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Surgical resection of jugular foramen tumors poses a significant challenge to skull base surgeons with the selection of an appropriate surgical approach, a matter of some debate. Jugular foramen metastatic tumors may mimic paragangliomas, and in some selected cases surgical resection is needed. In this video, we demonstrate the microsurgical gross total resection of a jugular foramen tumor via a postauricular trans-jugular trans-sigmoid approach. The patient is a 61-year-old man with a 7-year history of medullary thyroid cancer, who underwent three neck operations and radiation to the neck. He developed lower cranial nerve palsies (IX, X, and XI) with preoperative aspiration deficits, dysphonia, status post phonosurgery for vocal cord paralysis, profound sensorineural hearing loss, and muscle atrophy of the left shoulder. He initially received stereotactic radiation of the jugular foramen tumor at an outside hospital without histopathological diagnosis. Follow-up magnetic resonance images (MRIs) showed progressive enlargement of the tumor over the postradiation year. The decision was made to resect this tumor to enable histopathological diagnosis, and to provide local tumor control, since his primary disease has been stable. He underwent microsurgical gross total resection via a transjugular transsigmoid approach. After skeletonizing the sigmoid sinus and jugular bulb, the sigmoid sinus was ligated and rolled toward the jugular bulb, where the major part of the tumor was. Then, using the transjugular route, the tumor was removed en bloc. The surgery and postoperative course were uneventful. The histopathology was a thyroid medullary cancer metastasis. He was followed with serial MRIs, and there was no recurrent tumor at 2 years follow-up. In this video, microsurgical techniques and important steps for the resection of a jugular foramen metastatic tumor are demonstrated. The link to the video can be found at: https://youtu.be/oXC6fX2CC84 .

Objective: Follow-up ultrasonographic examinations in pregnant bitches to evaluate frequency and significance of embryo resorption., Material and Methods: In 39 Kangal bitches the number of gestational sacs was measured and vitality of embryos/fetuses was evaluated by real time ultrasonography daily from the 15th till the last day of gestation., Results: Five bitches (12.8%) showed embryonic resorption and one of these bitches exhibited a complete resorption. Fetal death could be observed in four females and was related to a total loss of the litter. After the first evidence of embryonic death gestational sacs remained detectable for 8.6±0.5days. The number of embryos of bitches with (10.8±1.8) or without embryo resorption (8.2±2.1) was statistically significantly different (p<0.05). On the other hand there was no statistically significant difference within the number of embryos of bitches suffering fetal death and bitches without embryo resorption (8.2±2.1) (p>0.05). A relationship between litter size and gestational length could not be verified (r=0.15; p>0.05)., Conclusion and Clinical Relevance: Due to these results the hypothesis is postulated that embryonic resorption is a kind of protective mechanism of the maternal organism against too large litter sizes.

In this article, a quite rare giant cavernous hemangioma located in right frontoparietal region of a 16 year-old boy is presented. Cavernous hemangiomas are commonly seen in extremities, neck, face and sometimes scalp, cutaneous or subcutaneous in localization. Giant cavernous hemangioma in the right frontoparietal region have been seen in two cases so far. In this article, we discussed the differential diagnosis, characteristics and therapy methods of giant cavernous hemangioma of the scalp.

