Firat Narin

Thalamic tumors in children.

IntroductionThalamic tumors are rare tumors which are usually diagnosed in the pediatric age group. Although recent developments in neurosurgical practice allow more radical treatments, information about outcome is scarce for these deep-seated challenging tumors.MethodsMedical records of 45 pediatric patients who presented with thalamic tumors between 1999 and 2012 were reviewed.DiscussionPrognostic implication of tumor characteristics and patient variables are discussed. Although challenging, recent innovations in the field of neurosurgery and refinements in technique may prolong survival in some cases.

Benign cerebellar pilocytic astrocytomas in children.

AIM Cerebellar astrocytomas are benign tumors of the central nervous system. They represent 10% of all pediatric intracranial brain tumors and 30% of all pediatric posterior fossa tumors especially in the first two decades of life. MATERIAL AND METHODS We reviewed the medical records of patients; age at the time of surgery, pre- and post operative magnetic resonance imaging (MRI), localisation of the tumor, hydrocephalus, surgical approach, pre- and post operative neurological status, post operative adjuvant therapy and outcome were documented. RESULTS The male to female ratio was 20/11. Age at the time of evaluation ranged from 3 to 23 years. Age at the time of surgery ranged from 1 to 18 years. Follow-up duration after surgery was 1-12 years. 55% of these tumors were located at the cerebellar vermis and 45% were at the cerebellar hemispheres. Complete surgical resection was done in 74% of these patients. 5 patients had a second operation because of residual tumor. Ventriculoperitoneal shunt insertion was performed in 3 of 31 patients because of symptomatic hydrocephalus and 1 patient had an endoscopic third ventriculostomy pre-operatively. 90% of these patients had no neurological sequelae at follow-up evaluation. CONCLUSION Cerebellar astrocytomas are benign tumors where total resection is possible in the majority of cases with an excellent outcome.

Comparison of nimodipine delivery routes in cerebral vasospasm after subarachnoid hemorrhage: an experimental study in rabbits.

BACKGROUND nimodipine is the most widely preferred and administered calcium channel blocker in cerebral vasospasm prevention and treatment. There is no experimental or clinical study investigating the comparative effects of routine treatment modalities. METHOD 35 male New Zealand White rabbits were assigned randomly to one of seven groups: Control, only SAH, SAH/oral nimodipine, SAH/IV nimodipine, SAH/IT nimodipine, SAH/IA nimodipine, SAH/angiography. FINDINGS basilar artery vessel diameters are measured by angiography. Basilar artery vessel diameters and luminal sectional areas are measured in pathology slides. Basilar artery thicknesses were significantly higher in group 2 and 7 than the others (p < 0.05). Luminal sectional areas in group 5 and 6 were significantly higher than other groups (p < 0.05). We found no significant difference in group 1, 5 and 6 (p > 0.05). Basilar section areas in group 3 and 4 were significantly higher than group 2 but lower than group 1. CONCLUSION this is the first study to show the most effective drug delivery route in CVS after SAH. Nimodipine treatment in cerebral vasospasm is useful. This study showed that selective IA nimodipine treatment and IT nimodipine treatment must be preferred to IV and oral treatments of chronic vasospasm following SAH.

Analysis of Traumatic Acute Subdural Hematomas: Outcomes and Predictive Factors In a Single Center Experience.

AIM In the present study, we evaluated the association of the Glasgow Coma Scale (GCS) score and amount of blood loss with mortality in patients presenting with traumatic acute subdural hematoma (ASDH). MATERIAL AND METHODS This retrospective study was performed on 99 patients who were operated for traumatic acute subdural hematoma (ASDH) without any systemic association at a single center. Epidural hematoma was reported to be the most common additional pathology. Age, sex, mechanism of trauma, time interval between onset of trauma and admission to the emergency ward, associated problems, thickness of hematoma and Glasgow Coma Scale (GCS) score at the time of admission and on discharge were all studied. RESULTS The GCS score was inversely proportional to the thickness of hematoma and interval between onset of trauma and surgery (p < 0.05). Although the mortality rate was reported to be high in traffic accidents, the rate was low in patients with head trauma only (p < 0.05). The mortality rate was high in patients with associated pathologies (p < 0.05). Lost patients were reported to be older patients with more extensive ASDH or those who presented earlier with a low GCS (p < 0.05). CONCLUSION ASDH is associated with high mortality. GCS score and the thickness of the ASDH are important predictors of mortality. Age, additional trauma, and interval between trauma and hospital admission are major predictive factors for mortality.

