Çocuklarda minimal invazif bir yöntem ile gergin kord serbestleştirilmesi : teknik not

Gergi omurilik serbestleştirilmesi pediatrik nöroşirurjide yaygın olarak yapılmaktadır. Günümüzde minimal invazif yöntemler gittikçe artan bir ilgi görmektedir. Cerrahi uygularken giriş yollarına en az hasar verilmesi ve normal dokunun azami korunması amaç olmuştur. Bizde günümüzde gergin omurilik sendromunun cerrahi tedavisinde uygulanan pek çok yöntemlerden farklı olarak olgudan hiçbir doku çıkartılmadan kordun serbestleştirilmesini sağlayan bir yöntemi tanıtmayı amaçladık. Bu yaklaşımın temel avantajı işlemin 2 cm kesi ile yapılması, ligamentum flavum ve lamina gibi kemik yapıların korunması ve buna bağlı gelişebilen skar dokusunun azalmasıdır.Teknik not: Olgu sitting-prone pozisyonda operasyon masasına alındı ve skopi ile L5-S1 mesafesi belirlendi. Orta hattın 0.5 cm lateralinden 2 cm vertikal kesi sonrasında cilt ve cilt altı dokular geçildi. L5 laminası rehberliğinde L5-S1 mesafesi ve mesafeyi örten ligamentum flavum ortaya kondu. Mikroskop çekildi ve Williams Ekartörü mesafeye yerleştirildi. Buraya kadarki işlemler disk cerrahisiyle aynıydı. Mikroskop altında flavum'a vertikal kesi yapılarak her iki dudağı sırtlarındaki dokuya basit sütür ile asılarak duranın rahat görünümü sağlandı. 0.5 cm'lik vertikal kesi ile tekal sak açıldı. Sinir oku yardımıyla filum bulunarak serbestleştirildi. Dura primer olarak mikro cerrahi enstrümanları ile dikildi ve üzerine flavum tekrar serildi.Tethered cord release is commonly performed in pediatric neurosurgery. Nowadays, minimally invasive procedures are created growing interest due to its highly tolerable nature for surgery. It has been main purpose a minimal damaging on access route and maximum protection of normal structures in surgery. We present a surgical treatment of tethered cord syndrome, by which is provided the cord releasing unlike the many methods being applied with tissue removal. The main advantage of performing this surgery through 2 cm hole is to avoid removing ligamentum flavum and bony structure like lamina in addition to reduce the length of the incision and the related scar tissue. J Clin Exp Invest 2014; 5 (1): 115-117Technical note: the patient was taken on the operating table in the sitting-prone position, and L5-S1 distance was determined by fluoroscopy. The skin and subcutaneous tissues was passed via a 2 cm vertical incision settled in 0.5 cm laterally from midline. L5-S1 distance and its covering ligamentum flavum are displayed by the guidance of L5 lamina. Williams's retractor was placed in the distance after fetching microscope. The foregoing procedures are the same with microdiscectomic surgery. By a vertical incision made on the flavum, its both layer was lifted up and hanged with simple suture on the back tissue for a comfortable exposure of the Dura. Thecal sac was opened by 0.5 cm long vertical incision on the Dura after obtaining secure CSF drainage with the help of yellowtipped syringe needle. With finding by a nerve hook, the phylum was burned and released securely. Then the Dura was sutured primarily for the closure by means of microsurgery instruments, and flavum was laid on it again

Minör kafa travmalı çocuklarda gözlemin önemi : olgu sunumu

Bu yazıda belirgin bası etkisi oluşturan ve acil cerrahi gerektiren geç epidural hematom olgusunun analizi sunulmaktadır. Böyle bir durumun oluşturacağı zararlardan korunmada klinik şüphe ile daha sık ve kolay bilgisayarlı tomografi incelemesinin anahtar rol oynadığını düşünüyoruz. Geç epidural hematomlar da klinik gerilemenin yakın takibi ile tekrar bilgisayarlı tomografi çekilmesi olguların erken saptanmasında en önemli faktördür.Here we present an analysis of the case of delayed epidural hematoma which had a significant mass effect and required surgical evacuation. We consider that maintaining a high clinical suspicion, coupled with a low threshold for computed tomography scanning, is the key to morbidity prevention in this situation. Close observation for signs of clinical deterioration and repeat CT scan are the most important factors for early detection of the delayed epidural hematoma

Travmanın eşlik etmediği akut monopleji nedeni olan intradural servikal disk hernisi

