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Allergic diseases have emerged as a major health care burden, especially in the western hemisphere. They are defined by overshooting reactions of an aberrant immune system to harmless exogenous stimuli. The T H 1/T H 2 paradigm assumes that a dominance of T H 2 cell activation and an inadequate T H 1 cell response are responsible for the development of allergies. However, the characterization of additional T helper cell subpopulations such as T H 9, T H 17, T H 22, T H GM-CSF and their interplay with regulatory T cells suggest further layers of complexity. This review summarizes state-of-the-art knowledge on T cell diversity and their induction, while revisiting the T H 1/T H 2 paradigm. With respect to these numerous contributors, it offers a new perspective on the pathogenesis of asthma, allergic rhinitis (AR) and atopic dermatitis (AD) incorporating recent discoveries in the field of T cell plasticity., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: Articulation of rostrum of sphenoid bone with alae of vomer forms a schindylesis type of joint. The circumference of this joint, called sphenovomerine suture (SVS), is very important in establishing a reliable surgical field in the endoscopic transsphenoidal pituitary surgery. Because of its vital role in endoscopic transsphenoidal pituitary surgery, this radio-anatomical study was designed to establish the morphological properties of SVS., Methods: In this study, the authors examined SVS in 235 patients (121 females and 114 males) on the computed tomography images of the paranasal sinus and made 4 measurements to describe SVS., Results: The mean distance between superior margin of the upper labial philtrum and top of SVS was 6.66 ± 0.43 cm for females and 7.44 ± 0.54 cm for males. The distance between the top of SVS and dorsum sellae was 3.08 ± 0.33 cm for females and 3.19 ± 0.32 cm for males, the alae of vomer angle in the upper surface was 74.22 ± 20.06° for females and 74.23 ± 19.68° for males. The distance between the most lateral points of 2 alae of vomer was 0.99 ± 0.17 and 1.01 ± 0.19 cm for females and males, respectively., Conclusions: For an easy and successful operation, removal of the SVS is very important as it will provide a better view of the sellar base and make the management of the surgical instruments easier in the wider safe surgical field thus created.

Objective: Craniopharyngioma resection is one of the most challenging surgical procedures. Herein, we describe our extended endoscopic endonasal transsphenoidal surgery (EETS) technique, and the results of 9 years of use on primary and recurrent/residual craniopharyngiomas., Methods: This study reviewed 28 EETSs in 25 patients with craniopharyngiomas between January 2006 and September 2015. The patients were divided into 2 groups, newly diagnosed patients (group A, n = 15), and patients having residual or recurrent tumors (group B, n = 10). There was no significant difference between the groups in terms of the largest tumor diameter (P = 0.495), and all patients underwent EETS. The clinical and ophthalmologic examinations, imaging studies, endocrinologic studies, and operative findings for these cases were reviewed retrospectively., Results: The number of gross total resections in group A was 13/15, and 7/10 in group B. Three of the patients developed postoperative cerebrospinal fluid leakage (all in group A). There were no neurovascular or ophthalmologic complications, and no meningitis or mortality was observed., Conclusions: There has been a notable increase in the use of EETS in the treatment of craniopharyngiomas during the last decade. Despite its increased use in the treatment of primary craniopharyngiomas, its implementation for recurrent or residual craniopharyngiomas has been viewed with suspicion. In this study, the results have been presented separately for primary and recurrent/residual craniopharyngiomas, so that the results can be compared. Overall, EETS is a reliable and successful surgical treatment method for primary and recurrent/residual craniopharyngiomas., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Splitting of the optic nerve by a pituitary adenoma is an extremely unusual condition with only 3 cases reported to date., Case Description: A 41-year-old woman presented with visual loss as a result of an aggressive pituitary macroadenoma causing the splitting of the right optic nerve. Possible mechanisms of this condition are discussed, and the literature is reviewed., Conclusions: In aneurysm and tumor cases, awareness of the exact anatomy is particularly important to preserve function. An overlooked duplication or penetration of cranial nerves may result in inadvertent injury to important structures and loss of function., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: We report herein a retrospective analysis of the results of 142 consecutive prolactinoma cases operated upon using an endoscopic endonasal trans-sphenoidal approach over a period of 6 years., Methods: Medical records of 142 cases were analysed with respect to indications for surgery, duration of hospital stay, early remission rates, failures and recurrence rates during a median follow-up of 36 months., Results: On the basis of magnetic resonance imaging (MRI) data, 19 patients (13.4 %) had microadenoma, 113 (79.6 %) had macroadenoma, and the remaining 10 (7.0 %) had giant adenomas. Cavernous sinus invasion was identified in 25 patients by MRI and confirmed during surgery. Atypical adenoma was diagnosed in 16 patients. Sparsely granulated prolactin adenoma was identified in 99 patients (69.7 %). Our results demonstrate that male sex and higher preoperative prolactin levels are independent factors predicting persistent disease. The post-surgical complications are as follows: 2.8 % patients had meningitis, 2.1 % patients had postoperative cerebrospinal fluid leak and 2.1 % patients had panhypopituitarism. At the end of follow-up, 74.6 % patients went into remission. During follow-up period, five patients who had initial remission developed recurrence., Conclusions: Our series together with literature data suggest that an endoscopic endonasal trans-sphenoidal approach in the treatment of proloctinomas has a favourable rate of remission. According to the findings of this study, endoscopic endonasal trans-sphenoidal surgery might be an appropriate therapy choice for patients with prolactinoma who could not have been managed with recommended therapeutic modalities.

