Focal megalencephaly: Intraoperative ultrasound imaging in epilepsy surgery

WOS: 000348275900021PubMed ID: 26578502Hemimegalencephaly is a rare neuronal migration disorder that can be defined as abnormal neural and glial proliferation localized to all or part of a cerebral hemisphere. Most patients demonstrate intractable epilepsy, with early onset before 1 year of age. Surgical resection is one of the treatment options. In recent years, many advanced intraoperative techniques have been used for brain surgery for various pathologies. Intraoperative ultrasonography is a time-saving and noninvasive method for intraoperative imaging. In this report, we present the use of intraoperative ultrasonography in a patient with focal megalencephaly as an anatomical navigation with the functional navigation system, electrocorticography. In this report, we present the use of intraoperative ultrasonography in a patient with focal megalencephaly as an anatomical navigation with the functional navigation system, electrocorticography

Relationship of intraoperative ultrasound characteristics with pathological grades and Ki-67 proliferation index in intracranial gliomas

WOS: 000352689100012PubMed ID: 26576577The purpose of the present study was to investigate the relationship between the intraoperative ultrasonographic appearances and the histopathological characteristics of glial tumors using the pathological grading system and the Ki-67 proliferation index. Patients with glial tumors who underwent surgery with the aid of intraoperative ultrasonography (IOUS) between September 2013 and August 2014 were included in the study. The lesions' IOUS characteristics were analyzed and compared with the results of surgical histopathological characteristics. Lesions were classified as low-grade gliomas (grade I-II, LGG) and high-grade gliomas (grade III-IV, HGG). The glioblastoma multiforme (grade IV, GBM) group was classified according to the Ki-67 values for further evaluation. The Chi square test (Fisher's exact test) was used for comparing the ultrasonographic characteristics of the low-grade and high-grade gliomas; HGG with different Ki-proliferation indexes. A value of P 0.05) was not significant. In the GBM group, all of the lesions with distinct margins and regular contours had Ki-67 values a parts per thousand currency sign15 %. We compared the intraoperative ultrasonographic characteristics of the Ki-67 > 15 % group with those of the Ki-67 a parts per thousand currency sign 15 % group for statistical significance. The difference between the echogenicity of the solid parts, margins, and contours was statistically significant between the groups (P 0.05). IOUS is a very useful imaging technique not only in defining the borders but also in characterizing the tumoral tissue. The IOUS characteristics of the glial tumors were a valuable tool in differentiating the grades of the glial tumors and might have a relationship with the Ki-67 proliferation index. We think this theory requires further investigation in more detailed comparative studies with larger numbers of patients

A simple technique for bone storage after decompressive craniectomy in children

WOS: 000357861100008PubMed ID: 25998533Cranial vault reconstruction in the pediatric population is a specialized procedure, which requires additional considerations. Generally, inherent difficulties of bone storage and cranioplasty are neglected in the literature. We present a simple method of bone storage and autologous cranioplasty in a small child with severe head injury. The child underwent surgical treatment with decompressive craniectomy. A bone flap was transversally divided into two pieces and stored under the galea. Bone storage and reconstruction of the cranial vault with our surgical technique is a safe, easy and cost-effective choice excluding the surgical trauma to obtain a new subcutanous pocket for bone storage in pediatric decompressive craniectomy patients

Intraoperative Neurophysiological Monitoring to Prevent New Neurological Deficits in Spinal Tumor Cases

OBJECTIVE: Intraoperative neurophysiological monitoring was carried out in patients with spinal cord tumors. These patients were retrospectively evaluated for postoperative new neurological deficits. METHODS: A total of 32 spinal tumor cases (8 servical, 14 thoracal, 10 lumbosacral); 17 male,15 female patients; between 2-66 years of age (mean 44,1± 20) operated in our center were evaluated. All of our cases were monitored with somatosensory evoked potentials (SEP) muscular motor evoked potentials (MEP) and free run electromiyography. Spinal MEP (D wave), bulbocavernousus reflex (BCR) and pudental SEP were obtained in appropiate cases. RESULTS: Five cases represented with temporary new neurological deficits postoperatively. All of these patients’ neurophysiological recording showed some temporary or permanent deterioration during surgery. None of our cases had a new permanent deficit, whereas the tumor was removed totally or almost totally in 26, subtotally in 4 and partially in 2 cases. CONCLUSION: The functional integrity of the lateral and dorsal columns of the spine can be assest by SEP and muscular MEP recording. Additonal information about the neurological tissue is given by spinal MEP, BCR and pudental SEP in appropiate cases. We did not experience any false positive and negative results in our cases and we believe that the combined use of intraoperative spinal and MEP in spinal column located tumors gives reliable information about postoperative neurological outcom