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Proliferative angiopathy represents the morphological basis of delayed cerebral vasospasm. The initial vasoconstriction and endothelial damage of the vasospastic arteries leads to an exaggerated response of the smooth muscle cells within the media leading to subintimal thickening and myonecrosis. Heparin reduces the exposure of the media to platelet derived growth factor, a mitogen from aggregating platelets responsible for the migration and proliferation of the myofibroblasts. Since systemic heparin in the setting of a subarachnoid haemorrhage would be unacceptable, we have tested the effect of heparin on proliferative angiopathy by injecting autologous non-heparinized blood into two groups of rats (N=12 each) and then inject the heparin into the spinal fluid of one group after one hour. We were able to show histologically that intracisternal heparin injection after the subarachnoid haemorrhage has reduced the vascular wall changes to a great degree. Heparinization of the cerebrospinal fluid carried out in conjunction with early operation for aneurysms may be a promising approach to prevent the morbid complications of SAH in the clinical setting. [ABSTRACT FROM AUTHOR]

Thirty-three patients fulfilling the clinical criteria for brain death were tested by Brainstem Auditory Evoked Potentials (BAEP) and Radionuclide Cerebral Angiography and Brain Perfusion Studies. There was a significant correlation between the BAEP and radionuclide study outcomes. All patients with absence of BAEP showed no cerebral perfusion. These findings, added to the clinical findings, resulted in a final diagnosis of brain death in all patients. It is concluded that BAEP and Radionuclide Cerebral Perfusion studies are useful adjuncts for proving that brain death has really occurred. [ABSTRACT FROM AUTHOR]

Summary¶ Background. Cerebral vasospasm after subarachnoid hemorrhage (SAH) has remained a major cause of morbidity and mortality in patients with SAH. Excitatory neurotransmitters are gathered in the extracellular space during ischemia due to cerebral vasospasm and initiate or stimulate a series of pathophysiological biochemical processes which consequently lead to neuronal death. Tizanidine (Sandoz compound DS 103–282, 5-chloro-4,2 (2-imidazolin-2-yl-amino)-2,1,3-benzothiazol hydrochloride) is a centrally-acting muscle relaxant and a selective α 2 adrenoreceptor agonist which shows its effect by stimulating presynaptic α 2 adrenoreceptors in central ASPergic and GLUergic system by inhibiting aspartic acid and glutamic acid release. In this study, the effect of Tizanidine on vasospasm was evaluated. Methods. We used a femoral artery vasospasm model in rats which has been described by Okada et al. 60 rats were examined in three groups. The first group was used as control group (Control) (n=20), in the second group subarachnoid hemorrhage was performed (SAH) (n=20), in the third group Tizanidine was administered in addition to SAH (SAH+Tizanidine administration) (n=20). Animals in SAH+Tizanidine administration group received 0,3 mg/kg/day intraperitoneally for 7 days. Seven days after the experiment, after perfusion-fixation, 10 mm segments of both femoral arteries were removed and the femoral artery was prepared for light microscope examination, scanning and transmission electron microscopy and for morphometric analysis. Results. There was a statistically significant difference between the electron, scanning and light microscopic observations and morphometric analysis of SAH+Tizanidine administration group and SAH group, and no statistically significant difference between SAH+Tizanidine administration group and control group. Conclusion. This study has disclosed that Tizanidine administration before the vasospasm reduces ultrastructural and morphometric vasospastic insult significantly. However, the clinical application of Tizanidine as a protective and therapeutic agent in cerebral vasospasm needs further studies including the employment of clinically more relevant SAH models. [ABSTRACT FROM AUTHOR]

Dural arteriovenous fistula, (AVF), a rare entity, presents most commonly in adults. An 11-month-old boy presented with symptoms of congenital toxoplasmosis associated with an extensive dural AVF of the torcular Herophili and bilateral occulusion of the transverse and sigmoid sinuses. His intracranial venous drainage had become rerouted via the cavernous sinuses to the ophthalmic veins. The relationship of toxoplasmosis and sinus thrombosis to the pathogenesis of dural AVF and their clinical and radiological features are discussed. [ABSTRACT FROM AUTHOR]