The anatomical variations of sylvian vein and cistern were investigated during the pterional approach in 750 operative cases with different pathologies. All patients were operated on at the Neurosurgical Department of Ataturk University Medical School, Erzurum, Turkiye. The patients underwent surgery for the lesions necessitating the right or left pterional approach. The findings were recorded during surgical intervention and observed through the operative sketches of the pathologies, the slides, and videotapes of the operations. In our study, we surgically classified the variations of sylvian vein, according to its branching and draining patterns. Type I: The fronto-orbital (frontosylvian), fronto-parietal (parietosylvian) and anterior temporal (temporosylvian) veins drain into one sylvian vein. Type II: Two superficial sylvian veins with separated basal vein draining into the sphenoparietal and Rosenthal's basal vein. Type III: Two superficial sylvian veins draining into the sphenoparietal and the superior petrosal veins. Type IV: Hypoplastic superficial sylvian vein and the deep one. Four types of sylvian vein variations were defined as follows. The type I was seen in 52.8% (n = 396), the type II was found in 19.2% (n = 144), type III was recorded in 18.2% (n = 137), and type IV, or hypoplastic and deep form was discovered in 9.8% (n = 73) of patients. The coursing of sylvian vein was in the temporal side (Temporal Coursing) in 62.4 percent of the cases (n = 469), in the frontal side (Frontal Coursing) in 25 % of the patients (n = 187) and in 9 percent of the cases (n = 67) in the deep localization (Deep Coursing). Only 3.6% of the cases (n = 27) showed Mixed Coursing. The variations of the sylvian cisterns were classified into three types, according to the relationships between the lateral fronto-orbital gyrus and the superior temporal gyrus. In Sylvian type, the frontal and temporal lobes are loosely (Sylvian Type A, wide and large) or tightly (Sylvian Type B, close and narrow) approximated on the surface thereby covering the substance of the sylvian cistern. In Frontal Type, the proximal part of the lateral fronto-orbital gyrus herniated into the temporal lobe. In Temporal Type, the proximal part of the superior temporal gyrus herniated into the lateral fronto-orbital gyrus. The variations of the sylvian cisterns in 750 patients with different pathologies, were as follows: in 47.7% (n = 358) Sylvian type A, in 27.2% percent (n = 204) Sylvian type B, in 16.3% (n = 122) frontal type and in 8.8% (n = 66) temporal type. We concluded that venous perfusion discorder of the brain is the most important factor during the pterional approach. Careful intraoperative assessment and protection of the sylvian vein, which is a surgical pitfall, is an indispensable part of the operation. The recognition of the anatomical variations of the sylvian vein and cistern, and the detailed knowledge of the microvascular relationships and the importance of preservation of this vein at that level, will allow the neurosurgeon, believing in the minimally invasive neurosurgical techniques, to construct a better and safer microdissection plan, to save time, and can prevent postoperative neurological deficits.

This microsurgical study attempts to analyze the intraoperative anatomic vascular variations associated with the anterior communicating artery (ACoA) aneurysms in 120 patients who were operated on at the Neurosurgical Department of Atatürk University Medical School, Erzurum, Türkiye. All patients underwent radical surgery for aneurysm by the right pterional approach. The findings were recorded during surgical intervention and through the slides and videotapes of the operations. A total of 72 (60%) of our patients had vascular variations in the vicinity of the ACoA. Marked hypoplasia of the A1 segment of anterior cerebral artery (ACA) at the right or left side (26.6%, n = 32), median artery of the corpus callosum (MACC) (14%, n = 17), duplication of the ACoA (8.3%, n = 10), duplication of the A1 segment of ACA (7.5%, n = 9) and azygous pericallosal artery (3.3%, n = 4) were the variations that were observed during operations. A retrospective study of the cerebral angiograms of the cases indicated that preoperative diagnosis of the A1 or ACoA duplication was not possible, 14 (82.4%) of the 17 MACC's were easily identified, while three (17.6%) could not be diagnosed. From this intraoperative study, we concluded that, regardless of whether a vascular variation has been identified preoperatively, ACoA aneurysm surgery should be undertaken with the possibility of an MACC in mind. The recognition of the anatomic variations of the ACoA and the detailed knowledge of the microvascular relationships of the aneurysms will allow the neurosurgeons to construct a better and safer microdissection plan to save time on the one hand and to prevent postoperative neurological deficits on the other.

