[Acute subdural hematomas: surgical treatment. Retrospective analysis of 73 cases]. / Akut subdural hematomlar: opere edilen. 73 olgunun retrospektif analizi.

The mortality and morbidity of acute subdural hematomas are still high although advanced diagnostic and treatment techniques. We evaluated 73 patients who were operated between 1995 and 2000 for acute subdural hematoma. The relation between mortality and morbidity rates and age, timing of surgery and Glasgow coma scala scores were analyzed. There was not statistically significant relation between age and mortality and morbidity rates. We concluded that Glasgow coma scala score at admission is an important prognostic factor and early surgery decreases mortality rate.

Effect of pinealectomy on immune parameters in rats with Staphylococcus aureus infection.

It is generally accepted that the pineal gland is a neuroendocrine organ. Several recent experiments have shown that the pineal gland has functional and anatomical connections, particularly with the immune system, and therefore the gland is now recognized as an important immunoneuroendocrine organ in both man and animals. The present study investigates the effect of pinealectomy on some immune parameters, including hematological alterations, and the response of the brain tissue against infection caused by Staphylococcus aureus. Experiments were performed on two different age groups of rats (neonatal and young). The results showed a significant reduction of the plasma zinc level in the third week following pinealectomy, impairment of the hematological parameters including lymphocyte, erythrocyte, and leucocyte, and the deficiency of the brain response to the infective agent, particularly in pinealectomized neonatal rats. In view of these data and as described previously, the pineal gland has a main regulatory function in immune physiology, but our study indicates that only neonatal immune functions are significantly affected by pinealectomy.

The effect of pinealectomy on immune parameters in different age groups in rats: results of the weekly alteration of the zinc level and the effect of melatonin administration on wound healing.

It is generally accepted that the pineal gland is a neuroendocrine organ. Several recent experiments have shown that the pineal gland has functional and anatomic connections with many organs and systems, particularly with the immune system, and, therefore, the gland is now recognised as an important immunoneuroendocrine organ both in man and animals. The present study investigates the effect of pinealectomy on some immune parameters including zinc pool alterations and wound healing process in different age group in rats and also investigates the effect of melatonin administration on wound healing in different age groups. Experiments were performed on two different age groups of rats (neonatal and young). We have experimentally shown the induction of immune depression by pinealectomy and the restorative competence of melatonin administration in the present study. The results also showed that the plasma zinc level was significantly reduced in the third week after the pinealectomy particularly in pinealectomised neonatal rats and the wound healing process affected only in pinealectomised neonatal rats but restored to normal by melatonin administration. In view of these data, as described previously, the pineal gland has a main regulatory function in immune physiology, but our study indicates that only neonatal immune functions are significantly affected by pinealectomy.

Surgical management of syringomyelia-Chiari complex.

Great variety exists in the indications and techniques recommended for the surgical treatment of syringomyelia-Chiari complex. More recently, magnetic resonance (MR) imaging has increased the frequency of diagnosis of this pathology and offered a unique opportunity to visualize cavities inside the spinal cord as well as their relationship to the cranio-cervical junction. This report presents 18 consecutive adult symptomatic syringomyelia patients with Chiari malformation who underwent foramen magnum decompression and syringosubarachnoid shunting. The principal indication for the surgery was significant progressive neurological deterioration. All patients underwent preoperative and postoperative MRI scans and were studied clinically and radiologically to assess the changes in the syrinx and their neurological picture after surgical intervention. All patients have been followed up for at least 36 months. No operative mortality was encountered; 88.9% of the patients showed improvement of neurological deficits together with radiological improvement and 11.1% of them revealed collapse of the syrinx cavity but no change in neurological status. None of the patients showed further deterioration of neurological function. The experience obtained from this study demonstrates that foramen magnum decompression to free the cerebro-spinal fluid (CSF) pathways combined with a syringosubarachnoid shunt performed at the same operation succeeds in effectively decompressing the syrinx cavity, and follow-up MR images reveal that this collapse is maintained. In view of these facts, we strongly recommend this technique, which seems to be the most rational surgical procedure in the treatment of syringomyelia-Chiari complex.

Subependymal giant-cell astrocytoma associated with tuberous sclerosis: case report.

Tuberous sclerosis is a neurocutaneous syndrome with a wide variety of clinical, pathologic, and radiologic manifestations. Intracranial phakomatosis has been reported to include subependymal nodules; cortical tubers, and subependymal giant-cell astrocytomas. Subependymal giant-cell astrocytomas are rare, benign brain tumors of unknown histogenesis which cause increased intracranial pressure, seizures, and focal neurologic signs. The only treatment of these tumors is total surgical removal, because they are not sensitive to irradiation and chemotherapy. We report a patient with tuberous sclerosis who underwent surgery for a large subependymal giant-cell astrocytoma.

