Fatih Erdi

Primary Spinal Intradural Extramedullary Hydatid Cyst in a Child

Abstract Background/Objective: Spinal hydatid cyst is a serious form of hydatid disease affecting less than 1% of the total cases of hydatid disease. We present a case of pathologically confirmed primary intradural spinal cyst hydatid in an otherwise healthy patient who showed no other evidence of systemic hydatid cyst disease. Case Report: An 8-year-old boy presented with back pain, left leg pain, and difficulty in walking. The patient had no other signs of systemic hydatid cyst disease. An intradural extramedullary cystic lesion was identified with magnetic resonance imaging and was shown to be a hydatid cyst by histopathologic examination after the surgical removal. Conclusion: Although extremely rare, primary intradural extramedullary hydatid cyst pathology might be the cause of leg pain and gait disturbance in children living in endemic areas.

N-acetylcysteine prevents vasospasm after subarachnoid hemorrhage.

BACKGROUND This study investigated the ability of NAC to prevent cerebral vasospasm in a rabbit model of SAH. METHODS Twenty-one, male New Zealand white rabbits were randomly divided into 3 groups of 7 rabbits each: group 1 (control), group 2 (SAH only), group 3 (SAH + NAC treatment). NAC (150 mg/kg, single dose, IP) was administered just before SAH and continued until 72 hours after SAH in group 3. Animals were killed 72 hours after SAH. Tissue MDA levels, SOD, and GSH-Px activities were measured, and basilar artery cross-sectional areas, arterial wall thickness, and endothelial apoptosis in a cross section of basillary artery were determined in all groups. RESULTS Intraperitoneal administration of NAC was found to be markedly effective against developing a cerebral vasospasm following a SAH in rabbits. It could significantly reduce elevated lipid peroxidation and increase the level of tissue GSH-Px and SOD enzymatic activities. Also, NAC treatment was found to be effective in increasing the luminal area and reducing wall thickness of the basilar artery. The morphology of arteries in the NAC treatment group was well protected. NAC markedly reduced apoptotic index and protects the endothelial integrity. CONCLUSIONS This study demonstrates, for the first time, that NAC treatment attenuates cerebral vasospasm in a rabbit SAH model. NAC treatment has significant neuroprotective effect and markedly prevents cerebral vasospasm after SAH. In conclusion, the NAC treatment might be beneficial in preventing cerebral vasospasm after SAH, thus showing potential for clinical implications.

Primary lumbar vertebral hydatid cyst.

Spinal hydatid cyst is a serious and rare infectious disease. We report a case of spinal hydatid cyst at the second lumbar vertebra, and we discuss the clinical presentation, diagnosis and surgical treatment of vertebral hydatid cyst.

Effects of iloprost and piracetam in spinal cord ischemia-reperfusion injury in the rabbit.

Study design:Experimental Study.Objectives:The aim of this study was to investigate the neuroprotective effects of iloprost and piracetam on spinal cord ischemia/reperfusion (I/R) injury in the rabbit.Settings:The Experimental Research Center of Selcuk University, Konya, Turkey.Methods:A total of 24 rabbits were divided into four groups of six rabbits each, as follows: group 1 (n=6) sham, laparotomy only; group 2 (n=6) I/R; group 3 (n=6) I/R+iloprost; and group 4 (n=6) I/R+piracetam. I/R was established in groups 2, 3 and 4. Subsequently, they were followed up neurologically for 24 h until the rabbits were killed; biochemical and histopathological examinations of samples from the spinal cord were carried out.Results:Neurological examination results were significantly better in the iloprost and piracetam groups compared with the I/R group (P<0.05). Neuroprotection was achieved with iloprost and piracetam by suppressing malondialdehyde (P<0.05), increasing glutathione peroxidase activity (P<0.05) and decreasing the xanthine oxidase level. In histopathological assessment, iloprost and piracetam groups were statistically different from the I/R group in terms of the number of apoptotic neurons in gray matter and white matter, as well as in terms of degenerated neurons and glial cells (P<0.05). No statistical difference was determined between the four groups in the number of degenerated glial cells (P>0.05).Conclusion:This study has shown that iloprost and piracetam have neuroprotective effects in I/R injury both neurologically and histopathologically because of inhibition of lipid peroxidation.

Primary spinal hydatid cyst in a patient with acquired immunodeficiency syndrome

Spinal hydatid cyst is a serious and unusual infectious disease. There is little information on infections caused by cestodes in patients with human immunodeficiency virus (HIV) infection. Although infrequent, infections by cestodes constitute a cause of disease in HIV-infected patients, especially in endemic areas. This report presents, for the first time in the literature, primary spinal cyst hydatid in a patient with acquired immunodeficiency syndrome.

Endovascular treatment of complex intracranial aneurysms by pipeline flow-diverter embolization device: a single-center experience

Abstract Objective: Endovascular coil embolization has become an effective treatment modality for most intracranial aneurysms. However, complex aneurysms including large and giant aneurysms, fusiform shaped aneurysms, wide necked aneurysm, or small aneurysm that are unsuitable for coil embolization are still deterrent to be treated. Flow diversion is a novel concept that is applied in the treatment of these complex intracranial aneurysms. Method: We review the results and important features of 25 aneurysms in 24 patients who underwent endovascular treatment by using the pipeline flow-diverter embolization device. Result: At 6 month follow-up, all aneurysms (100%) showed total occlusion in our series. Only one patient who had giant vertebrobasilar aneurysm experienced major complication related to endovascular treatment. Discussion: We suggest that parent artery reconstruction via flow diversion with the PED is a valid and safe treatment modality.