The early diagnosis of loosening is very important, since it provides a chance to protect the bone structure by means of a good postrevision outcome. Although the delayed stage of infected loosenings can easily be detected by clinical presentations, significant laboratory data and plain X-rays, diagnosis becomes a problem in the early stage. In this study the value of Tc-99m Nanocolloid (NCol) scintigraphy in the diagnosis of infected loosenings was evaluated in 28 patients with painful total hip arthroplasty and 10 controls without any complaint after total hip arthroplasty, by comparing this method with laboratory data, plain X-rays and 3-phase Tc-99m methylene diphosphonate (MDP) scintigraphy. Tc-99m NCol scintigraphy was found out to be a very valuable method with 100% sensitivity, 84% specificity in the diagnosis of infected prosthesis and it was superior to laboratory data, plain X-rays and 3-phase Tc-99m MDP scintigraphy, but requires to be evaluated in conjunction with plain X-rays for more information and in order to prevent false positive results. [ABSTRACT FROM AUTHOR]

Intervertebral disc herniation is an important health problem from both the social and economic aspect. It is often accompanied by a decrease in the content of water and proteoglycan (PG). The present study was undertaken to elucidate the effect of neodymium-yttrium-aluminum-garnet (Nd∶YAG) laser on degenerated disc tissue. In this study a ventral disc herniation model in guinea pigs was performed to study the effects of Nd∶YAG laser on degenerated disc with low water and PG content. Effect of Nd∶YAG laser on degenerated cervical disc tissue is examined from the aspects of biochemistry and radiology. In the acute period water, PG, and collagen content decreased due to the ablative effect of Nd∶YAG laser on disc tissue. When changes in the degenerated disc in the post-laser chronic period were compared with degenerated disc findings, statistically significant changes could not be be found. From the results of this study, there is no question that the Nd∶YAG laser offers many potential benefits, it remains to be proven whether or not this is of real benefit in the treatment of patients with degenerated disc disease. [ABSTRACT FROM AUTHOR]

Recent progress in pineal research emphasized the importance of this circumventricular organ in the phenomenon of ageing as well. The present study was undertaken to elucidate the effects of pineal gland on collagen ageing by spectrofluorometrically measuring collagen-cross-link bound fluorescein. Experiments were performed on three different age groups of rats (3-4 weeks, 8-10 weeks, 15 and more weeks). Fluorescein values were found to increase causally by age in the control group. Eight weeks after sham operation of all the groups fluorescein level increments were shown to be parallel with the values of normal physiological ageing values. In experimental groups; in 3-5 weeks old rats pinealectomy produced a significant premature collagen ageing and this was found to be completely reversed by foetal pineal gland transplantation, but the reversal was limited to a sham operation level. On the other hand although a premature collagen ageing was found to be induced 8 weeks after pinealectomy in 8-10 weeks old rats with a statistical significance both within subject values and between sham operation and pinealectomy, foetal pineal gland transplantation was found not to reverse the premature ageing induced by pinealectomy. In 15 weeks old and older groups of rats, pinealectomy was found to facilitate the intrinsic ageing phenomenon of collagen with statistical significance again both within subject values and between sham operation and pinealectomy. Foetal pineal gland transplantation was not performed in this age group of rats. On interpretation of the data of pinealectomy against sham operation for all the age groups, the maximum degree of percentage increase in collagen-cross-link bound fluorescein was found in 3-5 weeks old rats (%218). The percentage increase in fluorescein values was found to be %170 and %126 in 8-10 weeks old and 15 weeks old and older rat groups, respectively. Consequently, we have experimentally shown the induction of collagen ageing by pinealectomy and the restorative competence of foetal pineal gland transplantation in the present study. The results seem to be impressive and details of the ageing process are the subject of further research. [ABSTRACT FROM AUTHOR]

The effects of pineal gland, an endocrine organ known to affect the physiology of various organs and systems including the hypothalamo-hypophyseal axis, on the morphological characteristics of target organs were investigated in rats after pinealectomy and foetal pineal gland transplantation to a subpial cortical area close to the pinealectomized region. It was demonstrated that weight gain was significantly slower in pinealectomized male rats (p<0.01); pituitary gland weight was lower in the pinealectomized group (p<0.01) and transplantation had no effect on the weight of this organ; weight of adrenal gland and testis were lower after pinealectomy (p<0.01) but restored back to control levels after transplantation; the mitotic activity in seminiferous tubules increased with pinealectomy and returned back to control indexes after transplantation. Research on hypothalamic catecholaminergic content revealed a diminished histofluorescence in pinealectomized rats which showed a potentiated restoration after transplantation. The innervation of the pineal gland was studied by anterograde and retrograde injections of Wheat Germ Agglutinin Horse Radish Peroxidase from superior cervical ganglion and pineal gland, respectively. It was demonstrated that cell bodies were traced both at the transplanted tissue and hypothalamus. In view of these data, the multifunctional and a probable high level homeostatic harmony regulator essence of pineal gland is discussed. [ABSTRACT FROM AUTHOR]

