A. İskender Göçer

Huge bilateral pulmonary and pleural metastasis from intracranial meningioma: a case report and review of the literature

SummaryA case of recurrent meningioma with atypical features and extracranial metastases is reported. A 34-year-old female was operated in 1996, 2000, and 2002, and frontal parasagital meningioma was extirpated. Histological diagnoses of all the resected tumors were meningotheliomatous meningioma, WHO Grade I. However, 2 years later, the tumor recurred in the frontal scalp and was removed again totally. Histological diagnosis was reported as an atypical meningioma; meningotheliomatous type; WHO Grade II. She received radiation therapy. But the tumor had metastasized to the lung and pleura. Transthoracic tru-cut biopsy was performed from large mass of the left lung. Cytopathology was consistent with malignant meningioma, metastasis from the patient’s known intracranial meningioma. Ki-67 staining index at the primary and metastatic sites of the present cases were 7 and 5%, respectively. We reviewed and discussed the histopathological features and mechanisms of metastasizing meningioma.

Prognosis and prognostic factors for unexplained subarachnoid hemorrhage: review of 84 cases.

OBJECTIVE We conducted a retrospective study to investigate the prognosis, possible prognostic factors, and long-term natural history of subarachnoid hemorrhage of unexplained cause. METHODS This report contains a retrospective analysis of data for 84 patients with subarachnoid hemorrhage of unknown cause who were monitored for 1 month to 9.5 years, with an average follow-up period of 5.6 years. We evaluated the associations between computed tomographic (CT) scan features, clinical grade, loss of consciousness during hemorrhage, ventricular ratio, angiographic spasm, complications (such as death resulting from ischemia, early rebleeding, late rebleeding, epilepsy, hydrocephalus, and fixed ischemic deficits), and outcomes, using a nonparametric, two-sample, Kolmogorov-Smirnov test. The &khgr;2 test was used to test the independence of two categorical variables. RESULTS CT class exhibited a significant association with clinical grade (&ggr; = 0.865, P = 0.006), loss of consciousness during hemorrhage (&ggr; = 0.69, P = 0.001), and ventricular ratio (&ggr; = 0.8175, P = 0.01) but a nonsignificant association with angiographic vasospasm (&ggr; = 0.21, P = 0.2). Death resulting from ischemic complications and fixed ischemic deficits were strongly associated with clinical grade (P = 0.003 and P = 0.008, respectively) but weakly associated with CT class (P = 0.06 and P = 0.084, respectively). Angiographic vasospasm was strongly associated only with fixed ischemic deficits among complications (P = 0.001). Clinical outcome was strongly positively associated with CT class (&ggr; = 0.685, P = 0.001), clinical grade (&ggr; = 0.81, P = 0.001), and ventricular ratio (&ggr; = 0.57, P = 0.002) but weakly positively associated with loss of consciousness during hemorrhage (&ggr; = 0.459, P = 0.0487) and angiographic vasospasm (&ggr; = 0.48, P = 0.04). CONCLUSION Our study confirms earlier studies reporting a good prognosis for survival, but it does not confirm the earlier statements regarding low morbidity rates. Although clinical grade and the presence and amount of subarachnoid blood on CT scans are the major prognostic factors related to the incidence of ischemic complications, clinical grade and CT class are also the main parameters, with ventricular ratio, indicating clinical outcomes for patients with subarachnoid hemorrhage of unknown cause.

Intracranial Arachnoid Cysts: Clinical Features and Management of 35 Cases and Review of the Literature

The purpose of this study is to evaluate the distribution, clinical features, and treatment modalities of arachnoid cysts (ACs) in our clinic. The study was carried out between January 1, 1996 and November 31, 2002 at the Neurosurgery Department of Çukurova University Hospital, Adana, Turkey. Thirty-five patients (13 female and 22 male) with ACs demonstrated by cranial magnetic resonance imaging or computed tomography during this period were enrolled and discussed in this study. The middle cranial fossa was the most common location of ACs; ACs were located in the middle cranial fossa in 22 (62.9%) cases, followed by the cerebellopontine angle in 4 (11.4%) cases, the cerebral convexity in 3 (8.6%) cases, the suprasellar region in 2 (5.7%) cases, the quadrigeminal cisterns in 2 (5.7%) cases, and the retrocerebellar region in 2 (5.7%) cases. All cysts were unilateral: 25 (71.4%) were located on the left side, and 10 (28.6%) were located on the right side. The mean age at onset of clinical manifestations was 3 years, 6 months (range: 1 month to 12 years). The mean age at diagnosis was 8 years (range: 1–32 years). The most frequent clinical features on presentation were epileptic seizures (42.9%) and headache (28.6%). A few patients (9 [25.7%]) underwent surgery. Surgical intervention with microsurgical excision and fenestration was performed in 7 patients, and cystoperitoneal shunting was performed in 2 patients. The major indications for surgery of ACs are intractable seizures, intracranial hypertension, and compression of neuronal tissues. Headache only is not a surgical indication. Microsurgical excision and fenestration are safe and effective for the surgical treatment of ACs.

