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In this study we aimed to examine the effects on wound healing and nerve regeneration of human and rat amniotic membrane wraps around primary epineural anastomosis areas after a peripheral nerve transection injury in rats. We randomized 25 male adult rats with induced peripheral transection injuries into 5 groups (control, transection injury, primary epineural anastomosis [PEA] after injury, PEA with a human amniotic membrane [hAM] wrap, and PEA with a rat amniotic membrane [rAM] wrap groups and treated their injuries accordingly. We took tissue samples from the anastomosis regions, 12 weeks after the experiment, and analyzed them stereologically and ultrastructurally. We performed a statistical analysis with the recovered stereological counts and the measurement data. Our results showed that the use of amniotic membranes for allografts (between same species) instead of xenografts (between different species), along with microsurgery, provides a suitable microenvironment during the healing process with less immunological reaction on the injured site and supports axonal regeneration.

Purpose: The aim of the present study was to investigate the effect of etanercept (ETA) on histopathological and biochemical changes after traumatic brain injury (TBI) in rats. Materials and Methods: Thirty-six male Wistar albino rats were distributed into three groups (n = 12 each). Control group rats were not subjected to trauma. Trauma group rats were subjected to TBI only. ETA group rats were subjected to TBI plus ETA (5 mg/kg intraperitoneal [i.p.]). The groups were further subdivided into those sacrificed in the hyperacute stage (1 h after TBI) (control-1, trauma-1, and ETA-1 groups) and the acute stage (6 h after TBI) (control-6, trauma-6, and ETA-6 groups). Tissue levels of tumour necrosis factor-alpha, interleukin-1 beta, malondialdehyde, catalase, glutathione peroxidase, and superoxide dismutase were analyzed. Histopathological and ultrastructural evaluations were also performed. Results: i.p. administration of ETA at 1 and 6 h significantly reduced inflammatory cytokine expression, attenuated oxidative stress and lipid peroxidation, prevented apoptosis, and increased antioxidant defense mechanism activity in comparison to trauma group. Histopathological and ultrastructural abnormalities were significantly reduced in ETA-treated rats compared to closed head injury trauma groups. Conclusions: ETA significantly improves neural function and prevents post-TBI histopathological damage in rats.

Background: The aim of our study is to assess the neuroprotective effects of the tumor necrosis factor alpha (TNF-α) inhibitor etanercept (ETA) on histopathological and biochemical changes following spinal cord injury (SCI). Patients and Methods: Fifty-four male Wistar albino rats were randomly assigned into three main groups: The sham, trauma, and ETA group (n = 18 per group). Each of these groups was further divided into three subgroups (n = 6 per subgroup) based on the different tissue sampling times postinjury: 1 h, 6 h, and 24 h. Clip compression model was used for SCI. Rats in the ETA group were treated with 5 mg/kg of ETA immediately after the clip was removed. After 1, 6, and 24 h, the spinal cord was totally removed between the levels T8–T10. Sample tissue was immediately harvested and fixed for histopathological and electron microscopic examination and were analyzed for TNF-α, interleukin-1β (IL-1β), superoxide dismutase (SOD), adenosine deaminase, catalase (CAT), and malondialdehyde levels in both the tissue and serum. Results: The serum and tissue levels of cytokines and enzymes were seen to change after SCI between hyperacute, acute, and subacute stages. Treatment with ETA selectively inhibited TNF-α, and IL-1β expression together with increased levels of antioxidative enzymes (SOD, CAT). Conclusion: Early administration of ETA after SCI may remarkably attenuate neuronal injury by decreasing tissue and serum TNF-α and IL-1β levels, while increasing antioxidative enzymes such as SOD and CAT in subacute and acute stages, respectively.

Ependymomas are the most common gliomas of the conus and lower cord, with the cervical cord being the second most common location. These tumors can extend upward 3-4 vertebra, and some ependymomas can extend up over 15 segments. Depending on many factors, such as tumor size, lateralization, kyphotic deformity, and lordosis state, there are several posterior surgical options, including laminectomy, laminectomy and lateral mass screw-plate, and laminoplasty. In this study, we discuss a case of intradural intramedullary cervicothoracic ependymoma with long-segmental localization, as well as the general surgical principles of its excision with step-by-step demonstrative figures.

Calvarial and dural metastases of papillary thyroid carcinomas (PTC) are rarely reported in the medical literature. Most frequent calvarial metastases are seen to originate from lung, breast, and prostate cancers. Thyroid cancer metastases are generally well vascularized and cause destruction in the bone tissues. First choice of treatment in distant metastases of PTC is surgery and radioactive iodine treatment for the primary cause. Postsurgical radiotherapy is used in accepted and suitable patients.

In this retrospective study, surgical results of four patients with sacral tumors having disparate pathologic diagnoses, who were treated with partial or total sacrectomy and lumbopelvic stabilization were abstracted. Two patients were treated with partial sacral resection and two patients were treated with total sacrectomy and spinopelvic fixation. Fixation methods included spinopelvic fixation with rods and screws in two cases, reconstruction plate in one case, and fresh frozen allografts in two cases. Fibular allografts used for reconstruction accelerated bony union and enhanced the stability in two cases. Addition of polymethyl methacrylate in the cavity in the case of a giant cell tumor had a positive stabilizing effect on fixation. As a result, we can conclude that mechanical instability after sacral resection can be stabilized securely with lumbopelvic fixation and polymethyl methacrylate application or addition of fresh frozen allografts between the rods can augment the stability of the reconstruction.

