Mesut Mete

Intracranial hydatid cyst is a rare cause of midbrain herniation: A case report and literature review

Hydatid disease is a parasitic infection affecting the brain in about 2% of the cases. Brain involvement is most commonly observed in children. Here, we report a 13-year-old male patient who presented with headache, nausea, and vomiting. Before cranial computed tomography (CT) was performed, the patient had generalized epileptic seizures. He was disoriented, and had anisocoria with dilatation of the right pupilla. CT showed a cystic lesion of 10-cm diameter in the right temporoparietal region that had caused a shift of the midline structures to the contralateral side; an urgent operation was performed as there were signs of midbrain herniation.

Neurotoxic effects of local anesthetics on the mouse neuroblastoma NB2a cell line

Abstract Local anesthetics are used clinically for peripheral nerve blocks, epidural anesthesia, spinal anesthesia and pain management; large concentrations, continuous application and long exposure time can cause neurotoxicity. The mechanism of neurotoxicity caused by local anesthetics is unclear. Neurite outgrowth and apoptosis can be used to evaluate neurotoxic effects. Mouse neuroblastoma cells were induced to differentiate and generate neurites in the presence of local anesthetics. The culture medium was removed and replaced with serum-free medium plus 20 μl combinations of epidermal growth factor and fibroblast growth factor containing tetracaine, prilocaine, lidocaine or procaine at concentrations of 1, 10, 25, or 100 μl prior to neurite measurement. Cell viability, iNOS, eNOS and apoptosis were evaluated. Local anesthetics produced toxic effects by neurite inhibition at low concentrations and by apoptosis at high concentrations. There was an inverse relation between local anesthetic concentrations and cell viability. Comparison of different local anesthetics showed toxicity, as assessed by cell viability and apoptotic potency, in the following order: tetracaine > prilocaine > lidocaine > procaine. Procaine was the least neurotoxic local anesthetic and because it is short-acting, may be preferred for pain prevention during short procedures.

Congenital dermal sinus tract of the spine: experience of 16 patients.

Congenital dermal sinus tract is a rare entity which lined by epithelial cells and can end anywhere between subcutaneous planes to thecal sac. These tracts may be accompanied with other pathologies such as lipomyelomeningocele, myelomeningocele, split cord malformation, tethered cord, filum abnormality and inclusion tumors and treatment includes resection of tract with intradural exploration. The authors review their experience with 16 cases. Clinical, radiological appearance and treatment of these lesions discussed with literature review.

Missing Screw as a Rare Complication of Anterior Cervical Instrumentation

Although anterior cervical arthrodesis is an effective procedure for the treatment of cervical disorders, the method has some complications. Here, we describe this rare complication of cervical instrumentation with a literature review. A 23-year-old male patient was operated for a C6-C7 dislocation. At postoperative month 10, he presented with hemoptysis and dysphagia. Cervical roentgenograms showed anterior migrations of one broken screw and a plate-locking screw at the C6 corpus. One screw was missing. We concluded that the missing screw had perforated the esophagus and had been eliminated spontaneously through the gastrointestinal tract. No screw should migrate. Even loose screws should be noted in follow-up X-ray studies. If such findings are detected, a second operation for revision should be considered as soon as possible to prevent potentially fatal complications.

Tethered Cord Syndrome in Adults: Experience of 56 Patients.

AIM The aim of this study was to describe the results of surgery performed in a group of adult patients with tethered cord syndrome with their outcomes. MATERIAL AND METHODS This retrospective study included 56 patients. There were 38 females and 18 males. All patients were older than 18 years. RESULTS The mean age at referral was 36 years and 1 month. The mean follow-up period was 10 months 27 days. 95% of all patients with back and leg pains improved and 5% remained the same. Three patients with motor deficits remained the same in the postoperative period. Of the 16 patients with urological complaints, 10 improved, 5 unchanged and 1 patient died in the postoperative first day due to pulmonary embolism. CONCLUSION The syndrome of tethered cord may be a situation to be treated even in the elderly in case of normal level conus medullaris and filum terminale with a normal appearance as well as a low-lying conus and thick filum. To prevent overlooking the diagnosis of tethered cord and/or unnecessary spinal surgeries, the tethered cord syndrome should be remembered in the differential diagnosis list in the presence of back and leg pains, neurological deficits or urological complaints.

Slow progression and benign course of a primary malign melanoma of a lumbar nerve root

Over 90% of malignant melanomas of the spine are metastatic. arely, however, a primary malignant melanoma may originate rom the spine. In this setting, an intramedullary location is comon. The remaining malignant melanomas in this region originate rom the spinal cord or leptomeninges, which surround the nerve oots. The diagnosis is confirmed immunohistologically, as it is ifficult to distinguish a malignant melanoma from melanotic chwannoma and meningeal melanocytoma [5]. Total excision f a spinal malignant melanoma can have a better course with djuvant radiotherapy and chemotherapy [3]. This case report resents a patient who underwent surgery in 2007 and the athological diagnosis was a primary spinal malignant melanoma riginating from a nerve root. Despite metastasis, the patient as pain free and had no neurological deficits at the 4-year ollow-up.

Cutting filum terminale is very important in split cord malformation cases to achieve total release.