Pineal gland is an endocrine organ which exerts regulatory effects on the activity of various organs and systems. The present study was undertaken to highlight in experimental animals the possible integrative function of this endocrine organ on a behavioural pattern. Pinealectomy and foetal pineal gland transplantation to a subpial cortical area close to the pinealectomized region was performed. Behaviour was defined through motor activity induced by low (2 mg/ kg) and high (10 mg/kg) doses of amphetamine in rats. It was shown that pinealectomy produced significantly different patterns of behaviour induced by low and high doses of amphetamine. In sham operated animals low dose amphetamine induced a significant locomotor stimulation but without stereotyped activity. High dose amphetamine induced stereotyped activity. After pinealectomy even low dose amphetamine preoduced the behavioural pattern of stereotyped activity resembling a high dose amphetamine-induced behaviour. This differential effect of amphetamine, seen in pinealectomized rats, was completely restored after transplantation. On the other hand, melatonin treatment did not generate a significant alteration of behavioural profile either in the control or pinealectomized group of rats. Results are discussed with regard to the general regulatory function of the pineal gland. [ABSTRACT FROM AUTHOR]

The clinical, radiological and surgical findings of 56 patients with congenital malformations of the craniovertebral junction who underwent surgical intervention in the Department of Neurosurgery, Hacettepe University Medical School were reviewed. The anomalies were classified according to their embryonic origin. Forty-two cases of the series were major abnormalities formed by the combination of more than one germ layer. [ABSTRACT FROM AUTHOR]

The reactions of periventricular tissue of the lateral ventricle to non-infected and infected (Staphylococcus Epidermidis) silicone shunt tubing were examined by light and transmission electron microscopy. It was shown that reactive changes occurred in periventricular tissue in response to the implant of sterile shunt tubing. On the other hand in infected implanted silicone shunt tubing, proliferation of inflammatory cells within the ventricle and periventricular tissue, loss of integrity of the ependyma, glial cell proliferation, and excessive extracellular oedema were demonstrated. Proliferation of ependymal cells combined with inflammatory responses may be a factor in the pathogenesis of infected shunt obstruction. [ABSTRACT FROM AUTHOR]

A new experimental model was designed in which the regeneration of rat femoral nerve across a 8 mm excised gap was investigated after insertion of the distal and proximal stumps into the anatomically and functionally intact femoral artery (AIAB). This model was compared with groups of free artery and autologous nerve grafting. After a period of 12 weeks, a histological and electrophysiological analysis was carried out, which demonstrated that the AIAB and autologous nerve grafting group had a significantly higher percentage of regeneration compared with the free artery-graft group. The nerve regeneration and intraneural vascular reconstruction that occured within AIAB group were more successful than those that occured in the artery and nerve-grafting groups. [ABSTRACT FROM AUTHOR]

In prolactinoma surgery, especially in macro-adenomas, it is not always possible to remove the tumour totally. Cell remnants may cause a regrowth and continue hypersecretion. In order to find out whether tumour remnants could be destroyed by local application of bromocriptine, a research model has been designed. First, prolactin secreting pituitary tumours, removed during surgery, were implanted bilaterally into the brain tissue of rats. In eight rats, the viability of tumour transplants was proven histopathologically and their prolactin secretion was shown immunocytochemically. In a second step, on eight rats, sterile bromocriptine solution was applied topically to the tumour transplants on one side. The other side served as control. Histopathological examination of these treated tissues revealed fibrosis. Immunocytochemical analysis showed no secretory activity. Ultrastructural investigations also revealed evidence of degeneration of the treated cells. The natural course of the transplanted tumour tissues of the other side, as a control group, was also observed during the same 55-day period. [ABSTRACT FROM AUTHOR]

