Melih Bozkurt

An attempt to treat patients who have injured spinal cords with intralesional implantation of concentrated autologous bone marrow cells

BACKGROUND AIMS Spinal cord injury is common among young subjects involved in motor vehicle accidents. Mechanisms and attempts to reverse post-traumatic pathophysiologic consequences are still being investigated. Unfortunately no effective and well-established treatment modality has been developed so far. The regeneration capability of the human nervous system following an injury is highly limited. METHODS The study involved four patients (two male, two female) who had suffered spinal cord injury as a result of various types of trauma. On neurologic examination, all the patients were determined to be in American Spinal Injury Association (ASIA) grade A. All patients were treated with decompression, stabilization and fusion for vertebral trauma anteriorly, as well as intralesional implantation of cellular bone marrow concentrates using a posterior approach 1 month after the first operation. The patients were then treated and followed-up in the physical rehabilitation clinic. RESULTS At the end of the post-operative 1-year follow-up, two of the patients were classified as ASIA C while one was classified as ASIA B. One patient showed no neurologic change; none of the patients suffered from any complications or adverse effects as a result of intralesional application of bone marrow cells. CONCLUSIONS The results of this experimental study show the potential contribution of intralesional implantation of bone marrow to neuronal regeneration in the injured spinal cord, with neuronal changes. In light of the results of this experimental study, the potential for regenerative treatment in injuries of the human spinal cord is no longer a speculation but an observation.

Olfactory groove meningiomas.

Meningiomas originating from the olfactory groove account for approximately 10% of all intracranial meningiomas. They represent only 2% of all intracranial tumors. We present the diagnostic, clinical and pathological features of olfactory groove meningiomas and describe our surgical results and complications in a series of 25 patients. In 19 patients, surgery was via a bifrontal approach, and in the remaining six a pterional approach was used.

Olfactory functions after transsphenoidal pituitary surgery: Endoscopic versus microscopic approach

Olfactory disturbances could be observed following transsphenoidal pituitary surgeries. To our knowledge, no previous comparative studies on olfactory functions after transsphenoidal endoscopic and microscopic approaches have been performed.

How reliable and accurate is indocyanine green video angiography in the evaluation of aneurysm obliteration

INTRODUCTION Indocyanine green video angiography (ICG-VA) has been recently introduced into neurovascular surgery and gained a role in assessing vessel patency and obliteration of intracranial aneurysms (IA) after clipping. Although its correlation with intra-postoperative angiography was demonstrated in previous studies, difficulties in evaluating aneurysm obliteration have not been reported. We report reliability and accuracy of ICG-VA in 109 clipped aneurysms with attention given to five cases in which ICG-VA evaluation resulted in false indication that aneurysms were secure in terms of complete obliteration. MATERIALS AND METHODS A retrospective chart review was performed of IAs surgically treated by a single surgeon from January 2009. In all cases, aneurysm obliteration was confirmed by a combination of microdoppler ultrasonography (MUSG), ICG-VA, and post-operative angiography. RESULTS ICG-VA appropriately assessed vessel patency and aneurysm obliteration in 93.5% of aneurysms clipped. In four cases (3.6%), puncturing the dome of the aneurysm after satisfactory clipping revealed persistent flow within the aneurysm despite ICG-VA showing no flow after clipping. In one case (0.9%), ICG-VA showed persistent flow within the aneurysm and MUSG did not, and puncture of the dome confirmed no flow within the aneurysm. In one case (0.9%), ICG-VA failed to demonstrate residual neck. CONCLUSION ICG-VA is a simple and safe procedure and an important adjunct to microsurgical clipping of aneurysm. Although ICG-VA assesses vessel patency and obliteration of aneurysms in most cases, applying the principles of microsurgery in aneurysm clipping remains a main tool for obtaining the complete obliteration of aneurysm along with preservation of the normal vasculature.

Biomechanical comparison of inside-outside screws, cables, and regular screws, using a sawbone model

Our aim was to conduct a biomechanical comparison of the pull-out strengths of inside–outside (I/O) screws, cables, and bone screws to determine whether I/O screws provide greater pull-out resistance than cables or bone screws, and their effectiveness with the screw diameter. There is no remarkable biomechanical experimental study comparing the I/O technique with conventional spinal techniques. The diameter of the screw heads were also biomechanically tested to determine the optimal size that can be used. In this study, 45 blocks of 50×50×5 mm of “sawbone” (synthetic bone, model 1137, Pacific Research Laboratories, Vashon, WA, USA) were used as bone substitutes. Fifteen sets of 14-mm inside–outside Dynalok screws and nuts, 15 wire cables, and 15 bone screws were inserted into a separate sawbone block. An MTS Bionx materials testing machine was used to measure the load to failure of each implant. The mean values and standard deviations of each group were calculated and Student’s t-test was used for comparison. The load to failure of the inside–outside screws was significantly greater than that of the cables (p<0.0000004) and the regular bone screws (p<0.000002). The results also revealed that increasing the diameter of the head of the screw also increases the resistance against the pull-out strengths. Thus, using a larger screw in occipitocervical stabilization provides safe and stable fixation of the occipital bone to the cervical spine. This study also proved that sawbone is a useful and reliable alternative to allogenic fresh cadaveric bone grafts or animal bones for certain biomechanical testing.

