Incidental intracranial lipomas: Assessment of 163 patients.

Intracranial lipomas (ILs) are rare congenital lesions which consist 0.1-0.5% of intracranial lesions. They are usually asymptomatic. Our serial of 163 patients is the largest IL serial in literature. Files of the patients who were diagnosed with IL at outpatient clinic of neurosurgery between 2009 and 2018 were screened retrospectively. A total of 163 patients were detected to have been diagnosed with IL according to radiologic findings between 2009 and 2018. Of the patients, 96 were female and 67 were male. Intracranial lipomas are self-limited, slowly growing benign lesions which do not cause a mass effect. We believe that the present study would be a main source due to the currently available insufficient number of studies in literature.

Spontaneous regression of herniated nucleus pulposus: The clinical findings of 76 patients.

Lumbar disc hernia is common disease, affecting about 5% of the population. Many studies to date reported regression of disc herniation without surgical intervention.Medical records of the patients who applied to the spine clinic in an outpatient setting were retrospectively reviewed. Age, sex, radiological findings, neurological examinations, and medical treatments of the patients were evaluated.Male patients constituted 52.6% of the cases (n = 40) and 47.4% (n = 36) were female. The ages of the patients ranged from 25 to 82 years, with a mean of 48.5 ±â€Š12.1 years. Visual analog scale (VAS) measurements ranged from 0 to 8 and the mean was determined as 2.65 ±â€Š1.98. The VAS score of pain severity of 12 (15.78%) cases was 0, VAS score of 39 (51.31%) cases was 1 to 3, VAS score of 20 (26.31%) cases was 4 to 6, VAS score of 5 (6.57%) cases was 7 to 10. Eighteen (23.68%) of the cases underwent neuropathic pain treatment for more than 6 months. Fifteen (19.7%) patients also developed permanent motor deficits.Findings of our study show that there was no direct association between radiological improvement and clinical improvement. Indication for surgery still existed in a high number of patients, substantial of which developed permanent motor deficits. Current results suggest that we need to advise our patients in favor of early surgery as soon as indication for surgery is established upon neurological and radiological examination.

Spontaneous regression of cervical discs: Retrospective analysis of 14 cases.

Cervical disc herniation is a condition which arises from compression of cervical spinal nerve root by the degenerated disc and vast majority of the patients are aged between 30 and 40 years. Spontaneous regression of cervical disc was first reported by Kriegerand Maniker in 1992. Our study is the second large series in literature. Besides, 4 patients are the first who were shown to have resorption in C 4-5.The records of patients diagnosed with cervical disc herniation who applied to the Spine Polyclinic between 2014 and 2018 were reviewed retrospectively. The files of the patients who were recommended surgery with the diagnosis of cervical disc herniation were examined. Patients who did not accept surgery on their own initiative, but who attended our outpatient clinic for a check-up were included in the study.Of a total of 14 patients, 28.57% (n = 4) were male and 71.43% (n = 10) were female. Mean age of the patients was 40.79 (range 25-60).The results of the study indicate that likelihood of spontaneous regression is higher in para-central or foraminal disc compared to central disc hernias. Although there are a limited number of case reports in the literature, conservative treatment seems to be a good option in patients without neurological deficits, with foraminal disc hernias and not requiring emergency surgery.

Spinal paragangliomas: Surgical treatment and follow-up outcomes in eight cases.

Paragangliomas are neuro-endocrine tumors originating from the adrenal gland. They are usually benign and nonfunctioning, rarely seen in central nervous system. More than 90% of central nervous system paragangliomas are manifested as carotid and glomus jugulare tumors. Spinal paragangliomas are quite rare.The study was conducted through retrospective analysis of the files of the patients who had undergone surgery with pre-diagnosis of spinal intradural tumor between 2011 and 2017 and diagnosed with paraganglioma.A total of 8 patients (4 females and 4 males) were included in the study. Mean age of the patients was 51.1 years (28-64). Time to admission was mean 6.5 months (3 weeks-24 months). Recurrence was not observed in 7 patients, 1 patient is being followed up due to residual tumor.Treatment may be achieved through recognizing malignant transformation in patients who were not diagnosed histopathologically. We consider that quality of life of the patients may be improved through this way.

Retrospective Assessment of Early Changes in the Sacroiliac Joint After Posterior Lumbar Fusion Surgery via Magnetic Resonance Imaging and Computed Tomography.

