Kayaoğlu Cr

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.

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.

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.

Primary multiple hydatid cysts localizing in the petroclival area

Hydatid cyst of the posterior fossa is very rare. In this report we present a 22-year-old female who had primary multiple hydatid cysts localizing in the petroclival areas. The report is noteworthy because of the unusual location, and the cranial and spinal dissemination of cysts despite previous treatment.