Ewing's sarcoma is one of the malignant bone tumours, which occurs in various bones of the body. When the spinal column or skull bones are involved, it may cause spinal cord compression or brain invasion. In this study, 12 cases of Ewing's sarcoma with central nervous system (CNS) involvement are presented. Seven of them were male and five female. In seven of the cases tumoural mass was located in the spinal column, whereas in the others it was found in the cranium. The major complaints were motor weakness in the lower extremities in seven cases, and a mass on the cranial vault in four cases. On neurological examination, eight of the patients had impairment of movements of the extremities (67%), and seven had sensory loss (58%). All except one patient underwent surgery. In seven cases, decompressive laminectomy plus subtotal tumour excision was performed, in three, craniectomy with grossly total tumour excision, and in one, biopsy. In this report, age and sex distribution, complaints, clinical and laboratory findings, neurological examination, and histopathology of our cases are reviewed and surgical results are compared with others reported in the literature. [ABSTRACT FROM AUTHOR]

The effects of a cholesterol-rich diet and linolenate-derived polyunsaturated fatty acids (Omega-3; EPA and HDA) supplementation on the aortic ultrastructure and serum lipid profiles (total cholesterol, HDL-cholesterol, and LDL-cholesterol) were investigated in rabbits. Three groups were established as follows: Group 1 (control) rabbits received regular diet (n=8), Group 2 received regular diet enriched with cholesterol for 12 months (n=14), and Group 3 received regular diet enriched with cholesterol for 4 months, then replaced by Max-EPA supplementation in the remaining 8 months (n=14). Crater-like openings on the endothelial cells and the presence of lipid vacuoles in cholesterol-fed rabbits (Group 2) suggest a very rapid uptake of circulating plasma lipids from the aortic lumen. In Group 3, the ultrastructure of the endothelial cells was almost normal and no lipid vacuoles were noted. Lipids stored in the subendothelial and adventitial regions of the vessel were noted. Biochemical findings were in accordance with the ultrastructural findings in Groups 2 and 3. It is possible that, in the cholesterol-fed, EPA, and HDA-replaced rabbits, endothelial cells may stop or reduce lipid uptake from the lumen and/or the rate of transport of lipid particles may increase. In other words, the behavior of the endothelial cells might be altered by the polyunsaturated fatty acids, as well as their circulating lipid-lowering action. [ABSTRACT FROM AUTHOR]

52 patients with non-acoustic neurinoma tumors of the cerebellopontine angle undergoing surgery over a 16 year period (1974-1989) are analyzed with regard to epidemiologic factors, presenting symptoms, neurological findings, diagnostic procedures, surgical approaches, recurrences, and longterm survival rates. Meningiomas (20 cases) and epidermoid tumors (16 cases) outnumber the rare tumors which exhibit wide histological variation. Trigeminal neuralgia was found as a significantly frequent sign of epidermoids. Total removal was possible in nine meningiomas (45%), fourteen epidermoid tumors (87.5%) and 11 (69%) mostly malignant rare tumors. There were many longterm survivors in meningioma and epidermoid groups with a median follow-up period of 4.1 years. The results are compared to those reported in the literature and a brief review of reported rare tumors of the angle is presented. [ABSTRACT FROM AUTHOR]

Primary multiple cerebral hydatid cysts are extremely rare: In this paper, an 8-year-old male patient who has one primary cerebral hydatid cyst in each cerebral hemisphere is presented. CT findings and operation are discussed. The literature is reviewed and the incidence of multiple cerebral hydatid cyst is compared with the published reports. [ABSTRACT FROM AUTHOR]

A retrospective analysis of 32 patients older than 16 years of age treated at Neurosurgical Department of Hacettepe University within the last 30 years (1959-1988) for cerebellar medullobastoma was considered. The clinical features, treatment modalities and outcome are discussed. The survival rates for 5 and 10 years were 14% and 7% respectively. The results are compared with that of literature. [ABSTRACT FROM AUTHOR]

Nine cases of posterior fossa chordomas are presented. The clinical features, treatment, and outcomes are discussed. Two patients underwent transoral surgery. Advantages and disadvantages of this approach are discussed and related to the recent literature. [ABSTRACT FROM AUTHOR]

