Ahmet Menkü

Acute subdural hematoma: outcome and outcome prediction.

Patients with traumatic acute subdural hematoma were studied to determine the factors influencing outcome.Between January 1986 and August 1995, we collected 113 patients who underwent craniotomy for traumatic acute subdural hematoma. The relationship between initial clinical signs and the outcome 3 months after admission was studied retrospectively.Functional recovery was achieved in 38% of patients and the mortality was 60%. 91% of patients with a high Glasgow Coma Scale (GCS) score (9–15) and 23% of patients with a low GCS score (3–8) achieved functional recovery. All of 14 patients with a GCS score of 3 died. The mortality of patients with GCS scores of 4 and 5 was 95% to 75%, respectively. Patients over 61 years old had a mortality of 73% compared to 64% mortality for those aged 21–40 years. 97% of patients with bilateral unreactive pupil and 81% of patients with unilateral unreactive pupil died. The mortality rates of associated intracranial lesions were 91% in intracerebral hematoma, 87% in subarachnoid hemorrhage, 75% in contusion.Time from injury to surgical evacuation and type of surgical intervention did not affect mortality. Age and associated intracranial lesions were related to outcome. Severity of injury and pupillary response were the most important factors for predicting outcome.

Hemilaminectomy for the removal of the spinal lesions

Objective: We evaluated 20 patients with spinal lesions with respect to the value of unilateral hemilaminectomy at the Department of Neurosurgery, Erciyes University, Medical Faculty, Kayseri, Turkey. The operative technique of the limited approach for spinal lesions is described.Methods: The study is based on 20 prospective consecutive patients with spinal lesions who had unilateral hemilaminectomy. There were 12 women and eight men. Age ranged from 17 to 63 years mean (42 years) with a slight preponderance of women patients (60%). Spinal lesions were cervical in three cases, lumbar in five cases, and thoracic in 12 cases. Hemilaminectomy was performed by using a high speed drill.Results: Postoperative neurological status was unchanged in six cases, improved in 11 cases, and worsened in three cases. We only observed two cases of wound infections that were not related to our surgical approach. At the follow-up evaluation, which occurred approximately 25 months after surgery none of the patients showed spinal deformity or spinal instability.Conclusion: The rationale of attempting unilateral approach is to avoid damage to the dorsal static structures of the vertebral column. With the precise preoperative definition of the relationship of tumor to the surface of the spinal cord by contrast enhanced MRI, unilateral approaches might be more applicable to spinal lesions except invasive extradural lesions.Spinal Cord (2000) 38, 92–96.

Effect of methylprednisolone, tirilazad mesylate and vitamin E on lipid peroxidation after experimental spinal cord injury

Effect of methylprednisolone (MP), tirilazad mesylate (TM) and vitamin E on lipid peroxidation (LP) was evaluated in an experimental model of spinal cord compression injury in anesthetized rats. Forty rats, divided randomly into four groups, were injured by compressing on the spinal cord at Th 3 for 1 min. Bolus injections of saline solution, MP (30 mg/kg bolus and 5.4 mg/kg/h), TM (10 mg/kg four times per day), or vitamin E (30 mg/kg four times per day) were begun 1 h after the spinal cord injury (SCI). Twenty-four hours after treatment, the rats were killed, and malondialdehyde (MDA), a LP product, was measured in the spinal cord tissues. Rats treated with MP, TM and vitamin E had significantly decreased MDA levels (P<0.01) than rats in the control group. The lowest MDA levels were found in the TM group. These results suggest that MP, TM and vitamin E may have a protective effect against SCI in rats by its antioxidant effect.

Comparison of 16-row multislice CT angiography with conventional angiography for detection and evaluation of intracranial aneurysms

PURPOSE The aim of this study is to compare the diagnostic performance of 16-row computed tomographic angiography (MDCTA) with digital subtraction angiography (DSA) for the detection and characterization of intracranial aneurysms in patients with nontraumatic subarachnoid hemorrhages (SAH). MATERIALS AND METHODS One-hundred and twelve consecutive patients with suspected intracranial aneurysm underwent both 16-row MDCTA and DSA. The MDCT angiograms were interpreted in a blinded fashion by using combination with VRI, MIP and MPR techniques. Sensitivity specificity and accuracy were calculated for the CTA and DSA. The results were compared with each other. The DSA readers interpretation was accepted as the reference standard. RESULTS A total of 164 aneurysms were detected at DSA in 112 patients, no aneurysms were detected by DSA and MDCTA in 16 patients. Eight aneurysms were missed by MDCTA. The overall sensitivity, specificity, and accuracy of MDCTA on a per-aneurysm basis were 95.1%, 94.1%, and 95%, respectively. According to the size of the aneurysm less than 3mm; sensitivity, specificity and diagnostic accuracy of MDCTA were 86.1%, 94.1%, 88.6%, respectively. CONCLUSION This study suggests that MDCTA is equally as sensitive as DSA in the detection of intracranial aneurysms of greater than 3mm, and it also reveals 100% detection rate for ruptured aneurysms.

