Onur Ozgural

Primary pineal glioblastoma: a case report.

Glioblastoma is very rare in the pineal region. We report a case of glioblastoma in this region. This is the 18th case of primary glioblastoma in the pineal region and the second case that survived over two years according the literature. A 60-year-old man admitted with headache and ataxia that continued for the last 3 months. Physical examination was normal. Neurological examination revealed ataxia. There was no motor or sensory deficit. Computer tomography showed triventricular hydrocephalus and isodense rounded mass in the pineal region. Magnetic resonance images revealed a regular-edged heterogeneous contrast-enhanced tumor in pineal region. A ventriculoperitoneal shunt was inserted for hydrocephalus. After surgery, the ataxia and hydrocephalus were improved. Ten days later, serial stereotactic biopsies were performed. Histopathological specimens revealed glioblastoma. The patient was recommended to undergo radiotherapy and chemotherapy. The patient is still surviving without deficit two years after biopsy and shunt operation.

Arterial vascularization patterns of the splenium: An anatomical study.

The aim of this study was to provide detailed information about the arterial vascularization of the splenium of the corpus callosum (CC). The splenium is unique in that it is part of the largest commissural tract in the brain and a region in which pathologies are seen frequently. An exact description of the arterial vascularization of this part of the CC remains under debate. Thirty adult human brains (60 hemispheres) were obtained from routine autopsies. Cerebral arteries were separately cannulated and injected with colored latex. Then, the brains were fixed in formaldehyde, and dissections were performed using a surgical microscope. The diameter of the arterial branches supplying the splenium of the CC at their origin was investigated, and the vascularization patterns of these branches were observed. Vascular supply to the splenium was provided by the anterior pericallosal artery (40%) from the anterior circulation and by the posterior pericallosal artery (88%) and posterior accessory pericallosal artery (50%) from the posterior circulation. The vascularization pattern of the splenium differs in each hemisphere and is usually supplied by multiple branches. The arterial vascularization of the splenium of the CC was studied comprehensively considering the ongoing debate and the inadequacy of the studies on this issue currently available in the literature. This anatomical knowledge is essential during the treatment of pathologies in this region and especially for splenial arteriovenous malformations. Clin. Anat. 26:675–681, 2013.

Comparative Analysis of Vertebroplasty and Kyphoplasty for Osteoporotic Vertebral Compression Fractures

Study Design A retrospective study. Purpose The aim of this study is to compare the efficacy and outcome of vertebroplasty compared with unipedicular and bipedicular kyphoplasty for the treatment of osteoporotic vertebral compression fractures in terms of pain, functional capacity and height restoration rates. Overview of Literature The vertebroplasty procedure was first performed in 1984 for the treatment of a hemangioma at the C2 vertebra. Kyphoplasty was first performed in 1998 and includes vertebral height restoration in addition to using inflation balloons and high-viscosity cement. Both are efficacious, safe and long-lasting procedures. However, controversy still exists about pain relief, improvement in functional capacity, quality of life and height restoration the superiority of these procedures and assessment of appropriate and specific indications of one over the other remains undefined. Methods Between 2004 and 2011, 296 patients suffering from osteoporotic vertebral compression fracture underwent 433 vertebroplasty and kyphoplasty procedures. Visual analogue scale (VAS), the Oswestry Disability Index (ODI) and height restoration rates were used to evaluate the results. Results Mean height restoration rate was 24.16%±1.27% in the vertebroplasty group, 24.25%±1.28% in the unipedicular kyphoplasty group and 37.05%±1.21% in the bipedicular kyphoplasty group. VAS and ODI scores improved all of the groups. Conclusions Vertebroplasty and kyphoplasty are both effective in providing pain relief and improvement in functional capacity and quality of life after the procedure, but the bipedicular kyphoplasty procedure has a further advantage in terms of height restoration when compared to unipedicular kyphoplasty and vertebroplasty procedures.

Arterial vascularization of the pineal gland

PurposeThe arterial vascularization of the pineal gland (PG) remains a debatable subject. This study aims to provide detailed information about the arterial vascularization of the PG.MethodsThirty adult human brains were obtained from routine autopsies. Cerebral arteries were separately cannulated and injected with colored latex. The dissections were carried out using a surgical microscope. The diameters of the branches supplying the PG at their origin and vascularization areas of the branches of the arteries were investigated.ResultsThe main artery of the PG was the lateral pineal artery, and it originated from the posterior circulation. The other arteries included the medial pineal artery from the posterior circulation and the rostral pineal artery mainly from the anterior circulation. Posteromedial choroidal artery was an important artery that branched to the PG. The arterial supply to the PG was studied comprehensively considering the debate and inadequacy of previously published studies on this issue available in the literature.ConclusionsThis anatomical knowledge may be helpful for surgical treatment of pathologies of the PG, especially in children who develop more pathology in this region than adults.

