Spinal meningioma: Five-year experience of a single center

Aim: To discuss the natural history of spinal meningiomas (SMs) in our series, surgical approach options, and pathology results in light of the literature. Material and Methods: Of the 151 meningioma cases operated on between June 2014 and August 2020 in our center, 11 with spinal localization were analyzed retrospectively. Results: Three (27%) of our cases were male, eight (73%) were female, and 7.2% of all meningioma cases were located in the spine. The patients mostly presented with paraparesis, and 73% of the tumors had a thoracic localization and 64% had a lateral spinal localization. We were able to reach a 90% Simpson grade I resection limit after the opening procedure performed with mostly hemilaminectomy or laminoplasty. The histopathologies of all our cases were reported as meningothelial and transitionally weighted WHO grade I, and their postoperative clinical states showed a favorable progression according to the Karnofsky and McCormick scales. Conclusion: WHO grade I histopathology and thoracic spinal location are predominant in SMs. With low recurrence and mortality rates, favorable outcomes can be obtained with gross total resection in most cases. Due to the slow course of SMs, care should be taken against the possibility of misdiagnosis

Lumbar microdiscectomy with the simply modified taylor retractor

Aim: To describe the modifications we made to the Taylor retractor (TR) used in routine spinal surgery and present the results of cases that underwent surgery with the modified TR. Materials and Methods: We made two basic modifications to the TR used in standard spinal surgery practice: reducing the size of the instrument and reshaping the blade part. The study included the cases in which we performed unilateral lumbar microdiscectomy (LM) at one level with standard and modified TR between January 2016 and August 2020. The preoperative and postoperative thirdmonth low back pain and ODI scores were statistically analyzed. Results: The mean age of the 50 patients was 42 years, and the male/female ratio was 1.38. Except a skin infection in Group A, no other complication was seen. The mean follow-up period was 12 months. The length of incision was 28 mm in Group A and 17 mm in Group B. When the preoperative and postoperative third-month VAS and ODI scores were statistically analyzed in terms of low back pain, a significant difference was found (p<0.001). Conclusion: Microdiscectomy is a gold standard method in LDH surgery. TR is a practical and easily accessible surgical instrument in spinal surgery. Technological advances in optical systems have provided a significant reduction in normal tissue damage in LM. In addition, the modified TR we presented in this paper does not require a learning curve and can contribute to obtaining satisfactory results in terms of normal tissue damage and reducing postoperative low back pain complaints

The efficacy of ultrasound-guided anterior quadratus lumborum block for pain management following lumbar spinal surgery: A randomized controlled trial

Background: Quadratus lumborum block (QLB) is a fascial plane block. There is no randomized study on the efficacy of QLB for lumbar surgery. We evaluated the efficacy of QLB for postoperative pain management and patient satisfaction after lumbar disc herniation surgery (LDHS). Methods: Sixty patients with ASA score I-II planned for LDHS under general anesthesia were included. We allocated the patients into two groups: the QLB group (n = 30) or the control group (n = 30). QLB was performed with 30 ml 0.25% bupivacaine in the QLB group. Paracetamol 1 g IV 3 × 1 was ordered to the patients at the postoperative period. If the NRS score was ≥ 4, 1 mg/ kg tramadol IV was administered as rescue analgesia. Results: There was a reduction in the median static NRS at 0 h and 2 h with QLB compared to the control group (p < 0.05). There was no difference in the resting NRS at any other time point up to 24 h. The median dynamic NRS was significantly lower at 0, 2, 4, 8, and 16 h in the QLB group (p < 0.05). The need for rescue analgesia was significantly lower in the QLB group. The incidence of nausea was significantly higher in the control group. The postoperative patient satisfaction was significantly higher in the QLB group (p < 0.05). Conclusion: We found that the QLB is effective for pain control following LDHS

The effect of the number of open vertebral segments on the prognosis of newborns with midline closure defect: A single surgeon, single center experience

AIM: To investigate the effect of the number of open vertebral segments on the prognosis of newborns with midline closure defects (MCD), and the optimal timing for ventriculoperitoneal shunt (VPS) placement in those with MCD accompanied by hydrocephalus. MATERIAL and METHODS: A total of 63 patients (35 girls and 28 boys) were admitted to the neonatal intensive care unit between April 2016 and January 2019. The patients’ MCDs were examined in terms of type, localization, number of open vertebral segments, accompanying hydrocephalus (HC), surgical technique, and complications. RESULTS: The mean follow-up period was 12 months (6-24 months). Ten cases of meningocele (M) (15.9%), 41 cases of myelomeningocele (MM) (65%), and 12 cases of encephalocele (E) (19.1%) were identified. A VPS was inserted in 44 (69.8%) patients (E, 8; MM, 34; and M, 2), performed in 33 patients during the same admission, while 11 were shunted after discharge during the follow-up period. Thirty-four of the 41 cases of MM and all cases of M and E were primarily closed, while the remaining MMs required skin flaps. The M and MM cases were categorized according to the number of open vertebral segments and examined in CONCLUSION: In all pediatric cases, case-by-case evaluation, attention to hypothermia and meticulous hemostasis, protection of functional neural tissue, closing the defect as soon as possible, and treating accompanying HC during the same session, were tissue density correlated with the number of open vertebral segments and it was considered