Object: Acromegaly is a disease that has significant morbidity and mortality related to high levels of growth hormone (GH) and insulin-like growth factor-I (IGF-I), and is usually caused by pituitary adenomas. The goal in this study was to investigate the role of endoscopic transsphenoidal surgery and surgical experience in the treatment of GH adenoma cases in relation to surgical results and hormonal cure rates, and to perform a review of the literature., Methods: The authors present a retrospective analysis of 214 GH adenoma cases. Restoration of IGF-I levels to normal for age and sex, suppression of GH levels below 0.4 μg/L on the oral glucose tolerance test, and demonstration of the total removal of the tumor on MRI studies obtained after administration of contrast material at the 3-month postoperative follow-up visit were the criteria for cure., Results: In total 214 patients with a mean age of 41.9 ± 12 years (range 17-75 years) and a male/female ratio of 106/108 were enrolled in the study. Cure was achieved in 134 (62.6%) of 214 patients. One hundred sixty-nine patients were primary cases, and of these 109 (64.5%) were cured, whereas 61 patients were previously operated cases and of these 25 (41%) were cured. With a 51.1% decrease in the 1st month postoperatively, IGF-I levels were found to be predictive of cure (74.4% sensitivity and 73.7% specificity). Cut-off values for GH levels in predicting cure for the 1st day, 1st week, and 1st month postoperatively were 2.33, 2.05, and 2.25 μg/L, respectively. The cut-off value for surgical experience was 57 for primary surgeries (58.5% cure rate before this cut-off value compared with 72.6% after it; p = 0.025) and 108 for all operations (45.8% vs. 79.4%, p = 0.037). Although 28 patients were found to be in remission according to the criteria in 2000, they were not in remission according to the new consensus criteria. Nine of these cases (32.1%) had random GH levels < 1 μg/L at the 1-year follow-up. The 1-year IGF-I and GH levels in these 28 patients showed no significant difference when compared with the cases defined as cured according to the current criteria., Conclusions: In acromegaly treatment, transsphenoidal endoscopic surgery performed by an expert senior surgeon and increased surgical experience are important for higher cure rates. Random GH levels < 2.33 μg/L after the 1st day postoperatively and a > 50% decrease in IGF-I levels after the 1st month postoperatively are predictive of cure. Moreover, there is no urgency for additional therapy in patients with GH levels of 0.4-1 μg/L and MRI sequences showing no tumor at the 3-month follow-up, because for these cases remission can be achieved at the 1-year follow-up.