Surgical Management of Supratentorial Intracerebral Hemorrhages: Endoscopic Versus Open Surgery

OBJECTIVE Intracerebral hemorrhage continues to be a major global problem. No standard treatment or surgical procedure has been identified for intracerebral hemorrhages. High morbidity and mortality rates caused by conventional approaches and the disease itself have necessitated more-invasive treatment methods. The endoscopic approach is a more minimally invasive method than craniotomy, which is another alternative surgical treatment. METHODS We compared intracerebral hematoma drainage in 2 groups of 17 patients each, treated with minimally invasive endoscopic method versus craniotomy. All the patients were treated for supratentorial spontaneous hemorrhage between December 2013 and February 2017 at the Neurosurgery Clinic of Ankara University Faculty of Medicine. RESULTS We retrospectively evaluated 34 patients surgically treated between December 2013 and February 2017. All patients underwent surgery within the first 24 hours. Patients in the early surgery group had better surgical outcomes. In the neuroendoscopic group, Glasgow Coma Scale increased from 6 to 11 at 1 week postoperatively compared with 5 to 9 in the craniotomy group. CONCLUSIONS Minimally invasive endoscopic hematoma evacuation may be a good alternative surgical method for treating supratentorial spontaneous cerebral hematomas.

The Effect of Levetiracetam on Closure of the Midline in Early Chicken Embryos.

AIM Genetic predisposition and some environmental factors play an important role in the development of neural tube defects. Levetiracetam is a new drug that has been approved in the treatment of partial seizures. We aimed in this study to determine the effect of levetiracetam on chick embryos. MATERIAL AND METHODS One hundred and sixty fertile non-pathogenic Super Nick eggs were incubated for 24 hours and were divided into four groups of 40 eggs each. Levetiracetam was administered via the sub-blastodermic route. The eggs were incubated for another 24 hours. All eggs were opened at the 48th hour, and the embryos were evaluated morphologically and histopathologically. RESULTS The effects of levetiracetam on the embryo were correlated with the dose of levetiracetam. In the light of the results, it was determined that the use of increasing doses of levetiracetam led to defects of midline closure in early chicken embryos. CONCLUSION Levetiracetam, a new antiepileptic drug that is effective especially on calcium ion concentration, leads to defects in midline closure in embryos in a dose-dependent manner. Further studies are needed to show the mechanism of embryonic damage and the mechanisms of its teratogenous effects associated with genetic and environmental factors.

Is a Unilateral Surgical Approach Effective in Patients with Bilateral Leg Pain with Unilateral Lumbar Disc Herniation? A Prospective Nonrandomized Clinical and Surgical Study

OBJECTIVE To examine the surgical results of unilateral lumbar discectomy in patients with bilateral leg pain and discuss short- and long-term outcomes within the limits of lumbar decompression. METHODS We analyzed 60 patients with unilateral disc herniation who underwent unilateral lumbar discectomy and hemipartial laminectomy between 2014 and 2017. Group 1 (30 patients) had bilateral leg pain and unilateral lumbar disc herniation. Pain lateralization was determined radiologically. Group 2 (30 patients) had unilateral leg pain and unilateral lumbar disc herniation. Pain scores were preoperatively evaluated with visual analog scale (VAS) for both legs and Oswestry Disability Index (ODI) for overall life quality. In both groups, surgery was performed on the ipsilateral side of the herniated disc. Scores were repeated on postoperative day 1 and 1, 3, 6, 12, and 24 months later. VAS score differences for pain lateralization and disc levels were compared in group 1. ODI score differences were compared between both groups. Results were statistically analyzed. RESULTS VAS score differences were statistically significant at all follow-up time points in patients with ipsilateral and contralateral pain. VAS score differences between L4-L5 and L5-S1 level discopathies were statistically insignificant for all time points in both groups. All postoperative ODI score decreases for all time points were statistically significant (P < 0.001) for both groups, whereas the differences between groups 1 and 2 were statistically insignificant. CONCLUSIONS Conventional lumbar disc surgery alone is sufficient for the ipsilateral side of radiologically demonstrated disc herniation in patients with bilateral leg pain.

