Aykut Erbengi

Spinal hydatid cysts

Eleven cases of spinal hydatid cyst are reported. The patients were admitted with symptoms of compression of the spinal cord. The cysts were localized epidurally in 10 patients and intradurally but extramedullarily in one, and were confirmed histopatholgically after surgical intervention. The results are compared with those reported in the literature. Six of the patients were female and five were male. Their ages ranged from 10 to 65 years. All of the patients were treated surgically, with an incidence of cyst recurrence of 18% and no mortality. Mebendazole (Vermox) was given to two of the patients after their operations.

Management of brain abscess in children: review of 130 cases over a period of 21 years

The data on 130 children with brain abscesses treated over 21 years (1970–1990) were analyzed retrospectively. The whole group included four infants. Chronic ear infection and cyanotic congenital heart disease were the most common predisposing factors. In infants, meningitis and/or ventriculitis were dominant in the etiopathogenesis. Cases were evaluated according to the treatment received and also according to time periods. More than half of the patients (n=74) in this series were treated by primary or secondary excision. Computed tomography (CT) facilitated the diagnosis and helped the planning of treatment. Aspiration gained increasing credit after the advent of CT. Microorganisms could be identified in 54% of the cultured specimens. Staphylococci, streptococci and Proteus were the dominating microorganisms. Penicillin and chloramphenicol have long been the mainstay of antimicrobial therapy but have recently been replaced by third-generation cephalosporins and sulbactam-ampicillin combinations. Overall mortality was 15.5% but showed a decline from 30% in the pre-CT era to 6% in the last 5 years and to zero in the last three. Neither the location nor associated heart disease contributed to the mortality, but mortality among infants was as high as 50%.

Aneurysms of the distal anterior cerebral artery: Report of 14 cases and a review of the literature

BACKGROUND Distal anterior cerebral artery aneurysms are rare and compose about 4.5% of all intracranial aneurysms. They generally arise at the bifurcation of the pericallosal and callosomarginal arteries. Their surgical approach is different from those of other anterior circulation aneurysms. These aneurysms present some special difficulties for neurosurgeons, including narrow exposure in the interhemispheric fissure, dense adhesions between the cingulate gyri, difficulty in controlling the parent artery, and the association of multiple aneurysms and vascular anomalies. METHODS Between January 1975 and May 1996, 14 cases of saccular aneurysms of the distal anterior cerebral artery were operated at the University of Hacettepe. The clinical presentations, neuroradiological findings, and operative approaches of these aneurysms were analyzed. In addition, the clinical series and isolated case reports in the English literature were also extensively reviewed. RESULTS The incidence of the aneurysms in this location was 2.8% of a total of 494 surgically treated cases in our center. Of 14 patients, eight were women and six were men. Multiple aneurysms were found in five patients (35%). All patients were operated via the interhemispheric route. Thirteen patients had good outcome and one patient died. CONCLUSIONS We believe that all difficulties related to distal anterior cerebral artery aneurysms can be minimized with sufficient knowledge of microsurgery and surgical anatomy, using microtechniques and experience.

Congenital malformations of the craniovertebral junction: Classification and surgical treatment

SummaryThe clinical, radiological and surgical findings of 56 patients with congenital malformations of the craniovertebral junction who underwent surgical intervention in the Department of Neurosurgery, Hacettepe University Medical School were reviewed. The anomalies were classified according to their embryonic origin. Forty-two cases of the series were major abnormalities formed by the combination of more than one germ layer.

Pulmonary embolism in neurosurgical patients.

BACKGROUND Pulmonary embolism continues to be a frequent cause of morbidity and mortality in neurosurgical practice. This study was designed to investigate the presence of signs and/or symptoms helpful for an early diagnosis of pulmonary embolism and to evaluate the safety of heparin treatment in neurosurgical patients. METHOD We retrospectively reviewed 37 patients with pulmonary embolism among 6081 operated patients within the past 8 years at the Department of Neurosurgery, University of Hacettepe. RESULTS The overall incidence of pulmonary embolism was 0.42% and the mortality rate was 59.4%. The patients with cerebrovascular lesions had a significantly higher risk of pulmonary embolism compared with other neurosurgical pathologies. All patients were treated with heparin and subsequent oral warfarin therapy. None had intracranial or intraspinal bleeding while receiving anticoagulant therapy. CONCLUSIONS This study demonstrates that pulmonary embolism has a high mortality rate and heparin therapy can be used safely and without fear of intracranial or intraspinal bleeding.

Intramedullary Epidermoid Cyst of the Cervical Spinal Cord Associated with an Extraspinal Neuroenteric Cyst

A 4-year-old girl presented with an intramedullary epidermoid cyst of the cervical spinal cord. The clinical, radiological, and surgical features and a brief critical review of the literature are included in this report. The cyst contents were removed totally in two operations. The child had a coexisting neuroenteric cyst in the posterior mediastinum. To our knowledge, this coexistence has not been previously reported. Contemporary imaging modes and prospects of the surgical treatment are discussed.

Acquired torticollis as the only presenting symptom in children with posterior fossa tumors

Acquired torticollis is a symptom of an underlying disorder. It requires a thorough, meticulous search for the cause, because some of the problems associated with torticollis, such as posterior fossa tumor, can be life-threatening.

Subependymal giant cell astrocytoma associated with tuberous sclerosis: diagnostic and surgical characteristics of five cases with unusual features

Five children with tuberous sclerosis and intracranial tumors were surgically treated at Neurosurgery Department of Hacettepe University School of Medicine. Two of the five patients presented with the giant cell astrocytoma filling the third ventricle. Direct surgical intervention and tumor removal was carried out in all four patients (three with a total surgical resection and one with a subtotal resection) and cerebrospinal fluid shunting procedure in one. Histopathological examination revealed giant cell astrocytomas in four patients. Postoperatively, one died and the rest four patients survived with minor focal neurologic difficulties. The surgical results and the changing concepts in the treatment of tuberous sclerosis are discussed and the literature is reviewed.

Primary multiple cerebral hydatid cysts.

Primary multiple cerebral hydatid cysts are extremely rare: In this paper, an 8-year-old male patient who has one primary cerebral hydatid cyst in each cerebral hemisphere is presented. CT findings and operation are discussed. The literature is reviewed and the incidence of multiple cerebral hydatid cyst is compared with the published reports.

Aneurysmal bone cyst of the frontal bone

Aneurysmal bone cyst rarely affects the skull. We report two cases of aneurysmal bone cyst of the frontal bone. One of the cases is associated with pregnancy. The association of pregnancy with aneurysmal bone cyst and enlargement of the aneurysmal bone cyst during the pregnancy have been discussed.