Unilateral cervical facet fracture: Presentation of two cases and literature review

Study design: Two patients with diagnosis of unilateral cervical facet fracture due to motor vehicle accident (MVA) are presented, and the literature is reviewed. Objective: To discuss the diagnostic difficulties and management strategies in two patients with post-traumatic cervical facet fracture. Setting: Department of Neurosurgery, Zonguldak Karaelmas University, Faculty of Medicine, Turkey. Subject: Nonoperative treatment with immobilization was preferred in two female cases (33-34 years old) with diagnosis of C6-7 facet fracture following MVA. Magnetic resonance imaging (MRI) could be performed in acute period in the first case, but not in the second because of inadequate technical condition. Result: The first case with a good compliance to immobilization recovered without any neurological complication. However, the second case mobilized earlier and used a collar irregularly. Instability developed in the second case on the second month and surgical intervention with anterior approach was performed. Conclusion: The diagnosis of unilateral facet fractures is often missed and the treatment is still controversial. The compliance of the patient to cervical immobilization in nonoperative treatment plays a very important role in the development of late complications. MRI in the acute period may be useful in determining instability

Lumbar extradural extraosseous schwannoma causing extensive compression of the vertebral body

Destroyed vertebral body and posterior bone elements of the spine by a schwannoma may cause unstability. Besides the removal of the tumour tissue, the surgeons have to correct these bone deformities using stabilization techniques. In this report we present a patient operated for a spinal schwannoma originating from L5 nerve root with involvement of nearly half of the L5 vertebra. During surgery, the internal cortical layer of the vertebral body was found intact so instrumentation and fusion were not performed in our case. The patient presented no tumour recurrence after more than three years of unproblematic follow-ups

External ventricular drainage for acute obstructive hydrocephalus developing following spontaneous intracerebral haemorrhages

There is no consensus in the literature on the effects of the development of hydrocephalus on survival and disability after intracerebral haemorrhage (ICH) and the benefits of external ventricular drainage (EVD). In this open, prospective study, we investigated the clinical courses, radiological findings and outcome scores of 47 consecutive patients who were admitted to our clinic with spontaneous ICH. Hydrocephalus developed in 6 (12.8%) of the 47 patients, and EVD was applied in these 6 cases. In one of the 6 patients, the lesion was additionally excised due to the large cerebellar haematoma. Intraventricular haemorrhage was more common in patients developing hydrocephalus (83.3% vs. 29.3% in patients without hydrocephalus; p<0.05) and the lesions of all the patients were in the proximity of the ventricular system. Hospital mortality and functional outcome were not significantly different between patients with and without hydrocephalus. Our results shows that acute obstructive hydrocephalus should be anticipated if haematoma is near the ventricle or if it is opening to the ventricle. EVD is a life-saving and effective procedure that should be performed in patients who develop hydrocephalus following spontaneous intracerebral haemorrhage

Clinically Adult Onset of a Leptomeningeal Cyst after Head Trauma in Childhood: Case Report and Review of the Literature

Traumatic leptomeningeal cysts, also known as growing skull fractures, are a rare but serious complication of childhood cranial fractures and a very rare complication following head traumas in adults. We present the case of a 35-year-old woman with drug-resistant epileptic seizures caused by a traumatic leptomeningeal cyst from the head injury she suffered at the age of 18 months. Surgical treatment was performed with the removal of the leptomeningeal cyst, dural repair, and cranioplasty. She had no more epileptic seizures at her follow-ups. Although it is rare, after head trauma in childhood, adult patients have often complained of epileptic seizure. Surgical treatment is necessary to control the illness. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved

Late recurrent bleeding after surgical treatment for pituitary apoplexy

Pituitary apoplexy is an uncommon syndrome characterised by sudden onset of headache, meningeal signs, visual disturbances, ophthalmoplegia and confusion. Documented recurrent apoplexy or treated apoplexy is even rarer with only few reports in the literature. Between 1994 and 2001, 18 patients were treated for pituitary apoplexy at Bayindir Medical Centre through transsphenoidal route. In all, topical bromocriptine was applied after tumour resection as described by Ozgen. We hereby present the cases of two patients with recurrent apoplexy 3 and 7 years after the initial surgical treatment for pituitary adenoma with apoplexy. The patients were treated non-surgically with success. Additional treatment in the form of radiosurgery was found necessary for the first patient. Surgical excision of the pituitary tumours with apoplexy reduces the risk of recurrent bleedings but eradication is not a rule. These patients need to be followed closely in the postoperative period for possible recurrence of bleeding. © 2003 Elsevier Ltd. All rights reserved

Ischemia modified albumin increase indicating cardiac damage after experimental subarachnoid hemorrhage

Background: Cardiac complications are often developed after subarachnoid hemorrhage (SAH) and may cause sudden death of the patient. There are reports in the literature addressing ischemia modified albumin (IMA) as an early and useful marker in the diagnosis of ischemic heart events. The aim of this study is to evaluate serum IMA by using the albumin cobalt binding (ACB) test in the first, second, and seventh days of experimental SAH in rats.Twenty-eight Wistar albino rats were divided into four groups each consisting of seven animals. These were classified as control group, 1st, 2nd and 7th day SAH groups. SAH was done by transclival basilar artery puncture. Blood samples were collected under anesthesia from the left ventricles of the heart using the cardiac puncture method for IMA measurement. Histopathological examinations were performed on the heart and lung tissues. Albumin with by colorimetric, creatine kinase (CK), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) were determined on an automatic analyser using the enzymatic method. IMA using by ACB test was detected with spectrophotometer.Results: Serum IMA (p = 0.044) in seventh day of SAH were higher compared to the control group. Total injury scores of heart and lung tissue, also myocytolysis at day 7 were significantly higher than control group (p = 0.001, p = 0.001, p = 0.001), day 1 (p = 0.001, p = 0.001, p = 0.001) and day 2 (p = 0.001, p = 0.007, p = 0.001). A positive correlation between IMA - myocytolysis (r = 0.48, p = 0.008), and between IMA - heart tissue total injury score (r = 0.41, p = 0.029) was found.Conclusion: The results revealed that increased serum IMA may be related to myocardial stress after SAH. © 2014 Açi{dotless}kgöz et al.; licensee BioMed Central Ltd

Problems encountered in the surgical treatment of ligamentum flavum cysts

Ligamentum flavum cysts may cause pain, radicular symptoms and signs. The diagnosis of ligamentum flavum cyst is done by radiologic studies, surgical intervention and histopathological examinations of the ligaments. In an 80-year female patient, in the inner aspect of the ligamentum flavum a cyst about ten mm's was found, compressing the S1 nerve root. In literature survey seventy-five similar cases were found. Careful exploration, incision and excision of the cyst and the ligament and its adherence to dura mater and facet joint are main problems