Rüçhan Ergün

Neuroprotective effects of propofol following global cerebral ischemia in rats

Abstract. Propofol has cerebral vascular and metabolic effects similar to those of barbiturates, and it is used to maintain neurosurgical anesthesia because it reduces cerebral metabolic rate, cerebral blood flow, and intracranial pressure. Although the use of propofol as a cerebral protectant during certain neurosurgical procedures has been advocated, consensus has not been reached as to a protective effect of propofol on cerebral ischemia. In this study we observed the neuroprotective effects of propofol during global cerebral ischemia-reperfusion injury by the use of four-vessel occlusion method in a rat model. We measured the levels of malondialdehyde as a marker of lipid peroxidation in ischemic tissue, and the results indicate that propofol plays a role in the inhibition of neuronal death induced by brain ischemia.

Prognostic value of serum neuron-specific enolase levels after head injury

Neuron-specific enolase (NSE) is a dimeric cytoplasmic enzyme detected in high levels in neurons and acts in the glycolytic pathway. It is known that there is a quantitative relationship between the concentration of serum NSE and the degree of cell damage in the central nervous system. We examined serum levels of NSE by enzyme immunoassay in 89 patients with head injury and aimed to evaluate its relationship with neurological status and prognosis of the patients.

Orbital hydatid cysts: Report of four cases

Hydatid cysts of central nervous system are rare and comprise only 2% to 3% of all hydatid cysts reported. Orbital localization is very uncommon and has been reported less than 1 % of all hydatid diseases. The primary treatment of hydatid disease is surgical. The most important complication of the surgical treatment is secondary hydatidosis due to spillage of the cyst contents. Because of the difficulties of the orbital localization, total extirpation of the cysts without rupture is almost impossible. Preventing spontaneous rupture of the cysts during surgery and postoperative antihelmintic treatment should be taken into consideration in these cases.This study includes four cases who underwent surgery for orbital hydatid cysts. Radiological characteristics, operative technique and postoperative medical therapy are discussed.

Prognostic value of interleukin-1 beta levels after acute brain injury

Abstract Traumatic injury to central nervous system results in the production of inflammatory cytokines via intrinsic mechanisms by neurons, astrocytes and microglia, and extrinsic mechanisms by infiltrating macrophages, lymphocytes and other leukocytes. Interleukin-1 beta is the key mediator of the acute inflammatory host response. While this response is necessary for resolution of the pathologic event, the toxic nature of many of its products can cause significant tissue damage. We analyzed serum interleukin-1 beta levels by enzyme-linked immunosorbent assay in 48 patients with solitary head injury who were transported to our clinic immediately after trauma. We categorized the patients according to their initial Glasgow coma scores in three groups, and compared their serum interleukin-1 beta values both with their Glasgow coma initial and outcome scores. This study helped to provide quantitative data to estimate clinical impressions and prognosis after head injury.

Rare intracranial manifestations of frontal osteomas.

SummaryOsteomas of the paranasal sinuses are usually asymptomatic. When enlarged, they could give rise to intracranial manifestations and serious complications. Osteomas most commonly affect the fronto-ethmoid sinuses. They rarely show intra-orbital extension or cause intracranial complications such as CSF rhinorrhea, pneumocephalus and intracranial infection. We report two unusual cases of frontal osteomas complicated by rare manifestations such as intracranial mucocele, CSF leak, pneumocephalus and bacterial meningitis. We demonstrate the importance of these intracranial manifestations when these lesions are accompanied by neurological symptoms and signs with special emphasis on the importance of early treatment.

Craniocervical neurenteric cyst without associated abnormalities.

Spinal neurenteric (NE) cyst is an uncommon congenital cyst and frequently found in the cervical region. The clinical symptoms associated with this entity depend on the site of the lesion and are not typical for all such cysts. A definitive diagnosis can only be made by biopsy and histological examination. MRI can confirm these cystic masses and is the method of choice for their imaging investigation. They are often connected by a fibrous tract, fistula or cleft to structures derived from the primitive gut in the thoracic or abdominal cavities and are commonly associated with anterior spina bifida or other vertebral anomalies. We report a case of craniocervical NE cyst without associated abnormalities and discuss the implications for clinical diagnosis and management by a thorough review of the literature.

Early changes in the cervical foraminal area after anterior interbody fusion with polyetheretherketone (PEEK) cage containing synthetic bone particulate: a prospective study of 20 cases.

