Aşkın Şeker

A sine-wave-shaped skin incision for inserting deep-brain stimulators

BackgroundThe sine-wave-shaped skin incision is a technique that minimizes skin-related complications near burr hole caps after electrode placement for deep-brain stimulation (DBS).MethodsBetween 2011 and 2013, 54 DBS electrodes were implanted in 27 consecutive patients with Parkinson’s disease (PD), essential tremor, or dystonia. The sine-wave incision was used in 26 patients and conventional bilateral linear scalp incisions were used in one patient.ResultsNone of the patients whose operations involved sine-wave-shaped incisions developed hardware-linked complications such as skin infection or skin erosion. The one patient who underwent conventional bilateral linear scalp incisions developed a skin infection.ConclusionBy preserving the vascular anatomy of the scalp and reducing skin tension at the wound site, the sine-wave-shaped incision promotes wound healing.

Temporal expression analysis of angiogenesis-related genes in brain development

BackgroundThe current knowledge on molecular pathogenesis of cerebral vascular malformations (CVM), which are believed to arise during development, is very limited. To unravel the molecular mechanisms involved in CVMs, a detailed understanding of the brain vascular development at molecular level is crucial. In this study, we aimed to explore the temporal and comparative expression profile of angiogenesis-related genes in the establishment of brain vasculature.MethodsExpression of a total of 113 angiogenesis-related genes during murine brain development has been analyzed using low-density array systems designed for angiogenesis-related genes. Bai1 (brain specific angiogenesis inhibitor-1), a recently identified novel anti-angiogenic gene, has been selected for further characterization.ResultsWe found that 62 out of 113 analyzed genes have expression in brain development at varying levels. Nineteen of these were differentially expressed between embryonic and postnatal stages (>1.5 fold). Bai1 is strongly expressed on growing blood vessels of cerebral cortex and hippocampus, partially expressed in the lateral regions of striatum, but mostly absent on the thalamus.ConclusionBy showing the comparative expression analysis of angiogenesis-related genes throughout brain development, the data presented here will be a crucial addition to further functional studies on cerebrovascular research.

Assessment of antiangiogenic effect of imatinib mesylate on vestibular schwannoma tumors using in vivo corneal angiogenesis assay

OBJECT Angiogenesis and the platelet-derived growth factor (PDGF) pathway are active in the pathogenesis of vestibular schwannomas (VSs). The purpose of this study was to test whether imatinib mesylate (Gleevec), a PDGF receptor (PDGFR) blocker, reduces angiogenic capacity in sporadic VS and in VS associated with neurofibromatosis Type 2 (NF2) using a corneal angiogenesis assay. METHODS From 121 VS tissue samples stored in the tumor bank at the Marmara University Institute of Neurological Sciences, 10 samples (6 from sporadic cases, 4 from NF2-associated cases) were selected at random for use in this study. Expression of PDGF-A and PDGF-B and their receptors was evaluated in sporadic and NF2-associated VS as well as in glioblastoma (GBM) and normal brain tissue by means of immunohistochemistry and Western blot analysis. Corneal angiogenesis assay was then used to evaluate the angiogenic capacity of tissue specimens from sporadic and NF2-associated VS with and without imatinib treatment as well as positive and negative controls (GBM and normal brain tissue). RESULTS The angiogenic potential of the sporadic and NF2-associated VS tumor tissue differed significantly from that of the positive and negative control tissues (p <0.05). Furthermore, NF2-associated VS showed significantly lower angiogenic potential than sporadic VS (p <0.05). Imatinib treatment significantly reduced the angiogenic potential in both the sporadic VS and the NF2-associated VS groups. The level of PDGF-A and PDGFR-α as well as PDGF-B and PDGFR-β expression in sporadic VS and NF2-associated VS also differed significantly (p <0.05) from the levels in controls. Additionally the level of PDGFR-β was significantly higher in sporadic VS than in NF2-associated VS (p <0.05). CONCLUSIONS The findings of this study indicate that NF2-associated VS has significantly more angiogenic potential than sporadic VS and normal brain tissue. Additionally, imatinib reduces the angiogenic activity of both sporadic and NF2-associated VS. The authors conclude that imatinib may be a potential treatment for VS, especially for NF2-associated lesions that cannot be cured with resection or radiosurgery.

