Nurullah Yüceer

Tumours of the lateral ventricle. A retrospective review of 112 cases operated upon 1970–1997

Between the years 1970 and 1997, 112 patients with tumors of the lateral ventricle were operated on at the University of Ankara, School of Medicine, Department of Neurosurgery. Seventy-one patients (63.4 %) were male and 41 patients (36.6 %) female. Headache (35.7 %), nausea and vomiting (22.3 %) were the most common presenting complaints. Papilloedema (42.9 %), motor and sensory loss (25 %) were the most common findings at neurological examination. Complete tumor removal was accomplished in 38.4 % of the patients. Histopathologically, the most commonly seen types of the tumor were ependymoma (25 %) and astrocytoma (21.4 %). Among the various approach, the anterior transcortical (53.6 %) and the posterior transcortical (16 %) were the most commonly used. Eleven patients were reoperated for tumor recurrence. After surgery, radiation therapy was also performed on fourty-two patients. The morbidity and mortality rates were considerably higher before 1976 when the use of microneurosurgical techniques was introduced. After this, our morbidity and mortality rates decreased dramatically. The overall surgical mortality rate was 7.1 % before 1976; during the last 10 years (n:46), it was 6.5 %. In this report, our choice of operative approaches and the results will be discussed.

Hematoma of the ligamentum flavum in the lumbar spine:: Case report

Herniated nucleus pulposis, spondylotic spinal canal stenosis, neoplasms, infection, and spontaneous epidural hematoma [3,7,9] are the most common causes of spinal root and canal compression in the fourth to sixth decades of life. Ligamentum flavum hematoma, which is actually a type of epidural hematoma, is an extremely rare cause of spinal root or canal compression. We report the case of a 67-year-old man with a ligamentum flavum hematoma compressing the spinal canal at the L2-L3 level.

Hematoma of the ligamentum flavum in the lumbar spine

Herniated nucleus pulposis, spondylotic spinal canal stenosis, neoplasms, infection, and spontaneous epidural hematoma [3,7,9] are the most common causes of spinal root and canal compression in the fourth to sixth decades of life. Ligamentum flavum hematoma, which is actually a type of epidural hematoma, is an extremely rare cause of spinal root or canal compression. We report the case of a 67-year-old man with a ligamentum flavum hematoma compressing the spinal canal at the L2-L3 level.

Paravertebral malignant tumors of childhood: analysis of 28 pediatric patients

PurposeTo evaluate the clinical features and treatment results of the primary paravertebral malignant tumors (PMTs) in our department.MethodsMedical records of 28 children with primary PMTs treated between 1988–2007 were analyzed retrospectively.ResultsPrimary PMTs constituted 4.8% of the cancer cases in our department. Tumor diagnoses were mostly neuroblastoma (46.4%) and soft tissue sarcomas (35.7%). These cases presented with pain (64.3%), motor dysfunction (42.8%), sphincter dysfunction (35.7%), palpable mass (32.1%), and sensory deficits (7.1%). All tumors were extradural. Physical examination revealed motor deficits (53.6%), deep tendon reflex alterations (53.6%), sphincter dysfunction (35.7%), pathologic reflexes (25%), abnormal cutaneous reflexes (25%), and sensory deficits (17.8%). Sixteen had cord compression (CC; 13 clinical, three radiological CC). Eleven of them presented with advanced disease. Seven were managed by surgical departments by primary surgery (three unresponsive). Others were managed by pediatric oncology: five with corticosteroids ± chemotherapy (one unresponsive), one with radiotherapy (RT), and two with surgery for the clinical CC. Surgery was tumor excision in nine, laminectomy in nine, laminotomy in one, and delayed surgery after chemotherapy in two cases. In chemotherapy and surgery groups, there were neurologic sequela associated with the advanced disease at diagnosis in 38% and 37%, respectively. At 3-year median follow-up, nine patients died, 17 are alive (four with neurologic sequela), and two are lost of follow-up.ConclusionMajority of cases presented with advanced disease. Late referral is the major cause of morbidity and mortality. The CC caused by PMTs should be initially managed with corticosteroids ± chemotherapy to avoid the adverse late effects of RT and surgery.

