Ismail H. Tekkök

BRUCELLOSIS OF THE SPINE

The spinal form of brucellosis is still a disabling disease in many countries outside North America and northern and central Europe. Fifteen consecutive cases of spinal brucellosis diagnosed and treated over a 20-year period were reviewed retrospectively. Six patients were farmers, while 10 patients had a history of ingestion of unpasteurized milk or other dairy products. A high index of suspicion is necessary for the diagnosis, since there are no pathognomonic signs or symptoms. Radiological assessment of the disease was reviewed and highlights in the differential diagnoses were stressed. The diagnosis was based on actual culture of Brucella bacilli in seven patients. The principal treatment of brucellosis of the spine is conservative, namely, immobilization and antimicrobial therapy. We have found both a combination of ofloxacin and rifampin and ofloxacin monotherapy efficient as the early regimens used in this series. Three patients had to undergo surgery, since a diagnosis could not be made in any other way.

Management of brain abscess in children: review of 130 cases over a period of 21 years

The data on 130 children with brain abscesses treated over 21 years (1970–1990) were analyzed retrospectively. The whole group included four infants. Chronic ear infection and cyanotic congenital heart disease were the most common predisposing factors. In infants, meningitis and/or ventriculitis were dominant in the etiopathogenesis. Cases were evaluated according to the treatment received and also according to time periods. More than half of the patients (n=74) in this series were treated by primary or secondary excision. Computed tomography (CT) facilitated the diagnosis and helped the planning of treatment. Aspiration gained increasing credit after the advent of CT. Microorganisms could be identified in 54% of the cultured specimens. Staphylococci, streptococci and Proteus were the dominating microorganisms. Penicillin and chloramphenicol have long been the mainstay of antimicrobial therapy but have recently been replaced by third-generation cephalosporins and sulbactam-ampicillin combinations. Overall mortality was 15.5% but showed a decline from 30% in the pre-CT era to 6% in the last 5 years and to zero in the last three. Neither the location nor associated heart disease contributed to the mortality, but mortality among infants was as high as 50%.

Spontaneous spinal cord herniation: case report and review of the literature.

OBJECTIVE AND IMPORTANCE Spontaneous herniation of the spinal cord substance through a previously uninjured and/or untouched dura is a very exceptional occurrence. Spontaneous spinal cord herniation, which was first reported 25 years ago, is a cause of myelopathy that is treatable but difficult to diagnose. CLINICAL PRESENTATION A 49-year-old female patient who presented with a 3-year history of a burning sensation and hyperesthesia in her right leg and a 3-month history of left leg stiffness was diagnosed as exhibiting signs of Brown-Séquard syndrome. Magnetic resonance imaging of the thoracic spinal canal demonstrated S-shaped anterior kinking and transdural herniation of the spinal cord at the T3-T4 levels. INTERVENTION The patient underwent surgery via a three-level laminectomy. The herniated part of the spinal cord was microsurgically reduced, and the dural defect was repaired with Gore-Tex membrane (WL Gore & Associates, Flagstaff, AZ). The outcome of surgery was excellent. CONCLUSION Review of the world literature revealed 29 reported cases, with 27 of these cases being published since 1990. The clinical features, radiological diagnosis, and treatment options for this unique entity are summarized, with a synopsis of numerous misconceptions that appeared in the literature. With more familiarity with and increased awareness of this entity, more cases will be diagnosed.

Vertebral Hemangioma Symptomatic during Pregnancy–Report of a Case and Review of the Literature

A spinal tumor complicating pregnancy is a rare condition. A 25-year-old woman who became paraplegic during the 35th week of her second pregnancy presented during the postpartum period. She underwent two surgical interventions, and the cord compression caused by a T5 vertebral body hemangioma with laminar involvement and extradural extension was relieved. The occurrence of vertebral hemangiomas during pregnancy is discussed; the radiological features with special reference to magnetic resonance imaging are outlined; and cases from the literature are reviewed.

Primary spinal extradural hydatid disease: report of a case with magnetic resonance characteristics and pathological correlation.

A rare case of hydatid disease of the lumbar extradural area and of the paravertebral muscles is reported. The patient underwent surgery, resulting in complete recovery. The limitations of computed tomography and the benefits of magnetic resonance imaging in forming a diagnosis are discussed. Magnetic resonance has been found to be an invaluable tool, not only in detecting the soft tissue extent of the disease but also in delineating the viability of hydatid cysts.

Anaplastic Pleomorphic Xanthoastrocytomas

Malignancy potential of pleomorphic xanthoastrocytomas (PXAs) has rather been an underestimated reality. We report the case of a 13-year-old boy who presented with signs of increased intracranial pressure. The child had been epileptic since the age of 2. Computed tomography and magnetic resonance scans revealed a huge left frontal mass. At surgery, a subtotal excision was accomplished. Histopathological diagnosis was anaplastic PXA (grade III; WHO, 2000). The tumor showed an increased mitotic index and minimal endothelial proliferation. The patient died 3.5 months later due to a fatal intracranial hemorrhage. A review of the entire PXA literature revealed 15 well-documented cases of PXA with subsequent malignant transformation and 11 cases of primary anaplastic PXA. The prognosis was grim for both subsets of patients. Anaplastic PXAs clearly represent the transition between the original PXA concept and lipidized giant-cell glioblastoma.

Congenital external carotid-jugular fistula : report of two cases and a review of the literature

Congenital arteriovenous communications involving the external carotid artery and the jugular vein(s) are exceptionally rare. We report two cases of congenital external carotid-jugular fistulae with clinical, radiological, and surgical features and a review of the literature. The prospects of endovascular treatment and the limits of surgery are discussed.

Intramedullary Epidermoid Cyst of the Cervical Spinal Cord Associated with an Extraspinal Neuroenteric Cyst

A 4-year-old girl presented with an intramedullary epidermoid cyst of the cervical spinal cord. The clinical, radiological, and surgical features and a brief critical review of the literature are included in this report. The cyst contents were removed totally in two operations. The child had a coexisting neuroenteric cyst in the posterior mediastinum. To our knowledge, this coexistence has not been previously reported. Contemporary imaging modes and prospects of the surgical treatment are discussed.

Non-acoustic tumors of the cerebellopontine angle

Abstract52 patients with non-acoustic neurinoma tumors of the cerebellopontine angle undergoing surgery over a 16 year period (1974–1989) are analyzed with regard to epidemiologic factors, presenting symptoms, neurological findings, diagnostic procedures, surgical approaches, recurrences, and longterm survival rates. Meningiomas (20 cases) and epidermoid tumors (16 cases) outnumber the rare tumors which exhibit wide histological variation. Trigeminal neuralgia was found as a significantly frequent sign of epidermoids. Total removal was possible in nine meningiomas (45%), fourteen epidermoid tumors (87.5%) and 11 (69%) mostly malignant rare tumors. There were many longterm survivors in meningioma and epidermoid groups with a median follow-up period of 4.1 years. The results are compared to those reported in the literature and a brief review of reported rare tumors of the angle is presented.

Cerebellar medulloblastomas in adults

A retrospective analysis of 32 patients older than 16 years of age treated at Neurosurgical Department of Hacettepe University within the last 30 years (1959–1988) for cerebellar medullobastoma was considered. The clinical features, treatment modalities and outcome are discussed. The survival rates for 5 and 10 years were 14% and 7% respectively. The results are compared with that of literature.