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Extradural spinal angioma was diagnosed in the lomber region of a patient who referred to the neurosurgical clinic with signs and symptoms of disc herniation. The venous mass compressing the L2-3 roots bilaterally was coagulated by bipolar and the patient made an uneventuall recovery. This case is reported and the literature reviewed in reiation to the rarity of spinal angiomas and difficulties in diagnose.

AIM The atrium (trigone) is the most common site for intraventricular lesions. The parieto-occipital interhemispheric precuneal approach (POIPA) is one of the particular ways to reach these lesions. The aim of this study was to draw specific attention to the surgical difficulties of these lesions and to present our experience with this operative approach. MATERIAL AND METHODS Sixty-six patients with lesions located in the atrium of the lateral ventricles underwent surgical treatment in our institution using POIPA over a 13-year period. The clinical, radiological and surgical characteristics of these patients were retrieved and reviewed retrospectively. The histological diagnosis of the cases and postoperative complications were specifically focused on in this study. RESULTS Thirty-six (54.5%) patients were male and 30 patients were female with a mean age 37.9 years (range between 8 and 74 years). The lesion was in the right atrium in 25 cases and in the left in 41 (62.1%) patients. POIPA was used in all cases to remove the lesions. The most common tumor was glioblastoma (34.8%), followed by glial tumors grade I, II and III and meningiomas. The other lesions were metastases, ganglioglioma, epidermoid cysts and arteriovenous malformations. Gross total resection of the tumors was achieved in 59 patients (89.4%) while subtotal removal was performed in 7 cases. Five (7.5%) patients died within the first month after surgery. Conclusion: POIPA provides a safe and effective way to reach lesions located in the atrium of the lateral ventricle. Knowledge of precise anatomy associated with the meticulous surgical techniques decreases the surgical morbidity and mortality of the patients.

Ewing's sarcoma is one of the most common malignant tumors of the skeletal system in children and young adults. It most frequently stems from the long bones of the extremities. However, though uncommon, extraosseous localization can be seen. Epidural extraosseous presentations are extremely rare. In this case, the authors report on the long-term follow-up of a patient with this well-demonstrated, but uncommon localization, and the initial unique presentation of the patient, which clinically and radiologically mimicked a cervical abscess.

Objectives Anterior skull base defects are potentially lethal and surgical treatment must be performed as soon as possible. The purpose of this study was to evaluate whether our technique is effective or not in long-term period. Design Retrospective chart review of all patients whose data were entered into the Hospital Registry System between 1995 and 2015. Setting/Participants This study was performed at the Gaziantep University School of Medicine, Gaziantep, Turkey, in 2015 and included 78 patients who in the past 20 years underwent three-layer reconstruction surgery for anterior skull base defects at the same university. Main Outcome Measures Among the patients, defects repaired by transcranial approach had the lowest recurrence rate. Overall, successful repair was achieved in 100% of the patients. Results Pure transbasal approach was used as a single procedure on 71 (91%) patients. Combined approaches were used in seven (9%) cases. The extended transbasal approach was combined with a transfacial approach in four patients and with a pterional approach in three patients. Conclusion We encourage the use of three-layer reconstruction and recommend free fascia lata grafts and galeal flaps with vascularized pedicle as sealing material of choice in all types of cases such as tumor and trauma.

In this experimental study the efficiacy of methylprednisolone was investigated by neurophysiological and histopathological evaluation in a rabbit cauda equina model where injury was produced with an aneurysm clip (closed pressure 192 gr). High dose methylprednisolone (kg/30 mg) was administered by intravenous infusion in the 8th, 16th and 24th hours after injury followed by infusion of the same dosage every 6 hours for 24 hours. Nerve conduction velocity was measured before and early after trauma and 3 weeks after injury. Both neurophysiological and histopathological investigations demonstrated the neuroprotective effectiveness of methylprednisolone if it was given in the 8th hour after trauma. Although recovery was observed its efficiacy was less pronounced when it was given in the 16th and 24th hours.

Epidermoid cysts are rare benign tumors that are derived from the development of abnormally situated ectodermal tissue. Although they may originate from any part of the body head and neck region is occasionally affected. Epidermoid cyst originating from pterygopalatine fossa has not been reported previously in the literature. We report the first case of epidermoid cyst of pterygomaxillary fossa in this study.

