İsmail Hakkı Aydin

Intramedullary spinal tuberculoma: a case report.

Study Design. A case report showing an intramedullary thoracic spinal tuberculoma secondary to pulmonary tuberculosis in a 16-year-old patient with findings of subacute spinal cord compression. Objectives. The significance and the use of magnetic resonance imaging in the diagnosis of intramedullary tuberculoma, and the treatment of the patient that involves surgically the excision of intramedullary lesion followed by appropriate antituberculous therapy. Summary of Background Data. Tuberculomas of spinal cord are rare entities. The possibility of intramedullary tuberculoma should be seriously considered when an intraspinal mass is found, provided that pulmonary tuberculosis is present in the history of the patient. Method. Th4–Th5 laminectomy was performed. Intramedullary tuberculoma was excised through a myelotomy. Antituberculous treatment was applied after the surgery. Results. Excellent clinical outcome was obtained with a combination of both medical and surgical treatments. Conclusion. The intramedullary spinal tuberculoma, although a rare entity, must be considered in the differential diagnosis of the spinal cord compression in patients with a history of tuberculosis, human immunodeficiency virus, and those who have a bad socioeconomic condition and bad nutrition habit. When confronted with a progressing neurologic deficit, a combination of microsurgical resection and antituberculous chemotherapy with the avoidance of steroids should be the choice of treatment for intramedullary tuberculomas.

The Clinical, Radiological and Surgical Aspects of Cerebral Hydatid Cysts in Children

A series of 13 pediatric patients underwent surgery for cerebral hydatid cysts at the Department of Pediatric Neurosurgery between 1993 and 2003. Headache and motor weakness were the main initial signs of these patients. A round cystic lesion was the characteristic appearance on computed tomography of each patient. Different cyst locations such as the liver, kidney or spleen were detected in 5 patients. Surgery using Dowling’s technique was performed in all patients as the main treatment. Intraoperative rupture and cyst recurrence were observed in only 1 patient. Subdural effusion, intraparenchymal air and hemorrhage were the main complications observed after surgery. None of the patients died after surgery. Because of its efficacy combined with excellent results, surgery is currently the method of choice in the treatment of cerebral hydatid cyst in children.

Heubner's artery variations in Anterior Communicating Artery Aneurysms

SummaryThis study attempts to analyse the intra-operative anatomical findings of the recurrent artery of Heubner in 48 patients with Anterior Communicating Artery Aneurysm who were operated on at the Neurosurgical Department of Atatürk University Medical School, Erzurum, Türkiye. All patients underwent radical surgery for aneurysm by the right pterional approach. The findings were recorded during surgical intervention and through the dias and videotapes of the operations. The artery of Heubner originated from the junction of the A 1 and A 2 segments of the anterior cerebral artery (ACA) in 58%, from the A 2 segment of ACA in 23%, and from the A 1 segment of ACA 4%. It was asymmetrically taking off in 13% and hypoplastic in 2% of the cases.Three types of recurrent artery courses were defined. The type I or the superior course was seen in 71 %, the type II or the anterior course was found in 25% and type III or the posterior course was recorded in 4% of patients.We concluded that the recognition of the anatomical variations of the recurrent artery of Heubner and the detailed knowledge of the microvascular relationships of the anterior communicating artery (ACoA) complex, will allow neurosurgeons to construct a better and safer microdissection plan, to save time, and so prevent postoperative neurological deficit.

The variations of sylvian veins and cisterns in anterior circulation aneurysms: An operative study