Damage to the olfactory nerve during the pterional approach to the anterior communicating artery aneurysms has not previously been investigated in a quantified manner. In this retrospective study, 100 patients with anterior communicating artery aneurysms, for whom the pterional approach was employed, were observed from the point of view of postoperative olfactory nerve function. In the postoperative period only three cases suffered from the impaired sense of smell ipsilateral to the side of surgery. 15 patients objectively showed olfactory nerve distinctions. The functions of olfactory nerve could be preserved at a relatively high rate of 85 per cent. This high rate resulted from the microtechnique employed as well as the relatively cautious frontal lobe retraction which was less than 1.5 cm.

An optochiasmatic tuberculoma, encasing the chiasm and optic nerves, was found in a 58-year-old woman complaining of sudden beginning and progressive visual failure. The patient was treated by surgery and prolonged corticosteroids and continued triple antituberculous therapy. Pathological diagnosis was a tuberculoma confirmed by postoperative positive polymerase chain reaction against M. tuberculosis. Because the incidence of tuberculomas has increased, especially in developing countries, in recent years and they also involve optic nerves and chiasm, it is important to include optochiasmatic tuberculoma in the differential diagnosis of optic nerve and chiasm tumors. Including this case, only 31 instances of optochiasmatic tuberculoma have been reported in the literature.

The pterional approach is commonly employed in surgery of the anterior circulation and upper basilar artery aneurysms, as well as for the tumors of orbital, retroorbital, sellar, chiasmatic, subfrontal and prepontine areas and lesions around the sella especially for lesions behind the clivus. Also tumors arising from the medial sphenoid ridge, the superior orbital fissure, the anteromedial temporal surface, or the cavernous sinus region are approached through a pterional exposure. The surgical technique is based on the experience, training and observation of the neurosurgeon. One technique is not necessarily better than another. Regardless of the surgical technique, the end results depend on a rigorous, methodical, systematic, and step-by-step approach to the target, securing it with minimal injury to surrounding structures. In this study, we have analyzed the intraoperative anatomical findings of the Sylvian vein and fissure, lenticulostriatal artery, olfactory nerve, and recurrent artery of Heubner and showed the surgical pitfalls in 700 patients with different diagnoses that were operated on with the pterional approach. The findings were recorded during surgical interventions and through the slides and videotapes of the operations. Also, we have stressed the preservation of the frontotemporal branch of the facial nerve, the delicate retraction of frontal lobe, the cottonoid retraction in temporal lobe and the preservation of olfactory nerve functions.

Intracerebral-intraventricular haematoma was created experimentally by injecting coagulated autologous blood into the left cerebral hemispheres of rats, stereotactically 2200 U. Urokinase was injected into the haematomas of the treated group and the same volume of physiologic saline solution into the control group. Macroscopic evaluations were made at the end of 24 and 48 hours and lysis of the haematoma was observed in 90% of cases in the group treated with Urokinase. This ratio was 20% in the control group (P < 0.00001). In microscopical evaluation, no histopathological changes were observed in surrounding tissues in either group. It is concluded that local Urokinase administration may be an effective method of treatment in intracerebral aematomas.

We investigated the tissue fibrinolytic activity in an experimental model of intracerebral hematoma was developed in the guinea pig. Intracerebral hematoma was created by stereotaxically injecting 0.2 ml autologous blood into the left frontal lobe of a total 63 anesthetized adult male albino guinea pigs (weighing 280-350 gr.). The fibrinolytic activity was studied using conventional histochemical stain techniques. 20 guinea pigs were used for developing the intracerebral hematoma model; in the 43 guinea pigs, the intracerebral hematomas were studied sequentially. Intracerebral hematoma formation failed in 10 of 43 guinea pigs. Three guinea pigs died in the immediate postoperative period. It was diagnosed histopathologically purulent meningitis and ventriculitis in four guinea pigs. Tissue fibrinolytic activity was increased in the meninges and choroid plexus. No fibrinolytic activity was observed a during the first days (1 to 3 days after hematoma production). 3 to 5 days later, fibrinolytic activity was seen in the capillary buds surrounding the hematoma and among the infiltrating mononuclear cells. This activity reached highest levels for 7-14 days following production of the hematoma and decreased after 20 days. In conclusion, tissue fibrinolytic activity associated with neovascularisation and mononuclear cell infiltration appears to be important in lysis of intracerebral hematoma.

