Cüneyt Temiz

Clear cell meningioma: case report and literature review.

The clear cell meningioma is rare and a recently described histologic variant of meningioma. The most interesting aspect of clear cell meningioma is the high recurrence rate and agressiveness. Until now 17 intracranial clear cell meningioma cases had been reported in the English language literature. We present 2 new cases of clear cell meningioma which is discussed with the relevant literature.

Radiologic features of lumbar spine in ochronosis in late stages

Ochronosis is a rare hereditary disorder of tyrosine metabolism. Severe degenerative arthritis and spondylosis occur in the later stages of this disease. Radiologic examinations may reveal changes considered almost pathognomonic for ochronosis. We present the radiologic features of the lumbar spine in two ochronotic patients who were diagnosed after radiologic examinations in the late stages of the disease.

Effect of difluoromethylornithine on reperfusion injury after temporary middle cerebral artery occlusion

Polyamines have been shown to play an important role in the disturbance of the blood-brain barrier (BBB) in a number of pathological states including ischemia. BBB disturbances may be almost completely prevented by treating animals with the ornithine decarboxylase (ODC) inhibitor, alpha-difluoromethylornithine (DFMO). DFMO has been also shown to prevent N-Methyl-D-aspartate (NMDA) toxicity in tissue cultures. It has been suggested that the pathological disturbances in polyamine metabolism observed following cerebral ischemia, particularly the post-ischemic increase in putrescine, may contribute to the ischemic injury that is most evident in the CA1 subfield of the hippocampus. In this study, effects of DFMO in cerebral ischemia and reperfusion were examined. The results showed that inhibition of the polyamine system by DFMO decreased ischemic injury volume and brain tissue water content in a dose-dependent manner, without change in vital signs, including systemic arterial blood pressure, arterial partial oxygen pressure, regional cerebral blood flow and body temperature.

A Comparison of Bilateral Decompression via Unilateral Approach and Classic Laminectomy in Patients with Lumbar Spinal Stenosis: A retrospective Clinical Study.

AIM Bilateral decompression via unilateral approach is one of the minimally invasive methods used for degenerative spinal stenosis. The aim of this retrospective study was to observe the clinical and radiological results of classic laminectomy and bilateral decompression via unilateral approach applied for lumbar stenosis. MATERIAL AND METHODS The data of 40 patients who underwent surgical treatment for lumbar spinal stenosis with different techniques was reviewed retrospectively. The patients were divided into 2 groups according to the surgical technique. In the first group, patients underwent classic laminectomy, while in the second group patients underwent bilateral decompression via unilateral approach. Preoperative and postoperative computed tomography section areas of both groups were examined. Visual analogue scale (VAS) was used to evaluate low back and leg pain in preoperative and postoperative 1, 6, and 12 months. The two groups were compared in respect of surgery time and bleeding. RESULTS In both groups, postoperative low back and leg pain VAS scores declined compared to the preoperative condition. Low back pain VAS scores were lower at postoperartive 1, 6, and 12 months. The bleeding was higher in the 1st group, whereas the surgery time was higher in the 2nd group. CONCLUSION Bilateral decompression through unilateral approach is an effective method without instability effect, which provides sufficient decompression in the degenerative stenosis and increases patient comfort in the postoperative period.

Chondroid chordoma of the thoracic spine: case report

Sir, Chordomas are slow-growing, locally destructive tumours derived from remnants of the notochord. They occur mostly along the axial skeleton. The thoracic region is the least common area of involvement within the spine. Chondroid chordoma is defined as a chordoma with prominent cartilaginous foci, an entity which has better prognosis than classical chordoma. To our knowledge this is the first published case of chondroid chordoma in the thoracic spine. Chondroid chordoma should be considered in differential diagnosis of classical chordoma and other thoracic tumours. A 50-year-old male presented with progressive hemiparesia developing within 1 month and was admitted to the neurosurgery department of the Celal Bayar University Hospital. There was no history of trauma and his laboratory findings were normal. On computed tomography (CT) an extradurally located soft tissue mass with granular calcifications and relative stenosis of the spinal canal were seen. Lytic multiple lesions were approximately 20610 mm in size on both sides in T7, T8, T9 vertebral corpuses. On T1 weighted magnetic resonance imaging (MRI) the soft tissue mass was of predominantly low signal intensity and was causing significant compression of the cord at the level of T8. It was 40 mm in dimension at the saggital plane. The mass showed marked enhancement after contrast administration (Fig. 1). The patient underwent surgical excision as T8 corpectomy and stabilisation, followed by radiotherapy. There was no sign of recurrence 14 months post-operatively. Macroscopically, the mass was an extramedullar, encapsulated, grey-white lobular and cystic neoplasm. Microscopically, it contained areas showing chords or nests of cells with partly vacuolated cytoplasm (physaliphorous cells) embedded in a myxoid matrix and extensive cartilage formation with degenerative calcification (Fig. 2). Immunohistochemically, neoplastic cells showed strong staining for S-100 protein, vimentin, epithelial membrane antigen (EMA), pancytokeratin (Fig. 3), cytokeratin (CK)7 and CK20. Cartilaginous areas were negative except for S100 protein and vimentin. The mass was diagnosed as chondroid chordoma with these findings. Chordomas are rare locally aggressive tumours which arise from the primitive notochord. They may develop at any point along the original notochordal tract and have a slow growth pattern. Patients usually present with symptoms related to compression of the involved neural structures or other organs. Chondroid chordoma is an uncommon variant and is defined as a chordoma with prominent cartilaginous foci. Chordomas most commonly arise in the sacro-coccygeal or spheno-occipital regions. Spinal chordomas arise more frequently in the cervical than

Local Tissue Electrical Resistances in Transpedicular Screw Application in the Thoracolumbar Region.

