Hakan Tuna

Primary Intradural Extramedullary Hydatid Cyst

Spinal hydatid cysts account for 1% of all cases of hydatid disease; primary intradural hydatid cysts are uncommon. We present a case of pathologically confirmed intradural spinal cyst hydatid in an otherwise healthy patient who showed no other evidence of systemic hydatid cyst disease. The patient presented with back pain, paraparesis, and weakness. An intradural extramedullary cystic lesion was identified with magnetic resonance imaging and was shown to be a hydatid cyst by histopathologic examination after surgical removal. To our knowledge, this is the 25th case of hydatid cyst at an intradural extramedullary location reported in the literature.

Olfactory groove meningiomas.

Meningiomas originating from the olfactory groove account for approximately 10% of all intracranial meningiomas. They represent only 2% of all intracranial tumors. We present the diagnostic, clinical and pathological features of olfactory groove meningiomas and describe our surgical results and complications in a series of 25 patients. In 19 patients, surgery was via a bifrontal approach, and in the remaining six a pterional approach was used.

Aneurysmal bone cyst of the temporal bone: case report

BACKGROUND Aneurysmal bone cysts (ABCs) are uncommon lesions of the temporal bone and their occurrence in the calvarium is rare. CASE DESCRIPTION A case of a right temporal ABC is reported in a 14-year-old boy who presented swelling of the right temporal region. Magnetic resonance imaging showed a destructive and expansile bone lesion on the right anterior temporal and orbital bone. The lesion was removed in total by the right temporal craniotomy and orbitozygomatic osteotomy. ABC was diagnosed in the pathologic examination. The patient had good recovery during the postoperative course. CONCLUSIONS This report presents the diagnosis and imaging of an ABC in the temporal bone. This localization is very rare for ABC. Total excision, if feasible, is the ideal treatment.

Neuroprotective effect of mesna (2-mercaptoethane sulfonate) against spinal cord ischemia/reperfusion injury in rabbits

Although the precise mechanism by which ischemia/reperfusion injury occurs in the spinal cord remains unclear, it is evident that free oxygen radicals and apoptosis play major roles in the destruction of membrane lipids, damage to DNA and cell death. The apoptotic process involves activation of the caspase-3 cascade. Although it is widely used as a protective agent against cell injury, it is unknown whether mesna (2-mercaptoethane sulfonate) ameliorates neuronal ischemic injury. The aim of this study was to determine the effect of mesna on caspase-3 activity in a rabbit model. Adult rabbits underwent spinal cord ischemic injury via occlusion of the abdominal aorta for 20 min. Twenty-four hours after ischemia, spinal cord samples were obtained and tissue caspase-3 activity was measured. Rabbits that had been given a single dose of 150 mg/kg mesna had decreased caspase-3 activity in the spinal cord following ischemia/reperfusion injury, indicating a protective effect. However, caspase-3 activity was lower in rabbits given methylprednisolone than in those given mesna, indicating that methylprednisolone has the stronger protective effect of the two agents.

Cervical foraminal area and intervertebral height changes after titanium ring cage placement: preliminary results.

OBJECTIVE To investigate the effect of titanium ring cage implantation on cervical foraminal area and intervertebral height. METHODS Twenty-two patients with single level cervical disc herniation were enrolled in this study. All patients underwent a standard anterior cervical discectomy followed by titanium ring cage implantation. Radiographs were used for evaluation of the cervical foraminal area and intervertebral height in the pre- and postoperative periods. RESULTS Mean intervertebral heights were 0.7 +/- 0.1 cm (preoperative), 1.1 +/- 0.2 cm (early postoperative) and 0.9 +/- 0.2 (final measurement). Increase in intervertebral height at final follow-up was 0.2+/-0.1 cm (22.6+/-8.5%). Mean cervical foraminal areas were 0.4+/-0.1 cm2 (preoperative), 0.5 +/- 0.2 cm2 (early postoperative) and 0.5 +/- 0.1 cm2 (final measurement). Increase in cervical foraminal area at the final follow-up was 0.1 +/- 0.1 cm2. CONCLUSION Our study demonstrates that cervical intervertebral height and cervical foraminal area significantly increased after cervical ring cage placement but subsidence during the follow-up period negatively affects foraminal area. However, overall, there was a relative increase of foraminal area and intervertebral height when compared with preoperative values. Long-term follow-up is required to further assess the subsidence rate.

