[Show abstract][Hide abstract] ABSTRACT: Head trauma is associated with an acute phase response which is characterized by leucocytosis due to increased levels of catecholamine and cortisol. Early edema formation following severe head injury may also be associated with microglia activation. Therefore, increased white blood cell (WBC) count after head trauma may be a predictive parameter of the severity of craniocerebral trauma.
We retrospectively studied 59 patients with severe, moderate and minor injury between February 2007 and March 2009. WBC counts of all patients were obtained within the first day of their admission. All patients were divided into separate groups according to their Glasgow Coma Scale (GCS) scores and hospital stay durations. Their CT progressions and Glasgow Outcome Scale (GOS) scores were also assessed. The relationship between these parameters and WBC counts were evaluated by statistical methods.
There was a favorable correlation between WBC counts of the patients and GCS scores (pI0.01), hospital stay (p=0.006), CT progression (p < 0.01) and GOS scores (p < 0.01).
AWBC count exceeding 17.5 x 106/l has a predictive value for poor GCS score, and long hospital stay. CT progression tends to be seen in patients with moderate and severe head injury.
[Show abstract][Hide abstract] ABSTRACT: The Executive Committee of the Neurosurgical Society that functioned during 1988-1990 period under the leadership of Dr's Tunçalp Ozgen and Yücel Kanpolat realized many major accomplishments. Each of these senior neurosurgeons served as presidents of the Society for one year. Dr. Nur Altinörs was the General Secretary while Dr. Kemali Baykaner served as the associate secretary and Dr. Nuri Arda served as the treasurer thus composing the Executive Committee. The most important project was to receive the right to add "Turkish" to the title of the society. This required a long and tiresome formal process and final approval by the Turkish Government; the society gained the privilege of being the only organization to bear this title as far as neurosurgical societies in the country were concerned. This development enabled the society to be the legal representative of the Turkish Neurosurgical Community and maintain regular scientific and administrative relations with international neurosurgical organizations and societies.
[Show abstract][Hide abstract] ABSTRACT: The authors present a patient who underwent surgery for an ependymoma filling the fourth ventricle and the Sylvian aqueduct and thus extending to the posterior third ventricle. The tumor was totally removed and postoperatively a partial bilateral third nerve palsy developed. Only levator palpebrae and rectus superior were involved. Those subnuclei are located most medially close to the Sylvian aqueduct and such a clinical presentation is of anatomical interest.
[Show abstract][Hide abstract] ABSTRACT: Osteoid osteoma is a benign skeletal neoplasm composed of osteoid and woven bone. The majority of the lesions arise in the cortex of long bones. Osteoid osteoma of the spine is a rare primary spine tumor and those located at the thoracal spine are even rarer. The usual treatment involves complete resection, including the nidus, or alternatively radiofrequency percutaneous ablation is performed. The authors present a 32-year-old female with an unusual localization of the osteoid osteoma in the thoracal spine where imaging modalities were not conclusive for the diagnosis. The T1 vertebra lesion was successfully resected via a posterior approach with T1 laminectomy, including right side C7 and T1 foraminotomies, and vertebroplasty were performed. Histopathology reported the lesion as an osteoid osteoma.
[Show abstract][Hide abstract] ABSTRACT: Meningiomas arise from the meningoendothelial cells and are one of the most common tumors of the central nervous system. The HER-2/neu gene is located on the 17q11.2-q12 chromosome region and encodes an epidermal growth factor receptor. HER- 2/neu gene amplification and/or over expression have been studied most widely in breast carcinomas. Previous studies have shown the importance of HER-2/neu gene amplification on the prognosis of meningioma cases. In this study, we aimed to detect HER-2/neu gene copy number in archive materials of 55 meningioma patients by fluorescent in situ hybridization (FISH).
The patients included in the study had undergone surgery in the neurosurgery department of our hospital between 1999 and 2002. Tissue samples were classified histologically according to WHO 2007 guidelines. Interphase FISH was performed on 3 to 4microm thick paraffin embedded tissue sections for the detection of HER- 2/neu gene amplification status.
