Endoscopic Third Ventriculostomy for Obstructive Hydrocephalus and Ventriculocystostomy for Intraventricular Arachnoid Cysts.

OBJECTIVE: To evaluate and discuss the outcomes of a combination of ventriculocystostomy (VC) and endoscopic third ventriculostomy (ETV) for obstructive hydrocephalus (HCP) due to ventricular/cisternal arachnoid cysts, and only ETV for obstructive HCP due to different etiologies. METHODS: We retrospectively reviewed all 40 symptomatic patients (aged 4 months - 61 years) of obstructive HCP treated by ETV or VC+ETV during October 2014 - April 2019. VC+ETV was performed in 7 patients with intraventricular/cisternal arachnoid cyst and obstructive HCP. Only ETV was performed in 33 patients with obstructive HCP due to other etiologies. RESULTS: Successful ETV or VC+ETV surgery was performed in 35 patients. The procedure failed in 5 patients aged 90 percentile at the time of surgery. Another 5 patients aged 90 percentile).

Relation Between ILAE Hippocampal Sclerosis Classification and Clinical Findings in Temporal Lobe Epilepsy.

AIM: To investigate the relationship between clinical features and prognosis of the hippocampal sclerosis (HS) cases and International League Against Epilepsy (ILAE) histopathology classification. MATERIAL AND METHODS: A hundred patients with refractory epilepsy who were operated with the diagnosis of the Mesial Temporal Lobe Epilepsy were included in the study. Socio-demographic characteristics, clinical and family histories, post-operative ILAE and Engel epilepsy scores and diagnostic tests were recorded. At the same time, all of the pathological specimens were classified according to the new semi-quantitative ILAE classification. A significant statistical relationship was investigated between clinical data and HS-ILAE groups. RESULTS: There were 36 male 64 female patients. The mean follow-up period was 6.5 years. 75% of the cases were HS-ILAE type 1, 19% HS-ILAE type 2, 6% were unidentifiable. FCD3A was detected in 3 patients. The HS-ILAE Type 2 ratio was high on the rightsided cases. In addition, HS-ILAE Type 1 ratio was high in patients with early seizure onset and long duration of epilepsy. There was no significant relationship between long-term ILAE and Engel epilepsy outcome scores and HS-ILAE types. CONCLUSION: Resection of mesiotemporal structures in hippocampal sclerosis provides seizure control in at least two-thirds of cases. Histopathological findings may help us understand the epileptogenicity-prognosis of HS. The relationship between ILAE histopathology classification and clinical factors will become more obvious in the future. According to our study, there was a relationship between onset age of epilepsy, epilepsy duration, lesion side and HS-ILAE types. The reinforcement of these relationships with larger series will benefit clinicians.

Gamma Knife Radiosurgery for Anterior Clinoid Process Meningiomas: A Series of 61 Consecutive Patients.

OBJECTIVE: Gamma Knife radiosurgery (GKRS) outcomes for anterior clinoid process (ACP) meningiomas have not been specifically reported within any meningioma series. We present the initial and largest series in the literature that describes the presenting features, radiosurgery parameters, and radiologic and long-term clinical outcomes for 61 patients with ACP meningiomas treated with GKRS. METHODS: Medical records were reviewed for 61 consecutive patients at a single center who underwent GKRS for ACP meningioma between 2008 and 2016. RESULTS: Of 61 patients with ACP meningiomas, 49 (80%) were treated with GKRS as primary treatment, and 12 (20%) were treated with GKRS as an adjuvant therapy. Before GKRS, 29 patients presented with visual impairment and 50 patients presented with headache. Median patient age was 54.9 years. Median tumor volume was 3.2 cm3, and median margin dose was 12.0 Gy. The median radiologic follow-up time after GKRS was 75 months. During follow-up, tumor volume regressed in 37 cases (61%) and remained unchanged in 24 cases (39%). None of the patients experienced tumor volume progression. Tumor volume <3 cm3 was an independent predictor of tumor volume regression after GKRS (univariate analysis, P = 0.047; multivariate analysis, P = 0.049). Of 29 patients who presented with visual impairment, 16 (55%) improved after GKRS. None of the 61 patients developed new neurologic deficits after GKRS. CONCLUSIONS: GKRS provides a high rate of tumor volume control for ACP meningiomas as well as a low complication rate. Excellent tumor volume control was associated with smaller tumor size only.

Gamma knife radiosurgery for pituitary spindle cell oncocytomas.

