Ali Yilmaz

Characterization of an intracranial neurothekeoma: case report.

AIM Neurothekeomas are benign tumors of presumed neural sheath origin. They are primarily found in superficial soft tissues, located in the upper portion of the body. Here, we report a case of intracranial neurothekeoma. RESULTS A 37-year-old female presented at our clinic with sudden-onset left hemifacial pain of varying duration. The physical and neurological examination findings were normal. The magnetic resonance imaging scan showed a mass compressing the pons and extending from the medial section of the left middle fossa to the posterior fossa. The patient was operated on using a left presigmoid transpetrosal approach and the mass was totally removed. CONCLUSION Neurothekeomas, also known as nerve sheath myxomas, are rare benign tumors. There have been two previous cases reported with an intracranial location. The information presented here now represents the third such case in the literature.

Boric acid reduces axonal and myelin damage in experimental sciatic nerve injury

The aim of this study was to investigate the effects of boric acid in experimental acute sciatic nerve injury. Twenty-eight adult male rats were randomly divided into four equal groups (n = 7): control (C), boric acid (BA), sciatic nerve injury (I) , and sciatic nerve injury + boric acid treatment (BAI). Sciatic nerve injury was generated using a Yasargil aneurysm clip in the groups I and BAI. Boric acid was given four times at 100 mg/kg to rats in the groups BA and BAI after injury (by gavage at 0, 24, 48 and 72 hours) but no injury was made in the group BA. In vivo electrophysiological tests were performed at the end of the day 4 and sciatic nerve tissue samples were taken for histopathological examination. The amplitude of compound action potential, the nerve conduction velocity and the number of axons were significantly lower and the myelin structure was found to be broken in group I compared with those in groups C and BA. However, the amplitude of the compound action potential, the nerve conduction velocity and the number of axons were significantly greater in group BAI than in group I. Moreover, myelin injury was significantly milder and the intensity of nuclear factor kappa B immunostaining was significantly weaker in group BAI than in group I. The results of this study show that administration of boric acid at 100 mg/kg after sciatic nerve injury in rats markedly reduces myelin and axonal injury and improves the electrophysiological function of injured sciatic nerve possibly through alleviating oxidative stress reactions.

Investigation of Efficacy of Mitomycin-C, Sodium Hyaluronate and Human Amniotic Fluid in Preventing Epidural Fibrosis and Adhesion Using a Rat Laminectomy Model

Study Design A retrospective study. Purpose The aim of this study was to evalute the effects of mitomycin-C, sodium hyaluronate and human amniotic fluid on preventing spinal epidural fibrosis. Overview of Literature The role of scar tissue in pain formation is not exactly known, but it is reported that scar tissue causes adhesions between anatomic structures. Intensive fibrotic tissue compresses on anatomic structures and increases the sensitivity of the nerve root for recurrent herniation and lateral spinal stenosis via limiting movements of the root. Also, neuronal atrophy and axonal degeneration occur under scar tissue. Methods The study design included 4 groups of rats: group 1 was the control group, groups 2, 3, and 4 receieved antifibrotic agents, mitomycin-C (group 2), sodium hyaluronate (group 3), and human amniotic fluid (group 4). Midline incision for all animals were done on L5 for total laminectomy. Four weeks after the surgery, the rats were sacrificed and specimens were stained with hematoxylin-eosin and photos of the slides were taken for quantitive assesment of the scar tissue. Results There was no significant scar tissue in the experimental animals of groups 2, 3, and 4. It was found that there was no significant difference between drug groups, but there was a statistically significant difference between the drug groups and the control group. Conclusions This experimental study shows that implantation of mitomycin-C, sodium hyaluronate and human amniotic fluid reduces epidural fibrosis and adhesions after spinal laminectomy in rat models. Further studies in humans are needed to determine the complications of the agents researched.

Prevention of Epidural Fibrosis Using Ranibizumab in a Postlaminectomy Rat Model.

AIM One of the most significant reasons for persistent low back pain experienced after spinal surgery is epidural fibrosis seen after laminectomy procedures. This study shows the effects of Ranibizumab on spinal epidural fibrosis in the laminectomy area by blocking the effect of vascular endothelial growth factor. MATERIAL AND METHODS Twenty Wistar rats were used in this study. Rats were divided into two groups; a control group and a ranibizumab group. Only laminectomy was performed to the control group. In the ranibizumab group, 0.6 mg/kg ranibizumab diluted in 0.9% NaCl with the ratio of 1:10 was applied topically. Three weeks later, the vertebral columns were resected en bloc including the whole laminectomy area in both groups and evaluated histopathologically. Results were compared using statistical tools. RESULTS Based on the statistical analysis, our data show that less epidural fibrosis was seen in the ranibizumab group compared to the control group (P < 0.05). CONCLUSION Topically applied Ranibizumab is significantly effective in preventing epidural fibrosis in rats occurred after laminectomy.

Anterior spinal cord herniation after multilevel anterior cervical corpectomy: A case report.