Effect of Riluzole on Spinal Cord Regeneration with Hemisection Method Before Injury

OBJECTIVE The pathophysiology of spinal cord injury (SCI) with the information obtained to date has not been elucidated fully. A safe drug or treatment protocol that results in cell regeneration for SCI remains unknown. Neuroprotective and neuroregenerative effects of riluzole, administered after a SCI, have been shown in experimental studies. This study aimed to investigate the effect of riluzole on neural regeneration in a rat SCI model. METHODS Thirty-two rats were divided into 8 groups, with 4 rats in each group. Hemisection method was performed after T7-T9 laminectomy. Rats were intraperitoneally aministered with riluzole (6 mg/kg). Locomotor recovery of the rats was assessed at 1 day, and 1, 2, 3, and 4 weeks after the 21-point Basso, Beattie, and Bresnahan test. Subsequently, the spinal cords of the rats were scored according to a semiquantitative grading system using a light microscope, and the numbers of myelinated axons, neurons, and glial cells were calculated. RESULTS Basso, Beattie, and Bresnahan test changes were statistically significant when groups 4-6 and 8 were compared with the other groups (P < 0.05, P < 0.00625). The results of the numbers of neurons, glial cells, and myelinated axons were statistically significant. Especially group 8, in which riluzole was administered 5 days before injury, more positive clinical and histopathologic results were obtained. CONCLUSIONS Riluzole treatment is more effective when provided before injury. Riluzole may contribute to functional recovery when used in the preoperative period in patients who are at a high risk for permanent neurologic deficit.

Osteogenesis Imperfecta and Extra-/Intradural Hematomas: A Case Report and Review of the Literature

Osteogenesis imperfecta, also named as brittle bone disease, is characterized by fragile bones and short stature caused by mutations in the collagen gene. Subdural and intraparenchymal hematomas are defined and associated with trauma, vascular causes, and systemic bleeding diathesis. Skull fragility may lead to epidural hematoma, which is a life-threatening situation. Vascular fragility and intrinsic platelet defects are the causes of bleeding in patients with osteogenesis imperfecta, which is a major management challenge for neurosurgeons. Here, we reported on a 5-year-old boy with osteogenesis imperfecta with epidural hematoma and skull fracture following a trivial trauma, and made a literature review of 28 cases with extra-/intradural hematoma.

Median nerve schwannoma

Schwannoma, also known as neurilemmoma/neurinoma, is a benign true-capsuled tumour derived from the peripheral nerve sheath. Schwannomas are usually palpable, painless and solitary lesions. These tumours most frequently appear between 20 and 50 years of age, with similar incidence rates in males and females. Schwannomas can be readily separable from the surrounding tissue due to the presence of a true capsule. Thus, surgical excision is the most common treatment for schwannomas. In this paper, a median nerve schwannoma is presented. A 60-year-old male was admitted to our clinic with painful swelling at the flexor aspect of the forearm. Neurological examination revealed positive Tinel and Phalen signs, and electromyelography revealed prolonged median nerve latency. Magnetic resonance imaging detected a lesion in antecubital fossa (Fig. 1) and the lesion was completely excised using an operating microscope (Fig. 2a,b). The streptavidin–biotin peroxidase staining of the excised specimen revealed nuclear and cytoplasmic positivity for S-100. Both Antoni A and B patterns were observed. The lesion was diagnosed to be a schwannoma (Fig. 2c). At 6 months of follow-up, the patient reported no pain recurrence during palpation. Schwannoma and neurofibroma (NF) are two distinct types of peripheral nerve sheath tumour, of which schwannoma is the most common type (1%), accounting for 5% of all tumours in the upper extremity and 0.1–0.3% of all hand tumours. The ulnar and peroneal nerves are most frequently involved, whereas only 7% of schwannomas occur in the median nerve. Schwannoma may be associated with neurofibromatosis type 1, schwannomatosis or von Recklinghausen’s disease. However, the presented case had no syndromic signs or symptoms. The cardinal feature for the histopathological diagnosis of a schwannoma is an alternating pattern of Antoni A and B areas. Antoni A areas comprise spindle cells and Verocay bodies, while Antoni B areas are hypocellular. Immunopositivity for S-100 protein is specific to schwannomas and is useful for excluding NFs. Schwannoma diagnosis is often delayed because the neural tissue adapts to the pressure of these slow-growing tumours. Thus, schwannomas often initially present as a palpable mass, as noted in the present case. Radiological examinations reveal schwannomas as round or oval, located close to the nerve tissue, encapsulated, isolated and non-invasive. Although NFs show similar radiological findings, NFs are nonencapsulated and invasively grow into the surrounding nerves. Therefore, schwannoma cannot be distinguished from NFs using magnetic resonance imaging or computed tomography. Histopathological study is the only conclusive diagnostic method. The median nerve originates from the brachial plexus in the axilla and travels down the arm, first lateral to the brachial artery before crossing over to the medial side. The median nerve then enters the anterior compartment of the forearm via the cubital fossa. It leaves the cubital fossa by passing between the two heads of the pronator teres. In the forearm, the nerve travels between the flexor digitorum profundus and the flexor digitorum superficialis muscles. It enters the hand via the carpal tunnel deep to the flexor retinaculum and divides into two terminal branches. In our case, we preserved the brachial artery during mobilization of the median nerve. A search of the previous literature using terms ‘median nerve’, ‘schwannoma’ and ‘neurilemmoma’ retrieved 58 articles. After