OBJECTIVES: The need for lumbar-lumbosacral fusion surgery has increased in the recent decade. Although this type of surgical approach has been reported to provide better improvement in low back pain compared with conventional conservative treatments, the ratio of failure varies between 5% and 30% in different studies. METHODS: This retrospective study was conducted through screening patient files between January 2013 and January 2016. Preoperative and postoperative neurologic examination, Visual Analogue Scale, Oswestry Disability Index, and medical and surgical treatments of 66 patients were evaluated. RESULTS: The data from these 66 patients was included in this study. Of the patients, 28 were male and 38 were female. Mean age was 58.3 years for male and 60.1 years for female subjects. Mean duration of follow-up was 15 months. CONCLUSIONS: Our study has revealed that lumbosacral fusion surgery increases sacroiliac joint degeneration. We consider that magnetic resonance imaging is superior to computed tomography for detection of early stage sacroiliac joint degeneration.

Comparison of the Rigid Rod System with Modular Plate with the Finite Element Analysis in Short-Segment Posterior Stabilization in the Lower Lumbar Region.

AIM: Many studies are available in the literature on posterior spinal instrumentation, though the use of a rod and a plate is still controversial in the literature. In this study, a finite element analysis of the strength and superiority of modular rigid plate and rod systems, which are used in the lower lumbar region, in comparison with each other was used. MATERIAL AND METHODS: A Ti6Al4V (Grade 5) titanium biocompatible alloy anterior plate was used for the lumbar spine fixation device, and a finite element analysis was conducted on the human lumbar spine model. In this study, an intact spine, a rigid system fixed with a rod, and modular plate systems were evaluated at flexion, extension, lateral bending, and axial rotation. RESULTS: They did not show statistically significant superiority over one another in terms of limitations in movement during the range of motion exercises and rigidity. CONCLUSION: The posterior rigid stabilization system and novel stabilization system do not have a significant superiority over one another. Equivalent results in the limitation of movement and rigidity allow for the use of these systems for short-segment posterior spinal instrumentation with the same indications.

Retrospective Comparison of Radiological and Clinical Outcomes of PLIF and TLIF Techniques in Patients Who Underwent Lumbar Spinal Posterior Stabilization.

Degenerative disc disease and spinal stenosis lead to various symptoms. Degeneration of facet joints is added to this degenerative process with aging.Seventy-four patients who were admitted to the Spinal Column Outpatient Clinic of the Neurosurgery Department with a diagnosis of degenerative narrow spinal canal and lumbar spondylolisthesis between 2011 and 2013 and who underwent surgery were included in the study.Our study was conducted with 74 patients of whom 73.0% (n = 54) were female and 27.0% (n = 20) were male. Mean age was 54.86 ±â€Š7.87 years (range 34-74).Although we did not detect a difference between the two surgical methods with regard to clinical improvement, transforaminal lumbar interbody fusion (TLIF) is preferred due to radiological advantages observed one year later, ease of application, and the development of fewer complications.

Malgaigne Fracture in Childhood: A Case Report and Review of Literature.

Sacrum fractures are rare pathologies seen after spinal traumas. The incidence of a sacral fracture after trauma is 0.6% in childhood. A Malgaigne fracture is composed of fractures and dislocations of the anterior and posterior regions of the pelvis. This is the first reported case of Malgaigne fracture during childhood. A 12-year-old girl was admitted to our emergency room after having suffered a fall. Radiological tests revealed a zone 3 sacral fracture according to the Denis scoring, a subtype 2 sacral fracture according to the Roy-Camille classification, and a detachment in the symphysis pubis. Appropriate load distribution through a bilateral L5-S1-S2 transpedicular screw and a bilateral iliac wing screw, as well as neural decompression were performed together with an S1-S2 total laminectomy. It is very difficult to make a generalization for treatment of sacral fractures and Malgaigne fractures in childhood due to the small number of patients. Each patient should be individualized and lumbosacroiliac instability should be treated.

Thoracolumbar burst fractures requiring instrumented fusion: Should reducted bone fragments be removed? A retrospective study.

BACKGROUND: Thoracolumbar burst fractures are common clinical entity encountered in neurosurgical practice, accounting for 10-20% of all spinal fractures. Clinical picture could be devastating due to severe neurological deficits which lead the patients dependent both socially and emotionally. MATERIALS AND METHODS: This study compared two groups of patients who were operated because of thoracolumbar burst fracture secondary to spinal trauma in terms of neurologic deficits, degree of improvement, and radiologic measurements at one-year follow-up. The first group (group I) included the patients who underwent posterior total laminectomy, peroperative reduction of intracanal bone fragments, and posterior spinal instrumentation and the second group (group II) included the patients who underwent total laminectomy, and spinal instrumentation without reduction of free bone fragments. RESULTS: Neither group showed significant correlation with any measurement parameter. Radiological assessments and clinical improvements did not disclosed significant difference between the two groups at one-year follow-up. CONCLUSION: Retropulsion of free bone fragments extend the time of surgery and causes complications. This study found that there is no need to retropulse the bone fragments in the spinal canal in patients with unstable burst fractures who underwent total laminectomy and posterior long segment stabilization.

A Tethered Cord with Hemivertebra: A Case Report and Review of Literature.

