Fatma Ozlen

The distribution of extracellular matrix proteins and CD44S expression in human astrocytomas

Aims of the study were: 1. to establish the prevalence of CD44 protein expression in human astrocytomas; 2. to compare the distribution of the extracellular matrix in these tumors; 3. to investigate the relation between CD 44, the extracellular matrix proteins and the histological grade of the tumor. CD44, Type IV Collagen (Col IV), Laminin (LN), Fibronectin (FN), and Tenascin (TN) expression were detected by immunohistochemistry in formalin fixed paraffin embedded tissue samples of 52 astrocytic tumors: 35 glioblastomas (GB), 7 Anaplastic astrocytomas (AA) and 10 astrocytomas (A). The localization of Col IV was observed in the basement membrane of the vessel walls in most of the astrocytomas (88.4%) with a similar pattern obtained with LN staining. 7 of 10 A (70%), 2 of 7 AA (28%) and 9 of 35 GB (25.7%) showed LN positivity. There was a negative correlation between LN expression and tumor grade (p=0.03). FN was either localized in the basement membrane or showed thick multi-layered immunoreactivity of the vessel walls. FN expression was seen in 6 A (60%), 4 AA (57%) and all of 35 GB (100%). The FN distribution was not uniform and its staining intensity showed decrease in GB. 3A (30%), 3 AA (42%), 27 GB (77.1%) showed TN expression in the vessel walls and in some tumor cells of 19 GBs. TN expression was positively correlated with the degree of vascular endothelial proliferation in GB (p<0.05). The expression of CD44s was seen as plasma membrane positivity of glioma cells in 5 of 10A (50%), 3 of 7AA (42.3%) and 29 of 35 GB (82.8%). The intensity of immunoreaction was quite strong especially near the vessels. There was a good correlation between TN and CD44s expression in human astrocytic tumors (p=0.005). No relationship was observed between GFAP, ECM proteins and CD44s expression. Both CD44s and TN expression showed increase with malignancy in astrocytomas. These findings indicated that the histological malignancy of the astrocytomas was correlated with expression of TN and CD44s. It was suggested that in astrocytomas there was a biological relationship only between CD44 and TN, but none with the other ECM proteins. TN may play a role in angiogenesis in human astrocytic tumors.

Use of Cortoss as an alternative material in calvarial defects: the first clinical results in cranioplasty.

A clinical series of 13 patients who underwent cranioplasty using a new quick setting material, namely Cortoss™ was done over 3-year period. Thus, the primary objective of this study is to evaluate the role of Cortoss™ in the treatment calvarial defects which were mainly due to trauma (4 patients), tumor or tumor-like lesions (5 patients), middle cerebral infarction (3 patients), and gun shot wound (1 patient). The surgical technique was found to be simple and effective. Long-term follow-up (mean 24.3 months) demonstrated satisfactory results in terms of surgical (functional) and cosmetic outcomes. None of the patients developed complications including infections, foreign body reactions or material leakage. The results led us to suggest that the use of Cortoss™ in the case of calvarial defects seems to be safe, effective, quick, and a feasible method for cranioplasty. We conclude that the mechanical, immunologic, and technical-grafting properties of Cortoss™, together with its superior esthetic and psychological effects, probably will make it the best material for cranioplasty.

Surgical morbidity of invasive monitoring in epilepsy surgery: an experience from a single institution.

AIM This paper aimed to provide information related to surgical and neurological complications encountered following intracranial electrode placements in patients with medically intractable epilepsy. MATERIAL AND METHODS Retrospective review of 70 patients with either subdural grid/strip or depth electrode implanted between 2004 and 2009 at the Epilepsy Unit in Cerrahpasa Medical Faculty. RESULTS A total of 276 electrode implantations were performed in 70 patients. There were no deaths related to implantation. The occurrence of infection and intracranial hematoma were found to be 1.4 and 1.4%, respectively. A total of 1 patient (1.4%) showed transient neurological complications. The rate of overall morbidity including neurological complications was found to be 4.2% (n=3). CONCLUSION Based on our experience, intracranial electrode implantation is an effective and safe method with extremely low morbidity rate, especially in experienced hands.

Surgical treatment of trigonocephaly: technique and long-term results in 48 cases.

