Wyniki leczenia uszkodzenia nerwu strzałkowego na wysokości kolana: doświadczenie oddziału szpitala wo¡skowego

Background and purpose We investigated the management outcome of common peroneal nerve decompression at the knee level between the years 2005 and 2009. Material and methods Thirty consecutive patients with knee-level peroneal nerve injury who underwent decompression surgery and external neurolysis at our institution were evaluated preoperatively and postoperatively by electrophysiological studies and motor examination (Medical Research Council grading). Results Twenty-eight of the cases were male and 2 were female. Mean age was 31.1 for males and 57.5 for females. Physical activity during military training (overstretch/contusion) was the cause of nerve lesion in the majority of the patients (n = 28, 93%). Mean time interval between the diagnosis and the surgery was 5 months. Follow-up time ranged from 3 to 48 months (mean: 14 months). Twenty-nine of 30 (97%) patients recovered totally or near totally in foot/toe dorsiflexion. Conclusions Early decompression and neurolysis of the common peroneal nerve (CPN) at knee level after strenuous physical activity offers excellent functional recovery. Additionally, for knee-level CPN injuries, in order to minimize the postoperative scar, pain and delay in wound healing, we strictly advocate short ‘lazy S-shaped incision’ around the fibular head in supine position unlike the classical extensive opening up to the superior border of the popliteal fossa in prone position.Wstęp i cel pracy Autorzy ocenili wyniki chirurgicznego odbarczenia nerwu strzałkowego wspólnego na wysokości kolana, wykonywanego w latach 2005–2009. Materiał i metody Przedoperacyjnej i pooperacyjnej ocenie klinicznej (w skali Medical Research Council) oraz elektrofizjologicznej poddano 30 kolejnych pacjentów z uszkodzeniem nerwu strzałkowego na wysokości kolana, u których wykonano odbarczenie chirurgiczne z zewnętrzną neurolizą. Wyniki Wśród leczonych było 28 mężczyzn (średnia wieku: 31,1 roku) i dwie kobiety (średnia wieku: 57,5 roku). U zdecydowanej większości pacjentów (n = 28, 93%) przyczyną uszkodzenia nerwu była aktywność fizyczna w czasie szkolenia wojskowego (nadmierne rozciągnięcie/stłuczenie). Średnia czasu od rozpoznania do operacji wyniosła 5 miesięcy. Obserwacja po zabiegu trwała od 3 do 48 miesięcy (średnia: 14 miesięcy). U 29 na 30 chorych (97%) uzyskano pełny lub prawie pełny powrót zgięcia grzbietowego stopy/palców. Wnioski Wczesne chirurgiczne odbarczenie i neuroliza nerwu strzałkowego wspólnego na wysokości kolana w leczeniu urazu powstałego wskutek nadmiernej aktywności fizycznej daje możliwość znakomitej poprawy czynnościowej. Ponadto w przypadku uszkodzeń nerwu strzałkowego wspólnego na wysokości kolana w celu zminimalizowania blizny pooperacyjnej, nasilenia bólu i opóźnienia w gojeniu się rany pooperacyjnej autorzy usilnie zalecają krótkie cięcie w kształcie wydłużonej litery „S” wokół głowy strzałki u chorego w pozycji leżącej na plecach zamiast klasycznego otwarcia aż do górnej granicy dołu podkolanowego w pozycji leżącej na brzuchu

Instant and early efficacy of gamma knife treatment on trigeminal neuralgia

WOS: 000457150800005OBJECTIVE Trigeminal neuralgia (TN) is a common craniofacial pain syndrome manifested by the episodes of severe lancinating pain along the sensory region of the trigeminal nerve. Vascular compression theory has been postulated as the main cause of TN in the root entry zone of the trigeminal nerve. Microvascular decompression surgery is the most effective surgical option for the treatment of TN. Gamma knife surgery (GKS) is a minimally invasive treatment for drug-resistant trigeminal neuralgia (TN). We aimed to investigate the instant and early pain relief in 12 consecutive patients. METHODS This clinical study was conducted at the Department of Radiation Oncology, Medipol University, Turkey. The patient population consisted of 12 consecutive patients having medically refractory TN, with a median age of 60.5 (ranging from 50 to 77 years). Patients underwent GKS between March and January 2016, using the Gamma Knife Perfexion Model. A single 4 mm isocenter was positioned in the cisternal portion of the trigeminal nerve, and the mean maximum dose of 65 Gy (60-70 Gy) was delivered. RESULTS Satisfactory pain relief without any major complications was evident in all patients. The pain relief started after 1 hour to 3 days following the gamma knife procedure. CONCLUSION As a novel contribution to the relevant literature, instant and early pain relief was evident in all patients. In this context, a randomized prospective clinical trial with a larger patient population is necessary to optimize the instant and early efficacy of GKS in the treatment of TN

