Miktat Kaya

Alpha-lipoic acid reduces peridural fibrosis after laminectomy of lumbar vertebrae in rabbits

BackgroundPeridural fibrosis is an inevitable healing process causing failed back surgery syndrome after lumbar spinal operations. In this study, alpha-lipoic acid (ALA), reported to reduce fibrosis in liver, oral mucosa, and peritoneum, investigated as a potential candidate for prevention of peridural fibrosis.MethodTwelve adult New Zealand white male rabbits were divided into control (n = 5) and ALA groups (n = 7). Laminectomy of lumbar spine was performed and ALA was applied on the exposed dura mater topically in ALA group.ResultsAccording to histological peridural grading, the ALA group (median grade 1) showed significantly less peridural fibrosis than the control group (median grade 3, p = 0.005).ConclusionsALA is a promising substance in the prevention of peridural fibrosis, especially in early preoperative and postoperative period.

Postoperative cerebellar mutism and autistic spectrum disorder

PurposeI read the article “An Inside View of Autism” written by a 44-year-old autistic woman who had a successful international career designing livestock equipment. In this article, she wrote about her life, disease, and experiences as an autistic individual. She stated that “It is interesting that my speech resembled the stressed speech in young children who have had tumors removed from the cerebellum”.MethodsIn this article, we intend to review and extensively document both postoperative cerebellar mutism and autistic spectrum disorder.ResultsWe reviewed the clinical and neurological findings, etio-pathogenesis, neuroanatomy, mechanisms of development, and similarities between the etio-pathogenesis of both diseases.ConclusionsCerebellar lesions can produce mutism and dysarthria, symptoms sometimes seen in autistic spectrum disorder. In mammals, cerebellar lesions disturb motivated behavior and reduce social interactions, functions that are disturbed in autistic spectrum disorder and cerebellar mutism. The cerebellum and two regions within the frontal lobes are active in certain language tasks. Language is abnormal in autistic spectrum disorder and cerebellar mutism.

Spondylodiscitis as a spinal complication of transrectal ultrasound-guided needle biopsy of the prostate.

Study Design. A case report. Objective. To describe the presentation of pyogenic spondylodiscitis as an iatrogenic spinal complication of a transrectal ultrasound-guided needle biopsy of the prostate (TUGNBP), despite prophylactic use of antibiotics, and discuss possible route of infection. Summary of Background Data. Pyogenic spondylodiscitis is a rare complication of TUGNBP. Several similar case reports, have been previously published, including 1 by the authors of this case report; however, in the present case, spondylodiscitis occurred despite prophylactic antibiotic use. Methods. A 59-year-old man was admitted to the neurosurgery department, experiencing severe back and bilateral leg pain for 6 weeks. His neurological examination was normal. His medical and surgical histories were unremarkable, except for a TUGNBP performed 2 months ago because of the high serum levels of prostate-specific antigen levels. At the time of the biopsy, he had been given prophylactic oral antibiotic (ciprofloxacin, 500 mg twice a day) for 2 weeks. The day after biopsy, the patient experienced intermittent high fever and fatigue, and a week after biopsy, he complained of progressive back pain. Results. After 2 weeks, whole-body bone scan with Tc99m-MDP revealed hyperactivity at the level of L4 and L5 vertebral bodies. His contrast-enhanced magnetic resonance image of the lumbar spine showed diffuse contrast enhancement vertebral bodies and intervertebral disc of L4 and L5 along with contrast-enhanced circumferential epidural mass extending from S2 to L3 levels. L4 hemilaminectomy and epidural and intradiscal abscess drainage at the L4–L5 levels were performed. The diagnosis was consistent with acute discitis with Gram (−) bacilli, and microbiological culture was positive for Escherichia coli. He received intravenous and oral antibiotics for 6 weeks. Conclusion. Acute pyogenic spondylodiscitis should be considered among the major complications of TUGNBP and may occur despite prophylactic antibiotic use.