Background Vitamin B12 and alpha lipoic acid (ALA) are known to promote functional and morphological recovery after peripheral nerve injury. Objective To compare the regenerative and neuroprotective effects of vitamin B12 and ALA treatment after sciatic nerve injury. Methods A total of 40 rats were randomly assigned to control (sciatic nerve exposure without injury or anastomosis), sham (sciatic nerve injury and epineural anastomosis were performed but no treatment was administered), PS (isotonic saline was administered for 12 weeks after surgery), ALA (2 mg/kg ALA was administered for 12 weeks after surgery), and vitamin B12 groups (2 mg/kg cyanocobalamin was administered for 12 weeks after surgery). Functional recovery was determined by footprint analysis, in vivo neurophysiology, and ex vivo histopathological examination. Results ALA treatment produced significant improvements in sciatic functional index values and non-significant improvements on electroneuromyography compared to vitamin B12 treatment. Upon histopathological examination, the regenerative effects of ALA were relevant to axonal structural recovery whereas vitamin B12 produced greater improvements in edema and myelination. Conclusions While both vitamin B12 and ALA produced improvements after sciatic nerve injury, ALA was more functionally effective. The unique ultrastructural effects of vitamin B12 and ALA treatment should be considered in future studies.

Giant cell bone tumors are the most common precursor lesions of aneurysmal bone cysts (ABCs) developing secondarily. In giant cell bone tumors containing an explicit ABC component, the observation of the solid component of the giant cell bone tumor plays a critical role in the separation of the primary ABC. In general, ABC cases together with giant cell tumors in the bone are diagnosed histopathologically. The combination of giant cell bone tumor with superposed ABC and that of painful scoliosis with backache is rarely seen in children. In this case study, we discussed the diagnosis and the treatment of a giant cell tumor and superposed an ABC present in the fifth lumbar spine in a pediatric patient admitted to our clinic with a complaint of acute scoliotic back pain. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

BACKGROUND AND OBJECTIVE: In this article, we describe a patient unusual presenting with both arachnoiditis ossificans and syringomyelia. We have reviewed the patient’s evaluation, surgery, and treatment. CASE DESCRIPTION: This patient developed paraparesis following thoracolumbar spinal surgery to treat kyphosis secondary to ankylosing spondylitis. RESULTS: We performed a T9-T11 total laminectomy, drained the cyst, dissected and removed the calcified plaques posterior to the cord, and decompressed the neural structures. CONCLUSION: Symptomatic arachnoiditis ossificans (AO) a rare clinical manifestation is characterized by the calcification or ossification of the spinal arachnoid. The occurrence of AO with syringomyelia is rare. To date, a few cases with both AO and ankylosing spondylitis have been reported.

Glioblastoma multiforme (GBM) is a highly malignant primary brain tumor and is the most common primary malignancy of the central nervous system (CNS). It is also locally aggressive, invasive, and resistant to therapy. Extracranial seeding of GBM is very rare, but cerebrospinal fluid (CSF) seeding is observed in approximately 15–25 % of supratentorial GBM cases [1–3]. Spinal seeding of GBM metastasis is frequently observed in autopsy series, whilst symptomatic spinal metastases from primary GBM are rarely reported [3–5]. Here, we report the clinical features, radiographic findings, and management of a unique supratentorial GBM case presented with paraplegia secondary to massive spinal metastases.

AIM: To analyze the therapeutic effects of long-term alpha lipoic acid (A-LA) and vitamin B12 use via histomorphometric methods and electron microscopy in the transected sciatic nerves of rats. MATERIAL and METHODS: Forty rats were randomized into five groups (n=8/group). In group I, 1 cm segment of sciatic nerve was resected without any other intervention. In group II (sham), following right sciatic nerve transection, primary epineurial anastomosis was performed by placing the edges of the nerve end-to-end. In group III (saline), after right sciatic nerve transection, the ends of the nerves were brought together and closed after application of intraperitoneal physiologic saline. In group IV, 2 mg/kg of alpha lipoic acid and in group V, 2 mg/kg of vitamin B12 was administered intraperitoneally before surgical intervention. RESULTS: Histomorphometric and electron microscopic analyses revealed that vitamin 312 did not prevent structural changes, abnormal myelination and g-ratio deviations regarding the functional aspects of the sciatic nerve. Alpha lipoic acid was more effective in restructuring the histomorphometric and structural aspects of the nerve with more myelinated fibers with optimal values (0.55-0.68) than vitamin B12 groups, in which the number of myelinated nerve fibers significantly decreased at optimal intervals (0.55-0.68). CONCLUSION: A-LA administration following peripheral nerve transection injury is more effective in promoting nerve healing regarding the structural aspects of the sciatic nerve compared to vitamin B12 and also myelination of nerve fibers by increasing g-values.

