Enis Kuruoglu

Circumferential stabilization with ghost screwing after posterior resection of spinal metastases via transpedicular route.

Various surgical methods have been described for treating spinal metastases, namely, en bloc spondylectomy, minimally invasive techniques, and anterior and posterior approaches. The main goals in surgical intervention for these lesions are tumor removal and establishment of strong, durable stabilization. The least invasive method is always preferred. Posterior transpedicular spondylectomy meets all these needs, as this method achieves tumor excision and stabilization of the anterior and posterior spine through one posterior incision and in the same surgical session. The surgeon circumferentially excises a spinal metastasis and then achieves circumferential stabilization in the same session. Numerous circumferential stabilization methods have been used to date, including placement of free bone grafts or cages or acrylic grafts, or insertion of an acrylic graft supported by a Steinmann pin anteriorly and by posterior transpedicular fixators or a Luque rectangle posteriorly. This article describes seven cases of spinal metastasis in which an alternative circumferential stabilization technique known as “ghost screwing” was performed. The first step in this method is circumferential decompression, achieved with laminectomy followed by eggshell corpectomy via the transpedicular route. Then a short segmental transpedicular stabilization system is fixed to the vertebrae cranial and caudal to the laminectomy/corpectomy defect. Prior to fixing the rods in place, an additional screw is mounted on each rod such that the screw shaft protrudes into the defect space. Once the rods are fixed and the two extra screws are optimally positioned, acrylic bone cement is introduced into the defect site, encasing the ghost screws and forming an anterior graft upon hardening. The outcomes in our cases were excellent. All seven patients had uneventful postoperative periods and all experienced pain relief and were able to mobilize early. Direct connection of the anterior acrylic graft to the posterior fixation system via ghost screws makes this system strong and durable, and prevents subsidence or horizontal displacement of the graft. Such complications can be serious issues with other circumferential systems that use independent anterior and posterior fixators.

Localized Spontaneous Subarachnoid Hemorrhage as First Manifestation of Cerebral Venous Thrombosis

Cerebral venous thrombosis (CVT) may rarely manifest itself with pure subarachnoid hemorrhage (SAH). For a neurosurgeon, spontaneous SAH always suggests vascular pathologies as aneurysms or malformations. However, though rarely encountered, a spontaneous SAH may be an initial finding of CVT that requires prompt diagnosis with venous angiography to initiate treatment with anticoagulants. Obviously those are contraindicated in aneurysmal subarachnoid hemorrhage. Literature review discovered additional cases presented in this article. CVT may manifest itself with subarachnoidal hemorrhage atypically with a localized pattern rather than diffuse blood. A spontaneous subarachnoidal hemorrhage in atypical localization may be related to venous thrombosis and radiologic evaluation of cerebral venous system should be one of the initial diagnostic efforts in neurosurgical practice of such cases for early initiation of treatment with anticoagulants.

Proconvulsant effect of papaverine on penicillin-induced epileptiform activity in rats

AIM Papaverine is a vasodilator agent that is an opium alkaloid. It exhibits its effects by inhibiting the phosphodiesterase enzyme. Papaverine administration is widely used to avoid symptomatic vasospasm after subarachnoid hemorrhage. We aimed, in this research, to study the effects of papaverine on the epileptic discharges stimulated by penicillin. MATERIAL AND METHODS Adult female Wistar rats (220±30 g) were included in this research (n=30). Rats were anesthetized with urethane (1.25 g/kg) and then the left cerebral cortex was reached by opening a burr hole with a drill. Penicillin G sodium salt (500 IU)(200 IU/1 μl) was injected into the left lateral ventricle to produce epileptiform activity. Thirty minutes before penicillin G sodium injection, papaverine was administered at doses of 5, 10, 20 or 40 mg/kg intraperitoneally. RESULTS There was no significant difference in spike frequency between the control group and the groups given 5 mg/kg, 10 mg/ kg or 40 mg/kg papaverine, while 20 mg/kg papaverine significantly increased the spike frequency (p < 0.05). CONCLUSION Papaverine augments the epileptiform activity produced by penicillin injection. It is important to remember that papaverine might induce convulsions in patients who have epilepsy. More research is required to understand the mechanisms of the proconvulsant influence of papaverine in epilepsy.

Processes Petrolingualis of the Foramen Lacerum and Relationship with the Internal Carotid Artery

DOI: 10.4328/JCAM.4798 Received: 03.09.2016 Accepted: 03.10.2016 Printed: 01.05.2017 J Clin Anal Med 2017;8(3): 198-201 Corresponding Author: Enis Kuruoglu, Department of Neurosurgery, Ondokuz Mayis University, Medical Faculty, 55139 Samsun, Turkey. T.: +90 3623121919/2629 F.: +90 3624576041 E-Mail:drenis@hotmail.com Özet Petrolingual ligamentin üst sınırı, lacerum kısımdan internal karotid arterin kavernöz kısmının belirlenmesi için bir göstergedir. intrakranial anevrizmaların varlığını veya yokluğunu değerlendirmek için, bu çalışmaya dahil edilen hastalar bilgisayarlı tomografik anjiografi ile değerlendirildi. Görüntüleme verileri tıp (DICOM) formatında dijital görüntüleme için saklanmış ve ardından üç boyutlu görüntüleri nörovasküler görüntülere dönüştürmek için görüntüleme yazılımı ile analiz edilmiştir. 54 hastanın (27 erkek ve 27 kadın) nörovasküler görüntülerinden oluşturulan üç boyutlu hacim görüntüleri petrolingual çıkıntıyı analiz etmek için değerlendirildi. Tüm olgularda, petrolingual çıkıntı iç (temporal kemiğin petrous kısmı) ve yan (sfenoid kemik) tarafından belirlenmiştir. Bu kemik çıkıntı üç boyutlu bilgisayarlı tomografik anjiyografi yapılan hastalarda internal karotid arter sınıflandırılmasında kullanılabilir. Bu çalışmada, çıkıntının şekli ve onun karotid arter ile ilişkisi tanımlanmıştır.

Postlaminectomy bone and scar formations in presence of Ankaferd Blood Stopper and bitter melon (Momordica charantia); an experimental study.

AIM A quantitative model of postlaminectomy was designed in rats. The effects of Momordica Charantia (MC) and Ankaferd blood stopper (ABS) on the bone and scar formation after laminectomy were concurrently evaluated. MATERIAL AND METHODS Eighteen adult Wistar albino rats underwent lumbar laminectomy at L2-L3 vertebral levels, and were randomly assigned to one of three groups of six rats each. The Treatment group received MC and ABS treatment and the Control group was left untreated. Rats were sacrificed 4 weeks after treatment. Then; the lumbar spine was excised en-block, fixed and decalcified. Sections were stained with hematoxylin and eosin (H&E) and Massons trichrome, and evaluated for peridural fibrosis (PF), new bone formation, and vascular proliferation. RESULTS Total volume of new bone in the MC group was significantly increased in comparison to the Control group (p < 0.05). Also; there was highly significant increase in terms of the total volume of fibrous tissue in the MC and ABS groups when compared with the Control group (p < 0.01). Besides; there was a highly significant difference between the MC and the Control groups (p < 0.01) in point of total volume of vessel. CONCLUSION Both MC and ABS are not convenient to prevent the PF formation and MC may promote new bone formation and angiogenesis after lumbar laminectomy in rats.