Mature teratoma of the lateral ventricle: report of two cases.

Summary In this paper, two cases with mature teratoma of the lateral ventricle are presented. Teratomas are rare intracranial tumours and the most common location is in the midline pineal region. Lateral ventricle as the site of location is very rare. Between the years 1975 and 1996, 120 cases were operated on for lateral ventricle tumours at the University of Ankara, Department of Neurosurgery, and only two cases (% 1.6) were histologically identified as mature teratomas. It is generally accepted that benign teratomas are radioresistant and total removal of these tumours results in cure. If mature teratoma of the lateral ventricle is totally removed, as done in our cases, the prognosis is usually good.

Intrasellar epidermoid cyst presenting as pituitary apoplexy.

We herein present a patient with intrasellar epidermoid cyst presenting as pituitary apoplexy, who was operated upon with a trans-sphenoidal approach. The clinical presentation, radiological and histological differential diagnosis and type of surgical intervention for intrasellar epidermoid cysts are discussed.

Chordoma of the lumbar spine: a case report

Chordomas are rare tumors and they may arise anywhere along the spinal column and clival bone. The vast majority of tumors are found at skull base and sacrum. Chordomas involving the lumbar spine are rare. Approximately 6% of spinal chordomas originate in the lumbar vertebrae. We report a case of this chordoma arising from the lumbar vertebra.

The lumbar roots and pedicles: a morphometric analysis and anatomical features.

The objective of this study was to conduct a morphometric analysis of the lumbar nerve roots and surrounding structures. In this investigation, the lumbar roots were studied in 14 cadavers (70 lumbar vertebrae). Lumbar pedicle heights and widths were measured at every level of the lumbar vertebrae. The largest mean root diameter was 5.6 mm (L5 root) and the smallest 3.5 mm (L1 root). With regard to the root-dura exit angle, the widest was measured at L1 as 26.2+/-1.6 degrees and the narrowest at L5 as 16.3+/-2.4 degrees. The widest lumbar pedicle was measured at L5 as 17.1+/-4.2 mm and the narrowest at L1 as 8.4+/-1.8 mm. The longest lumbar pedicle was measured at L2 as 15.3+/-2.2 mm and the shortest at L4 as 13.8+/-2.3 mm. Quantitative measurements of lumbar root diameters, their exit angles from the dura, and lumbar pedicle heights and widths in anatomical dissection models may help us to gain a deeper understanding of the pathologies of this region and positively influence the success of surgical interventions.

Early protective effects of iloprost after experimental spinal cord ischemia in rabbits.

Summary¶ The potential role of Iloprost, a stable analogue of prostocyclin, in treating spinal cord ischemia was investigated in rabbits subjected to aortic occlusion for 15 minutes. Ten adult rabbits weighing 2–2.5 kg received an intravenous infusion of saline (SF) as a control group and 14 rabbits received an intravenous infusion of Iloprost, 25 μg/kg/h. Iloprost infusion was started immediately after clamping of the aorta and continued 60 minutes thereafter. Cortical somatosensorial evoked potentials (CSEP) were recorded during the pre-ischemic period as a baseline and post-ischemic readings were taken at 15, 30 and 60 minutes. There was no statistically significant difference between CSEP of the saline and Iloprost treated groups (p<0.05). All animals were examined neurologically by using a modification of Tarlov scale and all subjects were then deeply anesthetized and their spinal cords were removed for light and electron microscopic examinations at 24 h after spinal cord ischemia. In order to obtain an accurate comparison of ultrastructural changes between saline treated and Iloprost treated groups, a grading scale was performed. The light microscopic and ultrastructural analysis of the Iloprost treated group revealed that there was moderate protection of the myelin and axons and edema was attenuated. Findings of this study suggest that Iloprost exerts a protective effect on spinal cord ischemia. However, further studies are needed to reveal possible mechanisms of protection provided by Iloprost.