The agent, 2-mercaptoethane sulfonate (MESNA), is a synthetic small molecule, widely used as a systemic protective agent against chemotherapy toxicity, but is primarily used to reduce hemorrhagic cystitis induced by cyclophosphamide. Because MESNA has potential antioxidant and cytoprotective effects, so we hypothesized that MESNA may protect the brain against traumatic injury. Thirty-two rats were randomized into four groups of eight animals each; Group 1 (sham), Group 2 (trauma), Group 3 (150 mg/kg MESNA), Group 4 (30 mg/kg methylprednisolone). Only skin incision was performed in the sham group. In all the other groups, the traumatic brain injury model was created by an object weighing 450 g falling freely from a height of 70 cm through a copper tube on to the metal disc over the skull. The drugs were administered immediately after the injury. The animals were killed 24 h later. Brain tissues were extracted for analysis, where levels of tissue malondialdehyde, caspase-3, glutathione peroxidase, superoxide dismutase, nitric oxide, nitric oxide synthetase and xanthine oxidase were analyzed. Also, histopathological evaluation of the tissues was performed. After head trauma, tissue malondialdehyde levels increased; these levels were significantly decreased by MESNA administration. Caspase-3 levels were increased after trauma, but no effect of MESNA was determined in caspase-3 activity. Following trauma, both glutathione peroxidase and superoxide dismutase levels were decreased; MESNA increased the activity of both these antioxidant enzymes. Also, after trauma, nitric oxide, nitric oxide synthetase and xanthine oxidase levels were increased; administration of MESNA significantly decreased the levels of nitric oxide, nitric oxide synthetase and xanthine oxidase, promising an antioxidant activity. Histopathological analysis showed that MESNA protected the brain tissues well from injury. Although further studies considering different dose regimens and time intervals are required, MESNA was shown to be at least as effective as methylprednisolone in the traumatic brain injury model.

The aim of this study was to investigate the neuroprotective effects of propofol, thiopental, etomidate, and midazolam as anesthetic drugs in fetal rat brain in the ischemia-reperfusion (IR) model.Pregnant rats of day 19 were randomly allocated into eight groups. Fetal brain ischemia was induced by clamping the utero-ovarian artery bilaterally for 30 min and reperfusion was achieved by removing the clamps for 60 min. In the control group, fetal rat brains were obtained immediately after laparotomy. In the sham group, fetal rat brains were obtained 90 min after laparotomy. In the IR group, IR procedure was performed. No treatment was given in the IR group. One milliliter intralipid solution, 40 mg/kg propofol, 3 mg/kg thiopental, 0.1 mg/kg etomidate, and 3 mg/kg midazolam was administered intraperitoneally in the vehicle group, propofol group, thiopental group, etomidate group, and midazolam group, respectively, 20 min before IR procedure. At the end of the reperfusion period, the whole brains of the fetal rats were removed for evaluation of thiobarbituric acid reactive substances and for examination by electron microscopy.According to lipid peroxidation data, all the anesthetic drugs provide neuroprotection; however, ultrastructural findings and mitochondrial scoring confirms that only propofol and midazolam provides a strong neuroprotective effect.Propofol and midazolam may be used to protect fetal brain in case of acute fetal distress and hypoxic injury as a first choice anesthetic drug in cesarean delivery.

BackgroundLumbosacral plexopathies are rare and may develop as a result of various pathologies. The most common causes of lumbosacral plexopathy include infiltrative infections such as herpes zoster, parturition, tumors, postoperative complications of abdominopelvic surgery, and ischemic vascular injury resulting from intramuscular injections. Treatment is based on the etiology and the severity of the pain.FindingsWe describe herein the evaluation and treatment of a 37-year-old female patient who was admitted with complaints of pain in her left hip and sciatic nerve traces.ConclusionsPain resulting from lumbosacral plexopathy is a difficult diagnosis. Keys to the diagnosis include a clinical picture disproportional to lumbar–sacral magnetic resonance image findings. Treatment is determined by the etiology.

Chordoma is a locally aggressive but a slow-growing and rare malignant tumor. It arises from ectopic rests of notochordal tissue and it is most commonly seen in the sacral region (50% to 60%), skull base (35%), and spinal column (15%). At imaging, a chordoma typically manifests as a large destructiv

Gout is a common metabolic disease characterized by the development of arthritis and nephropathy related to the deposition of monosodium urate crystals within the joints, periarticular tissues, skin and kidneys. Tophus formation seen around the spinal column is very rare, while occurrences of spinal gout tophus without systemic gout disease are much more unique. In our study, we report a spinal gout case that presented with right sciatica without previous history of systemic gout disease.

