Effects of topically applied contractubex® on epidural fibrosis and axonal regeneration in injured rat sciatic nerve

AIM: To investigate the effects of Contractubex (R) (Cx) on peripheral nerve regeneration and scar formation. MATERIAL and METHODS: A surgical procedure involving sciatic nerve incision in 24 adult male Sprague-Dawley rats followed by epineural suturing was performed. In weeks 4 and 12 following surgery, macroscopic, histological, functional, and electromyographic examinations of the sciatic nerve were conducted. RESULTS: No significant difference was found between the Cx group and the control group in terms of sciatic function index (SFI) and distal latency results at week 4 (p>0.05). However, significant improvements in the Cx group were observed in SFI amplitudes and nerve action potentials at week 12 (p<0.001 and p<0.001, respectively). Significant improvements were found in the amplitudes of nerve action potentials in the treatment group after weeks 4 and 12 (p<0.05 and p<0.001, respectively). Macroscopically and histopathologically, epidural fibrosis decreased (p<0.05 and p<0.001, respectively). For both measurement times, the treatment group had significantly higher numbers of axons (week 4, p<0.05; week 12, p<0.001), and the treatment group had better results regarding its axon area (weeks 4 and 12, p<0.001) and myelin thickness (weeks 4 and 12, p<0.05). CONCLUSION: Cx, which is applied topically in peripheral nerve injury, affects axonal regeneration and axonal maturation positively and reduces the functional loss

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

Chordoid meningioma: Report of 5 cases and review of the literature

Chordoid meningioma is a rare, more aggressive subtype of meningioma. This study documents the histological, radiological and clinical features of seven tumours in five patients among 131 meningioma patients who were treated in the Department of Neurosurgery at Istanbul Medipol University between 2014 and 2019. There were two males and three females. All tumours were supratentorial. Surgical Simpson grade II resection was achieved in two cases, grade I in one and grade IV in two. One case relapsed and underwent further surgeries and adjuvant treatment. The chances of survival without recurrence after the Simpson grade I-II resection are high but close follow-up is recommended particularly if grade I cannot be achieved

Tętniaki tętnicy mózgu przedniej w odcinku dystalnym: analiza kliniczna

Background and purpose Distal anterior cerebral artery (DACA) aneurysms, also called pericallosal or A2 aneurysms, are rare and comprise about 1.5 to 9% of all intracranial aneurysms. In this study, a series of 10 patients with DACA aneurysms who were surgically treated in our clinic is presented and discussed, focusing on their clinical features and surgical outcomes. Material and methods A total of 344 patients with cerebral aneurysms were operated on in our clinic and 10 patients (2.9%) with DACA aneurysms were studied retrospectively. All patients underwent a computed tomography (CT) scan followed by four-vessel digital subtraction angiography (DSA). Results Initial CT revealed intracerebral haematoma (ICH) in 7 patients (70%) and in 2 of them the haematoma was over 3 cm in diameter. The pericallosal-callosomarginal bifurcation was the most common location in 9 patients (90%). Four cases (40%) showed multiple aneurysms. The mean waiting time for the operation was 4.8 days. Surgical clipping was performed in all the cases. Multiple aneurysms required two different craniotomies in the same session. The patients with ICH over 3 cm in diameter, in addition to poor preoperative grade, are likely to have a poor outcome, and so clinical grade is the definite factor affecting the surgical outcome of patients. Conclusions DACA aneurysms are usually small and bleeding occurs irrespective of their size because of the lack of resistant arachnoid membranes at the level of the pericallosal cisterns. All DACA aneurysms, even if very small in size or discovered incidentally, should be aggressively treated because of the high tendency to rupture.Wstęp i cel pracy Tętniaki tętnicy mózgu przedniej w odcinku dystalnym (distal anterior cerebral artery – DACA), określane również jako tętniaki tętnicy okołospoidłowej lub A2, są rzadkie i stanowią 1,5–9% wszystkich tętniaków śródczaszkowych. W pracy przedstawiono objawy kliniczne i wyniki leczenia chirurgicznego w serii 10 pacjentów z DACA leczonych w ośrodku autorów. Materiał i metody W ośrodku autorów operowano dotąd 344 pacjentów z tętniakami mózgu; przeanalizowano retrospektywnie dane 10 pacjentów (2,9%) z tętniakami DACA. U wszystkich chorych wykonano tomografię komputerową (TK) głowy, a następnie czteronaczyniową cyfrową angiografię subtrakcyjną naczyń mózgowych. Wyniki Obecność krwiaka śródmózgowego stwierdzono w pierwszej TK u 7 chorych (70%) – u 2 średnica krwiaka przekraczała 3 cm. Najczęstszą lokalizacją tętniaka było miejsce podziału na tętnicę okołospoidłową i spoidłowo-brzeżną (9 pacjentów, 90%). W 4 przypadkach (40%) stwierdzono tętniaki mnogie. Średni czas do operacji wyniósł 4,8 dnia. We wszystkich przypadkach wykonywano chirurgiczne klipsowanie tętniaka. W przypadkach tętniaków mnogich konieczne było wykonanie drugiej kraniotomii podczas tego samego zabiegu. Większe prawdopodobieństwo niekorzystnego wyniku leczenia dotyczy, oprócz chorych z niekorzystną punktacją kliniczną przed zabiegiem, również pacjentów z krwiakiem śródmózgowym o średnicy &gt; 3 cm. Stopień w ocenie klinicznej jest jednoznacznym czynnikiem określającym wynik leczenia chirurgicznego. Wnioski Tętniaki DACA są zwykle małe, a krwawienie pojawia się niezależnie od ich rozmiaru, ze względu na brak stawiających opór błon pajęczynówki na poziomie zbiorników okołospoidłowych. Wszystkie tętniaki DACA, nawet małe lub stwierdzone przypadkowo, powinny być leczone zdecydowanie, ze względu na ich dużą skłonność do pękania

