Prevention of Epidural Fibrosis in Rats by Local Administration of Mitomycin C or Daunorubicin.

AIM: Epineural adhesion after peripheral nerve surgery is common. The purpose of this study was to evaluate the macroscopic and histopathologic effects of topical mitomycin C and daunorubicin on epineural scar formation. MATERIAL AND METHODS: In this study, we used 15 rats (30 nerves). Two test groups and one control group were created. Sciatic nerve exposure was created bilaterally in each group (30 nerve examinations in total). In experimental group 1, cotton pads that had absorbed mitomycin C (0.5 mg/ml) were placed onto the nerves for 5 minutes while in experimental group 2, cotton pads that had absorbed daunorubicin (0.2 mg/ml) were placed onto the nerves for 5 minutes and cotton pads that had absorbed saline were applied to the control group. Eight weeks after the first surgery, surgical dissection was performed for the evaluation of neurolysis sites. Epineural adhesions were classified utilizing a numerical grading layout. RESULTS: We did not find any adverse effect with topically applied mitomycin C and daunorubicin. Within the 3 groups, no significant difference was seen in skin and fascia-muscle cavity closure (p > 0.05). Macroscopically, mitomycin C and daunorubicin decreased the adhesion of sciatic nerve to adjacent structures. There was intensive epineural scar formation in the control group. Scar tissue thickness and fibroblast/fibrocyte cell number were less in the two test groups compared with the control group (p < 0.001). There was no statistical difference between the two test groups. CONCLUSION: Epineural scar formation after peripheral nerve surgery may be reduced by using topical application of mitomycin C and daunorubicin.

Cavernous sinus invasion and effect of immunohistochemical features on remission in growth hormone secreting pituitary adenomas.

AIM: We examined the cavernous sinus invasion and tumor biological markers that influence the remission rate. Cavernous sinus (CS) invasion was evaluated radiologically. Tumor biological markers consisting of the tumor cell growth parameter Ki-67 and the cancer cell vasculature marker of vascular endothelial growth factor (VEGF) were evaluated. MATERIAL AND METHODS: We examined 28 immunohistochemically proven GH secreting pituitary adenoma patients who had been operated via endoscopic transsphenoidal surgery at Department of Neurosurgery, Kocaeli University Hospital between 2003 and 2008. Pathology preparations were stained with Ki-67 and VEGF. We evaluated remission at the postoperative 6th week. The basal GH level, nadir GH level and IGF-1 levels were evaluated to determine remission. RESULTS: Remission was achieved in 6 of 18 patients (33%) who had cavernous sinus invasion. Remission was achieved in 7 of 10 patients (70%) who did not have cavernous sinus invasion. There was no correlation between the Ki-67 proliferation index and cavernous sinus invasion (p=0.593). There was a positive correlation between VEGF expression and cavernous sinus invasion (p=0.03). CONCLUSION: The remission rate found less in the cavernous sinus invasion group. No association was found between Ki 67 proliferation index and cavernous sinus invasion. We found that a positive correlation between VEGF expression and cavernous sinus invasion. VEGF expression can therefore indirectly affect remission via cavernous sinus invasion.