Although numerous factors have been described that predict outcome after spontaneous intracerebral hemorrhage (ICH), very little is know about the role of hemorrhagic dilation of the third ventricle in development of hydrocephalus and prognosis. The objective of this study was to investigate whether the presence of hemorrhagic third ventricle dilation after ICH would predict development of hydrocephalus and outcome.We identified the patients with spontaneous ICH treated with external ventricular drainage (EVD) in this retrospective study. Computerized tomography (CT) was performed at admission within 24 hours of onset and retrospectively analysed to determine lesion size and location, status of third and fourth ventricle and frontal horn index (FHI). Glasgow coma scale (GCS) score, mean arterial pressure (MAP), etiology and demographic data were obtained from medical records. Outcome was determined using modified Rankin score at month 3. Patients with and without third ventricle dilation were compared in terms of hydrocephalus (FHI0.38), initial GCS score, age and MAP, and analyses were performed to determine whether third ventricle dilation was a predictor of poor outcome.Of the 22 patients studied, all had thalamic or basal ganglia hemorrhage with intraventricular hemorrhage (IVH) and all are treated with external ventricular drainage (EVD). Of the 22 patients, 12 had third ventricle dilation (widthor = 10 mm) and ten patients had non-dilated third ventricle (width10 mm). Patients with third ventricle dilation had lower GCS scores (7.4 +/- 1.8 versus 9.7 +/- 2.1, p0.005) and had higher FHI (0.46 +/- 0.06 versus 0.38 +/- 0.02, p0.005) as compared to patients with non-dilated third ventricle. The differences in age (59.5 +/- 9.4 versus 59.2 +/- 11.2) and MAP (128.3 +/- 16.0 versus 130.5 +/- 13.6) of the patients were not significant statistically. Sixty-six percent of patients (8/12) with third ventricle dilation and 60% of patients (6/10) with normal third ventricle were dead 6 months post-operation and mortality rate did not differ significantly.Although the roles of various factors are well described in the prognosis of spontaneous ICH, little is known about the role of third ventricle dilation. Based on our results, we concluded that third ventricle dilation is a poor prognostic factor.

PubMed ID: 26842882, Purpose: To review relevant data for the management of esophageal perforation after anterior cervical surgery. Methods: A case of delayed esophageal perforation after anterior cervical surgery has been presented and the relevant literature between 1958 and 2014 was reviewed. A total of 57 papers regarding esophageal perforation following anterior cervical surgery were found and utilized in this review. Results: The treatment options for esophageal perforation after anterior cervical surgery were discussed and a novel management algorithm was proposed. Conclusion: Following anterior cervical surgery, patients should be closely followed up in the postoperative period for risk of esophageal perforation. Development of symptoms like dysphagia, pneumonia, fever, odynophagia, hoarseness, weight loss, and breathing difficulty in patients with a history of previous anterior cervical surgery should alert us for a possible esophageal injury. Review of the literature revealed that conservative treatment is advocated for early and small esophageal perforations. Surgical treatment may be considered for large esophageal defects. © 2016, Springer-Verlag Berlin Heidelberg.

Post-traumatic inflammatory reactions may play an important role in the secondary injury processes that occur after spinal cord injury (SCI).1,2 New treatment strategies like Anakinra aim to block or attenuate the critical mediators of inflammation in ischemia and reperfusion damage after spinal cord injuries. Primary traumatic mechanical injury to the spinal cord may cause neuronal death with irreversible recovery or regeneration. Neurons continue to die for several hours after SCI; however, this neuronal death could potentially be prevented. A large number of biochemical, and molecular cellular interactions result in secondary neuronal death. One of these interactions is the local inflammatory response in the injured spinal cord. It is thought that microglial cells might be the source of cytotoxic cytokines such as tumor necrosis factor alpha (TNF-α) and interleukin-1 beta (IL-1β), which kill oligodendrocytes. Within one hour after SCI, increased synthesis, and/or secretion of IL-1β, is detectable at the injury site. Interleukin-1β is a member of the IL-1 cytokine family. The gene encoding this cytokine, and 8 other IL-1 family genes, form a cytokine gene cluster on chromosome 2.3 The mentioned cytokine is produced due to the activation of macrophages as a proprotein; the active form is produced secondary to the proteolytic action of caspase 1. The IL-1β is an important mediator of the inflammatory response, and is involved in a variety of cellular activities including cell proliferation, differentiation, and apoptosis.3 Anakinra is shown as an IL-1 receptor antagonist blocking the inflammation and cartilage degradation effects of naturally occurring IL-1 in rheumatoid arthritis, by competitively inhibiting the binding of IL-1 to the IL-1 type receptor.4 The IL-1 is produced in response to inflammatory stimuli and mediates various physiological responses including inflammatory and immunological reactions. In patients with rheumatoid arthritis, the natural IL-1 receptor antagonist is not found in sufficient concentrations in the synovium and synovial fluid to counteract the elevated IL-1 concentrations. Anakinra is considered a “biological response modifier” rather than a “disease-modifying antirheumatic drug” because it is able to selectively target the pathological elements of the disease.5 For this study, we determined the following endpoints of the inflammatory response: 1) histological damage, 2) cytokine expression (IL-1β), and 3) measurement of lipid peroxidation and oxidative stress (glutathione peroxidase [GPx], malondialdehyde [MDA], and superoxide dismutase [SOD]).6 The aim of the present study was to evaluate whether Anakinra administration could protect the spinal cord from lipid peroxidation and oxidative stress after SCI in rats.

A case of a dermoid cyst with intracranial extension in a 48-year-old female is reported. Intracranial extension of a dermoid cyst is very rare. During its slow growth, it extends to the cranium from different regions by invading neighboring bones. Treatment is surgery, and there is no indication for radiotherapy or chemotherapy.

Arteriovenous malformation (AVM) of the scalp is an uncommon entity. Its management is difficult because of its high shunt flow, complex vascular anatomy, and possible cosmetic complications. The etiology of scalp AVMs may be spontaneous or traumatic. Clinical symptoms frequently include pulsatile mass, headache, local pain, tinnitus; and less frequently, hemorrhage and necrosis. Selective angiography is the most significant diagnosis method. Surgical excision is especially effective in AVMs and the most frequently used treatment method. In this article, we discussed the clinical features and surgical management of scalp AVMs.

