Eyyub S. M. Al-Beyati

Olfactory functions after transsphenoidal pituitary surgery: Endoscopic versus microscopic approach

Olfactory disturbances could be observed following transsphenoidal pituitary surgeries. To our knowledge, no previous comparative studies on olfactory functions after transsphenoidal endoscopic and microscopic approaches have been performed.

CT-guided percutaneous cordotomy for intractable pain in what is more than a disease: lung malignancies.

AIM Lung cancer is the leading cause of cancer-related mortality worldwide. Pain is a common problem in these patients, yet inadequate or dissatisfactory management is prevalent. MATERIAL AND METHODS Between 1987 and 2012, 224 patients with intractable pain were treated with computerized tomography (CT)- guided cordotomy. Among them, 210 had intractable pain due to malignancies. The majority of the cases were diagnosed as pulmonary malignancies (108 patients). Sixty-seven were pulmonary carcinoma, 26 mesothelioma and 15 Pancoast tumors. RESULTS After cordotomy, 98.13% of cancer patients reported initial pain relief. Minimum and maximum preoperative scores of the Karnofsky Performance Scale were 20 and 70, versus postoperative scores of 40 and 90 (p < 0.001). The median preoperative VAS score was 8 (6-9). On the first postoperative day, the score dropped sharply to 0 (0-8) (p < 0.001). In this selected series of 108 percutaneous cordotomy procedures, as well as in the total series of 224 patients, there was no mortality or major morbidity. CONCLUSION CT-guided percutaneous cordotomy is an effective procedure that should be used in the treatment of cancer-related pain problems. We suggest that cordotomy should be preferred as soon as possible in patients who fail to respond to the classic analgesic therapy.

New practical landmarks to determine sigmoid sinus free zones for suboccipital approaches: an anatomical study.

Abstract Literature defines the landmarks to identify the courses and locations of the transverse and sigmoid sinuses on the outer surface of the skull and inner surface of the scalp. These natural landmarks may only be helpful after skin incision and are inadequate to determine the length and size of the skin incision. Still, there is a need to identify palpable landmarks easily to determine the ideal location to open the initial burr hole before an operation. Twenty-eight dried adult human skulls and 2 cadavers were evaluated. The zygomatic root, the inion, and the mastoid process were identified on the external, and the grooves for sigmoid and transverse sinuses, on the internal surfaces. The distances between the 3 landmarks and the midpoints, and the shortest distances of the midpoints to the border of the groove for sigmoid sinus and groove for transverse sinus were measured. Statistically significant differences were evaluated for both sides. Based on the measurements, the defined “artificial landmarks” can be considered safe points that involve no vascular structures and may be used to perform the initial burr hole during posterolateral approaches. Identification of the midpoints and palpation of the defined landmarks easily before the operation render the study feasible and practical unlike with natural landmarks. To avoid venous injury, the midpoints of mastoid-inion line and zygomatic root-inion line can be used safely in skin incision during posterior fossa approaches and craniotomy.

Surgical Management of Supratentorial Intracerebral Hemorrhages: Endoscopic Versus Open Surgery

OBJECTIVE Intracerebral hemorrhage continues to be a major global problem. No standard treatment or surgical procedure has been identified for intracerebral hemorrhages. High morbidity and mortality rates caused by conventional approaches and the disease itself have necessitated more-invasive treatment methods. The endoscopic approach is a more minimally invasive method than craniotomy, which is another alternative surgical treatment. METHODS We compared intracerebral hematoma drainage in 2 groups of 17 patients each, treated with minimally invasive endoscopic method versus craniotomy. All the patients were treated for supratentorial spontaneous hemorrhage between December 2013 and February 2017 at the Neurosurgery Clinic of Ankara University Faculty of Medicine. RESULTS We retrospectively evaluated 34 patients surgically treated between December 2013 and February 2017. All patients underwent surgery within the first 24 hours. Patients in the early surgery group had better surgical outcomes. In the neuroendoscopic group, Glasgow Coma Scale increased from 6 to 11 at 1 week postoperatively compared with 5 to 9 in the craniotomy group. CONCLUSIONS Minimally invasive endoscopic hematoma evacuation may be a good alternative surgical method for treating supratentorial spontaneous cerebral hematomas.

A curative treatment option for Complex Regional Pain Syndrome (CRPS) Type I: dorsal root entry zone operation (report of two cases).

Complex Regional Pain Syndrome Type I (CRPS-I) is a debated health problem concerning its pathophysiology and treatment strategies. A 12-year-old boy and a 35-year-old woman were diagnosed with CRPS-I at different times. They had previously undergone various types of interventions with no success. After one year of follow-up and observation, DREZ lesioning operation was performed. Afterwards, both cases had transient lower extremity ataxia. The first case was followed for 60 months with no recurrence and total cure. The second case was pain-free until the 6th month, when she required psychological support; she was followed for 33 months with partial satisfactory outcome. Although not a first-line option, DREZ lesioning procedure can be chosen and may be a curative option in selected cases of CRPS-I who are unresponsive to conventional therapies.