Dura içi disk herniasyonu nadir olarak bildirilmiştir ve intervertebral disk herniasyonlarının özel bir tipidir. En çok lomber bölgede görülür ve servikal ve torakal bölgede nadirdir. Travma olmaksızın servikal dura içi disk herniasyonu oldukça nadir görülüp, İngilizce literatürde 17 olgu bildirilmiştir ve Brown-Sequard sendromu, transvers myelopati ve radikülopati şeklinde kendini gösterebilir. Biz alt ekstremitede sadece monoplejiye neden olan nadir bir servikal intradural disk hernisi olgusunu sunduk. Bilgimize göre bu literatürde tanımlanan ilk olgudur. Olguya anterior yaklaşımla mikrodisektomi sonrası servikal kafes uygulaması yapıldı.Ahahtar kelimeler: Servikal disk hernisi, intradural, monopleji.Intradural disc herniation has been reported as a rare and particular type of intervertebral disc herniation. It occurs mostly in the lumbar spine, and rarely in the cervical or thoracic spine. Non-traumatic cervical intradural disc herniation is rare, with only 17 cases reported in English literature at the cervical region and can manifest itself by severe symptoms such as Brown-Sequard syndrome, transverse myelopathy and radiculopathy. We present a unique case of intradural cervical disc herniation only causing lower extremity monoplegia. To our knowledge, this is the first case described in the literature. The patient underwent microsurgical removal of the herniated disc via an anterior approach followed by interbody fixation using a cervical cage

Travmanın eşlik etmediği akut monopleji nedeni olan intradural servikal disk hernisi

Dura içi disk herniasyonu nadir olarak bildirilmiştir ve intervertebral disk herniasyonlarının özel bir tipidir. En çok lomber bölgede görülür ve servikal ve torakal bölgede nadirdir. Travma olmaksızın servikal dura içi disk herniasyonu oldukça nadir görülüp, İngilizce literatürde 17 olgu bildirilmiştir ve Brown-Sequard sendromu, transvers myelopati ve radikülopati şeklinde kendini gösterebilir. Biz alt ekstremitede sadece monoplejiye neden olan nadir bir servikal intradural disk hernisi olgusunu sunduk. Bilgimize göre bu literatürde tanımlanan ilk olgudur. Olguya anterior yaklaşımla mikrodisektomi sonrası servikal kafes uygulaması yapıldı.Intradural disc herniation has been reported as a rare and particular type of intervertebral disc herniation. It occurs mostly in the lumbar spine, and rarely in the cervical or thoracic spine. Non-traumatic cervical intradural disc herniation is rare, with only 17 cases reported in English literature at the cervical region and can manifest itself by severe symptoms such as Brown-Sequard syndrome, transverse myelopathy and radiculopathy. We present a unique case of intradural cervical disc herniation only causing lower extremity monoplegia. To our knowledge, this is the first case described in the literature. The patient underwent microsurgical removal of the herniated disc via an anterior approach followed by interbody fixation using a cervical cage

HUGE SEQUESTERED SPINAL DISC WITH TUMOR APPEARANCE: A CASE REPORT

A 52-year-old man presented with a voluminous mass lesion resembling an intraspinal-extradural tumor on magnetic resonance imaging. He had complaint ofmainly left lower extremity pain and numbnessfor 3 months, which is exacerbated suddenly a couple of days before admission. On neurological examination, he was accompanied by no lateralized motor deficits. Magnetic resonance imaging demonstrated a tumor-like longitudinal lesion, extending from the L4-5 to the L5-S1 intervertebral spaces and occupying more than the left half of the vertebral canal. The lesion, which is reported to be able to an extradural spinal tumor, turned out to be unusual sequestrated disc fragment thanks to the operatio

Prognostic factors in patients with glioblastoma multiforme (clinical research)

