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Introduction Pituicytoma is a rare tumor of the pituitary gland derived from neurohypophyseal pituicytes. Case 1 A 58-year-old female presented with decreased vision; she was admitted to the neurosurgery department of Ege University after the detection of a pituitary macroadenoma. Magnetic resonance imaging (MRI) showed a 28 * 18 * 17-mm suprasellar mass, and laboratory tests revealed hypopituitarism. Hydrocortisone and L-thyroxine treatment were initiated, and the patient underwent resection through the endoscopic endonasal approach (EEA). The histopathological examination revealed a pituicytoma. The recurrence of tumor was detected during the 1-year follow-up, and the patient is awaiting surgery. Case 2 A 70-year-old woman presented with visual changes; she had a past medical history of hypophyseal macroadenoma and pituicytoma resected through an EEA in 2012 and 2017, respectively. During follow-up, 2 years after the second surgery, MRI showed progression of the pituicytoma then measuring 38 x 23 x 22 mm; it had invaded the cavernous sinus and was causing hydrocephaly and panhypopituitarism. The patient underwent the third resection through the transcranial approach in order to minimize bleeding. After this surgery, the patient developed diabetes insipidus and underwent treatment with desmopressin. Histopathological examination revealed a pituicytoma. At 6-month follow-up, imaging showed a sellar suprasellar mass 37 x 22 x 24 mm invading the cavernous sinus, indicative of recurrence. In the postoperative period, the patient applied to the department of radiation oncology to have fractionated radiotherapy. Discussion Pituicytomas are known to be low-grade tumors; because of their rarity, they are a real challenge. These patients should be followed up closely.

The IDH mutation initially exhibits chemosensitive properties, progression-free survival cannot be achieved in the later grades, and malignant transformation occurs as a result of TMZ-induced hypermutation profile and adaptation to this profile. In this study, we evaluated the potential of the combination of TMZ and AZD7762 at molecular level, to increase the anticancer activity of TMZ in IDH-mutant U87-mg cells. We used the WST-1 test to evaluate cytotoxic effect of TMZ and AZD7762 combination with dose-effect and isobologram curves. The effects of the inhibitory and effective concentrations of the combination on apoptosis, cell cycle and gamma-H2AX phosphorylation were analyzed with flow cytometry. The expression of genes responsible for the DNA damage response was analyzed with qRT-PCR. The combination showed a synergistic effect with high dose reduction index. Single and combined administrations of TMZ and AZD7762 increased in G(2)/M arrest from 24 to 48 h, and cells in the G(2)/M phase shifted towards octaploidy at 72 h. While no double-strand breaks were detected after TMZ treatment, AZD7762 and combination treatments caused a significant increase in gamma-H2AX phosphorylation and increased apoptotic stimulation towards 72 h although TMZ did not cause apoptotic effect in IDH-mutant U87-mg cells. The genes controlling the apoptosis were determined to be upregulated in all three groups, and genes regarding cell cycle checkpoints were downregulated. Targeting Chk1/2 with AZD7762 simultaneously with TMZ may be a potential therapeutic strategy for both increasing the sensitivity of IDH-mutant glioma cells to TMZ and reducing the dose of TMZ. [GRAPHICS] ., Ege Universitesi [20840], Funding was provided by Ege Universitesi (20840).

PTEN, a dual-phosphatase and scaffold protein, is one of the most commonly mutated tumour suppressor gene across various cancer types in human. The aim of this study therefore was to investigate the stability, structural and functional effects, and pathogenicity of 12 missense PTEN mutations (R15S, E18G, G36R, N49I, Y68H, I101T, C105F, D109N, V133I, C136Y, R173C and N276S) found by next generation sequencing of the PTEN gene in tissue samples obtained from glioblastoma patients. Computational tools and molecular dynamic simulation programs were used to identify the deleterious effects of these mutations. Furthermore, PTEN mRNA and protein expression levels were evaluated by qRT-PCR, Western Blot, and immunohistochemistry staining methods. Various computational tools predicted strong deleterious effects for the G36R, C105F, C136Y and N276S mutations. Molecular dynamic simulation revealed a significant decrease in protein stability for the Y68H and N276S mutations when compared with the wild type protein; whereas, C105F, D109N, V133I and R173C showed partial stability reduction. Significant residual fluctuations were observed in the R15S, N49I and C136Y mutations and radius of gyration graphs revealed the most compact structure for D109N and least for C136Y. In summary, our study is the first one to show the presence of PTEN E18G, N49I, D109N and N276S mutations in glioblastoma patients; where, D109N is neutral and N276S is a damaging and disease-associated mutation. Communicated by Ramaswamy H. Sarma. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Objective: Tattooing has become more popular, especially in Western culture. We aimed to analyze the impacts of the presence of tattoos in the operative field for posterior thoracolumbar surgery. Methodology: This study was performed using data extracted from the medical files of 15 patients who underwent posterior thoracolumbar surgery between April 2013 and May 2020 in the neurosurgery department of our tertiary care center. Therapeutic, clinical, and cosmetic outcomes after surgery necessitating incision on the tattoo are presented together with a brief discussion of the current literature. Results: Our series consisted of nine women and six men with an average age of 31.03 (range, 17-45) years. The duration of follow-up was 52 (range, 6-90) months. Ten patients underwent posterior spinal stabilization, and a simple discectomy was performed on five patients. The therapeutic outcomes and clinical improvement were satisfactory in all patients. No complications attributed to the presence of tattoos were detected in any patients. Conclusion: Posterior thoracolumbar surgery usually necessitates a midline incision that may unavoidably result in the deformation of a tattoo. Our results yielded that therapeutic and cosmetic results in patients with tattoos in the operative field were acceptable in the vast majority of cases after posterior thoracolumbar surgery. © 2022 AVES. All rights reserved.

