Şanser Gül

Primary spinal extranodal Hodgkin's disease at two levels

About 90% of Hodgkins disease cases originate from lymph nodes whereas 10% from extranodal regions. Patients rarely present with spinal cord compression due to epidural Hodgkins disease. Primary spinal extradural Hodgkins disease which does not have any other organ involvement in the body is even rarer. A 39-year-old male patient who complained of lumbar pain had normal findings upon neurological examination. Radiological examination revealed a mass on the epidural space at level L3 and the involvement of the vertebral corpus accompanied by the involvement of C6 vertebral body. Primary focus could not be identified despite further investigation. The patient underwent L3 laminectomy and posterior decompression and biopsy was obtained from the lesion extending to epidural space. The pathological result was reported as lymphocyte dominant type Hodgkins disease. Flow cytometry was performed to the lesion, also. The patient was evaluated as Stage 4A according to Ann Arbor classification. Postoperative radiotherapy was applied to lumbar and cervical region. In the literature we have not come across any case of primary spinal extranodal Hodgkins disease with involvement at two levels. In conclusion, although it might be extremely rare, primary spinal extranodal Hodgkins disease with involvement at two levels might be observed.

Neurocutaneous melanosis associated with Dandy-Walker malformation

SummaryNeurocutaneous melanosis is an uncommon congenital disorder consisting of benign or malignant melanocytic tumors of the leptomeninges with large or numerous cutaneous congenital melanocytic nevi. The Dandy-Walker malformation occurs as an enlarged posterior fossa with high insertion of the tentorium, hypoplasia or aplasia of the cerebellar vermis, and cystic dilatation of the fourth ventricle. To our knowledge, the association of these two conditions has been reported only 14 times. In this article, we present a newborn patient with neurocutaneous melanosis associated with Dandy-Walker malformation, which was diagnosed by magnetic resonance imaging.

Migration of a bullet in the spinal canal

Migration of a bullet within the spinal canal after gunshot injury is rare. We report here the case of a penetrating gunshot injury of the lumbar spine at L3 with migration of the bullet within the spinal canal S2. The patient had marked paraparesis (proximal 1/5, distal 0/5 muscle strength) and anaesthesia at L3 and below, and had a hypocompliant, hyper-reflexive bladder with decreased capacity, and absent anal tonus. We removed osseous fragments in the canal with an L3 laminectomy and extracted the bullet by S2 laminectomy. After surgery, we observed an improvement in paraparesis, an increase in bladder capacity and urinary compliance, and improvement in anal tonus. The appropriate course of action in this type of injury remains unclear, because the number of cases described in the literature is not sufficient to provide a basis on which to make a definitive therapeutic decision. We herein review the literature describing cases in which a bullet in the spinal canal has migrated; we describe the treatment used and the outcomes in these cases.

A multilevel thoracolumbar meningioma in a young woman

SummarySpinal meningiomas of five or more vertebral segment long are very rare and also less common in younger patients. Under 50 years of age these tumors are more commonly genetical and have worse prognosis. A 25-year-old woman presented with back pain and progressive walking difficulty. An intradural extramedullary tumor extending from thoracal 9th to lumbar 2nd vertebral body was detected. The patient was operated and the tumor was totally removed. The histopathological diagnosis was angiomatous meningioma. Neurological symptoms and signs partially improved postoperatively. Interestingly, magnetic resonance imaging of this patient might easily be confused with ependymoma. Although we performed laminectomy and instrumentation, to maintain stability laminoplasty should be the first treatment modality for such a young patient.

Is the recurrence rate of chronic subdural hematomas dependent on the duration of drainage

Abstract Objectives: Chronic subdural hematoma (CSDH) is the most frequent type of intracranial hemorrhage which especially affects the elderly. Various surgical techniques have been reported for CSDH treatment; optimal treatment methods are still controversial. In this study, the effects of long drainage durations on results and recurrences were investigated in patients on whom closed system drainage with burr hole craniotomy was applied due to CSDH. Methods: 90 patients with 105 CSDH were operated between 2008 and 2016. Patients were divided into two groups based on the duration of drainage. Group A (n = 40) was determined as 2–4 days of closed-system drainage, while Group B (n = 50) was recorded as 5–7 days of closed-system drainage. Recurrence was defined as accumulation of blood in the operation area and recurrence of symptoms within the monitoring period of six months. Results: Recurrence was observed in 7 (15.6) of the Group A patients and 2 (3.3%) of the Group B patients. There was a statistically significant difference between groups in terms of recurrence rate (p = 0.04). Postoperative thickness of hematoma was measured in the first month follow-up computerized tomography. There was a statistically significant difference between groups in terms of postoperative thickness of residual hematoma (p = 0.05). Conclusion: 2–4 days of closed system drainage following burr hole craniotomy is an effective and reliable choice of treatment in CSDH. Nevertheless, increasing the duration of drainage to 5–7 days provided better results without increasing the risk of complication.

Bilateral Optic Perineuritis Developing with Intracranial Fibrillary Astrocytoma

Optic perineuritis is an uncommon variety of orbital inflammatory disease. A case with a 45-day history of headache and vomiting who was diagnosed with fibrillary astrocytoma of the right frontal lobe is reported. Progressive bilateral visual loss developing postoperatively was considered as bilateral optic perineuritis based on the pathological and radiological findings. However, extensive medical and surgical therapy failed to recover visual loss. By this case, the mechanisms and difficulties in the diagnosis were discussed.