Atretic cephalocele in adults

Dear editor, Cephaloceles are congenital brain anomalies with extracranial herniation of intracranial structures as a result of defects of the cranium and dura [1, 4]. Cephaloceles may communicate with the lateral ventricles and contain cerebrospinal fluid (CSF) [2]. Atretic parietal cephaloceles differ from the other cephaloceles as defined by Yokota by having small, non-cystic, flat or nodular lesions arising in the vertex midline [11]. The etio-pathogenesis is not fully understood. In its rudimentary or occult form, as proposed by many authors, the condition presents with a lesion beneath the scalp covered with skin and including meningeal, glial and neural tissues. A case of the adult form of atretic cephalocele is presented, and the differential diagnosis and therapeutic approach for the adult form are discussed in light of the literature findings. A 23-year-old female patient presented with a soft midline tissue mass of the scalp that had been present since birth. On physical examination, a partially alopecic mass that raised the skin was palpable on the scalp. There was no other pathology, and the neurological examination was normal. Cranial MRI of the patient revealed a bone defect in the parietal region on the calvaria in the midline, a lipoma of the scalp in the close vicinity and, intradurally, adipose tissue along the presumed falcine sinus toward the junction of the internal cerebral vein (Fig. 1). MR venography demonstrated that vein of Galen and the straight sinus (sinus rectus) were not well developed. The internal cerebral veins drained into the junction of the falcine sinus and the inferior sagittal sinus. These MRI findings suggested that the scalp lesion was an atretic cephalocele, continuous with the embryonic falcine sinus. No vein or any other vascular element was observed in the lipoma. Family screening did not reveal any positive history for cranial or spinal dysraphism. Atretic cephalocele may be isolated, co-exist with other cerebral anomalies or present with a part of known syndromes [6]. A familial, autosomal dominant trait has been reported [4, 7]. Even though atretic cephaloceles are classified under a single pathological heading, they in fact comprise a group of anomalies that depict marked differences with regard to radiological and clinical presentations. In contrast to adults in whom atretic cephaloceles usually present as a benign lesion, they can manifest as part of a syndrome associated with serious cerebral, ocular or muscular anomalies in the Acta Neurochir (2011) 153:2275–2277 DOI 10.1007/s00701-011-1119-x

Scoliosis-Associated Cervical Spine Pathologies

STUDY DESIGN A total of 126 scoliosis patients admitted to the hospital were screened for concomitant cervical pathologies. OBJECTIVES To investigate the prevalence of cervical spine pathologies and the clinical relevance of magnetic resonance imaging (MRI) in the evaluation of patients with neuromuscular, congenital, syndromic, and idiopathic scoliosis. BACKGROUND SUMMARY With the development of MRI, upper neural axis abnormalities such as syringomyelia and Chiari malformation are increasingly being found in patients with scoliosis, but no report in the literature describes other pathologies in the cervical area seen concomitant with different scoliosis types. METHODS A total of 126 consecutive patients who were classified as having neuromuscular, congenital, syndromic, and idiopathic scoliosis were retrospectively evaluated. Data regarding cervical neural axis abnormalities obtained from the MRI studies were analyzed and classified into each type of scoliosis group. RESULTS A total of 126 patients with scoliosis were evaluated for hindbrain and cervical spine anomalies. Patients were divided into 4 groups regarding the type of scoliosis. The cervical spine of all patients was evaluated with MRI and other radiologic methods when needed. The most frequently seen pathology was syringomyelia. Other pathologies found included congenital vertebral anomalies, Chiari malformation, arachnoid cyst, atlanto-axial dissociation, split cord, posterior vertebral fusion, vertebral hypoplasia, neurenteric cyst, myelomalacia, dermoid cyst, and decrease in craniovertebral angle. Cervical pathologies were most frequently seen in neuromuscular scoliosis, followed by congenital and syndromic groups. CONCLUSIONS Cervical spinal pathologies vary according to the type of scoliosis. The number of cervical spinal pathologies diagnosed in idiopathic scoliosis patients was least compared with neuromuscular and syndromic groups. The most common pathology was syringomyelia, followed by congenital vertebral anomalies and cerebral tonsillar hernia. Preoperative MRI scan provides vital information regarding cervical spinal pathologies encountered in scoliosis patients.