Amaç: Ege Üniversitesi Hastanesi (EÜH) veri tabanındaki 1327 Glioblastoma (GBM) olgusununepidemiyolojik ve genel sağ kalım (GSK) özelliklerini istatistiksel açıdan değerlendirmektir.Gereç Yöntem: EÜ Kanserle Savaş Uygulama ve Araştırma Merkezi (EÜKAM) tarafından 1992-2017arasında kanser veri tabanında toplanan 117139 kanser verisi içindeki 1327 GBM olgusudeğerlendirilmiştir.Bulgular: 1327 GBM hastası analiz edilmiştir. Tanı anı ortalama yaş 55,6 yıl bulunmuştur.Erkek/kadın oranı 1,52:1’dir. En sık tutulumun temporal lobta (%36,3) olduğu saptanmıştır. Tedavisiraporlanan 881 hastanın analizinde; olguların %30,2’sine yalnızca operasyon, %65,6’sına kombinetedaviler uygulanmıştır. Otuz beş hastada (%4,0) yalnızca radyoterapi (RT) uygulanırken 558 hastada(%63,3) kombine tedavide RT eklenmiştir. Tüm GBM hastalarının ortalama sağ kalım süresi 12,15aydır. Bir, iki, üç ve beş yıllık GSK oranları sırasıyla %50,4, %22,02, %11 ve %5’tir. Ortalama sağkalım erkeklerde 11,6 ay, kadınlarda 13,3 ay olarak saptanmıştır. Cinsiyet ile sağ kalım süresiarasında anlamlı ilişki saptanmamıştır. Yaş gruplarına göre sağ kalım analizinde ileri yaş gruplarındasağ kalımın anlamlı olarak azaldığı saptanmıştır (p, Aim: The aim of this study was to evaluate the epidemiological and overall survival rates(OS) of 1327cases of Glioblastoma (GBM) in Ege University Hospital (EÜH) database.Materials and Methods: 1327 GBM cases were evaluated in 117139 cancer data collected from thecancer database between 1992 and 2017 by the EU Cancer Control Application and Research Center.Results: 1327 GBM patients were analyzed. The mean age at diagnosis was 55.6 years. Themale/female ratio was 1.52:1. The most common involvement was found in temporal lobe (36.3%).Inanalysis of 881 patients whose treatment was reported. In 30.2% of the cases, only operation wasperformed and in 65.6% combined treatments were applied. RT was added in 558 patients (63.3%).The ortalama survival time of all GBM patients was 12.15 months. One, two, three and five-year OSrates were 50.4%, 22.02%, 11% and 5% respectively. Ortalama survival was 11.6 months for malesand 13.3 months for females No significant difference was found between sex and survival time.Survival analysis signify that survival decreased in older age groups (p

Amac: Bu calismanin amaci, Ege Universitesi Tip Fakultesi Hastanesi veri tabaninda bulunan, merkezi sinir sistemi (MSS) tumoru tanisi ile tedavi edilen 5877 adet olgunun epidemiyolojik ve genel sag kalim ozelliklerini istatistiksel acidan degerlendirmek ve literatur ile karsilastirmaktir. Gerec ve Yontem: 1992 ile 2017 yillari arasinda Ege Universitesi Tip Fakultesi Hastanesinde tani alan 5877 adet MSS kanseri olgusu, Ege Universitesi Kanserle Savas, Uygulama ve Arastirma Merkezi’nin (EUKAM) ozel egitimli ve sertifikali kanser kayit elemanlari tarafindan kayit altina alinan veriler, Ki-kare testi ve dogrusal modelleme yontemi kullanilarak analiz edilmis, p

Aim: To evaluate the role of Fractional anisotropy (FA) values obtained from diffusion tensor magnetic resonance imaging (DTI) in the differentiation and grading of brain tumors.Materials and Methods: This study examined the conventional and diffusion tensor MR imaging findings of twenty-seven patients diagnosed with brain tumors between 2008 and 2010. Patients were divided into four groups based on tumor types; meningiomas, low-grade gliomas, high-grade gliomas, and metastases. Fractional anisotropy (FA) values were then obtained from the solid components and (if present) peritumoral vasogenic edema of the tumors for each patient by using the region of interest (ROI) method. Finally, the patient groups were analyzed in terms of any statistically significant differences.Results: The FA values obtained from the solid portions and peritumoral edema of meningiomas were found to be higher than those of all other groups (p

