M. Mustafa Aldur

Complications of endoscopic surgery of the pituitary adenomas: analysis of 570 patients and review of the literature

Endoscopic transsphenoidal surgery is emerging as a minimally invasive and maximally effective procedure for pituitary adenomas. In this report we analyzed the complications in 624 procedures of endonasal transsphenoidal endoscopic surgery in the treatment of 570 patients with pituitary adenomas. The leading author (MB) operated pituitary adenomas via pure endoscopic endonasal transsphenoidal surgery between January 2006 and August 2011 at the Hacettepe University, Department of Neurosurgery in Ankara. Complications were assessed in 624 surgical procedures under five groups; rhinological, CSF leaks, infection, vascular and endocrinologic complications. We observed a total of 76 complications (12.1%). Rhinological complications occurred in 8 patients (1.3%): 4 epistaxis (0.6%) and 4 hyposmia (0.6%). Postoperative CSF leaks occurred in 8 patients (1.3%), and infectious complications occurred in 8 patients: 3 cases of sphenoidal sinusitis (0.4%), 5 cases of meningitis (0.8%). Only 1 case of internal carotid aneurysm rupture during the opening of sellar floor (0.16%) was observed. Endocrinologic complications occurred in 51 (8.1%) patients: Anterior pituitary deficiency in 12 (1.9%), transient diabetes insipidus (DI) in 29 (4.6%), permanent DI in 3 (0.4%) and inappropriate antidiuretic hormone secretion syndrome occurred in 7 (1.1%). There was no mortality directly related to the surgical procedure. The complication rates observed in our study suggests that the endoscopic pituitary surgery is at least as safe as microscopic transphenoidal surgery. These rates were obtained with due experience and well-coordinated teamwork. To further improve these rates, new technological developments will be helpful.

Variations in anatomy at the suprascapular notch possibly causing suprascapular nerve entrapment: an anatomical study

The purpose of the study was to determine anatomical variations at the suprascapular notch for better understanding of possible predisposing factors for suprascapular nerve entrapment. We dissected 32 shoulders of 16 cadavers between the ages of 39 and 74 years. We observed abnormally oriented superior fibers of the subscapularis muscle in five shoulders of the 16 cadavers, which were covering the entire anterior surface of the suprascapular notch and significantly reducing the available space for the suprascapular nerve. We also detected anterior coracoscapular ligament in six of the 32 shoulders, and calcified superior transverse scapular ligament in four of the shoulders. In this study, we classified the variations for the superior transverse scapular ligament. In conclusion, knowing the anatomical variations in detail along the course of the suprascapular nerve might be important for better understanding of location and source of the entrapment syndrome, especially for individuals who are involved in violent overhead sports activities such as volleyball and baseball. To our knowledge, close relationship of subscapularis muscle with the suprascapular nerve as a possible risk factor for suprascapular nerve entrapment has not been mentioned previously.

Hippocampus, glucocorticoids and neurocognitive functions in patients with first-episode major depressive disorders

The aim of this study was to determine whether there was any relationship between hippocampal volume, and glucocorticoid regulation, and cognitive dysfunctions in drug-naïve major depressive disorder (MDD) patients during their first episode. Twenty drug-free female MDD patients in their first episode and 15 healthy females as control subjects were included in the study. All subjects underwent 3.0 Tesla (T) magnetic resonance imaging (MRI), comprehensive neuropsychological testing and dexamethasone suppression tests (DST). The volumes of the right and left hippocampus of the patients were found to be significantly smaller than those of the controls. Patients were found to have significantly lower scores on measures of attention, working memory, psychomotor speed, executive functions, and visual and verbal memory fields. The performance of the patients only in the recollection memory and memory of reward-associated rules were positively correlated with hippocampal volumes. The volumes of the left and right hippocampus did not correlate with basal or post-dexamethasone cortisol levels. Our findings indicate that depressed patients have smaller hippocampi even in the earlier phase of their illness. Further research efforts are needed to explain the mechanisms that are responsible for the small hippocampus in depressed patients.

Frequency of septum pellucidum anomalies in non-psychotic population: a magnetic resonance imaging study.

This prospective MRI investigation was performed to investigate septum pellucidum (SP) anomalies in 505 (242 male, 263 female) non-psychotic persons. The mean age of the population was 39.179±0.904 (40.461±1.395 male, 38±1.166 female). There was no significant difference between the means of age in the male and female groups (t-test, DF=479, p>0.05). The SP anomalies were classified as cavitation anomalies (Type I) and absence of the SP (Type II). Type I anomalies were subdivided into four groups as isolated cavum septi pellucidi (Ia), cavum septi pellucidi et cavum vergae (Ib), anterior small triangular cavities (Ic), and cysts of the SP (Id). The incidences of the anomalies (Type I+Type II) were 17.31%, 1.89%, 7.55%, 3.53%, 7%, 4.55%, 4.76% and 6.06% for the age groups of 0-9, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69 and 70-79 years respectively. The anomalies were very significantly more frequent in the 0-9 years age group than in the other age groups (chi2=9.7858, DF=1, p<0.05). The incidences of the anomalies (Type I+Type II) were 6.34%, 5.37%, 7.22% for the whole, male, and female populations, respectively. These values were 1.39%, 1.65% and 1.14% for Type Ia, 2.77%, 2.89% and 2.66% for Type Ib, and 1.78%, 0.83% and 2.66% for Type Ic. Both Type Id and II anomalies were determined in only one case for each group in females (0.2%). There was no significant difference between the incidences of the anomalies in both sexes (chi2=0.45, DF=1, p>0.05).