Unilateral Cerebellar Agenesis With Minimal Clinical Symptoms

Unilateral cerebellar agenesis/hypoplasia is defined as total or partial lack of one of the cerebellar hemispheres and it may occur due to etiopathogenetically different mechanisms. Patients usually show cerebellar symptoms, yet patients may occasionally be asymptomatic. This study provides a discussion of 5 cases of unilateral, congenital, rather rare cerebellar agenesis in light of the related literature. Five cases with unilateral cerebellar agenesis/hypoplasia who were seen in the neurosurgery and neurology clinics between April 2010 to September 2013 were evaluated. The youngest patient was a 2-year-old, whereas the oldest one aged 37 years. Three patients were younger than 16 years, whereas 2 patients were older than 16 years; 4 patients were female, whereas 1 patient was male. All patients underwent detailed physical and neurological examinations as well as magnetic resonance imaging. The cerebellar tests of 4 of the patients revealed positive results, whereas one patient was asymptomatic and was diagnosed with cerebellar hypoplasia during examinations performed to find the cause of headaches. Of the 4 patients who had positive cerebellar tests of ataxia, dysdiadochokinesia, and dysmetria, 3 were children and 1 was an adult. Wherever necessary, the patients were subjected to additional examinations of electroencephalography, electromyography, blood tests, abdominal ultrasonography, ophthalmological examination, and psychiatric evaluation. The aim of this study was to point out the fact that unilateral cerebellar agenesis/hypoplasia, which is a rare cerebellar anatomical disorder, may occasionally show minimal clinical cerebellar findings, or may be asymptomatic.

Evaluation of Long-term Clinical Results of Percutaneous Plasma Disk Coagulation Treatment in Lumbar and Cervical Disk Herniation

Objective:We report on late period results in 70 lumbar and cervical patients, who underwent percutaneous plasma disk coagulation treatment in our clinic, evaluated using a visual analogue scale (VAS). Methods:In our study, we evaluated 70 patients who had Macnab grade 1-2-3 lumbar and cervical disk herniation in the lumbar 4-5 and cervical 5-6 levels, without posterior longitudinal ligament tear but with radiculopathy. Data took the form of early-period and late-period VAS scores. Two groups of patients were evaluated: group 1 comprised 35 patients who had L4-L5 lumbar disk herniation with Pfirrmann grade 1-2-3 degeneration, whereas group 2 comprised 35 patients who had C5-C6 cervical disk herniation with Pfirrmann grade 1-2-3 degeneration. Results:A total of 70 patients presented to our clinic between January 2010 and April 2013, who had Macnab grade 1-2-3 disk herniation and radiculopathy, and had previously undergone conservative treatment and physical treatment methods, and those with no improvement were given percutaneous plasma disk coagulation treatment. The youngest patient was 19 years old, and the oldest was 50, yielding an average age of 28 years. The average preoperative VAS score of patients in the Pfirrmann grade 1-2-3 group was 7.1, whereas the postoperative scores were 3.8 in month 1; 4.1 in month 6; 4.3 in year 1; and 4.4 in year 2. The preoperative VAS score of group 2 was 7.2, whereas the postoperative scores were 3.5 in month 1; 2.5 in month 6; 2.1 in year 1; and 2.4 in year 2. Conclusions:It was found that percutaneous plasma disk coagulation (D30) treatment in patients with Macnab grade 1-2-3 and Pfirrmann grade 1-2-3 degeneration was useful in lumbar and cervical herniations, but the results were more significant in cervical disk herniations.