Purpose. We aimed to evaluate the demographic and clinical features of patients with cervical spinal injuries secondary to shallow-water diving and share our therapeutic outcomes. Methods. A retrospective study was carried out using data extracted from the medical files of 39 patients (3 females and 36 males) who were treated surgically (n = 29) or conservatively (n = 10). Demographics, clinical features, operative data, American Spine Injury Association (ASIA) impairment scales, and Karnofsky Performance Status (KPS) results were noted. Results. The average age of our series (n = 39) was 31.59 ± 14.80 (range, 14 to 92) years. The vast majority of patients (n = 34, 87.2%) presented with isolated cervical trauma. At initial admission, neurological deficits were diagnosed in 22 (56.4%) patients. A single-level cervical involvement was noted in 18 (46.2%) patients, while 21 cases (53.8%) displayed injury involving multiple levels. The levels of cervical injury were C5 (n = 16, 41%), C6 (n = 11, 28.2%), C7 (n = 6, 15.4%), C1 (n = 5, 12.8%), and C4 (n = 1, 2.6%). A total of 22 patients had neurological deficits at admission. Surgery was performed using anterior (n = 21, 72.4%), posterior (n = 7, 24.1%), and combined anterior and posterior (n = 1, 3.4%) routes. Nine patients (23.1%) exhibited improvement in their neurological deficits. There were significant improvements in both the ASIA impairment scale and KPS results after treatment. Conclusion. Our data indicated that dive- or fall-related cervical spinal injuries are associated with profound morbidity. Reinforcement of primary prevention, identification of target population, and increased awareness on this topic are the key steps to minimize the frequency and severity of complications and to optimize therapeutic outcomes.

factPresentation

WOS: 000498620000009, PubMed: 31750046, Endoscopic transsphenoidal skull base surgery (ETSS) has become a standard approach in the treatment of sellar and clival lesions, such as pituitary adenoma and chordoma. Due to the close proximity of the clivus and the sella turcica to the inner ear, it is thought that bone drilling in the surgery may have effects on hearing. the aim of this study was to assess the effect of bone drilling in ETSS procedure on cochlear function. This study was performed on 18 patients who underwent ETSS procedure between December 2016 and May 2017. the study was designed as a prospective study. All of the data were prospectively collected. These included demographic data, date of surgery, type of surgery, preoperative pure-tone audiometry, and preoperative and postoperative distortion product otoacoustic emission (DPOAE) measurements. of the DPOAE measurements of the patients who were operated for pituitary adenoma, there was a statistically significant difference between the signal-to-noise ratio (SNR) measurements at 0.5, 1, 2 and 4 kHz ( p < 0.05). Additionally, there were no significant differences in preoperative and postoperative SNR measurements of six patients who were selected for clivus chordoma. When the preoperative and postoperative tonal audiometric tests of the patients were compared, no statistically significant difference was found ( p > 0.05). in conclusion, it is found that bone drilling in ETSS procedure has a negative effect on cochlear function in the early period. This is the first study to evaluate the degree of noise-induced cochlear damage in patients who were gone under ETSS procedure.

EgeUn###, Objectives Endoscopic techniques in pituitary surgery lead to inevitable mucosal loss of the sphenoethmoidal recess and posterior nasal septum in the nasal cavity. There is no other comparative study between primary reconstruction of septal perforation and secondary healing in the literature. The aim of this study is to evaluate postoperative patient morbidity with or without posterior septal perforation in endonasal pituitary surgery by comparing two commonly used techniques: rescue and double nasoseptal flaps. Design Prospectively randomized study. Setting Tertiary academic center. Participants Sixty patients underwent endoscopic endonasal pituitary surgery. Main Outcomes and Measures Functional results (breathing) using visual analog scale (VAS), sphenoid sinusitis, presence of synechia, perforation in the posterior septum, and crusting in the sphenoethmoidal recess were assessed. Results Pre- and postoperative mean VAS scores were 71.67 +/- 11.47 and 67.67 +/- 9.71 mm in the intact septum group and 77.67 +/- 14.06 and 62.67 +/- 10.48 mm in the posterior septal perforation group. There was a significant difference between pre- and postoperative VAS values in all groups. There was significant worsening in both groups; worsening in VAS values was much higher in the posterior septal perforation group. In the posterior septal perforation group, much more crusting was seen. Conclusions This is the first study to compare the postoperative patient morbidity in endoscopic endonasal pituitary surgery with and without a posterior septal perforation. Reconstruction of the posterior septum along with less mucosal loss yields better postoperative nasal symptom score.

Endoscopic endonasal approach has been successfully used for the management of pituitary tumors; however, the loss of septal mucosa especially around sphenoethmoidal recess and posterior nasal septum might be a disadvantage of this technique. The aim of this study is to describe a variation of the endonasal approach, “double nasoseptal flap” technique in endoscopic transsphenoidal pituitary surgery, and to evaluate its outcomes. The technique depends on fully harvested bigger nasoseptal flap on one side and smaller on the other. Thirty patients were included. Functional results were assessed by preoperative and postoperative first month visual analogue scale (VAS), and morphology was evaluated by achieving intact septum from the sphenoid ostium to the columella. Sphenoid sinusitis, the presence of synechia and crusting in the sphenoethmoidal recess was also assessed. Mean VAS was 71 and 67 mm preoperatively and postoperatively, respectively (p > 0.01). There were no septal perforations, synechia, and sphenoid sinusitis postoperatively. Three patients had (10 %) crusts on sphenoethmoidal recess on first month postoperatively. Double nasoseptal flap technique has advantages, such as wider exposure during surgery; prepared flaps could be used if needed, better morphological and functional outcomes postoperatively. The technique is safe without any perforations and minimal crusting.

