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J Nervous Sys Surgery 2010; 3(2):43-48
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Airway Management in Patients with Ankylosing Spondylitis Who Will Undergo Spinal Surgery
Melek AKSOY SARI 1, Orhan KALEMCİ 2, Düriye Gül BOZDOĞAN 1, Elvan ÖÇMEN 1, Kasım Zafer YÜKSEL 3, Kemal YÜCESOY 2, Necati GÖKMEN 1
1 Dokuz Eylül Üniversitesi Tıp Fakültesi, Anesteziyoloji Anabilim Dalı, İzmir
2 Dokuz Eylül Üniversitesi Tıp Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalı, İzmir
3 Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalı,
Kahramanmaraş
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Ankylosing Spondylitis (AS), is a chronic inflammatory disease of unknown etiology, characterized by inflammation and abnormal ossification of the spine and sacroiliac joints. In severe cases, because of cervical spine and atlantoksipital joint involvement, ROM is limited Airway management in patients with ankylosing spondylitis is a challenging problem for anesthesiologists. In this case series, unevenful anesthesia practise of seven ankylosing spondylitis patients scheduled for spinal surgery under general anesthesia are discussed.
Key words: Ankylosing Spondylitis, anesthesia, airway management
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J Nervous Sys Surgery 2010; 3(2):49-60
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Diffusion Tensor Imaging (DTI) and Practice in Neurosurgery
Yonca ANIK 1, İhsan ANIK2, Kenan KOÇ 2, Savaş CEYLAN 2, Ali DEMİRCİ 1
1 Kocaeli Üniversitesi Tıp Fakültesi Radyoloji Anabilim Dalı, Kocaeli
2 Kocaeli Üniversitesi Tıp Fakültesi Nöroşirürji Anabilim Dalı, Kocaeli
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Diffusion tensor imaging (DTI) is a magnetic resonance technique that provides quantitative data on white matter tracts of brain and in vivo demonstration of these fibers’orientation. Tractograghy is a general term for calculation of white matter structure via DTI data. Besides providing information on basic physiological data on white matter anatomy and variaton, it also gives information on the involvement and destruction of white matter tracts before tumor surgery. In this paper we discussed white matter tracts demontrated by DTI and also practices in neurosurgery.
Key words: Diffusion tensor imaging, tractography, white matter tracts, tumoral ınfilration
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J Nervous Sys Surgery 2010; 3(2):61-65
Comparison of Endoscopic and Microsurgical Techniques for Transsphenoidal Pituitary Surgery
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Ulaş CIKLA 1, Ali Özcan BİNATLI 2, Füsun DEMİRÇİVİ ÖZER 2, Engin ÇİFTÇİ 3
1 Gümüşhane Devlet Hastanesi, Gümüşhane
2 İzmir Tepecik Eğitim Hastanesi, İzmir
3 Denizli Devlet Hastanesi, Denizli
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Aim: In this retrospective analysis we aimed to determine the effectiveness of endoscopic, and microsurgical resection techniques, and their comparative impact on surgical outcomes in patients with pituitary adenomas operated via transphenoidal approach.
Material and Methods: Medical records of 54 patients with pituitary adenomas (patients with endocrinally inactive adenomas, n=18; growth hormone adenomas, n=18 or 18 prolactinomas, n=18), managed by microscopic endonasal transphenoidal technique (n=31) , endonasal transphenoidal technique (n=23) in The Ministry of Health, İzmir Tepecik Training, and Research Hospital were analyzed.
Results: Postoperative mean hospitalization periods were 4.4 days for endoscopic, and 6.8 days for microsurgical surgery. In a total of 23 endoscopic interventions rhinorrhea (n=2; 8.6 %), and transient diabetes insipidus (n= 1; 4.3 %) were seen. Only partial resection could be performed on 3 (12.9 %) patients, and 2 of them (8.6 %) relapsed within an average of 14 months. After microsurgical operations rhinorrhea (n=3; 9.6 %), transient (n=7; 22.6 %), and permanent diabetes insipidus (n=1; 3.2 %), minor nosebleed (n=1; 3.2 %), hyposmia (n=1; 3.2 %), and total optimalic, and oculomotor nerve involvement (n=1; 3.2 %) were detected.