A variation of the cords of the brachial plexus on the right and a communication between the musculocutaneous and median nerves on the left upper limb: a unique case.

During routine anatomical dissection of the upper extremity of a 64-year-old cadaver for educational purposes, we observed variations in the brachial plexus on each side. On the right an anomaly of cord formation was present and on the left there was a communication between the musculocutaneous nerve (MCN) and median nerve (MN). On the right side the brachial plexus showed two trunks, superior (C5 and C6) and inferior (C7, C8, and T1); the middle trunk was absent. The superior trunk bifurcated into anterior and posterior divisions, the anterior division continued as the lateral cord forming the MCN. The posterior division gave off the subscapular branch. The inferior trunk trifurcated into radial, median, and ulnar nerves. The radial nerve gave off the axillary and thoracodorsal nerves. The ulnar nerve gave off the median cutaneous nerves of the arm and forearm. The median nerve received a small ascending branch from the MCN. On the right side, there was a communicating branch from the MCN to the MN in the lower third of the arm region. This communicating branch also gave rise to a muscular branch to the brachialis muscle and the lateral cutaneous nerve of forearm. No additional heads of the biceps brachii muscle were observed in either upper limb. Knowledge of the variations of the brachial plexus in humans can be valuable for operations of the shoulder joint and its repair for providing an effective block or treatment for anesthetists and also for explaining otherwise incomprehensible clinical signs for neurologists.

The Supraorbital Keyhole Approach.

Aim:The major aim of the present anatomical study was to demonstrate the anatomical structures that can be visualized using the supraorbital keyhole approach, both endoscopically and microscopically, from an eyebrow incision to intracranial structures. Furthermore, it defines an optimal craniotomy for surgery. Methods:Fine dissection was performed on each side of 5 formalin-fixed adult cadavers according to the surgical procedures of the supraorbital keyhole approach, and each step was documented both endoscopically and microscopically. Furthermore, the distance between the superior temporal line and the supraorbital notch/foramen was measured from the 10 total sides of the 5 cadavers and from the 118 sides of the 59 autopsies. Results:Tumors and aneurysms of the anterior cranial fossa can be visualized during the supraorbital keyhole approach. The average distance between the superior temporal line and the supraorbital notch/foramen was measured. The distance obtained from the autopsies on the 25 females was 31.56 ± 4.03 mm on the right side and 31.04 ± 5.40 mm on the left side. The average distance obtained from the autopsies on the 34 males was 34.00 ± 4.59 mm on the right side and 33.59 ± 5.41 mm on the left side. There was no statistically significant difference between right and left in the female and male autopsies or between sexes. Conclusions:This anatomical study showed that structures in the anterior and middle cranial fossa can be reached via the supraorbital keyhole craniotomy approach with minimal brain retraction and adequate exposure and with minimal craniotomy size.

A unique case of intradural communicating branches between the accessory nerve and the dorsal roots of the cervical spinal nerves.

OBJECTIVE The accessory nerve has cranial and spinal roots. The cranial roots emerge from the medulla, whereas the spinal roots arise from motor cells within the ventral horn of C1-C7 segments of the spinal cord. Communications have been described between the spinal accessory nerve rootlets and the dorsal rootlets of cervical spinal nerves. In the present case, we report a communication that has not been reported before and discuss the functional anatomy. MATERIALS AND METHODS During the dissection of the craniovertebral junction of a 67-year-old formalin-fixed adult male cadaver, a connection between the spinal accessory nerve rootlets and the dorsal rootlets of the cervical spinal nerves was observed. RESULTS A communication between the spinal rootlets of the accessory nerve and the dorsal roots of cervical spinal nerves was present on the right and left side. On the right, a communication between the accessory nerve spinal rootlet and the dorsal rootlet of the fourth cervical spinal nerve existed. On the left, there were two branches from the lowest accessory nerve spinal rootlet, one run ventrally and the other dorsally to the spinal rootlet and reached the dorsal root of third cervical spinal nerve. The dorsal root of C1 did not exist on either the right or the left side. Further, an unusual spinal accessory nerve formation was also observed. DISCUSSION This case does not fit into any of the previously described classifications in the literature. Therefore, the different variations concerning the communications between the spinal rootlets of the accessory nerve and the cervical spinal nerves should be kept in mind during both surgical, especially radical neck dissections, and nonsurgical evaluations.

