Footdrop: An Unexpected Complication After Anterior Cervical Discectomy and Fusion Operation

Among the various postoperative complications of anterior cervical discectomy and fusion (ACDF) operation, common peroneal nerve (CPN) palsy is a rare one. In this report we present a 47 years old, female patient who suffered from foot drop postoperatively after an ACDF operation performed in supine position and discuss the medicolegal implications of intraoperative nerve injuries in the light of the foregoing literature. CPN palsy due to intraoperative positioning in neurosurgical practice is very seldomly reported. CPN palsy occurrence should be anticipated and prevented espacially in the presence of the risk factors. There is still a serious need for a more comprehensive understanding of these risk factors. On the other hand intraoperative nerve injuries are becoming a subject of litigation more frequently. The interdisciplinary responsibilities concerning the positioning must be clearly defined and it is essential that the documentation of positioning is carried out as accurately as possible. [Cukurova Med J 2015; 40(1.000): 147-150

Slitlike arachnoid valve because of post-traumatic symptomatic arachnoid cyst

WOS: 000256162100015Arachnoid cysts are intra-arachnoid collections of cerebrospinal fluid. Arachnoid cysts of the posterior fossa are rare lesions that are considered to be mostly congenital in origin. Arachnoid cysts of the posterior cranial fossa may manifest themselves in several different ways. When they are symptomatic, headache, gait disturbance, nausea, vomiting, focal neurologic signs, dizziness, and seizures are most common in the patients with increased intracranial pressure. Increased intracranial pressure is caused by the ball-valve mechanism of the cyst's membrane that communicates with subarachnoid space or arachnoid cells and contains specialized membranes and enzymes, which have secretory activity. A postsurgical arachnoid cyst in the posterior cranial fossa has doubled and slitlike arachnoid membrane that supports our knowledge about the underlining mechanism is reported

The Role of Cine Flow Magnetic Resonance Imaging in Patients with Chiari 0 Malformation

AIM: To define the role of phase-contrast cine magnetic resonance imaging (MRI) in deciding the therapeutic strategy and underlying pathophysiology resulting in syrinx formation in patients with Chiari type 0 malformation. MATERIAL and METHODS: Seven patients who were admitted to our clinic with the diagnosis of Chiari 0 malformation from January 2005 to July 2016 were enrolled in the study. All patients underwent a detailed preoperative neurological examination. Entire neuroaxis MRI and phase-contrast cine MRI were obtained preoperatively and postoperatively. RESULTS: Seven patients (5 female and 2 male) with Chiari type 0 malformation fulfilled the inclusion criteria. All of the patients had absent cine flow at the craniovertebral junction except two patients. These five patients underwent surgical interventions; suboccipital decompression and duraplasty. All of them showed both clinical and radiological improvement in the postoperative period. CONCLUSION: Cine flow MRI appears to be a useful tool in the management of patients with Chiari 0 malformation. There was a good correlation between the clinical presentation and cine flow preoperatively, and between clinical improvement and cine flow in the postoperative periodAIM: To define the role of phase-contrast cine magnetic resonance imaging (MRI) in deciding the therapeutic strategy and underlying pathophysiology resulting in syrinx formation in patients with Chiari type 0 malformation. MATERIAL and METHODS: Seven patients who were admitted to our clinic with the diagnosis of Chiari 0 malformation from January 2005 to July 2016 were enrolled in the study. All patients underwent a detailed preoperative neurological examination. Entire neuroaxis MRI and phase-contrast cine MRI were obtained preoperatively and postoperatively. RESULTS: Seven patients (5 female and 2 male) with Chiari type 0 malformation fulfilled the inclusion criteria. All of the patients had absent cine flow at the craniovertebral junction except two patients. These five patients underwent surgical interventions; suboccipital decompression and duraplasty. All of them showed both clinical and radiological improvement in the postoperative period. CONCLUSION: Cine flow MRI appears to be a useful tool in the management of patients with Chiari 0 malformation. There was a good correlation between the clinical presentation and cine flow preoperatively, and between clinical improvement and cine flow in the postoperative perio

Split Cord Malformations

WOS: 000360663100001Split cord malformations are rare form of occult spinal dysraphism in children. Split cord malformations are characterized by septum that cleaves the spinal canal in sagittal plane within the single or duplicated thecal sac. Although their precise incidence is unknown, split cord malformations are exceedingly rare and represent %3.8-5 of all congenital spinal anomalies. Characteristic neurological, urological, orthopedic clinical manifestations are variable and asymptomatic course is possible. Earlier diagnosis and surgical intervention for split cord malformations is associated with better long-term fuctional outcome. For this reason, diagnostic imaging is indicated for children with associated cutaneous and orthopedic signs. Additional congenital anomalies usually to accompany the split cord malformations. Earlier diagnosis, meticuolus surgical therapy and interdisciplinary careful evaluation and follow-up should be made for good prognosis