Sleeve Gastrectomy Ameliorates Mrna Expression of MatrixMetalloprotease I, III, V, IL-1a and IL-6 Genes in Substantia Nigra Tissuesof Obese Rats

Aim: To reveal metalloproteinase (MMP)-1, MMP-3, MMP-5, interleukin (IL)-1a and IL-6 gene expressions in substantia nigra region of brain in rats which undergone sleeve gastrectomy (SG) surgery. Methods: Rats were allocated into three groups in random, which were normal rats (Group I) (n=14), obese rats (Group II) (n=14), and obese rats subjected to SG (Group III) (n=14). MMP-1, MMP-3, MMP-5, IL-1a and IL-6 gene expressions were determined by polymerase chain reaction (PCR) and Real-time polymerase chain reaction (RTqPCR). Results: When normal (Group I), and obese (Group II) rats were compared, a decrease in expressions of MMP- 3 and IL-6 genes was observed in Group II. When obese rats (Group II) and obese rats subjected to SG (Group III) were compared, increases in the expressions of MMP-3 and IL-6 genes were observed in Group III. This phenomenon demonstrates that SG decreases obesity and consequently increases expressions of MMP-3 and IL-6 genes. Conclusion: These data show alterations of MMP-3 and IL-6 genes in the substantia nigra tissue of obese rats, consistent with the possibility that these changes may contribute to disease molecular background.

Effects of Borax and Sleeve Gastrectomy on mRNA Expression ofAntioxidant Genes in Substantia Nigra Tissue of Obese Rats

Aim: To evaluate the effects of borax and sleeve gastrectomy on mRNA expression of antioxidant genes in substantia nigra tissue of obese rats. Methods: Obese rats were fed with a high-fat diet containing 40% additional fat to the diet. Rats were allocated into four groups in random, which were normal rats (Group I) (n=14), obese rats subjected to SG (Group II) (n=14), obese rats subjected to borax (Group III) (n=14), and obese rats subjected to SG and borax (Group IV) (n=14). Catalase, superoxide dismutase (SOD) and glutathione S-transferase (GST) gene expressions were determined by polymerase chain reaction, real-time polymerase chain reaction (RT-qPCR) and western blotting. Results: When normal rats (Group I), and obese rats subjected to SG (Group II) were compared, a decrease in expressions of catalase, SOD and GST genes was observed in Group II. When obese rats subjected to borax (Group III) were compared with Group I and Group II, a decrease in expressions of catalase, SOD and GST genes was observed in Group III. This phenomenon demonstrates that borax and SG both decrease expressions of catalase, SOD and GST genes. Furthermore, the most significant decrease in expressions of catalase, SOD and GST genes was observed in obese rats subjected to SG and borax (Group IV) when compared to other three study groups. Conclusion: The borax decreases molecular obesity and consequently increases the expressions of Catalase, SOD and GST genes. These data show decrease of Catalase, SOD and GST genes in the substantia nigra tissue of obese rats, consistent with the possibility that these changes may contribute to disease pathogenesis.

Pneumocephalus After Traumatic Head Injury: Our Experience With 73 Cases in a Tertiary Care Center

Objective:The objective of the study was to outline the demographic, clinical, and radiologic features of traumatic pneumocephalus (TP) and to establish the parameters that may be associated with morbidity and mortality. Methods:A total of 73 TP patients (16 females, 57 male) with an average age of 32 years (range, 2 to 80 y) treated conservatively in the neurosurgery department of a tertiary care center were included in the study. Demographics, etiology, and location of TP, site of cranial fractures, occurrences of rhinorrhea, otorrhea, and meningitis, Glasgow Coma Scale, duration of hospitalization, and other parameters related to morbidity and mortality were investigated. Results:The most common cause of TP was traffic accidents (38.4%), and frontal (47.9%) and temporal (35.7%) lobes were affected most frequently. Incidences of meningitis and convulsion after TP were 8.4% and 12.3%, respectively. Otorrhea/rhinorrhea accompanied 80% of TP cases with meningitis, and patients with meningitis seemed to be hospitalized for a longer period. The mortality rate was 20% in TP patients with meningitis. In two thirds of cases, pneumocephalus was detected in epidural-subdural-subarachnoid or subarachnoid-intraparenchymal locations. Subdural hemorrhage and contusion accompanied TP in 22% of our patients. Conclusions:Our results indicate that TP can be treated medically in a vast majority of patients. Precautions and effective treatment against meningitis is crucial for minimizing morbidity and mortality in TP. Regression of pneumocephalus and recovery in terms of the neurological state can be followed closely with the Glasgow Coma Scale.