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

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

Microsurgical Clipping of Anterior Circle of Willis Aneurysms: A Retrospective Study

Objective: The surgical outcomes of anterior circle of Willis aneurysms were evaluated.Material and Methods: Between March 2015 and December 2016, 38 patients were operated and followed up for aneurysms. There were 15 female and 23 male patients with a mean age of 47 years (range: 17-78). Of the patients, 35 were diagnosed with subarachnoid hemorrhage (SAH). Of these patients, 54.2% (n=19) were operated within the first 24 hours. All patients were operated by the same surgeon with sylvian dissection. All clinical data in the hospital charts and outpatient records and radiological investigations stored in the archive were evaluated retrospectively.Results: The most commonly seen aneurysm was on the anterior communicating artery (44.8%). After that, aneurysms on the middle cerebral artery (31.6%), posterior communicating artery (13.2%), internal cerebral artery bifurcation (7.8%), and distal anterior cerebral artery were seen, respectively. There was a significant correlation between the location of the aneurysm and the mean age (p=0.009). All patients were followed in the intensive care unit after operation. After surgery, vasospasm was observed in 26.3% of patients. Patients with high SAH grade developed vasospasm significantly more frequently (p=0.03). Neurological examinations at discharge were normal in 17 patients with SAH and 3 patients without SAH. Four patients were discharged with minimal neurological deficit and 2 patients with severe deficit. Eight patients with World Federation of Neurosurgical Societies (WFNS) grade 4-5, 2 patients with grade 3, and 2 patients with grade 1-2 were lost. Postoperative Glasgow Coma Scale and SAH WFNS grades were found to be determinants for dying.Conclusion: Despite the development of endovascular techniques in the treatment of aneurysm, microsurgical clipping remains the first choice method to treat anterior system aneurysms. Closure of the aneurysm is the treatment priority. It is well known that early surgery reduces mortality and morbidity

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

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

Sudden Onset of Tetraparesis During Taking of Magnetic Resonance Imaging in a Patient with Undiagnosed Cervical Spinal Stenosis: A Case Report

Objective: To report a case with sudden-onset tetraparesis during taking magnetic resonance imaging (MRI).Case report: A 73-year-old man was referred with complaints of paresis of his arms and legs. His tetraparesis had developed suddenly while an MRI was performed 10 days before. He had a severe tetraparesis with 0/5 motor strength in his legs and 2/5 motor strength in his arms. On the MRI, a serious spinal stenosis at C3-4 and C4-5 levels and a faint myleopathic signal of the spinal cord at the level of the C4-5 disc space were seen. After posterior decompression, the patient’s tetraparesis improved gradually and he could walk independently and perform his daily activities with mild spasticity after 13 months.Conclusion: It is known that sudden neurological deficits may be seen in cervical trauma in patients with cervical spinal stenosis due to spondylosis. However, this case who did not have a trauma history showed us that a long period of positioning the neck beyond the patient’s control, even during the execution of MRI, may cause sudden deterioration

Plasma Thrombin-activatable Fibrinolysis Inhibitor Levels Correlate with the Disease Activity of Ulcerative Colitis

Tanoglu, Alpaslan/0000-0002-7477-6640WOS: 000380801100002PubMed: 27432089Objective Patients with ulcerative colitis (UC) are at an increased risk for thromboembolic events, particularly in patients with extensive and active disease. To date, a few studies have been published on the role of thrombin-activatable fibrinolysis inhibitor (TAFI) in UC. However, there are no reports in the literature investigating the effect of UC treatment on plasma TAFI levels. Methods The plasma TAFI antigen levels were quantitatively determined using ELISA kits for 20 UC patients at activation and remission, along with 17 healthy controls. The association between the TAFI levels and inflammatory markers was assessed to determine UC activation. To predict and determine the activation of UC, the Truelove-Witts index and the endoscopic activation index (EAI) were used for each subject. Results The plasma TAFI levels were higher in UC patients at activation of the disease compared with the remission state and in healthy controls. Spearman's correlation analyses revealed that the WBC (r: 0.586, p < 0.001), hsCRP (r: 0.593, p < 0.001) and EAI (r: 0.721, p < 0.001) were significantly correlated with the TAFI levels. The overall accuracy of TAFI in determining UC activation was 82.5% with a sensitivity, specificity, NPV and PPV of 80%, 85%, 81% and 84.2%, respectively (cut-off value: 156.2% and AUC: 0.879). Conclusion The present study demonstrates that the TAFI levels are elevated in the active state of UC. The assessment of TAFI levels in patients with UC in conjunction with other markers of inflammation may provide additional information for estimating UC activation and severity