PubMedID: 29960893 Objectives: In this study we retrospectively reviewed A. baumannii meningitis cases treated with tigecycline including regimens and evaluated the efficacy of tigecycline in the therapy. Patients and Methods: Study was performed in seven tertiary-care educational hospitals from five cities of Turkey and one center from France. We extracted data and outcomes of all adult (aged >18) patients with culture proven A. baumannii meningitis treated with tigecycline including antibiotic therapy until April 2016. Results: A total of 23 patients (15 male and eight female) fulfilled our inclusion criteria. All Acinetobacter strains were carbapenem-resistant and susceptible to tigecycline. Six cases received tigecycline monotherapy while 17 received tigecycline including combination therapy (10 with colistin, 4 with netilmicin, 3 with amikacin, 4 with meropenem). Seven of 23 cases (30%) died during the tigecycline including therapy (1 in monotherapy, 4 in colistin, 2 in netilmicin, 1 amikacin, one case received tigecycline + netilmicin followed by tigecycline + colistin). Hence, overall end of treatment (EOT) success was 70%. However, since further 27% died due to additional nosocomial infections, overall clinical success (relieved symptoms at the EOT and one-month post-therapy survival without any relapse or reinfection) decreased to 43%. Conclusion: We conclude that tigecycline may be an alternative in the salvage treatment of nosocomial multidrug-resistant Acinetobacter spp. meningitis. Acinetobacter spp. Meningitis. © 2018 Elsevier B.V.

Objective: Chordoma is a rare, primary malignant bone tumor derived from primitive notochord remnants in the skull base. Chordomas are slow-growing, low-grade neoplasms that are more likely to cause local recurrence, but distant metastases are uncommon. the aim of this study was to report the preoperative and postoperative results of chordoma patients who underwent endoscopic endonasal surgery. Material and Methods: This study included 10 patients (8 female and 2 male) who underwent endoscopic endonasal pituitary surgery due to chordoma in the Neurosurgery and Otolaryngology Departments of a tertiary medical center between May 2014 and August 2017. All data were obtained from patients’ folders and hospital information system retrospectively by evaluating complaints, operation notes, pathology results, radiological images, and postoperative control notes. Patients were evaluated in the postoperative period for a relapse or residual tumor, additional treatment, postoperative complications, and complaints which is regressed or not. Results: the mean age was 51 years (range, 16-79). Patients were admitted to the Otolaryngology Clinic with headache reported in 2 patients, vision loss in 1 patient, vision loss with headache in 6 patients, and nasal obstruction and headache in 1 patient. A physical examination showed the abducens paralysis in 3 patients and occulomotorius paralysis in 1 patient due to tumor indentation. All patients underwent endoscopic endonasal transethmoid and transsphenoid surgery. Complete gross tumor removal was achieved with the transsphenoidal approach in 9 patients, and the transsphenoidal and far-lateral transcondylar approach in 1 patient. Conclusion: Considering the local aggressive nature of tumor, radical surgery and adjuvant radiotherapy are the main treatments modalities of chordomas located in the skull base. the endoscopic endonasal transsphenoidal approach has become the gold standard method in daily practice due to its reliability and minimal morbidity.

The effects of minocycline on neuronal injury after spinal cord injury (SCI) are limited and controversial. Therefore we aimed to investigate the protective effects of minocycline on tissue and on serum concentrations of malondialdehyde (MDA) levels, superoxide dismutase (SOD) activity, glutathione peroxidase (GSH-Px) activity, tissue total antioxidant and oxidant status (TAS and TOS, respectively), and AST and LDH levels in rats with SCI.This study was performed on 7-8 weeks 38 male Wistar albino rats. The animals were randomly divided into five groups: group 1, Sham (n=8); group 2, SCI (spinal cord injury)/control (n=8); group 3, SCI+minocycline3 (n=7); group 4, SCI+minocycline30 (n=8) and group 5 SCI+minocycline90 (n=7). Blood and tissue samples were analysed for MDA, SOD, GSH-Px, TAS, TOS, AST and LDH levels.The MDA levels were significantly higher in SCI group compared to sham group (p0.001), and MDA levels were also significantly higher in SCI group compared to SCI+M3, SCI+M30, SCI+M90 (p0.05). SOD levels were significantly higher in SCI+M30 when compared to SCI and SCI+M3 groups (p0.05). GSH-Px levels decreased significantly in SCI and SCI+M3 groups compared to sham (p0.05). SCI+M3 group showed significantly decreased levels of TAS and TOS compared to SCI group (p0.05). TAS and TOS levels significantly increased in SCI+M90 group compared to SCI+M3 and SCI+M30 groups (p0.05).The present study demonstrates the dose-dependent antioxidant activity of minocycline against spinal cord injury in rats. Minocycline administration increased antioxidant enzyme levels and improved total antioxidant status.

