsulated heterogenous solid mass originated from left S1 spinal nerve extending into the pelvis and abdomen. Sigmoid colon and rectum were displaced to the right side, and bladder was displaced anteriorly. Left side of the S1 and S2 vertebral bodies, left S1 and S2 neural foramen were also eroded. It also compressed ureters causing bilateral hydronephrosis. The patient underwent a 2-stage procedure in which complete resection was achieved. CONCLUSIONS: We report the second case of a completely resected giant sacral schwannoma with bilateral hydronephrosis in the literature. Performing a 2-stage procedure is important in giant sacral schwannomas. Morbidity can be minimized, and extent of resection can be maximized with the help of combined anterior/posterior approach.

Blocking VEGF by Bevacizumab Attenuates VEGF-Induced Vasospasm After Experimental Subarachnoid Hemorrhage in Rabbits.

OBJECTIVE: Vasospasm after subarachnoid hemorrhage (SAH) plays a vital role in the development of delayed cerebral ischemia. Anti- vascular endothelial growth factor (VEGF) antibodies, like bevacizumab (BEV), may attenuate VEGF-stimulated angiogenesis, reduced vascular cell proliferation, and improve vasospasm after SAH. METHODS: Thirty-two adult male New Zealand white rabbits were randomly divided into 4 groups of 8 rabbits in each group: group 1 (control); group 2 (SAH); group 3 (SAH + vehicle); and group 4 (SAH + BEV). BEV (5 mg/kg, intraperitoneally) was administered 5 minutes after the intracisternal blood injection and continued for 72 hours once per day in the same dose for group 4. Animals were sacrificed 72 hours after SAH. Basilar artery cross-sectional areas, arterial wall thicknesses, and hippocampal degeneration scores were evaluated in all groups. RESULTS: VEGF is associated with the narrowing of the basilar artery. Treatment with BEV statistically significantly increased the cross-sectional area of the basilar artery when compared with the SAH and the vehicle groups. Basilar artery wall thicknesses in the BEV group was statistically significant smaller than in the SAH and vehicle groups. The hippocampal degeneration scores for the BEV and control groups were similar and significantly lower than those for the SAH and vehicle groups. CONCLUSIONS: Cellular proliferation and subsequent vessel wall thickening is a reason to delay cerebral ischemia and deterioration of the neurocognitive function. Intraperitoneal administration of BEV was found to attenuate cerebral vasospasm and prevent delayed cerebral ischemia and improve neurocognitive function after SAH in rabbits.

Effect of topical rifamycin application on epidural fibrosis in rats.

OBJECTIVES: This study aims to investigate the effects of topical rifamycin SV application on epidural fibrosis formation in a rat model. MATERIALS AND METHODS: Between March 2015 and April 2015, a total of 20 Wistar rats were equally and randomly divided into laminectomy only group (control group) and laminectomy and rifamycin SV group (treatment group). Laminectomy was performed between L3-L5 in all rats. Surgical field was irrigated with 1 mL rifamycin SV (1 mL). After four weeks, vertebral columns of the rats were removed en bloc between the L1 and L5 levels, and epidural fibrosis and arachnoid involvement were histopathologically evaluated and graded. RESULTS: Grade 3 epidural fibrosis formation ratio was lower in the treatment group (40%) compared to the control group (80%). However, there was no statistically significant difference between the treatment and control groups in terms of epidural fibrosis (p=0.164) and arachnoid involvement (p=0.303). CONCLUSION: Intraoperative rifamycin irrigation tends to reduce epidural fibrosis formation risk, although not statistically significant.

The Preventative Effect of α-Tocopherol on Spinal Epidural Fibrosis After Laminectomy in a Rat Model.

AIM: To assess the efficacy of α-tocopherol as a topical antifibrotic agent on epidural fibrosis in lumbar laminectomy procedures. MATERIAL AND METHODS: A total of 32 adult rats were assigned into four groups, with eight rats in each group. Standard laminectomy was performed in every rat. In group 1, no treatment was administered after laminectomy. In group 2, a saline-soaked absorbable gelatin sponge was left on the dura mater after laminectomy. In group 3, only α-tocopherol was used on the dura mater after laminectomy. In group 4, a gelatin sponge soaked with α-tocopherol was used after laminectomy. En bloc vertebral columns between T10 and L5 were removed after sacrifice on postoperative day 30. Specimens were evaluated for degree of fibrosis and arachnoidal invasions. RESULTS: Statistically significant differences were found in the mean of fibrosis grades between groups (p=0.001). Differences in mean arachnoidal invasion were not statistically significant (p > 0.05). CONCLUSION: Topical application of α-tocopherol could effectively reduce the development of epidural fibrosis in an experimental laminectomy model.