Unreported anatomical variation of septum pellucidum.

During gross anatomy dissections of the brain, a developmental abnormality of the septum pellucidum was found in a 31‐year‐old male cadaver. Other parts of the central nervous system in this cadaver were normal in every aspect. Histological samples were taken from the neighboring areas of this abnormality, and they were examined under light microscope and scanning electron microscope. In this abnormality of the septum pellucidum, the two laminae of the septum pellucidum were fused together and there was a hole located 1 cm anterior to its apex. The maximum diameter of the hole was 0.5 cm in the sagittal plane and 0.6 cm in the vertical plane. In the light microscopic and scanning electron microscopic examinations, the free margin of this foramen was regular, and the surrounding tissue was intact and histologically unique to the septum pellucidum. Ependymal cells were present at the free margin of the foramen. Cavum vergae, cavum septum pellucidum, and agenesis of the septum pellucidum are described in the literature. These three abnormalities are seen in cadavers usually with histories of schizophrenia and other psychiatric or neurologic disorders. In a retrospective study, the cadaver with this abnormality had a history of schizophrenia and no history or signs of any kind of brain or head operation. As far as we could ascertain, the abnormality described here has not been reported previously. Clin. Anat. 10:245–249, 1997.

Multiple variations in the azygos venous system: a preaortic interazygos vein and the absence of hemiazygos vein

Abstract. Multiple variations of the azygos venous system were detected during routine dissection. The hemiazygos vein was underdeveloped. On the left side of the thorax, posterior intercostal veins between the 8th and 11th intercostal spaces and the subcostal vein drained into the azygos vein independently. In addition, the posterior 4th, 5th, 6th and 7th intercostal veins united and formed two superior and inferior trunks. The superior common trunk, at the level of the T4 vertebra, crossed the vertebral column obliquely, lying anterior to the aorta and posterior to the esophagus, opening into the azygos vein at the level of the T4 vertebra. The other structures in this part were normal. There were different courses of the azygos vein system. This variation is important in mediastinal surgery and also in the interpretation of radiographs.

A case with dextrocardia, ventricular septal defect, persistent left superior vena cava and drainage of the great cardiac vein into the left internal thoracic vein

A 17-month-old female patient was operated on for ventricular septal defect and pulmonary stenosis. During the operation several cardiac anomalies were observed these were dextrocardia, ventricular septal defect, persistent left superior vena cava, drainage of the great cardiac vein into the left internal thoracic vein and a pericardial pouch. These anomalies have not previously been reported together.

An anomalous course of the interazygos vein.

SummaryDuring an anatomic dissection of the posterior mediastinum, an unusual course of the interazygos v. was noted. The hemiazygos v. ascended to the 8th thoracic vertebra, in front of the vertebral column. It left the column, ascending obliquely, and passing in front of the aorta and behind the oesophagus. This transverse segment, crossing the midline, is called the interazygos v. It may be confused with different lesions situated at this level: aneurysm, tumour or lymph node hypertrophy, during CT or MRI studies. Secondly, the surgeon must be aware of this azygos variation as a possible cause of haemorrhage during a procedure in this region.RésuméLors d’une dissection anatomique du médiastin postérieur, un trajet inhabituel de la v. interazygos a été constaté. La v. hemiazygos montait jusqu’ à la huitième vertèbre thoracique, en avant de la colonne vertébrale. Elle quittait la colonne, obliquement ascendante, passant en avant de l’aorte et en arrière de l’oesophage. Ce segment transversal, croisant la ligne médiane, est appelé la v. interazygos. On peut la confondre avec différentes lésions siégeant à ce niveau: anévrysme, tumeur, hypertrophie lymphonodale, lors d’une exploration par CT ou IRM. En second lieu, l’opérateur doit être conscient de cette variation azygos, cause possible d’hémorragie lors d’une intervention dans cette région.

ELECTRON MICROSCOPIC EXAMINATION OF THE MYELINATED AXONS OF CORPUS CALLOSUM IN PERFUSED YOUNG AND OLD RATS

In this study, the myelinated axons of parts of the corpus callosums of young and old rats were examined under the electron microscope and a grading system was performed for quantiating the ultrastructural pathological changes of these axons. Except the old splenium group, the only ultrastructural pathological change, observed in the myelinated axons was the separation in myelin configuration. In addition to this finding, in the old splenium group, in some of the myelinated axons, an interruption was observed in the myelin configuration. Additionally, these ultrastructural pathological findings were present in the larger sized myelinated axons of the corpus callosum.

Multiple variations of the deep artery of arm: double deep artery of arm and deep artery of arm with the superior ulnar collateral artery: A case report

Multiple variations of the deep artery of arm were observed during routine gross anatomic dissection of the right upper extremity of a 54-year-old male cadaver. In this case study, a double deep artery of arm and the deep artery of arm with the superior ulnar collateral artery were reported. The anatomic origin of the deep artery of arm is variable. In the literature, a double deep brachialis since its origin is reported in 0.7% and the deep brachial with the superior ulnar collateral artery in 22.3%. Such variations are considered to be occurring during embryologic development. These type of variations are important both in surgical and clinical situations.