Nocardia brain abscess mimicking brain tumour in immunocompetent patients: report of two cases and review of the literature

SummaryNocardia brain abscess is a rare intracranial lesion and has been reported in immunocompromised patients. An optimal treatment approach has not been established. However, early diagnosis and appropriate antimicrobial therapy are very important factors for a good outcome. We report two unusual cases of Nocardia brain abscess simulating brain tumour in immunocompetent patients. One of the cases was presumed to be a primary brain tumour and the other a metastatic brain tumour. They underwent surgical gross total resection. After Nocardia asteroides was seen on Gram’s stain and subsequently identified by culture, appropriate antibiotic therapy was initiated.

Migration of Abdominal Catheter of Ventriculoperitoneal Shunt into the Scrotum

Summary Four cases of migration of the ventriculoperitoneal (V-P) shunt tip through patent processes vaginalis resulting in scrotal hydrocele are presented. These cases are considered a rare complication of V-P shunts and causal mechanisms are discussed with a review of the literature.

Intradural lumbar disc herniation: report of two cases

Abstract Intradural lumbar disc herniation (ILDH) is a rare pathology. The pathogenesis of ILDH is not known with certainty. Adhesions between the ventral wall of the dura and the posterior longitudinal ligament (PLL) could act as a preconditioning factor. Diagnosis of ILDH is difficult and seldom suspected preoperatively. Prompt surgery is necessary because the neurologic prognosis appears to be closely linked to preoperative duration of neurologic symptoms. Despite preoperatively significant neurological deficits, the prognosis following surgery is good. We report on two new cases of ILDH of high lumbar locations L1–2 and L2–3 with difficult differential diagnoses, and the possible pathogenic factors are discussed.

Cervical spondylotic myelopathy and radiculopathy treated by oblique corpectomies without fusion

Oblique corpectomy (OC) is an alternative technique for the resection of spondylotic spurs ventral to the cervical spinal cord contributing to cervical spondylotic myelopathy (CSM) and cervical spondylotic radiculopathy (CSR). To evaluate the efficacy of OC for the treatment of cervical spondylotic myeloradiculopathy, we reviewed our experience with OC. Twenty-six patients, 18 males and 8 females, were studied. They averaged 51.3 years of age (range 30–72), Thirteen had myelopathy and 13, radiculopathy. Both magnetic resonance (MR) imaging and computed tomography (CT) were performed preoperatively to define the extent of pathology. The Modified Japanese Orthopedic Association (JOA) score was used to grade the quality of the outcome. Neurologic and radiologic results were assessed. Good and excellent results were observed in 76.9% of the cases with myelopathy. Improvement of radicular symptoms was noted in 84.6% of the cases with radiculopathy. Neuroimaging studies confirmed satisfactory anatomical decompression in all patients. Sagittal alignment decreased from 13° to 12°. The degree of postoperative recovery seemed to be directly related to the age and severity of the preoperative myelopathy. This surgical technique has shown excellent clinical outcomes with fast recovery and adequate anatomical decompression in patients with CSM and CSR.

Ultrasound Guidance in Intracranial Tumor Resection: Correlation with Postoperative Magnetic Resonance Findings

Purpose: To determine the inter-method agreement between intraoperative ultrasonography and postoperative contrast-enhanced magnetic resonance imaging (MRI) in detecting tumor residue. Material and Methods: After resection was completed, the cavity borders of 32 tumors were examined with a 7 MHz intraoperative probe. Any echogenic region>5 mm in thickness extending from the surgical cavity into the brain substance was taken as the sonographic criterion for residual tumor. A continuous echogenic rim<5 mm was considered normal. Results were correlated with gadolinium-enhanced MRI obtained within 48 h after surgery. Results: The kappa value for inter-method agreement was 0.72. There were four cases in whom MRI showed residue despite a negative sonography: extensive edema or Surgicel along the cavity borders (three cases with glioblastoma multiforme) and the cystic component in the vicinity of cerebrospinal fluid (a case with pituitary macroadenoma) may be the reason for the residue going undetected. In a case with glioblastoma multiforme, residual enhancement was<5 mm in thickness. Conclusion: Intraoperative ultrasound is an effective tool for maximizing the extent of intracranial tumor resection. Surgical use has to be minimized if intraoperative ultrasound is to be used as an adjunct to surgery. Tumors with preoperatively detected cystic components in the proximity of CSF-containing spaces have to be carefully evaluated with intraoperative ultrasound if residual cystic components are to be detected. A low-thickness echogenic rim should not be considered a reliable sign of the absence of residue.

Is skull fracture necessary for developing an intradiploic pseudomeningocele as a complication of head injury in adulthood

SummaryWe report the case of an adult with a posttraumatic intradiploic pseudomeningocele which caused an expanded osteolytic skull lesion. Local pain and swelling, the only symptoms of the lesion, regressed after surgery. Intradiploic pseudomeningocele must be distinguished from intradiploic leptomeningeal cyst, which is of traumatic origin or arachnoid cyst and epidermoid cyst, which are of congenital origin. We also discuss the development of intradiploic pseudomeningoceleafter head trauma without skull fracture in adulthood and suggest a possible mechanism.