Dural Metastasis From Breast Carcinoma Mimicking Subdural Hematoma: Case Report

WOS: 000347122100022While intracerebral metastases are common, insulated dural metastases are seen very rarely. The clinical and radiological features of this uncommon condition are often unsuspected and could mimic various benign conditions such as meningioma and subdural hematoma (SDH) as reported in the literature. In this report, we presented a case of 62-year-old female patient with dural metastasis from breast carcinoma mimicking subdural hematoma. We describe the presentation, evaluation and differential diagnosis of this rare case. Our experience in this case has led us to consider metastasis as a differential diagnosis even when a subdural hematoma with uncommon radiological image is diagnosed. Contrast enhanced scan techniques should be recommended for patients in whom dural metastasis is suspected

The Effect of Deferoxamine on Superoxide Dismutase and Histopathological Changes Following Experimental Spinal Cord Injury

WOS: 000361529400009Aim: Primary traumatic spinal cord injury is defined as the injury occurring at the time of the trauma. The metabolic and biochemical processes lead to the secondary trauma in the following hours after the primary trauma. Free radicals and ischemic reperfusion injury are two factors which play role in secondary injury. An iron chelating agent deferoxamine has treatment effect on secondary injury mechanisms by binding free iron ion. This study is based on these effects of deferoxamine. Material and Methods: The experimental spinal cord injury model was applied on 26 rats. In control group I, 10 rats were sacrificed to provide normal spinal cord histopathology and biochemical baseline values. In group II, 6 rats underwent six segment laminectomy and spinal cord injury was produced by extradural compression of the exposed cord by aneurysm clip. Same procedures were performed in 10 rats in group III, but they also received 100mg/kg/day intraperitoneal injection of deferoxamine. Group II and III were sacrificed at 48 hours after the trauma. The effect of deferoxamine on superoxide dismutase and histopathological findings were studied. Results: Superoxide dismutase values of the treatment group were found to decrease significantly when compared to the trauma group. The histopathological evaluation revealed the preservation of spinal cord structure in the treatment group. Conclusion: Results showed that deferoxamine, might reduce secondary injury in damaged rat spinal cord tissue, by a possible mechanism of decreasing the production of free radicals

Ultrastructural and biochemical effects of trauma on normal and dehydrated brain - A research study and review

WOS: 000240335400008Background: In hypertonic dehydration, fluid loss is known to be from the intracellular compartment. Also fluid loss in vascular bed increases the osmotic pressure and results with decrease of fluid flow to these compartments. We applied hypertonic dehydration by fluid restriction to evaluate the effects of dehydration on posttraumatic brain edema and swelling. Methods: Four groups, each including 10 pigs composed the study group. Group 1: we performed craniectomy and followed up for I hour for intracranial pressure (ICP) measurement. Group 2: we performed craniectomy and hypertonic dehydration by fluid restriction for 3 days and followed up for I hour for ICP, measurement. Group. 3: we performed brain trauma with Madsen trauma model. Group 4: we performed brain trauma after dehydration. Findings: ICP was found to be 10 mm Hg at the first, 6.5 mm Hg at the second group but increased gradually after trauma in group 3. At the fourth group ICP was high at the first 30 minutes. After the experiment brain fluid level was 80.9% at the first, 77.9% at the second, 83.5% at the third, and 82.8% at the fourth groups. Ultrastructural examination revealed normal brain tissue at the first, light degeneration at the second, advanced degeneration at the third group. The fourth group was also highly degenerated but was found to be better than the third group. Brain superoxide dismutase and malondialdehyde levels were found to be increased. Interpretation: Even though hypertonic dehydration causes minimal cellular degeneration it increases the resistance of brain to trauma and high ICP especially at the first 30 minutes

Deferoksaminin Deneysel Omurilik Yaralanmasını Takiben Süperoksit Dismutaz ve Histopatolojik Değişiklikler Üzerine Etkisi