We found HER-2/neu gene amplification in 7 (12.73%) patients. Another 2 patients had only one signal for the HER-2/neu region. We confirmed this finding by a second hybridization with the chromosome 17p13.1 (p53) probe.
According to our results, HER-2/neu amplification could be regarded as an additional genetic factor playing role in meningioma pathogenesis together with known chromosomal abnormalities.
[Show abstract][Hide abstract] ABSTRACT: Vitamin K deficiency bleeding (VKDB) represents a clinical picture characterized by bleedings due to insufficient levels of vitamin-K-dependent hemostatic factors. VKDB can be classified into three groups as early, classic, and late according to time of occurrence. Late-type VKDB has particular importance due to frequent intracranial hemorrhages that lead to high mortality and morbidity. In our study, we aimed to emphasize the importance of vitamin K prophylaxis in prevention of late-type VKDB.
Data of 12 infants treated for intracranial hemorrhage due to late-type VKDB in Baskent University Hospitals between June 1998 and June 2005 have been analyzed.
The ages of patients ranged between 25 and 90 days. Five were born in the hospital and seven were born at home. None of the infants born at home received vitamin K prophylaxis. Hemorrhages were classified as intraparenchymal in 58.33%, subarachnoid in 50.00%, subdural in 50.00%, intraventricular in 41.66%, and epidural in 8.33% according to cranial computerized tomography findings. Surgery was performed in seven cases (58.33%). A total of six patients died (50.00%). Three of the deaths were from the surgery-performed group.
All newborns should receive vitamin K prophylaxis to prevent bleeding due to vitamin K deficiency. Symptoms of any predisposing disease and warning bleeds must be noticed early and additional doses of vitamin K should be administered, if required.
Child s Nervous System 08/2008; 24(7):821-5. · 1.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 60-year-old female was admitted to our clinic complaining of a long-lasting headache. Cranial magnetic resonance imagining examination of the patient revealed a 22x24 mm extra-axial, well-demarcated, mass lesion based on the left tentorium. The patient underwent a craniotomy and the tumor was totally excised with the adjacent tentorium. The histopathological examination of the tumor complied with the diagnosis of schwannoma. The rest of the clinical course was uneventful and the patient was released from the hospital without any neurological deficit. Intracranial schwannomas can rarely originate from atypical dural locations and radiological techniques are not always helpful in distinguishing tentorial schwannoma from tentorial meningioma. We presented a patient with a tentorium schwannoma mimicking meningioma and discussed the current literature.
[Show abstract][Hide abstract] ABSTRACT: Patients undergoing nasal septoplasty can face many complications. Some of these complications are rare but their results are life threatening. Being aware of this complication could prevent further problems such as enlargement of the bone and dural defect, herniation of the meninges and brain tissue through the defect by pulsation of the brain and ascending infection. With early diagnosis, a less aggressive method could be used to treat this complication.
A 50-year-old woman was admitted our hospital with the complaint of loss of consciousness. Her Glasgow coma score was 7 on admission. She had no lateralizing signs, but had nuchal rigidity. Blood pressure was 200/110mm Hg, the respiratory pattern was apneic, complete blood count revealed 12000 leucocytes/mm3 and arterial blood gases showed respiratory acidosis and other biochemical parameters were within normal limits. Computerized cranial tomography (CCT) showed diffuse brain edema without evidence of other signs. Lumbar puncture was performed revealing purulent and highly viscous cerebrospinal fluid (CSF).
Late diagnosis and late repair of arachnoidodural tearing could lead to life-threatening complications, and cases with meningitis and larger defects may require more extensive surgery instead of transnasal endoscopic repair.
[Show abstract][Hide abstract] ABSTRACT: Nogo-A is a myelin-associated neurite outgrowth inhibitory protein that limits elongation of central nerve fibers, neuronal regeneration and plasticity. We investigated the effect of delivering an inhibitory peptide that neutralizes Nogo-A on neuronal recovery following mild cortical contusion injury.
