Rapid recurrence of a malignant meningioma: Case report

This short report presents a case that developed rapid recurrence of a malignant meningioma. The meningioma was located on the right temporal lobe and total removal (Simpson grade-II) was performed. Radiotherapy was not given and the lesion recurred within four months. The MIB-1 (Ki-67) index was 30 % and the tumor fulfilled all the criteria of anaplasia. After the second surgery, patient was transferred to the Radiation Oncology for radiotherapy. Should we questioned the extent of surgery? Neurosurgeons should be careful and close follow-up the patients with malignant meningioma

Lateral tethering intraspinal lipoma with scoliosis

The authors present an unusual case of an intradural lipoma at the thoracolumbar level causing lateral tethering of the spine, with complicated scoliosis. A 6-year-old girl was admitted with progressive change in posture detected by her parents. Thoracolumbar scoliosis was detected by physical examination and X-ray studies. Spinal magnetic resonance imaging revealed an intradural lipoma and right lateral tethering of the spine at the upper lumbar level. After surgical release of lateral tethering and resection of the lipoma, fusion was performed by the orthopedic surgery team. Radiological and intraoperative findings of this extremely rare case are discussed

The effects of high dose progesterone on neural tube development in early chick embryos

Background: Although folic acid deficiency is known to be one of the factors in the development of spina bifida and other neural tube defects (NTD) the exact pathophysiology still remains unclear. Progesterone is an endogenous hormone which increases significantly during pregnancy. Aims: We aimed to study the possible negative effects of high dose progesterone on neural tube development in early chick embryos. In order to test our hypothesis, early chick embryos were exposed to physiological saline, normal and high doses of progesterone. Settings and Design: 160 fertile, specific pathogen free white leghorn eggs (Gallus gallus), all at stage eight of development were divided into four equal groups. Materials and Methods: The first group was incubated without any operation. The second group was injected with physiological saline. The third and fourth groups were injected with two and twenty times more than physiologic doses of progesterone respectively. After 48 hours of incubation, all embryos were analyzed for the presence of NTDs under light microscopy. Statistical Analysis Used: None. Results: At 48 hours of incubation, 84% (135/160) of the embryos passed characteristics of Stage 12 development and were included to the study. None of the eggs in the first three groups showed NTDs, whereas 81.8% (27/33) of the eggs in the fourth group showed NTDs. Conclusions: Our study showed that progesterone at levels twenty times more than its physiologic level might cause NTDs. Further studies are needed to explain the mechanisms of this teratogenic effect

Comparison of the effects of levetiracetam and valproic acid on neural tube defect formation in the chick embryo: an experimental study

WOS: 000486455600009Aim: The aim of this study is to compare the dosage-related effects of levetiracetam and valproic acid on neural tube defect formation in chick embryos, when applied as monotherapy and in combination. Material and Method: A total of 360 fertilized pathogens-free white-Leghorn eggs were used in the study. The eggs were allowed to incubate for 72 hours. Total of six groups were formed where each medication was administered in low (250 mcg) and high (500 mcg) doses and in combination. Results obtained from the control and sham groups were compared. Results: The prevalence of NTD was found to be significantly lower in the group that received levetiracetam compared to the group that was treated with valproic acid. It was determined that NTD prevalence increased with a dosage increase in both groups. The prevalence of NTD was found to be significantly higher in groups where the two medications were administered in combination compared to the groups that received a single medication. Discussion: Both levetiracetam and valproic acid have the potential to create NTD. Valproic acid has a higher potential of creating NTD compared to levetiracetam. The likeliness of causing NTD significantly increases depending on dosage for both medications. Both medications have the potential to create NTD during pregnancy and must be used with caution

The effects of valproic acid and levetiracetam on chicken embryos

For patients with epilepsy, anti-epileptic medication is generally the first line of treatment, but treating pregnant women with epilepsy can be a challenge. Standard anti-epileptic medications have caused developmental abnormalities, so much effort has been put into developing antiepileptic medications with minimal teratogenic effects. In this experimental study, the new-generation anti-epileptic medication levetiracetam and the standard anti-epileptic medication valproic acid were compared in terms of teratogenicity by studying embryonic development in 360 fertile White-Leghorn chicken eggs (conception day 0). We found that levetiracetam may cause severe developmental abnormalities, and is likely not safe for use in pregnant women. As expected, valproic acid caused more frequent developmental abnormalities than levetiracetam, and the risk increased still further when both drugs were administered in combination. Levetiracetam should be used cautiously in pregnant women with epilepsy. (C) 2010 Elsevier Ltd. All rights reserved

Terminal Syringomyelia Mimicking an Intramedullary Tumor: Case Report

In this report, the authors present a 14-year-old male patient admitted with progressive paraparesis and urinary incontinence that developed in a 3-month period. Thoracolumbar MRI revealed an intramedullary lesion starting from the level of the T10 vertebra and extending to fill the sacral spinal canal. Based on the radiological findings an intramedullary tumor was suspected. Exploratory operation with right L5 hemilaminectomy was done and the intraoperative finding was syringomyelia which was punctured with releasing of the tethered cord. The patient was followed for 3 years with clinical and radiological regression of the pathology and no symptoms and sings have remained. Syringomyelia can mimic intramedullary tumors clinically and radiologically. That is why it is useful to consider exploratory hemilaminectomy to confirm diagnosis

Depressed skull fracture overlying the superior sagittal sinus as a cause of benign intracranial hypertension - Case report

The use of surgical treatment for depressed skull fractures that are located over major venous sinuses is a matter of controversy. However, if clinical and radiological findings of sinus obliteration and related intracranial hypertension are present, surgical decompression is indicated. The authors present the case of a 38-year-old man who had a depressed skull fracture overlying the posterior one-third portion of the superior sagittal sinus. The lesion was initially treated conservatively and the patient was readmitted 1 month later with signs and symptoms of intracranial hypertension. The role of radiological investigation in the detection of venous sinus flow and indications for surgical treatment are discussed. If venous sinus flow obstruction is revealed in the presence of signs and symptoms of intracranial hypertension, surgery is indicated as the first line of treatment

Treatment of symptomatic interhemispheric arachnoid cysts by cystoperitoneal shunting

Arachnoid cysts (AC) located within the interhemispheric fissure are rare, frequently associated with agenesis or hypogenesis of the corpus callosum. The optimal method for surgical treatment is under debate. In this study, we retrospectively reviewed the clinical results of seven infants (five males, two females; mean age, 5.1 months) with large interhemispheric AC who underwent cystoperitoneal shunting (CP) and evaluated the long-term efficacy in terms of clinical data, psychomotor development and neuroimaging. All patients were symptomatic and operated on before they reached 1 year of age. In three patients, additional ventricular catheters were inserted due to concomitant hydrocephalus. The additional catheters were joined with the cyst catheters and the peritoneal catheters with Y-shaped connectors in the same session. The patients were followed up for an average of 57 months (range 24-120 months). The clinical and developmental outcome was good in most patients with complete resolution of symptoms and signs. The developmental outcome scale, which included cognitive and psychomotor development, was "good" (normal) or "fair" (near normal) for six of seven patients. Radiologically, the cyst was completely or nearly totally resolved in five patients, and partially resolved in two. In these symptomatic patients with interhemispheric AC, CP shunting provided favorable treatment outcomes with complete or near-total resolution of symptoms and reduction in cyst size or disappearance of the cyst. (C) 2009 Elsevier Ltd. All rights reserved