Postlaminektomi Rat Modelinde Etanerseptin Spinal Epidural Fibrozis Üzerine Etkisi

AMAÇ: Posterior spinal cerrahi sonrası duramatere yapışık epidural fibrozis formasyonu vücudun cerrahiye karşı vermiş olduğu normal bir reaksiyondur. Aşırı epidural fibrozis postlaminektomi sendromuna yol açan önemli nedenlerden biridir. Etanersept tümör nekrozis faktör alfayı inhibe ederek fibroblast migrasyonunu engeller ve sonuç olarak fibrozis gelişmesini önler. Bu çalışmanın amacı; topikal uygulanan etanerseptin rat laminektomi modelinde gelişen epidural fibrozis üzerine etkisini araştırmaktır. YÖNTEM ve GEREÇLER: 24 Wistar rat rastgele ve eşit olarak üç gruba (Kontrol, spongostan ve etanersept) ayrıldı. Bütün ratlara L3-L5 laminektomi yapıldı. Spongostana emdirilmiş salin (0.1mg/kg) ve etanersept (300 µg/kg) direkt duramatere uygulandı ve duramater üzerinde bırakıldı. 4 hafta sonra ratların T10-L5 arası omurgaları enblok olarak çıkartılarak, epidural fibrozis ve araknoidal tutulum histopatolojik olarak incelendi ve derecelendirildi. BULGULAR: Kontrol grubu ile karşılaştırıldığında topikal uygulanan etanersept grubunda epidural fibrozisin istatistiksel olarak anlamlı derecede azaldığı görüldü (p0.05). SONUÇ: Çalışmamız; topikal uygulanan etanerseptin laminektomi yapılmış ratlarda gelişen epidural fibrozisin azaltılmasında etkili olduğunu göstermiştir.AIM: The formation of epidural fibrosis adjacent to the dura mater after posterior spinal surgery is a normal reaction of the body to surgery. Extensive epidural fibrosis is one of the important causes of postlaminectomy syndrome. Etanercept inhibits tumor necrosis factor-alpha and decreases fibroblast migration. Thus, etanercept prevents the formation of fibrosis. The aim of this study was to investigate the effects of topical application of etanercept on epidural fibrosis after laminectomy in a rat model. MATERIAL and METHODS: Twenty-four Wistar rats were equally and randomly divided into three groups (control, spongostan and etanercept). Laminectomy was performed between L3 and L5 in all the rats. Spongostan soaked with saline (0.1 mg/kg) and etanercept (300 µg/kg) was directly exposed to and left on the dura mater. Four weeks later, the vertebral columns of the rats were removed en bloc between T10 and L5, and epidural fibrosis and arachnoidal involvement were evaluated and graded histopathologically. RESULTS: Our data revealed that epidural fibrosis was reduced significantly in the rats treated with etanercept, compared to the control groups (p<0.05). CONCLUSION: Our study demonstrated that topical application of etanercept can be effective in reducing epidural fibrosis in rats after laminectomy

Postlaminektomi Rat Modelinde Etanerseptin Spinal Epidural Fibrozis Üzerine Etkisi

