Hulagu Kaptan

Lumbar spinal stenosis in elderly patients

Abstract:  Over a 3‐year period in our clinic, surgeons operated on 32 persons over 65 years old with lumbar spinal stenosis. This article presents the retrospective analysis of the clinical, radiological, and short‐term surgical outcomes. The stenosis seen most commonly among the elderly develops focally at the intervertebral junctions as a result of a complex process of disc degeneration, facet arthropathy, ligamentum flavum hypertrophy, spondylosis, and sometimes spondylolisthesis. All patients underwent a midline decompressive laminectomy with foraminotomies at the affected levels, and discectomy was performed in persons with lumbar disc hernia. Average age was 71.15 ± 5.09 (65–80); 50% (16) were women, and 50% (16) were men. The most frequent symptoms were pain (96.9%) and neurological claudication (90.6%). The average preoperative duration of the symptoms was 139.87 ± 115.03 weeks. The most frequent neurological symptoms were reflex disturbances (62.5%), Lasèquess sign (SLR) (+)(53%), and motor deficit (50%). The anteroposterior diameter of the spinal canal was less than 11.5 mm in 71.9% of the cases. In 62.5% of the patients, partial recovery was observed in the short term; 68.8% of the patients underwent laminectomy. Of those, 87.5% had total and 12.5% had partial laminectomies. In addition to laminectomy, discectomy was performed in 31.3% of the patients. Total laminectomy was more likely to be performed on patients older than 65 years, because the anteroposterior diameter was more likely to be below 11.5 mm in this cohort of patients. In lumbar stenosis, surgical treatment—decompression—is an effective method. Surgery has been demonstrated to be effective even in patients over the age of 75 years.

An Unappreciated Correlation : Surgical Treatment of Lumbosacral Disc Disease and Erectile Dysfunction

OBJECTIVE The aim of the present study was to assess the effect of lumbar disc herniation surgery for low back pain on the erectile functioning. METHODS Thirty-eight patients, with age ranging from 22 to 56 years, who had presented with pain due to herniated lumbar discs were included in the study. International Index of Erectile Function (IIEF) Short Form questionnaire was used to evaluate the erectile functioning. Patient visits on the 1st week,1st month and 3rd month postoperatively were analyzed. Pain scores were also noted together with side effects and the complications of the surgery. RESULTS Of the 38 patients, 18 patients had reported erectile dysfunction; 10 patients mild and 8 patients moderate erectile dysfunction. Twenty patients did not report erectile problems. The herniation levels mostly were L5-S1 in 12 (31.6%). Overall, erectile dysfunction rates have improved in 31.7% of those previously with erectile dysfunction in a 3 month period after the surgery. Best results were obtained in those patients with mild erectile dysfunction preoperatively. CONCLUSION Mild erectile dysfunction together with radiculopathy tends to improve after lumbosacral disc surgery. Moderate and severe erectile dysfunction may be related to a more severe nerve injury or to vascular and/or psychiatric factors. An evaluation of erectile functioning should routinely be performed in patients with lumbosacral disc disease both for data accumulation and for medico legal causes since the documentation of the correlation between erectile dysfunction and lumbosacral disc disease is still lacking.

Cranial Intraosseous Meningioma

Intraosseos meningiomas are rare cranial lesions. A case of 50 year-old woman with complaining of subcutaneous mass right forehead and head acne. The mass is axial views of the preoperative CT scans showing hyperostosis of the right temporal bone. The lesion was treated with wide surgical excision and cranioplasty. Histological examination of tumor specimen revealed transitional meningioma invading the skull bone. There were no postoperative complications. Patient was discharged on the third postoperative day. This article reviews the radiographic and clinical findings of patients with primary intraosseous meningiomas.

Epidemiological approach to emergent cranial surgery of cranial traumas

Objective : In this study, we aim to define the emergent cranial surgery of cranial trauma cases in terms of the reason of occurance, diagnosis, prognostic factors and results. Methods: 153 cases hospitalized in our clinic during a four year period were statistically analysed in accordance with trauma etiology, age, gender, application GCS (Glascow Coma Score) mortality rate, location and established patology. Results : 76% (116) of the 153 cases were male. The most frequent etiological reasons were, in descending order, traffic accident 52% (n = 80), fall 34% (n = 53), direct trauma to the head 14(n =20). 45% (n = 69) were diagnosed epidural haematomas, 26% (n = 40) were diagnosed depression fractures and 3% (n = 5) were diagnosed intracerebral haematomas. A meaningful statistical difference was found in the comparison of the diagnosis regarding gender (p=0,012) age group (p=0,0282) and GCS (p=0,0001). Conclusions : In order to prevent cranial traumas, studies aimed at minimizing traffic accidents should be undertaken. The most essential action after the accident has occured is triage, and this is of great importance in order to establish communication among the health institutions.