High levels of endogenous cortisol due to Cushing's disease cause significant mortality and morbidity. Treatment of Cushing's disease is challenging. For many years, transsphenoidal microsurgical resection of the adenoma has been the treatment of choice. However, recently, neuroendoscope has taken its place in the neurosurgeon's armamentarium, and the endoscopic transsphenoidal resection of pituitary tumors has become a familiar approach. Our aim was to present the results of pure endoscopic surgery in the treatment of corticotropinomas for comparison with the results of previous endoscopic and microsurgical series. We present a retrospective analysis of 90 patients with diagnosis of Cushing's disease who were operated between 2006 and 2012. Among 90 patients, a total of 81 (90.0 %) had a remission (28 out of 29 macroadenomas (96.6 %) and 53 out of 61 microadenoma patients (86.9 %)). Of note is that 66 out of 69 (95.7 %) primary patients (i.e., those who were operated in our center) and 15 out of 21 (71.4 %) patients previously operated in other centers reached a hypo/eucortisolemic state. A remission rate comparable with previous endoscopic series was achieved. In nine patients, it was not possible to achieve remission at all. On the other hand, only four of our cases (5.6 %) had a recurrence, and with reoperation, all of these patients entered a re-remission. To our knowledge, our series is the largest series studying endoscopically operated adrenocorticotropic hormone-secreting adenomas. Our results suggest that the endoscopic approach has opened a new avenue in the treatment of Cushing's disease, previously a therapeutic challenge for both the clinician and the neurosurgeon. Endoscopic approach in the treatment of Cushing's disease is clearly better for patients because of its low morbidity rates and short duration of hospital stay. On the other hand, long-term follow-up of our patients will show whether these favorable observations will persist.

Objective: Dural opening and closures are major steps in endoscopic pituitary surgery. Restoring the normal anatomy at the end of the procedure creates a natural barrier between the intrasellar compartment and the sinonasal cavity., Methods: In this study, we present a relatively simple dural opening and closure technique for endoscopic pituitary surgery. This technique provides a better alternative to the use of a more complex nasoseptal flap or the multilevel closure with artificial materials as it restores the normal anatomy after the tumor removal and provides a better physiological barrier between the sinonasal cavity and the intrasellar compartment. Incision is performed in circular or horseshoe fashion leaving a small peduncle, and then the dura is reflected., Results: Of the 733 endoscopic transsphenoidal procedures in 667 patients conducted between January 2006 and May 2012, we used this described technique in 50 cases (7.4%). In these 50 cases with dural flap, there was no postoperative CSF leakage. Intraoperative CSF leakage was observed in 135 (20.2%) of the 667 patients. In 15 (11.1%) of these 135 patients we used the dural flap technique accompanied with fat and/or fascia lata support. There was no postoperative leakage in these patients. In the remaining 120 (89.9%) patients who had intraoperative CSF leakage, we used fat and/or fascia lata for the reconstruction of the sella floor. But we observed postoperative CSF leakage in 12 (10%) of the 120 patients without the dural flap which were reoperated., Conclusion: The dural flap technique we employ has several advantages. First of all, it allows optimal physiological reconstruction after the surgery. Secondly, the bridge between the flap and the main dura helps maintain the vascular supply, which in turn can radically shorten the healing time. Thirdly, this technique is obviously a better alternative to the time consuming and expensive multilevel closures with tissue sealants and artificial grafts., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Endoscopic transsphenoidal surgery is emerging as a minimally invasive and maximally effective procedure for pituitary adenomas. In this report we analyzed the complications in 624 procedures of endonasal transsphenoidal endoscopic surgery in the treatment of 570 patients with pituitary adenomas. The leading author (MB) operated pituitary adenomas via pure endoscopic endonasal transsphenoidal surgery between January 2006 and August 2011 at the Hacettepe University, Department of Neurosurgery in Ankara. Complications were assessed in 624 surgical procedures under five groups; rhinological, CSF leaks, infection, vascular and endocrinologic complications. We observed a total of 76 complications (12.1%). Rhinological complications occurred in 8 patients (1.3%): 4 epistaxis (0.6%) and 4 hyposmia (0.6%). Postoperative CSF leaks occurred in 8 patients (1.3%), and infectious complications occurred in 8 patients: 3 cases of sphenoidal sinusitis (0.4%), 5 cases of meningitis (0.8%). Only 1 case of internal carotid aneurysm rupture during the opening of sellar floor (0.16%) was observed. Endocrinologic complications occurred in 51 (8.1%) patients: Anterior pituitary deficiency in 12 (1.9%), transient diabetes insipidus (DI) in 29 (4.6%), permanent DI in 3 (0.4%) and inappropriate antidiuretic hormone secretion syndrome occurred in 7 (1.1%). There was no mortality directly related to the surgical procedure. The complication rates observed in our study suggests that the endoscopic pituitary surgery is at least as safe as microscopic transphenoidal surgery. These rates were obtained with due experience and well-coordinated teamwork. To further improve these rates, new technological developments will be helpful.

