Ümit Dursun Acar

Ossified thoracic spinal meningioma in childhood: A case report and review of the literature

Spinal ossified meningiomas are extremely rare. This is a report of a study on a 15-year-old boy with thoracic spinal ossified meningioma. The meningioma was resected totally. Histopathological examination revealed a transitional meningioma (psammomatous+meningothelial). Immunohistochemically, Ki 67 antibody was applied but no positive staining was present. The surgical and pathological aspects of spinal ossified meningiomas were reviewed.

Functional results and the risk factors of reoperations after lumbar disc surgery

Factors such as driving motor vehicles, sedentary occupations, vibration, smoking, previous full-term pregnancies, physical inactivity, increased body mass index (BMI), and a tall stature are associated with symptomatic disc herniations. Fitness and strength is postulated to protect an individual from disc rupture. The objective of our study was to determine the pain levels and differences of functional and economic situations of patients who had undergone one or more than one operation due to lumbar disc herniation and to put forward the effect of risk factors that may be potential, especially from the aspect of undergoing reoperation. Patients who had undergone one (n=46) or more than one operation (n=34) due to lumbar disc herniation were included in the study. It was a prospective study with evaluation on the day the patients were discharged and at second and sixth months after lumbar disc operation. The Oswestry Disability Index (ODI) was used in determining the functional disability associated with back pain; the Prolo Functional Economic Rating Scale (Prolo scale) was used in determining the effect of back pain on functional and economic situations. In the ODI measurements made in the postoperative second and sixth months, significant differences appeared in favor of patients who had undergone one operation (p<0.05). According to the Prolo scale, it was found that the economic situation was better in the sixth month and the functional situation was better in the second and sixth months in patients having undergone one operation (p<0.05). The logistic regression analysis demonstrated that the lack of regular physical exercise was a significant predictor for reoperation (OR, 4.595; CI, 1.38–15.28), whereas gender, age, BMI, occupation, or smoking did not indicate so much significance as regular exercise.

Intracranial penetrating injury associated with an intraoperative epidural haematoma caused by a spring-laden pin of a multipoise headrest

Lack of an intermediary piece that should have been placed between the pin and spring resulted in skull penetration due to a rapid waste in the springs compensatory capacity. Checking integrity of internal pieces should be performed regularly. Designing intermediary piece and spring as a single piece might increase safety.

Pin site metastasis of meningioma.

Metastasis of meningiomas due to iatrogenic implantation of tumour cells is extremely rare and only four cases have been reported to date. In this study, we report a 45-year-old female patient who presented with meningioma metastasis at the pin site of head holder applied in the original operation.

Giant thrombosed aneurysm of the vertebral artery in childhood: an extremely rare case

In childhood, a significant proportion of giant aneurysms usually occur at the vertebrobasilary system. Nonetheless, giant totally thrombosed aneurysm which only involves the vertebral portion of the vertebrobasilary system is very rare. Up to this time, in childhood, a few giant aneurysm originating from vertebral artery have been reported, and to our knowledge only one case was reported to be totally thrombosed. The enlargement tendency of totally thrombosed aneurysms and management of these cases are still controversial. Thus, diagnosis and follow-up of cases where a radical approach could not be performed require a multi-modality radiologic approach. In this study, we reported a case of angiographically occult giant thrombosed vertebral artery aneurysm, which is extremely rare, and discussed the importance of CT and MRI in evaluation of these patients before surgical treatment.

Comparison of partial excision with simple section of the transverse carpal ligament in the treatment of carpal tunnel syndrome.

&NA; In the surgical treatment of carpal tunnel syndrome, debate has commonly focused on whether decompression should be performed by open or blind techniques. Contrarily, the goal of the present study was to determine whether instead of simple section, partial excision of the transverse carpal ligament has contributed to better results. Because complete healing of the transverse carpal ligament observed during reoperations has been reported elsewhere, the charts of 75 carpal tunnel syndrome patients who had been treated with open technique at Dokuz Eylül University were reviewed. Statistical analysis was performed using the Fishers exact test and Students t test when appropriate. Thirty‐five patients had been treated with simple section of the transverse carpal ligament, whereas 40 had been treated with partial excision. Internal neurolysis was also performed in 19 of the patients, 11 of whom were treated with partial excision. The average follow‐up time was 3.8 years. The comparisons regarding the overall operative outcomes did not show any significant difference between the two different techniques of releasing the transverse carpal ligament. In patients treated without neurolysis, results of partial excision of the transverse carpal ligament improved when compared with those of simple section, but this superiority was not statistically significant. There seemed to be statistically higher reoperation rates and worse outcomes after neurolysis (p < 0.05). Reoperation was required in eight patients (11 percent). Five of the patients who underwent reoperation had initially been treated with partial excision and neurolysis, whereas two had been treated with simple section and neurolysis. Another patient who had undergone reoperation had initially undergone only simple section. The mean time to return to work or daily activities did not differ between the types of applied technique for releasing the transverse carpal ligament. However, neurolysis lengthened these periods significantly when performed (p < 0.05). In the present study, partial excision of the transverse carpal ligament without adding neurolysis offered relatively better results than simple section. Verification of this finding endoscopically, if applicable, may improve the success rate of surgical therapy in patients with carpal tunnel syndrome. (Plast. Reconstr. Surg. 109: 1953, 2002.)

