Necati Ucler

Cavernous hemangioma of the parietal bone

Patient: Male, 38 Final Diagnosis: Cavernous hemangioma Symptoms: Headache • parietal mass Medication: — Clinical Procedure: — Specialty: Neurosurgery Objective: A rare disease Background: Bone hemangioma is a vascular hemartoma of bone structures. In general, this pathology is detected on incidentally investigated patients’ films. Bone hemangioma is most commonly seen in 4th decade of life and the male/female ratio is 1/1.5. The locations of these lesions are commonly long bones of the vertebral column and the skull. Primary bone hemangiomas constitute less than 1% of all bone tumors, and they are seen at 0.2% in the calvarial region. Case Report: Cases with this pathology are seen on incidental radiological evaluations. We report the case of a 38-year-old man with localized headache and a palpable mass in the left parietal region, admitted and operated on after cranial CT and MRI. Pathology investigation revealed a cavernous hemangioma. Conclusions: We suspected that in our case head trauma may have been the cause of cavernous hemangioma in the calvarial region, because cavernous hemangiomas are rarely located there. Localized headache and minor discomfort can be seen with this pathology. The best treatment for cavernous hemangiomas is the removal of the mass within the limits of safe surgery.

The association of sphenoidal encephalocele and right anophthalmia with septo-optic dysplasia: a case report.

Septo-optic dysplasia (SOD) is an extremely rare congenital anomaly, characterized with optic nerve hypoplasia and absence of septum pellucidum and/or pituitary dysfunction. In addition to classical findings of SOD, we report for the first time an 11-year-old boy, with encephalocele extending to the right sphenoidal sinus, right anophthalmia and normal pituitary functions. Despite all the major anomalies, the patients presenting symptoms were very few and during the 11-year period the SDO had caused no complaints in our case. These findings show that the SOD course may be fairly benign. No neurological problem was encountered in the patients follow-up, except headache. We believe that SOD should be kept in mind because of its rarity and the severity of its combined pathologies.

A Retrospective Analysis of Neonatal Encephalocele Predisposing Factors and Outcomes

Objective: This study evaluates the predisposing factors and outcomes of surgical management of encephaloceles at our institution. Materials and Methods: A retrospective analysis of 32 occipital encephaloceles managed operatively at the Neurosurgery Department Clinics of the Faculty of Medicine, Adıyaman University, was performed between 2011 and 2015. Results: Among the study population, 19 mothers had been exposed to TORCH infections (toxoplasma, rubella, cytomegalovirus, herpes simplex virus), 18 were in consanguineous marriages, and 3 had regular prenatal screening. Associated congenital anomalies were common. Eight infants required reoperation, and 9 died during follow-up. Conclusions: The study identified key areas for prevention. Knowledge of the intracranial and associated anomalies can guide management.

The Comparison of Pain Management Efficiency of Ultrasonography-guided Facet Joint Injection With Fluoroscopy-guided Injection in Lower Lumbar Facet Syndrome

Objective:The aim is to evaluate the efficiency of ultrasonograhy-guided lower lumbar facet injection. Materials and Methods:Fifty cases admitted to Department of Neurosurgery, Elazig Education and Research Hospital, had no surgical pathology in lumbar magnetic resonance imaging, and whose pain was thought to be related to facet joint and in whom facet joint injection was performed, were included in the study. The injection was performed with C-arm fluoroscopy for 25 of patients, the other 25 were injected with ultrasonography control. The initial injection levels, average age, sex, and body mass indexes of the patients were recorded. Oswestry disability scale (ODI) and the Visual analog scores (VAS) were repeated at the sixth hour and 12th week were recorded. The results were statistically compared. Results:Pain management was considered achieved at a statistically significant level when the preoperative and postoperative degrees of ODI and the VAS were compared with P<0.05. When the postoperative early and 12th week ODI and the VAS are compared, no statistically significant differences between groups 1 and 2 was present (P>0.05). Conclusion:The ultrasonography-guided facet intra-articular injections, like fluoroscopy-guided injections, are efficient and successful at diagnosis and short-term pain management and should be kept in mind as a safer, cheaper alternative method to computed tomography, fluoroscopy-guided algological injections.

Management Strategies for Hydrocephalus in Alobar Holoprosencephaly: A Case Report and Discussion

Holoprosencephaly is a rare congenital malformation resulting from an impaired midline division of the prosencephalon into distinct cerebral hemispheres. Hydrocephalus is a frequent problem among the few survivors with alobar holoprosencephaly (aHPE), its most severe form. The literature about neurosurgical management of hydrocephalus in this condition is limited and dispersed, and there are still some points that need to be resolved. We report the case of a newborn with aHPE, hydrocephalus, and central diabetes insipidus. We delineate the complexity of the management of these patients and emphasize the benefits of using an initial programmable shunt valve. Further discussion about management strategies includes reviewing previous reports and the benefits of shunting for hypothalamic osmoreceptor function.

Occipital Condyle Fracture Extending to the Inferior Part of the Clivus

Although rarely reported in the literature, serious occipital and condylar fractures have been diagnosed more often with the widespread use of computed cranial tomography in traumas. In this paper, a 16-year-old female with a left occipital fracture extending from the left occipital condyle anterior of the hypoglossal canal to the inferior part of the clivus is presented. The fracture which had caused a neurological deficit was cured with conservative treatment. For delayed hypoglossal nerve paralysis due to swelling within the canal, methylprednisolone was started, and a complete cure was attained in about 10 days. Traumatic damage of bony structures of the condyle and clivus at the junction of many vital nerves, vessels, and ligaments may lead to traumatic deficit and death.