AMAÇ: Posterior spinal cerrahi sonrası duramatere yapışık epidural fibrozis formasyonu vücudun cerrahiye karşı vermiş olduğu normal bir reaksiyondur. Aşırı epidural fibrozis postlaminektomi sendromuna yol açan önemli nedenlerden biridir. Etanersept tümör nekrozis faktör alfayı inhibe ederek fibroblast migrasyonunu engeller ve sonuç olarak fibrozis gelişmesini önler. Bu çalışmanın amacı; topikal uygulanan etanerseptin rat laminektomi modelinde gelişen epidural fibrozis üzerine etkisini araştırmaktır. YÖNTEM ve GEREÇLER: 24 Wistar rat rastgele ve eşit olarak üç gruba (Kontrol, spongostan ve etanersept) ayrıldı. Bütün ratlara L3-L5 laminektomi yapıldı. Spongostana emdirilmiş salin (0.1mg/kg) ve etanersept (300 µg/kg) direkt duramatere uygulandı ve duramater üzerinde bırakıldı. 4 hafta sonra ratların T10-L5 arası omurgaları enblok olarak çıkartılarak, epidural fibrozis ve araknoidal tutulum histopatolojik olarak incelendi ve derecelendirildi. BULGULAR: Kontrol grubu ile karşılaştırıldığında topikal uygulanan etanersept grubunda epidural fibrozisin istatistiksel olarak anlamlı derecede azaldığı görüldü (p0.05). SONUÇ: Çalışmamız; topikal uygulanan etanerseptin laminektomi yapılmış ratlarda gelişen epidural fibrozisin azaltılmasında etkili olduğunu göstermiştir.AIM: The formation of epidural fibrosis adjacent to the dura mater after posterior spinal surgery is a normal reaction of the body to surgery. Extensive epidural fibrosis is one of the important causes of postlaminectomy syndrome. Etanercept inhibits tumor necrosis factor-alpha and decreases fibroblast migration. Thus, etanercept prevents the formation of fibrosis. The aim of this study was to investigate the effects of topical application of etanercept on epidural fibrosis after laminectomy in a rat model. MATERIAL and METHODS: Twenty-four Wistar rats were equally and randomly divided into three groups (control, spongostan and etanercept). Laminectomy was performed between L3 and L5 in all the rats. Spongostan soaked with saline (0.1 mg/kg) and etanercept (300 µg/kg) was directly exposed to and left on the dura mater. Four weeks later, the vertebral columns of the rats were removed en bloc between T10 and L5, and epidural fibrosis and arachnoidal involvement were evaluated and graded histopathologically. RESULTS: Our data revealed that epidural fibrosis was reduced significantly in the rats treated with etanercept, compared to the control groups (p<0.05). CONCLUSION: Our study demonstrated that topical application of etanercept can be effective in reducing epidural fibrosis in rats after laminectomy

Use of decorin to prevent epidural fibrosis in a post-laminectomy rat model

PubMed ID: 24374200The formation of epidural fibrosis adjacent to the dura mater is a complex multi-step process that is associated with a marked reduction in tissue cellularity and the excessive deposition of extracellular matrix components. Extensive epidural fibrosis is a major cause of post-laminectomy syndrome. Decorin strongly inhibits fibrosis formation in various tissues via blockade of transforming growth factor-?1. The aim of this study was to investigate the effects of a topical application of decorin on the formation of epidural fibrosis in a rat laminectomy model. Twenty-four female Wistar albino rats (250-350 g) were equally and randomly divided into three groups (control, spongostan and decorin). Laminectomy was performed between the L3 and L5 levels in all rats. The dura mater was directly exposed to spongostan soaked with saline (2 cc/kg) or decorin (100 ?g/kg). Four weeks later, the laminectomized spine of the rats was completely removed between the L3 and L5 levels. The extent of the epidural fibrosis and arachnoidal involvement was histopathologically evaluated and graded. Our data revealed that epidural fibrosis was significantly reduced in the group treated with decorin compared to the spongostan and control groups (P<0.05). Our study demonstrates that the topical application of decorin can be effective in reducing the formation of epidural fibrosis in a simple laminectomy rat model. © 2013 Elsevier B.V

The Effect of Etanercept on Spinal Epidural Fibrosis in a Postlaminectomy Rat Model