41 rats were allocated into the control and NEP1-40 treatment groups. PBS was applied following trauma over the parietal cortex after opening the dura in the control group. NEP1-40 solution was immediately applied following trauma after opening the dura in the treatment group. Each group was further divided into 3 subgroups and sacrificed on the third, eighth, and 21st days after injury. The brains were removed for analysis.
Immunohistochemical staining of the injured cortex for pan-cadherin revealed a significant increase in staining in the NEP 1-40 treatment group at the 8th and 21st days after injury. Electron microscopic evaluation revealed better cytoarchitectural preservation in the axons of the animals treated with NEP 1-40.
We observed improved preservation of injured neurons after topical application of NEP 1-40 following mild cortical injury. Pan-cadherin expression may correlate with the recovery of neurons and axonal bodies. Electron microscopical findings confirmed better preservation of neuronal structures after NEP1-40 treatment. Pan-cadherin is a good marker for neuronal recovery after cortical injury.
[Show abstract][Hide abstract] ABSTRACT: Radiological imaging techniques provide early detection of neurological diseases but they do not always provide an adequate and reliable diagnosis. With the help of stereotactic biopsy techniques, it is possible to access brain lesions safely and with high precision. We described the surgical method used in our clinic and discussed our results with the help of the current literature.
Ninety-four patients underwent computerized tomography-guided stereotactic brain biopsy in our clinic. Anatomical locations, diagnostic yield and accuracy of the procedure, morbidity and mortality rates were analyzed.
A total of 100 stereotactic surgery procedures were performed on 94 patients. The localizations of the lesions were 13.83% frontal, 21.27% temporal, 27.66% parietal, 4.25% occipital, 4.25% multiple, 27.66% deep seated and 1.06% suprasellar. The histopathological diagnoses were 61.71% neuro-epithelial tumors, 8.51% metastases and 10.64% infectious lesions. Diagnostic yield was 86.16% and the accuracy was 90% in our series.
Computerized tomography-guided stereotactic brain biopsy is a reliable and safe method. Main diagnostic problems in SBB are tissue heterogeneity, insufficient material and sampling error. These problems can be minimized by careful correlation of clinical, radiological and histopathological findings by an experienced team and by using modern technologies.
[Show abstract][Hide abstract] ABSTRACT: The most common localization of dysembryoplastic neuroepithelial tumors (DNTs) is the supratentorial cortex, often in the temporal lobe. However, intraventricular localization of a DNT is extremely rare.
A 30-year-old woman presented with a 1-year history of epileptic seizures. The seizures had not been controlled despite standard doses of antiepileptics.
Neuroimaging results demonstrated a lesion located in the occipital horn of the right lateral ventricle. The lesion was totally removed. Based on histopathological and immunohistochemical evaluation, a DNT was diagnosed. Over the course of the next 8 months, the patient's epileptic seizures were under control. The most recent neuroimaging examinations revealed neither residual nor recurrent tumor.
Because DNTs are surgically curable and neither radiotherapy nor chemotherapy is required after surgery, recognition of an intraventricular DNT in this location is extremely important.
[Show abstract][Hide abstract] ABSTRACT: Tarsal tunnel syndrome (TTS) is defined as the entrapment of the posterior tibial nerve in the tarsal tunnel of the ankle. The etiologies of tarsal tunnel syndrome are mainly the presence of a ganglion, osseous prominence with tarsal bone coalition, trauma, varicose veins, neurinoma, hypertrophy of the flexor retinaculum, or systemic disease (rheumatoid arthritis, ankylosing spondylitis). However, no specific cause can be identified in some cases. Patients with chronic renal failure tend to develop peripheral nerve entrapment and carpal tunnel syndrome is the best-known peripheral entrapment neuropathy among them. Contrary to carpal tunnel syndrome, tarsal tunnel syndrome is observed less frequently in chronic renal failure patients. The common presenting symptoms of TTS are paresthesias and/or pain in the plantar side of the foot. Motor symptoms are rarely detected. Diagnosis is made primarily by electroneuromyographic studies and physical examination. Surgery is the treatment of choice and the outcome is generally favourable. In this report, we present a patient with tarsal tunnel syndrome complicating peritoneal dialysis.
