Yalçin Kocaoğullar

Lateral posterior fossa venous sinus relationships to surface landmarks

BACKGROUND Knowing the location of the venous sinuses in the combined lateral posterior fossa and lateral cranial base approach is important to prevent their inadvertent injury. The identification of surface landmarks related to these structures is useful in planning such surgical approaches. METHODS Twelve injected adult cadaver specimens and 10 dried skulls were used to study the relationship of the venous sinuses to various surface anatomic structures. RESULTS The asterion was not clearly seen in 60% of the studied cadaver sides. The asterion was always clearly seen in the dry skull preparations. The upper margin of the superior nuchal line was found to range from 1.5 mm to 14 mm inferior to the lower margin of the lateral transverse sinus. In 85% of our specimens, the mastoid groove was found to completely overlie the sigmoid sinus. CONCLUSIONS The asterion was found to be variable in its anatomic relations to other identifiable structures. This variability in relation to other posterior fossa bony landmarks limits its overall usefulness as a consistently stable marker for intracranial structures. The first and most superolateral burr hole for lateral posterior fossa procedures can be safely placed 1 cm below the superior nuchal line and 1 cm medial to the top of the mastoid groove. A burr hole in this location will avoid the transverse and sigmoid sinuses, as well as the transverse-sigmoid junction, yet will be high enough and lateral enough to provide easy exposure of these venous sinuses for all lateral posterior fossa procedures.

Intracerebral schwannoma: case report and review

A case of intraparenchymal schwannoma of the brain in a 4-year-old girl is presented. Most of the small number of intracranial schwannomas unassociated with cranial nerves, reported have occurred in children or young adults. There is no male or female predominance. Most of the parenchymatous schwannomas are located supratentorially. The presence of a cyst together with the tumor appears to be characteristic of intraparenchymal schwannoma of the brain.

Multiple and infected cerebral hydatid cysts. Case report

A case of multiple and infected cerebral hydatid cysts is described. The diagnosis was based on operation and histopatology. So far only two infected cysts have been described in the English literature.

N-acetylcysteine prevents vasospasm after subarachnoid hemorrhage.

BACKGROUND This study investigated the ability of NAC to prevent cerebral vasospasm in a rabbit model of SAH. METHODS Twenty-one, male New Zealand white rabbits were randomly divided into 3 groups of 7 rabbits each: group 1 (control), group 2 (SAH only), group 3 (SAH + NAC treatment). NAC (150 mg/kg, single dose, IP) was administered just before SAH and continued until 72 hours after SAH in group 3. Animals were killed 72 hours after SAH. Tissue MDA levels, SOD, and GSH-Px activities were measured, and basilar artery cross-sectional areas, arterial wall thickness, and endothelial apoptosis in a cross section of basillary artery were determined in all groups. RESULTS Intraperitoneal administration of NAC was found to be markedly effective against developing a cerebral vasospasm following a SAH in rabbits. It could significantly reduce elevated lipid peroxidation and increase the level of tissue GSH-Px and SOD enzymatic activities. Also, NAC treatment was found to be effective in increasing the luminal area and reducing wall thickness of the basilar artery. The morphology of arteries in the NAC treatment group was well protected. NAC markedly reduced apoptotic index and protects the endothelial integrity. CONCLUSIONS This study demonstrates, for the first time, that NAC treatment attenuates cerebral vasospasm in a rabbit SAH model. NAC treatment has significant neuroprotective effect and markedly prevents cerebral vasospasm after SAH. In conclusion, the NAC treatment might be beneficial in preventing cerebral vasospasm after SAH, thus showing potential for clinical implications.

Arachnoid cyst within the fourth ventricle: a case report

The authors report a case of fourth ventricular arachnoid cyst that presented clinically with the criteria of normal pressure hydrocephalus. Only a few cases of intraventricular arachnoid cyst have been recorded in the literature. In our case, a posterior approach was used via a midline suboccipital craniectomy and the cyst was excised.

