Factors Affecting Resorption Following Cranioplasty with an Autologous Bone Graft.

AIM: To evaluate the relationship between the surgical techniques, the waiting time for surgery, postoperative distance between the graft-bone margin and the percentage of bone resorption, we analyzed patients who underwent cranioplasty. Cranioplasty is a necessary surgery to preserve brain tissue and provide an appropriate microenvironment. MATERIAL AND METHODS: In this study, patients who underwent autologous bone grafting after decompressive craniectomy by the Neurosurgery Clinic of University of Health Sciences Ankara Training and Research Hospital between 2018 and 2021 were examined. RESULTS: Thirty-nine patients who underwent autologous cranioplasty following decompressive craniectomy were included in the study. The average expected time for cranioplasty surgery following decompressive craniectomy was 16.97±13.478 weeks (min:2 max:62 weeks). The expected time between decompressive craniectomy and cranioplasty surgeries and resorption rates were compared. The resorption rate was above 30% in 7 of 10 patients with 24 weeks or more between craniectomy and cranioplasty, and less than 30% in 17 of 25 patients in surgeries less than 24 weeks (p=0.04). Following cranioplasty surgery, the distance between the graft-bone margin and the resorption rates were also compared. In this analysis, statistically significant differences were detected between the distance between the graft-bone border and the resorption rates. Resorption rates increased in 15 of 19 patients with a postcranioplasty distance of 1 mm or more (p < 0.00001). CONCLUSION: Early cranioplasty surgery is important in order to reduce complications that may occur after craniectomy. In addition, it is important to keep the defect area small in size during craniectomy surgery and to keep the cutting edge thinner when the bone graft is taken, in order to reduce the development of bone graft resorption.

The Evaluation of Dermatological Disease Profiles of Neurosurgery Inpatients: A Tertiary Clinic Experience.

BACKGROUND: Both the skin and neuronal systems originate from the ectoderm. In patients hospitalized for neurosurgery, their skin may be affected by genetic and environmental factors. OBJECTIVE: This study researched disease relationships by evaluating the profile of hospitalized neurosurgery patients who consulted with dermatology in a tertiary clinic (Neurosurgery Clinic, Ankara Training and Research Hospital, Ankara). METHODS: This study included hospitalized neurosurgery patients who consulted with dermatology. Age, gender, type of hospitalization, neurosurgical diseases, and dermatology diseases were selected as study variables. The medical health records of the patients were retrospectively scanned and analyzed. RESULTS: A total of 172 consultations were analyzed. The mean age of patients was 44.7 years old ranging from 1 year to 99 years old. The percentage of male patients was 54.7%; 25.5% of the patients were hospitalized for cerebral vascular diseases, 30.2% for spinal diseases, 22.1% for tumors, 12.2% for infections, and 1.2% for other neurosurgical diseases. The most commonly diagnosed dermatological disease in patients was drug eruptions (18.6%), followed by seborrheic dermatitis (16.2%) and contact dermatitis (14.5%). CONCLUSION: According to this study, the most commonly diagnosed dermatological diseases in neurosurgery inpatients were drug eruption, contact dermatitis, and seborrheic dermatitis. The results of this study may be helpful in terms of neurosurgical training planning and treatment management.

