Pediatric Hydrocephalus and the Primary Care Provider.

Hydrocephalus is a pathologic condition that results in the disruption of normal cerebrospinal fluid flow dynamics often characterized by an increase in intracranial pressure resulting in an abnormal dilation of the ventricles. The goal of this article was to provide the necessary background information to understand the pathophysiology related to hydrocephalus, recognize the presenting signs and symptoms of hydrocephalus, identify when to initiate a workup with further studies, and understand the management of pediatric patients with a new and preexisting diagnosis of hydrocephalus.

Cerebral contusion as a rare cause of foot drop: case report.

A 74-year-old woman, taking anticoagulant therapy for chronic heart failure, presented to our emergency room with left dorsiflexion weakness 8 hours from after multitrauma. A detailed neurological examination revealed only 0/5 strength in the left foot dorsiflexion without any upper motor neuron signs. While there was no spinal cord pathology detected, cranial computed tomography demonstrated a lesion in the right parasagittal localization consistent with hemorrhagic contusion. Clinical follow-ups showed an improvement in neurological findings with muscle power of 3/5 in day 5 and 5/5 in day 45 of admission. The parasagittal region has a foot localization in the homonculus and lesions in this area can rarely present with the foot drop sign. Thus, parasagittal region lesions should always be kept in mind in foot drop cases.

Two level cervical corpectomy with iliac crest fusion and rigid plate fixation: a retrospective study with a three-year follow-up.

AIM: There is no clear knowlegde in the literature about two-level vertebral corpectomy using the iliac bone crest for fusion and rigid plate fixation. We present our experience with two-vertebral level cervical corpectomy and reconstruction. MATERIAL AND METHODS: Each patient was graded according to the Nuricks Grade (1972) and the modified Japanese Orthopaedic Association (mJOA) Scale (1991), and the recovery rates were calculated. All patients had two-level vertabral corpectomy. Anterior iliac crest bone graft with titanium plate fixation was applied to all patients. RESULTS: Postoperatively the mJOA score raised up to 15.5. Mean recovery rate was 69%. Average 25.2 degrees correction of kyphosis was achieved in 21 patients. Among the postoperative complications, three cases (12%) had temporary C5 nerve palsy that was resolved in three weeks, two cases had (8 %) graft malposition and infection, and three cases (%12) had temporary donor site pain. CONCLUSION: Excellent fusion rates can be achieved following two-level corpectomy with iliac bone graft repacement. This techique is easy, cost effective and safe. If the bone graft is harvested from the iliac crest by standart approach and between anatomical landmarks, most patients do not experience persistent pain at the donor site.

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.

Dose-dependent ultrastructural and morphometric alterations after erythropoietin treatment in rat femoral artery vasospasm model.

PURPOSE: Cerebral vasospasm is the common cause of poor outcome after aneurysmal subarachnoid hemorrhage (aSAH). Although many agents are experimentally and clinicaly used to protect or recover from vasospasm, an effective neurotherapeutic drug is still missing. Erythropoietin (EPO) is recently a promising candidate. The aim of this study is to investigate the dose-dependent effects of recombinant human EPO (rhEPO) on arterial wall in a rat femoral artery vasospasm model. METHODS: Thirty two animals were divided into four groups: vasospasm without any treatment (group A), vasospasm +250 IU/kg rhEPO group (group B), vasospasm +500 IU/kg rhEPO group (group C), and control group (group D). Rat femoral artery vasospasm model was used. For groups B and C, 7 days of 250 IU/kg and 500 IU/kg intraperitoneal rhEPO in 0.3 ml saline were administered respectively; and for groups A and D, 0.3 ml saline were administered intraperitoneally without any treatment. After 7 days, histological and morphometric analyses were carried out. RESULTS: Vasospasm alone group demonstrated the highest vessel wall thicknesses, comparing to other groups (p < 0.001). While for groups B and C, vessel wall thickness values were significantly higher than the control group (p < 0.001), between these two groups, there was no significant difference achieved (p > 0.05). CONCLUSION: In our study, there was no significant difference between the two rhEPO treatment groups, but rhEPO treatment was shown to be histologically and morphometrically effective in vasospasm. However, if dosage of EPO treatment is augmented, successful results may be achieved.