AimSplit cord malformations (SCMs) are rare congenital anomalies of the vertebrae and the spinal cord. Tethered cord syndrome (TCS) is a clinical condition of various origins that arises from tension on the spinal cord. Radiographic findings may include and/or associate split cord malformations and the other neural tube defects. However, the spinal cord can even be tethered by a filum terminale with normal appearance and normal level conus medullaris in magnetic resonance imaging (MRI). The aim of our study is to show whether SMC patients with normal or abnormal MRI findings had all histological abnormal filum terminale and also to show that the standard SCM repairing operation without cutting filum will not achieve total release.Material and methodsWe have reviewed 33 SCM patients between July 2005 and December 2013. They were operated by adding untethering procedure of filum terminale following standard surgical intervention, and a part of the filum was taken for histopathological examination even though MRI did not show the presence of abnormality of filum terminale.ResultsWe found that abnormal filum terminale with a normal appearance may had dense collagen fibers, wide and numerous capillaries, and hyaline formation, while normal filum terminale is a mixture of collagen fibers and blood vessels. We did not obtain positive Verhoeff elastic fiber staining. The elastic fibers had disappeared in all fila terminalia, except control cadaver group.ConclusionOur results showed that all fila of SCM patients had loss of elastic fibers and increased of hyalinization, which means loss of elasticity of filum terminale. Less severe traction may remain asymptomatic in childhood and present with neurological dysfunction later in life. For this reason, surgical procedure of SCM patients including releasing of filum terminale seems more beneficial for the patients and be better for long term.

Differences in individual susceptibility affect the development of trigeminal neuralgia.

Trigeminal neuralgia is a syndrome due to dysfunctional hyperactivity of the trigeminal nerve, and is characterized by a sudden, usually unilateral, recurrent lancinating pain arising from one or more divisions of the nerve. The most accepted pathogenetic mechanism for trigeminal neuralgia is compression of the nerve at its dorsal root entry zone or in its distal course. In this paper, we report four cases with trigeminal neuralgia due to an unknown mechanism after an intracranial intervention. The onset of trigeminal neuralgia after surgical interventions that are unrelated to the trigeminal nerve suggests that in patients with greater individual susceptibility, nerve contact with the vascular structure due to postoperative pressure and changes in cerebrospinal fluid flow may cause the onset of pain.

Neuroprotective effects of oleocanthal, a compound in virgin olive oil, in a rat model of traumatic brain injury

AIM To evaluate the neuroprotective effects of deocanthal OC in a rat model of traumatic brain injury (TBI). MATERIAL AND METHODS Twenty-six adult male, Wistar albino rats were used. The rats were divided into 4 groups. Group 1 was the sham group (n=5). Group 2 was the trauma group (n=5) where rats were treated with 10 mg/kg saline intraperitoneally (IP) twice a day. Groups 3 and 4, rats were treated with 10 (group 3, n=8) or 30 (group 4, n=8) mg/kg OC IP twice a day. For each group, brain samples were collected 72 hours after injury. Brain samples and blood were evaluated with histopathological and biochemical methods. RESULTS Histopathological evaluation revealed a significant difference between Group 2 and Group 4. Biochemical findings demonstrated that the oxidative stress index was highest in Group 2 and lowest in Group 4. CONCLUSION OC has a protective effect on neural cells after TBI. This effect is achieved by reducing oxidative stress and apoptosis.

Scoliosis may be the first symptom of the tethered spinal cord.

Background: Tethered cord syndrome (TCS) is a progressive clinical entity that arises from abnormal spinal cord tension. Scoliosis may be a unique symptom in TCS. The aim of this study is to investigate prognosis after releasing the filum terminale in scoliosis due to TCS with/without findings in magnetic resonance imaging (MRI) and to draw attention to the importance of somatosensorial evoked potentials (SSEP) on the differential diagnosis of idiopathic scoliosis versus scoliosis due to TCS with normal appearance of filum terminale and conus medullaris. Materials and Methods: Eleven female and seven male patients with progressive scoliosis were included in the study. They were evaluated radiologically, SSEP and urodynamical studies. Preoperative and postoperative anteroposterior full spine X-rays were obtained for measuring the Cobbs angle. MRI was performed in all cases for probable additional spinal abnormalities. All patients underwent filum terminale sectioning through a L5 hemilaminectomy. The resected filum terminale were subjected to histopathological examination. Results: The mean Cobb angle was 31.6° (range 18°–45°). Eight patients (44.45%) had a normal appearance of filum terminale and normal level conus medullaris in MRI, but conduction delay and/or block was seen on SSEP. In the histopathological examination of filum terminale dense collagen fibers, hyaline degeneration and loss of elastic fibers were observed. Postoperatively none of the patients showed worsening of the Cobb angle. Three patients showed improvement of scoliosis. Conclusion: In TCS presented with scoliosis, untethering must be performed prior to the corrective spinal surgery. Absence of MRI findings does not definitely exclude TCS. SSEP is an important additional guidance in the diagnosis of TCS. After untethering, a followup period of 6 months is essential to show it untethering helps in stopping the progress of the scoliotic curve. In spite of non progression (curve stopped lesser than 45°) or even improvement of scoliosis, there may be no need for major orthopedic surgical intervention.