Conclusion: Endonasal transaminasenssphenoidal surgery performed either by endoscopic or microsurgical approaches is a safe, and effective therapeutical modality in pituitary adenomas.Endoscopic pituitary surgery has provided highly satisfactory outcomes.
Key words: Transsphenoidal, endoscopy, microsurgery, pituitary, adenoma
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J Nervous Sys Surgery 2010; 3(2):66-71
Neuroprotective Effect of ACE Inhibitors Following Cerebral Ischemia in Rats: Histopathological Evaluation
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Süleyman COŞKUN 1, Gökşin ŞENGÜL 1, Murteza ÇAKIR 1, Ahmet HACIMÜFTÜOĞLU 2, Fatih SARUHAN 2, Mustafa Kemal ÇOBAN 1, Muhammet ÇALIK 3
1 Ataturk University Medical Faculty, Departments of Neurosurgery, Erzurum
2 Ataturk University Medical Faculty, Departments of Pharmacology, Erzurum
3 Ataturk University Medical Faculty, Departments of Pathology, Erzurum
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Objective: Angiotensin converting enzyme (ACE) inhibitors are frequently used in the treatment of essential hypertension causing disorders especially in the cerebral circulation. In this study, neuroprotective effect, and mechanism of action of ACE inhibitors in focal cerebral ischemia created in rats via unilateral common carotid artery ligation were examined and their effects on behavior patterns were tested.
Methods: Thirty rats were used in this study. The rats were separated into 5 groups randomly. Following left common carotid artery ligation, Group 1 was given captopril, Group 2 ramipril, and Group 3 perindopril. Group 4 received normal saline for 7 days, and Group 5 was used as a control group. The rats were sacrificed after carrying out behavioral tests for 7 days. Their exenterated brains were histopathologically examined.
Results: Neuronal damage was lower in ACE inhibitor groupa in comparison to the normal saline group The lowest neuronal damage was observed in the perindopril group. The results of behavioral tests indicated that ACE inhibitors did not have any effect on behavior patterns in cerebral ischemia.
Conclusions: Our data indicate that perindopril, ramipril and captopril have beneficial effects in brain ischemia and should be tried as therapeutic agents in the management of this condition.
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J Nervous Sys Surgery 2010; 3(2):72-74
A Giant PICA Aneurysm: Case Report |
Çağatay ÇALIKOĞLU, Ömer AYKANAT
Düzce Üniversitesi Tıp Fakültesi Beyin ve Sinir Cerrahisi Anabilim Dalı, Düzce
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We present a rare case of giant aneurysm of the proximal posterior inferior cerebellar artery (PICA). A 22- year old man referred with a diagnosis of ventricular hemorrhage was hospitalized. Digital substraction angiography (DSA) revealed a 4 cm- aneurysm of the left proximal posterior inferior cerebellar artery. Because of possible re-bleeding of the giant aneurysm, neurological health state of the patient worsened suddenly, and the patient died.
Key words: Giant aneurysm, posterior inferior cerebellar artery, digital substraction angiography
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J Nervous Sys Surgery 2010; 3(2):75-77
Intracranial Aneurysm Mimicking Cerebral Cavernous Malformation
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Fatih BAYRAKLI 1, Aydın SAV 2, Selçuk PEKER 3
1 Cumhuriyet University Medical Faculty Department of Neurosurgery, Sivas
2 Acıbadem University Medical Faculty Department of Pathology, İstanbul
3 Acıbadem University Medical Faculty Department of Neurosurgery, İstanbul
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Vascular pathologies of the brain have different clinical, and neuroradiological manifestations which enable the establishment of definitive diagnosis preoperatively. We report a case of intracranial aneurysm presenting with epileptiform manifestations, and unusual magnetic resonance imaging (MRI) findings which preoperatively diagnosed as cerebral cavernous malformation. We have highlighted the possible mechanism of the unusual MRI appearance and differential diagnosis of the lesion.