Correlation of alterations on Na+-K+/Mg+2 ATPase activity, lipid peroxidation and ultrastructural findings following experimental spinal cord injury with and without intravenous methylprednisolone treatment

The sodium-potassium activated and magnesium dependent adenosine-5′-triphosphatase (Na+−K+/Mg+2 ATPase EC 3.6.1.3.) activity and lipid peroxidation and early ultrastructural findings are determined in rat spinal cord at the early stage of trauma produced by a surgical clip on the thoracal 2–7 segments. The effect of treatment with intravenous methylprednisolone (MP) was evaluated the basis of these biochemical alterations and ultrastructural findings in the same model. The specific activity of the membrane bound enzyme Na+−K+/Mg+2 ATPase was promptly reduced in as early as ten minutes following spinal cord injury and remained at a level lower than the levels in the control group and in the sham-operated group. Methylprednisolone treatment immediately after the trauma attenuated the inactivation of Na+−K+/Mg+2 ATPase. On the other hand, there was significant difference in lipid peroxide content between the sham-operated and the injured animals. Methylprednisolone treatment reduced thiobarbituric acid reactive substance (TBARS) content in Group IV. We determined a positive relationship among membrane-bound enzyme Na+ K+/Mg+2 ATPase activity, malondialdehyde (MDA) content and early ultrastructural changes in the traumatized and treated groups.These data provide evidence for a beneficial effect of methylprednisolone on the activation of Na+−K+/Mg+2 ATPase and lipid peroxidation and early ultrastructural changes in spinal cord injured rats. The possible mechanism of methylprednisolone effects on the membrane function and lipid peroxidation, and the correlation of biochemical changes with ultrastructural findings are briefly discussed.

Intraventricular Meningiomas: A Review of the Literature and Report of 8 Cases

Intraventricular meningiomas are rare tumors, comprising only 0.5% to 5% of all intracranial meningiomas. In this article, 8 cases of histopathologically proven intraventricular meningioma that were treated at the Çukurova University Neurosurgery Department are discussed. The radiologic, histologic, and clinical findings of intraventricular meningiomas and the surgical approach to lateral intraventricular meningiomas were reviewed retrospectively. Our 8 patients ranged in age from 18 to 65 years (mean = 44.6 years). Two patients were male and 6 were female, for a 1:3 male-to-female ratio. Computed tomography and magnetic resonance imaging demonstrated the 7 tumors within the lateral ventricle and only 1 tumor within the third ventricle. All lateral ventricular tumors were located in the region of the trigone. Headache and hemiparesis were the most common presenting symptoms. Histologic studies revealed meningotheliomatous meningiomas in 5 patients, transitional meningioma in 2 patients, and anaplastic (malignant) meningioma in 1 patient. The superior parieto-occipital approach in 5 patients, posterior middle temporal gyrus approach in 2 patients, and posterior transcallosal approach in 1 patient were used for surgical therapy, and total resection was achieved in all patients. The overall neurologic outcome at follow-up (mean follow-up = 12 months, range: 1 month to 5 years) was excellent (no deficit) in 4 patients, good (some deficit but independent) in 2 patients, and poor (dependent) in 1 patient. One patient died after surgery. We conclude that intraventricular meningiomas are curable by complete surgical resection. This is possible with little neurologic morbidity when the neurosurgeon understands the surgical approaches available and the indications for those approaches.

Congenital Peripheral Facial Palsy Associated with Cerebellopontine Angle Arachnoid Cyst

Objects: A rare case of cerebellopontine angle arachnoid cyst leading to congenital peripheral facial palsy was presented. Clinical Presentation: A 1-year-old girl presented with peripheral facial paralysis since birth. Computed tomography and magnetic resonance imaging revealed left cerebellopontine angle arachnoid cyst causing moderate displacement of the brain stem. Intervention: Retrosigmoid suboccipital craniotomy was performed and microsurgical resection of the cyst wall and fenestration of the cyst to the basal cisterns were achieved. Conclusions: Cerebellopontine angle arachnoid cyst should be considered as a potential cause of congenital peripheral facial palsy.