Severe complications that develop in the early stages in patients with acute leukemia have a mortal course. Bleeding, leukostasis, and less frequently, infections are responsible for early mortality. Hemorrhage is most common in acute leukemia and usually leads to death. Hemorrhage may occur due to chemotherapy or bone marrow transplantation in patients with acute leukemia. Leukocytosis, thrombocytopenia, sepsis, and coagulopathy increase the risk of bleeding. There may be multiple etiologic factors. Subdural or subarachnoid hemorrhage is less common than an intra-axial hemorrhage. The incidence of spontaneous subdural hematoma is higher in patients with leukemia. Although advances in the treatment of platelet transfusion and disseminated intravascular coagulation have decreased the incidence of hemorrhagic complications in patients receiving chemotherapy for acute leukemia, intracranial hemorrhage-related deaths are a significant problem. We discussed the etiology and management of chronic subdural hematoma detected in a two-year-old male patient with Acute Myeloid Leukemia and hyperleukocytosis.

Lipomas are capsulated benign tumours that are commonly found in all body parts. A lipoma is a well-defined mesenchymal tumour that arises from the adipose tissue. Although giant lipomas are rare in the head and neck regions, when they are located here, they are most commonly found in the subcutaneous posterior neck area. Recurrence as well as invasion is very rare after total surgical excision. In this article, we present two rare cases of giant lipomas in the posterior occipitocervical region, which is an exceptional location.

AIM The aim of this study was to assess the surgical outcome and the prognostic importance of clinical and radiological data of patients operated emergently for an extraaxial hematoma causing brain herniation. MATERIAL AND METHODS This retrospective study comprised 108 adult patients who were operated due to herniated traumatic extraaxial hematomas from January 2000 to January 2013. RESULTS Of 108 patients, 63 patients (58.3%) were diagnosed as subdural hematoma (SDH), and 45 patients (41.7%) as epidural hematoma (EDH). An unfavorable outcome was significantly increased for patients who were diagnosed as SDH (90.4%) compared with EDH patients (33.3%). Mortality rate for herniated SDH patients was 65.1%, and 26.6% for herniated EDH patients. High mortality and unfavorable outcome ratios were associated with Glasgow Coma Scale scores at admission, mean postoperative intracranial pressure (ICP) values, type of the brain herniation, interval from the time of trauma to the time of hematoma decompression, the duration of the brain herniation, intraoperative acute brain swelling, hematoma volume and thickness, degree of the midline shift and the obliteration of the basal cisterns. CONCLUSION Our data showed that, postoperative ICP values were one most important predictor of the mortality. We recommended postoperative ICP monitoring for all patients presenting with the brain herniation due to traumatic extraaxial hematoma.

Objectives This study aims to evaluate the clinicopathologic characteristics and treatment modalities of 73 patients with benign and malign sacral tumors and infections from a single institution. Patients and methods Seventy-three patients (42 males, 31 females; mean age 48.9 years), who were treated between July 1991 and December 2013, with benign, malign tumors, and infections of the sacrum were retrospectively analyzed for a mean follow-up period of 25.4 months, and a review of the literature was conducted. While 36 patients were treated surgically, 37 were treated medically. Fifty-four patients were diagnosed with malign, and 19 with benign or infectious tumors. Results In 54 patients with malign tumors, metastasis was the most common diagnosis in 20 patients followed by chordoma in 11, and multiple myeloma in 10 patients. Common benign lesions were osteomyelitis in four patients, and giant cell tumor and schwannoma in three patients each. Local recurrence was most commonly observed in the chordoma and chondrosarcoma groups with a rate of 50%. Seven patients including five with metastatic disease, one with chondrosarcoma, and one with chordoma died during follow-ups. While urinary and anal incontinence developed in seven patients after sacral resection, deep infection was reported in four, and superficial infection was reported in two patients. Conclusion Because of the high complication rates in malign sacral tumors, we should perform wide resections with partial or total sacrectomy. Chordoma and chondrosarcoma patients should be screened closely due to a possible recurrence risk after sacrectomy while preserving the nerve roots as possible. Aggressive curettage should be combined with adjuvant methods in benign lesions due to high recurrence rates in sacral localization.

Fibrous lesions of the head and the maxillofacial region are generally slow-developing benign tumors that may aggressively take course in clinical terms. These locally destructive lesions show a high recurrence rates unless they are removed gross totally. Sarcomatoid degeneration is also reported to develop in recurring lesions. Difficulties in the diagnosis, classification, and treatment make this entity complex for several years. These tumors are frequently seen among children and young adults. The maxilla and the mandibula are the 2 most common sites that the tumor originates. In our article, we discuss a 59-year-old man whose condition was diagnosed as an ossified fibroma revealing craniofacial extension. Accompanied by literature findings, it has been underlined that, as well as with the pathologic criteria, clinical features and radiologic images should be evaluated together for a specific diagnosis in fibrous lesions.

