Canan Erzen

Cervical spondylotic myelopathy: surgical results and factors affecting prognosis.

OBJECTIVE A variety of factors may affect surgical outcome in patients with cervical spondylotic myelopathy. The aim of this study is to determine these factors on the basis of preoperative radiological and clinical data. METHODS To assess the factors affecting postoperative outcome after surgery for cervical spondylotic myelopathy, the clinical and radiological data of 27 patients with cervical spondylotic myelopathy were reviewed. Functional and neurological statuses were assessed using the Japanese Orthopaedic Association (JOA) scale modified by Benzel. In all patients, the effect of age, symptom duration, cervical curvature, presence or absence of preoperative high signal intensity within the spinal cord as revealed by T2-weighted magnetic resonance imaging, and diameters of the spinal canal and vertebral body on pre- and postoperative neurological statuses were investigated. Plain radiographs were obtained for all patients, magnetic resonance images for 21 patients (77.8%), computed tomographic scans for 13 patients (48.1%), myelograms for 6 patients (22.2%), and computed tomographic myelograms for 4 patients (14.8%). There were five patients with a JOA score of 10, six patients with a JOA score of 11, six patients with a JOA score of 12, four patients with a JOA score of 13, four patients with a JOA score of 14, one patient with a JOA score of 15, and one patient with a JOA score of 16. All patients underwent cervical laminectomies. The mean follow-up period was 54.1 months. The final neurological examinations revealed improvement in the JOA scores of 85.1 % of the patients. RESULTS Statistical analysis of all patients revealed mean JOA scores of 12.185 +/- 1.618 and 14.370 +/- 2.15 before surgery and at final examination, respectively. The difference between the preoperative JOA score and the final JOA score was determined to be statistically significant (P < 0.0001). Statistical analyses also showed better neurological improvement in patients younger than 60 years and in patients with normal preoperative cervical lordosis. Although patients without preoperative high signal intensity of the spinal cord showed a better improvement rate than did patients with preoperative high signal intensity, the determined difference was statistically insignificant. CONCLUSION It can be concluded that age and abnormal cervical curvature predict less postoperative neurological improvement. The presence of preoperative high signal intensity within the spinal cord may also reflect less neurological improvement.

MAGNETIC RESONANCE IMAGING CHARACTERISTICS OF BENIGN MACROCEPHALY IN CHILDREN

Benign macrocephaly of infancy is a common problem in the child neurology practice. The radiologic features of this entity are not well defined. In most of the previous studies, macrocephalic patients were evaluated by computed tomography. To define the radiologic characteristics of this entity, 20 children with macrocephaly with normal neurologic examinations were enrolled in the study. All the patients were evaluated by magnetic resonance imaging studies. Sixty-five percent of patients had enlargement of the subarachnoid space and 35% of patients had megalencephaly. None of the patients had subdural collections. The mean age of patients with enlargement of the subarachnoid space was found to be younger than those with megalencephaly. The cases with parental histories of macrocephaly demonstrated both enlargement of the subarachnoid space and megalencephaly. Our results suggest that the radiologic finding of benign macrocephaly can be both enlargement of the subarachnoid space and megalencephaly. (J Child Neurol 1999;14:678-682).

Diffusion tensor imaging of Guillain-Mollaret triangle in patients with hypertrophic olivary degeneration.

The aim of the study is to analyze diffusion tensor imaging (DTI) characteristics of the Guillain‐Mollaret triangle (GMT) in patients with hypertrophic olivary degeneration (HOD) and to investigate their correlation with previously reported histopathology. DTI was performed in 10 patients diagnosed with HOD. Fractional anisotropy, apparent diffusion coefficient, axial diffusivity, and radial diffusivity were measured in the inferior olivary nucleus (IO), the central tegmental tract, the red and the dentate nuclei, and the superior cerebellar peduncle of HOD patients and compared to age, sex, and side‐matched 10 neurologically normal population. The prominent finding on DTI in affected IO was an increase in radial diffusivity compatible with demyelination. While conventional magnetic resonance imaging did not show any sign of involvement in the other components of GMT, DTI demonstrated signal changes in all anatomical components of the GMT. Main DTI findings in GMT of patients with HOD were an increase in radial diffusivity representing demyelination and an increase in axial diffusivity that is reflective of neuronal hypertrophy. DTI parameters can reflect the spatiotemporal evolution of transneuronal degeneration associated with HOD in a manner consistent with the known pathologic stages of HOD.