Spinal dysraphisms are defined as open and closed dysraphisms. A hemivertebra is a congenital condition seen in 61% of patients with congenital anomalies. The first report of the excision of a hemivertebra was by Royle in 1928. A sixteen-year-old girl was admitted to our clinic with a congenital stain on the waist and a normal neurological examination. No new cases have been reported in recent literature. Our case, which is also rare, is associated with a tethered cord only and no other congenital abnormalities.

Intraoperative antepulsion of a posterior lumbar interbody fusion cage: three case reports.

Spinal fusion surgery techniques develop together with technologic advancements. New complications are seen as the result of new techniques and these may be very severe due to spinal cord and vascular structures in the lumbar region. The posterior lumbar interbody fusion cage (PLIFC) was shown to enhance spinal fusion and to prevent pseudoarthrosis due to its basic dynamic characteristics. PLIFC migrations are usually observed during the postoperative period, just after the mobilization of the patient and usually toward spinal canal. Migration to the retroperitoneal region is a extremely rare condition in the literature. In this article we discussed three cases of PLIFC antepulsion into the retroperitoneal region during the intraoperative period.

Comparison of Wiltse and classical methods in surgery of lumbar spinal stenosis and spondylolisthesis.

AIM: Minimally invasive approaches to posterior lumbar surgery are available today that can enhance patient comfort by greatly reducing tissue damage and offer better clinical results. However, such methods have not yet gained widespread popularity despite their significant advantages. This study compares the Wiltse method and the classical method of lumbar surgery based a cohort, clinical study of 57 patients. The patients all had degenerative lumbar spinal stenosis and/or spondylolisthesis and had developed multifidus muscular atrophy. MATERIALS AND METHODS: We enrolled 57 patients admitted to our clinic between April 2012 and September 2013 with a diagnosis of degenerative lumbar spinal stenosis and/or spondylolisthesis. These were treated with the classic posterior approach (n=26) or the Wiltse method (n=31). FINDINGS: In the classical method group, the ratio of female to male patients was 20/6 and the mean age was 58.19±10.17 years. A comparison of preoperative and postoperative multifidus muscle cross-sectional measurements (average of right and left) revealed a 36.09% atrophy level in the classical method group and a 26.34% atrophy level in the Wiltse group (p<0.01). However, atrophy development was 18.82% higher in the classical method group (p<0.05) relative to the Wiltse group. CONCLUSION: The Wiltse method is less invasive and causes less tissue damage. It reduces the change of hemorrhage and multifidus muscles and offers a shorter duration of hospitalization with less pain.

Retrospective, Demographic, and Clinical Investigation of the Causes of Postoperative Infection in Patients With Lumbar Spinal Stenosis Who Underwent Posterior Stabilization.

Owing to the increasing population of elderly patients, a large number of patients with degenerative spondylosis are currently being surgically treated. Although basic measures for decreasing postoperative surgical infections (PSIs) are considered, it still remains among the leading causes of morbidity and mortality. The aim of this retrospective analysis is to present possible causes leading to PSI in patients who underwent surgery for lumbar degenerative spondylosis and highlight how it can be avoided to decrease morbidity and mortality. The study included 540 patients who underwent posterior stabilization due to degenerative lumbar stenosis between January 2013 and January 2014. The data before and after surgery was retrieved from the hospital charts. Patients with degenerative lumbar stenosis who were operated upon in this study had >2 levels of laminectomy and facetectomy. For this reason, posterior stabilization was performed for all the patients included in this study. Determining the causes of postoperative infection (PI) following spinal surgeries performed with instrumentation is a struggle. Seventeen different parameters that may be related to PI were evaluated in this study. The presence of systemic diseases, unknown glove perforations, and perioperative blood transfusions were among the parameters that increased the prevalence of PI. Alternatively, prolene sutures, double-layered gloves, and the use of rifampicin Sv (RIS) decreased the incidence of PI. Although the presence of systemic diseases, unnoticed glove perforations, and perioperative blood transfusions increased PIs, prolene suture material, double-layered gloves, and the use of RIS decreased PIs.

Extraosseous, epidural cavernous hemangioma with back pain.

BACKGROUND: Cavernous malformations are characterized by enlarged vascular structures located in benign neural tissues within the cerebellum and spinal cord of the central nervous system. Cavernous hemangiomas (CHs) account for 5% to 12% of all spinal vascular malformations. CASE REPORT: We removed a hemorrhagic thoracic mass in a 40-year-old male patient who presented with progressive neurological deficits. CONCLUSIONS: We found it appropriate to present this case due to its rarity.

Isolated Transverse Clivus Fracture without Neurodeficit: Case Report and Review of Literature.