WOS: 000340227300011PubMed: 25050674AIM: The formation of epidural fibrosis adjacent to the dura mater after posterior spinal surgery is a normal reaction of the body to surgery. Extensive epidural fibrosis is one of the important causes of postlaminectomy syndrome. Etanercept inhibits tumor necrosis factor-alpha and decreases fibroblast migration. Thus, etanercept prevents the formation of fibrosis. The aim of this study was to investigate the effects of topical application of etanercept on epidural fibrosis after laminectomy in a rat model. MATERIAL and METHODS:Twenty-four Wistar rats were equally and randomly divided into three groups (control, spongostan and etanercept). Laminectomy was performed between L3 and L5 in all the rats. Spongostan soaked with saline (0.1 mg/kg) and etanercept (300 mu g/kg) was directly exposed to and left on the dura mater. Four weeks later, the vertebral columns of the rats were removed en bloc between T10 and L5, and epidural fibrosis and arachnoidal involvement were evaluated and graded histopathologically. RESULTS: Our data revealed that epidural fibrosis was reduced significantly in the rats treated with etanercept, compared to the control groups (p<0.05). CONCLUSION: Our study demonstrated that topical application of etanercept can be effective in reducing epidural fibrosis in rats after laminectomy

Flow diverter stents in the treatment of cerebral aneurysms less than 5 mm

AIM: To evaluate the safety and efficacy of flow diverter (FD) stents in the treatment of intracranial aneurysms less than 5 mm. MATERIAL and METHODS: We treated 66 aneurysms in 43 patients with aneurysms less than 5 mm. Of the patients, 29 were females and 14 males (mean age: 50.2 years). Headache was the most frequent symptom. In 8 patients, the aneurysms were recanalized and these had been treated with coils or stent-assisted coiling. All aneurysms were in the anterior circulation. In the treatment, one of the SILK, Pipeline, Derivo or FRED FD stents was used for each patient. Neurointerventional stent medication (double antiplatelet) was used. All patients were investigated for new ischemic lesions with diffusion-weighted imaging one day later. The first follow-up angiogram was planned 3-6 months later. RESULTS: The treatment was technically successful in all patients. Minor complications occurred in 3 patients (7%). In one patient, thrombus inside the SILK was seen and was relieved with tirofiban. The second patient bled from the right common femoral artery entrance, which was operated on. In the third patient, the complication was technical. All patients were discharged without any neurological deficit. The mean follow-up period was 26 (6-52) months. Of the aneurysms, 64 (97.0%) were completely closed. CONCLUSION: The FD treatment of cerebral, anterior circulation small aneurysms less than 5 mm is effective and safe

Cervico-medullary compression ratio: A novel radiological parameter correlating with clinical severity in Chiari type 1 malformation

WOS: 000450134600021PubMed ID: 30236638Objectives: Chiari malformation type 1 (CM-1) is associated with cough headache, intracranial hypertension, cerebellar and spinal cord symptoms/signs. Herniated cerebellar tonsil length (HCTL) is widely used radiological parameter to determine the severity of CM-1, but with limited utility due to its weak correlation with some clinico-radiological findings. In this study, we aimed to evaluate a novel, practical parameter (cervico-medullary compression ratio; "CMCR") for its relationship with clinico-radiological findings in CM-1. Patients and methods: Thirty-five adult patients (17 F, 18 M) with CM-1 were included in this retrospective study. Head CT and craniospinal MR images were assessed. CMCR was calculated as the ratio of herniated cerebellar tonsil surface area to foramen magnum surface area, and HCTL was measured. These two parameters were correlated with clinical and radiological findings. Results: The mean CMCR was 0.60 +/- 0.15 and mean HCTL was 8.91 +/- 3.4 mm with no significant difference between gender and age groups for both parameters. For cough headache (0.64 +/- 0.14 vs 0.52 +/- 0.15, p = 0.043) and syringomyelia (0.67 +/- 0.11 vs 0.56 +/- 0.16, p = 0.039), only CMCR; for intracranial hypertension (CMCR: 0.64 +/- 0.14 vs 0.55 +/- 0.16, p = 0.049; HCTL: 9.66 +/- 3.59 mm vs 7.79 +/- 3.03 mm; p = 0.045) and cerebellar symptoms (CMCR: 0.65 +/- 0.14 vs 0.54 +/- 0.16, p = 0.048; HCTL: 10.4 +/- 3.5 mm vs 7.4 +/- 2.8 mm, p = 0.041), both CMCR and HTCL were significantly different between patients with and without respective findings. However, neither CMCR nor HTCL was different between patients with and without spinal cord symptoms and hydrocephalus. Conclusion: CMCR is a superior numerical parameter than HCTL for the assessment of clinical severity in CM-1 cases and needs further validation with larger studies