Retrospective Evaluation of Patients with Spontaneous Intracerebral Hematomas

AIM: To investigate the relationship among the modified Rankin scores of patients who had intracerebral hematomas at discharge, demographic characteristics of the patients, and the characteristics of the hematoma. MATERIAL AND METHODS: In this study, patients diagnosed with intracerebral hematoma and treated at the Ministry of Health Ankara Training and Research Hospital Neurosurgery Clinic between January 2010 and December 2020 were examined retrospectively. The age, gender, comorbidity, anticoagulant?antiaggregant use, and Glasgow Coma Scale score of the patients were obtained from hospital records. The modified Rankin scale (mRS) was used to assess patients at discharge. RESULTS: Herein, a total of 114 patients with supratentorial intracerebral hematoma were evaluated. The modified Rankin score ranged from 0 to 6, with a mean score of 3.47 ± 2.26. When the patients were evaluated based on their discharge status, the mortality rate was 33.3% (n=38). Fifty percent of the patients who used anticoagulant?antiaggregant died. High mRS scores were seen more frequently in advanced age. Among the other diseases of the patients, hypertension and the use of anticoagulant? antiaggregant were found to be statistically significant with high mRS scores (p < 0.001). Patients with low Glasgow Coma Scale score at the time of admission had significantly higher mRS scores (p < 0.001). CONCLUSION: Patients with advanced age, hypertension, and anticoagulant?antiaggregant use had a higher mRS score after hematoma formation. Preventable risk factors for spontaneous intraparenchymal hematomas are among the leading causes of disability, and early detection and treatment of underlying diseases are critical for hematoma prevention. Awareness about risk factors should be the priority to improve early diagnosis and reduce treatment disability rates.

The Comparison of Autologous Bone, Methyl-Methacrylate, Porous Polyethylene, and Titanium Mesh in Cranioplasty.

AIM: To discuss four different materials that are frequently used in cranioplasty, and to reveal their advantages and disadvantages. MATERIAL AND METHODS: We retrospectively reviewed 85 of our cranioplasty surgeries between 2016 and 2019. Reconstruction surgeries were excluded from our study due to craniofacial trauma. RESULTS: Of the materials used in cranioplasty, 33 are autologous bone, 32 are methyl-methacrylate, 12 are porous polyethylene, and 8 are titanium mesh. Complications developed in 16 patients. Of these, 10 are infection, 3 are flap collapse, 2 are wound healing disorders, and 1 is reactive effusion complications due to the used material. The highest complication rate was 21.9% in cranioplasty with methyl-methacrylate. No major complications were observed in cranioplasty with titanium mesh. CONCLUSION: Cranioplasty, which are among the surgeries with high complications in neurosurgery, maintain their importance today. As technology is developed and cost problems are resolved, cranioplasty takes its place among the safer and standard neurosurgical operations.

Effect of Propolis on Neurological Recovery After Experimental Spinal Cord Injury.

AIM: To examine the effect of propolis on the healing process in terms of both electrophysiological and ultrastructural parameters in a rat model of experimental spinal cord injury. MATERIAL AND METHODS: Thirty rats were divided into control, spinal cord trauma, and treated trauma groups with 10 rats per group. The rats were sacrificed after 10 days. Before sacrifice, all rats were neurologically assessed by electrophysiological monitoring, and immediately after sacrifice, the spinal cord was examined ultrastructurally by transmission electron microscopy (TEM). RESULTS: According to the electrophysiological examination, the treatment group was statistically significantly different from the trauma group. However, no statistically significant difference was found between the control and treatment groups. In terms of the TEM examination, the treatment group was significantly different from the trauma group. CONCLUSION: In this study, propolis was administered just before the induction of trauma, and the findings suggest that the use of propolis has a positive effect on the healing process. This implies that in order to prevent postoperative deficits, this treatment may be preferably applied before spinal cord surgery for trauma.

The Effect of Alpha Lipoic Acid on Cerebrospinal Fluid Biochemistry and Brain Edema After Experimental Traumatic Brain Injury.

AIM: To investigate the effect of alpha lipoic acid on cerebrospinal fluid (CSF) osmolarity and brain tissue water ratio in a rabbit model of traumatic brain injury. MATERIAL AND METHODS: Using a previously established model of traumatic brain injury using liquid nitrogen, 36 New Zealand rabbits were randomized into six groups (three treatment groups, a no trauma/no treatment group, a trauma/no treatment group, and a no trauma/treatment group). The treatment groups were administered intravenous alpha lipoic acid at different times of the experiment. Cerebrospinal fluid was obtained 96 hours after injury/treatment via cisterna magna puncture; glucose, blood urea nitrogen, and sodium levels were measured and osmolarity was calculated. Brain tissue water ratio was determined using wet and dry brain weights. The therapeutic effect of alpha lipoic acid was evaluated by comparing cerebrospinal fluid osmolarity and brain tissue water ratio between study groups. RESULTS: Based on cerebrospinal fluid osmolarity values, alpha lipoic acid treatment effectiveness was greatest in the group that received 3 doses after trauma. CONCLUSION: Alpha lipoic acid is effictive in the treatment of brain edema after experimental traumatic brain injury.