A case of cerebral venous infarction (CVI) as a complication of acute otitis media (AOM) was presented in a 16-month-old male patient. The patient admitted with AOM in the right ear, ipsilateral facial paralysis and contralateral hemiplegia. Computerized tomography of the brain showed low density areas involving both the cortex and subcortical white matter in the right frontoparietal region, and there were patchy and multifocal enhancing areas with intravenous contrast enhancement. These findings disclosed the diagnosis of venous infarctions involving the superficial cortical veins on the right side. Complete recovery was achieved with 2 weeks of sulbactam-ampicilline, amikacin and prednisolone treatment. Although it is rather rare, CVI should also be remembered among the otogenic intracranial complications.

A rare case with cystic dilatation of spinal nerve root sheats in the lumbo-sacral area was presented. Myelography with non-ionic contrast media demonstrated the pathology in more accuracy than cornputed tomography with myelography and greatly faciliated the diagnosis of this condition. Images, clinical pattern, indication for operation and surgical treatrnent are briefly discussed.

Seven cases with signs and symptoms of cauda equina compression due to narrow spinal canal were presented. Accurate diagnose was made with myelography and surgical findings. Ali the patients except one made complete recovery after surgery.

In this paper, we report a rare case of a 29-year-old boy who presented with papillary meningioma originating from the posterior fossa meninges. After a long, disease-free period, however, spinal drop metastases occurred 32 months after resection of the primary tumor. The primary and metastatic lesions had a similar histological appearance, meaning that multiple spinal metastatic lesions occurred through CSF route even after a gross total resection of the tumor. Tumor seeding during surgery is the evident reason for spinal metastasis, although we strictly adhered to the standard precautions for operations for malignant tumors such as obstruction of the cisterna magna with cotton paddies, and changing surgical gloves and instruments during the operation. In this report, we briefly discuss an exceedingly rare variant of meningioma, the papillary variant, and suggest a new approach, a CSF sampling, in the management of both malignant and benign meningiomas. CSF sampling allows for the early detection of metastasis and of tumor cells before metastasis has occurred, thus allowing treatment to begin as soon as possible. This early detection and management is possibly associated with longer survival. Furthermore, we discussed that meningiomas are tumors that are not as benign as initially thought.

Injury to peripheral nerves during injections of therapeutic agents such as penicillin G potassium is common in developing countries. It has been shown that cyclosporin A, a powerful immunosuppressive agent, can retard Wallerian degeneration after peripheral nerve crush injury. However, few studies are reported on the effects of cyclosporin A on peripheral nerve drug injection injury. This study aimed to assess the time-dependent efficacy of cyclosporine-A as an immunosuppressant therapy in an experimental rat nerve injection injury model established by penicillin G potassium injection. The rats were randomly divided into three groups based on the length of time after nerve injury induced by penicillin G potassium administration (30 minutes, 8 or 24 hours). The compound muscle action potentials were recorded pre-injury, early post-injury (within 1 hour) and 4 weeks after injury and compared statistically. Tissue samples were taken from each animal for histological analysis. Compared to the control group, a significant improvement of the compound muscle action potential amplitude value was observed only when cyclosporine-A was administered within 30 minutes of the injection injury (P < 0.05); at 8 or 24 hours after cyclosporine-A administration, compound muscle action potential amplitude was not changed compared with the control group. Thus, early immunosuppressant drug therapy may be a good alternative neuroprotective therapy option in experimental nerve injection injury induced by penicillin G potassium injection.

A congenital cholesteatoma or epidermoid is a benign mass that causes devastating effects if left untreated. An unusual case with a congenital cholesteatoma located in the mastoid region complicated by epidural abscess, sinus thrombosis, and cutaneous fistula is presented. The patient had normal otologic findings and had no neurologic deficit. A review of the literature found no report of a similar case.

PubMedID: 7784701 Although many substances have been tested in the search for an ideal dural substitute, an entirely satisfactory material has still not been found. The authors report an experimental study involving the closure of dural defects in rabbits with biomaterials developed from pig peritoneum and pericardium. Macroscopic and histologic examination, performed over a period between 15 and 45 days after implantation showed slight or no adhesion between the graft material and the cortex. No infection, CSF leakage, fistula or toxicity was noticed. The results demonstrated that these biomaterials could be used as satisfactory dural substitutes. © 1995 Springer-Verlag.