The evaluation of the effects of steroid treatment on the tumor and peritumoral edema by DWI and MR spectroscopy in brain tumors

Objective To investigate the effects of dexamethasone on brain tumor and peritumoral edema by different sequences of magnetic resonance imaging (MRI). Materials and methods MRI was performed in 28 patients with brain tumor. Patients were divided into the 3 groups based on the histological diagnosis; Group I: high-grade glial tumor, Group II: low-grade glial tumor, and Group III: brain metastasis. The measurements of peritumoral edema volume and apparent diffusion coefficient (ADC) values were performed while the peak areas of cerebral metabolites were measured by spectroscopy in groups I and II. The changes in edema volumes, ADC values and cholin/creatine peak areas were compared. Results The volume of peritumoral edema was decreased in groups I and II, but increased in group III after dexamethasone treatment. These changes were not statistically significant for 3 groups. ADC value was decreased in group I and increased in groups II and III. Changes in ADC values were statistically significant. Cholin/creatine peak areas were decreased after dexamethasone in groups I and II, but these changes were also not significant. Conclusion Dexamethasone has no significant effect on the volume of peritumoral edema in glial tumor and metastasis. Moreover, dexamethasone increases the fluid movements in low grade gliomas and metastases, decreases in high grade gliomas. However, more comprehensive clinical studies are needed to show the effects of dexamethasone on brain tumors and peritumoral edema

Wyniki leczenia uszkodzenia nerwu strzałkowego na wysokości kolana: doświadczenie oddziału szpitala wo¡skowego

Background and purpose We investigated the management outcome of common peroneal nerve decompression at the knee level between the years 2005 and 2009. Material and methods Thirty consecutive patients with knee-level peroneal nerve injury who underwent decompression surgery and external neurolysis at our institution were evaluated preoperatively and postoperatively by electrophysiological studies and motor examination (Medical Research Council grading). Results Twenty-eight of the cases were male and 2 were female. Mean age was 31.1 for males and 57.5 for females. Physical activity during military training (overstretch/contusion) was the cause of nerve lesion in the majority of the patients (n = 28, 93%). Mean time interval between the diagnosis and the surgery was 5 months. Follow-up time ranged from 3 to 48 months (mean: 14 months). Twenty-nine of 30 (97%) patients recovered totally or near totally in foot/toe dorsiflexion. Conclusions Early decompression and neurolysis of the common peroneal nerve (CPN) at knee level after strenuous physical activity offers excellent functional recovery. Additionally, for knee-level CPN injuries, in order to minimize the postoperative scar, pain and delay in wound healing, we strictly advocate short ‘lazy S-shaped incision’ around the fibular head in supine position unlike the classical extensive opening up to the superior border of the popliteal fossa in prone position.Wstęp i cel pracy Autorzy ocenili wyniki chirurgicznego odbarczenia nerwu strzałkowego wspólnego na wysokości kolana, wykonywanego w latach 2005–2009. Materiał i metody Przedoperacyjnej i pooperacyjnej ocenie klinicznej (w skali Medical Research Council) oraz elektrofizjologicznej poddano 30 kolejnych pacjentów z uszkodzeniem nerwu strzałkowego na wysokości kolana, u których wykonano odbarczenie chirurgiczne z zewnętrzną neurolizą. Wyniki Wśród leczonych było 28 mężczyzn (średnia wieku: 31,1 roku) i dwie kobiety (średnia wieku: 57,5 roku). U zdecydowanej większości pacjentów (n = 28, 93%) przyczyną uszkodzenia nerwu była aktywność fizyczna w czasie szkolenia wojskowego (nadmierne rozciągnięcie/stłuczenie). Średnia czasu od rozpoznania do operacji wyniosła 5 miesięcy. Obserwacja po zabiegu trwała od 3 do 48 miesięcy (średnia: 14 miesięcy). U 29 na 30 chorych (97%) uzyskano pełny lub prawie pełny powrót zgięcia grzbietowego stopy/palców. Wnioski Wczesne chirurgiczne odbarczenie i neuroliza nerwu strzałkowego wspólnego na wysokości kolana w leczeniu urazu powstałego wskutek nadmiernej aktywności fizycznej daje możliwość znakomitej poprawy czynnościowej. Ponadto w przypadku uszkodzeń nerwu strzałkowego wspólnego na wysokości kolana w celu zminimalizowania blizny pooperacyjnej, nasilenia bólu i opóźnienia w gojeniu się rany pooperacyjnej autorzy usilnie zalecają krótkie cięcie w kształcie wydłużonej litery „S” wokół głowy strzałki u chorego w pozycji leżącej na plecach zamiast klasycznego otwarcia aż do górnej granicy dołu podkolanowego w pozycji leżącej na brzuchu

Limited Dorsal Myeloschisis with and without Type I Split Cord Malformation: Report of 3 Cases and Surgical Nuances

