Root Compression Due to Swollen Oxidized Regenerated Cellulose after Cervical Disc Surgery

Oxidized regenerated cellulose is a hemostatic material that is frequently used in neurosurgery. While it is often left in place to avoid postoperative hematoma, in rare cases it may cause neural tissue compression. A case with severe radicular pain due to swollen oxidized regenerated cellulose after anterior cervical disc surgery was reported. A 37-year-old female was operated for a C5-6 disc herniation. After anterior microdiscectomy, severe radicular pain developed due to a retained piece of swollen oxidized regenerated cellulose. Complaints resolved completely after removal of the material causing the compression. Neurological deficits may develop with even a small amount of oxidized regenerated cellulose left behind on the surface of the dura after spinal surgery. We need to keep in mind that this is foreign material that should be used in small quantities. If possible, it must be removed after hemostasis has been achieved

Co-occurrence of Chiari Type 1 Malformation, Syringomyelia, Anterior Thoracic Meningocele And Neurofibromatosis Type 1: A Very Rare Case Report

Background: Neurofibromatosis type 1 (NF-1) is an autosomal dominant hereditary disease associated with neurological and skeletal dysplasias. It is known that anterior thoracic meningocele, which is a rare pathology, may be associated with NF-1. Chiari type 1 malformation (CM-1) is a developmental disorder possibly caused by mesodermal deficiency frequently leading to syringomyelia. CM-1 may also be associated with NF-1. However, no case in which all of these four pathologies occur together has been reported in the literature.Case Report: We present a 45-year-old female with known NF-1 without any neurological signs or symptoms. In her thoracic imaging performed for multinodular goiter investigation, an anterior thoracic meningocele was seen. Her spinal and brain magnetic resonance imaging (MRI) investigations revealed presence of CM-1 and syringomyelia as well. Although the patient was not neurologically compromised, surgical treatment for CM-1 and syringomyelia was offered because of the width of the syringomyelia. However, the patient did not accept the operation.Conclusion: Although NF-1 may be associated with CM-1/syringomyelia or anterior thoracic meningocele, there was no case with all of these pathologies together reported in literature. This case reminded us that NF-1 cases, even in the absence of any neurological complaints, must be evaluated for a possible presence of spinal and brain pathologies

Clinical Outcomes and Factors Affecting the Outcome of Decompressive Craniectomy: Analysis of 50 Cases

Objective: Decompressive craniectomy (DC) is used as the last-stage method in the treatment of increased intracranial pressure (ICP). However, clinical outcomes reported in the literature are contradictory.Methods: Medical records were retrospectively reviewed for 50 increased ICP cases that had been diagnosed and undergone DC at our hospital between February 2011 and February 2017. The patients’ characteristics such as age, sex, presence of comorbidities, pre- and postoperative Glasgow Coma Scale (GCS) scores, blood pressure, hemoglobin values, radiological findings, DC time, width of craniectomy, length of stay in the intensive care unit (ICU), and Glasgow Outcome Scale (GOS) were recorded. According to their outcome, the patients were divided into two groups with good (GOS = 4-5) and poor (GOS = 1-3) prognosis, respectively, according to their last examination. It was evaluated whether these parameters showed significant differences between the groups and between the deceased patients and survivors.Results: A total of 50 patients (35 male and 15 female) had been treated with DC. The mean age was 40.5±22.2 years. Head trauma was the etiology of increased ICP in 68% of the cases (n=34). The median of preoperative GCS was 6 (range: 3-15), and the mean midline shift on admission was 10.3±5.1 mm. Seventy-two percent of the cases (n=36) were treated with DC on the day of admission from the emergency department. The median of postoperative GCS was 7 (range: 3-15). The patients were followed up for a mean of 24.4 days in the ICU, and 30 patients were lost after a mean of 24.6 days. The survivors were followed up for a mean of 7.4±12.5 months. Factors affecting survival periods were age of the patient, short edge length of the DC (not long edge) and early postoperative GCS score after the DC. The comparison between survivors and deceased patients showed that the mean age of survivors was significantly lower than that of deceased patients (p=0.047). Postoperative GCS scores after DC were significantly lower in the patients who had died (p=0.0001).Conclusion: Age, short edge length of the craniectomy and postoperative neurological status are factors affecting surgical outcomes. These factors can play a role in selecting patient candidates who have to receive DC

Sudden Onset of Tetraparesis During Taking of Magnetic Resonance Imaging in a Patient with Undiagnosed Cervical Spinal Stenosis: A Case Report

Objective: To report a case with sudden-onset tetraparesis during taking magnetic resonance imaging (MRI).Case report: A 73-year-old man was referred with complaints of paresis of his arms and legs. His tetraparesis had developed suddenly while an MRI was performed 10 days before. He had a severe tetraparesis with 0/5 motor strength in his legs and 2/5 motor strength in his arms. On the MRI, a serious spinal stenosis at C3-4 and C4-5 levels and a faint myleopathic signal of the spinal cord at the level of the C4-5 disc space were seen. After posterior decompression, the patient’s tetraparesis improved gradually and he could walk independently and perform his daily activities with mild spasticity after 13 months.Conclusion: It is known that sudden neurological deficits may be seen in cervical trauma in patients with cervical spinal stenosis due to spondylosis. However, this case who did not have a trauma history showed us that a long period of positioning the neck beyond the patient’s control, even during the execution of MRI, may cause sudden deterioration