Many complications related to the resection of an ossified posterior longitudinal ligament via the anterior approach have been reported. Postoperative neurological deterioration is one such complication that may appear due to massive anterior spinal cord herniation related to a dural defect following resection of the ossified posterior longitudinal ligament. Specifically, spinal cord herniations have been reported to be associated with posterior approaches, and a large number of theories regarding this association have been offered by various authors. However, anterior spinal cord herniation is extremely rare, and its pathophysiology has not yet been explained. In this case report, we report a male patient who experienced anterior spinal cord herniation following anterior surgery. Spinal cord herniation may develop following the removal of the anterior cervical corpectomy. Therefore, surgeons should be aware of this condition when planning treatments for cervical spondylotic myelopathy via the anterior approach.

Symptomatic pneumocephalus after lumbar disc surgery: a case report.

Symptomatic pneumocephalus is frequently seen after traumatic fracture of the skull base bone. However, it has rarely been reported after spinal surgery and its mechanism has not been fully explained. In this paper, we present a 30 year old male patient who had lumbar discectomy due to a symptomatic midline lumbar disc herniation. He had developed symptomatic pneumocephalus after the lumbar disc surgery associated with application of a vacuum suction device. We present and discuss our patient in the light of the literatures.

Morphological Assessment of Cadaveric Radial, Brachial and Subclavian Arteries: A Neurointerventional Approach.

Objective The transradial catheterization (TRC) is becoming widespread, primarily for neurointerventions. Therefore, the evaluation of radial artery puncture in clinical practice and a better understanding of the anatomy are important to improve the safety of neuroendovascular surgery. Methods Ten formalin-fixed adult Korean cadavers were dissected to expose radial artery (RA), brachial artery (BrA) and subclvian artery (ScA), bilaterally. Vessel lengths and diameters were meaured using a caliper and distance between the specific point of vessels and the anatomical landmarks including the radial styloid process, the medial epicondyle of the humerus, the sternoclavicular joint, and the vertebral artery orifice were also measured. Results The average length between the radial (RAPS) and the BrA puncture sites (BrAPS) and between the vertebral artery orifice (VAO) and the BrA bifurcation (BrAB) did not differ between sides (p>0.05). The average length between the radial styloid process (RSP) and the RAPS was 13.41±2.19 mm, and the RSP was 26.85±2.47 mm from the median nerve (MN). The mean length between the medial epicondyle (ME) and the BrAPS as 44.23±5.47 mm, whereas the distance between the ME and the MN was 42.23±4.77 mm. The average VAO-ScA angle was 70.94±6.12°, and the length between the ScA junction (SCJ) and the VAO was 60.30±8.48 mm. Conclusion This study provides basic anatomical information about the radial artery and the brachial route and can help improving new techniques, selection of size and shape of catheters for TRC. This can help neurointerventionists who adopt a transradial neuroendovascular approach and offers comprehensive and safe care to their patients.

Calcified Intracranial Hydatid Cyst: Case Report

We present a 26-year-old patient who did farming related work had an asymptomatic intracranial hydatid cyst. A calcified intracranial cystic mass was found on radiological investigations and the patient underwent surgery. The mass was totally excised. The histopathology result reported a hydatid cyst. There were no postoperative complications. Calcification is quite rare in cerebral hydatid cyst. The computed tomography and magnetic resonance imaging provide information that is especially useful for preoperative diagnosis. Observing membrane detachment and daughter cysts during these investigations is pathognomonic. The presence of calcification in the cyst wall and intracystic membranes indicated hydatid cyst.

Effect of etanercept on the formation of epidural fibrosis in an experimental model

AIM To investigate the effects of local and systemic administration of etanercept on the formation of epidural fibrosis. MATERIAL AND METHODS Twenty-eight rats were randomly divided into four equal groups (Control, SpongostanTM, Local etanercept and Systemic etanercept) and laminectomy was performed between T11 and L1 in all rats. SpongostanTM was soaked with saline (0.1 mg/kg), local etanercept (300 ?g/kg) was applied with SpongostanTM and systemic etanercept (300 ?g/kg/week) was applied subcutaneously. Four weeks later, the vertebral column from T9 to L3, including the paraspinal muscles and epidural scar tissue, was removed en bloc, and epidural fibrosis and arachnoidal involvement were graded and evaluated histopathologically. RESULTS The grading of epidural fibrosis was statistically significantly lower in systemic and local administration of etanercept groups compared to the control group (p < 0.005), but systemic etanercept administration was more effective. CONCLUSION Systemic administration of etanercept can be effective in reducing epidural fibrosis in rats after laminectomy.

Efficacy of Lumboperitoneal Shunting in Patients with Normal Pressure Hydrocephalus.

AIM To evaluate the effectiveness of lumboperitoneal (LP) shunt procedures in the treatment of normal pressure hydrocephalus (NPH). MATERIAL AND METHODS A medical record review was conducted to obtain demographic, clinical, laboratory data, as well as pre-, intra, -postoperative details of 65 patients who underwent LP shunt surgery for NPH between January 1, 2001 and January 1, 2014 in the Neurosurgery Clinics of Ankara Training and Research Hospital and Ankara Numune Hospital. RESULTS At the 3rd month after LP shunt surgery, headache was resolved in almost all patients. At the end of first year, while statistically significant improvements were noted in the Modified Rankin Scale Scores and Mini-Mental State Examination Scores, gait disturbance, urinary incontinence and cognitive functions were improved by 86%, 72% and 65% of the patients, respectively. CONCLUSION LP shunt surgery is associated with a lower rate of complication in comparison to ventriculoperitoneal shunt surgery and is an effective procedure in the treatment of NPH.