Epileptic seizures caused by encephalomalasic cysts following radiotherapy: a case report

INTRODUCTION: Cerebral radionecrosis is a delayed and rarely observed complication of radiotherapy. Cerebral radionecrosis may occur as cystic encephalomalasic formations which cover the intracranial region. These cysts may, in rare cases, become quite large. They may cause drug-resistant seizures, neurological deficits and consciousness disorders. CASE PRESENTATION: A 55-year-old, Turkish female patient was admitted to hospital with seizure, consciousness disorder and weakness in the right side of her body. The patient had history of an operation in the left maxillary area due to basal cell carcinoma 7 years previously and then history of radiotherapy due to relapse 2 years later the operation. The patient had large cystic encephalomalasic lesions. Despite steroid and dual antiepileptic treatments, the patient's complaints had significantly worsened and seizures continued. Surgical treatment resulted in a significant improvement. CONCLUSION: This report underlines the significance of surgery in cerebral radionecrosis treatment in well-selected cases using appropriate approaches

Subgaleal Migration of the Distal Catheter of a Ventriculoperitoneal Shunt

Proximal migration of the distal end of a ventriculoperitoneal shunt has been observed much more rarely than other numerous shunt-related complications. Subgaleal migration of the peritoneal end is one of the samples. In the preset report we have discussed a case of subgaleal migration of the peritoneal end detected as a result of the examinations performed for shunt dysfunction. There was ventricular dilatation on CT scan of the brain. X-ray examinations confirmed proper ventricular catheter and shunt valve placement but a complete migration of distal (peritoneal) catheter into the subgaleal space. Then the patient’s shunt was revised. When our case and the literature were examined, we observed that this complication was frequently encountered during the first postoperative months, in the pediatric ages and in patients with advanced hydrocephalus. Besides, we have detected that the peritoneal catheters had tendency to migration into the subgaleal tissues similar to pre-insertion forms of the preoperatively original packages

Ganglioneuroblastoma of the Thoracic Spinal Cord: a Very Rare Case Report

An eight‑month‑old male child was admitted with weakness and swelling in the feet. Paraparesis and bilateral lower extremity edema were present in the neurological examination. Thoracic MRI showed an intradural intramedullary mass 61 × 11 mm in size in the T5–T10 levels. Laminotomy between the T5–T10 vertebrae was performed. A mass with smooth borders was separated from most of the neural tissue. In the postoperative MRI, we observed a contrast enhancing area, considered a residual fragment, only 5 × 4 mm in size. Histopathological properties were compatible with the intermixed subtype of ganglioneuroblastoma. Only a limited number of thoracic cord Ganglioneuroblastoma reports have been previously published. Although very rare in children and young adults, ganglioneuroblastoma should be included in the differential diagnosis of thoracic cord tumors. It is difficult to obtain a preoperative diagnosis with clinical features and radiological investigations. Diagnosis depends on histopathological examinations. Curative treatment should be in the form of a complete resection of the tumor. In partially resected cases, adjuvant radiotherapy may become necessary, along with close follow‑up

Cranioplasty with preoperatively customized Polymethyl-methacrylate by using 3-Dimensional Printed Polyethylene Terephthalate Glycol Mold

Cranioplasty is a reconstructive procedure for the repair of skull defects or deformities. Polymethyl-methacrylate (PMMA) is a commonly used alloplastic material when autologous bone is unavailable. However, manual shaping of bone cement for frontal and orbital bone defects is challenging and may not lead to cosmetically satisfactory results. Advances in computer-aided 3-dimensional (3D) design and printing technology allow the production of patient-customized implants with improved cosmetic and functional results. A 39-year-old female patient presented with right-sided frontal swelling and headache. Computerized tomography (CT) demonstrated a right frontal calvarial mass extending to the orbital wall. The boundaries of the lesion were marked using a 3D design software. A polyethylene terephthalate glycol (PETG) mold was manufactured with help of a 3D printer. Artificial bone flap was formed by pouring PMMA into the mold. After surgical resection of the calvarial mass, customized PMMA implant was applied with titanium mini plate and screws. The defect was closed properly with good aesthetic results. Production of customized PMMA cranioplasty implants with 3D printed molds is a useful technique and can be preferred for calvarial defects due to skull tumors, bone resorption and traumatic bone loss