Plasmocytoma is a plasma cell tumor, which occurs in various structures of the body. When the spinal column is involved, it may cause cord compression. In this study, 14 cases of spinal plasmocytomas are presented. Seven of them were male and seven female. The major complaints were pain in twelve cases, motor weakness in eight cases, and bladder disturbance in six cases. On neurological examination, twelve of the patients had impairment of extremity movements (85.7%), and eight had sensory losses (57.1%). Compression was more frequent in the thoracic region. There was a total block in nine and partial block in five cases. All patients underwent surgery. In thirteen cases laminectomy was performed, in one thoracotomy. In this report, complaints, clinical and laboratory findings, neurological examination, and histopathology of our cases are reviewed and the results discussed. [ABSTRACT FROM AUTHOR]

The data on 130 children with brain abscesses treated over 21 years (1970-1990) were analyzed retrospectively. The whole group included four infants. Chronic ear infection and cyanotic congenital heart disease were the most common predisposing factors. In infants, meningitis and/or ventriculitis were dominant in the etiopathogenesis. Cases were evaluated according to the treatment received and also according to time periods. More than half of the patients ( n=74) in this series were treated by primary or secondary excision. Computed tomography (CT) facilitated the diagnosis and helped the planning of treatment. Aspiration gained increasing credit after the advent of CT. Microorganisms could be identified in 54% of the cultured specimens. Staphylococci, streptococci and Proteus were the dominating microorganisms. Penicillin and chloramphenicol have long been the mainstay of antimicrobial therapy but have recently been replaced by third-generation cephalosporins and sulbactam-ampicillin combinations. Overall mortality was 15.5% but showed a decline from 30% in the pre-CT era to 6% in the last 5 years and to zero in the last three. Neither the location nor associated heart disease contributed to the mortality, but mortality among infants was as high as 50%. [ABSTRACT FROM AUTHOR]

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The Middle East is the term used for more than ten countries with populations characterized by different ethnic roots and religions and with diverse political and economic power. It is probably the most unstable part of the whole world, having spent centuries struggling for a settled situation. Reflecting this political turmoil, the health problems and priorities in these countries are very different than in western countries. Medical associations, including neurosurgical associations, in most of these countries have very little communication with international societies compared with such associations in other parts of the world. Although one or two neurosurgeons in almost every country in the region enjoy some prominence in the international neurosurgical arena, almost no society-based relationships have been established among Middle East countries. Pediatric neurosurgery has been regarded as a subspecialty in the Middle East countries for the last two decades. Although it is not well organized except in Turkey and Israel, most of the countries in this region now have neurosurgeons who give special attention to pediatric neurosurgery within their general neurosurgical proctice. Practicing neurosurgeons are few and and far between; there are certainly not enough of them to allow specialization in specific fields of neurosurgery in most countries in the Middle East. Moreover, owing to political and economic problems, most countries in the region are behind the standard neurosurgical agenda. Nonetheless, the flow rate of papers submitted to Child’s Nervous System from several countries in the region has been slowly but progressively increasing. Hopefully, political stabilization in the near future will activate progress in pediatric neurosurgery along with neurosurgery in this region. [ABSTRACT FROM AUTHOR]

It was previously reported that a low density area in the posterior aspect of the intervertebral disk is an additional computed tomography (CT) finding suggesting a herniated nucleuos pulposus. In this report the incidence of this finding, its correlation with the duration of symptoms and severity of herniation, were studied on 59 herniated intervertebral disks of 50 cases. [ABSTRACT FROM AUTHOR]

Acquired torticollis is a symptom of an underlying disorder. It requires a thorough, meticulous search for the cause, because some of the problems associated with torticollis, such as posterior fossa tumor, can be life-threatening. [ABSTRACT FROM AUTHOR]

In this paper we present two paraspinal Burkitt's lymphomas, with paraplegia. This entity is very rare in our country. In the evaluation of a paraplegic child, we believe that Burkitt's lymphoma should always be kept in mind. [ABSTRACT FROM AUTHOR]

An unusual case of primary extranodal Burkitt's-type lymphoma of the frontal base dura and adjacent bone with intradural invasion is reported in a 5-year-old child who presented with unilateral loss of vision in the left eye. Tissue diagnosis was obtained through a craniotomy and the patient received radiotherapy plus intravenous and intrathecal chemotherapy. The tumor regression and improvement in vision was well documented by means of CT and visual evoked potential studies (VEP). A review of the literature on this exceptionally rare tumor is presented. [ABSTRACT FROM AUTHOR]