Alparslan Senel

Fatal fever of unknown origin in acute cervical spinal cord injury: five cases.

Abstract Background/Objective: Patients with traumatic upper thoracic and cervical spinal cord injuries are at increased risk for the development of autonomic dysfunction, including thermodysregulation. Thermoregulation is identified as an autonomic function, although the exact mechanisms of thermodysregulation have not been completely recognized. Quad fever is a hyperthermic thermoregulatory disorder that occurs in people with acute cervical and upper thoracic spinal cord injuries. First described in 1982, it has not been widely discussed in the literature. Methods: Case reports of 5 patients with cervical spinal cord injury (SCI). Results: Five of 18 patients (28%) with acute cervical SCI who were admitted during a 1-year period had fatal complications caused by persistent hyperthermia of unknown origin. Conclusions: Patients with acute traumatic cervical and upper thoracic SCI are at risk for thermoregulatory dysfunction. Changes in the hypothalamic axis may be implicated, especially in the light of modification in hypothalamic afferent nerves, but this hypothesis has not yet been explored. Thermodysregulation may be an early sign of autonomic dysfunction. A comprehensive guideline is needed for the management of elevated body temperature in critically ill patients with cervical SCI, because this condition may be fatal.

Circumferential stabilization with ghost screwing after posterior resection of spinal metastases via transpedicular route.

Various surgical methods have been described for treating spinal metastases, namely, en bloc spondylectomy, minimally invasive techniques, and anterior and posterior approaches. The main goals in surgical intervention for these lesions are tumor removal and establishment of strong, durable stabilization. The least invasive method is always preferred. Posterior transpedicular spondylectomy meets all these needs, as this method achieves tumor excision and stabilization of the anterior and posterior spine through one posterior incision and in the same surgical session. The surgeon circumferentially excises a spinal metastasis and then achieves circumferential stabilization in the same session. Numerous circumferential stabilization methods have been used to date, including placement of free bone grafts or cages or acrylic grafts, or insertion of an acrylic graft supported by a Steinmann pin anteriorly and by posterior transpedicular fixators or a Luque rectangle posteriorly. This article describes seven cases of spinal metastasis in which an alternative circumferential stabilization technique known as “ghost screwing” was performed. The first step in this method is circumferential decompression, achieved with laminectomy followed by eggshell corpectomy via the transpedicular route. Then a short segmental transpedicular stabilization system is fixed to the vertebrae cranial and caudal to the laminectomy/corpectomy defect. Prior to fixing the rods in place, an additional screw is mounted on each rod such that the screw shaft protrudes into the defect space. Once the rods are fixed and the two extra screws are optimally positioned, acrylic bone cement is introduced into the defect site, encasing the ghost screws and forming an anterior graft upon hardening. The outcomes in our cases were excellent. All seven patients had uneventful postoperative periods and all experienced pain relief and were able to mobilize early. Direct connection of the anterior acrylic graft to the posterior fixation system via ghost screws makes this system strong and durable, and prevents subsidence or horizontal displacement of the graft. Such complications can be serious issues with other circumferential systems that use independent anterior and posterior fixators.

Simple technique for removing broken pedicular screw with plain and serviceable screwdriver

Removing the broken pedicular screw after spinal hardware failure is usually problematic. A specially designed simple screwdriver and easy removal technique of broken pedicular screw with this screwdriver are described in this article.

There are no estrogen and progesterone receptors in cerebral cavernomas: A preliminary immunohistochemical study

BACKGROUND Literature consistently mentions that pregnancy and hormonal therapy probably increase the bleeding rate and seizure expression of cerebral cavernomas. Either increased hormonal activity or embryogenesis related abundant expression of some growth factors such as VEGF, bFGF, and placental growth factor during pregnancy were proposed to initiate angiogenic process and vascular proliferation in cavernomas, thereby increasing their bleeding rate and seizure expression. METHODS To reveal whether estrogen and/or progesterone have direct effect on cerebral cavernomas, their receptor expressions were studied immunohistochemically in recently excised 12 cerebral cavernomas. RESULTS Study showed no expression of either estrogen or progesterone receptors in cerebral cavernomas even the staining worked well in positive control tissues of infiltrative ductal carcinoma. CONCLUSIONS Aggressive behavior of cerebral cavernomas during pregnancy is a commonly proven observation and attributed to some hormonal effects. However, this effect seems not related to effect of estrogen or progesterone on cavernoma tissue via receptor binding.

Localized Spontaneous Subarachnoid Hemorrhage as First Manifestation of Cerebral Venous Thrombosis

Cerebral venous thrombosis (CVT) may rarely manifest itself with pure subarachnoid hemorrhage (SAH). For a neurosurgeon, spontaneous SAH always suggests vascular pathologies as aneurysms or malformations. However, though rarely encountered, a spontaneous SAH may be an initial finding of CVT that requires prompt diagnosis with venous angiography to initiate treatment with anticoagulants. Obviously those are contraindicated in aneurysmal subarachnoid hemorrhage. Literature review discovered additional cases presented in this article. CVT may manifest itself with subarachnoidal hemorrhage atypically with a localized pattern rather than diffuse blood. A spontaneous subarachnoidal hemorrhage in atypical localization may be related to venous thrombosis and radiologic evaluation of cerebral venous system should be one of the initial diagnostic efforts in neurosurgical practice of such cases for early initiation of treatment with anticoagulants.

Laminectome, a New Drilling Kerrison Rongeur for Partial Hemilaminectomy

Partial laminectomy is commonly used in spinal surgery, and the Kerrison rongeur, drill, and ultrasonic bone aspirators are instruments used for laminectomy. Alternatively, a simple, cheap, and safe instrument, the laminectome, was designed by us for partial laminectomy. Inspired by the classic model of a Kerrison rongeur, a new instrument was designed in which instead of the superior sliding blade, a modification to hold a surgical drill was added to the rongeur model. Manual grasping of the handles of this new instrument approximates the superior sliding drill to the lower limiting base, and then the accompanying action of the drill penetrates the intervening bone of the lamina. The handling of the instrument is very easy; production is inexpensive, and an ordinary surgical drill could be attached to it. Laminectomy with this instrument is quite comfortable and safe, and it effectively shortened the surgical time in our cases. The laminectome is a very practical and safe instrument and can be used safely for partial laminectomy.