Atypical teratoid/rhabdoid tumor in an infant conceived by in vitro fertilization

BackgroundAtypical teratoid/rhabdoid tumor (ATsRT) is a rare tumor and extremely aggressive embryonal neoplasm of the central nervous system. Brain tumors in infant are suggestive of some oncogenic prenatal factors.Case presentationWe report on a case of ATRT in a 4-month-old infant conceived by in vitro fertilization (IVF). Some previous reports have raised a question about the possible relation between IVF and childhood cancer, particularly embryonal tumors.ConclusionReport of such cases may provide some evidence to identify if there is a real association between congenital tumors and IVF.

The early protective effects of L-arginine and Ng-nitro-L-arginine methyl ester after experimental acute spinal cord injury. A light and electron microscopic study

The purpose of this study was to investigate the early protective effects of L-arginine and Ng-nitro-L-arginine methyl ester (L-NAME) after acute spinal cord injury. Acute spinal cord injury was performed by epidural application of an aneurysm clip at thoracic (T) 7 - 11 level. L-arginine at a dose of 750 microg/kg/min was administered 10 min before acute spinal cord injury and continued for 30 min to 10 animals (Group II). L-NAME at a dose of 250 microg/kg/min was administered 10 min before acute spinal cord injury and continued for 30 min to 10 animals (Group III). No drug was administered to 10 animals after acute spinal cord injury (Group I). Light and electron microscopic analysis were performed in all of the groups. Oedema of perineural, axoplasm or white matter in the L-arginine-treated group was less than in Group I and Group III. Thickening in the walls of the arterioles and venules in the L-arginine-treated group was much milder than in Group I and Group III. Degeneration of myelinated axons in the L-arginine-treated group was milder than in the control group. But there was no different between Group II and Group III.

A Case of Central Precocious Puberty Due to Concomitant Hypothalamic Hamartoma and Juvenile Pilocytic Astrocytoma

Central precocious puberty (CPP) is caused by premature activation of the hypothalamo-pituitary-gonadal axis. More than 50% of boys with CPP have an identifiable etiology. Hypothalamic hamartoma (HH), hydrocephalus, tumors, infections, congenital defects, ischemia, radiation, or injury of the brain are the most common causes of secondary CPP. In this report, we present the case of a 2 years and 9 months old male patient who had a 30x40 mm contrast-enhancing suprasellar mass and was histopathologically diagnosed with giant HH. However, since HHs are designated as non-enhancing masses, considering the possibility of an incomplete diagnosis of a glial tumor, the patient was followed up. Clinical and radiological follow-up revealed stable findings with no evidence of tumor growth until the third year after surgery when he presented with neurological deficit due to the rapid growth of the suprasellar mass. After the second surgery, histopathological examination of the biopsy specimen revealed the lesion to be a juvenile pilocytic astrocytoma (PA). The concomitance of HH and juvenile PA is very rare. To our knowledge, this is the first report of a patient with concomitant juvenile PA and HH who developed CPP and did not have gelastic epilepsy despite the rapidly growing giant mass.

Solitary ectopic lacrimal gland tissue of the orbit presenting with unilateral proptosis in a 5-year-old child

Ectopic lacrimal gland tissue (ELGT) of the orbit is seen rarely. A 5-year-old child with an ELGT of the right orbit causing to unilateral proptosis is presented. Computerized tomography and magnetic resonance imaging studies showed an irregular, soft-tissue in the right orbit, without bony erosion. The lesion was excised subtotally by right frontal transcranial approach.

Original articleHematoma of the ligamentum flavum in the lumbar spine:: Case report

Herniated nucleus pulposis, spondylotic spinal canal stenosis, neoplasms, infection, and spontaneous epidural hematoma [3,7,9] are the most common causes of spinal root and canal compression in the fourth to sixth decades of life. Ligamentum flavum hematoma, which is actually a type of epidural hematoma, is an extremely rare cause of spinal root or canal compression. We report the case of a 67-year-old man with a ligamentum flavum hematoma compressing the spinal canal at the L2-L3 level.