Key words: Intracranial aneurysm, cerebral cavernous malformation, cerebral vascular malformations, intracranial hemorrhage, chronic hematoma, hemosiderin rim
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J Nervous Sys Surgery 2010; 3(2):78-80
A Case of Subdural Hematoma Emerging After Spinal Anaesthesia |
Süleyman COŞKUN 1, Serkan ZENGİN 1, Ayşenur COŞKUN 2, Gökşin ŞENGÜL 1
1 Atatürk University Medical Faculty Department of Neurosurgery, Erzurum
2 Atatürk University Medical Faculty Department of Anaesthesiology, Erzurum
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Subdural bleeding occurs as a consequence of a rupture in dural sinuses or superficial cortical veins. It is generally related to trauma while it may also occur in association with coagulopathy, arachnoid cyst, vascular malformation, meningioma, metastatic cancer, dural sarcoma, lumbar puncture, iatrogenic dehydration, shunt Implanted for hydrocephaly and spinal anaesthesia. Subdural bleeding is a rare but serious complication of dural puncture. In the present article, a case of a subdural hematoma following spinal anaesthesia is presented. Subdural bleeding should be considered in case of a headache occurring after a spinal anaesthesia.
Key words: Lumbar puncture, spinal anaesthesia, subdural hematoma |
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J Nervous Sys Surgery 2010; 3(2):81-83
Recurrent Fibromatosis After Thoracolumbar Stabilization: Case Report |
Ayçiçek Dilber ÇEÇEN, Yasin KİBAR, Hikmet SÜSLÜ, Necati TATARLI, Tufan HİÇDÖNMEZ
Dr. Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi 2. Nöroşirürji Kliniği, İstanbul
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Fibromatosis which might be seen after trauma and irradiation defines mesenchymal tumors which are thought to have genetic, endocrinological and familial etiological factors. They manifest biological behaviour patterns varying from benign fibrous lesions to fibrosarcoma. We report a case of a 28-year-old man with a history of motorcycle accident presenting with a T10 compression fracture who underwent posterior transpedicular stabilization and fusion with bone allograft. After 22 months, he presented with a solid paravertebral mass at the incision site. This case is the first to be found at the incison scar extending to the superior pedicular screw insertion point after thoracal fracture stabilization.
Key words: Fibromatosis, bulging at the operation site, soft-tissue tumor, spinal stabilization, NF I
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J Nervous Sys Surgery 2010; 3(2):84-88
Radiological Findings and Differential Diagnosis of a Patient with Os Odontoideum: Case Report |
Kemal YÜCESOY 1, Mürvet YÜKSEL 2, Orhan KALEMCİ 1, Kasım Zafer YÜKSEL 3
1 Dokuz Eylül Üniversitesi Tıp Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalı, İzmir
2 Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı,
Kahramanmaraş
3 Kahramanmaras Sütçü İmam Üniversitesi Tıp Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalı,
Kahramanmaraş
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Os odontoideum is a distinct oval and/or circular bone fragment which is segregated from the hypoplastic odontoid process. This is the most frequently detected anomaly of the odontoid process that may cause atlanto-axial instability and myelopathy. This anomaly can mimic Type I and II odontoid fractures. Accurate diagnosis is mandatory to prevent treatment failures. In this study, we present a 22 year- old female patient with severe neck pain. Diagnosis of os odontoideum was established, and the diagnosis of acute odontoid fracture was discarded in this 22 year-old female patient with radiologic findings such as characteristic cortex with smooth contours, no history of recent trauma, sclerosis and hypertrophy of the anterior tubercle of the atlas. Radiological methods used in the diagnosis and differential diagnosis of this case were discussed in detail.
Key words: Os odontoideum, differential diagnosis, radiology, dynamic CT
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