Lomber Disk Herniasyonunda Ba��ar�S�Z Bel Cerrahisi; Epidural Fibrozis Ve N�Ks Olgular�N�N Reoperasyondaki Ba��ar� Skorlamas�N�N Retrospektif İNcelenmesi

Aim: In this work, failed back surgery syndrome(FBSS) which observed in Lomber disc herniation(DH) postoperatively is analysed; and especially epidural fibrosis and recurrent cases are retrospectively analysed through calculating the success scores. Method: Our work had been carried out between January/2000 – December/2006. In our clinic, 1268 cases in total were examined that were operated by reason of lomber disc herniation in our clinic. Among the cases that were included to the study, the 70 were evaluated as FBSS and the radiological evidences, surgical and clinical findings were analysed retrospectively. Result: Of all the patients 36 were women (51%), the 34 were male (48.6 %). Their ages changed between 22-74 and the age average was found as 49.9. Of all the reoperated cases; the 45 (64%) were reoperated by reason of recurrent DH, 9 (12.8%) epidural fibrosis and recurrent DH, 8 (11.4% ) paraspinal abse, 3 (4.2%) lomber stenosis, 3 (4.2%) foraminal stenosis, 1 (1.4%) postoperative discitis, 1(1.4%) Cerebro spinal fluid (CSF) fistule. While the success rate of the cases with epidural fibriosis was found as 37.2 % ; 75.9% success rate was recorded for the patients with recurrent DH. Statistical comparison was found as meaningful. (p< 0.05) Conclusion: The most frequent reoperation cause for the patients who were operated by reason of lomber DH is the recurrent herniations which occur at the same level; the same side or the opposite side. The cases with epidural fibriosis must be well-assessed radiologically and clinically and the most effective treatment plan should be aimed and formed.Amaç: Bu çalışmada Lomber DH cerrahisi sonrası görülen BBC, özellikle epidural fibrozis ve nüks olgularının reoperasyondaki başarı skorlamaları yapılarak retrospektif olarak incelenmiştir. Metod: Çalışmamız Ocak 2000- Aralık 2006 tarihleri arasında kliniğimizde lomber disk hernisi nedeniyle opere edilen toplam 1268 olguda yapıldı. Çalışmaya dahil edilen olgular arasında 70 olgu BBC olarak değerlendirilip radyolojik bulguları, ameliyat bulgularıve klinik bulguları retrospektif olarak analiz edildi. Bulgular: Olguların 36’sı kadın (%51.4), 34’ü erkek (%48.6), yaş sınırı 22-74 arasında olup, yaş ortalaması 49.9 bulundu. 45’i (%64) nüks DH, 9’u (%12.8) epidural fibrozis ve nüks DH, 8’i (%11.4) paraspinal abse, 1’i (%1.4) postoperatif diskitis, 3’ü (%4.2) darkanal, 3’ü (%4.2) foraminal stenoz, 1’i (%1.4) de BOS fistülü nedeni ile reopere edildi. Reopere edilen epidural fibrozisli vakalarda başarı oranı % 37.3 bulunurken, nüks DH lerde ise %75.9 olarak bulundu. İstatistiksel karşılaştırılması anlamlı bulundu (p<0.05). Sonuç: Lomber DH operasyonu geçiren hastalarda en sık (%64) reoperasyon sebebi aynı seviyede, aynı taraf veya karşı tarafta oluşan nüks disk hernileridir epidural fibrozis bulunan olgular radyolojik ve klinik olarak çok iyi değerlendirmeli en uygun tedavi planı amaçlanmalıdır

Giant tentorial dural arteriovenous fistula treated by a combination of trans-arterial embolization and surgery