Bilateral Cerebellopontine Angle Osteomas: Case Report and Review of the Literature.

Osteomas and exostoses of cerebellopontine angle (CPA) are very rare, benign, and usually slow-growing lesions; few case reports have been published about these lesions in literature. The most common localizations of these temporal bone lesions are the mastoid cortex and the external acoustic canal. To our knowledge, only two cases of bilateral osteoma arising from both internal acoustic canals (IACs) have been reported. However, these tumors are usually asymptomatic and diagnose incidentally, and they can cause symptoms related to the 7th and 8th cranial nerve involvement. We report on a 75-year-old woman affected with bilateral osteoma of CPA and review the literature that 27 cases of IAC osteoma and exostoses have been reported.

Efficacy of Lumboperitoneal Shunting in Patients with Normal Pressure Hydrocephalus.

AIM: To evaluate the effectiveness of lumboperitoneal (LP) shunt procedures in the treatment of normal pressure hydrocephalus (NPH). MATERIAL AND METHODS: A medical record review was conducted to obtain demographic, clinical, laboratory data, as well as pre-, intra, -postoperative details of 65 patients who underwent LP shunt surgery for NPH between January 1, 2001 and January 1, 2014 in the Neurosurgery Clinics of Ankara Training and Research Hospital and Ankara Numune Hospital. RESULTS: At the 3rd month after LP shunt surgery, headache was resolved in almost all patients. At the end of first year, while statistically significant improvements were noted in the Modified Rankin Scale Scores and Mini-Mental State Examination Scores, gait disturbance, urinary incontinence and cognitive functions were improved by 86%, 72% and 65% of the patients, respectively. CONCLUSION: LP shunt surgery is associated with a lower rate of complication in comparison to ventriculoperitoneal shunt surgery and is an effective procedure in the treatment of NPH.

Sphingomonas Paucimobilis: A Rare Infectious Agent Found in Cerebrospinal Fluid.

Sphingomonas paucimobilis (S. paucimobilis) is a gram negative bacillus. It has existed in soil, drinking water and plants. It has been isolated from distilled water tanks, respirators, and hemodialysis devices at the hospital setting. Patients with chronic disorders or immune suppression may be susceptible to infections with it. This microorganism has also been reported to infect healthy persons. Both nosocomial and community-acquired infections have been reported. So far, a variety of infections have been reported, including sepsis, septic pulmonary embolism, septic arthritis, peritonitis, and endophthalmitis. Only 2 cases of meningitis have been reported so far in the literature. So far, no previous reports of culture proliferation have been reported in patients with external ventricular drains, as was the case in our patient. Therefore, our case is the first to have S. paucimobilis proliferation in cerebrospinal fluid culture during intensive care unit stay for an external ventricular drain.

Pericallosal Lipomas: A Series of 10 Cases with Clinical and Radiological Features.