AIM Bacitracin is one of the most frequently used agents for the topical irrigation of the cerebral cortex. The aim of this study is to investigate whether bacitracin has histopathological and ultrastructural effects when applied topically to the cerebral cortex. MATERIAL AND METHODS Twenty-eight rats were randomly assigned to four groups. Except the control group, each rat underwent left frontoparietal craniectomy with dural removal. Then, in the sham group a piece of dry absorbable gelatin sponge was placed over the left hemisphere; in the saline group a gelatin sponge soaked in normal saline; and in the bacitracin group a gelatin sponge soaked in 500 units bacitracin was used. After 48 hours, brain tissues were extracted for histopathological and electron microscopic analyses. RESULTS Among the four groups dark stained neurons were found to be statistically higher in number in the bacitracin group compared with the control, sham and saline groups. Electron microscopic evaluation revealed that, in the bacitracin group, almost all cytoplasmic organelles were poorly preserved. CONCLUSION Topical application of the bacitracin on to the cerebral cortex caused histopathological and ultrastructural changes in the neural tissue. These changes may be an evidence for the neurotoxic effects of bacitracin.

Epidermoid cysts are rare benign tumors that constitute 0.3% to 1.8% of all intracranial tumors. They are inclusion tumors that include epidermoid elements and are most commonly located in the cerebellopontine angle cistern and the parasellar region, and their location in the diploic space is very rare. These lesions slowly grow and usually do not involve the intracranial compartment. In this article, a case of giant epidermoid cyst located in the left frontal intradiploic space is presented with clinical, radiologic features and surgical treatment.

Posttraumatic spondyloptosis develops as a result of complete subluxation of the vertebral bodies and causes complete transection of the spinal cord. Severe trauma-related spondyloptosis of the upper-mid thoracic region is a rare form of spinal trauma. Traumatic midthoracic spondyloptosis is quite rare, and radiology plays an important role in the diagnosis and treatment of this condition. Surgical reconstruction and stabilization are required for early mobilization and rehabilitation of patients with this injury. Here, we report the clinical features, radiographic findings, and management of an unusual case of traumatic midthoracic spondyloptosis that showed complete spinal cord transection and was operated.

Introduction In this study, we tried to determine whether darbepoetin-α would protect the brain from oxidative stress and apoptosis in a rat traumatic brain injury model. Material and methods The animals were randomized into four groups; group 1 (sham), group 2 (trauma), group 3 (darbepoetin α), group 4 (methylprednisolone). In the sham group only the skin incision was performed. In all the other groups, a moderate traumatic brain injury modelwas applied. Results Following trauma both glutathione peroxidase, superoxide dismutase levels decreased (p < 0.001 for both); darbepoetin-α increased the activity of both antioxidant enzymes (p = 0.001 and p < 0.001 respectively). Trauma caused significant elevation in the nitric oxide synthetase and xanthine oxidase levels (p < 0.001 for both). Administration of darbepoetin-α significantly decreased the levels of nitric oxide synthetase and xanthine oxidase (p < 0.001 for both). Also, trauma caused significant elevation in the nitric oxide levels (p < 0.001); darbepoetin-α administration caused statistically significant reduction in the nitric oxide levels (p < 0.001). On the other hand, malondialdehyde levels were increased following trauma (p < 0.001), and darbepoetin α significantly reduced the malondialdehyde levels (p < 0.001). Due to the elevated apoptotic activity following the injury, caspase-3 activity increased significantly. Darbepoetin-α treatment significantly inhibited apoptosis by lowering the caspase-3 activity (p < 0.001). In the darbepoetin group, histopathological score was lower than the trauma group (p = 0.016). Conclusions In this study, darbepoetin-α was shown to be at least as effective as methylprednisolone in protecting brain from oxidative stress, lipid peroxidation and apoptosis.

Eosinophilic granuloma is a type of histiocytosis X that is a benign bone tumor. Multifocal extradural and intradural involvement in adults is extremely uncommon because 90% of cases occur in boys younger than 10 years. The etiology of this disease is unknown, but it occurs with the accumulation of eosinophils and histiocytes in the medullary layers of the bone. The beginning of the inflammatory process in the dural membrane after migration of Langerhans cells may result in intradural involvement and sinus invasion into the nearby tissue. For multiple bone lesions, the use of chemotherapy, radiotherapy, and systematic cortisone is effective. In this study, we discuss the case of a 44-year-old man with sinus compression and multiple painful cranial swellings who was admitted to our clinic.

Solitary plasmacytoma comprises 2%-10% of all plasma cell diseases. Cranial localization of plasmacytoma is quite rare. They may emerge after years without systemic involvement and symptoms. They may be confused with other tumors as they are not remembered primarily in radiological diagnosis. The definite diagnosis is made upon histopathological examination. Surgical resection followed by radiotherapy is the first choice of therapy. Chemotherapy may be administered for secretory tumors. In this paper, we discussed a patient who underwent surgery with the prediagnosis of meningioma and histopathologically diagnosed with plasmacytoma.