OBJECT The authors present their experience in the surgical treatment of metopic synostosis by orbital bandeau remodeling and frontal bone rotation. The pitfalls and advantages of the surgical technique are discussed, along with the long-term clinical results in 48 consecutive cases. METHODS Forty-eight consecutive patients in whom trigonocephaly was diagnosed between 1990 and 2009 were treated with frontal bone rotation and frontoorbital bandeau remodeling. Of these patients, 38 (79%) were boys and 10 (21%) were girls. The age at the time of surgical treatment ranged between 4 and 42 months (mean ± SD 11.4 ± 8.7 months). The average follow-up period was 5.5 ± 4.2 years (range 5 months-19 years). The preoperative and latest postoperative photographs of the patients were evaluated for the following features: 1) shape of the forehead; 2) hypotelorism; and 3) temporal depression. Scores of 0, 1, or 2 were assigned for each item: 0 was normal, 1 meant moderate deformity, and 2 denoted severe deformity. RESULTS In the early postoperative period, no complications were documented. The average hospitalization period was 4 days. Follow-up radiographs or 3D CT scans were obtained at regular intervals. The mean preoperative scores for the evaluated items were 1.38 ± 0.49 for the shape of the forehead, 1.33 ± 0.48 for hypotelorism, and 1.7 ± 0.46 for the temporal depression. The mean postoperative scores were 0.06 ± 0.24 for the shape of the forehead, 0.21 ± 0.4 for hypotelorism, and 0.67 ± 0.48 for the temporal depression. Overall, the total preoperative score dropped from 4.4 to 0.93 postoperatively (p < 0.05). All the patients were contented with the cosmetic results. CONCLUSIONS Early detection and treatment of metopic suture synostosis has a significant, favorable influence on the outcomes. Good understanding of the structural abnormality and the pathophysiological mechanisms of the possible complications is very important for performing proper surgical reconstruction.

Decompressive craniectomy in patients with cerebral infarction due to malignant vasospasm after aneurysmal subarachnoid hemorrhage

Aim: The authors present their experience and the clinical results in decompressive craniectomy (DC) in patients with vasospasm after aneurysmal subarachnoid hemorrhage (SAH). Materials and Methods: Between 2002 and 2010, six patients underwent DC due to cerebral infarct and edema secondary to vasospasm after aneurysmal SAH. Four patients were male, and two were female. The age of patients ranged between 33 and 60 (mean: 47,6 ± 11,4). The follow up period ranged between 12 to 104 months (mean: 47,6 ± 36,6). The SAH grading according World Federation of Neurosurgeons (WFNS) score ranged between 3 to 5. Results: Last documented modified Rankin Score (mRS) ranged between 2 to 6. One patient died in the following year after decompression due to pneumonia and sepsis. Two patients had moderate disability (mRS of 4) and three patients continue their life with minimal deficit and no major dependency (mRS score 2 and 3). Conclusion: DC can be a life-saving procedure which provides a better outcome in patients with cerebral infarction secondary to vasospasm and SAH. However, the small number of the patients in this study is the main limitation of the accuracy of the results, and more studies with larger numbers are required to evaluate the efficiency of DC in this group of patients.

Expressions of some vital molecules: glioblastoma multiforme versus normal tissues

Abstract Objective: The aim of this study was to assess plasma and/or tissue levels of adhesion and apoptotic molecules, cytokines, nitric oxide metabolites, levels of lipid peroxidation, myeloperoxidase and superoxide dismutase in patients with glioblastoma multiforme and controls. Methods: All the molecules were evaluated in 25 tumors and 30 controls: 15 were normal healthy subjects for plasma and 15 were normal brain tissues that were collected during autopsy. Commercially available kits for measurements were used. Results: Superoxide dismutase was significantly lower in tumors, while all other molecules were significantly elevated compared to the controls (p=0·0001). Superoxide dismutase negatively correlated with plasma interleukin-1beta (p=0·04) and plasma Fas (p=0·016). Plasma intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 correlated positively with plasma 3-nitrotyrosine (p=0·019) and nitrite/nitrate (p=0·019), respectively. Furthermore, plasma interleukin-1beta also positively correlated with plasma nitrite/nitrate (p=0·003). Discussion: These results suggest that there is a complex relationship between pro- and anti-apoptotic molecules in glioblastoma multiforme pathogenesis. Thus, targeting multiple pathways with advanced chemotherapeutic agents or radiotheraupetic regimens following total resections might be helpful in patients with glioblastoma multiforme since preventing a single pathway does not seem to be reasonable.