Aim: Intracranial hypotension may have variable clinical presentation. The imaging characteristics of intracranial hypotension are especially well depicted on magnetic resonance imaging studies. Although the clinical and radiological manifestations of spontaneous intracranial hypotension are increasingly recognized in many reports, many other abnormalities in this disorder and complicating cases still exist., Material and Methods: A 16-year-old patient suffering from nausea vomiting and blurred consciousness was admitted to the hospital. MRI showed diffuse pachymeningeal thickening resembling intracranial hypotension and ventricular enlargement like compensated hydrocephalus. The patient was investigated and treated using endoscopic third ventriculostomy., Conclusion: The authors presented a case of intracranial hypotension complicated with hydrocephalus. Specific causes for intracranial hypotension as well as additional new treatment options will also be discussed.

Arterial bleeding during transsphenoidal surgery for pituitary adenoma is known complication. This usually happens due to rupture of intracavernous carotid or delayed hemorrhage due to the carotico-cavernous fistula and/or pseudoaneurysm. There is also evidence that cavernous carotid aneurysms may occur with pituitary tumors, yet largest series failed to demonstrate any link between aneurysm formation and pituitary tumors. Usually such an aneurysm rupture results in formation of carotico-cavernous fistula. However, pituitary apoplexy and even epistaxis have been reported. In this paper we present a patient with recurrent pituitary adenoma and cavernous carotid artery aneurysm, which caused significant hemorrhage during the surgery. Although retrospective analysis of MRI disclosed that the patient had the aneurysm before the first surgery, it remained silent until the second operation. Therefore neurosurgeons should be very susceptive to any signal changes on preoperative MR images, especially in recurrent cases, where normal anatomical relations are disturbed by fibrotic tissue. Also, we reviewed the vascular complication of pituitary surgery based on the literature.