Tumor Immunized Autologous Natural Killer Cell (NK) Therapy/Compassionate Use

As well known, diffuse infiltrative pontine glioma (DIPG)-despite all available treatment modalities- carries a dismal prognosis with a mean survival of around one year [1]. A four year old boy was referred to me with a radiological diagnosis of DIPG. He was irradiated and a ventriculoperitoneal shunt (VPs) was inserted in a health facility in Europe. On admission (seven months after the diagnosis), patient was tracheostomized, conscious, quariparetic and with bilateral abducens and lower cranial nerve paresis. I decided to operate on the patient in order to debulk the necrotic pontine mass and to verify the radiological diagnosis histopathologically. Additionally, I planned to co-culture the tumoral cells with the natural killer (NK) cells isolated from the peripheral venous blood to investigate the immunization and potentiation of autologous NK cells against glioma cells in vitro after the ethical committee approval was obtained from the Istanbul Aydin University. In January 2019, pontine mass was partially removed via telo-velar approach under neurophysiological monitorization with no additional post op deficits and the unilateral abducens nerve recovery. Tumor specimens were sent to the tissue culture labs and the cell culture procedures were carried out meticulously. Meanwhile, routine histopathological evaluation reported the pontine lesion as DIPG (Grade 4 astrocytoma) officially

Revisiting a historical phenomenon: Myodil droplets in the subarachnoid space

WOS: 000423136200065PubMed ID: 29323010Myodil (iodophenylundecylic acid, a fatty acid) is an oil-based positive contrast media that has been widely used in myelography, ventriculography, and cisternography. [1] However, the use of oil-based contrast agents has been stopped long ago because of the potentially severe complications arising from their usage, including arachnoiditis and anaphylaxis. Thus, images of remnant material of intradural oil-based contrast are rarely encountered nowadays. We present a patient in whom incidentally detected myodil remnants were seen on computed tomography (CT). Additionally, we obtained and present the follow-up CT and magnetic resonance images (MRI) of this patient

Persistent sciatalgia due to a wandering bipolar forceps tip after posterior lumbar stabilization: A case report

WOS: 000384801600009There are several reports in the literature about the retained surgical materials as a cause of radicular pain or sensory impairment after spinal surgery. We report a patient with a persistent radicular pain in the distribution of left S1 nerve dermatome following lumbar stabilization surgery. Retained bipolar forceps tip has not been reported previously in the literature as a cause of sciatalgia after posterior lumbar surgery

Microvascular decompression as a surgical management for trigeminal neuralgia: A critical review of the literature

Trigeminal neuralgia (TN) is a common pain syndrome and is characterized by recurrent episodes of intense lancinating pain in one or more divisions of the trigeminal nerve. Neurovascular compression (NVC) has been considered as the main cause of TN in the root entry zone (REZ) of the trigeminal nerve in the cerebellopontine angle cistern. Microvascular decompression (MVD) is the surgical procedure of choice for the treatment of medically refractory TN. MVD has also been shown to provide pain relief even in patients without visible neurovascular compression. Additionally, it has been accepted that MVD can provide the highest rate of long-term patient satisfaction with the lowest rate of pain recurrence. We did, systematic review of the subject and also our own experiences

Topical application of cyclosporine reduces epineurial fibrosis: Gross post-surgical, histopathological and ultrastructural analysis in a rat sciatic nerve model

