Extreme Calvarial and Upper Cervical Hyperpneumatization: A Case Report

The pneumatization of bones of cranial base other than the mastoid process and temporal bone is a pathologic and rare condition, and it may cause some serious complications. Extension of the pneumatization to the cranial vault and upper cervical bones is extremely rare. A 67 year-old man was admitted with complaint of chronic nonspecific headache for a long time. He had no history of head trauma or otologic infection. Physical examination not revealed fever, any palpable swelling, rhinorrhea or otorrhea. There was only a slight right sensorineural hearing loss. Brain computerized tomography (CT) revealed hyperpneumatization in the right mastoid process and right temporal bone, bilateral occipital, parietal and frontal bones, and right side of the atlas. There was no pneumocephalus, but there was free air under the scalp of the right suboccipital region and around the right condyle, right transverse process of the atlas and right paravertebral region of the upper cervical vertebrae. Extrathecal cerebrospinal fluid (CSF) leakage was not detected by CT cisternography with intrathecal contrast administration and by the radionuclide cisternogram

Comparing The Rate of Radiological and Clinical Adjacent Segment Degeneration After Simple Anterior Cervical Discectomy Versus Discectomy Plus Fusion

Objective: To evaluate and compare the radiological changes on adjacent mobile segments and clinical findings in patients having undergone single-segment simple anterior cervical discectomy versus discectomy plus intervertebral fusion.Material and Methods: Twenty-five patients were treated with discectomy plus fusion and 20 patients with simple discectomy. Clinical pictures of the patients were evaluated with ODOM criteria before and 1 year after operation, and their improvement rates were calculated. The disc heights of superior and inferior adjacent segments, superior and inferior foramen heights, superior and inferior end plate heights of superior and inferior adjacent segments, new osteophyte development, segmental angulation and loss of cervical lordosis were evaluated on cervical radiographies before and 1 year after operation.Results: Although there were new degenerative findings in adjacent mobile segments in all patients when preoperative and postoperative measurements were compared, these radiological findings did not translate into clinical findings. In the fusion group, radiological degeneration findings were seen more frequently statistically; however, clinical results were not different between the two groups. On the other hand, loss of lordosis was significantly more frequent in the simple discectomy group.Conclusion: Although adding fusion to single-segment anterior cervical discectomy caused more frequent radiological degenerative changes in adjacent segments after 1 year compared to simple discectomy, clinical results were similar. It was thought that longer follow-up was necessary to observe clinical adjacent segment disease that was expected to become more frequent because of excessive mobility due to fusion

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

Hydrogel Implant Causing Lumbar Radiculopathy: A Case Report

Objective: One of the new treatment methods for lumbar degenerative disc disease is percutaneous application of a hydrogel implant into the intervertebral disc. The aim of this method is to increase the disc height, to widen the neural foramen, and to decrease discogenic pain and leg pain caused by root compression. However, there may be serious complications related to intervertebral hydrogel implants that have been increasingly used during the last few years because of their minimally-invasive nature. A case with lumbar root compression due to hydrogel implant is being reported.Case Report: A 61-year-old male was admitted with severe left leg pain due to compression of the left L5 root by a hydrogel implant that had been percutaneously introduced into the L4-5 disc level 6 months ago. On magnetic resonance imaging, a lesion compressing the left L5 root at the L4-5 disc level and mimicking a disc herniation was seen. It was hypointense on T1-weighted and hyperintense on T2-weighted sections. The implant was removed by an open surgery.Conclusion: An intervertebral hydrogel implant swells up by absorbing water from adjacent tissues. Actually, this is the main mechanism of action by which it provides an increase of disc height. However, if it swells up excessively, it may spill over through the spinal canal and thus cause root or dural sac compression and neurological compromise

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

Isolated Fourth Ventricle Associated with Treated Hydrocephalus and Chiari type 2 Malformation

Isolated fourth ventricle is a rare condition seen as a result of anatomical or functional occlusion of the inlet and outlet holes of the fourth ventricle. It may be seen in cases with Chiari type 2 malformation, too. We report a 20-month-old boy with isolated fourth ventricle presenting with weakness in his arms. He had been treated for myelomeningocele and hydrocephalus in the neonatal period and followed for Chiari type 2 malformation. The isolated fourth ventricle developed in the presence of a well-functioning lateral ventricle shunt. He was treated with a new shunt into the fourth ventricle