Limited dorsal myeloschisis (LDM) is a rare form of spina bifida which is characterized by a fibroneural stalk between the inner part of the skin and the spinal cord. It may be associated with split cord malformation (SCM). Diagnosis and management of this complex malformation is challenging. We presented 3 different cases of LDM. Two of them were associated with Type I SCM and the other had no associated malformation. All of them were evaluated radiologically just after the birth and underwent surgical treatment under intraoperative neuromonitoring. They were discharged without any complication. Newborns with spinal cystic lesions should be carefully evaluated for spinal malformations after the birth and treated surgically as soon as possible in order to prevent neurological and urological complications secondary to tethered cord syndrome. Surgical technique in LDM-SCM patients is quite different than the patients with solitary LDM

A new method of patient's head positioning in suboccipital retrosigmoid approach

Background: The retrosigmoid approach is a common route to the cerebellopontine angle and lateral clivus. Patient′s head positioning just before the operation is crucial to perform the procedure effectively and safely. Aim : The aim of the study is to determine the positional angle of the head on preoperative axial sequences of the cranial magnetic resonance imaging (MRI). Materials and Methods : The angle between the line drawn along the petrous bone ventral to the internal auditory canal and the line drawn parallel to the dorsal face of the clivus on the axial view of MRI sequences was measured. Results : This method of patient positioning has resulted in minimal cerebellar retraction, less time in the preoperative preparation period and less postoperative headache and neck pain. Conclusions : This method can provide quick and better exposure of the cerebellopontine angle. Preoperative measurement of positional angle on axial MRI sequences is a very simple and sufficient way to determine the angle of the head that is turned to the contralateral side

The Use of Neuronavigation and Intraoperative Imaging in Spinal Stabilization Surgery

AIM: Misplacement of pedicle screw is the serious complication of spinal surgeries. Intraoperative imaging techniques and navigation systems are currently in use for the prevention of this complication. The aim of this study was to document the results of our experience with the navigation and intraoperative imaging technique and to share our experience with our colleagues. MATERIAL and METHODS: Between 2011 and 2014, one hundred and two patients underwent instrumented spinal surgery while using intraoperative computed tomography (iCT) and a navigation system. All patients had a CT scan performed no more than three days postoperatively to confirm adequate placement of the screws. The accuracy of pedicle screw placement was assessed by postoperative CT scan. Pedicle violations were graded according to an established classification system. RESULTS: In the 36-month period, a total of 610 screws in 102 patients were evaluated. Stabilization surgery was performed in the lumbosacral region in 51 (50%) patients, lumbar region in 35 (34.31%) patients, cervical region in 5 (4.9%) patients, thoracolumbar region in 7 (6.86%) patients and thoracic region in 4 (3.92%) patients. Of the 610 screws, 396 (64.91%) were placed in lumbar, 66 (10.81%) in thoracic, 106 (17.37%) in sacral and 42 (6.8%) in cervical vertebrae. Of the 610 screws, 599 screws (98.18%) were placed without a breach. Grade 1 breaches occurred in 8 screws (1.31%), Grade 2 breaches occurred in 2 screws (0.32%), and Grade 3 breaches in 1 screw (0.16%). No dural defect or neurological deficit occurred after the surgeries. CONCLUSION: The use of an ICT scan associated with a navigation system increases the accuracy of pedicle screw placement. This system protects the surgical team from fluoroscopic radiation exposure and the patient from the complications of screw misplacement and repeated surgeries

Glutathione S-Transferases and Cytochrome P450 Enzyme Expression in Patients with Intracranial Tumors: Preliminary Report of 55 Patients

WOS: 000464382200009PubMed: 30321868Objective: Intracranial tumors are one of the most frightening and difficult-to-treat tumor types. In addition to surgery, protocols such as chemotherapy and radiotherapy also take place in the treatment. Glutathione S-transferase (GST) and cytochrome P450 (CYP) enzymes are prominent drug-metabolizing enzymes in the human body. The aim of this study is to show the expression of GSTP1, GSTM1, CYP1A1, and CYP1B1 in different types of brain tumors and compare our results with those in the literature. Subjects and Methods: The expression of GSTP1, GSTM1, CYP1A1, and CYP1B1 was analyzed using immunostaining in 55 patients with intracranial tumors in 2016-2017. For GST and CYP expression in normal brain tissue, samples of a portion of surrounding normal brain tissue as well as a matched far neighbor of tumor tissue were used. The demographic features of the patients were documented and the expression results compared. Results: The mean age of the patients was 46.72 years; 29 patients were female and 26 were male. Fifty-seven specimens were obtained from 55 patients. Among them, meningioma was diagnosed in 12, metastases in 12, glioblastoma in 9, and pituitary adenoma in 5. The highest GSTP1, GSTM1, and CYP1A1 expressions were observed in pituitary adenomas. The lowest GSTP1 expression was detected in glioblastomas and the lowest CYP1B1 expression in pituitary adenomas. Conclusion: GSTP1 and CYP expression is increased in intracranial tumors. These results should be confirmed with a larger series and different enzyme subtypes. (c) 2018 The Author(s) Published by S. Karger AG, BaselTurkish Neurosurgical SocietyThis study was partly supported by the Turkish Neurosurgical Society. We are grateful to Dr. Gulsah Kose for the statistical analysis