Memduh Kerman

Assessment of outcome of carpal tunnel syndrome: a comparison of electrophysiological findings and a self-administered Boston questionnaire.

The relationship between nerve conduction studies and the self-administered Boston Questionnaire that measures the severity of symptoms and functional status in carpal tunnel syndrome was assessed in 44 patients with idiopathic carpal tunnel syndrome. The patients were examined preoperatively and 3 and 6 months postoperatively. Although both the clinical outcome and electrophysiological findings improved significantly after surgery, we observed no correlation between improvements in nerve conduction and the questionnaire scores.

Measurement of spinal canal diameters in young subjects with lumbosacral transitional vertebra

Abstract. Despite the high prevalence of lumbosacral transitional vertebra (LSTV), little is known about the biomechanics of this condition. In addition, as previous studies have focused solely on symptomatic and elderly LSTV patients, the relationship between LSTV and congenital or developmental spinal stenosis remains uncertain. In the present study, the spinal canal diameters were measured in young subjects in whom degenerative changes have not yet become significant. Seventeen young adults with LSTV and 24 normal controls were included in this study. The spinal canal sagittal diameter, interpedicular distance, interfacet distance and lateral recess diameter were measured using CT scans. There was no significant difference in the measured values between the two groups. In conclusion, the results indicate that there is no relationship between LSTV and a congenitally narrower canal.

Comparison of open carpal tunnel release and local steroid treatment outcomes in idiopathic carpal tunnel syndrome

Abstract. To compare the efficacy of local steroid injection and open carpal tunnel release, a symptom and functional status questionnaire (Boston Questionnaire) and sensory and motor nerve conduction studies were performed in 90 patients with electrophysiologically proven idiopathic carpal tunnel syndrome, of whom 44 were treated surgically and 46 by two-dose steroid injection. Electrophysiologic studies and the Boston Questionnaire were applied before and at the 3rd and 6th months after treatment. Both groups showed significant improvement at first follow-up. The surgically treated group showed a significant and further improvement of symptoms and conduction values between the 3rd- and 6th-month evaluations, whereas no significant change was observed in the patient group treated by steroid injection. By the end of follow-up, 5% of the hands in the open carpal tunnel release (OCTR) group and 13% of the hands in the local steroid injection (LSIG) group showed electrophysiological worsening, and 5% of the hands in the OCTR group and 22% of the hands in the LSIG group showed symptomatic worsening. Our results show that steroid injection provides an improvement comparable with that from surgical release of the median nerve at a 3-month interval. However, this improvement is not long-lasting.

Management of Skull Base Fractures

The risk of developing an intracranial complication after head injury is greater in those who have sustained a skull fracture. Fractures of the basis cranii are usually the result of extension of a vault fracture. The most important complications of these fractures are cerebrospinal fluid (CSF) fistula, related infection and pneumocephalus with fistula, and cranial nerve and intracranial major vessel injury. Although CSF fistulas and posttraumatic meningitis have been discussed extensively in the literature, neurovascular complications of basilar skull fractures have not been so well described. Posttraumatic evaluation and management of basal skull fractures have not yet been standardized. Here, we have classified basal skull fractures according to site and evaluated the posttraumatic complications. Anterior and middle cranial base fractures generally cause upper cranial nerve injuries (I, II, III, IV, V, and VI) and vascular injuries to the carotid artery and middle cerebral artery. Posterior cranial base fractures are associated with injury to the lower cranial nerves (IX, X, XI, and XII) and major venous sinuses. Laterobasal fractures, including those of the petrous bone, are usually associated with deficits of facial and vestibulocochlear nerves (VII and VIII). Controversies in the management of skull base fractures and related complications have gained little attention in medical practice. Many authors have discussed prophylactic antibiotic therapy for CSF fistulas caused by basal skull fractures, but there has not been a standardized protocol for CSF leak management. Early evaluation of skull base fractures and related complications has been discussed in many articles, but the timing of surgical interventions for basal skull fractures and related complications has not been standardized.

Neurosurgical procedures in pregnancy

PURPOSE: Over the past few decades maternal mortality has progressively declined because of improved management of the major obstetric problems of hemorrhage, infection, and toxemia. As a result, the relative incidence of deaths resulting from non obstetric causes has increased. Chief among nonobstetric causes are neurologic disorders. Those most common during pregnancy are low back pain, intracranial tumors, subarachnoid hemorrhage, and neurotrauma. The management of the neurosurgical pathologies during pregnancy needs some specifications for both the mother and the fetus. METHODS: We performed a retrospective study evaluating the clinical, radiological, and surgical characteristics of 9 patients who have cranial neuropathologies and have undergone neurosurgical intervention. RESULTS: Most of the patients in this study had vaginal delivery. Prominent neurosurgical disease related to cerebral damage. Every patient underwent a laboratory and radiological evaluation. All except one survived the neurosurgical pathology. Neither baby nor mother had significant problem during delivery and neurosurgical intervention. CONCLUSION: Pregnant women may face to every kind of neurosurgical pathology that nonpregnant women have faced. In addition, pregnancy itself, gives rise some metabolic changes in the women and those changes may cause some neurologic pathologies to be symptomatic or to aggravate the present symptomatology. Because of those reasons, close neurologic follow up of a pregnant woman is of vital importance. At the end of a pregnancy having experienced some neurologic interventions including diagnostic evaluation or surgical intervention does not necessitates the cesarean section for a neurologically intact infant and mother.

Ratlarda Lipid Peroksidasyonun İndüklendiği Spinal Kord Hasarında Melatoninin Etkisi: Malondialdehitin Tanısal Önemi

Melatonin is a potent antioxidant agent produced by the pineal gland. In this study we aimed to investigate the neuro-protective effect of melatonin on ischemic spinal cord in the rats. Aortic clamp was used for the occlusion of the abdominal aorta for 30 minutes. Twenty four Winstar male rats were used for this study and rats were divided randomly into 4 groups: control group (sham group, n: 5), sham+melatonin treated group (receiving 10mg/kg melatonin intraperitoneally, n: 5), ischemia/reperfusion group (undergoing occlusion but receiving no pharmacologic intervention, n: 7), melatonin + ischemia/reperfusion group (undergoing occlusion and receiving 10mg/kg melatonin intraperitoneally 10 minutes after ischemia, n: 7). Spinal cord samples were taken for the malondialdehyde (MDA) analyses. In the aort occlusion group, the MDA levels, indicating the extend of lipid peroxidation, were significantly higher than the other groups (p<0.05). Also in the aort occlusion + melatonin group the levels of MDA was significantly reduced compared to the aort occlusion group (p<0.05). In this study, we showed that injection of melatonin reduces the effects of secondary injury and facilitate the recovery of the damaged spinal cord.