Ceren Kizmazoglu

Neuroprotective Effect of Resveratrol on Acute Brain Ischemia Reperfusion Injury by Measuring Annexin V, p53, Bcl-2 Levels in Rats

Background Cerebral ischemia is as a result of insufficient cerebral blood flow for cerebral metabolic functions. Resveratrol is a natural phytoalexin that can be extracted from grapes skin and had potent role in treating the cerebral ischemia. Apoptosis, a genetically programmed cellular event which occurs after ischemia and leads to biochemical and morphological changes in cells. There are some useful markers for apoptosis like Bcl-2, bax, and p53. The last reports, researchers verify the apoptosis with early markers like Annexin V. Methods We preferred in this experimental study a model of global cerebral infarction which was induced by bilateral common carotid artery occlusion method. Rats were randomly divided into 4 groups : sham, ischemia-reperfusion (I/R), I/R plus 20 mg/kg resveratrol and I/R plus 40 mg/kg resveratrol. Statistical analysis was performed using Sigmastat 3.5 ve IBM SPSS Statistics 20. We considered a result significant when p<0.001. Results After administration of resveratrol, Bcl-2 and Annexin levels were significantly increased (p<0.001). Depending on the dose of resveratrol, Bcl2 levels increased, p53 levels decreased but Annexin V did not effected. P53 levels were significantly increased in ishemia group, so apoptosis is higher compared to other groups. Conclusion In the acute period, Annexin V levels misleading us because the apoptotic cell counts could not reach a certain level. Therefore we should support our results with bcl-2 and p53.

Outcomes and Complications of Endoscopic Versus Microscopic Transsphenoidal Surgery in Pituitary Adenoma.

AbstractThis retrospective study aimed to define outcomes and complications of endoscopic versus microscopic transsphenoidal surgery in pituitary adenoma. Data of 94 patients who underwent transsphenoidal endoscopic (n = 45) or microscopic surgery (n = 49) between June 2000 and June 2014 for pituitary adenoma, performed at Katip Çelebi University Hospital, were retrospectively analyzed. The patients’ symptomatology, type of adenoma, radiologic findings, surgical outcomes, and preoperative and postoperative complications were investigated. The total subtotal resection rate was 73.4% (69 patients) and partial resection rate was 26.6% (25 patients). Total subtotal resection rate was 77.6% (38 patients) in the microscopic group and 68.9% (31 patients) in the endoscopic group. Total resection was seen more often in the endoscopic group than in the microscopic group, with no significant difference between the groups. Four patients (8.2%) in the microscopic group had postoperative cerebrospinal fluid leak compared with 3 patients (6.7%) in the endoscopic group. Two patients (2.1%) had hematoma, with 1 patient each in the endoscopic and microscopic group. Panhypopituitarism development rate was higher in the endoscopic group (no significant difference between the 2 groups). One patient (2%) developed blindness in the microscopic group and 1 (2.2%) had meningitis in the endoscopic group. Based on this study, the total resection rate was higher in the microscopic group than in the endoscopic group. However, outcomes and complication rate did not differ significantly between the 2 surgical techniques. Both techniques have advantages and disadvantages. Prospective randomized controlled trials should be conducted to compare the 2 surgical methods.

Are pedicular screws and lateral hook screws more resistant against pullout than conventional spinal hooks and screws in terminal vertebral segment fixation

OBJECTIVES This study aims to biomechanically evaluate and compare four well-known types of terminal spinal constructs to a novel construct composed of a transpedicular screw with a lateral hook screw in terms of axial pullout strength in terminal vertebral segment fixation. MATERIALS AND METHODS Forty fresh-frozen lamb spines were divided into five groups with eight spines each. To stabilize the transverse process, a pedicular screw alone was used in group 1, a sublaminar hook alone was used in group 2, a sublaminar hook and a pedicular screw were used in group 3, claw hook alone was used in group 4, and a pedicular screw with a lateral hook screw was used in group 5. Biomechanical tests were performed using an axial compression testing machine and two noncontact camera systems. RESULTS The mean pullout strength value was 927 N for group 1, 626 N for group 2, 988 N for group 3, 972 N for group 4, and 1194 N for group 5. Pullout strength values were statistically significantly higher in groups 3 and 4 compared to groups 1 and 2. There was no statistically significant difference between groups 3 and 4. Pullout strength value of group 5 was statistically significantly higher than the other groups. CONCLUSION Pedicular screw with a lateral hook screw had the highest fixation value. Lateral hook screw may assist to prevent pullout in patients with pullout risk and hyperkyphosis and after hyperkyphosis surgery. Further prospective clinical studies are needed to show the benefit of such a construct in reducing the risk of distal instrumentation pullout.

Lumbar Disc Herniation Associated with Contralateral Neurological Deficit: Can Venous Congestion Be the Cause?

Lumbar disc herniation (LDH) associated with a contralateral neurological deficit is sometimes encountered by surgeons. Compression against the opposite pedicle in case of a large discal herniation and prominent stenotic changes of contralateral side are held responsible for contralateral symptoms and findings. In this study, we report a case of LDH associated with a painless contralateral neurological deficit. Prominent venous engorgement and congestion at the contralateral side of discal herniation were detected during the operation. Its treatment with bipolar coagulation and significant improvement was seen after the operation.

Biomechanical comparison of intact lumbar lamb spine and endoscopic discectomized lamb spine.