BACKGROUND: Clivus is a bony surface in the posterior cranial fossa, serving as the support of the brainstem and thus neighboring important structures because of its location. Skull base fractures that cannot be shown by conventional radiography can be clearly imaged by high-resolution bone window computed tomography. CASE REPORT: A 44 years-old male referred to the emergency department because of a traffic accident in the car. His only complaint was a severe neckache. His X-ray examination showed no pathology. The computed tomographic examination showed no parenchymal pathology, but a isolated transverse fracture in the clivus. CONCLUSIONS: The computed tomographic examination showed isolated transverse fracture in the clivus our case presented in this paper is the first case of transverse clivus fracture without additional cranial bone fracture and neurologic deficit in the literature.

Combined therapy for distant metastasis of sacral chordoma.

Chordomas are known as rare primary malign tumours that have formed from primitive notochord remains. Sacral chordomas grow slowly but locally and aggressively. Chordomas are locally invasive and have low tendency to metastasis and have a poor prognosis in long-term follow-up. Metastasis may be seen in a rate of 5-40% of the chordomas. Metastasis of chordomas is common in liver, lung, lymph nodes, peritoneum, and brain. The treatment approaches, including surgery, have been discussed in the literature before. Susceptibility to radiotherapy and chemotherapy is controversial in these tumours. The success of surgical treatment affects survival directly. In this report, we will report a sacral chordoma case in which an intraperitoneal distant metastasis occurred and discuss the surgical approach.

Primary intraosseous meningioma mimicking osteosarcoma: case report.

With an incidence rate of 15-20%, meningiomas are one of the most common brain tumors among benign intracranial tumors. They are distributed as follows in intracranial localizations: parasagittal and falx (25%), convexity (18%), sphenoid wing (18%), parasellar (12%), posterior fossa (10%), intraventricular (2%), intraorbital (1%), and extracranial (1%). The most common extradural localizations are the paranasal sinuses, nasal cavity, skin, neck, glands, and intraosseous space. Intradiploic meningiomas are generally localized in the frontoparietal and orbital regions. Due to their low incidence and lack of adequate preoperative diagnostic testing, intradiploic meningiomas are generally mistaken for primary calvarial bone tumors and en plaque meningiomas. Our case was discussed here with literature findings since primary intradiploic meningioma is uncommon and poses diagnostic challenges.

Intraorbital Encephalocele Presenting with Exophthalmos and Orbital Dystopia : CT and MRI Findings.

A 15-year-old female patient with progressive pulsatile exophthalmos caused by intraorbital encephalocele was evaluated with computed tomography (CT) and magnetic resonance imaging (MRI) in our clinic. She had no history of trauma or reconstructive surgery. When she was a little girl, she had undergone surgery for congenital glaucoma on the right eye. On the three-dimensional image of CT, a hypoplasic bone defect was observed in the greater wing of the right sphenoid bone. MRI and CT scan showed herniation through this defect of the arachnoid membrane and protruded cerebral tissue into the right orbita. Intraorbital encephalocele is an important entity that can cause pulsatile exophthalmos and blindness.

Thoracic extraosseous epidural cavernous hemangioma.

Cavernous hemangiomas were first reported in 1929 by Globus and Doshay, and are defined as benign vascular structures developed between the neural tissues occurring in the central nervous system, consisting of a dilated vascular bed. Cavernous hemangiomas comprise nearly 5-12% of all spinal vascular malformations; however, existence in the epidural space without bone involvement is rare. Only 4% of all cavernous hemangiomas (0.22/1.000.000) are purely epidural cavernous hemangiomas. In this case report, we removed a hemorrhagic thoracic mass presenting with progressive neurological deficits in a 55-year-old male patient. We found this case to be appropriate for presentation due to the rare occurrence of this type of cavernous hemangioma.

Intracranial repair of posttraumatic cerebrospinal fluid rhinorrhea associated with recurrent meningitis.

OBJECTIVE: The purposes of this study are to assess the efficacy of our intracranial surgery and evaluate the association between failure after first surgical repair and the risk factors that have been applied on a group of 13 patients affected by posttraumatic cerebrospinal fluid rhinorrhea associated with recurrent meningitis. METHODS: We retrospectively collected data on 13 patients referred to our institution. All patients had history of head trauma and experienced 2 or more episodes of meningitis. RESULTS: Three of the 13 patients had craniectomy defect due to previous trauma and surgery, 9 patients had linear fracture, and 1 patient had no apparent fracture line on preoperative radiologic evaluation. Ten of the 13 patients had identified frontal bone fracture involving the frontal sinus during surgery. Dural tear was identified intradurally and was repaired using a fascia lata graft with or without fibrin glue. Fibrin glue was applied over the suture in 7 patients. Three of the 13 patients had large dural defects. CONCLUSIONS: The size of bone and dural defect seems to be an important prognostic factor of episodes of meningitis. The use of fibrin glue to fixate fascia lata graft did not benefit the outcome.