Histochemical and immunohistochemical features of a case showing association of meningioma and prolactinoma containing amyloid.

We report the rare case of a 43-year-old woman with a simultaneous meningioma of the sphenoid wing and an amyloid-containing prolactinoma. The patient, who presented with a 17-year history of amenorrhea, and galactorrhea, was found to have a 10-mm mass in the pituitary gland. During excision of this lesion, another mass was noticed, which was located in the sphenoid wing. Both lesions were completely excised. Histopathological examination revealed that the pituitary tumor was a prolactinoma with diffuse amyloid deposition and that the second tumor was a typical meningioma. The coexistence of a prolactinoma containing amyloid and a meningioma is very rare in the literature, so this case is presented here with its histochemical and immunohistochemical features. We discuss the significance of prolactinoma containing amyloid and the simultaneous presentation of these two tumors.

Rare gynecological condition causing sciatic pain

A 59-year-old women admitted to hospital with complaints of pain radiating from the low back and back of the right leg to the toes, numbness and inability to walk due to pain. She was referred to the neurosurgery department with a tentative diagnosis of herniated lumbar disc. On neurological examination, the patient was unable to bring her right foot to a completely neutral position in dorsiflexion and big toe dorsiflexion was 415 of its motor capacity, with hypoesthesia in the L4, Ls, S,, SZ, dermatomes, femoral extension test and Laseques’s sign were also positive on the right leg. The patient stated that the intrathecal pressure raising maneuvers as coughing and sneezing did not aggravate the pain. X-ray of abdomen and lumbosacral region revealed a 3 x 3 cm opacity at the right side of the pelvis (Fig. 1). Myelography and computed tomography (CT) did not reveal any particular pathology. The patient was referred to gynecology department for further evaluation of the pelvic opacity. On gynecological examination, a 3 x 3 cm in size solid mass in the upper right part of the uterus was detected. This was suspected to be a calcified subserous myoma or an -ovarian tumor. On laparatomy, uterus was observed in normal postmenapausal size, with a calcified myoma, 3 x 3 cm in dimensions, being found in the upper right portion of the uterus. Pathological examination following total abdominal hysterectomy and oophorectomy revealed calcified degenerated myoma. Immediately after the operation the patient was free from all complaints and the pathological signs, observed on the day of admission. The im-

Evaluation of early period physical performance, physical activity, pain and disability levels of patients operated for cervical disc hernia

Abstract. Study design: A prospective study made into cervical disc hernias.Objectives: To assess the changes in the early postoperative period of the patients with cervical disc hernia in terms of the painand disability we measured according to ‘The Neck Pain and Disability Scale’, physical performance, fatigue, fear of activity(kinesiophobia), physical activity levels.Setting: Neurosurgical department.Summaryofbackgrounddata: Kinesiophobiaanditsassociatedavoidancebehaviorinthedevelopmentofchronicmusculoskeletalpain has been of great concern over the past decade, thus rendering appropriate and detailed assessments in the postoperativeperiod very important.Methods: Sixteenpatients operated onbecause ofcervical discherniawereincluded inourstudy. Thepain anddisability, physicalperformance, fatigue, kinesiophobia, and physical levels of the patients were evaluated pre-postoperatively, during discharge andat the end of the second month.Results: While pain, disability measured according to ‘The Neck Pain and Disability Scale’ fatigue were decreasing, allperformance measurements except the sit/stand, lying/sit and loaded reach were getting highest scores on the 2nd postoperativemonth. Although kinesiophobia, peaked at the 2nd postoperative month, physical activity level had also arrived the preoperativelevel at this time.Conclusion: Increased kinesiophobia, affected the physical performances and physical activity levels of the patients in daily livesin spite of decreased pain, disability and fatigue. Kinesiophobia had effects on postoperative recovery duration, daily life, andreturn to work. A detailed evaluation should be performed particularly for kinesiophobia in early postoperative period.Keywords: Cervical fusion, neck pain, performance, physical activity, performance early period