OBJECTIVES This study aims to perform a biomechanical comparison of changes on motion segments after minimally invasive percutaneous endoscopically discectomized and intact spine and to investigate the effects of endoscopic discectomy on the lumbar spine of the lamb. MATERIALS AND METHODS Ten fresh-frozen lamb spines were used in this study. Percutaneous endoscopic discectomy was performed on each spine at L4-L5 level. The biomechanical tests for both intact spine and endoscopically discectomized spine were performed by using axial compression testing machine. The axial compression was applied to all specimens with a loading speed of 5 mm/min. 8400 N/mm moment was applied to each specimen to achieve flexion and extension motions, right and left bending through a specially designed fixture. RESULTS In axial compression and flexion tests, the specimens were more stable based on displacement values. The displacement values of discected spines were closer to the values of intact specimens. Comparing both groups, only displacement values of the left-bending anteroposterior test were significant (p≤0.05). CONCLUSION Percutaneous transforaminal endoscopic discectomy (PTED) has no biomechanical and clinical disadvantages. Endoscopic discectomy has also no stability disadvantages. Only anteroposterior displacement values of left bending test were statistically significant. We consider that the reason for such results were due to the fact that PTED was performed on the left side of all specimens.

Clinical outcome of surgery techniques in patients with brain abscess

1 Ceren Kızmazoglu1, Hasan Emre Aydın2, Safak Ozyoruk1, Muharrem Furkan Yuzbası1, Ismail Kaya2, Orhan Kalemci1, Mehmet Nuri Arda1 1Department of Neurosurgery, Dokuz Eylül University School of Medicine, Izmir, 2Department of Neurosurgery, Dumlupınar Unıversity Evliya Çelebi Training and Research Hospital, Kütahya, Turkey Clinical outcome brain abscess Clinical outcome of surgery techniques in patients with brain abscess

Intraparenchymal supratentorial papillary meningioma: a case report

Although intraparenchymal meningiomas have rarely been reported in the literature, the papillary type has been reported only as infratentorial. Here we report the case of a 21-year-old female patient with intraparenchymal lesion. To our knowledge, this case describes the first report of a patient with a supratentorial intraparenchymal papillary meningioma.

Dominant Occipital Sinus Complicating Surgery of a Fourth Ventricular Mass.

BACKGROUND We describe a case of a fourth ventricular mass requiring a modified approach to its management owing to a rare variation of the occipital sinus (OS). CASE DESCRIPTION A 32-year-old female presented with persistent headache and nausea. Magnetic resonance imaging revealed a fourth ventricular mass and hydrocephalus. Venous sinus anatomy appeared unusual, and thus magnetic resonance venography was performed, which identified the OS as the main drainage pathway for the entire brain, providing the sole drainage between the superior sagittal sinus and the jugular veins through the marginal sinus. Both the transverse and sigmoid sinuses were hypoplastic, and flow through the straight sinus was diminished. Thus, endoscopic third ventriculostomy and biopsy were performed as the first step. Postoperatively, the patients nausea persisted and biopsy results were inconclusive, and thus a second surgery was planned. The dural opening was tailored so as not to damage the OS and marginal sinus, and the tumor was resected subtotally through the limited dural opening. Histopathological analysis identified a low-grade glioma. CONCLUSIONS Rare variations of the venous/sinus anatomy may fundamentally change the surgical management plan, and recognizing such variations is crucial to minimizing the risk of potentially fatal complications.

Effects of Quercetin and Mannitol on Erythropoietin Levels in Rats Following Acute Severe Traumatic Brain Injury

Objective The aim of this study to investigate the normal values of erythropoietin (EPO) and neuroprotective effects of quercetin and mannitol on EPO and hematocrit levels after acute severe traumatic brain injury (TBI) in rat model. Methods A weight-drop impact acceleration model of TBI was used on 40 male Wistar rats. The animals were divided into sham (group I), TBI (group II), TBI+quercetin (50 mg/kg intravenously) (group III), and TBI+mannitol (1 mg/kg intravenously) (group IV) groups. The malondialdehyde, glutathione peroxidase, catalase, EPO, and hematocrit levels were measured 1 and 4 hour after injury. Two-way repeated measures analysis of variance and Tukey’s test were used for statistical analysis. Results The malondialdehyde levels decreased significantly after administration of quercetin and mannitol compared with those in group II. Catalase and glutathione peroxidase levels increased significantly in groups III and IV. Serum EPO levels decreased significantly after mannitol but not after quercetin administration. Serum hematocrit levels did not change significantly after quercetin and mannitol administration 1 hour after trauma. However, mannitol administration decreased serum hematocrit levels significantly after 4 hour. Conclusion This study suggests that quercetin may be a good alternative treatment for TBI, as it did not decrease the EPO levels.

Neurocysticercosis as a single lesion mimicking glial tumor

Neurocysticercosis is a well known central nervous system parasitosis around the world. The tapeworm Taenia solium is responsible for this infection. However, a single brain lesion is rarely reported. The differential diagnosis of neurocysticercosis is very important because of its misdiagnosis with many different brain lesions. We have reported a patient whose neurocysticercosis is appeared as a single lesion mimicking glial tumor. A 44yearold female patient admitted to our hospital with seizure and headache A 7-8 mm single cystic lesion which has an enhanced periferic gadolinium and surrounded by perifocal edema in the right parietal lobe was determined at magnetic resonance imaging. The lesion resection was done through a right parietal craniotomy. The diagnosis of cysticercosis was confirmed by histological examinations. Neurocysticercosis should be considered in the differential diagnosis of the solitary brain lesions.