Glioblastoma multiforme (GBM) is the most common form of primary brain tumors. Although mutations in isocitrate dehydrogenase-132 patients (mean age, years: 58±14.0) diagnosed with primary glioblastoma multiforme were screened for IDH1 mutations (R132H, R132S, R132C and R132L) by direct sequencing. Serum VEGF and tumor tissue HIF1-alpha levels were measured by enzyme-linked immunosorbent assay. Associations between categoric variables were determined using chi-square tests. Differences between two groups were compared withSix percent of patients were found to be heterozygous for R132H mutation. Tumor HIF1-alpha and serum VEGF levels were found to be significantly increased inOur results suggest that mutated IDH1 may contribute to carcinogenesis via induction of HIF-1 alpha pathway in primary GBM.

The current literature describing surgical and endovascular interventions in blister-like aneurysms (BAs) offers no clear consensus on the optimal treatment modality. The aim of this study was to assess the clinical and angiographic features of ruptured BAs treated endovascularly using predominantly flow-diversion strategy.The initial clinical and radiological findings, endovascular treatment results, clinical outcomes, and follow-up angiographic findings of seven BAs (one man and six women; mean age, 44.5 years; range, 33-50 years) were retrospectively evaluated.All seven BAs were located in the supraclinoid internal carotid artery. Two patients were managed initially by other endovascular treatment options, after that flow-diverting strategy became intention to treat in these two and the remaining five patients. Flow-diverting treatment with pipeline stent (Covidien/Ev3) could be accomplished in all but one patient who was treated by parent artery occlusion due to an access problem. Dual antiaggregant loading was performed 6-8 h before treatment in all patients. No re-bleeding or thrombotic complication occurred periprocedurally. Long-term control angiography was available in all patients revealing occluded aneurysm. The clinical outcome (mRS) was good in five and moderate in two patients.Endovascular reconstructive treatment of a ruptured BA using a flow-diverting device is a promising strategy that can be performed with acceptable clinical and good radiological results.

Background: Spinal cord injury (SCI) is a leading cause of morbidity and mortality among youth and adults. Secondary injury mechanisms within the spinal cord (SC) are well known to cause deterioration after an acute impact. Free radical scavengers are among the most studied agents in animal models of SCI. Edaravone is a scavenger of hydroxyl radicals. Methods: We aimed to measure and compare the effects of both methylprednisolone and edaravone on tissue and on serum concentrations of nitric oxide (NO), malondialdehyde (MDA) levels, superoxide dismutase (SOD) activity, glutathione peroxidase (GSH-Px) activity, and tissue total antioxidant capacity (TAC) in rats with SCI. SCI was induced in four groups of Wistar albino rats by a weight-drop method. The neurological function of the rats was periodically tested. At the end of the experiment, blood samples were collected, and SC tissue samples were harvested for biochemical evaluation. Results: The tissue level of NO was decreased in the edaravone-treated group compared with the no-treatment group (p < 0.05). The tissue levels of SOD and GSH-Px were higher in the edaravone-treated group than in the no-treatment group (p < 0.05). The serum levels of NO were lower in the edaravone-treated and methylprednisolone-treated groups than in the no-treatment group (p < 0.05). The serum levels of SOD in the edaravone-treated group did not differ from those of any other group. The serum levels of MDA in the edaravone-treated and no-treatment groups were higher than in the two other groups (p < 0.05). Tissue levels of MDA in the edaravone-treated group were lower than in the no-treatment group (p < 0.05). Tissue levels of TAC in the edaravone-treated group were higher than in the no-treatment and methylprednisolone-treated groups (p < 0.05). The neurological outcome scores of the animals in treatment groups did not depict any statistically significant improvement in motor functions. However, edaravone seemed to prevent further worsening of the immediate post-SCI neurological status. Conclusion: Our biochemical analyses indicate that edaravone is capable of blunting the increased oxidative stress that follows SCI. We show, for the first time, that edaravone enhances the TAC in SC tissue. This beneficial effect of edaravone on antioxidant status may act to minimize the secondary neurological damage that occurs during the acute phase after SCI.

Tadalafil is a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5). Nitric oxide (NO) functions as a retrograde neurotransmitter in the spinal cord, and postsynaptic structures respond to NO by producing cGMP. The concentrations of cGMP in the spinal cord are controlled by the actions of PDE. The aim of the study was to evaluate and compare the effects of the use of both methylprednisolone and tadalafil on serum and tissue concentrations of NO, malondialdehyde (MDA) levels, superoxide dismutase (SOD) activity, and tissue glutathione peroxidase (GSH-Px) activity in rats with spinal cord injury (SCI). SCI was induced in Wistar albino rats by dropping a 10 g rod from a 5.0 cm height at T8-10. The 28 rats were randomly divided into four equal groups: tadalafil, methylprednisolone, non-treatment and sham groups. Rats were neurologically tested at 24 hours after trauma. At the end of the experiment, blood samples were collected and spinal cord tissue samples were harvested for biochemical evaluation. The tissue level of NO was increased in the tadalafil group compared with the non-treatment and methylprednisolone groups (p0.05). The tissue levels of SOD and GSH-Px did not differ between the groups. Serum levels of NO were higher in the tadalafil group than in the non-treatment group (p0.05). The increase in serum SOD levels was greater in the tadalafil group than the methylprednisolone group. Serum MDA levels in the tadalafil and methylprednisolone groups tended to be lower than in the non-treatment group (p0.05). Tissue MDA levels in the tadalafil and methylprednisolone groups tended to be lower than in the non-treatment group and sham groups (p0.05). Although there was no difference in neurological outcome scores between the tadalafil, methylprednisolone and non-treatment groups (p0.05), the animals in the tadalafil and methylprednisolone groups tended to have better scores than the non-treatment group. Thus, tadalafil appears to be beneficial in reducing the effects of injury to the spinal cord by increasing tissue levels of NO and serum activity of SOD.