Does Ventriculoperitoneal Shunting Improve Thyroid Hormone Levels in Hydrocephalic Newborns

Objective/Aim: The aim of this report was to investigate the effect of ventriculoperitoneal shunt insertion for the treatment of hydrocephalus on thyroid hormones in the first 3 months of life. Methods: Thyroid-stimulating hormone (TSH), free T3 (fT3), and free T4 (fT4) levels were compared at 7 days (preoperatively) and at 30 and 90 days (postoperatively) after birth between 25 ventriculoperitoneal shunt-inserted hydrocephalic newborns and 20 healthy newborns. Results: The TSH level at 7 days was higher in the hydrocephalic patient group (6.33 µIU) compared to the control group (3.76 µIU). This value was significantly decreased at 90 days in the ventriculoperitoneal shunt-inserted newborns (2.35 µIU) compared to the control group (3.33 µIU; p < 0.05). There were no significant differences between time points for fT4 and fT3 values in the patient group or for TSH, fT4, and fT3 values in the control group. Conclusion: We propose that a ventriculoperitoneal shunt inserted in the early period of life may have beneficial effects on thyroid hormones.

Lumbar Disc Surgery with Epidural Anesthesia: Review of 700 Cases

AIM Lumbar disc surgery can be performed under general anesthesia or regional anesthesia methods. There are long-standing discussions between neurosurgeons, orthopedic surgeons and anesthesiologists concerning the use of epidural anesthesia in lumbar surgery. The results of this studys 700 lumbar disc surgery cases operated with epidural anesthesia in our clinic between September 2006 and December 2011 will contribute to these discussions. MATERIAL AND METHODS This study included 700 patients underwent lumbar disc surgery with epidural anesthesia, which consisted of 388 males (55%) and 312 females (45%). Forty-two of these cases had recurrence disc herniation and only 11 of 42 cases were operated in our department. RESULTS Eleven of 700 cases had dural injury and were repaired intraoperatively by primary sutures and tissue sealants. Infection of the incision site developed in six patients, who healed with appropriate antibiotic treatment with no problems. In addition to those 700 cases, 22 patients received general anesthesia in which we started with epidural anesthesia. Microdiscectomies were performed in 578 of 700 cases, and open surgery in 122 cases. CONCLUSION This study showed that epidural anesthesia seems more advantageous for some patients since it does not have some of the risks that general anesthesia bears.

The Comparison of the Application of Percutaneous Transpedicular and Extrapedicular Vertebroplasty: Which Approach has Better Results?

Background:Vertebral compression fractures are a common complication of various pathologies. Vertebroplasty is a choice in these fractures, but the approach to the fractured vertebra corpus with this technique is relatively an important issue. Patients and Methods:In this retrospective study, we evaluated and compared 90 patients with vertebral fractures treated with extrapedicular or transpedicular vertebroplasty, with respect to visual analog score (VAS), cement leakage risk, postoperative bed rest time, and postoperative analgesic use. Results:Our retrospective study showed that intraspinal canal and intervertebral cement leakage were lower in the extrapedicular group than in the transpedicular group (1 vs. 3 and 3 vs. 6). In addition, postoperative bed rest time and postoperative anagesic use were higher in the transpedicular group than in the extrapedicular group (24 vs. 15 h and 7 vs. 3 d). When compared, the extrapedicular group had lower cost and first-year VAS than the transpedicular group, despite preoperative VAS being higher in the extrapedicular group. Conclusions:Our comparative retrospective study showed that extrapedicular approach has better results with respect to VAS, cement leakage risk, postoperative bed rest time, and postoperative analgesic use. In addition to these advantages, extrapedicular approach may have some potential complications, but these complications may be prevented from meticulous manipulations.

Psychiatric disorders in lumbar stenosis with chronic pain and their effects on lumbar stenosis surgery

Yard. Doç. Dr. Şeyho Cem Yücetaş, Kafkas Üniversitesi, Kars, Türkiye Tel. 0474 225 21 06 Email. seyhocem@hotmail.com Geliş Tarihi: 23.10.2014 • Kabul Tarihi: 21.05.2015 ABSTRACT AIM: Lumbar stenosis is a painful disorder frequently observed in advanced ages. Pain is a complaint that has significant consequences to quality of life. In this study, it was analyzed whether there are any comorbid psychiatric disorders in patients with lumbar stenosis and the variances in postoperative Visual Analogue Scale scores of these patients. METHODS: Eighty patients who were evaluated and operated by the Department of Neurosurgery between December 2012 and April 2013 were subject to retrospective analysis. All patients were preoperatively consulted to a psychiatrist. The psychiatrist administered the SCID-I/CV (Structured clinical interview for DSM-IV axis I disorders, clinical version), Beck Depression Scale and Beck Anxiety Scale. Those patients with comorbid psychiatric disorders were given treatment with an SSRI (selective serotonin reuptake inhibitors) type antidepressant and regular follow-ups were made. Visual Analogue Scale scores of patients with or without comorbid psychiatric disorder were compared in the preoperative term and the postoperative months 1 and 6. RESULTS: Out of 80 patients diagnosed with lumbar stenosis, 22 were detected with major depression, 8 with generalized anxiety disorder and 5 with somatization disorder. The median, minimum and maximum Visual Analogue Scale scores of lumbar stenosis patients without comorbid psychiatric disorders was 3.7 (3.2–4.2) in the postoperative month 1 and 3.3 (2.7–3.9) in the postoperative month 6. The median, minimum and maximum Visual Analogue Scale scores of 35 lumbar stenosis patients with comorbid psychiatric disorders was 5.8 (5.3–6.4) in the postoperative month 1 and 3.4 (2.5–4.0) 6 months after psychiatric treatment was initiated. CONCLUSION: Our aim was to emphasize that the treatment of comorbid psychiatric disorders in patients operated for chronic pain lumbar stenosis increases postoperative success.