Virchow–Robin spaces cyst

IntroductionVirchow –Robin spaces (VRS) are pial-lined, interstitial fluid-filled perivascular spaces that surround the perforating cere-bral vessels. These normal anatomical structures are thoughtto be involved in the drainage of interstitial fluid and also toplay an immunomodulatory role by hosting macrophages [2,21].Theirroleinmultiplesclerosis,seniledementia,andsmallvessel disease in the elderly has recently been addressed invarious studies [3, 29, 30]. VRS are normally less than 2 mmin diameter and can be visible in basal ganglia and/orsupratentorial white matter on high-resolution magnetic reso-nance (MR) imaging of all healthy individuals [12, 26].When VRS become focally expanded, they can causeneurological symptoms resulting from mass effect. VRSdilations occur in all age groups although their frequencyand size (particularly in supratentorial white matter andbasal ganglia) was found to increase with age [8, 30].They appear in typical anatomical locations either unilat-erally or bilaterally, can be solitary or multiloculated, andmay cause non-specific neurological symptoms like head-ache. When located in mesencephalothalamic region, theycause hydrocephalus and can be misdiagnosed as cysticneoplasms [23]. Here, we briefly review relevant literatureon VRS cysts focusing on natural history, radiologicalimaging, differential diagnosis, and management options,and report on long-term follow-up of a patient withmultiloculated VRS cyst in the dorsal brainstem causinghydrocephalus and requiring surgery.Clinical presentationVRS dilations are asymptomatic unless they grossly enlargeandcauseasubsequentmasseffect[23]. The prevalence ofdilatedVRSinhealthypopulationisestimatedtobeashighas1.6–4.8 % in different studies enrolling asymptomatic indi-viduals who underwent brain imaging [7, 26]. Despite highprevalence, they are rarely seen by clinicians because mostindividuals with VRS dilations are asymptomatic.Clinical presentation depends on the degree of expansion andspace-occupying effect of the cysts. Generally, symptomsreflect the anatomical location. Nearly half of the patientssuffer from non-specific headache [23]. Vertigo, cognitiveimpairments, pyramidal and extrapyramidal signs, ataxia, vi-sual changes, oculomotor abnormalities, and seizures werealso reportedto beassociatedwith VRS cysts. Pediatric casesmay also present with developmental delay, macrocephaly,and hydrocephalus signs [4, 23].It is worth noting that VRS cysts in supratentorial whitematter, even if present across large areas, do not lead to severesymptoms in most cases. A great portion of the cases is asymp-tomaticandsomewerefoundtocauserelativelymildsymptomslike headache, memory disturban ces, hemifacial tics, dementia,seizures,etc.[7, 15, 16] However, cysts that occur inmesencephalothalamic region almost exclusively cause obstruc-tive hydrocephalus due to the compression of the third ventricleand/or aquaductus cerebri. These giant VRS cysts can alsopresentwithcranialnervesignsduetomasseffect.Theliteraturesearch through Medline (via PubMed) yielded 17 studies inwhich a total of 26 patients were reported to have giant VRScysts resulting in hydrocephalus and thus requiring surgicalintervention [1, 4–6, 9–11, 13, 14, 17, 19, 20, 22–25, 29]. Aclinico-radiological summary of these cases is given in Table 1.Radiological imaging and anatomical locationMagneticresonanceimaging(MRI)isthemodalityofchoiceforimaging VRS. Technical advances leading to high-spatial-

Topiramate as a neuroprotective agent in a rat model of spinal cord injury

Topiramate (TPM) is a widely used antiepileptic and antimigraine agent which has been shown to exert neuroprotective effects in various experimental traumatic brain injury and stroke models. However, its utility in spinal cord injury has not been studied extensively. Thus, we evaluated effects of TPM on secondary cellular injury mechanisms in an experimental rat model of traumatic spinal cord injury (SCI). After rat models of thoracic contusive SCI were established by free weight-drop method, TPM (40 mg/kg) was given at 12-hour intervals for four times orally. Post TPM treatment, malondialdehyde and protein carbonyl levels were significantly reduced and reduced glutathione levels were increased, while immunoreactivity for endothelial nitric oxide synthase, inducible nitric oxide synthase, and apoptotic peptidase activating factor 1 was diminished in SCI rats. In addition, TPM treatment improved the functional recovery of SCI rats. This study suggests that administration of TPM exerts neuroprotective effects on SCI.

The Effect of Phosphodiesterase Inhibitor Tadalafil on Vasospasm Following Subarachnoid Hemorrhage in an Experimental Rabbit Model

BACKGROUND despite the years of study on it, cerebral vasospasm following subarachnoid hemorrhage is still an important cause of mortality and morbidity. The presented study was undertaken to show whether phosphodiesterase inhibitor tadalafil can attenuate the vasospasm process following subarachnoid bleeding. METHOD in this study, 20 male New Zealand White rabbits weighing 2,500-3,000 g were randomly assigned to four groups. Animals in group 1 were controls. In group 2, animals were given oral tadalafil at 12, 24 and 36 h and SAH was not induced. SAH induced animals in group 3 did not receive any medication. In group 4, animals received tadalafil at 12, 24 and 36 h after SAH induction. All animals were sacrificed via exsanguination at 48 h after induction of SAH. Brains and brainstems with overlying basilar arteries were removed and stored in fixative at +4°C overnight. Basilar arteries were sectioned from four separate zones, and four sections were obtained from each rabbit. Basilar artery luminal section areas were measured by using SPOT for Windows version 4.1. Statistical comparisons were performed using Kruskal Wallis and ANOVA tests. FINDINGS the SAH induced group which had been treated with tadalafil had significantly greater basilar artery luminal area than the untreated group (p < 0.05). There was no significant difference between control group and non-SAH induced group in terms of luminal areas. CONCLUSION tadalafil has a potentially preventive effect in treatment of cerebral vasospasm following subarachnoid bleeding.