Facial nerve outcome and extent of resection in cystic versus solid vestibular schwannomas in radiosurgery era.

OBJECTIVE Cystic vestibular schwannomas (CVSs) are a subgroup of vestibular schwannomas (VSs) that are reported to be associated with unpredictable clinical behavior and unfavorable postoperative outcomes. The authors aimed to review their experience with microsurgical treatment of CVSs in terms of extent of resection and postoperative facial nerve (FN) function and compare these outcomes with those of their solid counterparts. METHODS Two hundred-eleven VS patients were treated surgically between 2006 and 2017. Tumors were defined as cystic when preoperative neuroimaging demonstrated cyst formation that was confirmed by intraoperative findings. Solid VS (SVSs) with similar classes were used for comparison. Clinical data of the patients were reviewed retrospectively, including clinical notes and images, as well as operative, pathology, and neuroradiology reports. RESULTS Thirty-two patients (20 males and 12 females) with a mean age of 52.2 years (range 17-77 years) underwent microsurgical resection of 33 CVSs (mean size 3.6 cm, range 1.5-5 cm). Forty-nine patients (26 males and 23 females) with a mean age of 49.9 years (range 21-75 years) underwent microsurgical resection of 49 SVSs (mean size 3 cm, range 2-4.5 cm). All operations were performed via either a retrosigmoid or a translabyrinthine approach. Gross-total resection was achieved in 30 cases in the CVS group (90.9%) and 37 in the SVS group (75.5%). The main reason for subtotal and near-total resection was adherence of the tumor to the brainstem and/or FN in both groups. None of the patients with subtotal or near-total resection in the CVS group demonstrated symptomatic regrowth of the tumor during the mean follow-up period of 41.6 months (range 18-82 months). The FN was anatomically preserved in all patients in both groups. Good FN outcomes were achieved in 15 of CVS (grade I-II; 45.5%) and 35 of SVS (71.4%) surgeries at discharge. Good and fair FN functions were noted in 22 (grade I-II; 81.5%) and 5 (grade III only; 18.5%) of the CVS patients, respectively, at the 1-year follow-up; none of the patients showed poor FN function. CONCLUSIONS Surgery of CVSs does not necessarily result in poor outcomes in terms of the extent of resection and FN function. Special care should be exercised to preserve anatomical continuity of the FN during surgery, since long-term FN function outcomes are much more satisfactory than short-term results. High rates of gross-total resection and good FN outcomes in our study may also suggest that microsurgery stands as the treatment of choice in select cases of large CVSs and SVSs in the era of radiosurgery.

Resection of complex occipital arteriovenous malformation with giant varix: demonstration of microsurgical technique.

The complexity of arteriovenous malformations (AVMs) does not necessarily preclude surgical resection. In this video the authors present a 72-year-old male who was known to have an occipital AVM with a large draining varix for the previous 10 years. The patient had progressively worsening visual and cognitive deficits over several years. Total surgical resection was achieved following single stage preoperative embolization. Although resection of the AVMs is challenging, even in experienced hands, it offers a cure and may improve patient clinical outcome. The video can be found here: https://youtu.be/YI1AwGjJdvo .

Anti-edematous, anti-inflammatory and neuroprotective effect of etanercept in acute stage in experimental head injury.

BACKGROUND: To study the anti-edematous, anti-inflammatory, and neuroprotective effect of etanercept in the model of experimental head injury. METHODS: In this study, 40 male-adult Spraque-Dawley rats, with weight ranging from 250g to 300g, were used. The rats are divided into groups as control; non-penetrating trauma; trauma +NS; post-traumatic normal saline; trauma + D; post-traumatic dexamethasone and trauma + E. All medicines were given into peritoneum. After applying trauma and medicine, rats were decapitated in the 24th hour and the samples were studied histopathologically. RESULTS: In the study, a statistically significant difference was observed between the groups of trauma + NS and trauma dexamethasone according to the variables of edema and inflammation, but no difference was observed according to the variables of neuronal damage, astrocytic damage, and glial apoptosis. Moreover, a significant difference was observed between groups of Trauma + NS and trauma+etanercept and between the groups of trauma + dexamethasone and trauma + etanercept in terms of all variables. CONCLUSION: It was observed that etanercept has anti-edematous, anti-inflammatory, and neuroprotective effect on the rats which experienced traumatic brain injury.