Telmisartan ameliorates oxidative stress and subarachnoid haemorrhage-induced cerebral vasospasm

Objectives: Growing evidence suggests that oxidative stress is one of the factors contributing to subarachnoid haemorrhage (SAH)-induced cerebral vasospasm. SAH-induced cerebral vasospam alters thioredoxin (Trx) cycle enzymes and thioredoxin-interacting protein (TXNIP) as an important endogenous antioxidant system. In this study, we have explored the effects of telmisartan on the vascular morphological changes, endothelial apoptosis, tissue oxidative stress status and the level of Trx cycle enzymes/ TXNIP in a rabbit SAH model. Methods: Forty male New Zealand rabbits were randomly divided into five groups of eight rabbits each: control group, sham group, SAH group, SAH + vehicle group and SAH + telmisartan group. SAH was created by a single cisterna magna blood injection. SAH + telmisartan group received telmisartan treatment (5 mg/kg intraperitoneal, once daily) for 72 h. The brainstem tissue Trx1, Trx2, Trx reductase (TrxR), TrxR1and TXNIP levels were investigated. Total oxidant status (TOS), total antioxidant status (TAS), malondialdehyde (MDA) levels and tumour necrosis factor alpha (TNF alpha) levels were investigated. Basilar artery segments were investigated for cross-sectional area, wall thickness measurements and endothelial apoptosis. Results: Telmisartan treatment restored the lowered level of Trx1, TrxR, TAS and the expression of TrxR1 seen in SAH. Telmisartan treatment also decreased TXNIP expression, TOS, MDA and TNF alpha levels. Morphological changes of cerebral vasospasm were attenuated after treatment. Endothelial apoptosis significantly reduced. Discussion: Treatment with telmisartan ameliorates oxidative stress and SAH-induced cerebral vasospasm in rabbits. These effects of telmisartan may be associated with downregulation of TXNIP and upregulation of Trx/TrxR.

Congenital carotid-jugular fistula in a child: a case report.

Congenital carotid–jugular (CJ) fistula of the neck is a very rare clinical entity that has various causes. The CJ fistulas are particularly prone to complications unlike other peripheral arteriovenous fistulas. The aim of this report is to present a case of a CJ fistula between the external carotid and the external jugular vein, which was successfully closed with detachable balloon by an endovascular approach. A 14-year-old child was admitted to our clinic with a pulsatile neck swelling. There was no previous history of trauma. A high-flow fistula between the external carotid and the external jugular vein was determined. The fistula was closed with detachable balloon by an endovascular approach. The postoperative angiogram demonstrated complete resolution of the fistula. Endovascular treatment of CJ fistulas with detachable balloons is a safe and less traumatic technique and may be an effective alternative to the open surgery in selected patients.

Radiological anatomy of the C7 vertebra: Clinical implications in spine surgery

Context: This study was designed to understand and define the special radio-anatomic morphometry of C7 vertebra by using multidetector computed tomography (MDCT). Aims: The major aim of the study was to detect the gender- and side-related morphometric differences of C7 vertebra among subjects. Setting and design: Our radiology unit database scanned for MDCT sections of the C7 vertebra. Materials and Methods: A total of 214 patients (134 men, 80 women) were selected. A detailed morphometric evaluation of C7 was done. Statistical analysis used: T test, ANOVA. Lamina length (P < 0.001), pedicle length (P < 0.001), outer cortical (P = 0.01) and inner cancellous pedicle (P < 0.001) width, pedicle angle to sagittal plane (P < 0.001) values were statistically significantly different on the right versus left side. When the results were stratified by gender, lamina length, inner cancellous lamina height, pedicle length, inner cancellous pedicle height, outer cortical pedicle width, lateral mass anteroposterior length, anteroposterior length of C7 corpus, height of C7 corpus (P < 0.001), C6-7 (P = 0.013) and C7-T1disc height (P = 0.04), transverse foramina perpendicular width at C7 (P = 0.046) values were found to be statistically significantly different. Vertebral artery most commonly enters into the transverse foramina at C6 level. Conclusions: Gender and side differences are important factors for preoperative planning and showed significant differences among subjects. MDCT is a practical option for investigating the exact anatomical features of osseous structures.

Endovascular management of a collateral network aneurysm in a patient with spontaneous internal carotid artery occlusion

Spontaneous “non-moyamoya” arterial occlusion of the intracranial arteries is very unusual. Progressive occlusion of a major intracranial artery, independently from the etiology, can lead to the development of collateral arterial networks that supply blood flow to distal territories beyond the occlusion. These collateral arteries are typically small and conduct low flows, but the hemodynamic stress within them can lead to aneurysm formation within the collateral network. In this report we present a case of spontaneous internal carotid artery occlusion and collateral network aneurysm for the first time in the literature and discuss the main features of the etiology and endovascular treatment of this rare, challenging aneurysm.