- [Show abstract] [Hide abstract] ABSTRACT: Patients usually suffer significant pain after lumbar laminectomy. Wound infiltration with local anesthetics is a useful method for postoperative pain control. Our aim was to compare the efficacies of preemptive wound infiltration with bupivacaine and levobupivacaine. MATERIAL and 60 patients were randomized three groups as follows: Group L wound infiltration with 20 mL 0.25% levobupivacaine and 40 mg methylprednisolone just before wound closure; Group B wound infiltration with 20 mL 0.25% bupivacaine and 40 mg methylprednisolone before closure; Group C had this region infiltrated with 20 ml physiological saline. Demographic data, vital signs, postoperative pain scores and morphine usage were recorded. First analgesic requirement time was significantly shorter in the control group compared to other two groups (p < 0.001). Group B had the lowest cumulative morphine consumption at the end of 24 hours within 0-4, 4-12 and 12-24 hours time intervals and the values were not significant when compared with Group L, however the consumption of both groups was significantly lower compared to the control group (p < 0.001). Our data suggest that preoperative infiltration of the wound site with bupivacaine or levobupivacaine provides similarly effective pain control with reduced opiate dose after unilateral lumbar laminectomy.
- [Show abstract] [Hide abstract] ABSTRACT: Background: The artery of Percheron (AOP) is a single thalamoperforating arterial trunk that provides bilateral supply to the paramedian thalami and the rostral midbrain. As this rare anatomical variant artery may be involved in endovascular procedures or encountered surgically during basilar terminus aneurysms, the present study was warranted. Method: Thirty-four adult (20 male and 14 female) formalin-fixed cadaveric brains underwent dissection of the 68 posterior cerebral arteries. Observations were made of the presence and the variations of the thalamoperforating arteries as well as the presence of the AOP. Findings: Thalamoperforating arteries arose from the superior or posterior surfaces of the P1 segment at a mean of a 1.87 mm (range, 0.39-5.25 mm) distance from the basilar apex and entered the brain through the posterior perforated substance. The average number was 4.25 (range 1-9), and the mean diameter was 0.73 mm (range 0.46-1.16 mm). Thalamoperforating arteries were classified into four different types according to their origin at the P1 segment: type I (bilateral multiple, n = 19), 55.8 %; type II (unilateral multiple, unilateral single, n = 4), 11.7 %; type III (bilateral single, n = 7), 20.5 %; type IV [one side with a single branch, the other side with no branches (the AOP), n = 4], 11.7 %. In three separate specimens with ruptured basilar artery aneurysms, the origin of the thalamoperforating arteries was incorporated not only into the posterior aspect of the aneurysm neck but also into the fundus. Conclusions: In about one tenth of cases the possibility of the presence of a single arterial trunk that supplies the two paramedian thalamic territories should be taken into consideration during treatment planning of basilar terminus aneurysms. Furthermore, our data show that the thalamoperforating arteries may take off from both the aneurysm neck and the fundus.
- [Show abstract] [Hide abstract] ABSTRACT: Introduction: Colloid cysts represent 0.5-1% of all intracranial neoplasms and 55% of the third ventricular lesions. In this study, we emphasized the principles of treatment in pediatric cases with third venricular colloid cysts treated by using anterior interhemispheric transcallosal approach. Materials and Method: The patients aged 16 years and below with colloid cysts, operated between 2001-2009, were evaluated retrospectively. Results: There were 3 males and 1 female patients aged between 12-16 (mean age 13.75) years. The mean duration of symptoms were 2.5 months and mean duration of follow-up 46.75 (15-102) months. All the patients had frontal headache as a main complaint; 2 patients also had nausea and vomiting; and 1 patient also had numbness on the left side of his body. Three patients had bilateral marked papil edema while 1 patient had no neurological deficit. Cyst was hyperintense and hypointense in cranial computed tomography of 2 and 1 patients, respectively. T1-, and T2-weighted cranial magnetic resonance images were iso-, and hyperintense in 2 patients while hypo-, and hyperintense in 1 patient, while hyper-, and isointense in 1 patient respectively. Interhemispheric-transcallosal- transforaminal approach was used in all patients. In 3 patients, total excision was performed while in 1 patient, a small part of capsule attached to thalamostriate vein was left. There were no cyst recurrences at follow-up. Conclusions: Although various approaches had been described to reach the third ventricular colloid cyst; we preferred the transcallosal approach in all of our pediatric patients since the approach does not cause any cortical breach and provides secure tumour resection.
- [Show abstract] [Hide abstract] ABSTRACT: Brain glioblastoma multiforme is a malignant and highly aggressive entity that rarely shows extracranial and extraneural invasion. In the past 70 years, only eight cases of subcutaneous metastases have been reported. A case of glioblastoma multiforme with extensive local cutaneous and subcutaneous involvement of previous surgical sites and a metastatic mass, which had developed in the graft donor area of the tensor fascia lata tendon used for the reconstruction of dura. According to the excisional biopsy results, the developed mass was defined as a gliosarcoma carrying the exact characteristics of the primary tumor. Contaminated surgical tools and instruments can facilitate the distant spread of tumor cells. Therefore, the renewal of the surgical tools and instruments and irrigation of the surgical area after primary tumor resection is emphasized.