AIM The aim of this study was to investigate the neuroprotective effect of magnesium sulfate and dexamethasone on oxidative damage in intrauterine ischemia. MATERIAL AND METHODS In this study, 19-day pregnant rats were divided into five groups. Fetal brain ischemia was achieved in the ischemia/ reperfusion (I/R) group by bilaterally closing the utero-ovarian artery with aneurysm clips for 30 min and subsequently removing the aneurysm clips for 60 min for reperfusion. Mg (600 mg/kg) and dexamethasone (0.25 mg/kg) were administered 20 min before the I/R insult. The lipid peroxidation in the brain tissue was determined by the concentration of thiobarbituric acid reactive substances (TBARS). The mitochondrial score was calculated after an evaluation with electron microscopy. RESULTS Both the electron microscope and TBARS data showed a significant difference between the control and I/R groups. The Mg and dexamethasone treatment groups exhibited significantly lower TBARS values compared to the IR group. Similarly, the mitochondrial scores in the Mg and dexamethasone treatment groups were significantly lower than those in the I/R group. CONCLUSION Result showed that magnesium sulfate and dexamethasone prevent lipid peroxidation and reduce mitochondrial injury thus suggests neuroprotective effects in fetal rat brain in intrauterine ischemia-reperfusion (I/R) injury.

Objective We present the extremely rare case of sacral osteomyelitis due to an anterior sacral meningocele (ASM) with fistula to the skin. We also discuss the case's clinical significance and the importance of imaging in diagnosis. Methods A 28-year-old female patient was referred to our clinic due to back and hip pain, erythema, and purulent discharge from the right gluteal region. Neurological examination was normal except for pain in the gluteal region. Physical examination revealed a porus lateral to the right gluteal region. Lumbar magnetic resonance imaging (MRI)showed osteomyelitis and a minimal occult sacral meningocele in the anterior sacral region. Contrast-enhanced radiographic imaging clearly showed the fistula tract. The patient underwent surgery via the posterior approach; debridement of the sacral osteomyelitis was performed and the fistula tract toward the skin was closed. Results She was pain free after surgery. There were no postoperative complications. Conclusion Although vertebral osteomyelitis due to ASMs is extremely rare, the risk of infection increases in cases of a fistula to the skin. When investigating the etiology of treatment-resistant infections, especially of the skin, sacral osteomyelitis and an underlying anomaly must be kept in mind.

Objectives: Surgical outcome of the patients undergoing decompression and minimal medial epicondylectomy were retrospectively evaluated. Methods: 16 patients who underwent decompression and minimal medial epicondylectomy for the treatment of cubital tunnel syndrome (CTS) were retrospectively evaluated. 11 female (68.75%) and 5 male (31.25%) patients suffering from unilateral CTS that is unresponsive to conservative treatment were included to the study. Average age was 39.18±14.36 years. Left side involvement occurred in 12 patients (75%), while right side involvement occurred in 4 patients (%25). McGowan classification of ulnar nerve injury was used for the surgical grading. Grade 1 in four patients (25%), grade 2 in 11 patients (68.75%), and grade 3 in 1 patient (6.25%). Cervical disc herniation, thoracic outlet syndrome and other entrapment neuropathies were ruled out preoperatively. Results of surgical treatment were evaluated according to Wilson–Krout criteria. Patients were followed during 18 – 64 months in average. Findings: Symptomatic relief was achieved in all of the patients. Postoperative controls in the 1st, 6th and 12th months revealed excellent results for 12 patients (75%), good results for 3 patients (18.75%), and a medium result for 1 patient (6.25%). No patient experienced ulnar nerve paralysis, medial elbow instability and impairment in the pronator – flexor muscle group in the postoperative period. Pain and sensitivity in the osteotomy site of 3 patients (75%) who underwent minimal medial epicondylectomy disappeared three months later. Results: Minimal medial epicondylectomy and decompression are reliable and effective methods for the treatment of cubital tunnel syndrome with less complication rates.

Localization of malignant schwannoma in the head and neck region is rare. Malignant schwannoma is a highly aggressive, slowly growing, encapsulated tumor of nerve sheath origin. The most common presentation of this tumor is a subcutaneous progressively enlarging mass with or without neurologic symptoms. These tumors arise from neurofibromas with or without von Recklinghausen disease, and most of the remains develop from peripheral nerve trunks. We report a case with recurrent malignant schwannoma of the scalp that is an uncommon presentation and discuss the clinicopathologic properties of this tumor.

Study Design: Retrospective case series. Purpose: The objectives of this study were to determine and discuss the surgical planning of patients who underwent operations following diagnoses of thoracal and lumbar spinal schwannomas. We also aimed to discuss the application of unilateral hemilaminectomy for the microsurgery of schwannomas. Overview of Literature: Schwannomas are located in different regions and sites. These differences require several surgical approaches. Unilateral laminectomy without stabilization of the spine provides a more minimally invasive removal of the tumor Methods: In this retrospective study, 15 patients with spinal schwannomas were evaluated with regards to age, sex, onset history, neurological findings, tumor locations, McCormick scale, surgical procedure, and operational results. The lateral approach provides exposure of intradural structures and posterior paraspinal regions. Extensions of tumors cause problem for the surgeon in terms of approach, resectability of the tumor, and stability of the spine. Gross total resection was achieved in all cases, and none of the patients necessary required a fusion procedure. Results: Five patients were males and 10 were females. The age interval was 29-65 years. The tumor was located in the lumbar region in 9 patients, in the thoracic region in 2 patients, and in the thoracolumbar junction in 4 patients. The intradural lesions were removed by laminectomy and the extradural lesions were resected with hemilaminectomy. The paramedian route was used to explore the extraspinal part of the tumor. Costotransversectomy was for the thoracic region. Subtotal resection was performed in 1 patient. Patient symptoms recovered gradually in the postoperative period. Conclusions: Resection of giant schwannomas is challenging and usually requires a different approach. We describe the complete resection of complex dumbbell or paraspinal schwannomas of the thoracic and lumbar spine by unilateral hemilaminectomy.