The Anatomy of the Posterior Cranial Fossa

The posterior cranial fossa contains the most complex intracranial anatomy. Posterior fossa is strategically important situated at the outlet of the cerebrospinal fluid flow from the ventricular system. The posterior fossa extends from the tentorial incisura, through which it communicates with the supratentorial space, to the foramen magnum, through which it communicates with the spinal canal. It is bounded in front by dorsum sellae, the posterior part of sphenoid body, and clival part of the occipital bone; behind by the lower portion of the squamosal port of the occipital bone; and on each side by the petrous and mastoid parts of the temporal bone, the lateral part of occipital bone, and above and behind by a small part of mastoid angle of the parietal bone. The cerebellum consists of three anatomical parts; a median vermis and two lateral hemispheres. The central vermis is elevated above the level of the hemispheres on the upper surface of the cerebellum, contrary to its deep depression on the suboccipital surface. The cerebellum has fissures that divide the organ into series of layers or leaves. The largest and deepest fissure is the horizontal sulcus. The horizontal sulcus divides the semilunar lobule into inferior and superior semilunar lobules. The vermis is positioned between the two hemispheres and is an important structure in the transvermian approach as it connects both hemispheres. Culmen represents the most apical part of the vermis at the tentorial surface. From posterior to anterior, the subdivisions of superior vermis are represented by lingula, central lobule, monticulus, and folium vermis. Vermal parts of the posterior lobe are, in the following order, the declive, folium, tuber, pyramid, and uvula. The folium vermis is a short, narrow, and concealed band-like structure at the posterior extremity of the vermis. The superior semilunar lobule occupies the posterior third of the upper surface of the hemisphere and connected below by the horizontal sulcus. The superior semilunar lobule receives fibers mainly from middle cerebellar peduncles that are referred to as pontinecerebellar and corticocerebellar fibers.

28 haftalik bir gebede hizli nörolojik kötüleşmeye neden olan foramen magnum meningiomu

Hepatic artery pseudoaneurysm is an uncommon and a late complication after a blunt hepatic trauma. Although hepatic artery pseudoaneurysms may stay silent, it is usually better to treat them due to the high hemorrhage risk they cause. We are presenting a patient with post traumatic hepatic laceration who had serious bleeding with late onset after percutaneous drainage of the old hematoma. On a multidetector computerised tomography (MDCT) scan, a large hematoma surrounding a pseudoaneurysm was diagnosed which was treated with endovascular cyanoacrylate (glue) embolisation.Although meningiomas are known as slow-growing tumors, they can present accelerated growth pattern due to hormonal receptor expression during pregnancy. The authors present a foramen magnum meningioma causing rapid life threatening neurological deterioration in a 28-week pregnant woman. Possible treatment strategies for this rare clinical scenario are also discussed.

Resolution of hemifacial spasm after successful treatment of posterior fossa arteriovenous malformation by gamma knife radiosurgery

Hemifacial spasm (HFS) is a condition manifested by involunary unilateral contraction of the facial muscles. Most of symptoms ssociated with HFS result from compression of facial nerve at the oot exit zone. Such compression is usually caused by nearby vesels. Hemifacial spasm may also develop from other pathologies hat involve cerebellopontine angle (CPA), such as tumors, arterivenous malformations (AVMs), or aneurysms that impact the root xit zone of the facial nerve. Microvascular decompression (MVD) s preferred surgical treatment for most patients with HFS [1]. We eport a case of HFS caused by an AVM in CPA in which the patient as treated with gamma knife radiosurgery.