Background: This prospective study aimed to determine the spectrum and the main risk factors of surgical site infection (SSI) after neurosurgical procedures in our clinic.Methods: Consecutive patients undergoing neurosurgery between November 1, 2001, and November 1, 2002, were recruited for the study. All patients were followed for a minimum of 2 weeks postoperatively and all SSIs were recorded. The complete medical records of each case were reviewed, and data on 14 possible risk factors were extracted. Statistical analyses were performed to identify the risk factors for SSIs.Results: A total of 31 postoperative SSIs were identified among 503 cases included in the study, with a resulting overall infection rate of 6.2%. The risk of SSI was increased by age (odds ratio [OR], 1.1; 95% confidence interval [CI], 1.0-1.1; P.039), operation type such as "shunt operations" (OR, 670.4: 95% CI, 2.6-171123.1; P = .021), presence of foreign body (OR, 141.0; 95% CI, 2.5-7925.9; P = .016), presence of diabetes mellitus (OR, 24.3-1 95% CI, 2.1-284.9; P = .011), and intracranial pressure monitoring (OR, 4878.9; 95% CI, 23.8-1001229; P = .002). The predominantly isolated microorganisms in patients with SSIs were Staphylococcus aureus (22 [71.0%]), Acinetobacter baumanii (5 [16.1%]), and Staphylococcus epidermidis (4 [12.9%]).Conclusions: SSIs remain an important problem in neurosurgery. Identification of the risk factors for SSI will help physicians to improve patient care and may decrease mortality, morbidity, and health care costs of neurosurgery patients. (C) 2005 Elsevier Inc. All rights reserved.

OBJECTS:A rare case of cerebellopontine angle arachnoid cyst leading to congenital peripheral facial palsy was presented.CLINICAL PRESENTATION:A 1-year-old girl presented with peripheral facial paralysis since birth. Computed tomography and magnetic resonance imaging revealed left cerebellopontine angle arachnoid cyst causing moderate displacement of the brain stem.INTERVENTION:Retrosigmoid suboccipital craniotomy was performed and microsurgical resection of the cyst wall and fenestration of the cyst to the basal cisterns were achieved.CONCLUSIONS:Cerebellopontine angle arachnoid cyst should be considered as a potential cause of congenital peripheral facial palsy.

Intraventricular meningiomas are rare tumors, comprising only 0.5% to 5% of all intracranial meningiomas. In this article, 8 cases of histopathologically proven intraventricular meningioma that were treated at the Çukurova University Neurosurgery Department are discussed. The radiologic, histologic, and clinical findings of intraventricular meningiomas and the surgical approach to lateral intraventricular meningiomas were reviewed retrospectively. Our 8 patients ranged in age from 18 to 65 years (mean = 44.6 years). Two patients were male and 6 were female, for a 1:3 male-to-female ratio. Computed tomography and magnetic resonance imaging demonstrated the 7 tumors within the lateral ventricle and only 1 tumor within the third ventricle. All lateral ventricular tumors were located in the region of the trigone. Headache and hemiparesis were the most common presenting symptoms. Histologic studies revealed meningotheliomatous meningiomas in 5 patients, transitional meningioma in 2 patients, and anaplastic (malignant) meningioma in 1 patient. The superior parieto-occipital approach in 5 patients, posterior middle temporal gyrus approach in 2 patients, and posterior transcallosal approach in 1 patient were used for surgical therapy, and total resection was achieved in all patients. The overall neurologic outcome at follow-up (mean follow-up = 12 months, range: 1 month to 5 years) was excellent (no deficit) in 4 patients, good (some deficit but independent) in 2 patients, and poor (dependent) in 1 patient. One patient died after surgery. We conclude that intraventricular meningiomas are curable by complete surgical resection. This is possible with little neurologic morbidity when the neurosurgeon understands the surgical approaches available and the indications for those approaches.

Intraventricular meningiomas are rare tumors, comprising only 0.5% to 5% of all intracranial meningiomas. In this article, 8 cases of histopathologically proven intraventricular meningioma that were treated at the Qukurova University Neurosurgery Department are discussed. The radiologic, histologic, and clinical findings of intraventricular meningiomas and the surgical approach to lateral intraventricular meningiomas were reviewed retrospectively. Our 8 patients ranged in age from 18 to 65 years (mean = 44.6 years). Two patients were male and 6 were female, for a 1:3 male-to-female ratio. Computed tomography and magnetic resonance imaging demonstrated the 7 tumors within the lateral ventricle and only 1 tumor within the third ventricle. All lateral ventricular tumors were located in the region of the trigone. Headache and hemiparesis were the most common presenting symptoms. Histologic studies revealed meningo-theliomatous meningiomas in 5 patients, transitional meningioma in 2 patients, and anaplastic (malignant) meningioma in 1 patient. The superior parieto-occipital approach in 5 patients, posterior middle temporal gyrus approach in 2 patients, and posterior transcallosal approach in 1 patient were used for surgical therapy, and total resection was achieved in all patients. The overall neurologic outcome at follow-up (mean follow-up = 12 months, range: 1 month to 5 years) was excellent (no deficit) in 4 patients, good (some deficit but independent) in 2 patients, and poor (dependent) in 1 patient. One patient died after surgery. We conclude that intraventricular meningiomas are curable by complete surgical resection. This is possible with little neurologic morbidity when the neurosurgeon understands the surgical approaches available and the indications for those approaches.