To reduce the risk of iatrogenic injury to sympathetic chain during anterior and anterolateral approaches to the cervical spine, its location has to be well defined and known by surgeons. We analyzed the course of sympathetic chain and its ganglia from C7 up to its entry into the cranial base and its relationship mainly with the longus colli (LC). Formalin fixed 20 human cadavers were dissected under operating microscope. Measurement of the dimensions of the ganglia, distance of the trunk to the LC, and the angles identifying the course of the chain were performed. Superior and inferior cervical/cervicothoracic ganglion were observed in all specimens, the middle cervical ganglion was observed in 48% of the specimens. The middle ganglion consisted of two ganglia in 10% of the dissected sides. Forty percent of the inferior cervical/cervicothoracic ganglion was at the C7 level, 25% was at C7-Th1 disc level, and 35% was at Th1 level. Vertebral ganglion was detected in only 8% of the specimens. The course of the sympathetic trunk converges medially descending from upper cervical levels to the lower levels. Anterior surgical approach to the cervical spine is a commonly used procedure. Although Horner syndrome due to sympathetic injury is not a common sequence of cervical operations, our findings support the current few reports on the subject and should be useful to any surgeon who operates in the cervical region to avoid this uncommon complication.

Aim Tumors of various organs that metastasize to bone do not neglect calvarium as a target. The aim of this study was to characterize the calvarial tumors. Material and methods We retrospectively reviewed 45 consecutive patients operated for calvarial masses from January 2002 till May 2012 at our hospital. Skull base tumors and patients ≤18 years were excluded. Results Three groups of lesions were found - calvarial metastases (15/45), primary tumors (5/45) and tumor-like lesions (25/45). Malignant lesions were equitable by gender distribution, higher age of onset (median age of primary =55; secondary = 60 years) and benign lesions by younger age (median = 35) and female bias (18/25). Calvarial metastases mostly presented with local swelling (10/15), local pain (6/15) and rarely neurologic deficit. There was associated dural sinus thrombosis (4/20 of malignant; 1/25 of benign lesions) and osteolysis (3/5 primary malignant, 13/15 secondary and 18/25 of benign lesions). Complete surgical excision was possible with minimal morbidity in all except one patient and nil mortality. Conclusion Nearly half (20/45) of the calvarial lesions tend to be malignant with most of them presenting as silent painless masses. Surgical excision should be considered only after suitable investigation and appropriate neurosurgical set-up.

Craniopharyngiomas are the most frequently encountered suprasellar tumors in children. Although they have a benign histology, total resection without morbidity is very difficult. We aimed to review the results of pediatric craniopharyngioma patients treated in eight institutions in Turkey. There were 51 boys and 36 girls, ranging in age from 20 months to 18 years (mean 10.2 years). The most frequent symptom was headache, followed by visual disturbances. Hydrocephalus was seen most frequently in tumors greater than 4 cm in size (P=0.002). Hydrocephalus was associated with the decreased gross total resection (P=0.043). The recurrence (28%) was significantly higher in patients with subtotal and partial tumor removal (P=0.010). Bad outcome was significantly associated with tumor dimension (P=0.039); the greater the tumor dimension, the worse the outcome. Outcome was significantly better in patients older than 10 years (P=0.032). Gender, tumor type and location, presence of hydrocephalus and calcification, histological type of craniopharyngioma, and surgical approach did not have a significant effect on the outcome. The treatment should be individualized and a multidisciplinary approach should be used. The goal of surgery should be gross total removal without mortality and with acceptable morbidity.

PURPOSE: Pseudoprogression is defined among the glioblastoma (GBM) patients as clinical deterioration and/or radiological enlargement and contrast enhancement after radiochemotherapy which resolves during the follow-up. It is typically detected within 3 months after radiochemotherapy. Late pseudoprogression is not common and not clearly defined yet. We analyzed 33 patients who were reoperated for clinical/radiological progression after chemoradiotherapy and compared the clinicopathologic characteristics of the patients without any histologic evidence of tumor with those having real tumor progression. MATERIAL AND METHODS: We identified histologically verified GBM patients who underwent a second tumor resection after radiochemotherapy due to clinical deterioration and/ or radiologically progression between January 2010- October 2013. All pathological specimens were evaluated in our center and were separated in two groups; GroupA: real recurrence of GBM, Group B:late pseudo progression, either no evidence of tumor, complete necrosis or treatment related changes reminding tumor regression. We determined survival after primary surgery and re-resection with regard to pathological results using Kaplan-Meier estimates. RESULTS: 33 patients were included in this study. Median age was 51 (range:17-72), male/female ratio was 2.3/1. After the radiochemotherapy, clinical deterioration and/ or radiologically progression was detected median 10 months later (range: 4-22months).After the secondary surgery, 18 patients (55%) showed late pseudoprogression but 15 patients (45%) experienced real tumor recurrence in the pathological evaluation. From the diagnosis, 2-year survival rate was 26.3% in whole group. 2-year survival rate was 36% in patients who had late pseudoprogression and 16.7% in patients who had real tumor progression (p:0,45). After the secondary surgery, 2 year survival rate was 11% in cases with late pseudoprogression and median survival was 9 months (range:4-28 months). In patients who experienced real tumor recurrence, 2-year survival after secondary surgery was%0 and median survival was 4 months (range: 2-12 months) . Median time to recurrence was 9 months (range :5-22 months) in patients with late pseudoprogression but 11 months (range:4-18 months) in patients experienced real tumor recurrence. CONCLUSION: GBM patients occasionally undergone reoperation due to clinical deterioration or radiological progression, however no evidence of tumor is found in some cases which may be defined as late pseudoprogression. The survival of these patients are better than the cases with tumor progression.