WOS: 000417623700017AIM: To investigate the anti-scarring potential of topical cyclosporine on rat sciatic nerves. MATERIAL and METHODS: Both sciatic nerves were exposed in 24 adult male albino Wistar rats, and an abrasion injury was made on the biceps femoris close to the sciatic nerve. Cotton pads soaked with cyclosporine (5 mg/mL) and saline (0.9% NaCl) were placed around the nerves for 10 minutes in the experimental group and control group, respectively. All rats were sacrificed 8 weeks later and the sciatic nerves were examined. Epineurial adhesions were assessed using light and electron microscopy. Quantitative histological parameters, epineurial thickness, and scar density were evaluated in the histological investigation. RESULTS: Significantly fewer epineurial adhesions were observed in the cyclosporine group in the post-surgical assessment, and the histopathological and ultrastructural examinations of the nerve segments than in the controls. The cyclosporine- treated animals had a statistically significant reduction in the density and quantity of epineurial scarring compared with the controls. CONCLUSION: Topical cyclosporine effectively reduces epineurial scar formation on rat sciatic nerves

The effects of tibolone on the human primary glioblastoma multiforme cell culture and the rat C6 glioma model

Objectives: In the light of recent advances in tumor biology and genetics, we hypothesized that tibolone, an estrogen receptor agonist, may have antiproliferative effects on primary human glioblastoma cells and rat C6 malignant glioma cell lines. We thought that tibolone should exert its antiproliferative effects by augmenting glial cell differentiation through the naive, nonhypermethylated estrogen receptors in the glioma cells

Topical Application of Cyclosporine Reduces Epineurial Fibrosis: Gross Post-surgical, Histopathological and Ultrastructural Analysis in a Rat Sciatic Nerve Model

AIm: To investigate the anti-scarring potential of topical cyclosporine on rat sciatic nerves. mATERIAl and mEThODS: Both sciatic nerves were exposed in 24 adult male albino Wistar rats, and an abrasion injury was made on the biceps femoris close to the sciatic nerve. Cotton pads soaked with cyclosporine (5 mg/mL) and saline (0.9% NaCl) were placed around the nerves for 10 minutes in the experimental group and control group, respectively. All rats were sacrificed 8 weeks later and the sciatic nerves were examined. Epineurial adhesions were assessed using light and electron microscopy. Quantitative histological parameters, epineurial thickness, and scar density were evaluated in the histological investigation. RESUlTS: Significantly fewer epineurial adhesions were observed in the cyclosporine group in the post-surgical assessment, and the histopathological and ultrastructural examinations of the nerve segments than in the controls. The cyclosporine-treated animals had a statistically significant reduction in the density and quantity of epineurial scarring compared with the controls. CONClUSION: Topical cyclosporine effectively reduces epineurial scar formation on rat sciatic nervesAIm: To investigate the anti-scarring potential of topical cyclosporine on rat sciatic nerves. mATERIAl and mEThODS: Both sciatic nerves were exposed in 24 adult male albino Wistar rats, and an abrasion injury was made on the biceps femoris close to the sciatic nerve. Cotton pads soaked with cyclosporine (5 mg/mL) and saline (0.9% NaCl) were placed around the nerves for 10 minutes in the experimental group and control group, respectively. All rats were sacrificed 8 weeks later and the sciatic nerves were examined. Epineurial adhesions were assessed using light and electron microscopy. Quantitative histological parameters, epineurial thickness, and scar density were evaluated in the histological investigation. RESUlTS: Significantly fewer epineurial adhesions were observed in the cyclosporine group in the post-surgical assessment, and the histopathological and ultrastructural examinations of the nerve segments than in the controls. The cyclosporine-treated animals had a statistically significant reduction in the density and quantity of epineurial scarring compared with the controls. CONClUSION: Topical cyclosporine effectively reduces epineurial scar formation on rat sciatic nerve

Effect of magnesium, MK-801 and combination of magnesium and MK-801 on blood-brain barrier permeability and brain edema after experimental traumatic diffuse brain injury

Objective: Glutamate antagonists are very attractive drugs in laboratory works to protect neural tissue against ischemia. In this work, the effects of magnesium, MK-801 and combination of magnesium and MK-801 on blood-brain barrier (BBB) and brain edema after experimentally induced traumatic brain injury are evaluated