[Show abstract][Hide abstract] ABSTRACT: A chloroma or granulocytic sarcoma is an extramedullary leukemia. It can be encountered at any anatomical location, but until now only three cases have been reported in the cerebellopontine angle. We present an 8-year old patient with an extraaxial chloroma of the cerebellopontine angle to highlight this very rare and malignant pathology in the differential diagnosis of cerebellopontine angle tumors. The presented case, being the fourth chloroma in the cerebellopontine angle, occurred in the absence of relapse which is very unusual for these lesions. Chloroma should be remembered as a very rare and a malignant pathology in the differential diagnosis of pediatric cerebellopontine angle tumors.
[Show abstract][Hide abstract] ABSTRACT: Intraoperative monitoring is considered as a useful tool to prevent neurological damage during different neurosurgical procedures. Somatosensory evoked potentials (SEP) allow simultaneous assessment of several cortical and sub cortical centers. In this case presentation, we report intraoperative monitoring of an elderly patient with craniovertebral junction meningioma. Tibial SEP responses were elicited by stimulation of the tibial nerve; the recordings were visually analyzed for the presence of the main peaks P40-N50, peak to peak amplitudes, peak latencies and compared to baseline recordings throughout the procedure. During decompression from the medial aspect of the medulla SEP responses were lost for a brief period of time. Surgeons achieved total tumor removal and the patient left the operating room without any neurological deficit.
[Show abstract][Hide abstract] ABSTRACT: Hemangiomas are tumors of vascular origin comprising approximately 7% of all benign tumors. Intramuscular hemangioma is a rare condition and hemangiomas of the head and neck make up less than 15% of intramuscular hemangiomas. Temporalis muscle is an uncommon location for intramuscular hemangioma and seldom reported in the literature. Radiological methods are generally insufficient for the correct diagnosis and surgery is the treatment of choice to exclude malignancy and for adequate treatment of these lesions. A 37-year-old male was admitted with a slowly growing painless mass in his right temporal fossa. The lesion was surgically excised and histopathology confirmed the diagnosis of cavernous hemangioma. Diagnosis and treatment modalities for temporalis muscle hemangiomas are discussed.
[Show abstract][Hide abstract] ABSTRACT: Venous angiomas were found to be the most common cerebral vascular malformations, composing 63% of such lesions in two autopsy series. Annual bleeding risk associated with venous angiomas is about 0.22 % per year. Venous angiomas are generally silent lesions because of their dynamic features, and are low flow and low pressure vascular structures draining normal brain tissue. An angioma rarely causes symptoms such as bleeding, seizure, hemifacial spasm, trigeminal neuralgia, aqueduct compression, nonhemorrhagic infarction and thrombosis of the draining vein. Even if it should bleed, the lesion can be managed conservatively in asymptomatic or mildly symptomatic patients. In this paper we report two venous angioma cases. The first patient bled twice in a short period of time and the angioma was located at the posterior fossa next to the left lateral recess. The second patient recently suffered a cerebral stroke that was located in the vicinity of the right caudate nucleus and not associated with the venous angioma that was located next to the left caudate nucleus. This patient had been under warfarin sodium treatment for 14 years due to his previous coronary artery bypass surgery, but unknowingly there was a venous angioma located next to the caudate nucleus.
