A Rare Case of Concomitant Intramedullary Gangliocytoma at the Cervicomedullary Junction in Patient with Neuroendocrine Tumor of Lung

Ganglion cell tumors (GCT) are divided into two subtypes : gangliocytoma and ganglioglioma. Intramedullary gangliocytomas are extremely rare. A 20-year-old male patient with pain of neck, who also had a previously known neuroendocrine tumor of lung, was operated for mass found in the cervicomedullary junction with a presumptive diagnosis of metastases. Only partial resection could be performed. Pathological diagnosis had been reported as gangliocytoma. Only ten cases of intramedullary gangliocytoma have been reported in the literature. Although association with scoliosis and Von Recklinghausen's disease were previously reported in the literature, no gangliocytoma case concomitant with endocrine tumor of lung have been published. Pathological study is the most important diagnostic method for gangliocytomas. Surgical excision is the primary treatment, but difficulty in total surgical tumor resection is the most important problem

Rapid Spontaneous Resolution of Acute Epidural Hematoma: A Case Report and Review of the Literature

Background: Epidural hematomas (EDH) are pathologies in which the early diagnosis and treatment are important. Resolution under 24 hours is very rare. Case Report: An 11-month-old male patient was brought to the emergency department with head trauma from falling out of bed onto his back. There were no neurological deficits, except for the patient being somnolent. Computed tomography (CT) of the patient revealed subgaleal edema in the right parietal region, linear fracture and image consistent with EDH with a thickness of about 9 mm underneath fracture. A control CT was performed after 3 hours as somnolence continued in follow-up of the patient. Hematoma in the epidural region was observed to completely resolve and edema in the subgaleal region was observed to gain hemorrhagic characteristics. Conclusion: In total, 15 cases have been reported, including our case, in the literature with resolution less than 24 hours. Our case has the fourth fastest resolution ever reported in the English literature. We think that the most important factor in the rapid spontaneous resolution is the presence of a connection between the epidural and epicranial space, either through a fracture or cranial suture

Bone Cement Leakage in Transpedicular Percutaneous Vertebroplasty: Analysis of 20 Patients

Objective: Percutaneous vertebroplasty (PVP) is one of the frequently preferred interventional methods in spinal surgery. Although it is classified as minimally invasive, the most common complication of this procedure is bone cement leakage. Leakage of bone cement is often asymptomatic, but can lead to serious complications such as paraplegia and pulmonary embolism. In this study, we aimed to investigate the complications and consequences of cement leakage in the percutaneous vertebroplasty procedure. Methods: Between 2009 and 2015, 20 (14 female and 6 male, mean age 69.7) patients who underwent percutaneous vertebroplasty to 26 vertebrae were included in the study. 17 vertebrae were treated for osteoporotic compression (65.3%), 4 vertebrae for pathologic compression fractures (15.3%), 4 vertebrae for traumatic compression fractures (15.3%) and 1 vertebrae for painful hemangioma (3.8%). Leakage localizations of bone cement were classified as venous plexus, paravertebral soft tissue, spinal canal, intervertebral foramen, into the niddle channel and intervertebral disc space. Results: Twelve vertebrae showed no leakage (46.1%). 5 vertebrae had leakage into the niddle channel (19.2%), and 3 had leakage to vertebra disc space leakage (11.5%) and 2 vertebrae had to venous plexus and paravertebral tissue leakage (7.6%) Foraminal and spinal canal leakage (3.8%) was observed in one patient on single level. Radicular pain was seen in one patient. Partial pain control was observed in 20% of the patients while 80% of the patients had complete pain control on follow ups. Conclusion: Major complications following percutaneous vertebroplasty are mostly due to bone cement leaks. In order to prevent major complications, it is necessary to determine the possible causes of leakage. Performing the application with the correct technique with properly prepared bone cement is essential. Also usage of contast dye may be useful for pre-injection risk of leakage complications