SummaryThe anatomical variations of Sylvian vein and cistern were investigated during the pterional approach in 230 patients with 276 aneurysms of anterior circulation arteries, that were operated on at the Neurosurgical Department of Atatürk University Medical School, Erzurum, Turkiye. All patients underwent radical surgery for aneurysm by the right or left pterional approach. The findings were recorded during surgical intervention and observed through the slides and videotapes of the operations.In our study, we surgically classified the variations of the Sylvian vein, according to its branching and draining patterns. Type I: The fronto-orbital (frontosylvian), fronto-parietal (parietosylvian) and anterior temporal (temporosylvian) veins drain into one sylvian vein. Type II: Two superficial Sylvian veins with separated basal vein draining into the sphenoparietal and Rosenthals basal vein. Type III: Two superficial Sylvian veins draining into the sphenoparietal and the superior petrosal veins. Type IV: Hypoplastic superficial Sylvian vein and the deep one. Four types of Sylvian vein variations were defined as follows. The Type I was seen in 45% (n = 103), the Type II was found in 29% (n = 67), Type III was recorded in 15% (n = 34) and Type IV, or hypoplastic and deep form was discovered in 11% (n = 26) of patients. The course of the Sylvian vein was on the temporal side (Temporal Coursing) in 70 percent of the cases (n= 160), on the frontal side (Frontal Coursing) in 19% of the patients (n = 45) and in 8 percent of the cases (n= 18) in the deep localization (Deep Coursing). Only 3 percent of the cases (n = 7) showed a mixed course. The variations of the Sylvian cisterns were classified into three types, according to the relationships between the lateral fronto-orbital gyrus and the superior temporal gyrus. In Sylvian Type, the frontal and temporal lobes are loosely (Sylvian Type A, Large) or tightly (Sylvian Type B, Close and Narrow) approximated on the surface thereby covering the area of the Sylvian cistern. In frontal type, the proximal part of the lateral fronto-orbital gyrus herniated into the temporal lobe. In temporal type, the proximal part of the superior temporal gyrus herniated into the lateral fronto-orbital gyrus. The variations of the Sylvian cisterns in 230 patients were as follows: in 31% (n = 71) Sylvian Type A, in 21% (n = 48) Sylvian Type B, in 34% (n = 78) Frontal Type, and in 14% (n = 33) Temporal Type.We concluded that venous perfusion disorder of the brain is the most important factor during the pterional approach. Careful intraoperative assessment and protection of the Sylvian vein, which is a surgical pitfall, is an indispensable part of the operation. The recognition of the anatomical variations of the Sylvian vein and cistern, and the detailed knowledge of the microvascular relationships at that level will allow the neurosurgeon to construct a better and safter microdissection plan, to save time and can prevent postoperative neurological deficits.

The variations of lenticulostriate arteries in the middle cerebral artery aneurysms

SummaryThis study attempts to analyse the intra-operative anatomical findings of the lenticulostriate artery (LSA) in 60 patients with middle cerebral artery (MCA) aneurysms who were operated on at the Neurosurgical Department of Atatürk University Medical School, Erzurum, Türkiye.All patients underwent radical surgery for aneurysm by the right or left pterional approach. The findings were recorded during surgical intervention using slides and videotapes of the operations. On average there were 4 (range, 1–14, total number=240) LSAs, in one hemisphere, per case with MCA aneurysm. Twenty percent of LSAs (n=48) arise from the prebifurcation part of the M1 segment, 65% (n=156) arise from the postbifurcation part of the M1 segment, and 15% (n=36) arise from the proximal part of the M2 segment. The great majority of the LSAs (85%, n=204) orginated along the proximal part of the MCA. Of a total of 240 LSAs, 125 (52%) originated from one single large vessel, a stem artery which then divided after 2–10 mm into many branches, 85 (35%) originated as two large proximal trunks, and 30 (13%) originated as multiple small arteries arising along the whole infero-medial wall of the M1 segment of MCA.We concluded that recognition of the anatomical variations of the LSA and detailed knowledge of the microvascular relationships of the MCA aneurysms, will allow neurosurgeons to construct a better and safer microdissection plan, to save time, and to prevent postoperative neurological deficits.