A 37-year-old man is reported with post-traumatic extradural hematoma complicating an arachnoid cyst in the middle cranial fossa. While subdural and intracystic hemorrhages are well-known complications from this malformation, the association with extradural hematoma has only been reported in three cases in the literature. We describe a case occurring after head injury and discuss the etiology and treatment.

10 giant intracranial aneurysms in children were treated consecutively in Neurosurgical Department of Atatürk University, Erzurum, Turkey between 1985-1989. A total of 60 aneurysms of normal size were operated on in the same period. Of the ten cases 6 were male and 4 were female. All the patients were under 17-years old. In 6 cases, the onset of symptoms was sudden subarachnoid hemorrhage, in 3 cases presenting symptoms were insidious imitating a intracranial mass, and in one case, clinical manifestation was epileptic seizure. Among 6 cases with subarachnoid hemorrhage, 3 were in IV grade according to Hunt-Hess scale, 2 were in III grade and one in II grade. Angiographic localisation of the aneurysms was in the middle cerebral artery in 9 cases and in the anterior communicating artery in one case. During the operation, blood pressure was not lowered. All the patients were operated on with normal blood pressure without hypotension. In 4 cases, intramural thrombosis was detected. The necks of aneurysms were occluded by suitable clips. The aneurysms were excised in 4 cases after clipping. One patient died in the early postoperative period, and 9 cases remained alive and were free of symptoms after the operation for one to 4 years. We conclude that especially giant aneurysms in children should be treated surgically without exercising hypotension during operation.

In microvascular end-to-side anastomoses it is highly important to accomplish the operation with the least damage on the vascular structure and its constituents or the peripheral tissues. In the present study the author introduces a new atraumatic technique to obtain the best visualization of the posterior wall of the end-to-side anastomosis.

42 patients with cerebral abscesses were treated from 1979 until the end of the first six months of 1987 at the Neurosurgical Department of the Faculty of Medicine, Atatürk University, Erzurum, Turkey. The present study aims at studying these patients to determine the factors affecting on prognosis. The patients were studied for the duration of complaints, pre-operational condition, the location of the abscesses, the microorganisms responsible for them, and the techniques of operation applied, by taking their sex and age into consideration. All of the cases were treated operatively. Of these, 18 were treated by excision and 24 were applied drainage, whose percentage was 43 and 57 respectively, 85% of the cases were under 60 years of age. The rate of mortality of the cases with cerebral abscesses was 19%. This rate was between 15% and 37.5% in the cases of several age groups whose complaints lasted less than two months. This rate reached 100% with a sudden increase in the cases who had a duration of complaints over four months. The rate of mortality was 6.2% in the cases with a clear conscious and cooperative ability while it had a significant increase in the patients in pre-coma or coma to go up to 50% and 75% respectively. No correlation was observed between the rate of mortality and the age of the patients but the location and extension of the abscesses had an effect on this rate. The abscesses, covering more than one lobe, had a mortality rate of 31.2%, while the ones with parietal location caused no single death. To conclude, we can say, based on this study, that the age and sex of patients and the operative technique have no effect on the rate of mortality while it is obviously influenced by the duration of the complaints and the pre-operative condition. Consequently, we would like to stress up on early diagnosis and treatment of such cases.

In this study 43 diagnosed and operated chronic subdural hematomas events analysed clinically in the Neurosurgical Department of Atatürk University Erzurum, Turkey. 60.4% of the patients were found to be under 60 years of age. The most frequent findings were pathological reflexes, and hemiparesis at the rates of 58.1% and 50.4% respectively. All of operations were performed using the burr-hole craniostomy and closed system drainage technique.