Pravastatin has neuroprotective effects against aging but its role in brain injury remains unclear. This study evaluated the effects of pravastatin on the ultrastructural changes and hemorheological parameters in rats after traumatic brain injury (TBI) of right parietal cortical contusion by a controlled weight-dropping method. There were three groups: (I) Sham operated group; (II) TBI + vehicle (saline) group; and (III) TBI + pravastatin group. Right parietal craniectomy was performed in all groups. In TBI + pravastatin group, pravastatin was administered orally at a dose of 1 mg/kg every day for 7 days starting at 24 hours after the injury. Plasma viscosity, erythrocyte deformability and erythrocyte aggregation were measured from blood samples of all rats on 2nd, 7th and 15th days. At the same time electron microscopic study was done on designated days for groups II and III. Treatment with pravastatin markedly increased aggregation amplitude and γIsc max values and significantly decreased erythrocyte deformability but did not change plasma viscosity in 2 weeks time. Ultrastructural parameters such as perinuclear edema, mitochondrial swelling and intraneuronal vacuoles were detected in lower degree in the statin group when compared to the saline group, especially decreased demyelinization and endothelial detachment was prominent. As a result, the hyperviscosity state with increased erythrocyte aggregation and decreased erythrocyte deformability induced by pravastatin in this study was accompanied by an improvement of the ultrastructural findings in TBI. This hyperviscosity state may be a compensatory mechanism to increase the oxygenation of the injured tissue by inducing the release of antiaggregant and vasodilatory substances by increasing shear stress. Therefore, we suggest that prolonged pravastatin usage may exert affirmative effects on traumatic brain injury conditions by increasing blood viscosity.

Unlabelled: Simvastatin is a hypocholesterolemic agent presumed to cause peripheral neuropathy. We arranged an experimental design which focuses on the effect of simvastatin on peripheral nerves and neural regeneration. Sciatic nerve injury was performed at midthigh region of male wistar rats either by clamp compression or fine cut. Electrophysiological and electron microscopical studies were carried out to assess the effect of simvastatin on peripheral nerve and nerve regeneration. There was no difference between the groups that were given simvastatin and standard regimen in the sciatic nerve when electrophysiological measurements were concerned. However, some of the rats that were given simvastatin show reduction in axoplasm density (intensity) of myelinated nerve fibers and prominent vacuolization of myelin sheath according to light and electron microscopic studies. Sciatic nerve compound muscle activation potential measurements of the animals given simvastatin showed that this drug doesn't have a delaying effect on the peripheral nerve recovery time. Electrophysiological measurements showed that simvastatin did not influence nerve regeneration however it was found to induce severe vacuolization of myelin sheath of the sciatic nerve. It was apparent that the drug induces some form of structural dysfunction as myelin changes supported by electron microscopical studies., Conclusion: simvastatin was shown to delay regeneration as shown in microscopic studies but still there was no influence on nerve regeneration.

The case of a 32-year-old woman at 29 weeks gestational age with acromegaly initially diagnosed in pregnancy is presented. During follow-up at 34 weeks of gestation, concomitant emergency cesarean section and transsphenoidal surgery were performed because of advancing vision loss. In tertiary centers, success in pregnancy can be made possible for a patient with acromegaly under the constant supervision of an obstetrician and neurosurgeon.

The interactions of aluminium(III) ion with the triprotic catechol derivatives (H3L), 2,3-dihydroxybenzoic acid (2,3-DHBA), 3,4-dihydroxyphenylacetic acid (3,4-DHPA), 3,4-dihydroxybenzoic acid (3,4-DHBA), and 3,4-dihydroxyhydrocinnamic acid (3,4-DHHCA) were investigated in aqueous solution at 25.0 degrees C. The Calvin-Bjerrum titration method was adopted for the determination of formation constants of proton-ligand and aluminium(III)-ligand complexes. Potentiometric and spectroscopic results indicated that these catechol derivatives exhibit a true bidentate character. The chelation occurs via their catecholate sites, with the exception of 2,3-DHBA. In the case of 2,3-DHBA complexes, the dominant species are either the salicylate type (COO-, O-) or catecholate type (O-, O-) complex. The protonation constants of ligands and their formation constants of Al(III) complexes were also correlated. The order of decreasing stabilities of complexes is: 3,4-DHPA>3,4-DHBA>3,4-DHHCA>2,3-DHBA.