The effect of etanercept on spinal epidural fibrosis in a postlaminectomy rat model.

AIM: The formation of epidural fibrosis adjacent to the dura mater after posterior spinal surgery is a normal reaction of the body to surgery. Extensive epidural fibrosis is one of the important causes of postlaminectomy syndrome. Etanercept inhibits tumor necrosis factor-alpha and decreases fibroblast migration. Thus, etanercept prevents the formation of fibrosis. The aim of this study was to investigate the effects of topical application of etanercept on epidural fibrosis after laminectomy in a rat model. MATERIAL AND METHODS: Twenty-four Wistar rats were equally and randomly divided into three groups (control, spongostan and etanercept). Laminectomy was performed between L3 and L5 in all the rats. Spongostan soaked with saline (0.1 mg/kg) and etanercept (300 µg/kg) was directly exposed to and left on the dura mater. Four weeks later, the vertebral columns of the rats were removed en bloc between T10 and L5, and epidural fibrosis and arachnoidal involvement were evaluated and graded histopathologically. RESULTS: Our data revealed that epidural fibrosis was reduced significantly in the rats treated with etanercept, compared to the control groups (p < 0.05). CONCLUSION: Our study demonstrated that topical application of etanercept can be effective in reducing epidural fibrosis in rats after laminectomy.

[Occipital condyle fractures: a case report]. / Oksipital kondil kiriklari: Bir olgu sunumu.

Occipital condyle fractures are rare, and conservative treatment is sufficient for many cases. Surgical treatment may be required if the condyle fracture is accompanied by atlantooccipital dislocation. Unfortunately, condyle fracture generally cannot be diagnosed with X-ray in the emergency department. Recently, computed tomography scans have been used more frequently, and enable easier diagnosis of these types of fractures. In this report, we describe a patient who admitted to our emergency department after a major trauma. She complained of neck pain, and maxillofacial trauma was more evident. Her cervical X-rays were normal, but cervical computed tomography revealed unilateral occipital condyle fracture.

Use of decorin to prevent epidural fibrosis in a post-laminectomy rat model.

The formation of epidural fibrosis adjacent to the dura mater is a complex multi-step process that is associated with a marked reduction in tissue cellularity and the excessive deposition of extracellular matrix components. Extensive epidural fibrosis is a major cause of post-laminectomy syndrome. Decorin strongly inhibits fibrosis formation in various tissues via blockade of transforming growth factor-ß1. The aim of this study was to investigate the effects of a topical application of decorin on the formation of epidural fibrosis in a rat laminectomy model. Twenty-four female Wistar albino rats (250-350 g) were equally and randomly divided into three groups (control, spongostan and decorin). Laminectomy was performed between the L3 and L5 levels in all rats. The dura mater was directly exposed to spongostan soaked with saline (2 cc/kg) or decorin (100 µg/kg). Four weeks later, the laminectomized spine of the rats was completely removed between the L3 and L5 levels. The extent of the epidural fibrosis and arachnoidal involvement was histopathologically evaluated and graded. Our data revealed that epidural fibrosis was significantly reduced in the group treated with decorin compared to the spongostan and control groups (P<0.05). Our study demonstrates that the topical application of decorin can be effective in reducing the formation of epidural fibrosis in a simple laminectomy rat model.

Pineal epidermoid tumors: report of five cases.

AIM: The aim of this study was to retrospectively analyse the clinical, radiological features and surgical outcome of pineal epidermoid tumors treated at a single neurosurgical department. MATERIAL AND METHODS: We performed surgery on five patients with pineal region epidermoid tumors at a single neurosurgical department between the years 1998 and 2006. Headache, diplopia and ataxia were the most common presenting findings. Parinaud's syndrome was found in three patients. Hydrocephalus was demonstrated radiologically in two patients. RESULTS: Two patients were operated on with the occipital-transtentorial approach, two were operated on with the infratentorial-supracerebellar approach and one was operated on with van Wagenen's approach. Recurrence of tumor was observed in one patient. One patient died at the first postoperative month due to ventriculitis. CONCLUSION: Total removal of epidermoid tumors may provide good clinical recovery and may reduce the possibility of tumor recurrence and shunt placement.