Aim: To define the independent variables that affect the life spans of patients with glioblastoma multiforme (GBM). Materials and methods: This study was conducted in the neurosurgery clinic of Erciyes University’s Faculty of Medicine, lasting from February 2000 to September 2006. A total of 98 patients were diagnosed with GBM after tumor resections. Patients’ demographic, neurological, radiological, surgical, and clinical features and adjunct therapies were analyzed retrospectively. Results: Of the 98 patients, 36 (36.7%) were female and 62 (65.4%) were male. There were 15 patients (15.3%) still alive. The median survival time (MST) of the gross total resection and subtotal resection groups was 12 and 8 months, respectively. The group with postoperative Karnofsky performance scores (KPS) of ≥70 included 56 patients; their survival rate was 19.6% and their MST was 14 months (confidence interval [CI] 95%, 10–18). The postoperative KPS of <70 group included 42 patients; their MST was 4 months (CI 95%, 3–6) and their survival rate was 9.5%. After the radiotherapy, of the 73 patients who underwent chemotherapy, the survival rate was 19.2% and the MST was 14 months (CI 95%, 10–18). The group without chemotherapy had a MST of 2 months (CI 95%, 1–3) and a survival rate of 4%. In a univariate analysis, the MST of age groups I (<45), II (45–59), and III (≥60) were 15 months (CI 95%, 7–23), 10 months (CI 95%, 7–13), and 5 months (CI 95%, 3–7), respectively. The preoperative and postoperative median tumor volume detected was 79 (14–668) and 6 (0–64) mm3, respectively. Conclusion: Multivariate Cox regression analyses showed that prognostic factors are young age, postoperative KPS, chemotherapy, and postoperative tumor volume.Aim: To define the independent variables that affect the life spans of patients with glioblastoma multiforme (GBM). Materials and methods: This study was conducted in the neurosurgery clinic of Erciyes University’s Faculty of Medicine, lasting from February 2000 to September 2006. A total of 98 patients were diagnosed with GBM after tumor resections. Patients’ demographic, neurological, radiological, surgical, and clinical features and adjunct therapies were analyzed retrospectively. Results: Of the 98 patients, 36 (36.7%) were female and 62 (65.4%) were male. There were 15 patients (15.3%) still alive. The median survival time (MST) of the gross total resection and subtotal resection groups was 12 and 8 months, respectively. The group with postoperative Karnofsky performance scores (KPS) of ≥70 included 56 patients; their survival rate was 19.6% and their MST was 14 months (confidence interval [CI] 95%, 10–18). The postoperative KPS of <70 group included 42 patients; their MST was 4 months (CI 95%, 3–6) and their survival rate was 9.5%. After the radiotherapy, of the 73 patients who underwent chemotherapy, the survival rate was 19.2% and the MST was 14 months (CI 95%, 10–18). The group without chemotherapy had a MST of 2 months (CI 95%, 1–3) and a survival rate of 4%. In a univariate analysis, the MST of age groups I (<45), II (45–59), and III (≥60) were 15 months (CI 95%, 7–23), 10 months (CI 95%, 7–13), and 5 months (CI 95%, 3–7), respectively. The preoperative and postoperative median tumor volume detected was 79 (14–668) and 6 (0–64) mm3, respectively. Conclusion: Multivariate Cox regression analyses showed that prognostic factors are young age, postoperative KPS, chemotherapy, and postoperative tumor volume

Protective effects of intralipid and caffeic acid phenyl esther (CAPE) on neurotoxicity induced by ethanol in rats

AIm: Ethanol causes oxidative degradation of the mitochondrial genome in the brain. This effect could contribute to the development of brain injury in some alcoholic patients. We investigated the protective effect of caffeic acid phenyl esther (CAPE) and intralipid (IL) on oxidative stress and neurotoxicity induced by ethanol intake.mATERIAl and mEThODS: The forty-eight rats were randomly divided into seven groups. Ethanol was administered for acute toxicity. IL and CAPE were administered immediately after ethanol intake. Total oxidant status (TOS), total antioxidant status (TAS), and oxidative status index (OSi) were evaluated and histologic examination of cerebellum and brain tissue with Hematoxylin-Eosin and immuno-histochemical dyes was performed. RESUlTS: In the ethanol group, TAS levels were significantly lower than the other groups and this finding indicates that the toxic effect of ethanol reduces antioxidant levels. In the ethanol group, TOS levels were significantly higher than the other groups. These results showed that ethanol induced oxidative stress. IL treatment increased TAS levels, and CAPE decreased TOS levels against ethanol toxicity. There was correlation between TAS and TOS levels. Also, histopathologic results confirmed these biochemical results. CONClUSION: CAPE and IL treatment could be effective course of therapy to enhance therapeutic efficacy and may provide a promising approach for the treatment of neurotoxicity and oxidative stress induced by ethanol in clinic.AIm: Ethanol causes oxidative degradation of the mitochondrial genome in the brain. This effect could contribute to the development of brain injury in some alcoholic patients. We investigated the protective effect of caffeic acid phenyl esther (CAPE) and intralipid (IL) on oxidative stress and neurotoxicity induced by ethanol intake.mATERIAl and mEThODS: The forty-eight rats were randomly divided into seven groups. Ethanol was administered for acute toxicity. IL and CAPE were administered immediately after ethanol intake. Total oxidant status (TOS), total antioxidant status (TAS), and oxidative status index (OSi) were evaluated and histologic examination of cerebellum and brain tissue with Hematoxylin-Eosin and immuno-histochemical dyes was performed. RESUlTS: In the ethanol group, TAS levels were significantly lower than the other groups and this finding indicates that the toxic effect of ethanol reduces antioxidant levels. In the ethanol group, TOS levels were significantly higher than the other groups. These results showed that ethanol induced oxidative stress. IL treatment increased TAS levels, and CAPE decreased TOS levels against ethanol toxicity. There was correlation between TAS and TOS levels. Also, histopathologic results confirmed these biochemical results. CONClUSION: CAPE and IL treatment could be effective course of therapy to enhance therapeutic efficacy and may provide a promising approach for the treatment of neurotoxicity and oxidative stress induced by ethanol in clinic