AIM: A pericallosal lipoma is a fat-containing lesion occurring in the interhemispheric fissure closely related to the corpus callosum, which is often abnormal. This is the most common location for an intracranial lipoma. In this study, we aim to report on the clinical and radiographic aspects of ten patients diagnosed with pericallosal lipomas. MATERIAL AND METHODS: A retrospective analysis of patients who presented to the neurology and neurosurgery outpatient clinics of Kayseri Training and Research Hospital between 2010 and 2014 revealed that 10 patients had the diagnosis of pericallosal lipoma. The clinical and magnetic resonance imaging data were obtained by reviewing their files. RESULTS: Ten patients with an average age of 35.8 years (11-80 years) were included in the study. The mean follow-up was 17 months (8-31 months). No neurological deficits related to the lesions were found during neurological examination in any of the patients. Four patients had tubulonodular lipomas while the other 6 presented with curvilinear lipomas. Four patients (40%) displayed a coexistent corpus callosum hypoplasia. In contrast to previous reports, 3 of these patients had a curvilinear lipoma while the remaining one had tubulonodular lipoma. Also, one of the patients displayed plaque lesions attributable to multiple sclerosis. During the follow-up period, no growth in the lipomas was recorded in any of the patients. No surgical intervention was performed as none of the patients displayed symptoms caused by the lipoma. CONCLUSION: In this study, we found a stronger association of corpus callosum hypoplasia with posteriorly situated curvilinear lipomas. Our results are in disagreement with previous studies, which suggested corpus callosum anomalies were more often associated with anteriorly situated tubulonodular lipomas. Pericallosal lipomas are benign, self-limiting or slow-growing lesions that generally remain asymptomatic. These lesions occur in the midline and surround critical neurovascular structures. Therefore, surgical intervention should be avoided in asymptomatic cases.

Lipoma of the quadrigeminal cistern: report of 12 cases with clinical and radiological features.

AIM: To present the magnetic resonance imaging (MRI) characteristics and clinical features of 12 patients with quadrigeminal cistern lipoma. MATERIAL AND METHODS: A series of 12 patients with quadrigeminal cistern lipoma were followed up between 2010 and 2013 at the Kayseri Training and Research Hospital's Department of Neurosurgery. MRI characteristics and clinical features of the 12 patients were evaluated. RESULTS: A total of 12 patients were followed up. The mean age was 36.25 years (range 6 - 74 years). All patients' neurological findings were normal, except one patient had strabismus. MRI revealed a tubulonodular type lipoma in eleven patients and curvilinear type lipoma in one patient. Two patients (16.6%) had associated Chiari malformation type 1. Calcification was found only in two patients (16.6%). None of patients had a corpus callosum malformation or associated hydrocephalus. The mean follow-up period was 17.2 months (range 3-36 months) and no patient showed progression. CONCLUSION: Intracranial lipomas are considered benign, slow-growing congenital malformations due to infiltration of adipocytes into the neural tissue and conservative management should therefore be preferred.

Antiedema effects of proanthocyanidin on experimental traumatic brain edema.

AIM: Brain edema developing due to central nervous system trauma is still a significant reason of mortality and morbidity. There is still no definite approach for the medical treatment of brain edema despite many clinical and laboratory studies in recent years. We therefore investigated the effect of proanthocyanidin, an antioxidant agent, on brain edema in this study. MATERIAL AND METHODS: A total of 30 rats were used and divided into three as the control, trauma and treated trauma groups. Subjects were sacrificed after 72 hours. The brain tissue-water ratio was evaluated and biochemical analysis of brain tissue performed. RESULTS: The difference between the treated trauma and control groups was statistically significant while the trauma and control groups were relatively similar. Rats that had undergone trauma and received proanthocyanidin treatment were statistically significant and different from the trauma group rats regarding the biochemical analysis results, brain tissue water ratio, and the cold damage enzymatic antioxidant defense system of cortical neural tissue. CONCLUSION: We believe that proanthocyanidin, an antioxidant substance, can be an effective treatment for brain edema.

Vertebrojugular arteriovenous fistula and pseudoaneurysm formation due to penetrating vertebral artery injury: case report and review of the literature.

Vertebral artery injury including thrombosis, arteriovenous fistula (AVF), pseudo-aneurysm and hemorrhage may be iatrogenic or due to penetrating or blunt trauma. Although mostly asymptomatic, vertebral artery injury may also present with vertebrobasilar insufficiency findings, cephalgia, radicular pain or myelopathy due to blockade of arterial flow, arterial steal phenomenon and venous hypertension. The gold standard for diagnosis is digital subtraction angiography (DSA). Doppler ultrasonography, magnetic resonance-angiography and computerized tomography-angiography are also helpful. Endovascular treatment is now used more commonly. We present a case with sharp bread knife injury of the vertebral artery that was also complicated with a vertebrojugular fistula and pseudo-aneurysm together with the diagnostic and management options and a review of the current literature.

