Orkun Koban

Is intraoperative ultrasound required in cervical spinal tumors? A prospective study.

AIM To determine the role of intraoperative ultrasonography (IOUSG) in the surgical management of patients with intradural spinal tumors. MATERIAL AND METHODS Twenty-six patients with intradural spinal cord tumors were surgically treated under intraoperative ultrasonographic guidance between January 2007 and May 2011. Guidance with IOUSG was used in 26 patients, of which 14 fourteen had extramedullary and 12 had intramedullary tumors. Intraoperative ultrasound assistance was used to localize each tumor exactly before opening the dura. The extent of tumor resection was verified using axial and sagittal sonographic views. The extent of tumor resection achieved with IOUSG guidance was assessed on postoperative early control MRI sections. RESULTS Total tumor resection was achieved in 22 (84%) of 26 cases. All of the residual tumors were typically intramedullary and infiltrative. The sensitivity of IOUSG for the determination of the extent of resection was found to be 92%. Ultrasonography was found to be effective in identification of tumor boundaries and protection of spinal cord vessels. The average time spent for IOUSG assessment was 7 minutes. CONCLUSION Intraoperative ultrasonography is practical, reliable and highly sensitive for spinal cord surgery. It not only enhances surgical orientation, but also reduces morbidity and helps to resect the tumor completely.

Cerebral Alveolar Echinococcosis Concomitant with Liver and Lung Lesions in a Young Adult Patient: Case Report and Literature Review.

We present the case of a 25-year-old male harboring multiple brain lesions mimicking tumor metastasis that were revealed to be caused by Echinococcus multilocularis. Cerebral echinococcosis with multiple lesions is rare and might be confused with a brain abscess, tuberculoma, or metastatic tumor disease. Brain magnetic resonance imaging and serological studies are helpful in the differential diagnosis. In case of E. multilocularis, cerebral invasion is the late stage of the disease that necessitates an aggressive treatment protocol.

Migrating bullet in the thecal sac at the level of the conus medullaris without neurological deficit

Bullets can lodge in the organs, blood vessels or thecal sac. To our knowledge, a migrating bullet at the level of the conus medullaris without neurological deficit has never been reported. We present our patient along with a discussion of bullet migration in the spinal canal and its mechanisms, diagnosis and treatment. A 29-year-old man was admitted to the emergency department due to a gunshot wound in the right upper quadrant of his abdomen. He had no neurological deficit. Spinal CT scan and plain radiography showed the bullet had passed through the L2 vertebral body and had migrated downwards until it had lost its energy and come to rest in the spinal canal at the L3 vertebra level. There was a grade 5 injury to the pancreas head concomitant with mesenteric injury of the transverse colon, harboring a 0.5 cm hole. He had an emergent laparotomy to have a Roux-en-Y reconstruction and repair of the transverse colon. After his general status stabilized, he was taken back to the operating room to extract the bullet from the spinal canal. L3 and partial L2 laminectomy were performed. The dura was opened and the bullet was observed intrathecally. No cerebrospinal fluid fistula was observed. The surgeries and post-operative period were uneventful.

The Effect of Technological Devices on Cervical Lordosis

PURPOSE: There is a need for cervical flexion and even cervical hyperflexion for the use of technological devices, especially mobile phones. We investigated the effect of this use on the cervical lordosis angle. MATERIAL AND METHODS: A group of 156 patients who applied with only neck pain between 2013–2016 and had no additional problems were included. Patients are specifically questioned about mobile phone, tablet, and other devices usage. The value obtained by multiplying the year of usage and the average usage (hour) in daily life was determined as the total usage value (an average hour per day x year: hy). Cervical lordosis angles were statistically compared with the total time of use. RESULTS: In the general ROC analysis, the cut-off value was found to be 20.5 hy. When the cut-off value is tested, the overall accuracy is very good with 72.4%. The true estimate of true risk and non-risk is quite high. The ROC analysis is statistically significant. CONCLUSION: The use of computing devices, especially mobile telephones, and the increase in the flexion of the cervical spine indicate that cervical vertebral problems will increase even in younger people in future. Also, to using with attention at this point, ergonomic devices must also be developed.

The clinical comparison between the patients operated for unilateral radiculopathy via contralateral(facet-sparing)and ipsilateral side approach

AIM To compare clinical outcomes of the patients operated from the contralateral or ipsilateral side for unilateral radiculopathy in spinal stenosis. MATERIAL AND METHODS This was a retrospective study. Twenty patients were listed as Group 1 (Contralateral) with unilateral radiculopathy and spinal stenosis with/without lateral recess syndrome or foraminal stenosis. Decompression from opposite side of radiculopathy was performed to Group 1 patients. Decompression from the radiculopathy side was performed to the patients in Group 2 (Ipsilateral). Twenty eight patients were listed as Group 2. Back pain visual analogue scale (VAS) score and leg pain VAS score were assessed at preoperative, postoperative 1st month and postoperative 12th month. The results were compared statistically. RESULTS Two patients were excluded because of reoperation at the 2nd month from the Group 2 to assessment 12th month VAS score. There was no significant difference between two groups at 1st month back pain VAS and leg pain VAS scores. There was no significant difference between two groups at 12th month back pain VAS and leg pain VAS scores. Dynamic stabilization was performed at 2nd month to two patients after the first operations for instability. So, there was no difference in clinical outcomes between the patients treated by contralateral approach and ipsilateral approach when instability did not occur. However, there is a risk of instability of the same side approach and surgery owing to shaving of the facet joint. CONCLUSION In the contralateral approach, the recess of the contralateral side and foramen can be better seen than in the ipsilateral approach. So, this is a facet-sparing approach to spinal stenosis with/without lateral recess syndrome or foraminal stenosis with unilateral radiculopathy. The contralateral approach to unilateral radicular complaints is quite effective. With this approach, facet joints are protected from possible instability.