Abstract Objectives: Although the use of intervertebral fusion after anterior cervical microdiscectomy remains controversial, a new surgical device is proposed for use in intervertebral fusion instead of bone graft. The authors evaluate the effects of implantation of polyetheretherketone (PEEK) cage containing synthetic bone particulate on the height and cross-sectional area of the foramen, the intervertebral disk height and the degree of lordosis. Methods: Twenty consecutive patients with radiculopathy owing to cervical disk herniation were scheduled. They underwent multislice computed tomographic scanning pre-operatively and 1 day post-operatively. Results: Pre-operatively, the mean height of the right foramina was 8.807 ± 1.120 mm, the left foramina was 9.500 ± 1.529 mm. Post-operatively, the mean foraminal height of the right side was 11.080 ± 1.121 mm and 10.020 ± 1.453 mm on the left. This difference reached statistical significance on the right foraminal height (p=0.000) but not on the left side (p=0.078). The mean area of the right foramina was 46.82 ± 14.54 mm2 and 52.71 ± 15.62 mm2 on the left side pre-operatively. Post-operatively, the values were 60.87 ± 15.91 mm2 and 55.83 ± 13.88 mm2 respectively. In terms of pre-operative value, the 1 day post-operative measurement reached again statistical significance (p=0.002) on the right side. The mean value of disk height was 3.653 ± 0.596 mm pre-operatively and 6.387 ± 0.533 mm at 1 day post-operatively. This difference is statistically significant (p=0.000). Discussion: Implantation of a PEEK cage containing synthetic bone particulate in the treatment of cervical disk disease offers good immediate stabilization by easier implantation technique and avoids donor site morbidity. It provides an increase in height and cross-sectional area of the neural foramina. These preliminary results suggest that interbody fusion cages appear to be safe and effective.

Hydrothorax: Transdiaphragmatic Migration of a Ventriculoperitoneal Shunt Catheter

Symptomatic hydrothorax following ventriculoperitoneal shunt insertion is a very rare complication. The patient was a 5-month-old child known to have had shunted congenital hydrocephalus two months before. He presented to the emergency room in respiratory distress. Chest X-ray and computerized tomography images confirmed left hydrothorax and showed transdiaphragmatic migration of the tip of the peritoneal catheter to the thoracic cavity. After the catheter had been shortened and replaced to the peritoneal cavity, the patient’s symptoms abated.

Spontaneous regression of a huge subligamentous extruded disc herniation: short report of an illustrative case

Herniated nucleus pulposus (HNP) is a common cause of radicular and low-back pain. Although some patients need surgical intervention because of prolonged intolerable leg pain, the majority heal with conservative treatment. Recently, with the advent of imaging diagnostic methods, there is an increasing interest in the phenomenon of spontaneous resorption of the HNP. We presented a case of lumbar HNP at the L4–L5 level in which clinical improvement was associated with a significant decrease in size of a huge subligamentous extruded disc herniation, documented on serial magnetic resonance imaging (MRI) scans.

Intradiscal electrothermal treatment for chronic discogenic low back pain: a prospective outcome study of 39 patients with the Oswestry disability index at 18 month follow-up

Abstract Objective: The authors evaluate the efficacy of intradiscal electrothermal therapy (IDET) for discogenic pain on outcome of patients using the Oswestry disability index (ODI) after 18 month follow-up. Methods: Thirty-nine patients with chronic discogenic low back pain who failed to improve following conservative treatment were considered for this study. Inclusion criteria included the presence of one- or two-level symptomatic disk degeneration without evidence of nerve root compression. Patients were excluded if there was severe disk degeneration together with loss of more than 50% disk height. We measured the outcome scores at minimum of 18 month period with the Turkish version of the ODI and compared them with pre-treatment scores. Results: All procedures were considered technically successful and there were no device-related complications. Mean ODI scores of 39 patients pre-operatively and post-operatively 6, 12 and 18 months were 45.7436 ± 11.6545, 24.7692 ± 10.7861, 23.0256 ± 10.6412 and 21.4872 ± 10.0286, respectively. The effect of treatment was calculated as the difference between the scores before and after treatment. They were 20.9744 ± 12.5394, 22.7179 ± 12.5697 and 24.2564 ± 12.5922 after the same follow-up periods. There was a significant difference (p<0.01) between all the mean scores after treatment (6, 12 and 18 months) compared with the pre-IDET mean ODI. Discussion: Although various alterations in outcome scores have been reported in previous works, we found nearly four in five patients (79.48%) who clearly benefited from this therapy. This procedure may become a middle step for carefully selected group of patients who failed non-operative treatment before surgical intervention.