Factors Affecting the Outcome in Traumatic Subarachnoid Hemorrhage

Objective: To define risk factors affecting the outcome in traumatic subarachnoid hemorrhage.Material and Methods: Forty-four patients with traumatic subarachnoid hemorrhage were evaluated retrospectively. They were divided into three groups according to their age: elderly (≥65 years), adult (16- 64 years), and children (<16 years). The clinical picture on admission was evaluated using the Glasgow Coma Scale. The patients were also divided into three groups according to their coma grading on admission: mild injury (Glasgow Coma Scale score 13-15), moderate injury (8-12), and severe injury (3-7). The amount of subarachnoid blood shown in computerized tomography was evaluated according to the Fisher index, and additional tomography findings were recorded. At last follow-up, presence of headache and neurological deficits as well as return to work or school were investigated, and the last clinical picture was evaluated with the Glasgow Outcome Scale.Results: There were 11 children, 23 adults and 10 elderly patients. Twelve patients died between 1-49 days after trauma; the others were followed for a mean of 14.6 months (from 10 to 30 months). In the children group, Glasgow Coma Scale score was significantly higher (p=0.004), subarachnoid blood amount was significantly lesser, and Glasgow Outcome Scale score was significantly better compared to the other groups. For all groups, higher trauma severity on admission was associated with higher Fisher index (p=0.016). Most important factors affecting clinical results were severity of head injury on admission (p=0.0001), Fisher index (p=0.003), and presence of additional findings on computerized tomography (p=0.0001).Conclusion: Traumatic subarachnoid hemorrhage usually has a good clinical outcome in children; however, in elderly patients, the outcome is worse, and there are usually additional intracranial traumatic lesions. Most important factors affecting outcome are blood amount on first computerized tomography, head trauma severity, and presence of additional intracranial traumatic lesions

Cervical Spinal Cord Injury in Patients with Cervical Canal Stenosis without Radiologic Evidence of Trauma: Evaluation of 15 Consecutive Cases

Objective: Cervical spinal canal stenosis is a well-known risk factor for spinal cord injury. In some patients, spinal cord injury is the first symptom of spinal stenosis. Therefore, some authors recommend preventive decompression of the spinal canal in asymptomatic patients with spinal stenosis. In this study, we aimed to determine the outcome of patients with spinal cord injury associated with cervical spinal canal stenosis and the rate of previously asymptomatic patients.Material and Methods: Data of 15 consecutive patients were evaluated. Improvement of neurological deficits during followup was accepted as good outcome and mortality and unchanging neurological deficits were accepted as worse outcome.Results: All patients were male, aged between 44 and 85 years. High-energy traumas caused injury in 7 of the cases and low-energy traumas in the others. Nine cases had central cord injury and 6 had other types of traumas. Only 2 patients had been diagnosed with minor symptoms associated with cervical canal stenosis before trauma, while the other patients had been asymptomatic. One patient did not consent to undergo an operation and two others could not be operated because of their general status; the latter 2 patients died. The other 12 patients were decompressed 0 to 40 days after trauma. Two other patients with severe transverse-type cord injury also died postoperatively. The other patients were followed for 1 to 48 months (22.7±17.7 months). In 2 patients, neurological deficits had not improved on last follow-up. Deficits had completely or partly improved in the other patients, including the one who had not accepted the operation. Central cord injury had a significantly better prognosis than other types (p=0.0019). Age, cervical canal diameter, and motor and sensory scores of the American Spinal Injury Association scale, type of trauma, and level of spinal cord injury were not significantly different in the patients with good and worse prognosis.Conclusion:The rate of asymptomatic patients before trauma was very high in patients with spinal cord injury associated with cervical spinal canal stenosis. Therefore, the treatment decision must be carefully assessed in asymptomatic cervical spinal stenosis patients. Catastrophic consequences of spinal trauma may be seen in patients with cervical spinal canal stenosis even in asymptomatic patients. Central cord syndrome had a good prognosis in these patients. Other types of injuries such as transverse and motor types had a worse outcome

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

Spontaneous Acute Subdural Hematoma due to Intracranial Hypotension Secondary to Lumboperitoneal Shunt: A Case Report and Review of the Literature

Objective:To report a rare case with spontaneous intracranial acute subdural hematoma due to overdrainage of cerebrospinal fluid after lumboperitoneal shunting and to review the literature on this topic.Case report: A 53-year-old lady with spontaneous acute subdural hematoma developing 3 years after lumboperitoneal shunting for treatment of benign intracranial hypertension is reported. She was treated with shunt removal and hematoma evacuation.Material and Methods: We found 16 cases with intracranial bleeding developing spontaneously or after mild head injury after lumboperitoneal shunting. The characteristics of the patients were recorded, the outcome was given according to the Glasgow Outcome Scale, and a Glasgow Outcome Scale score from 1-3 was accepted as worse outcome. The factors affecting outcome were evaluated.Results: There were 10 females and 7 males aged 59.7±15.1 years. In most cases, the primary disease treated by lumboperitoneal shunting was hydrocephalus or benign intracranial hypertension. In 12 of the cases, the bleeding happened into the subdural space and in 5 into other compartments (intracerebral or subarachnoid bleeding). Five of the cases died, and 62.5% had a worse outcome. The only factor affecting outcome was the time span from lumboperitoneal shunting to intracranial bleeding. This time was significantly shorter in the patients with worse outcome (3.7 versus 38.6 months).Conclusions: Lumboperitoneal shunting may cause serious complications such as intracranial bleeding due to overdrainage of cerebrospinal fluid via shunt. Patients with lumboperitoneal shunting must be followed very closely for development of intracranial hypotension especially during the first few months after shunting