OBJECTIVES: Spindle cell oncocytomas (SCOs) are benign lesions of the posterior portion of the pituitary gland that typically come to neurosurgical attention due to compression of the sellar or parasellar structures, and headaches. Initial treatment options for SCOs include surgical resection, particularly via the transsphenoidal approach. However, given that initial resection tends to be insufficient and subsequent revision surgery carries high complication risk, adjuvant treatment modalities may appear to offer promising solutions for controlling tumor progression. This report focuses on a potential new therapeutic option for SCOs, gamma knife radiosurgery (GKRS). PATIENTS AND METHODS: The authors identified all patients at one center who had a pituitary lesion treated with GKRS between 2005 and 2016. Five patients with histopathologically confirmed SCO who underwent GKRS were retrospectively identified and included in the present study RESULTS: The mean patient age was 52 years (range, 41-61 years). The most common presenting symptom was visual disturbance. All five patients had a history of transsphenoidal surgical resection prior to GKRS therapy. The mean tumor volume was 2.25 cm3 (range 0.7-5.38 cm3). The median tumor margin dose was 12 Gy (range, 12-14 Gy), and the median maximal dose was 24 Gy (range, 24-35 Gy). The median isodose was 50 (range, 40-50). No tumor volume progression was observed during radiological follow-up after GKRS (mean, 52 months; range, 36-84 months). At last follow-up, no neurological, endocrinological, or visual complications had been observed. CONCLUSION: Given their highly vascular and adherent nature, SCOs can be challenging tumors to treat, in particular when they recur. In our five cases, GKRS provided excellent tumor volume control for approximately 4.3 years on average. These results suggest that GKRS is a safe and effective treatment modality for histopathologically confirmed residual SCO.

A comparison of the type IX collagen levels of the intervertebral disc materials in diabetic and non-diabetic patients who treated with lumbar microdiscectomy.

PURPOSE: The purpose of this study was to compare type IX collagen levels in the intervertebral disc (IVD) materials of diabetic and non-diabetic patients with lumbar disc herniation and to determine whether there is a relationship between diabetes mellitus (DM) and type IX collagen levels in degenerated discs. METHODS: Overall, 30 non-diabetic patients and 30 type II diabetic patients who underwent lumbar microdiscectomy were included in this study. All patients underwent lumbar microdiscectomy, and IVD samples were obtained during the surgery. Deparaffinization, macroscopic digestion, and staining procedures were performed immunohistochemically. Fractional area stained, staining intensity, and total staining score were graded semi-quantitatively. The results were evaluated within a 95% confidence interval, and significance was evaluated as bidirectional at 0.05 and 0.01 significance levels. RESULTS: The type IX collagen staining intensities and fractional area stained were lower in the diabetic group than those in the non-diabetic group (p = 0.001). The total immunoreactivity staining scores of type IX collagen in the diabetic group were statistically lower at higher significance levels than the total immunoreactivity staining scores of type IX collagen in the non-diabetic group (p = 0.001). The duration of DM of the patients with DM was increased, the total immunoreactivity staining score of type IX collagen was decreased (p = 0.001). CONCLUSIONS: Diabetes reduces the type IX collagen level in the intervertebral disc and the duration of diabetes is the most important factor for this reduction. Diabetes may play a role in the development of disc herniation by reducing type IX collagen levels in the intervertebral disc. However, the causes of increased herniation in diabetic patients still have to be determined.

The Efficacy of Gabapentin in the Treatment of Pain Due to Far Lateral Lumbar Disc Herniations.

OBJECTIVES: Far lateral lumbar disc herniations (FLLDHs) can cause difficulty and differences in diagnosis and treatment compared with intraspinal herniation. We have aimed to analyze the efficacy of gabapentin as a noninvasive treatment of pain in patients with isolated FLLDH. METHODS: Thirteen patients with isolated FLLDH were evaluated for the study prospectively. All of the cases were diagnosed by lumbar magnetic resonance imaging. The previously prescribed medical therapy of the patients was not changed and gabapentin (3 × 600 mg/d) was added. For each patient, visual analog scale and Odom criteria were administered and recorded at 4 time points as follows: pretreatment and days 1, 7, and 30 posttreatment. Paired t test was used to examine scores of the cases before and after gabapentin treatment. Results were considered significant at P < 0.05, and 95% confidence interval was calculated. RESULTS: Mean visual analog scale score was 9.3 in the pretreatment period, and reduced to 5, 2.6, and 1.3 on posttreatment days 1, 7, and 30, respectively (P < 0.05). Mean Odom criteria score was 4 before gabapentin treatment. It decreased to 2.3 at posttreatment day 1 and 1.5 at day 7. At the end of 1 month, symptoms had resolved completely in all cases (P < 0.05). CONCLUSIONS: Gabapentin provided fast and effective relief of pain caused by FLLDH. We advise that the gabapentin should be kept in mind in the first-step medication of pain for such patients. Direct compression of the dorsal root ganglion or its distal part may be related to the intense pain-relief effect provided by gabapentin.