Submandibular and Intracranial Hydatid Cyst in an Adolescent

Objectives An unusual case of hydatid disease is reported. Review of the pertinent literature did not reveal any hydatid disease located simultaneously in both the intracranial and submandibular glands. This is the first case with hydatid disease occurring in both locations at the same time.

A Case With Prepontine (Clival) Arachnoid Cyst Manifested as Trigeminal Neuralgia

Most cases of “idiopathic” trigeminal neuralgia are thought to originate from vascular compression of the trigeminal root entry zone. In this case, we describe a young man presenting with the symptoms of trigeminal neuralgia associated with a prepontine (clival) arachnoid cyst.

Preventive effects of intraperitoneal selenium on cerebral vasospasm in experimental subarachnoid hemorrhage.

Vasospasm is an important cause of morbidity and mortality with subarachnoid hemorrhage (SAH). The effect of intraperitoneal administration of selenium, which is an antioxidant on cerebral vasospasm was investigated in an experimental model. By means of intracisternal blood injection model, SAH was induced in 24 rabbits, which were randomly divided into 3 groups (group 1= control group, group 2=SAH alone group, and group 3=SAH plus selenium group). Basilar artery angiography was performed on day 0 and day 3 as described. Intraperitoneal selenium (0.05 mg/kg) treatment was started after the induction of SAH and administered once a day. Three days later, the animals were killed and the basilar artery was examined histologically for the luminal diameter and thickness of the arterial muscular wall. The mean values for the measurements of angiographic luminal diameter, pathologic luminal area, muscular wall thickness derived from the blind observer were analyzed statistically. There was no statistically significant difference in basal angiographic luminal diameter evaluation between groups 1-2-3 (P>0.005). But in third day angiography; comparison of group 2 and group 1-3 showed statistically significant differences (P<0.001). In pathologic investigation; there was statistically significant difference in luminal area and muscular wall thickness of the basilar artery between groups 1, 2, and 3 (P<0.005). Intraperitoneal selenium treatment was found effective by increasing the angiographic diameter; pathologic luminal area and reducing muscular wall thickness measurements. This is the first study to show that intraperitoneal administration of selenium is effective in preventing vasospasm after SAH in rabbits.

Anatomic and radiologic analysis of the atlantal part of the vertebral artery

The horizontal third segment (V3h) of the vertebral artery (VA) in 7 cadavers (14 sides) was dissected and the anatomical measurements recorded. Measurements from 24 healthy individuals (48 sides) were taken for comparison using multislice CT scanning. The distance between the medial tip of the VA V3h and the line passing through the mid point of the posterior tuberculum of the atlas was marked as length A. The distance between the medial tip of the VA V3h and the point penetrating the dura mater was classified as length B. The angle between these lines was the alpha (alpha) angle. Measurements were taken when the head was in a neutral position, as well as in maximum right and left rotation, extension and flexion. In cadavers, the mean alpha angle (+/-S.D.) was 82.42+/-10.34 degrees and 83.21+/-10.81 degrees on the right and left side, respectively. On multislice CT scanning, the mean alpha angle was 81.64+/-10.15 degrees on the right and 83.77+/-10.65 degrees on the left. These angles varied with the position of the head.

Lumboperitoneal shunt in a patient with Behçet’s disease with medically refractory intracranial hypertension

A 21-year-old male presented with severe throbbing headache, nausea, vomiting and progressive visual loss. Clinical examination revealed bilateral papilledema and left abducens nerve palsy. MRI showed findings consistent with dural sinus thrombosis. Combinging the clinical findings, MRI and a positive pathergy test, the patient was diagnosed with dural sinus thrombosis associated with Behçets disease (BD). Despite acetazolamide, prednisone, azathioprine and repeated lumbar punctures, his signs and symptoms of intracranial hypertension gradually worsened. Therefore, lumboperitoneal shunting was planned after which rapid resolution of intracranial hypertension was observed. After reviewing similar reports, we suggest that lumboperitoneal shunt placement can be an effective treatment for patients with BD with medically refractory intracranial hypertension associated with dural sinus thrombosis.