Spontaneous resolution of post-traumatic chronic subdural hematoma: A case report

PubMed ID: 29541313Chronic subdural hematomas often occurs in late middle and old age following trivial head trauma. Surgical intervention is the first treatment option in chronic subdural hematomas which compressed the cerebral parenchym. Hematoma may be calcified or ossified in untreated patients. Spontaneous resolution of post-traumatic chronic subdural hematoma is a rare event. Spontaneous resolution is rarer if the subdural hematoma is bilateral. In the literature, this condition is reported mostly in patients with idiopathic thrombocytopenic purpura. Here, we present a case of spontaneously resolved post-traumatic bilateral chronic subdural hematoma within a period of one month in a 55-year-old male and we discuss the probable mechanisms of pathophysiology in the spontaneous resolution of chronic subdural hematoma. © Hakan Yilmaz et al

An evaluation of internet use by neurosurgery patients prior to lumbar disc surgery and of information available on internet

PubMed ID: 28460344Objective The aim of this study was to evaluate the Internet use of a group of lumbar disc surgery candidates in order to determine the rate of Internet search by the patients on their disorders and more importantly the reliability of the accessed websites. Patients and methods Fifty patients who were scheduled for lumbar disc surgery were divided into 2 groups, namely patients who accepted the surgery at the first offer and those who wanted to think over. Educational level information was obtained and patients were asked whether they had searched their disorder and offered surgery on the Internet. Then, a questionnaire was administered and the reliability of the websites was evaluated. Correction: The first 30 websites on the first 3 pages of Google® search engine, the most commonly used search engine in Turkey, were evaluated with the DISCERN® instrument. Results Of 50 patients, 33 (66%) had conducted a search for the surgery on the Internet. All university graduates, 88.2% of high school graduates, and 18.7% of primary-secondary school graduates had conducted an Internet search. The quality and reliability of the information was high (4.5 points) for 2 (7.1%) websites, moderate (2.3 points) for 6 websites (21.4%) and poor (1 point) for 20 websites (71.4%) as scored with the DISCERN® instrument. The mean DISCERN® score of was 1.1 for websites of health-related institutions or healthcare news, 2.75 for personal websites of physicians and 2.5 for personal websites of non-physicians. The mean DISCERN® score of all websites was 1.5. Conclusion Most of the patients undergoing lumbar disc surgery at our clinic had searched information about the surgical procedure on the Internet. We found that 92.9% of the websites evaluated with the DISCERN® instrument had inadequate information, suggesting low-level reliability. © 2017 Elsevier B.V

Intraventricular Gadoteric Acid Intoxication: First Report

PubMed ID: 29292188Background: Gadolinium-based contrast agents are relatively safe for use in magnetic resonance imaging (MRI) of nervous system pathology. Few reports have been reported regarding the severe adverse effects. These are mostly mild anaphylactoid reactions, especially in the vulnerable group. Case Description: We report a case of an adverse effect of gadoteric acid concerning the misuse as intraventricular administration. To our knowledge, this is the first report related to intraventricular spillage and its results. A 38-year-old male patient with a complaint of headache and drowsiness was admitted to the hospital, after which cranial MRI revealed that he had a posterior fossa mass. An operation was performed with the catheterization of the lateral ventricule as a safety device at the beginning, and later mass was evacuated gross totally. Frozen pathology result showed the tumor was medulloblastoma. On the first postoperative day a control contrasted cranial and total spinal MRI was planned. He was observed to have a tonic-clonic generalized seizure soon after returning to the ward. After giving the acute management with antiepileptics, the patient was stabilized and it was recognized that the patient was administered contrast media by the intraventricular route. Symptomatic treatment and cerebrospinal fluid irrigation by external ventricular drainage helped the patient's improvement. After a week his symptoms were relieved and he had no complications during outpatient controls. Conclusions: In addition to formal basic supportive treatment, cerebrospinal fluid irrigation of the toxic contrast material is the best management method in case of such an unexpected misadministration of gadoteric acid. © 2017 Elsevier Inc

The modified lateral supraorbital approach

PubMed ID: 29207882Purpose: Lateral supraorbital approach is a simpler and quicker method than pterional approach. It provides a more anterior projection when compared to the pterional approach. There are some minor differences of the modified lateral supraorbital approach when compared to lateral supraorbital approach. It is directed more subfrontally and anterior than the pterional and lateral supraorbital approach. Material and methods: We used modified lateral supraorbital approach in 100 cases between 2012 and 2015 in Medical Park İzmir Hospital/Turkey. The assessed data were as follows: age, gender, Glasgow coma scale at admission, the localization of pathology, the condition of surgical obliteration for aneurysm, excision grade for meningioma, length of stay in the hospital and Glasgow outcoma scale at discharge. Results: Of all patients, 58 (58%) were men and 42 (42%) were women. Our cases were anterior communicating artery aneurysms (41 cases), tuberculum sella and medial sphenoid wing meningiomas (22 cases), middle cerebral artery aneurysms (15 cases), olfactory groove meningiomas (15 cases), anterior choroidal artery aneurysms (4 cases) and posterior communicating artery aneurysms (3 cases). 4 patients died and the mortality rate of the study cohort was 4%. Conclusions: The MLSA is faster, simpler and less invasive than the PA and LSA. © 2017, © 2017 The Neurosurgical Foundation

Study on prophylactic efficacies of daptomycin and vancomycin in a rat model of MRSA infection secondary to spinal implantation [Spinal enstrümantasyon sonrasi{dotless} MRSA enfeksiyonu oluşturulmuş rat modeli üzerinde vankomisin ve daptomisin'in profilaktik etkileri]

The present study aims to investigate the prophylactic effects of daptomycin and vancomycin in an experimental spinal infection induced by spinal implantation. The study involved inoculation of a bacterial suspension prepared with the MRSA ATCC 43300 strain to the implant bed and to the peripheral tissue immediately the implantation of titanium spinal implants to the bone in adult Winstar rats. The animals were divided into three groups; seven rats in the first group received no antibiotics, while the seven rats in group two and eight rats in group three received daptomycin and vancomycin, respectively. Microbiological and histological assessments were carried out on rats with induced infections. In the swab cultures of deep surgical areas, vancomycin demonstrated inhibition of infection of the surgical site in half of animals (50%) whereas daptomycin exhibited the same effect in more animals (71.4%), which was statistically significant compared to the control group (p0.05). As a result; comparing control group, preventive effects of daptomycin and vancomycin in infection induced model of spinal implantation with high bacteria inoculums were not found statistically significant whereas daptomycin showed statistically significant inhibition on deep surgical area infection