Magnetic Resonance Guided Stereotactic Biopsy of Intracranial Lesions: Analysis of 310 Cases

Objective: Stereotaxic biopsy is an important surgical procedure that provides definite diagnosis in brain lesions. It is possible to obtain diagnosis with minimal invasive manner in deeply located and critical localized lesions. There are large case series in the literature. We aimed to present our experience of magnetic resonance (MR) guided 310 stereotaxic biopsies in this study. Method:We retrospectively evaluated age and gender distribution, locations of the lesions, histopathologic results, and complications of 310 cases which MR guided stereotactic biopsied was performed in our clinic between 2012 and 2018. In addition, technical information was also provided. Results:Stereotactic frame application was performed with local anesthesia and surgical procedure was performed by under general anesthesia. Of 310 patients 169 were male (55%) and were 141 female (45%). Mean age was 57.28 (3-87). 184 of the lesions were hemispheric (59%), and the most common diagnosis was glioblastoma multiforme (34.19%). 8 patients were not diagnosed (2%). Complications developed in 13 cases (4%) and 2 of cases were died in the early phase due to the procedure (0.6%). Histopathological diagnostic success was 99% Conclusion:The results of our study show that the stereotactic biopsy procedure applied in the MRI guideline is reliable and feasible with low complication rate and high effectiveness in cases where definitive histopathologic results are required for treatment planning

Stubborn hiccups as a sign of massive apoplexy in a naive acromegaly patient with pituitary macroadenoma

Pituitary apoplexy (PA) may very rarely present with hiccups. A 32-year-old man with classical acromegaloid features was admitted with headache, nausea, vomiting and stubborn hiccups. Pituitary magnetic resonance imaging (MRI) demonstrated apoplexy of a macroadenoma with suprasellar extension abutting the optic chiasm. Plasma growth hormone (GH) levels exhibited suppression (below <1 ng/mL) at all time points during GH suppression test with 75 g oral glucose. After treatment with corticosteroid agents, he underwent transsphenoidal pituitary surgery and hiccups disappeared postoperatively. The GH secretion potential of the tumor was clearly demonstrated immunohistochemically. We conclude that stubborn hiccups in a patient with a pituitary macroadenoma may be a sign of massive apoplexy that may result in hormonal remission

Effects of Atorvastatin on Experimental Spinal Cord lschemia-Reperfusion Injury in Rabbits

AIM: Extent of secondary injury is the determinant of tissue destruction and functional worsening after primary spinal cord injury (SCI). Data have accumulated on alleviation of secondary injury in SCI from many studies on the subject. Besides its cholesterol lowering effects, statins are known to have anti-inflammatory and anti-oxidant effects which are the main targets of spinal cord research. This study aims to evaluate the effects of atorvastatin on experimental spinal cord ischemia-reperfusion injury. MATERIAL and METHODS: Thirty adult male New Zealand rabbits were allocated into control, ischemia-reperfusion (I/R) and treatment groups. Treatment group received 5 mg/kg of atorvastatin via lavage for the preceding 14 days. Other groups received placebo during the same time period. After two weeks, animals in the I/R and treatment groups underwent abdominal temporary aorta occlusion for 30 minutes. Neurological condition of the animals was recorded during the 48 hours of observation. Afterwards, animals were sacrificed and levels of malondialdehyde, glutathione and nitric oxide in spinal cord tissue and plasma and the histopathological tissue changes were determined. RESULTS: Animals in the treatment groups demonstrated significantly better results than the I/R group regarding biochemical markers. Neurological evaluation using the Tarlov scale demonstrated significantly better results at the 48th hour in treatment group. Histopathological results were also better in the treatment groups. CONCLUSION: Results of this study demonstrate the neuroprotective effects of atorvastatin. Atorvastatin has favorable effects on biochemical markers of oxidative stress in SCI. Further studies with larger cohorts and different time periods are also needed

Does the dominant hand factor have an effect on postoperative recovery in the surgical treatment of carpal tunnel syndrome?