[Show abstract][Hide abstract] ABSTRACT: The hypertension is an uncommon cause in acute spinal epidural haematomas. The severe motor disability and need to emergency treatment to avoid the permanent neurological impairments underline its importance. Seventy-five year old male, admitted with acute paraplegia, numbness in the lower extremities and urinary incontinence for 4 hours. The neurological examination showed complete paraplegia, numbness from the below of thoracal 9 dermatomes, and loss of all sensory motor reflexes including anal reflexes. The blood pressure was 210/120 mm Hg on his admission. Thoracolomber magnetic resonance examinations detected an acute epidural haematoma, which was compressing to the cord. The patient underwent emergent laminectomy involving T 9 to L 2 and clots were removed with microsurgical technique. The patient was mobilized on the 3. and discharged from the hospital on the 7. postoperative day without neurological impairment. Although majority of the spontaneous spinal epidural haematomas is a recognized idiopathic condition, hypertension is much more commonly seen etiological factor than estimated. Early diagnosis, surgical decompression of the spinal cord and high dose corticosteroids might result in complete recovery.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 02/2005; 11(1):73-5. · 0.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Meningiomas are the most frequent benign tumors of the intracranial cavity. The classification and underlying pathogenetic mechanisms have been reported to be investigated by both pathological and genetic methods. In this study, we aimed to detect 1p36 and 22qter deletions by fluorescence in situ hybridization (FISH) in archival materials of 50 intracranial meningioma patients. The clinical material consisted of paraffin-embedded tissue sections from 50 patients who were surgically treated and had histopathologic diagnosis of an intracranial meningioma. We observed 1p36 deletion in 23/50 (46%) and 22qter deletion in 33/50 (66%) patients. In addition, we observed 22qter deletion in 26/36 (72.2%) patients with meningothelial meningioma. This finding implies that 22qter deletion might play an important role in the pathogenesis of meningothelial meningioma. On the other hand, no alterations were documented in the frequency of these chromosomal alterations according to the grade of meningiomas, suggesting that malignant progression of these tumors depends on other, more relevant, genetic changes.
Pathology & Oncology Research 02/2005; 11(4):224-8. · 1.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Meningiomas for the most part are slow-growing benign tumors, but complete removal can be difficult and recurrence is an issue. The aim of this study was to re-evaluate tumors diagnosed as meningioma previously in our hospital, according to the latest World Health Organization classification. We also examined the relationships among parameters such as brain invasion, histological grade and Ki-67 and p53 expression in these tumors.
Meningioma biopsy specimens numbering 60 (48 grade I, 11 grade II, and 1 grade III tumors) were examined immunohistochemically using monoclonal antibodies for Ki-67 (MIB-1) and p53 protein. The MIB-1 labeling index (LI) for each tumor was calculated as a percentage based on the number of stained cells per total cells counted. The level of p53 expression in each sample was semiquantatively evaluated as < 1%, 1 - 10%, 10 - 70%, or > 70%. Any value > 1% was accepted as presence of p53 expression.
Of the 60 meningiomas, 7 (11.7%) exhibited brain invasion. The mean MIB-1 LI values for the grade I and grade II tumors were 1.1% and 2.3%, respectively. The corresponding levels of p53 protein expression in these groups were 54.1% and 72.7%. The MIB-1 LI and the level of p53 expression in the one grade III meningioma were 6.7% and 10 - 70%, respectively. Histological grade was significantly correlated with MIB-1 LI and with p53 expression (p < 0.01 for both). Brain invasion was not correlated with histological grade, MIB-1 LI, or p53 expression.
The results indicate that MIB-1 LI and p53 protein expression are good indicators of histological grade in meningioma and may be particularly valuable for distinguishing borderline atypical meningiomas. The number of cases was limited, but the findings also suggest that brain invasion is a prognostic parameter independent of grade, MIB-1 LI and p53 expression.
[Show abstract][Hide abstract] ABSTRACT: Chordoid meningioma is a rare variant of meningioma that bears a striking histological resemblance to chordoma and has greater likelihood of recurrence. Although most meningiomas occur in the intracranial, orbital and intravertebral cavities, rare meningiomas have been reported in extracranial organs; thus, it is important to be able to distinguish them from other neoplasms that have similar histology but different biological behavior and therapies. A case of chordoid meningioma in a 48-year-old woman who did not have Castleman's syndrome is described in the present report. The patient presented with a mass in her left frontoparietal region, and had been suffering from headaches for many years. Magnetic resonance imaging of the brain demonstrated an expansive lytic lesion in the squamous portion of the left temporal bone. The lesion extended in both directions. Histological examination of the surgical specimen revealed a tumor composed of cords and nests of eosinophilic vacuolated cells embedded in a myxoid matrix. A typical meningiomatous pattern was observed focally, and positive staining of the tumor cells for vimentin and epithelial membrane antigen confirmed the diagnosis of chordoid meningioma.