Şükrü Aykol

Late hypoglossal nerve palsy following fracture of the occipital condyle

Fracture of the occipital condyle is a rare problem that can easily be overlooked. We report a patient with occipital condyle fracture who was neurologically intact on admission, and who developed hypoglossal nerve palsy in the late posttraumatic period. The diagnosis was facilitated by the aid of computed tomography.

Inhibition of epidural scar tissue formation after spinal surgery: external irradiation vs. spinal membrane application.

PURPOSE The scar tissue that forms after lumbar dissection is a severe complication and a cause of lumbar and radicular pain. It was recently shown that radiotherapy could inhibit peridural fibrosis after laminectomy. In this study, the efficiency of external irradiation was compared with spinal membrane application. METHOD AND MATERIALS Thirty male New Zealand rabbits underwent L5 laminectomy. Ten rabbits each received a single fraction of 900-cGy external irradiation administered by 9-MeV electron beam 24 h after the surgery. Ten other rabbits each had spinal membrane applied during laminectomy. The remaining 10 rabbits constituted the control group. All of the rabbits were killed 30 days after the laminectomy. Axial histologic sections through the laminectomy defect were evaluated. Each specimen was scored for the extent and density of fibrosis and arachnoidal adherence. RESULTS The extent and density of fibrosis and arachnoidal adherence differed significantly between the control group and the treatment groups (p < 0.05). However, the extent and density of fibrosis and arachnoidal adherence did not differ significantly between the spinal membrane and irradiation groups (p > 0.05). CONCLUSION This preliminary study showed that high-single-fraction/low-total-dose administered postoperatively can successfully inhibit postsurgical epidural fibrosis as effectively as applied spinal membrane.

THE EFFECT OF 2-CHLOROADENOSINE ON LIPID PEROXIDE LEVEL DURING EXPERIMENTAL CEREBRAL ISCHEMIA-REPERFUSION IN GERBILS

Oxygen free radicals may be implicated in the pathogenesis of ischemia-reperfusion damage. It is known that 2-chloroadenosine (2-CADO) has neuromodulatory effects and prevents the neuronal damage seen in the period of postischemia reperfusion. However, direct effects of 2-CADO on lipid peroxidation have not been investigated previously. The attack on the cell membrane by free radicals leads to lipid peroxidation, which can be assayed by the malondialdehyde (MDA) level. The aim of this study was to determine the effect of 2-CADO therapy on lipid peroxidation in experimental forebrain ischemia and postischemia reperfusion in Mongolian gerbils. Cerebral ischemia was induced by a bilateral 30-mm occlusion of the common carotid arteries. 2-Chloroadenosine (0.6 mg/kg, IV) was administered 5 min subsequent to ischemia. Ischemia was followed by reperfusion for 30 min. The MDA level was measured by the thiobarbituric acid (TBA) test. Bilateral carotid artery occlusion for 30 min in gerbils resulted in no significant change in MDA level in the brain. The MDA level was higher in postischemia reperfusion than in the ischemic group. 2-Chloroadenosine treatment did not change the MDA level in the ischemic period. However, the MDA level recovered significantly upon 2-CADO therapy during reperfusion following ischemia. These results suggest that 2-CADO may offer some degree of protection against oxidative stress in cerebral ischemia-reperfusion damage.

The effect of deferoxamine on brain lipid peroxide levels and Na-K ATPase activity following experimental subarachnoid hemorrhage.

1. In the present study we have studied the effects of deferoxamine treatment on lipid peroxidation and Na-K ATPase activity after experimental induction of subarachnoid haemorrhage (SAH) in guinea pigs. 2. We assessed the extent of lipid peroxidation by measuring the level of malondialdehyde and Na-K ATPase activity in 3 different groups (sham-operated, SAH, SAH + deferoxamine). 3. There was no significant difference in lipid peroxide content between sham-operated and haemorrhagic animals, but Na-K ATPase activity decreased after SAH. 4. Deferoxamine treatment reduced the malondialdehyde content and induced the recovery of Na-K ATPase activity, exerting a brain protective role against the detrimental effects of the haemorrhage.

Neuroprotective effects of gabapentin in experimental spinal cord injury.

BACKGROUND Extensive research has focused on neuroprotection after spinal cord trauma to alleviate the effects of secondary injury. This study aims to investigate the neuroprotective effects of gabapentin in experimental spinal cord injury. METHODS Thirty-six adult, male Wistar rats received spinal cord injury using the clip compression method. Animals were divided into five groups. High (200 mg/kg) and low doses (30 mg/kg) of gabapentin were administered to the animals in the treatment groups after spinal cord trauma and ultrastructural findings and lipid peroxidation levels of these two groups were compared with the animals that received only laminectomy, only trauma, and trauma and 30 mg/kg methylprednisolone. RESULTS Regarding tissue lipid peroxidation levels after trauma, animals in gabapentin groups demonstrated better results than the trauma group. However, these results were no better than the methylprednisolone group. The results regarding the ultrastructural findings were similar. Treatment groups demonstrated better ultrastructural findings than the trauma group. In addition, the results of the high dose gabapentin group were significantly better than the low dose gabapentin group. CONCLUSIONS Gabapentin demonstrated similar neuroprotective effects as methylprednisolone in early phase of spinal cord injury. Further studies with different experimental settings including neurological outcome are required to achieve conclusive results.