Primer spinal kökenli GBM (spinal GBM) çok yaygın bir patoloji değildir. Bu çalışma, nadir olarak görülen bu tümörün klinik sunumu, seyri, yönetimi ve sonuçlarını özetlerken, 3 olguluk bir spinal GBM serisini bildirmektedir. Bu spinal GBM’ye sahip 3 olguluk seride, olgulardan biri tumor cerrahisinden 10 ay sonra hidrosefali nedeniyle opere edilmiştir. Bir diğer olguda ise, cerrahi girişimi takiben serebral metastaz gözlenmiştir. Post-operatif süreçte, tumor cerrahi sonrası olgulardan 2’si radyoterapi ve diğer olgu da kombine radyoterapi ve steroid terapiyle birlikte kemoterapi almıştır. İlgili literatürün gözden geçirilmesi, rapor edilen primer spinal GBM’li olguların sayıca azlığı nedeniyle bu konunun daha yakından incelenmesinin gerekliliğini ortaya koymaktadır. Beyin kökenli GBM’ye kıyasla, omurilikte görülen GBM daha saldırgandır; gelişimi sırasında beyine doğru yayılabilir (metastaz) ve bu yayılma neticesinde hidrosefaliye yol açabilir., Primary spinal glioblastoma multiforme (spinal GBM) is not a very common entity. This paper presents an outline of this rare neoplasm, its clinical presentation, course, management and outcome and reports a 3-case series of spinal GBM. In this 3-case series with spinal GBM, one of the patients was operated for hydrocephalous 10 months later following the tumor surgery and another patient had cerebral metastasis after the surgery. In the postoperative period, two of the cases received radiotherapy and one received combined radiotherapy and chemotherapy with steroid therapy together following the tumor surgery. The review of the pertinent literature has revealed that due to the scarcity of the reported cases of primary spinal GBMs, this issue requires a closer look. GBM behaves more aggressive in medulla spinalis than it behaves when it originates from cerebrum. It may disseminate to the cerebrum during its course and it may cause hydrocephalus due to this dissemination (metastasis).

Brain involvement of hydatid disease accounts for 1 to 4% of all cases. Extra-Dural, intra-calvarial location is even less. We report, a 24 years old woman with primary intra-calvarial hydatid cyst that presented as an extradural cystic mass lesion of the posterior fossa. In the case presented, removal of the pathology without rupture could not be achieved. As same with the other locations, hydatid cysts of calvaria must be tried to be removed without rupture when possible. However, this exceptional host, the calvaria, seems to ease the pre-mature rupture of the cyst due to the neighboring sharp edges of the bone. In such situations, excessive irrigation with hyper-tonic solutions, %3 NaCl for example, is known to be effective for preventing dissemination. Pre-operative diagnosis is very important for surgical planning. Extra-dural locations of cystic lesions must remind the surgeon hydatid cysts especially in the countries where the disease is more common. J. Exp. Clin. Med., 2012; 29:77-79

Primary spinal glioblastoma multiforme (spinal GBM) is not a very common entity. This paper presents an outline of this rare neoplasm, its clinical presentation, course, management and outcome and reports a 3-case series of spinal GBM. In this 3-case series with spinal GBM, one of the patients was operated for hydrocephalous 10 months later following the tumor surgery and another patient had cerebral metastasis after the surgery. In the postoperative period, two of the cases received radiotherapy and one received combined radiotherapy and chemotherapy with steroid therapy together following the tumor surgery. The review of the pertinent literature has revealed that due to the scarcity of the reported cases of primary spinal GBMs, this issue requires a closer look. GBM behaves more aggressive in medulla spinalis than it behaves when it originates from cerebrum. It may disseminate to the cerebrum during its course and it may cause hydrocephalus due to this dissemination (metastasis).

Chordoma is known to be the most common primary tumor of the sacrum. Its surgery is challenging from many aspects. A large amount of bleeding is one of the biggest issues. A 52-year-old woman was admitted to our clinic with a huge mass at sacrum. The mass was diagnosed as chordoma after a needle biopsy. Prior to the surgery, a balloon dilation catheter (BDC) was placed in the distal abdominal aorta via the femoral artery. Just after the skin incision, the BDC was inflated with contrast medium and total occlusion of the aorta was achieved. At the end of the operation we observed that total hemorrhage had decreased dramatically. No complications were recorded except hypertension during the occlusion of the aorta which was expected. The patient was discharged after two weeks of hospitalization post-operatively without any neurological deficit. Our report is the second in the neurosurgical literature to our knowledge. Although this result is preliminary and needs to be replicated and expanded upon, our first experience with this method is effective for decreasing the amount of bleeding. We believe that our method prevents hemo-dynamical problems caused by massive bleeding and complications secondary to massive transfusion.

