Intraosseous meningioma mimicking osteosarcoma in an adolescent: a case report.

Intaosseous meningiomas (IM) are the one of the less frequent benign tumors of the skull. The etiology of IM has not been cleared yet. The frontoparietal and orbital regions are the most common locations for IM. The average age for IM diagnosis is 50.5. A 16-year-old girl with a right frontoparietal mass was referred to our outpatient clinic. Cranial CT revealed a mass lesion which resulted in expansion in the right parietal and posterior frontal bone, having lytic and sclerotic regions inside with accompanying irregular cortex in inner and outer tables of the calvarium. Prediagnosis was osteosarcoma according to the imaging studies and after the performed biopsy and consecutive surgery, the lesion was diagnosed as IM. Though CT with bone windows is often useful, it is not always diagnostic. Biopsy plays an important role in calvarial vault lesions for planning the treatment. In our case, malignant criteria in radiology did not match the benign histology revealed. Radiological preoperative misdiagnosis of meningioma is possible.

Cerebellar mutism following posterior fossa tumor resection in children.

AIM: Cerebellar mutism is a documented complication of posterior fossa surgery in pediatric ages. Risk factors such as the type of tumor, size, and location of tumor, hyrdrocephalus, postoperative cerebellar swelling for cerebellar mutism were investigated in this study. MATERIAL AND METHODS: A consecutive series of 32 children with a cerebellar tumor were operated on at the Haseki Educational and Research Hospital, Department of Neurosurgery, between 1990 and 2005. Their speech and neuroradiological studies were systematically analysed both preoperatively and postoperatively RESULTS: Cerebellar mutism developed in ten children (32%) in the early postoperative period. The type of tumor, midline localization, and vermian incision were significant single independent risk factors. In addition, an interdependency of possible risk factors (tumor > 5 cm, medulloblastoma) was found. The latency for the development of mutism ranged from 0 to 90 days (mean 15.6 d). The speech returned to normal in eight patients. All cases were accompanied by cerebellar ataxia. CONCLUSION: Mutism after posterior fossa tumor resection is also associated with ataxia. Cerebellar mutism usually has a self-limiting course and a favorable prognosis.

Neuroprotective effects of acetyl-L-carnithine in experimental chronic compression neuropathy. A prospective, randomized and placebo-control trials.

OBJECTIVE: We designed this experimental study to examine the potential positive influences of the acetylated derivative of acetyl-L-carnithine, an endogenous substance present in the nervous system, on chronic compression neuropathy. This is the first study ever published on the medical treatment of experimental chronic compression neuropathy. MATERIALS AND METHODS: Five groups composed of 5 rats each were used in the study. Group 1: The control group, in which a 1 cm-long segment proximally from the bifurcation point of the right sciatic nerve of each rat was excised, accompanied by removal of the right soleus muscle. Group 2: The compression neuropathy model group, in which the right sciatic nerve of each rat was compressed for 30 days. Group 3: The right sciatic nerves were compressed for 30 days, followed by decompression and assessment on the 60th day. Group 4: The right sciatic nerves were compressed for 30 days, followed by decompression and acetyl-Lcarnithine administration between days 30 and 60. Group 5: The right sciatic nerves were compressed for 30 days, followed by acetyl-L-carnithine administration from day 30 to 60 without decompression. The study continued with the rats in the other 3 groups. Rats in the 3rd group were treated with decompression only and kept for another 1 month. Rats in the 4th group received acetyl-L-carnithine at a dose of 20 mg/kg/day intraperitoneally for 1 month after decompression, whereas rats in the 5th group received only intraperitoneal acetyl-L-carnithine at a dose of 20 mg/kg/day without decompression. Like the rats in groups 1 and 2, these rats were also sacrificed with ether overdose, with their right sciatic nerves and soleus muscles being excised for histopathological examination and weighing, respectively. CONCLUSION: In our study, it was found that decompression significantly improves the recovery rate of peripheral nerve as compared with that without decompression, and that acetyl-L-carnithine coadministered with decompression enhances clinical and histopathological recovery. In addition, the use of silicon tubes in such experiments was found to be likely to have prominent advantages.

Combined approach for far-lateral lumbar disc herniation.

This study evaluated the combination of the classical interlaminar approach and the intertransverse route through a midline approach for the treatment of 18 patients with far-lateral lumbar disc herniations, as identified by magnetic resonance imaging. The patients presented with acute severe sciatica, antalgic posture, positive Lasègue sign and femoral stretch test, motor and sensory deficits, and reflex loss findings. Discectomy of all 18 patients was performed by the combined approach. Neurological outcome of all patients was excellent in the follow-up period, ranging from 5 to 8 years. This combined midline approach permits complete evacuation of the involved disc level and treatment of additional bone resection procedures. Therefore, we advocate this approach in far-lateral lumbar disc herniation cases.

Pancreatic involvement in Von Hippel-Lindau disease.

BACKGROUND: Involvement of the pancreas in Von Hippel-Lindau disease that is a tumor predisposing syndrome mentioned in literature with some morbid and mortal progression. AIMS: For evaluation the faith of the pancreatic involvement in VHL disease we analysed our patient population with VHL disease. MATERIALS AND METHODS: 12 of the 56 patients that were evaluated in our institute with the diagnosis of Von Hippel-Lindau disease had pancreatic involvement. They are periodically examined for 5 years follow up period. Their retrospective analysis was accomplished. RESULTS AND CONCLUSIONS: Pancreatic involvement in our patient population disclosed lesions that were multicysts or serous cystadenomas. During follow up period, we did not observe significant morbidity related to pancreatic involvement. Repeated radiological examination of pancreatic lesions disclosed insignificant modifications such as slight increase or decrease in size. Whereas we considered morbidity and mortality related to renal and central nervous system pathologies in VHL disease. Shortly, even pancreatic involvement in VHL disease requires close clinical follow up, morbidity and mortality in this case is not severe as in renal and the central nervous system involvement.

A child with spinal intramedullary abscess.

CASE REPORT: We report a case of an intramedullary spinal cord abscess (ISCA) in a 14-month-old child. This case demonstrates clinical and radiological features and emphasizes the importance of early diagnosis and treatment. Early surgical intervention and adjuvant antibiotic therapy have been shown to improve the clinical outcome. Successful outcome depends on early diagnosis and aggressive management. DISCUSSION: Spinal intramedullary abscess is a rare neurosurgical entity. They can hardly be distinguished from neoplasms. Hart described the first case in 1830. Since then, approximately 70 cases have been reported. An acute spinal intramedullary abscess may present as a cord syndrome with back pain and fever, contrasting with chronic spinal intramedullary abscess, which tends to have a less specific symptomatology.