Amaç: Birincil omurilik hasarı travma esnasında ortaya çıkan yaralanma olarak tanımlanmaktadır. Birincil travmayı takip eden saatlerde ortaya çıkan metabolik ve biyokimyasal süreçler ikincil hasarlanmaya sebep olurlar. Serbest radikaller ve iskemik reperfüzyon hasarı ikincil hasarlanmada rol oynayan faktörlerdir. Deferoksamin serbest demir iyonlarını bağlayarak sekonder hasarlanma mekanizmaları üzerinde tedavi edici etkisi bulunan demir bağlayıcı bir ajandır. Bu çalışma deferoksaminin bu etkilerini incelemektedir. Yöntem ve Gereçler: 26 sıçan üzerinde deneysel omurilik yaralanması modeli uygulandı. Kontrol grubu I' de, normal omurilik histopatolojisi ve biyokimyasal bazal değerlerini elde etmek için 10 sıçan sakrifiye edildi. Grup II' de, 6 sıçana 6 mesafe laminektomi uygulandı ve anevrizma klipleri ile ekstradural kompresyon uygulanarak omurilik yaralanması oluşturuldu. Grup III' de ise, 10 sıçana aynı işlem uygulandı, aynı zamanda 100 mg/kg/gün dozunda periton içi enjeksiyonla deferoksamin de verildi. Grup II ve III travmadan 48 saat sonra sakrifiye edildi. Deferoksaminin süperoksit dismutaz üzerine etkileri ve histopatolojik bulguları çalışıldı. Bulgular: Travma grubu ile karşılaştırıldığında tedavi grubunun süperoksit dismutaz değerlerinde anlamlı bir şekilde düşüş saptandı. Histopatolojik değerlendirme tedavi grubunda omurilik yapısındaki korunmayı gösterdi. Sonuç: Elde ettiğimiz bulgular deferoksaminin, serbest radikallerin üretimini azalttığı olası mekanizma ile hasarlı sıçan omuriliklerinde ikincil hasarlanmayı azalttığını göstermiştir.Aim: Primary traumatic spinal cord injury is defined as the injury occurring at the time of the trauma. The metabolic and biochemical processes lead to the secondary trauma in the following hours after the primary trauma. Free radicals and ischemic reperfusion injury are two factors which play role in secondary injury. An iron chelating agent deferoxamine has treatment effect on secondary injury mechanisms by binding free iron ion. This study is based on these effects of deferoxamine. Material and Methods: The experimental spinal cord injury model was applied on 26 rats. In control group I, 10 rats were sacrificed to provide normal spinal cord histopathology and biochemical baseline values. In group II, 6 rats underwent six segment laminectomy and spinal cord injury was produced by extradural compression of the exposed cord by aneurysm clip. Same procedures were performed in 10 rats in group III, but they also received 100mg/kg/day intraperitoneal injection of deferoxamine. Group II and III were sacrificed at 48 hours after the trauma. The effect of deferoxamine on superoxide dismutase and histopathological findings were studied. Results: Superoxide dismutase values of the treatment group were found to decrease significantly when compared to the trauma group. The histopathological evaluation revealed the preservation of spinal cord structure in the treatment group. Conclusion: Results showed that deferoxamine, might reduce secondary injury in damaged rat spinal cord tissue, by a possible mechanism of decreasing the production of free radicals

Diffuse Idiopathic Skeletal Hyperostosis: Neurosurgical Cause of Dysphagia

Diffuse idiopathic skeletal hyperostosis (DISH) is a chronic entesopathy which causes excessive formation of osteophytes along the ventral spine in the absence of degenerative, traumatic and inflammatory pathologies of spinal ligaments or paravertebral muscles. Dysphagia is the most common symptom of this disease which may need surgical management. In this article, we report three cases with diffuse idiopathic skeletal hyperostosis treated in our department. The clinical and diagnostic imaging characteristics along with treatments performed and outcomes of these three patients were described. Diffuse idiopathic skeletal hyperostosis is an idiopathic rheumatological disorder which may need surgical treatments in severe forms of the disease. [Cukurova Med J 2015; 40(Suppl 1): 51-57

Treatment of chronic subdural hematoma: 5-year clinical experience

WOS: 000439240200002Introduction: Chronic subdural hematoma is one of the most common types of intracranial hemorrhage, especially in the elderly. Multiple standart surgical techniques exist for the evacuation of chronic subdural hematoma. We compared the results of treatment with burr-hole craniostomy and craniotomy techniques. Materials and Methods: A retrospective study was performed on 93 patients who underwent surgical treatment with chronic subdural hematoma. Two surgical procedures were performed; burr-hole craniostomy with membranectomy (Group A) and craniotomy with extensive membranectomy (Group B). Results: The general outcome of the patients was good. Overall, the rate of reoperation was 11%. Individual reoperation rates of the groups were 14% and 5%, respectively. Coagulopathy was the most common cause of rebleeding in the reoperated patients' group (80%) and the remaining patients had cerebral atrophy which was preventing re-expansion of the brain. In 76 patients, neurologic status improved significantly in the postoperative period and the operative mortality rate was found 4%. Conclusion: Both surgical techniques seem to be effective for the treatment of chronic subdural hemtaoma. Coagulopathy and brain atrophy are defined as two major risk factors for recurrence