Effect of Riluzole on Spinal Cord Regeneration with Hemisection Method Before Injury

OBJECTIVE The pathophysiology of spinal cord injury (SCI) with the information obtained to date has not been elucidated fully. A safe drug or treatment protocol that results in cell regeneration for SCI remains unknown. Neuroprotective and neuroregenerative effects of riluzole, administered after a SCI, have been shown in experimental studies. This study aimed to investigate the effect of riluzole on neural regeneration in a rat SCI model. METHODS Thirty-two rats were divided into 8 groups, with 4 rats in each group. Hemisection method was performed after T7-T9 laminectomy. Rats were intraperitoneally aministered with riluzole (6 mg/kg). Locomotor recovery of the rats was assessed at 1 day, and 1, 2, 3, and 4 weeks after the 21-point Basso, Beattie, and Bresnahan test. Subsequently, the spinal cords of the rats were scored according to a semiquantitative grading system using a light microscope, and the numbers of myelinated axons, neurons, and glial cells were calculated. RESULTS Basso, Beattie, and Bresnahan test changes were statistically significant when groups 4-6 and 8 were compared with the other groups (P < 0.05, P < 0.00625). The results of the numbers of neurons, glial cells, and myelinated axons were statistically significant. Especially group 8, in which riluzole was administered 5 days before injury, more positive clinical and histopathologic results were obtained. CONCLUSIONS Riluzole treatment is more effective when provided before injury. Riluzole may contribute to functional recovery when used in the preoperative period in patients who are at a high risk for permanent neurologic deficit.

Coincidental feeding artery aneurysm presents during glioblastoma surgery: a case report and literature review

The medical literature reports an association between cerebral neoplasms and aneurysm formation. Some related aneurysms are detected during preoperative screening, whereas others are detected during or after surgery. We report a case of a patient with a de novo cerebral feeding artery aneurysm that we managed during glioblastoma surgery. We present a brief review of the literature on the co-existence of brain tumours, particularly that related to high-grade glioma and aneurysms. The literature discusses several mechanisms underlying tumour formation accompanied by aneurysm formation. Also some classifications were proposed grouping such aneurysms. We question the necessity for the routine use of vascular imaging for patients with glioblastoma.The medical literature reports an association between cerebral neoplasms and aneurysm formation. Some related aneurysms are detected during preoperative screening, whereas others are detected during or after surgery. We report a patient with de novo cerebral feeding artery aneurysm that we managed during glioblastoma surgery. We present a brief review of the literature on the coexistence of brain tumors, particularly that related to high-grade glioma and aneurysms. The literature discusses several mechanisms underlying tumor formation accompanied by aneurysm formation. Some classifications were also proposed for grouping such aneurysms. We question the necessity of the routine use of vascular imaging for patients with glioblastoma.

Preoperative Exposure of Sigmoid Sinus Trajectory in Posterolateral Cranial Base Approaches Using a New Landmark Through a Neurosurgical Perspective

Abstract The location of burr holes in posterolateral cranial base approaches should be appropriate to provide an adequate operative field, and surgical freedom is crucial for bone window opening. The aim of this study was to search for more convenient and easily detectable landmarks in comparison with current landmarks in posterolateral cranial base surgery. Twenty 3-dimensional reconstructed head and neck computed tomography angiography images (group 1) and 20 cadaver heads (group 2) were evaluated. An imaginary line connecting the angle of the mandible and the mastoid tip was extended upward. A second line passing through the lateral edge of the zygomatic arch was also extended posteriorly. The authors examined if the first line met with the sigmoid sinus throughout its course and determined the location of the intersection point of these 2 lines relative to the sigmoid-transverse sinus junction. The intersection point did not correspond to the sinus region in 3 images from group 1 and 4 specimens from group 2. The matching of the mandibula-mastoid line trajectory with the sigmoid sinus course was unacceptable in 4 images and 5 cadavers. For venous anatomy preservation and anatomic skull base fossa orientation during posterolateral cranial base approaches, upward extension of the mandibula-mastoid line can be a proper landmark for surgical planning in this region. The authors’ proposed superficial anatomical line and intersection point over the skull could be used as a reliable indicator for the external projection of the sigmoid sinus and an appropriate initial burr-hole location.

Fatal rupture of dissecting anterior inferior cerebellar artery aneurysm as an unexpected complication after anterior skull base surgery: a case report

Aneurysm of the anterior inferior cerebellar artery (AICA) is a very rare entity and the manifestation and manipulation of such aneurysms remain contentious. In this paper, we report a case where a successful surgery for an olfactory groove meningioma was performed and the patient discharged but readmitted to hospital with loss of consciousness and subsequently passed away three hours after re-admission. The patient was diagnosed with subarachnoid hemorrhage. The cause of the fatal subarachnoid hemorrhage was rupture of a new onsetting AICA dissecting aneurysm which had provided neither clinical nor radiological signs before the operation. We discuss the possible causes of the formation of such aneurysm.

Staged Bilateral Nucleus Caudalis DREZ Lesioning for Persistent Idiopathic Facial Pain: Exceptional Case Report

Persistent idiopathic facial pain (PIFP) is a rare but challenging type of facial pain. How to manipulate such a problem becomes more contentious in cases with bilateral complaints. In situations when conventional treatments fail to reduce the pain, some treatment options like nucleus caudalis dorsal root entry zone (DREZ) lesioning shine as valuable means of managing such intractable problems. Herein, we report an individual with bilateral PIFP in which the patient suffered from intractable pain and was the first to undergo bilateral nucleus caudalis DREZ operation for PIFP. The patient was followed up and the procedure resulted in immediate and complete pain relief.