Kamil Melih Akay

spinal Pigmented Villonodular Synovitis : A Case Report

Study Design This case report illustrates a young male patient with thoracal spinal pigmented villonodular synovitis who presented with difficulty in walking. Objectives The treatment of this lesion with posterior approach for preventing neurological deterioration and follow‐up with magnetic resonance imaging studies. Summary of Background Data Spinal involvement of pigmented villonodular synovitis rare. It is treated by radical surgical excision. But in some cases, as in our case, surgical total excision of the lesion with a one‐stage operation is not possible. For this reason, in such cases, follow‐up studies with magnetic resonance images are sufficient. This report represents the 14th case of spinal involvement of pigmented villonodular synovitis. Methods The patient presented with difficulty walking and received surgery including posterior decompression and subtotal tumor excision. All neurologic signs and symptoms disappeared in a short period. Postoperatively, follow‐up studies with magnetic resonance imaging were performed and regrowth of residual lesion was not detected. Results The patient was discharged home without neurologic deficit. Follow‐up studies with magnetic resonance images showed no regrowth of residual lesion. Conclusions The principle of surgical management of spinal lesions causing neurologic deficit is early surgical decompression. Although pigmented villonodular synovitis requires total excision, in the presented case total excision of lesion was impossible, because vertebral body involvement needs an anterior or posterolateral approach. During the 16‐month follow up, regrowth of the lesion has not occurred. These observations indicate that surgical decompression and follow‐up of a patient with magnetic resonance imaging constitute a satisfactory treatment of pigmented villonodular synovitis.

Dorsal Bony Septum: A Split Cord Malformation Variant

Split cord malformations (SCMs) are rare spinal anomalies and their classification is still a matter of debate. There is no widespread consensus on the embryological basis of this entity. The unified theory, proposed by Pang et al. [Neurosurgery 1992;31:451–480], was an attempt to explain the embryogenetic mechanism as a basic error occurring around the time when the primitive neuroenteric canal closes. We report two unusual cases of SCMs with a dorsally situated bony spur. We analyzed the radiological, clinical and surgical features of the lesions and were not able to classify these cases according to the unified theory. Further embryological studies should be conducted to elucidate the mechanisms of occurrence of these lesions, and the dorsal bony septum variant should be considered in SCM surgery.

Surgical Outcomes of Ulnar Nerve Lesions in Children

The ulnar nerve provides the major motor innervation of the interosseous muscles of the hand and the flexor muscles of the wrist and the fourth and fifth digits. Injury is most common at the wrist, forearm or elbow, secondary to trauma or entrapment. Pediatric ulnar nerve lesions differ from adult lesions by their quicker axonal regeneration. Neural plasticity is also greater in children. We analyzed 21 pediatric patients with ulnar nerve lesion who underwent surgical treatment between 1995 and 2002 to determine if there were differences in the neurological outcome in terms of the type of lesion and surgery. Data showed that excellent results were found in 100% of the lesions treated by simple decompression and nearly 58% of the lesions treated by neurolysis. Good results were obtained in 33% of lesions treated by neurolysis. There were fair results for surgery performed in discontinuous lesions.

Surgical outcomes of cerebellar tumors in children.

Cerebellar tumors in childhood are generally associated with a favorable outcome if they are managed appropriately. 27 cases of pediatric cerebellar tumors, operated over a 7-year period, are presented. Histopathological diagnoses were as follows: pilocytic astrocytoma (48.2%); medulloblastoma (22.2%); ependymoma (18.5%); fibrillary astrocytoma grade III (3.7%); cystic oligodendroglioma (3.7%), and hemangioblastoma (3.7%). Microscopic gross total resection was achieved in 16 (59.3%) of 27 cases. The total removal of pediatric cerebellar tumors without neurological deficit is possible with appropriate microsurgical techniques excluding brain stem invasion. The follow-up periods must be shorter if brain stem invasion exists. Radiotherapy and chemotherapy are the adjuvant therapies according to the pathological diagnosis and the patient’s age.

Desmoplastic fibroma of the cervical spine

There have been only a few cases of desmoplastic fibroma of the spine in the literature and only one of them was purely located on the cervical spine. We report a new patient with the diagnosis of desmoplastic fibroma of the fourth cervical spine. The patient had the complaints of left arm and neck pain. After his radiological evaluation, a mass lesion was found on the left lamina of the fourth cervical spine. Surgical treatment was performed, and the histopathological examination revealed the diagnosis of desmoplastic fibroma. Patients with desmoplastic fibroma of the cervical spine may present with the arm and neck pain mimicking cervical disc disease. Higher index of suspicion by the clinicians must be practiced to make the appropriate diagnosis. Successful surgical outcome may be achieved in these patients.

Congenital absence of internal carotid artery associated with hypogonadotropic hypogonadism: A case report

Congenital absence of internal carotid artery is a relatively rare disorder. It may be an isolated entity or combined with other organ or system anomalies. Investigations of a 19-year-old male patient with hypogonadotropic hypogonadism and hypothyroidism suffering from intracerebral and subarachnoid hemorrhages showed absence of the left internal carotid artery. The association of endocrinologic disorders and congenital absence of internal carotid artery is discussed with the pertinent literature. In conclusion, association of the absence of internal carotid artery and hypogonadism is extremely rare. Patients with absence of internal carotid artery may also have intracerebral and subarachnoid hemorrhages and should be followed up closely.

The initial treatment of meningocele and myelomeningocele lesions in adulthood: experiences with seven patients.

This is a retrospective study of patients having undergone surgical treatment of spina bifida cystica (SBC) lesions in adulthood. The objectives were to assess the clinical, radiological, and surgical characteristics of SBC lesions in adults. There is almost no study assessing these characteristics. Seven adult male patients with SBC lesions, ages between 20 and 23 (mean 21.1), had their primary evaluations between 1995 and 1999 in the Military Hospital, Ýzmir, and Gülhane Military Medical Academy, Ankara. A temporary cerebrospinal fluid leak in the patient with the thoracic lesion and a temporary partial urinary incontinence in the patient with the lumbosacral lesion occurred. The most common preoperative complaint was low back pain. This improved in three of four patients (75%) but did not disappear. Although it is rare, an adult with an untreated SBC is a possible entity. These lesions should be included in the differential diagnosis of dorsal midline lesions in adults. Even though they appear as a simple spinal meningocele clinically, preoperative MR imaging and CT are necessary and helpful in the precise diagnosis and surgical planning.

CIRSOID ANEURYSMS OF THE SCALP

Cirsoid aneurysm of the scalp are rare disorders, they can cause headaches, excessive bleeding when traumatized, epilepsy, tinnitus, and deformity. They are currently diagnosed by digital subtraction angiography. Treatment is controversial, many options have been described. In this paper surgery was found to be effective when compared with other methods, there were fewer complications and both surgeon and patient were satisfied with the results.