Traumatic Transient Herniation Concomitant with Tonsillar Hemorrhagic Contusion in a Child

Downward displacement of cerebellar tonsils more than 5 mm below the foramen magnum is named as Chiari type I malformation and named benign tonsillar ectopia if herniation is less than 3 mm. It does not just depend on congenital causes. There are also some reasons for acquired Chiari Type 1 and benign tonsillar ectopia/herniation. Trauma is one of them. Trauma may increase tonsillar ectopia or may be the cause of new-onset Chiari type 1. The relationship between the tonsil contusion and its position is unclear. We present a case of pediatric age group with tonsillar herniation with a hemorrhagic contusion. Only 1 case has been presented so far in the literature. A case with unilateral tonsil contusion has not been presented to date. We will discuss the possible reasons for taking the place of the tonsils to the above level of the foramen magnum in the follow-up period, by looking at the literature.

The Necessity of Follow-Up Brain Computed-Tomography Scans: Is It the Pathology Itself Or Our Fear that We Should Overcome?

AIM: This study aimed to make a retrospective analysis of pediatric patients with head traumas that were admitted to one hospital setting and to make an analysis of the patients for whom follow-up CT scans were obtained. METHODS: Pediatric head trauma cases were retrospectively retrieved from the hospital’s electronic database. Patients’ charts, CT scans and surgical notes were evaluated by one of the authors. Repeat CT scans for operated patients were excluded from the total number of repeat CT scans. RESULTS: One thousand one hundred and thirty-eight pediatric patients were admitted to the clinic due to head traumas. Brain CT scan was requested in 863 patients (76%) in the cohort. Follow-up brain CT scans were obtained in 102 patients. Additional abnormal finding requiring surgical intervention was observed in only one patient (isolated 4th ventricle hematoma) on the control CTs (1% of repeat CT scans), who developed obstructive hydrocephalus. None of the patients with no more than 1 cm epidural hematoma in its widest dimension and repeat CT scans obtained 1.5 hours after the trauma necessitated surgery. CONCLUSION: Follow-up CT scans changed clinical approach in only one patient in the present series. When ordering CT scan in the follow-up of pediatric traumas, benefits and harms should be weighted based upon time interval from trauma onset to initial CT scan and underlying pathology.

Isolated Unilateral Temporalis Muscle Hypertrophy; A Case Report and Review of The Literature

Isolated unilateral temporalis muscle hypertrophy is very rare pathology that 9 cases have been submitted to till day.We report the 10th case of this rare condition and review the literature. Swelling of masticatory muscles may be isolated or may be present together. It is accused of reactive and nonreactive causes in ethiology. Significant pathologies accompany non-reactive causes. Some reactive causes are parafunctional jaw habits, gum chewing habits, bruxism. Biopsy is the gold standard method of separating reactive and nonreactive causes. The treatment can be shaped according to the biopsy result. Medical treatment, surgery and botox are available to treat the reactive causes. Botox therapy is the most effective. There is no clear information in the literature about the size of swelling in untreated patients. We do not have an extra treatment after the patient’s biopsy. Follow up period of the patient is currently ongoing and the size of swelling does not increase.

Postoperative multilevel lumbar anterior epidural empyema without spondylodiscitis

An 87-year-old man with persistent low back pain of 3 weeks’ duration following a month-old disc surgery at the L4–L5 levels was admitted to our hospital. Spinal magnetic resonance imaging (MRI) revealed anterior epidural lesion between L1 and L5. The lesion was hyperintense on T2weighted images and hypointense on T1-weighted images comparing muscle intensity (Figs. 1 Left, Right and 2 Left). Postcontrast T1-weighted magnetic resonance images showed peripheral intense enhancement (Figs. 1 Right and 2 Right). Diffusion weighted image showed the lesion to be brightly hyperintense, and the apparent diffusion coefficient map demonstrated restricted diffusion (Fig. 3). Multilevel epidural empyema was diagnosed with these MRI findings. There was T2 hyperintensity in the L4–L5 disc caused by discectomy, but MRI findings of spondylodiscitis were not detected. A small subcutaneous abscess was also seen in the surgical site (Fig. 1 Right). Spinal epidural empyema is a rare disease and has been reported in elderly patients as a complication of septic infection or spinal surgery [1,2].

Involvement of two consecutive vertebral bodies and intervertebral disc space in dorsal spinal hydatid disease

A 59-year-old man who had a history of hepatic hydatid cyst operation presented with progressive back pain and paraparesis. Thoracic spine magnetic resonance imaging revealed heterogeneous low and high signal in the T9, T10 vertebral bodies and intervertebral disc space on both T1and T2weighted magnetic resonance imaging caused by hydatid disease. The intraspinal extradural cystic components of the lesion demonstrated low T1 signal and high T2 signal with low-signal-intensity rims on images (Figs. 1 and 2). Postcontrast images did not reveal significant enhancement (Fig. 3). Plain computed tomography demonstrated destruction of the T9, T10 vertebral end plates and posterior portion of the T10 vertebral body with sclerotic areas (Fig. 4). Surgery was performed, and a pathologic examination confirmed the diagnosis of hydatid disease. Involvement of two consecutive vertebral bodies together with intervertebral disc space involvement in dorsal spinal hydatid disease is extremely rare and should be considered in the differential diagnosis of atypical spondylodiscitis.