Hakan Cakin

Is the Elapsed Time following the Placement of a Ventriculoperitoneal Shunt Catheter an Individual Risk Factor for Shunt Fractures

In this study, we examined whether the resistance of peritoneal catheters against the retraction force changed over time following shunt placement, and the role of this resistance in shunt fracture is discussed. We investigated peritoneal catheters removed from patients treated with a ventriculoperitoneal shunt because of hydrocephalus; previously, patients underwent shunt revision. The maximum tension, maximum elongation and elongation percentages of the peritoneal catheters were measured. The mean and maximum tension values of the revised peritoneal catheters were increased compared to the unused catheters. The maximum elongation and elongation rates were significantly decreased. The changes in the maximum elongation, elongation rate and tension values were unrelated to the time elapsed after catheter insertion. This finding indicates that the time elapsed following peritoneal catheter placement was not an individual factor based on the strength of the response of the organism to the foreign body and the mechanical trauma exposed in shunt fractures.

How innocent is corpus callosum dysgenesis

Background/Aims: We aimed to investigate the relationship between corpus callosum dysgenesis (CCD) and associated asymptomatic closed spinal dysraphisms (CSDs). Methods: 2,840 pediatric patients who were referred to our outpatient clinic between the years 2005 and 2013 with the diagnosis of microcephaly, macrocephaly, congenital hydrocephaly, epilepsy, mental-motor retardation and suspicion of intracranial mass were evaluated. Eighty-five patients were identified with a CCD by cranial magnetic resonance imaging (MRI). The 85 patients with CCD were evaluated by whole spinal vertebral MRI for possible CSD and the results were evaluated. Results: 31/85 (36.4%) patients (20 males, 11 females) were detected to have radiological findings of CSD. The most common radiological finding was a low-lying conus medullaris, either alone, or as part of a multiple pathology in 26 of the 31 patients, followed by diastematomyelia in 16 of 31 cases and spinal lipoma in 4 of the 31 cases. Conclusion: When the neuroaxis emerges as a whole, the structures of embryological ectodermal origin and cranial and spinal structures are not independent regions from each other and thus, asymptomatic CSDs have been demonstrated to accompany CCD. In diseases of neural origin in which early diagnosis is of the utmost importance, each case with dysgenesis, diagnosed incidentally or during differential diagnosis, should be evaluated for possible CSD and should be treated with a multidisciplinary approach before any neurological deficit appears.

Smartphones and Programmable Shunts: Are These Indispensable Phones Safe and Smart?

OBJECTIVE This study aimed to determine whether smartphones affect programmable shunts. METHODS iPhone 5S (Apple Inc., Cupertino, CA, USA) and Samsung Galaxy S5 (Samsung Electronics, Gumi, South Korea) smartphones were chosen for this study. For both phones, magnetic field mapping was performed with 3-dimensional magnetic scanning systems constructed with high-precision motorized stages, and a Hall effect sensor was used to measure the flux density on the smartphone surface. The distance (h) between the distal outlet of the reservoir and the rugby ball of the Strata valve (Medtronic Inc., Minneapolis, MN, USA) was measured using highly sensitive microanalysis optical method. During optical microanalysis, while keeping a 3-cm distance between the valve and the magnetic generator, the h value (μm) was recorded for different magnetic flux densities (MFDs). Then, direct x-ray radiography was performed for radiologic assessment after each process under different magnetic fields. For analysis of the Codman Certas valve (Codman Neuro, Raynham, MA, USA), the magnet orientation and the angle between the magnet with the tantalum ball were measured with the same optical analysis. RESULTS Maximum MFDs found 62 G for iPhone 5S and 61 G for Samsung Galaxy S5. When the magnetic generator formed a current at 0, 30, 60, and 90 G, the h values of the Strata valve adjusted to 100 mm H2O opening pressure were 320, 280, 190, and 175 μm, respectively. When the magnetic generator was removed from the environment, the h value returned to 320 μm. In direct graphs taken after each optical analysis at different Gauss values, substitution was not observed at the indicator. The angle in the Codman Certas valve was 123.9°, 112.5°, and 103.6° at the magnetic flux densities of 0, 60, and 90 G, respectively. When the magnetic field was removed (0 G), the angle was still 103.6°, suggesting an irreversible effect in the shunt construct. CONCLUSIONS Smartphones exert reversible effects on Strata programmable valves without producing remarkable radiologic findings and irreversible effects on Codman Certas valves.