We report a rare case of ependymoma with vacuolar features, signet cells, pigmentation and numerous Rosenthal fibers arising in the fourth ventricle of a 35-year-old woman. The tumor was composed of cells with cytoplasmic vacuoles, signet cells and clear cells. The clear cells were compactly arranged resembling oligodendroglioma. Pseudovascular and ependymal rosettes were observed only in focal areas. Additionally, some tumor cells contained brown cytoplasmic pigment, which was histochemically compatible with lipofuscin and neuromelanin. On immunohistochemical examination, the tumor cells were positive for S100, glial fibrillary acidic protein and vimentin, and negative for synaptophysin, cytokeratin, neurofilament and HMB45. Epithelial membrane antigen staining showed dot-like and small vesicular reactivity. The case is presented to increase familiarity with these extraordinary variants of ependymoma.

We report a case of toxoplasmic encephalitis (TE) in a young woman without prior history of human immunodeficiency virus (HIV) infection. She was referred to our clinic with a diagnosis of multiple metastases following cerebral magnetic resonance imaging (MRI) revealing multiple ring-enhanced mass lesions. She had suffered from headaches for four weeks and there had been new onset of confusion and left hemiparesis. Soon after hospitalization, her neurological status rapidly deteriorated and she was operated for decompression. Pathology examination revealed TE and her blood samples were found to be HIV positive. We conclude that TE should be considered in the differential diagnosis of multiple lesions in sexually active individuals including cases without a prior history of HIV infection.

15th European Congress of Clinical Microbiology and Infectious Diseases -- APR 02-05, 2005 -- -- Copenhagen, DENMARK, WOS: 000233421000010, PubMed: 16221540, The aim of this study was to compare the antibacterial activity of teicoplanin and vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) meningitis using a rabbit meningitis model. The MRSA strain ATCC 43300 was used to infect the rabbits. The vancomycin group received 20 mg/kg vancomycin every 12 h (q12h), the teicoplanin group received 6 mg/kg teicoplanin q12h and the control group did not receive any treatment. Drug levels were measured using a bioassay technique. Bacterial counts in the treatment groups were significantly lower (P < 0.05) than those of the control group at 12 h and 24 h after treatment. When the treatment groups were compared, the bacterial counts after 12 h or 24 h of treatment were similar (P > 0.05). These data suggest that the antibacterial activity of vancomycin and teicoplanin are similar in experimental MRSA meningitis of rabbits. (C) 2005 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

AIM: Since 1996, all of the cases which apply to the Department of Neurological Surgery at Ege University and who undergo a surgery with the pre-diagnosis of a central nervous system tumor, are discussed on the Ege Neuro-oncology Board (Ege Noro-onkoloji Konseyi, ENOK) for further adjuvant treatment and follow-up. Aim of this study is to evaluate the demographical and epidemiological features of the cases enrolled, from 1st January 1996 to 31 December 2013. MATERIAL AND METHODS: Database of Ege Neuro-oncology Board (ENOK) was analyzed retrospectively in this descriptive study. 161 cases younger then 18 years old were excluded. Pathological diagnosis were classified regarding the 2007 world Health Organization (WHO). RESULTS: 5970 adult cases were enrolled and evaluated on the board of ENOK, between 1996 and 2013. It is detected that until 2005, number of cases enrolled were less then 300 per year and exceeded 400 per year after 2006. 484 (8.1%) of the all cases were non-tumoral. 49 (0.8%) cases were not operated due to lack of consent or other medical conditions. Total number of the all cases who were performed a surgery was 5437. 50.7% was male. The most common age group of the patients was 50-59 with 1289 cases (23.7%). The second most common age group was 40-49 consisting 1154 (21.2%) cases. The origin of the tumors was classified as neuro-epithelial tissue in 1586 (29.2%), meninges in 1319 (24.3%), pituitary in 736 (13.5%), metastasis in 650 (12.0%), cranial and peripheral nerves in 389 (7.2%), others in 262 (4.8%), un-certain in 211 (3.9%), lymphoma and other hem poetic in 124 (2.1%), sellar region in 74 (1.4%), mixt in 38 (0.7%), germ cell in 16 (0.3%) of the cases. The most common tumors diagnosed with female had meningeal origins (n = 906, 33.9%). The most common tumors diagnosed with male were neuro-epithelial tumors (n = 940, 34.1%). The second most common for female were neuro-epithelial tumors (n = 645, 24.1%) as for male were metastasis (n = 447, 16.2%). DISCUSSION AND CONCLUSION: Multi-disciplinary tumor boards in neuro-oncology are essential for treatment planning of each individual case. They also supply unique databases for epidemiological and demographical surveys. Especially in the developing world official medical registries may lack of certain and sufficient scientific data and detail. High volume neuro-oncological databases may be constituted only when the boards assembly regularly and keep its recordings meticulously for long period of years. Our epidemiological results are in parallel with the existing literature.

WOS: 000284693400062, PubMed ID: 20980575, In this report, we present a case of postneurosurgical meningitis due to Providencia stuartii, which was treated successfully with meropenem therapy lasting 21 days.