Does gabapentin affect neural tube development? Experimental study using an early stage chick embryo model

AIM: To determine whether using gabapentin (GBP), especially in the first maternal trimester, would affect the neural tube development of embryos in an early stage chick embryo (ESCE) model. MATERIAL and METHODS: One hundred fertile specific pathogen-free (SPF) chick eggs were used to investigate neurulation; they were divided into four groups of 25 eggs (Groups A, B, C, and D including control, subtherapeutic, therapeutic, and supratherapeutic dose subjects, respectively). After 30 hours of incubation, all eggs reached the ninth stage of embryonic development, as defined by Hamburger and Hamilton. GBP was administered through the subblastoderm, and the eggs were incubated for 72 hours. The embryos were macroscopically and histopathologically investigated with hematoxylin eosin following incubation and extraction. RESULTS: In the 72nd hour of the study, a total of 6 eggs showed no embryo development. We detected 1 (4.34%), 13 (59.09%), 15 (65.21%), and 18 (81.81%) neural tube defective embryos in groups A, B, C, and D, respectively. Statistically, the differences between the groups were significant, especially in the comparisons of all GBP groups to the control group (p'0.001). However, there was no significant difference between groups B, C, and D. Additionally, we suggest that at all doses, GBP could cause neural tube defects in the ESCE. CONCLUSION: Based on these results, we concluded that GBP use at any dose led to midline closure defects in ESCEs. This is the first report in the literature on GBP using an ESCE model. However, further investigations with a larger sample size are required to assess its effect at lower doses and to determine the mechanisms of embryonic damage

Metástasis de adenocarcinoma de páncreas intramedular: Primer caso en la literatura

Background: Pancreatic cancer is a common gastrointestinal malignancy, and is often associated with a poor prognosis. Although liver is generally seen as a distant metastasis point, it has been shown that it can metastasize to any organ, especially the gastrointestinal tract, and approximately 0.3% of metastases are observed in spinal cord. Case description: We report a 36-year-old woman with a prior history of pancreatic adenocarcinoma who presented to us with a thoracic intramedullary lesion and recent onset of neurological deficits. She underwent surgery with histological confirmation of a diagnosis of metastatic adenocarcinoma. Conclusion: To our knowledge there is no prior report of pure intramedullary spinal cord metastasis from a pancreatic adenocarcinoma in the literature. We report the present patient in view of the rarity of intramedullary spinal cord metastasis and its clinical significance. Although intramedullary metastases are rare, they should be investigated in every patient with malignancy and progressive neurological deficit. While its general prognosis is poor regardless of the type of treatment, early diagnosis and treatment is important in terms of quality of life and survival.Antecedentes El cáncer de páncreas es una neoplasia maligna gastrointestinal común y, a menudo, se asocia con un mal pronóstico. Aunque el hígado generalmente se ve como un punto de metástasis distante, se ha demostrado que puede hacer metástasis a cualquier órgano, especialmente al tracto gastrointestinal, y aproximadamente el 0,3% de las metástasis se observan en la médula espinal. Descripción del caso Presentamos una mujer de 36 años con antecedentes de adenocarcinoma de páncreas que se presentó con una lesión intramedular torácica y de reciente aparición de déficits neurológicos. Fue intervenida quirúrgicamente con confirmación histológica de diagnóstico de adenocarcinoma metastásico. Conclusión Hasta donde sabemos, no existe en la literatura ningún informe previo de metástasis intramedular pura de la médula espinal de un adenocarcinoma pancreático. Presentamos el presente paciente en vista de la rareza de la metástasis intramedular de la médula espinal y su importancia clínica. Aunque las metástasis intramedulares son raras, deben investigarse en todo paciente con neoplasia maligna y déficit neurológico progresivo. Si bien su pronóstico general es malo independientemente del tipo de tratamiento, el diagnóstico y el tratamiento precoces son importantes en términos de calidad de vida y supervivencia

Intramedullary schwannoma of cervicomedullary junction: A case report

Background: Intramedullary schwannomas of brain stem and spinal cord are extremely rare. In almost all cases, homogeneous, asymmetrical or circular intensive gadolinium enhancement has been demonstrated. However, no cases reported previously with minimal contrast enhancement in cervicomedullary junction. Case description: A 38-year old man presented with a one-month history of constant, radiative right shoulder and arm pain. There was no pathological finding in his neurological examination. Also, physical evidence or family history of neurofibromatosis was not found. Magnetic resonance imaging of brain and cervical spine showed intramedullary, solid-cystic lesion localized in the cervicomedullary junction with unobvious gadolinium enhancement. The mass was gross totally resected through a sub-occipital craniotomy via midline approach. Postoperative pathological examination confirmed diagnosis of schwannoma. No changes were detected in the neurological examination of the patient after the operation. Conclusions: There are 3 previously reported intramedullary schwannomas of the cervicomedullary junction in the literature. To the best of our knowledge, this is the first case of unobvious contrast enhancing intramedullary schwannoma of the cervicomedullary junction. The possibility of schwannoma should not be excluded when a mass with slight contrast enhancement is detected in the intramedullary region of the cervicomedullary junction

Late Epilepsy Due to Intracranial Sewing Needle: Case Report

We present two adult cases who presented with seizures and found to have intracranial sewing needles incidentally during their evaluation. The mechanism, treatment and medicolegal aspects are discusse