Stavudine, a potent antiviral agent for treating human immunodeficiency virus (HIV) infections, was radiolabeled with (11)C by methylation of a specifically designed precursor, 5'-O-(2-tetrahydropyranyl)-5-bromo-2',3'-didehydro-3'-deoxythymidine, with (11)C H(3)I. The radiolabeled drug was isolated by reverse phase HPLC. A total time of approximately 45 minutes was required for synthesis, purification and isolation of (11)C stavudine with chemical and radiochemical purities of greater than 98%. (11)C stavudine was combined with unlabeled drug (2.0 mg/kg) and used to study its pharmacokinetics in rats by measurement of radioactivity in excised tissues. In this species, there was rapid accumulation of drug in all tissue. In all tissues, with the exceptions of testis and brain, highest concentrations of drug were detected at 5 minutes after injection and decreased monotonically thereafter. The peak concentration (microg/g) of stavudine in blood was 1.78 +/- 0.16 and similar levels were achieved in most other tissues; heart 1.66 +/- 0.11, lung 1.60 +/- 0.15, liver 2.13 +/- 0.17, spleen 1.61 +/- 0.15, adrenal 1.47 +/- 0.20, stomach 1.40 +/- 0.11, GI tract 1.44 +/- 0.14, skeletal muscle 1.38 +/- 0.15 and bone 1.30 +/- 0.16. Much higher peak concentrations were achieved in kidney; 7.23 +/- 0.57 microg/g. Concentrations in testis were lower and remained relatively constant over 1 hour; peak 0.62 +/- 0.14 microg/g at 15 min Brain concentrations were low but increased monotonically over time; peak 0.26 +/- 0.02 microg/g at 60 min. Future PET studies with this radiopharmaceutical will allow in vivo measurements of the pharmacokinetics of stavudine in both animal models and human subjects.

Intramedullary epidermoid cysts of the spinal cord are rare lesions. The authors report a case of giant intramedullary epidermoid cyst at the cervicothoracic region. A 6-year-old boy presented with motor and sensory loss related to a spinal intramedullary epidermoid cyst. Almost all cyst content was liquid and it was surgically removed totally in two successive operations. To the author's knowledge, this is the largest intramedullary epidermoid cyst published in the literature and no other case of intramedullary epidermoid cyst with a complete liquid content has been reported before. The authors discuss the clinical features, MR imaging characteristics and surgical findings of this rare tumor and review the associated literature.

The circadian rhythm of stroke and myocardial infarction (MI) may be related to the circadian rhythm of melatonin, and erythrocyte deformability may be the key mechanism in this relationship. Therefore, this study has been performed to determine if there is a relationship between the pineal gland and melatonin and red cell deformability. Twenty-eight rats underwent pinealectomy, pinealectomy plus melatonin administration (200 mg/kg), or no treatment (n=7 in each group). Erythrocyte deformability was determined using the filtration technique. The results are reported in mean (+/-SD) seconds: control: 1.45+/-0.44; pinealectomy (A): 1.55+/-0.16; pinealectomy (B): 1.34+/-0.26 and pinealectomy and melatonin: 2.56+/-0.69. Pinealectomy by itself did not cause any statistically significant change in erythrocyte deformability but the addition of melatonin significantly decreased it. These results suggest a relationship between melatonin and erythrocyte deformability. Further investigations may uncover the causes of the circadian rhythm of stroke and MI, which may help improve chronobiological therapies.

Acute bacterial parotitis subsequent to major abdominal surgery is well documented, reportedly occurring in as many as 0.1% of patients. Postoperative parotitis has been reported between 1 to 15 weeks after surgery, commonly appearing within 2 weeks of the procedure. However, postoperative parotitis has not been reported previously after neurosurgical procedures. The authors report five cases of postoperative parotitis after neurosurgical operations in the sitting position with mild flexion and rotation of the head. This group of patients accounted for 0.16% of all craniotomy and 1.9% of all sitting position neurosurgical procedures performed in the authors' institution from 1996 through 2001. Neck flexion and head tilt in the sitting position might have an influence on acute parotitis. The authors found that the side of the parotitis was on the opposite side of the head rotation. Dehydration therapy may also be a contributing factor. The objective of this paper is to state that parotitis is a possible complication in neurosurgical patients operated on in sitting position and to discuss its pathophysiology and treatment options.