Pleomorphic xanthoastrocytoma associated with von Recklinghausen neurofibromatosis.

The authors present a case of pleomorphic xanthoastrocytoma that occurred in a 14-year-old boy with von Recklinghausens neurofibromatosis. The circumscribed turmor with a cystic component was located in the medial right temporal lobe. The designation of pleomorphic xanthoastrocytoma has been suggested for this neoplasm on the basis of its unique histological features. These include positive glial fibrillary acidic protein staining.

Computed Tomography and Magnetic Resonance Imaging in Three Patients with Tolosa-Hunt Syndrome

Three patients with Tolosa-Hunt syndrome were examined by computed tomography (CT) and magnetic resonance imaging (MRI). CT of the brain did not reveal any definite abnormality in any of the patients. MRI demonstrated an abnormal soft tissue area in the cavernous sinus in only 1 patient. There was clinical improvement after corticosteroid therapy. MRI is mandatory for demonstrating lesions in the cavernous sinus or in the superior orbital fissure in patients with THS.

A new, more dependable methodology for the use of Transcranial Doppler ultrasonography in the management of Subarachnoid haemorrhage

SummaryThe role of transcranial Doppler ultrasound (TCD) in clinical decision making about vasospasm due to subarachnoid haemorrhage (SAH), shows a great variation according to neurosurgical clinics.In this prospective study, a total of 143 patients, admitted to Marmara University Department of Neurosurgery between January 1991 to March 1995 and treated surgically with the diagnosis of aneurysmal SAH, were examined by TCD. Eighty of these patients fulfilled the requirements for inclusion. In order to increase clinical dependability of TCD, a new grading system is proposed and tested in comparison with the one previously used, which takes absolute flow velocities as the main parameter in grading. The new, individually based TCD grading system is proposed to minimize the pitfalls caused by proximal stenosis, wide range of normal Vm values and proximally evolving vasospasm.We concluded that: 1) The new, individually based TCD grading system has a high degree of clinical dependability. 2) Daily TCD examinations supply reliable predictive information about developing delayed ischaemic deficit (DID). If a TCD Gr II patient shows an increase of 35cm/sec (in 24 hours) in Vm value, his probability of developing DID was found to be 60% (p<0.05); if a TCD Gr B III patient shows the same rate of increase in Vm, his probability of developing DID was 80% (<0.05). 3) TCD has an important clinical role in decision making about the management of SAH patients. 4) Surgical manipulation causes a reversible increase of one or two TCD-grades in the early postoperative days.

CT cisternography in evaluation of cerebrospinal fluid rhinorrhea

SummaryThe clinical, radiological and surgical features of 14 patients who presented with cerebrospinal fluid rhinorrhea and had undergone surgical treatment during a three-year period are given with special reference to pre-operative evaluation by CT cisternography. The merits and demerits of this technique are discussed.

Magnetic resonance imaging in the diagnosis of spinal hydatid cyst disease. Case report

A very rare case of multiple spinal hydatid disease causing paraplegia is presented. The neuroradiological evaluation included an MRI study. The surgical approach and the medical treatment of the disease is discussed, with a review of the literature.

Surgical considerations in patients with lumbar spinal root anomalies

Lumbosacral nerve root anomalies are rare and can cause diagnostic confusion. In this report we present 12 patients with lumbar root anomalies. Emphasis is placed on preoperative neuroradiological evaluation and the surgical implications of these anomalies.

Venous variations in the region of the third ventricle: the role of MR venography

In this study, we examined the anatomical variations of the subependymal veins in the region of the foramen of Monro and the third ventricle by MR time of flight (TOF) venography. Fifty healthy subjects, ten patients with third-ventricle tumors, and four patients with lateral-ventricle tumors were included in the study. The courses of the anterior septal vein (ASV), thalamostriate vein (TSV), and internal cerebral vein (ICV) were studied. The proximity of the venous angle, the false venous angle, and the ASV–ICV junction to the posterior margin of the foramen of Monro was measured. In 69 (53.9%) sides, the ASV–ICV junction was located at the venous angle and at the posterior margin of the foramen of Monro. In 59 (46.1%) sides, the ASV–ICV junction was located beyond the foramen of Monro. Our study shows the high incidence of posteriorly located ASV–ICV junctions, which can be crucial in the planning of a better surgical approach. We strongly recommend that MR venography, which is a short radiological examination, be used before one operates on third-ventricle and lateral-ventricle tumors.