The therapeutic value of proanthocyanidin in experimental cerebral vasospasm following subarachnoid hemorrhage.

AIM: We aimed to examine the basilar artery in an experimental subarachnoid hemorrhage (SAH) model both from the ultrastructural and radiological aspects and tried to evaluate the benefit of proanthocyanidin (PC), an antioxidant matter, in reducing vasospasm. MATERIAL AND METHODS: A total of 21 male New Zealand rabbits were divided into three groups after performing angiography. Group I: Control group, Group II: Subarachnoid hemorrhage group, Group III: Subarachnoid hemorrhage and Proanthocyanidin group (100 mg/kg/ day). Rabbits were sacrificed on the 5th day after angiography. A segment of the basilar artery, 4 mm in length, was prepared for ultrastructural examination. RESULTS: There was no ultrastructural or radiological abnormality in the basilar artery in Group 1. In the basilar artery digital subtraction angiography (DSA) of Group 2, a statistically significant decrease in basilar artery calibration was found (p < 0.05). There was no damage in the endothelium, subendothelium, tunica media and adventitia of the basilar artery ultrastructurally but a statistically significant narrowing in lumen diameter was seen. There was also no difference in basilar artery calibration in the DSA of Group 3 (p > 0.05). No damage was seen in the basilar artery ultrastructurally. CONCLUSION: Proanthocyanidin with its strong antioxidant effect and possible vasomotor action can significantly attenuate SAH-induced vasospasm.

Epidural hematoma after minor trauma on patient with biparietal osteodystrophy.

Thinning of parietal bone bilaterally is extremely rare but well known phenomenon. Approximate prevalence is 0.4-0.5% according to radiological scans, case reports and anthropologic researches. Even though biparietal osteodystrophy occurs mostly in over 60-year-old women, it shows no special association with race or geographical area tendency. Current definition was changed by understanding that is a pathological situation, not an anatomical variety or result of growing old in time. Biparietal osteodystrophy may have an unusual presentation and treatment still remains unclear. We aim to present a patient with biparietal osteodystrophy associated with minor head trauma that caused parietal fracture and epidural hematoma underneath.

Three-dimensional volume rendering digital subtraction angiography in comparison with two-dimensional digital subtraction angiography and rotational angiography for detecting aneurysms and their morphological properties in patients with subarachnoid hemorrhage.

OBJECTIVE: Subarachnoid hemorrhage (SAH), which can cause mortality and severe morbidity, is a serious condition whose underlying cause must be determined. We aimed to compare 2D digital subtraction angiography (2DDSA), rotational angiography (RA) and 3D volume rendering digital subtraction angiography (3DVRDSA) for detecting aneurysms and their morphological properties in patients with subarachnoid hemorrhage. MATERIALS AND METHODS: After an initial diagnosis of SAH with computed tomography, 122 patients (52 males and 70 females with a mean age of 47.77 ± 12.81 ranging between 20 and 83 years) underwent 2DDSA imaging, RA and 3DVRDSA imaging for detection of aneurysms. The location of the aneurysm, the best working angles, the dome/neck ratios, the largest diameter of the aneurysm, the shape of the aneurysm, the presence of spasms or pseudostenoses, and the relationship to the neighboring arteries were recorded. RESULTS: 2DDSA missed 15.6% of the aneurysms that had a mean size of 2.79 ± 0.74 mm. RA was superior to 2DDSA for detecting aneurysm neck, and 3DVRDSA was superior to RA for detecting aneurysm neck. 3DVRDSA conclusively depicted the shape of the aneurysms in all patients. 3DVRDSA imaging was superior to 2DDSA and RA in the detection of the aneurysm relationship to neighboring arteries. The sensitivity and specificity of 3DVRDSA imaging for the detection of vasospasms were 100 and 84%, respectively. CONCLUSIONS: 3DVRDSA imaging is superior to 2DDSA and RA for detecting intracranial aneurysms and their morphological properties, especially those of small, ruptured aneurysms. However, 2DDSA should not be neglected in cases of vasospasm.