Chordoma of the lumbar spine: a case report

Chordomas are rare tumors and they may arise anywhere along the spinal column and clival bone. The vast majority of tumors are found at skull base and sacrum. Chordomas involving the lumbar spine are rare. Approximately 6% of spinal chordomas originate in the lumbar vertebrae. We report a case of this chordoma arising from the lumbar vertebra.

Correlation of matrix metalloproteinase-3 expression with patient age, magnetic resonance imaging and histopathological grade in lumbar disc degeneration.

AIM The purpose of the present study is to analyze the expression of matrix metalloproteinase-3 (MMP-3), magnetic resonance imaging (MRI) grading and histopathological alterations of the intervertebral disc (IVD) for correlations with each other and with the age, gender and low back pain duration of the patients who had undergone operations for lumbar disc herniation (LDH). MATERIAL AND METHODS Forty-two patients were admitted to our clinic with signs of LDH and underwent surgery for LDH at 48 IVD levels. In all cases, specimens for histological and immunohistochemical analyses were removed from the IVD space. Lumbar IVD degeneration on MRI of the 48 IVDs from which surgical specimens had been obtained was classified into five grades using the Pfirrmann classification. RESULTS In the degenerated IVD, the expression of MMP-3, MRI grading and histopathological alterations of the IVD displayed significant correlation. Increased age is closely related with aforementioned alterations. There was no correlation between MMP-3 expression and age, gender and duration of the pain. CONCLUSION For evaluating and treating IVD degeneration, MRI is a good and non-invasive diagnostic tool to determine the severity of degeneration. MMP-3 may be a therapeutic target of the degenerated IVD.

Primary pineal glioblastoma: a case report.

Glioblastoma is very rare in the pineal region. We report a case of glioblastoma in this region. This is the 18th case of primary glioblastoma in the pineal region and the second case that survived over two years according the literature. A 60-year-old man admitted with headache and ataxia that continued for the last 3 months. Physical examination was normal. Neurological examination revealed ataxia. There was no motor or sensory deficit. Computer tomography showed triventricular hydrocephalus and isodense rounded mass in the pineal region. Magnetic resonance images revealed a regular-edged heterogeneous contrast-enhanced tumor in pineal region. A ventriculoperitoneal shunt was inserted for hydrocephalus. After surgery, the ataxia and hydrocephalus were improved. Ten days later, serial stereotactic biopsies were performed. Histopathological specimens revealed glioblastoma. The patient was recommended to undergo radiotherapy and chemotherapy. The patient is still surviving without deficit two years after biopsy and shunt operation.

Sciatic nerve schwannoma: case report.

Schwannomas are common, truly encapsulated and benign peripheral nerve sheath tumors. Their occurrence in extracranial locations is rare. Schwannomas most commonly occur in adults between 20 and 50 years of age. Their symptomatology usually mimics sciatic pain due to herniated disc. The most common clinical presentation of sciatic nerve schwannoma is a painful palpable mass. A 40-year-old woman was admitted to our neurosurgery department with a slow-growing mass at the medial right posterior thigh. Magnetic resonance imaging (MRI) showed a mass involving the right sciatic nerve in its middle portion. No neurological deficit was noted postoperatively. The result of the histopathological examination was reported as schwannoma. We report a case of large sciatic schwannoma with chronic sciatica.

Anatomical relationship and positions of the lumbar and sacral segments of the spinal cord according to the vertebral bodies and the spinal roots

Segments of the spinal cord generally do not correspond to the respective vertebral level and there are many anatomical variations in terms of the segment and the level of vertebra. The aim of this study is to investigate the variations and levels of lumbar and sacral spinal cord segments with reference to the axilla of the T11, T12, and L1 spinal nerve roots and adjacent vertebrae. Morphometric measurements were made on 16 formalin fixed adult cadaveric spinal cords. We observed termination of the spinal cord between the axilla of the L1 and L2 spinal nerve roots in 15 specimens (93.8%). In all cadavers the emergence of the T11, T12, and the L1 spinal nerve roots was at the level of the lower one‐third of the same vertebral body. In 15 specimens (93.8%), the beginning of the lumbar spinal cord segment was found to be above the T11 spinal nerve root axilla and corresponded to the upper one‐third of the T11 vertebral body. The beginning of the sacral spinal cord segment occurred above the L1 spinal nerve root axilla and corresponded to the upper one‐third of the L1 vertebral body. The results of this study showed that when the conus medullaris is located at the L1–L2 level, the beginning of the lumbar spinal cord segment always corresponds to the body of T11 vertebra. This study provides detailed information about the correspondence of the spinal cord segments with reference to the axilla of the spinal nerve roots. Clin. Anat. 27:227–233, 2014.