AIM To determine local tissue electrical resistance differences generated during a screw pass from the pedicle to another tissue rather than determining all individual electrical tissue resistance values. MATERIAL AND METHODS We attempted to measure electrical resistance values of regional tissues in addition to fluoroscopic imaging during application of fixation via a transpedicular screw. We also attempted to detect local tissue electrical resistance alterations in case of malposition of the screw inside the pedicle. For this purpose, local tissue electrical resistances of 10 transpedicular tracks opened with standard track openers bilaterally in 5 vertebrae, and of spinal cord accessed by puncturing the medial walls of three vertebrae in a cadaver were measured. These resistance differences were not only measured in human cadaveric tissue but also in 36 pedicles belonging to a total of 18 vertebrae between Th 1-S1 vertebrae of a sheep cadaver. Both medial and lateral walls were drilled to measure local tissue resistance differences in a sheep cadaver. RESULTS Our results indicated that local tissue electrical resistance changes were statistically significant in both human and sheep cadaver. CONCLUSION It is possible to prevent screw malposition using a simple and cheap electrical resistance measurement. Local tissue electrical resistance measurement during transpedicular screw insertion is a safe, simple, cheap, and practical method.

A study made by using actigraphy regarding the effects on sleep of cervical disk herniation surgery

AIM To analyze the relationship between the severity of pain and sleep disorder using wrist actigraphy in patients with cervical disc herniation (CDH). MATERIAL AND METHODS Fifty patients with the diagnosis of CDH underwent subjective tests and actigraphic analysis in preoperative period, and at the end of postoperative first week and postoperative first month. The data of the subjective tests and actigraphic analysis were compared. RESULTS There was a strong and statistically significant negative correlation between the subjective tests of Visual Analog Scale (VAS) for Pain 0-1-2 and the objective parameters of Sleep Onset Latency (SOL) 0-1-2 (rs= -0.798, p=0.009 - rs= - 0.832, p=0.006 - rs=- 0.710, p=0.004). There was a positive correlation between the subjective tests of VAS for Pain 0-1-2 and the objective parameters of Sleep Efficiency (SEF) 0-1-2 (rs=0.721, p=0.006 - rs= 0.768, p=0.001 - rs= 0.748, p=0.001). CONCLUSION Actigraphy may be used for the evaluation of cervical disc surgery, as an alternative and objective test for sleep disorders.

Combined Therapy for Distant Metastasis of Sacral Chordoma

Chordomas are known as rare primary malign tumours that have formed from primitive notochord remains. Sacral chordomas grow slowly but locally and aggressively. Chordomas are locally invasive and have low tendency to metastasis and have a poor prognosis in long-term follow-up. Metastasis may be seen in a rate of 5–40% of the chordomas. Metastasis of chordomas is common in liver, lung, lymph nodes, peritoneum, and brain. The treatment approaches, including surgery, have been discussed in the literature before. Susceptibility to radiotherapy and chemotherapy is controversial in these tumours. The success of surgical treatment affects survival directly. In this report, we will report a sacral chordoma case in which an intraperitoneal distant metastasis occurred and discuss the surgical approach.

Preoperative and postoperative evaluation of somatosensorial evoked potentials of upper extremities in cervical intervertebral disc herniation.

This study aims to determine the dysfunction caused by existing pathological condition in structures involved in the transfer of sensory functions of the neural system in cervical disc herniation, and to establish whether or not the level and degree of this anatomical damage can be anticipated by SEP (Somatosensorial Evoked Potentials). We compared the obtained SEP values for statistical significance using the Friedman Variation Analysis. In parameters with statistical significance, the Wilcoxon Signed Rank test was used to identify when significant improvements occurred. The study found that the statistical data of the latency of the N14 wave originating from the dorsal column nuclei of the medulla spinalis and dorsal column gray matter improved (p < 0.05) in the postoperative period compared with the preoperative values. Using the Wilcoxon Signed Rank test, we studied postoperative months separately in regard to the difference in the latency of the N14 wave, and found the statistically significant improvement to be marked particularly in months 3 and 6 postoperatively (p < 0.05). In conclusion, we suggest that SEP is a useful tool to check the functional condition of the dorsal spinal column. The benefit of the SEP utilization is the ability to determine the severity of the pathological condition preoperatively and follow the patients functional postoperative improvement.