The significance of neuron specific enolase levels in cerebrospinal fluid and serum after experimental traumatic brain damage

SummaryIn the posttraumatic period, measurement of neural tissue enzymes in serum and cerebrospinal fluid gives quantitative information about the severity of the head injury. In our study, we evaluated the relationship between the serum and cerebrospinal fluid levels of neuron specific enolase and the severity of trauma. Head traumas at different severity were applied experimentally (Mild 0.038 N, Moderate 0.057 N, Severe 0.3 N). Serum and cerebrospinal fluid levels of neuron specific enolase were measured in trauma and control groups of rats. Only in the severe trauma group, the neuron specific enolase levels of cerebrospinal fluid were significantly increased. There was no statistically significant difference between the groups when serum neuron specific enolase levels were evaluated.Our data leads us to conclude that trauma, causing significant neural damage, results in an increase in cerebrospinal fluid neuron specific enolase levels, however the serum neuron specific enolase levels do not seem to run parallel with that increase.

An experimental model of traumatic nasoethmoidal cerebrospinal fluid fistula.

Cerebrospinal fluid fistula secondary to head trauma is a potentially dangerous problem and precise localization and radical treatment is mandatory. The diagnostic technique is either computed tomography cisternography or MR cisternography. For evaluating the safety of diagnostic modalities and efficacy of treatment especially in terms of surgery, animal studies demonstrating traumatic cerebrospinal fistula model are indispensable not only for neurosurgeons but also for neuroradiologists. The authors in this paper describe a traumatic cerebrospinal fistula in an animal model using rabbits. The cerebrospinal fluid leakage was demonstrated successfully in all eight rabbits and was verified by computed tomography cisternography. The results led us to conclude that rabbit model of traumatic cerebrospinal fluid fistula is safe and has low mortality and morbidity rates. Further studies including larger number of animals should be considered in order to verify safety more accurately.

Management of Cushing's disease using cavernous sinus sampling: Effectiveness in tumor lateralization

OBJECTIVE The aim of this study was to determine the accuracy of bilateral cavernous sinus sampling (CSS) in preoperative tumor lateralization (right/left) within the pituitary in patients with Cushings disease (CD). PATIENTS AND METHODS The study consisted of 26 consecutive patients who had undergone CSS followed by transsphenoidal surgery (TS) for CD between 2000 and 2006 at our institution. The magnetic resonance imaging (MRI) of the selected patients either revealed a normal pituitary or a lesion <or=6mm within the gland. Simultaneous bilateral CSS with corticotropin releasing hormone (CRH) stimulation were performed in all cases and the data was analyzed in relation to the results of the MRI studies, intraoperative and pathological findings and the outcome. RESULTS Early remission was achieved in 23 patients (88%) and CSS predicted the correct localization of the adenoma in 22 patients (85%). No lateralization (elevated levels in both sides) was detected during CSS in two patients, due to lesions within the central part of the pituitary. In four cases, there was a false positive lateralization, in which no microadenoma could be located in the lateralized side of the pituitary, resulting in no remission. There were no complications related to the CSS. CONCLUSION CSS in CD seems to be a valuable and safe diagnostic tool, which can predict the correct location of the pituitary adenoma in 85% of the cases.

A new aneurysm wrapping material: polyglactin 910+fibrin sealant

Aneurysms experimentally induced by using the silver nitrate coagulation method in 10 Wistar Albino rats are wrapped with Polyglactin 910 and Fibrin Sealant. 6 weeks later the rats are sacrificed and compared with the control group. In the group in which Polyglactin 910 and Fibrin Sealant were used as the wrapping material, non-specific inflammatory granulation tissue development around the ancurysms is observed. We suggest that a Polyglactin 910 and Fibrin Sealant combination can be used as a wrapping material in the treatment of aneurysms where clipping is not possible.