A preliminary histopathological study of the effect of agmatine on diffuse brain injury in rats

The present study evaluates the effects of agmatine on histopathological damage following traumatic injury using a clinically relevant model of diffuse brain injury. A total of 27 male Sprague-Dawley rats weighing 200-225 g were anaesthetised and subjected to head trauma using Marmarous impact-acceleration model. The rats were then separated into two main groups: one was treated with agmatine and the other with saline for up to 4 days immediately after head trauma. Rats from both groups were killed 1, 3 or 8 days post-injury. The brains were examined histopathologically and scored according to the axonal, neuronal and vascular changes associated with diffuse brain injury. There were no significant differences between the groups at 1 day or 3 days after trauma, but evaluation after 8 days revealed a significant improvement in the group treated with agmatine. Our data indicate that agmatine has a beneficial effect in diffuse brain injury and should be trialled for therapeutic use in the management of this condition.

Treatment of spinal hydatid disease: a single center experience.

In Turkey, spinal hydatidosis remains a serious health problem that is associated with high morbidity and mortality. This study was undertaken to analyze the clinical, radiological, and surgical aspects and outcomes for five patients with spinal hydatidosis who were treated surgically at the Department of Neurosurgery of Ataturk University, Turkey. Despite the introduction of modern surgical and pharmacological therapy the disease remains difficult to cure, and patient outcomes are not satisfactory because of the high incidence of recurrence.

Postoperative anosmia after removal of pituitary gland adenomas using the pterional approach

SummaryThere have been several studies on anosmia following operations on anterior circulation aneurysms, but no similar study has yet been reported on pituitary gland adenomas which required the transcranial approach.In this study, 38 cases with pituitary gland adenomas, for whom the pterional approach was employed, were observed retrospectively from the point of view of postoperative olfactory nerve function.In the postoperative period only one case complained of impaired sense of smell on the operated side. Eight cases objectively showed olfactory nerve disfunctions. The olfactory nerve function could be preserved at a relatively high rate of 79 per cent. This high rate, we think, resulted from the microtechnique employed as well as the relatively cautious frontal retraction which was less than 1,5 cm.

Alveolar echinococcosis of the brain in five patients.

Cerebral alveolar echinococcis is a biologically aggressive infestation that mimics a malignant neoplasm radiologically and macroscopically. This paper describes the clinical and radiological aspects of the disease, with new diagnostic studies, and discusses the surgical treatment of this infestation. The records of five patients with cerebral alveolar echinococcis treated at our center between 2000 and 2004 were reviewed. Three patients underwent radical surgical treatment and received antihelminthic therapy post-operatively, two of whom experienced asymptomatic recurrence. Two patients with multiple lesions were treated with antihelminthic therapy alone. The prognosis was poor for these patients. Radical surgery combined with antihelminthic therapy of sufficient duration are mandatory to prevent the progression of symptoms but the disease continues to be difficult to cure.

The effect of very early cisternal irrigation on basilar artery spasm after SAH in the rat model

SummaryThe authors have investigated the effect of very early irrigation of the cerebrospinal fluid (CSF) space in the haemorrhage rat model of vasospasm. Fifteen rats had basilar cistern irrigation with physiological saline for 3 hours after subarachnoid haemorrhage (SAH), and fifteen control rats had subarachnoid haemorrhage without irrigation of clot.The changes in basilar arteries diameters were determined by angiograms obtained from the rats. The post haemorrhage angiograms showed significant basilar artery spasm in both groups (P⩽0.0005, t-test). However in the last angiogram the basilar artery diameter was found to have the same value measured before subarachnoid haemorrhage in the irrigation group whereas no obvious change was observed in the control group. In the irrigation group the mean diameter of the basilar artery in the last angiogram was 0.412 mm. (0.30 mm to 0.50 mm). None of the animals, treated by cisternal irrigation, showed angiographic vasospasm while the latter group did (P⩽0.0005). Animals treated with physiological saline irrigation had a median clot grade of 0.40 (range grade 0 to 2); control rats had a median grade 2.86 (range grade 1 to 4, P<0.001, Mann-Withney U test), on the brain stem, indicating significant reduction of clot by lavage.In conclusion, performance of experimental physiological saline irrigation at a very early time after subarachnoid haemorrhage prevents the arteriographic and morphological changes of both acute and late vasospasms.