Medical treatment of primary extradural solitary lumbar hydatid disease.

Hydatid disease of the spine is rare and has a poor prognosis, presenting both diagnostic and therapeutic challenges. Paraplegia is the most serious complication of the disease and is caused by compression of the spinal cord by the cysts. We report a 30-year-old woman with an isolated primary hydatid cyst that responded to treatment with albendazole. She presented with back and right leg pain. MRI of the lumbar spine showed a solitary cyst measuring 2.2 x 2.7 cm, with an intraspinal extension at L4-L5. Physical examination did not reveal any focal deficit and the patient was treated with albendazole drug therapy (400mg daily). After 7 months' treatment, she had improved both clinically and radiologically. Albendazole drug therapy appears to be effective for conservative treatment of patients with primary solitary hydatid disease in the lumbar spine.

Delamination technique together with longitudinal incisions for treatment of Chiari I/syringomyelia complex: a prospective clinical study.

BACKGROUND: Treatment modalities in Chiari malformation type 1(CMI) accompanied by syringomyelia have not yet been standardized. Pathologies such as a small posterior fossa and thickened dura mater have been discussed previously. Various techniques have been explored to enlarge the foramen magnum and to expand the dura. The aim of this clinical study was to explore a new technique of excision of the external dura accompanied by widening the cisterna magna and making longitudinal incisions in the internal dura, without disturbing the arachnoid. METHODS: Ten patients with CMI and syringomyelia, operated between 2004 and 2006, formed this prospective series. All cases underwent foramen magnum decompression of 3 x 3 cm area with C1-C2 (partial) laminectomy, resection of foramen magnum fibrous band, excision of external dura, delamination and widening of internal dura with longitudinal incisions. RESULTS: Patients were aged between 25 and 58 years and occipital headache was the most common complaint. The mean duration of preoperative symptoms was 4 years and the follow-up time was 25 months. Clinical progression was halted for all patients; eight patients completely recovered and two reported no change. In one patient, there was a transient cerebrospinal fluid (CSF) fistula that was treated with tissue adhesive. While syringomyelia persisted radiologically with radiological stability in five patients; for three patients the syringomyelic cavity decreased in size, and for the remaining two it regressed completely. CONCLUSION: Removal of the fibrous band and the outer dural layer, at level of foramen magnum, together with the incision of inner dural layer appears to be good technique in adult CMI patients. The advantages are short operation time, no need for duraplasty, sufficient posterior fossa decompression, absence of CSF fistulas as a result of extra arachnoidal surgery, and short duration of hospitalization. Hence this surgical technique has advantages compared to other techniques.

Replacement of vertebral lamina (laminoplasty) in surgery for lumbar isthmic spondylolisthesis. A prospective clinical study.

BACKGROUND: The use of lamina as a graft for fusion in isthmic lumbar spondylolisthesis (LIS) is not known. In the present prospective clinical study, we used the laminoplasty technique and reported on its outcomes. MATERIAL AND METHOD: Twenty cases that have been operated in our clinic due to G1 and G2 ISL between February 2003 and December 2006 were clinically and radiologically examined. The clinical assessment of the patients was carried out with the Prolo Economic and Functional scale. RESULTS: Both interbody fusion and laminoplasty procedures concerning 88 pedicles in total were performed on 20 cases of which 10 were at the L4-5 level, whereas 6 were at the L5-S1 level and 2 were at the L3-4-5 level. Five (25%) cases also had coexisting spinal stenosis. 19 (95%) patients had solid fusion but one (5%) had no solid fusion formation while having posterior fusion along with a clinical neurological examination result similar to the one obtained during the preoperative period. In conclusion, the anterior fusion rate was 95%. The most remarkable finding among the patients was the recovery observed at the 2nd month. The Prolo scale results of the cases were good and the follow-up time was 23.5 months. CONCLUSION: The laminoplasty technique is a method which presents advantages in isthmic spondylolisthesis cases such as short duration of operation, absence of graft donor site complications, preservation of the osteoligamentous structures of the posterior column and a high probability of achievement of fusion through only a posterior approach at a single session; therefore, we believe it is an alternative surgical technique.