The use of neuronal nuclear antigen (NeuN) as a reliable neuronal marker in the differential diagnosis of clear cell neoplasms of the central nervous system was determined in a biopsy series of 23 cases. Immunohistochemical analyses were carried out by antisera against neuronal nuclear antigen, synaptophysin, neuron-specific enolase, microtubule-associated protein 2, and glial fibrillary acidic protein. All eight central neurocytomas were characteristically immunolabeled by NeuN. NeuN immunoreactivity was uniformly strong and basically located in the nuclei of neurocytes. Despite this uniform staining pattern of central neurocytomas, 12 cases of oligodendrogliomas and three cases of ependymoma were negative for NeuN. As the diagnostic criteria for central neurocytoma include immunohistochemical and/or ultrastructural evidence for neuronal differentiation, NeuN as a sensitive and specific neuronal marker in formalin-fixed, paraffin-embedded tissues may greatly facilitate the differential diagnosis of central neurocytomas.

Neurocutaneous melanosis is a rare dysmorphogenesis associated with single or multiple giant pigmented cutaneous nevi and diffuse involvement of the leptomeninges anywhere in the central nervous system (CNS). It is interesting that almost 8-10% of patients had associated Dandy-Walker malformation in the literature, suggesting a common origin of the developmental abnormalities. In this article, we present a 2-year-old patient with neurocutaneous melanosis associated with Dandy-Walker malformation. We reviewed the literature and discuss the pathogenesis based on the preferred hypotheses so far., (Copyright 2001 S. Karger AG, Basel.)

A case of hydatid disease of the intra and parasacral area is reported. This rare localization was probably due to previous abdominal hydatid cyst surgery. The patient underwent surgery, with a small opening in the SI lamina and the cysts were removed totally with the aid of a rigid endoscope. The surgical technique used and MRI findings are discussed.

The spinal form of brucellosis is still a disabling disease in many countries outside North America and northern and central Europe. Fifteen consecutive cases of spinal brucellosis diagnosed and treated over a 20-year period were reviewed retrospectively. Six patients were farmers, while 10 patients had a history of ingestion of unpasteurized milk or other dairy products. A high index of suspicion is necessary for the diagnosis, since there are no pathognomonic signs or symptoms. Radiological assessment of the disease was reviewed and highlights in the differential diagnoses were stressed. The diagnosis was based on actual culture of Brucella bacilli in seven patients. The principal treatment of brucellosis of the spine is conservative, namely, immobilization and antimicrobial therapy. We have found both a combination of ofloxacin and rifampin and ofloxacin monotherapy efficient as the early regimens used in this series. Three patients had to undergo surgery, since a diagnosis could not be made in any other way.

Cranial chondrosarcomas are rare. The majority of cases arise from the base of the skull and are most common in adult life. In this report, an infant with a chondrosarcoma of the temporal bone is discussed. We are not aware of a previously reported case of chondrosarcoma of the temporal bone in this age group.

In this paper, we present 14 cases with depression fracture of the occipital bone in pediatric age. There were 7 males and 7 females. Their ages ranged from 1 year to 15 years with a median of 5.8 years. The most common causes were: falling (8 cases); traffic accidents (2); assault (2 cases). Five of our 14 cases had compound fractures and the remaining 9 had closed fractures. Epidural and subdural hematomas were observed in 5 and 1 cases, respectively. There was significant improvement in 11 cases; two patients died.

Testicular tumors in the pediatric age group are rare. Yolk sac tumor (YST) is the most common malignant tumor of germinal origin in this group, and it may spread to the retroperitoneal lymph nodes. We have been unable to find any previously published report of metastasis of testicular YST to the epidural space of the spinal cord presenting as a cause of spinal cord compression.