Immunomodulatory effectiveness of azithromycin in prevention of postlaminectomy epidural fibrosis

Abstract Objective: One of the important causes of failed back surgery is the extensive peridural fibrosis collecting in the surgical field after spinal surgeries. Today we know that inflammatory mechanisms mediated by the immune system of the body plays an important role in generation of fibrosis. Azithromycin, a macrolide antibiotic, has proven immunomodulatory effects in various diseases. This study aims to investigate the effects of azithromycin on peridural fibrosis Methods: Twenty-four Wistar rats received laminectomies before dividing them into three groups randomly. Animals of the control group received normal saline intraperitoneally while animals in the treatment groups received low (20 mg/kg) and high (80 mg/kg) doses of azithromycin intraperitoneally after surgical interventions. The amount of fibrosis, fibroblast density and inflammatory cell density were analyzed histologically. Results: Analysis demonstrated significantly reduced fibrosis, fibroblast density and inflammatory cell density in treatment groups compared to the control group. There was no difference between the treatment groups. Conclusion: Immune system plays critical roles in tissue repair and fibrogenesis. Results of our study demonstrated that azithromycin application reduced formation of peridural fibrosis in experimental laminectomy model in rats. Further studies with different dose regimes and different application routes are required to carry these results to an advanced level.

Sella turcica fractures in a trauma series and their clinical significance

BACKGROUND Fractures in the region of the sella turcica (ST) are usually associated with severe blunt head trauma and may produce many complications. The true incidence is difficult to assess since there have been only about 30 cases reported in the literature. METHODS A total of 470 computed tomography (CT) sections--with optimum bone window images of skull bone--of 1600 head trauma patients who were admitted between 1979 and 1992, inclusive, to the Neurosurgery Department of Gazi University Medical School were analyzed retrospectively. RESULTS There were a total of 17 patients with a fracture of the ST, constituting an incidence of 3.6%, and there was a preponderance of children. CONCLUSIONS Computed tomography was very helpful in assessing the extent of ST fractures. In our cases, these fractures were not associated with a high complication or death rate, although a cerebrospinal fluid fistula was present in 53%.

Results of radiosurgery for trigeminal neuralgia: Ankara experience

Abstract Object. The purpose of this retrospective study is to demonstrate the effectiveness of Gamma Knife radiosurgery for essential trigeminal neuralgia (TGN) and assess the long-term outcome in a cohort from Turkey. Methods. From 2004 to 2011, 93 cases of essential TGN were treated with single radiosurgery (RS). Female:male ratio was 45:48 and the mean age of the population was 57.06 years. Mean suffering time before treatment was 88.26 months. V2 + V3 was the most effected branch. 38.7% of the cases had no previous invasive procedures. Each case received doses ranging from 70 to 90 Gy in a target located at the pontine trigeminal root entry zone of the trigeminal nerve. Statistical analyses were performed to evaluate the outcome and factors leading to outcome status. Results. The median follow-up period was 28 months. Of the cases 31.2% had poor outcome related to treatment failure after single RS session. The excellent and good outcomes were achieved in 29% and 39.8% of patients, respectively. The probability of maintaining pain relief was calculated as 67% at 36 months and 58% at 72 months. The only complication encountered was facial dysesthesia and was positive in 68.8% of patients. The presence of facial dysesthesia was significantly correlated with better outcomes. In this study, no other factor was determined to have significant influence on outcome. Conclusion. RS treatment for TGN is safe and effective. A multicenter, prospective, randomized controlled trial is needed to determine a guideline for better treatment protocols.

Stereotactic biopsy of the brain mass lesions: a tertiary hospital experience

Objectives: Stereotactic biopsy (SB) is a guided technic performed for the lesions on eloquent brain areas. The aim of this study is revealing the diagnostic reliability and the risk ratio of SB. Methods: Data of patients performed SB due to various intracranial lesions was collected retrospectively. The study took place in Department of Neurosurgery, Gazi University Faculty of Medicine between February 2004 and April 2014. Data analysis performed in terms of age, gender, lesion location, histopathology, and outcomes of surgery. Results: Sixty percent of patients were male (146 patients) and forty percent of them was female (96 patients), between the ages of 11 and 84 years (mean age of 49 years) with a total number of 242. Mortality and morbidity rates were respectively 0.4% and 3.3%. The overall diagnostic yield was 81% (196 patients), while 19% (46 patients) had nonspecific results, which did cannot lead any further therapy. Among 36 patients of whom pathologies were confirmed with an excisional biopsy, the diagnostic accuracy was shown in 24 patients (67%). Conclusions: Beside low risk of mortality and morbidity, the high rate of non-diagnostic results and low rate of diagnostic accuracy are the limitations of SB, which should be improved by careful skills to obtain more specimen, sophisticated software for planning, and intraoperative pathological examination for guaranteeing.