Electrophysiological Effects of Bosentan in Rats with Induced Cerebral Ischemia-Reperfusion

We examined the effect of bosentan, an ETA and ETB receptor antagonist, on EEG, an indicator of neuronal activity, in rats with experimentally induced cerebral ischemia-reperfusion. The rats were divided into three groups with seven rats in each group. Before the procedures, the EEGs of all rats were recorded for ten minutes. 30 mg/kg bosentan in 2 cc physiological serum was administered to the first group, and the second and third groups were injected with 2 cc physiological serum intraperitoneally. After the administration, the right and the left common carotid arteries of the animals in Groups 1 and 2 were clipped for 10 minutes using aneurysm clippings. The rats in the third group received only a subcutaneous incision. Ten minutes after the clips were removed in the first and second groups and after the incision in the third group, EEG recordings were repeated for 10 minutes. All the rats were decapitated and MDA values in the brain tissue were measured for evaluation of the efficiency of induced cerebral ischemia. Induced cerebral ischemia was performed effectively because the MDA levels in Groups 1 and 2 were elevated, compared to the levels in Group 3 (p<0.05). After the application of the Cerebral Ischemia-Reperfusion Technique, the EEG showed minimal slowing in the rats in Group 1, and generalized diffuse slowing in the rats in Group 2 compared to pre-ischemic findings. Bosentan may reduce the damage induced by ischemia on neuronal electrophysiology, likely through its vasodilation effect on cerebral vessels

An unusual case of neuro-Behcet's disease presenting with co-occurence of cerebral venous sinus thrombosis with basilar artery occlusion

WOS: 000320363800029PubMed: 22661102Non-parenchymal neuro-Behcet disease generally affects cerebral venous sinuses, whereas intracranial intracerebral arterial involvement has been rarely reported. But co-involvement of both intracranial intracerebral artery and venous vascular systems in a patient at the same time has not been mentioned before. To the best of our knowledge, this case involving a 25-year-old male with a 7-year history of Behcet disease is the first reported of this type of involvement. He developed occlusion of the basilar artery together with thrombosis of the left sigmoid sinus, distal internal jugular vein, and straight sinus. He was successfully treated with a combination of high-dose steroid and cyclophosphamide. Cranial magnetic resonance angiography demonstrated the resolution of these abnormalities

Cranially migrated lumbar intervertebral disc herniations: A multicenter analysis with long-term outcome

Objective: Risk factors of cranial migration were investigated in patients with lumbar disc herniation (LDH) that migrated in the cranial direction and the long-term outcomes are discussed in this study. Materials and Methods: Patients who underwent surgery for LDH at four different centers between 2012 and 2017 were studied. Extraligamentous discs were located in the lateral part of the posterior longitudinal ligament (PLL) within the spinal canal of the axial plane, and subligamentous discs were located under the PLL. The extent of cranial migration was calculated as a percentage of the height of the migrated corpus. Based on the extent of cranial migration, partial hemilaminectomy or hemilaminectomy was performed at different rates in each patient and the amount of laminectomy performed was recorded. During surgery, all free fragments were attempted to be removed. The appropriate technique was decided intraoperatively, and the surgery was performed on an individual patient basis. Results: Of 1289 patients who underwent surgery for LDH, 654 (50.73%) had caudal migration, 576 (44.68%) had migration at the level of the disc, and 59 (4.57%) had cranial migration. Analysis of 59 patients with cranial migration according to the localization of the disc fragment revealed that 31 had extraligamentous and 28 had subligamentous fragments (P = 0.024). Conclusions: Extraligamentous intervertebral disc fragments migrate more cranially than subligamentous intervertebral fragments. The anatomy of the PLL that varies along the corpus is the main reason for the weakness of the resistance of the disc material to the dorsolateral region, direction of discrete force vectors, and orientation of the disc fragment due to torsional vertebral movements