Kemal Benli

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.

Cystic cavernous hemangioma of the cerebellopontine angle: case report.

A case of cystic cavernous hemangioma of the cerebellopontine angle is described. The clinical findings, location of the tumor, and computed tomographic findings were unusual. This rare lesion must be considered in the differential diagnosis of cystic infratentorial masses.

Neurocutaneous Melanosis Associated with Dandy-Walker Malformation

Neurocutaneous melanosis is a rare dysmorphogenesis associated with single or multiple giant pigmented cutaneous nevi and diffuse involvement of the leptomeninges anywhere in the central nervous system (CNS). It is interesting that almost 8–10% of patients had associated Dandy-Walker malformation in the literature, suggesting a common origin of the developmental abnormalities. In this article, we present a 2-year-old patient with neurocutaneous melanosis associated with Dandy-Walker malformation. We reviewed the literature and discuss the pathogenesis based on the preferred hypotheses so far.

Solitary Dural Plasmacytoma

Solitary intracranial plasmacytomas are exceedingly rare. Before this case report, only 14 cases of solitary dural and 4 cases of intracerebral plasmacytomas had been reported in the literature. We present a case of solitary plasmacytoma originating from the right frontal dura mater in a 52-year-old man; we also review the literature on the previous cases. To our knowledge, our patient is the first patient with a solitary dural plasmacytoma to be examined with magnetic resonance imaging.

Blood loss and transfusion rates during repair of craniofacial deformities.

Surgical procedures for correction of craniofacial deformities resulted in unavoidable and extensive blood loss in small children and infants. Almost all of the patients undergoing these procedures will undergo a blood transfusion either during or immediately after the operation. A retrospective review of 30 patients who underwent craniofacial surgery was performed in this study to determine the magnitude of transfusion required for craniofacial surgery, document transfusion morbidity, and identify variables associated with the transfusion. The mean estimated blood loss was 566.8 mL, the mean intraoperative transfusion was 394.8 mL, the mean postoperative transfusion was 103.2 mL, and the mean total transfusion was 505 mL. The mean operative time was 450 minutes, the mean preoperative hemoglobin and the mean postoperative hemoglobin before hospital discharge were 11.6 g/dL and 10.3 g/dL, respectively. Craniofacial surgical procedures involve extensive scalp dissection and calvarial and facial bone osteotomies in patients with a low total blood volume. Every medical and surgical strategy for minimizing the need for blood transfusion should be considered.

Solvent-dehydrated calvarial allografts in craniofacial surgery.

Craniofacial surgery almost always requires the use of bone grafting. Although autografts are the standard procedure for bone grafting, it is sometimes not possible to harvest bone, and autografts have particular risks. The use of allograft bone provides a reasonable alternative to meet the need for graft material. Solvent dehydration is a multistage procedure in which human cadaveric bone is processed by osmotic exchange baths and gamma sterilization. This processing avoids the risk of infection transmission, decreases antigenicity, and does not weaken the mechanical properties of the bone. Solvent-dehydrated, gamma-irradiated human calvarial bone allografts were used for reconstruction of craniofacial deformities in 24 patients between 1988 and 2002. Resorption of the allografts and results of the surgical intervention were evaluated with plain radiographs and three-dimensional computed tomography 12 months after surgery, in 21 patients. Serologic tests for human immunodeficiency virus-1 antibody, hepatitis B surface antigen, and hepatitis C antigen were also performed. Biopsy specimens were taken from the allografts. Average follow-up in this group was 30 months (range, 8 to 60 months), and results of serologic tests were negative in all patients. Seventy-one percent of the patients (15 of 21) showed no resorption, with partial and complete allograft fusion. One patient had nearly total graft loss and the remaining five patients had 10 to 25 percent graft resorption. Rigid fixation of the allograft, contact with the dura and periosteum, and prevention of dead spaces around the allograft are the most important factors in achieving a satisfactory result. In solvent-dehydrated bone allografts, sterilization and antigenic tissue cleaning are achieved after several steps with a minimal dose of radiation. The result is a nonantigenic, sterile mechanical scaffold that can tolerate external forces. Although autografts are the standard in craniofacial surgery, solvent-dehydrated calvarial bone allografts produced successful results in selected cases.

Congenital nasal encephalocele: a review of 35 cases

Congenital encephaloceles are rare lesions which are usually seen in the occipital region, in the West. They may rarely be seen in the frontal region and they have distinct diagnostic features, together with several other pathological conditions occurring in this region. In order to emphasize these points, a retrospective analysis of 35 cases which have been operated on in our clinic, is made in this study. The findings are compared with the data obtained from the literature.

Malignant teratoma of the cerebellopontine angle: case report.

A case of malignant teratoma of the cerebellopontine angle is presented. Preoperative findings suggested an acoustic neurinoma or a meningioma. Particularly in adulthood, malignant teratomas arising in unusual locations can simulate common intracranial tumors.

Epidural metastasis of testicular yolk sac tumor : an unusual cause of spinal cord compression

Testicular tumors in the pediatric age group are rare. Yolk sac tumor (YST) is the most common malignant tumor of germinal origin in this group, and it may spread to the retroperitoneal lymph nodes. We have been unable to find any previously published report of metastasis of testicular YST to the epidural space of the spinal cord presenting as a cause of spinal cord compression.

Mandibular reconstruction in Goldenhar syndrome using temporalis muscle osteofascial flap.

Goldenhar syndrome is a well-known developmental anomaly of the maxillofacial skeleton and hemifacial soft tissue. Maxillofacial anomalies of that syndrome can be managed by a variety of means such as inlay- or onlay-applied nonvascularized bone grafts, vascularized osteocutaneous/osseous flaps, or distraction osteogenesis. Vascularized full-thickness calvarial bone grafting is an important option for mandibular reconstruction for cases in which, for one reason or another, other techniques are not available, not applicable, or have failed. A mandibular defect of a 6-year-old boy presenting with bilateral preauricular skin tags, right microtia, right mandibular hypoplasia (with missing right condylar head and ascending ramus of the mandible) was reconstructed with right vascularized full-thickness calvarial bone grafting. Preoperative three-dimensional computed tomographic scans were used to acquire the stereolithographic biomodeling of the patient for assessing the amount of bone defect and precise planning of the surgery. Panoramic, anteroposterior, and lateral cephalograms and three-dimensional computed tomographic scans were obtained before and after the surgery and in the follow-up period for the evaluation of amount of relapse in the follow-up period. Clinical follow up and bone scintigraphy were used to assess the viability of transferred vascularized calvarial bone graft in the postoperative period. Plain radiographic evaluation with anteroposterior radiographs showed that mandibular symmetry increased and normooclusive closure of incisive teeth was achieved after surgery and retained in the postoperative period. Radiographs taken 1 year after surgery demonstrated that there was a slight relapse (1 mm) to the right side in the mandible when the results were compared with early postoperative ones. Postoperative three-dimensional computed tomographic evaluation of bony structures 3 months after operation showed that the transferred bone retained its volume. Sequential bone scintigraphies, performed to assess the vascularity of the grafts 1 week, 1 month, and 1 year after the operation, demonstrated the viability of transferred vascularized bone graft. The temporalis muscle osteofascial flap is a reliable method for mandibular reconstruction. It lessens the operative time, lessens surgical team labor, minimizes postoperative morbidity and discomfort, minimizes the hospital stay period, and minimizes financial expenses without renouncing the bone-healing capacity and increases aesthetic outcome by camouflaging the donor site scar in scalp and minimizing the facial scarring.