Evaluation of cortical brain parenchyma, by diffusion and perfusion mri, before and after chronic subdural hematoma surgery

AIM To evaluate microcirculatory changes in neighboring parenchyma as a result of pressure due to chronic subdural hematoma (CSDH) in early and late periods after hematoma drainage. MATERIAL AND METHODS The subject group consisted of 25 patients who underwent CSDH drainage. Brain diffusion and perfusion magnetic resonance images (MRIs) were obtained preoperatively, and at 48 hours (early period) and 2 months (late period) postoperatively. Measurements were performed on 1 cm2 regions of interest (ROI) in the neighboring parenchymal tissue. RESULTS The early postoperative diffusion values showed improvement compared to the preoperative values. The late postoperative values showed improvement compared to the preoperative and early postoperative values. The early postoperative perfusion values showed slight decline compared to the preoperative values. However, the late postoperative values showed improvement compared to the preoperative and early postoperative values. CONCLUSION The fact that there was an increase in diffusion values from early to late postoperative periods, compared with the preoperative period, indicates that the beneficial effects of surgery increase over time. Brain perfusion was found to be slightly decreased in early postoperative period. Following CSDH drainage, neurological deteriorations are observed in some patients in the early postoperative periods; a slight impairment in perfusion may account for this. However, during the late postoperative period, perfusion was seen to recover prominently.

The Comparison of the Application of Percutaneous Transpedicular and Extrapedicular Vertebroplasty: Which Approach has Better Results?

Background:Vertebral compression fractures are a common complication of various pathologies. Vertebroplasty is a choice in these fractures, but the approach to the fractured vertebra corpus with this technique is relatively an important issue. Patients and Methods:In this retrospective study, we evaluated and compared 90 patients with vertebral fractures treated with extrapedicular or transpedicular vertebroplasty, with respect to visual analog score (VAS), cement leakage risk, postoperative bed rest time, and postoperative analgesic use. Results:Our retrospective study showed that intraspinal canal and intervertebral cement leakage were lower in the extrapedicular group than in the transpedicular group (1 vs. 3 and 3 vs. 6). In addition, postoperative bed rest time and postoperative anagesic use were higher in the transpedicular group than in the extrapedicular group (24 vs. 15 h and 7 vs. 3 d). When compared, the extrapedicular group had lower cost and first-year VAS than the transpedicular group, despite preoperative VAS being higher in the extrapedicular group. Conclusions:Our comparative retrospective study showed that extrapedicular approach has better results with respect to VAS, cement leakage risk, postoperative bed rest time, and postoperative analgesic use. In addition to these advantages, extrapedicular approach may have some potential complications, but these complications may be prevented from meticulous manipulations.

Primer Bir Psikiyatrik Bozukluğu Taklit Eden Spontan Rüptüre İntrakraniyal Dermoid Kist

We discussed the case of a 14-year-old patient with acute onset of psychiatric symptoms for two months who had been examined and different antipsychotic drugs had been prescribed by several psychiatrists without any neuroradiological imaging. Because of unresponsiveness to the antipsychotic drugs, computed tomography and magnetic resonance imaging were performed which revealed a ruptured intracranial dermoid cyst. The patient underwent surgery and antipsychotic medications were withdrawn in short time. The emphasis of this case is that intracranial lesions can present with neuropsychiatric symptoms and findings only without any neurological deficit or signs.

Migration of fragments into the spinal canal after intervertebral polyethylene glycol implantation: an extremely rare adverse effect

Percutaneous intervertebral hydrogel (polyethylene glycol) implantation is a current treatment procedure that aims to restore hydration of a degenerated disc. There have been a few studies that claim that polyethylene glycol is successful for pain relief as the intervertebral space restores its hydration and elasticity. This procedure is reported to be indicated for discogenic low-back pain and mild radicular pain as it contributes to disc restoration. In this report, the authors describe the case of a 43-year-old woman who was admitted with low-back and right leg pain. Muscle strength in dorsiflexion of the right ankle and right toe was 3/5. The patient had undergone hydrogel implantation for L4-5 intervertebral disc restoration 2 days prior to presentation. There was a significant increase in the patients complaints after hydrogel implantation, and acute weakness in the right ankle and toe had developed. Magnetic resonance imaging of the lumbar vertebrae, which was performed before the hydrogel implantation, showed a significant narrowing of the L4-5 disc space height, and a disc herniation that extended to the right neural foramen and caused compression of the dural sac. The patient underwent surgery immediately. The sequestered disc fragment that caused a prominent stenosis in the spinal canal, as well as hydrogel fragments, was removed. There was an improvement in the patients complaints and motor deficit postoperatively. In this paper, a very rare complication is reported. In patients who have increased pain after intervertebral hydrogel implantation and who develop a neurological deficit, the migration of the applied material into the spinal canal should be considered.

Free floating ventricular shunt catheter between lateral ventricles: a case report of an unusual ventriculoperitoneal shunt complication.

Ventriculoperitoneal (VP) shunt proximal tip disconnection is rarely seen as a shunt complication. Shunt dysfunction and hydrocephaly can develop due to this disconnection. Presented here is a case of a disconnection of the ventricular catheter from the shunt valve, which passed between both lateral ventricles by free floating in the brain CT. The patient was operated on for hydrocephaly. The dysfunctional shunt valve and peritoneal catheter were removed and a new VP shunt system was implemented. Although some publications report that the ventricular catheter can be disconnected from the shunt valve, can adhere to the intraventricular structures, and can be a source of infection, no studies similar to the current case were found in the literature reporting a free floating ventricular catheter between the lateral ventricles.