Object. The authors examined the relationships of brain-tumor interfaces, specific magnetic resonance (MR) imaging features, and angiographic findings in meningiomas to predict tumor cleavage and difficulty of resection.Methods. Magnetic resonance imaging studies, angiographic data, operative reports, clinical data, and histopathological findings were examined retrospectively in this series, which included 126 patients with intracranial meningiomas who underwent operations in which microsurgical techniques were used. The authors have identified three kinds of brain-tumor interfaces characterized by various difficulties in microsurgical dissection: smooth type, intermediate type, and invasive type. The signal intensity on T-1-weighted MR images was very similar regardless of the type of brain-tumor interface (p > 0.1). However, on T-2-weighted images the different interfaces seemed to correlate very precisely with the signal intensity and the amount of peritumoral edema (p < 0.01), allowing the prediction of microsurgical effort required during surgery. On angiographic studies, the pial-cortical arterial supply was seen to participate almost equally with the meningeal-dural arterial supply in vascularizing the tumor in 57.9% of patients. Meningiomas demonstrating hypervascularization on angiography, particularly those fed by the pial-cortical arteries, exhibited significantly more severe edema compared with those supplied only from meningeal arteries (p < 0.01). Indeed, a positive correlation was found between the vascular supply from pial-cortical arteries and the type of cleavage (p < 0.05).Conclusions. In this analysis the authors proved that there is a strong correlation between the amount of peritumoral edema, hyperintensity of the tumor on T-2-weighted images, cortical penetration, vascular supply from pial-cortical arteries, and cleavage of the meningioma. Therefore, the consequent difficulty of microsurgical dissection can be predicted preoperatively by analyzing MR imaging and angiographic studies.

Penetrating and perforating periorbital puncture wounds by lead pencils are not rare, but ones that reach the brain stem are extremely unusual. We recently treated a patient with of this type of injury. A newly sharpened lead pencil was accidentally introduced through the subconjunctiva at the inner canthus of the right eye. It passed along the medial border of the globe transorbitally and went through the superior orbital fissure into the temporal fossa, then continued through the lateral side of the sella and posterior clinoid, reaching the brain stem. The entire pencil was removed inch by inch without incident under CT control. Meanwhile, the operative team remained ready in case of emergency bleeding. The patient's postoperative course was uneventful, but the initial neurologic deficit of the patient remained fixed.

Since computerized tomography scanning became available at the Division of Neurosurgery in July, 1979, 13 patients have undergone removal of colloid cysts of the third ventricle by transfrontal or transcallosal routes. Computerized tomography has increased the number of colloid cysts detected in the foramen of Monro during neurological diagnostic workups. The clinical and diagnostic aspects and changing concepts in the treatment of colloid cysts are reviewed.

A patient with a giant intracavernous carotid aneurysm usually has symptoms and signs of a space-occupying lesion, producing one of a variety of types of cavernous sinus syndromes. Epistaxis is an unusual feature in these patients. A patient who noted the onset of repeated arterial epistaxis 2 years after a severe head injury was found to have a traumatic aneurysm of the cavernous portion of internal carotid artery. After angiography, he suddenly developed profuse, pulsatile, arterial epistaxis and had a cardiopulmonary arrest. This case and a review of previously reported cases emphasize the importance of early cerebral angiography in patients with posttraumatic recurrent epistaxis.

Obstruction at the foramen of Monro resulting in unilateral hydrocephalus is an uncommon entity that may be caused by a wide range of lesions including tumors, vascular malformations, and inflammatory conditions. A case of unilateral hydrocephalus secondary to congenital atresia of the foramen of Monro treated with stereotactic fenestration of the septum pellucidum is presented.

From 1980 through 1991, 78 patients with brain abscess were treated at the Cukurova University School of Medicine Department of Neurosurgery by surgical excision and antimicrobial therapy. Males predominated in all age groups. Although only 17 percent had a predisposing conditions such as local sinus infection, cyanotic heart disease, the majority of the cases had some evidence of a systemic infection such as peripheral leucocytosis and elevated erythrocyte sedimentation rate. The correct diagnosis was commonly not considered despite to these clues of an infective process on admission. The operative mortality was 20% which was similar to the other series reported in the literature. However in spite of significant progress with the advent of computerized tomography, microbiology and antibiotic treatment, difficulties in early diagnosis are held to be responsible for the residual high mortality. Although the appropriate antibiotic therapy, adjuvant medical therapies to control perioperative brain swelling, and the application of reliable surgical techniques have decreased the mortality and morbidity rates, the best result can only be obtained to a wider number of patients if the physician remains alert to the possibility of an intracranial abscess.