Tentorial dural arteriovenous fistulae are uncommon lesions but can be life-threatening. A 34-year-old male presented with intractable headache, seizures, and visual disturbance. Three-dimensional computed tomography (CT) angiography and digital subtraction angiography demonstrated a right tentorial dural arteriovenous fistula supplied by both internal and external carotid systems and draining into a giant venous ampula. Transarterial embolization of the external carotid feeders with Onyx (TM, ev3, Irvine, CA) was carried out. Postembolization angiography revealed persistence of a portion of the fistula supplied by the temporo-occipital branch of right middle cerebral artery. The patient underwent right temporo-occipital craniotomy, division of the feeders and resection of the entire fistula and coagulation of the leptomeningeal arterialized veins. Complete elimination of the fistula was demonstrated by angiography. Postoperative recovery was uneventful; the patient did not develop any fresh neurologic deficits. We review the relevant literature and discuss the rationale for managing these lesions

Atypical Intracerebral Schwannoma Mimicking Glial Tumor: Case Report

A rare case of a solitary schwannoma arising within parenchyma of the brain is reported. A 37-year old right-handed man presented with a 3-month history of progressive headaches, lethargy and vomiting. The initial diagnosis being considered was primary intracranial tumor, including high-grade astrocytoma, metastasis or lymphoma Histopathological examination revealed schwannoma. Cysts, calcification and mild to moderate peritumoral edema are common in intracerebral schwannomas. However, our case is atypical and has no cystic component, calcification or vascularization. The pathogenesis and neuroradiological findings of intraparenchymal schwannomas are discussed and we review the related literature

Is skull fracture necessary for developing an intradiploic pseudomeningocele as a complication of head injury in adulthood?

We report the case of an adult with a posttraumatic intradiploic pseudomeningocele which caused an expanded osteolytic skull lesion. Local pain and swelling, the only symptoms of the lesion, regressed after surgery. Intradiploic pseudomeningocele must be distinguished from intradiploic leptomeningeal cyst, which is of traumatic origin or arachnoid cyst and epidermoid cyst, which are of congenital origin. We also discuss the development of intradiploic pseudomeningoceleafter head trauma without skull fracture in adulthood and suggest a possible mechanism

Intradural lumbar disc herniation: report of two cases

Intradural lumbar disc herniation (ILDH) is a rare pathology. The pathogenesis of ILDH is not known with certainty. Adhesions between the ventral wall of the dura and the posterior longitudinal ligament (PLL) could act as a preconditioning factor. Diagnosis of ILDH is difficult and seldom suspected preoperatively. Prompt surgery is necessary because the neurologic prognosis appears to be closely linked to preoperative duration of neurologic symptoms. Despite preoperatively significant neurological deficits, the prognosis following surgery is good. We report on two new cases of ILDH of high lumbar locations L1-2 and L2-3 with difficult differential diagnoses, and the possible pathogenic factors are discussed

EFFECTS OF TRH AND HIGH-DOSE CORTICOSTEROID-THERAPY ON EVOKED-POTENTIALS, AND TISSUE NA+, K+ AND WATER-CONTENT IN EXPERIMENTAL SPINAL-INJURY

The therapeutic effects of continuous infusion of thyrotropin-releasing hormone (TRH) and methylprednisolone (MP) in experimental spinal cord injury were studied in Swiss albino rats. Thirty rats received a 53-g clip-compression injury on the cord at T1, then were allocated randomly and blindly to one of three treatment groups (ten animals in each): (1) control; received equal volumes of saline solution; (2) MP; received 30 mg/kg methylprednisolone i.v. 1 h after trauma, followed by infusion of 5.4 mg/kg/per hour i.v. for 3 h. (3) TRH: received 2 mg/kg TRH i.v. 1 h after trauma, followed by infusion of 1 mg/kg/per hour i.v. for 3h. MP and TRH treatments significantly improved somatosensory-evoked potentials (SEPs; P < 0.001). Both treatments significantly reduced water content, decreased Na+ content and increased the K+ content of the cord segment that included the centre of the impact (P < 0.01). Our data provide evidence for the beneficial effects of high-dose corticosteroid and TRH in promoting electrophysiological recovery and preserving spinal cord tissue following experimental injury