Objective: Carpal Tunnel Syndrome (CTS) is the most frequently encountered entrapment neuropathy. Surgical treatment is usually suggested to patients with severe symptoms. In this study, we aimed to examine the effect of the dominant hand on the clinical results of CTS decompression surgery

Does the dominant hand factor have an effect on postoperative recovery in the surgical treatment of carpal tunnel syndrome?

Objective: Carpal Tunnel Syndrome (CTS) is the most frequently encountered entrapment neuropathy. Surgical treatment is usually suggested to patients with severe symptoms. In this study, we aimed to examine the effect of the dominant hand on the clinical results of CTS decompression surgery

Safety and Efficacy of Ventriculostomy Procedures under Dual Antiplatelet Therapy in Patients Treated with Stent Assisted Coiling in Subarachnoid Hemorrhage

AIM: Stent assisted coiling (SAC) is an alternative in the treatment of ruptured aneurysms. Stenting requires the use of dual antiplatelet agents. Hydrocephalus is a complication of subarachnoid hemorrhage (SAH) and may require ventriculostomy. Antiplatelet treatment carries a risk of hemorrhage in ventriculostomy. The anti-aggregant effect starts at least four hours after the initial doses of treatment. However, in many studies, ventriculostomy was performed before antiplatelet treatment and hemorrhagic complications were related to the procedure. The aim of this study was to determine the risk of ventriculostomy related hemorrhage in patients with impaired thrombocyte function and to contribute to the literature. MATERIAL and METHODS: Between 2011 and 2016, 53 patients treated with SAC due to SAH in our clinic were retrospectively evaluated. Hemorrhagic complication risks due to antiplatelet therapy related to ventriculostomy were also evaluated. RESULTS: All of the ventricular catheter procedures were performed at least 1 day after the dual therapy (in average 4.3 days after SAC). In 5 patients 1 ventriculostomy was performed, in 2 patients 2, and in 1 patient 6 ventriculostomies were performed. Although radiological hemorrhage was present on the catheter tract in 4 patients, no temporary or permanent neurological deficit was observed. CONCLUSION: Impaired thrombocyte functions pose a risk in ventriculostomy. Also, evaluating the risk of hemorrhage before the antiplatelet treatment reaches its full effect may lead to false results. Studies with small patient groups with anti-aggregant therapy and impaired thrombocyte functions also contribute to the literature. Larger studies regarding this subject are needed

Usefulness of End-to-Side Bridging Anastomosis of Sural Nerve to Tibial Nerve : An Experimental Research

Objective : Repair of sensorial nerve defect is an important issue on peripheric nerve surgery. The aim of the present study was to determine the effects of sensory-motor nerve bridging on the denervated dermatomal area, in rats with sensory nerve defects, using a neural cell adhesion molecule (NCAM). Methods : We compared the efficacy of end-to-side (ETS) coaptation of the tibial nerve for sural nerve defect repair, in 32 Sprague-Dawley rats. Rats were assigned to 1 of 4 groups : group A was the sham operated group, group B rats had sural nerves sectioned and buried in neighboring muscles, group C experienced nerve sectioning and end-to-end (ETE) anastomosis, and group D had sural nerves sectioned and ETS anastomosis was performed using atibial nerve bridge. Neurological evaluation included the skin pinch test and histological evaluation was performed by assessing NCAM expression in nerve terminals. Results : Rats in the denervated group yielded negative results for the skin pinch tests, while animals in the surgical intervention groups (group C and D) demonstrated positive results. As predicted, there were no positively stained skin specimens in the denervated group (group B); however, the surgery groups demonstrated significant staining. NCAM expression was also significantly higher in the surgery groups. However, the mean NCAM values were not significantly different between group C and group D. Conclusion : Previous research indicates that ETE nerve repair is the gold standard for peripheral nerve defect repair. However, ETS repair is an effective alternative method in cases of sensorial nerve defect when ETE repair is not possible