The effect of Nitrogen Mustard on the enzymatic antioxidant defense of rat brain tissue and the therapeutic value of proanthocyanidin.

AIM: Nitrogen Mustard (NM) is an alkylating agent that damages cellular nuclear DNA after penetrating tissue. This results in cytostatic, mutagenic and cytotoxic effects. We used biochemical analyses to investigate the effect of NM gas administered through the dermal and respiratory routes, on the brain cortex of rats and also tried to show whether the antioxidant Proanthocyanidin (PC) could decrease this effect. MATERIAL AND METHODS: A total of 30 rats were randomized into three groups: Group I: Control group, Group II: NM group, and Group III: NM + PC group. The rats were sacrificed 3 days after NM gas exposure. A segment of the cortical tissue was prepared for biochemical analyses. RESULTS: Biochemical analyses of cortical neural tissue regarding the Enzymatic Antioxidant Defense against NM were performed. The results of these analyses implied that PC was effective for healing of cortical neural tissue. CONCLUSION: These findings imply that structural changes induced by mustard gas can be prevented and restored by proanthocyanidin treatment.

Spontaneus resolution of a traumatic vertebral artery pseudoaneurysm.

Injuries of the vertebral artery are rare and are usually seen after penetrating or blunt cervical trauma. Vertebral artery injuries (VAI) have been reported in 0.5% of blunt trauma cases. These injuries can lead to hemorrhage, thrombosis, arteriovenous fistula or traumatic pseudoaneurysm in the early or late period. They must be treated carefully due to their increased risk of morbidity and mortality. In this case report, we present a case of asymptomatic traumatic vertebral artery pseudoaneurysm(TVAP) seen after cervical spinal trauma with C5-C6 listhesis developing afterwards, treated with anterior-posterior stabilization and fusion. Spontaneous resolution of the pseudoaneurysm is demonstrated by vertebral arter angiogrphy.

The effect of nitrogen mustard on the rat brain and the therapeutic value of proanthocyanidin.

AIM: Nitrogen Mustard (NM) is an alkylating agent that damages cellular nuclear DNA after penetrating tissue. This results in cytostatic, mutagenic and cytotoxic effects. We used the electron microscope to investigate the effect of NM gas administered through the dermal and respiratory routes to rats on the brain cortex and also tried to show whether the antioxidant Proanthocyanidin (PC) could decrease this effect. MATERIAL AND METHODS: A total of 32 rats were randomized into four groups: Group I: Control group, Group II: PC group, Group III: NM group, Group IV: NM + PC group. The rats were sacrificed 3 days after NM gas exposure. A segment of the cortical tissue was prepared for electron microscopy. RESULTS: We used the electron microscope for cellular analysis of NM on cortical neural cells. These investigations revealed degeneration of the cortical neural cell nuclei together with oedema and axonal degeneration in the subcortical neural tissue. The group receiving antioxidants was found to have less oedema and degeneration. CONCLUSION: These findings imply that structural changes induced by mustard gas can be prevented and restored by proanthocyanidin treatment.

Giant cell reparative granuloma of the axis.

Giant cell reparative granuloma (GCRG) is a rare, benign fibroosseous lesion. It typically arises in the mandible and maxilla, and less frequently in the skull bones. We report a case of GCRG of the axis, which is the first to be reported in the literature. A 35-year-old man was admitted to our clinic with the complaint of pain at his neck. There was no neurological deficit. CT and MRI showed a lesion destructing the body of the axis. Biopsy specimens were taken through the transoral-transpharyngeal route. Histopathological diagnosis was GCRG. The lesion was removed subtotally by the same route. We filled the tumor cavity with a bone graft and the patient was discharged with a halo brace without any neurological deficits. The follow-up CT revealed one year after the surgery showed sclerosis at the tumor site. The etiopathogenesis of GCRG is still controversial and the differential diagnosis, especially from giant cell tumor of bone is quite difficult. The treatment of choice for these lesions is complete surgical removal. Some authors recommend radiotherapy if total removal fails.