Prognostic value of serum neuron-specific enolase levels after head injury.

Neuron-specific enolase (NSE) is a dimeric cytoplasmic enzyme detected in high levels in neurons and acts in the glycolytic pathway. It is known that there is a quantitative relationship between the concentration of serum NSE and the degree of cell damage in the central nervous system. We examined serum levels of NSE by enzyme immunoassay in 89 patients with head injury and aimed to evaluate its relationship with neurological status and prognosis of the patients.

Sacrococcygeal chordomas: problems in diagnosis and management.

Chordomas are rare, insidious, and slow-growing but locally aggressive, malignant tumors originating from the primitive notochord and localized along the axial skeleton. Between 1988 and 1993, four patients with sacrococcygeal chordomas were treated at the Ankara Numune State Hospital. There was a median 17-month interval between the onset of symptoms and diagnosis. In all patients, a posterior approach was used. In addition, two patients were treated with adjuvant radiation therapy. There were no serious intra- or postoperative complications. Early diagnosis and surgery plus radiation therapy seem to provide the best results in terms of survival.

Asymptomatic or minimally symptomatic traumatic epidural haematomas: comparison of the results of surgical and conservative management related to SPECT and neuropsychological tests. Preliminary results.

One hundred and thirteen patients with asymptomatic or minimally symptomatic epidural heamatomas treated surgically or conservatively in our department were collected prospectively. Between 3 and 6 months after the head injury a SPECT (single photon emission computed tomography) study for evaluation of the three-dimensional cerebral blood flow distribution and extensive neuropsychological tests were performed in 22 patients. The preliminary results of this prospective study have demonstrated that minimally symptomatic or asymptomatic EDHs cause no pathologic SPECT findings and that neuropsychological impairment and duration of the haematoma do not affect the results of conservative management.

Cranio-cerebral erosion: delayed diagnosis and treatment.

Cranio-cerebral erosion is a well-known complication of calvarian fracture with underlying dural tear and cerebral injury in infancy and early childhood. The anatomy, pathogenesis and natural evolution of these lesions remain obscure. The common clinical symptoms are seizures, focal neurological deficits, impairment of consciousness and a soft subgaleal mass. Three patients of cranio-cerebral erosion who underwent delayed surgery in their adult lives are presented to illustrate the common and uncommon features, and their long-term outcome is discussed.

Role of surgical treatment in 70 patients with vertebral metastasis causing cord or root compression.

Spinal metastasis plays an important role in the survival rate and general condition of cancer patients. In this paper, we present 70 patients with metastatic spinal tumors, diagnosed and surgically treated in the Departments of Neurosurgery and Orthopedics of Ankara Numune State Hospital between 1984 and 1993. Our clinical observations suggest that the survival rate is influenced by the type of the primary lesion, pathology, and the patient's preoperative physical and neurological status.

Cervical laminar exostosis in multiple hereditary osteochondromatosis: anterior stabilization and fusion technique for preventing instability.

Multiple hereditary osteochondromatosis is a genetically transmitted disorder consisting of multiple projections of bone capped by cartilage, which are called exostoses. Spinal cord compression due to expansion of a laminar osteochondroma is rare but well recognized. Surgical decompression usually improves the patient's neurological status but, in cervical exostosis, post-laminectomy kyphosis and instability problems, especially in the high-risk adolescent group, form the most significant potential difficulties in the postoperative period. We report a case of cervical laminar exostosis that was treated by anterior stabilization and fusion and discuss the benefits of this technique.

Orbital hydatid cysts: report of four cases.

Hydatid cysts of central nervous system are rare and comprise only 2% to 3% of all hydatid cysts reported. Orbital localization is very uncommon and has been reported less than 1% of all hydatid diseases. The primary treatment of hydatid disease is surgical. The most important complication of the surgical treatment is secondary hydatidosis due to spillage of the cyst contents. Because of the difficulties of the orbital localization, total extirpation of the cysts without rupture is almost impossible. Preventing spontaneous rupture of the cysts during surgery and postoperative antihelmintic treatment should be taken into consideration in these cases. This study includes four cases who underwent surgery for orbital hydatid cysts. Radiological characteristics, operative technique and postoperative medical therapy are discussed.

Enterogenous cyst of the cervicomedullary junction. A case report.

Enterogenous cyst of the cervicomedullary junction extending from C2 level to the anterior aspect of the medulla oblongata was diagnosed in a 23-year-old male with a one month history of episodic tetraparesis and bilateral horizontal nystagmus. The cyst was removed subtotally except for a small portion at the point of the attachment to the anterior aspect of the medulla oblongata by a laminectomy of C1-C2 and a suboccipital craniectomy. Histopathological and immunohistochemical examinations revealed that the cyst originated exclusively from the endoderm.