Effects of Antithrombin III on Myeloperoxidase Activity, Superoxide Dismutase Activity, and Malondialdehyde Levels and Histopathological Findings after Spinal Cord Injury in the Rat

OBJECTIVE:Among the many possible mechanisms of the secondary spinal cord injury (SCI), microcirculatory disturbances as a result of activated leukocyte-induced endothelial cell injury is important because it is potentially treatable and reversible. Currently, clinically available pharmacological agents for treatment of acute SCI do not inhibit neutrophil activation. The effect of antithrombin III (AT-III) on neutrophil activation was studied in rats with SCI produced with an aneurysm clip on the T2–T7 segments. METHODS:Forty rats were randomly allocated to four groups. Group I (10 rats) was killed to provide normal spinal cord tissue for testing. Group II (10 rats) underwent a six-segment laminectomy for the effects of total laminectomy to be determined. In Group III, 10 rats underwent a six-segment laminectomy and SCI was produced by extradural compression of the exposed cord. The same procedures were performed in 10 rats in Group IV, but they also received one (250 IU/kg) intraperitoneal injection of AT-III immediately after the injury and a second dose 24 hours later. The animals from Groups II through IV were killed 48 hours after the trauma. The effect of AT-III on the myeloperoxidase activity, superoxide dismutase activity, and malondialdehyde levels and histopathological findings were studied. RESULTS:Myeloperoxidase activity, superoxide dismutase activity, and malondialdehyde levels were significantly lower and there was less histopathological damage in the AT-III treatment group than in the trauma group. CONCLUSION:The results demonstrate that AT-III treatment may reduce secondary structural changes in damaged rat spinal cord tissue by inhibiting leukocyte activation.

Effect of neutralization of rat IL-6 bioactivity on collateral blood supply from retrograde flow via cortical anastomoses in the rat central nervous system.

Abstract The purpose of this study was to determine whether neutralization of rat interleukin-6 (IL-6) bioactivity increases the collateral blood supply from retrograde flow via the major middle cerebral artery branches after experimental middle cerebral artery occlusion in the rat. Seventy rats were randomly allocated to four main groups: Group I (n = 10) consisted of normal controls; Group II (n = 20) underwent craniectomy only; Group III (n = 20) was subjected to middle cerebral artery occlusion; and Group IV (n = 20) underwent middle cerebral artery occlusion and treatment with anti-rat IL-6 antibody. Half of the rats from each of Groups II, III and IV were killed at 24 h and the other half at 72 h after craniectomy alone or occlusion. A single dose of antibody did not affect middle cerebral artery caliber, but administration of three doses resulted in a significant increase in the diameter of middle cerebral artery compared to the findings in the corresponding occlusion-only groups. The results suggest that neutralization of rat IL-6 bioactivity in longterm recovery increases the collateral blood supply from retrograde flow via cortical anastomoses after experimental arterial occlusion in the rat brain. [Neurol Res 2002; 24: 405-408]

The relationships among ultrastructural angiogenic features, Na+ K+, Ca+2, Mg+2 ATP-ase activities and SOD concentration in the microvasculature of intracranial meningiomas and glial tumors.

Abstract The purpose of this study was to investigate the relationship among ultrastructural angiogenic features, adenosine-5′-triphosphatase (ATP-ase) activities and superoxide dismutase (SOD) concentration in the microvasculature of intracranial meningiomas and glial tumors. We examined 20 tumor materials from 20 adult patients with intracranial meningioma or glial tumor who underwent selective surgery, dividing them into two groups based on the type of the tumors. Group I consisted of 10 meningioma-materials, and Group II of 10 glial tumor-materials. Na+ -K+, Mg+2 and Ca+2 ATP-ase activities in Group I were significantly higher than those in Group II (p < 0.01). The SOD activity in Group I was significantly lower than that in Group II (p < 0.01). According to electron microscopic findings, vascular endothelial proliferation and ultrastructural cytoplasmic changes in the glial tumors were more prominent than those in the meningiomas. Our results show that there is a meaningful correlation among an increased endothelial proliferation, a decreased ATP-ase level and an increased SOD activity in the meningiomas and glial tumors. [Neurol Res 2002; 24: 286-290]