Ganglioglioma mimicking the cerebral abscess in advanced age: a case report.

Ganglioglioma is one of the rare mixed neuronal glial tumors of the central nerve system. It is responsible for 0.4 - 2% of the intracranial tumors observed in infants and young matures. Its most common localization is the supratentorial region. Typically, the first symptom is epilepsy. Due to the glial structure, that rare tumor can exhibit a malign transformation. Growing slowly through several months or years, it forms neurological dysfunction. The standard treatment of that supratentorial tumor is usually total resection. If an anaplastic quality is observed, the patient undergoes radiotherapy after the surgical intervention. In this article, we presented a 53-year-old patient who presented with headache and dysphasia. The patient was operated for the cystic mass in the left parietal lobe reported as an abscess. The pathology was reported as ganglioglioma and we discussed the case according to the literature.

Comparison of deferoxamine and methylprednisolone: protective effect of pharmacological agents on lipid peroxidation in spinal cord injury in rats.

STUDY DESIGN: Experimental study. OBJECTIVE: To investigate the protective effect of deferoxamine (DFO) administration in comparison with methylprednisolone (MP) on lipid peroxidation and antioxidants after spinal cord injury (SCI) in rats. SUMMARY OF BACKGROUND DATA: DFO is used for treating an iron-chelating agent, which is also used in the treatment of iron poisoning and thalassaemia. The neuroprotective effect of DFO was evaulated as a therapeutic agent for SCI. METHODS: Forty Wistar rats were randomly divided into 5 groups as sham laminectomy (n = 8), laminectomy with SCI (n = 8), laminectomy with SCI and 0.9% saline intraperitoneal (i.p.) (n = 8), laminectomy with SCI and 30 mg/kg MP i.p. (n = 8), and laminectomy with SCI and 30 mg/kg DFO i.p. (n = 8). Neurological deficits were examined 24 hours after trauma, and all rats were killed. Spinal cord segments were harvested for both biochemical and histopathological evaluation. RESULTS: At 24 hours post-SCI, whereas malondialdehyde levels were increased, superoxide dismutase, catalase, and glutathione peroxidase levels were decreased in groups I, II, and III. MP and DFO treatment decreased MDA levels and increased superoxide dismutase CAT, and glutathione peroxidase levels in control and study groups. There was no statistically significant difference between treatment with MP and DFO (P> 0.05). All rats were paraplegic after SCI, except in the sham group. Histopathological improvement was observed in control and study groups. CONCLUSION: This study indicates that beneficial effects may be provided and further studies need to investigate the dose-dependent beneficial and side effects of DFO in SCI. LEVEL OF EVIDENCE: N/A.

Surgical results of degenerative spondylolisthesis patients over 70 years old: a single-center experience and clinical outcomes.

AIM: The aim of this study is to evaluate results of surgery in Degenerative Spondylolisthesis (DS) patients over 70 years old. MATERIAL AND METHODS: This is a non-randomized retrospective analysis of the clinical outcome of 34 patients older than 70 years who underwent surgery. At the end of two-year follow-up period, preoperative and postoperative courses were assessed by Oswestry Disability Index (ODI) and Visual Analog Scales (VAS). RESULTS: The mean age was 75 years (range 70-86 years). The mean duration of symptoms was 13.5 years (range 2-30 years). All patients underwent physiotherapy and also 15 (11 female, 4 male) patients used brace. L4-L5 was the most commonly affected level (n=26), Preoperative ODI and VAS scores were mean 71,63 (range 34-100) and 6,77 (range 2-9) (p < 0,05). Postoperative ODI and VAS scores were mean 22,73 (range 0-100) and 2,13 (range 0-10) (p < 0,05). Patients were asked if they had known the outcome, would they accept surgical treatment or not. 86.6% (n=26) of the patients answered the question positively. CONCLUSION: A conventional decompressive laminectomy with foraminotomy and posterolateral fusion in situ with transpedicular instrumentation is necessary and reduces pain and recovers functional disability in elderly patients over 70 years old with DS.

Cystic giant prolactinoma in childhood.

In childhood and adolescence, pituitary adenomas are rare and half are prolactinomas. However, cystic giant prolactinoma in prepuberty is extremely rare. In this report, we present a 10-year-old boy with a cystic giant prolactinoma who was treated with two-stage surgery as the tumor was dumbbell shaped. To our knowledge, this is the second reported case of a cystic giant prolactinoma in a prepubertal child.