Non-missile intracranial injuries caused by foreign bodies are quite uncommon in civilian practice. Nails, knives, screwdrivers and sewing needles are the most commonly reported agents. The authors report a unique case of an adult male patient who suffered a penetrating craniocerebral injury caused by a falling concrete reinforcing iron (rebar) from the fourth floor of a building under construction. The foreign body was safely removed by a right parietal craniectomy as a result of detailed radiological evaluation and preoperative planning. To the best of authors' knowledge, the successful surgical treatment of a penetrating brain injury caused by a rebar has not been reported previously.

The aim of this study was to assess the clinical course of patients with acute low back pain (LBP) throughout 12 weeks and to identify the prognostic factors for non-recovery in the short term.A total of 91 patients with acute LBP (3 weeks) were included in this study. Baseline assessments including demographic variables, clinical characteristics of pain, lost work time and results of clinical examination were noted. Pain intensity, disability, general health perception and depression were assessed according to visual analogue scale, Roland Morris Disability Questionnaire (RMDQ), Nottingham Health Profile (NHP) and Beck Depression Inventory, respectively. Patients were assessed for pain intensity and disability at baseline, and at 1, 2, 4, 8 and 12 weeks of follow-up. Recovery was considered if patients scored4 on the RMDQ and pain had resolved. At the 2nd week of follow-up, patients were divided into two groups according to recovery (Group 1) or non-recovery (Group 2) to identify the prognostic factors, which were analysed by multiple logistic regression.At 2 weeks, 52 (57.1%) of the patients had recovered and only eight (8.7%) developed chronic LBP. Mean pain intensity and mean disability scores dropped 96.7 and 96.4%, respectively, of initial levels during the 12 weeks. Sixty per cent of 63 employed patients reported lost time from work. A comparison between groups revealed that finger-floor distance, RMDQ and NHP (pain, physical mobility, emotional reactions, sleep, energy level, and distress subgroups) were statistically significantly lower in Group 1, and NHP-pain was strongly associated with non-recovery in the short term.Acute LBP patients with disability generally recover in the first weeks. General health perception (NHP) - pain subgroup score was identified in particular as the best prognostic factor for non-recovery in the short term. Hence, pain should be given particular consideration in baseline assessments of acute LBP patients.

To the Editor: We present a case of cerebellar ischemia following a lumbar spinal surgery with prolonged prone position. Acute cerebellar ischemia after lumbar surgery is extremely rare, and its exact cause is not well known [1, 2]. Compression of vertebral arteries as a result of the prone position and unusual neck rotation with prolonged surgery have been demonstrated as the causes of cerebellar hypoperfusion leading to ischemia [2, 3]. Our patient was an ASA physical status II, 69-year-old man with degenerative lumbar stenosis at L2–L3–L4 levels. The patient had small ischemic areas on his previous cranial magnetic resonance imaging (MRI), and a left vertebral artery occlusion was detected on his previous computed tomography (CT) angiography performed 2 years ago; with no neurological symptoms or signs relevant to those lesions. Clopidogrel and acetyl salicylic acid administered previously were discontinued 7 days before the operation to avoid the risk of intraoperative bleeding. Compression stockings were applied to the patient to prevent the thromboembolic events of both cardiovascular and central nervous system. The patient was turned into prone position with his head semiflexed and mildly turned to his right side on a donut cushion, not exceeding his normal range of motion. Neutral position could not be achieved because of his short neck. Parallel chest foams were placed because of lack of a spine frame. Total laminectomy and fusion by transpedicular screw stabilization was performed at L2 to L5 levels, and the duration of the operation was 6 h. Throughout the surgery, mean arterial pressure was kept at 65–70 mmHg levels for the majority of the operation. The patient had altering levels of consciousness, dysarthria, and dizziness 2 h after the surgery. Brain CT scan demonstrated an acute cerebellar ischemia with surrounding edema in both hemispheres, more marked on the left side (Fig. 1). The patient was discharged from the hospital 4 weeks later with satisfying recovery of consciousness and dizziness, although his dysarthria improved very slowly. The position of our patient might have compromised the blood flow of right vertebral artery. Also, our patient had a prior left vertebral arterial occlusion. Both the position and the prior left vertebral arterial occlusion might have contributed to the ischemia involving both sides of the cerebellum. Our preventive measures were the application of compression stockings and avoiding hypotension and extensive neck rotation. Additionally, a low molecular heparin prophylaxis could have been considered to prevent possible contribution of thromboembolic complication. Further, aspirin should have not been discontinued, as suggested in a most recent review [4]. We conclude that preference of neutral alignment of the neck, maintenance of mean arterial pressure in normal range, and F. Harman M. Yaman E. Kaptanoglu Department of Neurosurgery, Near East University Faculty of Medicine, Lefkosa, Mersin 10, Turkey