Stereotactic biopsy of the brain mass lesions: a tertiary hospital experience

Objectives: Stereotactic biopsy (SB) is a guided technic performed for the lesions on eloquent brain areas. The aim of this study is revealing the diagnostic reliability and the risk ratio of SB. Methods: Data of patients performed SB due to various intracranial lesions was collected retrospectively. The study took place in Department of Neurosurgery, Gazi University Faculty of Medicine between February 2004 and April 2014. Data analysis performed in terms of age, gender, lesion location, histopathology, and outcomes of surgery. Results: Sixty percent of patients were male (146 patients) and forty percent of them was female (96 patients), between the ages of 11 and 84 years (mean age of 49 years) with a total number of 242. Mortality and morbidity rates were respectively 0.4% and 3.3%. The overall diagnostic yield was 81% (196 patients), while 19% (46 patients) had nonspecific results, which did cannot lead any further therapy. Among 36 patients of whom pathologies were confirmed with an excisional biopsy, the diagnostic accuracy was shown in 24 patients (67%). Conclusions: Beside low risk of mortality and morbidity, the high rate of non-diagnostic results and low rate of diagnostic accuracy are the limitations of SB, which should be improved by careful skills to obtain more specimen, sophisticated software for planning, and intraoperative pathological examination for guaranteeing

The role of hydrogen sulphid on experimental cerebral vasospasm

Anevrizmal subaraknoid kanama 6-11/100000 insidansa sahiptir. Serebral vasospazm serebral arterlerin daralmasıdır. Semptomatik serebral vasospazm, intrakraniyal arteriyel anevrizma rüptürü sonrası hastaların %30?da ortaya çıkan, subaraknoid kanamaya (SAK) bağlı morbidite ve mortalitenin birinci nedenidir. Neredeyse yarım yüzyıldır, serebral vazospazm konusunda geniş çapta araştırmalar yapılmakla beraber, halen nedenleri ve tedavisi hakkında istenen noktaya gelinememiştir. Tedavide birçok vazodilatatör ajan denenmiş ancak klinikte istenen başarıya ulaşılamamıştır. Hidrojen Sülfür (H2S), nitrik oksit ve karbon monoksitten sonra vücutta bulunan üçüncü gaz yapıdaki nörotransmitterdir. CBS, santral sinir sisteminde H2S sentezinden sorumlu ana enzimken, CSE daha çok kardiyovasküler sistemde H2S sentezinde rol oynar. Nörolojik, kardiyovasküler, gastrointestinal, genitoüriner ve endokrin sistemlerde birçok etkisi saptanan, birçok fizyolojik ve patolojik olayda rol oynadığı giderek artan biçimde anlaşılan H2S?in serebrovasküler sistemdeki rolü tartışmalıdır. Bu çalışmada deneysel olarak normal ve serebral vazospazm yaratılmış ratlarda baziler arterde H2S düzeylerinin saptanması, H2S donör ve inhibitörleri verilen deneklerde serebral vazospazmın nasıl etkilendiğinin belirlenmesi suretiyle H2S?in deneysel serebral vazospazmdaki rolünün araştırılması hedeflenmiştir. Kontrol, SAK, NaHS, AOAA, PPG, SAK+NaHS, SAK+AOAA ve SAK+PPG gruplarında ratların baziler arter lümen çapı ve duvar kalınlıkları ile baziler arterde CBS ve CSE enzim aktiviteleri immünhistokimyasal olarak değerlendirildi. Çalışmada SAK yapılan ve yapılmayan hayvanlarda NaHS?in belirgin vazodilatatör etkinliği saptanmıştır. AOAA ve PPG baziler arter ve beyin sapında CSE ve CBS enzim aktivitesini azaltmaktadır. Sonuç olarak SAK sonrası gelişen vazospazmda H2S?in rolünü inceleyen çalışmamızda, H2S?in sahip olduğu vazodilatatör etkinliği ile terapotik potansiyeli olduğu görülmektedir. Bu potansiyelin daha net biçimde ortaya konabilmesi için daha geniş çalışmalar gerekmektedir.Aneurysmal subarachnoid hemorrhage has an incidence of 6-11/100.000. Cerebral vasospasm describes narrowing of cerebral arteries. Symptomatic cerebral vasospasm occurres in approximately 30% of patients after subarachnoid hemorrhage (SAH) due to intracranial aneurysm rupture. Almost half a century, researches performed a wide range of cerebral vasospasm study but it is still not at the desired point for the causes and treatment. Hydrogen Sulfide (H2S), the third gaseous neurotransmitter after nitric oxide and carbon monoxide in the body. CBS is the major enzyme which is responsible for the synthesis of H2S, in the central nervous system, while CSE is more effective in the cardiovascular system. In neurological, cardiovascular, gastrointestinal, genitourinary, and endocrine systems many effects of H2S have been identified. It plays many roles in many physiological and pathological conditions, but its effects on cerebrovascular system are controversial. In this study, in normal rats and rats with cerebral vasospasm, investigating the role of H2S, by detecting the H2S levels in basilar artery and analysing how the H2S donors and inhibitors effect the cerebral vasospasm were aimed. In control, SAH, NaHS, AOAA, PPG, SAH+NaHS, SAH+AOAA and SAH+PPG groups, the basilar artery lumen diameter and wall thickness, CBS and CSE enzyme activity in basilar artery and brain stem were assessed by immunohistochemistry. As a result, the study which examines the role of H2S in cerebral vasospasm after SAH, the therapeutic potential H2S with its vasodilator activity is observed

Effects of positive end-expiratory pressure on intracranial pressure during pneumoperitoneum and Trendelenburg position in a porcine model

Background/aim: This study was undertaken to evaluate the effects of positive end-expiratory pressure (PEEP) levels on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) and to determine the appropriate PEEP level during steep Trendelenburg position combined with pneumoperitoneum. Materials and methods: Ten pigs were included in this study. Pneumoperitoneum and Trendelenburg position were maintained and PEEP titration was initiated. Arterial pressure, heart rate, arterial blood gas, ICP, and CPP were recorded at the following time points: baseline (T0), 30 min after positioning and pneumoperitoneum (T1), PEEP 5 (T2), PEEP 10 (T3), PEEP 15 (T4), and PEEP 20 (T5). Results: MAP significantly increased at T1 compared to T0 and decreased at T4 and T5 compared to T1. ICP was 9.5 mmHg and CPP was 69.3 mmHg at T0. CO2 insufflation and steep Trendelenburg position did not cause any significant difference in ICP and CPP. ICP increased and CPP decreased significantly at T4 and T5 compared to both T0 and T1. PaO2 and PaO2/FiO(2) decreased significantly at T1 and T2 compared to T0, while both increased significantly at T3, T4, and T5 compared to T1. Conclusion: PEEP of 10 cmH(2)O was effective for providing oxygenation while preserving hemodynamic stability, ICP, and CPP in this model

Postdural puncture subdural hematoma or postdural puncture headache? -two cases report-

WOS: 000420619800014PubMed: 26495064Spinal anesthesia is widely used for many obstetric, gynecological, orthopedic, and urological operations. Subdural hematomas may occur after trauma and are associated with high morbidity and mortality rates. Postdural puncture headache (PDPH) is a benign condition and the most frequent complication of spinal anesthesia. The high rate of headache after spinal anesthesia may mask or delay the diagnosis of subdural hematoma. The true incidence of postdural puncture subdural hematoma (PDPSH) is unknown because most affected patients are probably managed without investigation. Therefore, the true incidence of PDPSH may be greater than suggested by previous reports. The differentiation of headache associated with subdural hematoma from PDPH is crucial. We herein report two cases of bilateral subdural hematoma after epidural anesthesia and emphasize the importance of suspicion for PDPSH and careful evaluation of patients with headache after spinal anesthesia

Wewnątrzkomorowy dysembrioplastyczny guz neuroepitelialny – opis przypadku

Dysembryoplastic neuroepithelial tumour (DNT) is located in the cerebral cortex with very few exceptions. In this article, an extremely rare case of intraventricular DNT originating from the septum pellucidum is reported. A 25-year-old woman presented with 5-month history of headache. Cranial magnetic resonance imaging (MRI) scans revealed a mass in the right lateral and third ventricle which was hypointense on T1-weighted image, and hyperintense on T2-weighted images. No contrast enhancement was detected. The lesion was excised totally using a transcallosal-transventricular approach. Immunohistochemical examination revealed DNT. The patient was discharged without any neurological deficits. Intraventricular DNT presents with symptoms of increased intracranial pressure rather than seizures. Distinguishing DNT from other intraventricular tumours is essential as DNT is characterized by benign clinical course and does not require adjuvant therapy.Dysembrioplastyczne guzy neuroepitelialne (DNT) są umiejscowione, z nielicznymi wyjątkami, w korze mózgowej. W bieżącej pracy autorzy przedstawiają wyjątkowo rzadki przypadek chorej z DNT położonym wewnątrzkomorowo, wychodzącym z przegrody przezroczystej. Chora, 25 lat, zgłosiła się z powodu utrzymującego się od 5 miesięcy bólu głowy. W badaniu za pomocą rezonansu magnetycznego uwidoczniono guz położony w komorze bocznej prawej i w komorze trzeciej, hipointensywny w obrazach T1-zależnych, hiperintensywny w obrazach T2-zależnych i niewzmacniający się po podaniu środka kontrastowego. Guz wycięto w całości z dojścia przez ciało modzelowate i przez komorę. W badaniu immunohistochemicznym stwierdzono DNT. Chora została wypisana do domu bez ubytkowych objawów neurologicznych. Wewnątrzkomorowe DNT przejawiają się raczej wystąpieniem objawów wzmożonego ciśnienia śródczaszkowego niż napadów padaczkowych. Odróżnianie DNT od innych guzów wewnątrzkomorowych jest nieodzowne ze względu na fakt, że guz przebiega łagodnie i nie wymaga leczenia wspomagającego

Spine Tango in Turkish: Development of a Local Registry System

AIM: Successfully established registry systems, rather than personal efforts to collect data, are required to record, analyze, compare and secure patient related data. Unfortunately, our country does not have such patient registry systems for spinal pathologies and surgeries at this time. In order to fill this gap in patient management in Turkey, the authors adopted already established Spine Tango registry system in a unique way answering the requirements of our health system. This article aims to present the adaptation process of Spine Tango forms for use in Turkish and describe the first implementation with 50 patients treated for spinal pathologies in a tertiary referral center. MATERIAL and METHODS: In 2011, an effort was initiated by the first author to translate the original Spine Tango forms into Turkish. Funding for this project was provided by authors themselves. With the assistance of a Spine Tango team, the translation process was completed. The Turkish forms were then used in an academic institution with a high spinal workload. A local solution was developed by the authors using commercially available software and mobile instruments. This system was tested with 50 spine patients from June 2012 to January 2013. RESULTS: The analysis of the data gathered using the new Turkey Spine Tango registry system was successful. CONCLUSION: In an environment of exponentially increasing medical data, successfully established registry systems have the potential to facilitate patient management. The authors recommend the use of Turkish Spine Tango forms for clinics performing spinal interventions