- OBJECTIVE: Basilar invagination is one of the most frequently observed abnormalities at the craniovertebral into the foramen magnum. - METHODS: The current study included 27 patients who -nderwent surgery for basilar invagination between October 2013 and January 2023. The study group was divided into 2 groups according to basilar invagination types; type I (the presence of type A atlantoaxial instability and instability is the main pathology) and type II (the presence of type B and C atlantoaxial instability and skull base dysgenesis is the main pathology). Craniometric parameters included in the study were atlantodental interval, posterior atlantodental interval, Chamberlain's line violation, clivus-canal angle, Welcher's basal angle, and Boogaard angle. - RESULTS: The mean age of the patients was 24.30 +/- 14.36 years (5-57 years). Fourteen patients (51.9%) were female, and 13 patients (48.1%) were male. Ten patients (37%) had type I basilar invagination, and 17 patients (63%) had type II basilar invagination. Preoperative and postoperative atlantodental interval and Boogaard angle were significantly higher in type I basilar invagination, as preoperative and postoperative posterior atlantodental interval and clivus-canal angle were significantly higher in type II basilar invagination. There was a positive strong correlation between Chamberlain's line violation and Boogaard angle. Postoperative Chamberlain's line violation was significantly higher in occipitocervical fixation (P = 0.035). C1 lateral mass screw fixation was found more successful in Chamberlain's line violation correction than occipital plates. Occipitocervical fixation was found to be associated with higher postoperative Nurick scores (P = 0.015) and complication rates (P = 0.020). Cages applied to the C1-C2 joint space were found to be associated with higher fusion rates (P = 0.023) and lower complication rates (P = 0.024). - CONCLUSIONS: In the present study, it was found that C1-C2 fixation was more successful in correcting craniometric parameters and had lower complication rates than occipitocervical fixation. In appropriate patients, it was determined that cage application increased the success rates of the operations.

Purpose: The aim of this study was to evaluate the effect of neurosurgical procedures on procalcitonin levels and the role of procalcitonin in distinguishing the inflammatory reaction due to surgery and postoperative infection. Materials and Methods: This study was performed on 27 patients with hydrocephalus. Among these patients, 10 patients had ventricular drainage while 17 had ventriculoperitoneal shunt. The changes in the values of procalcitonin, white blood cell count, C-reactive protein and body temperature were examined in the preoperative 1st and during postoperative 7 days. Results: All the patients had statistically significant increase in the body temperature values of the postoperative 1st day compared to preoperative values. C-reactive protein peaked in the postoperative 2nd day and, after that, followed a regular kinetic to show a decrease pattern. C-reactive protein was found to be 3 times higher in the postoperative 5th day compared to the preoperative value. Procalcitonin was found to remain in normal limits in all the patients that did not develop infection while the same was observed to increase in patients with infection. Conclusion: Procalcitonin will be a serious and safer parameter for the follow-up of the systemic complications following surgery upon the conclusions obtained with studies that include a higher number of patients and varying types of operations.

The surgical management of the giant and/or pituitary tumor presents technical problems entirely different in magnitude from the more usual pituitary mass. The outcome for transcranial microsurgery in giant adenomas, although it has improved significantly in recent reports, can still include morbidity. Giant adenomas as they expand involve a majority of the parasellar cranial nerves, cavernous sinus, anterior circulation arteries, posterior circulation arteries perforating arteries, and hypothalamus. Because of the importance of preserving these structures when encountering giant pituitary adenomas, the possible course, shape, and anatomical displacement found with these giant tumors should be known in detail. The correct surgical corridors chosen should offer the greatest exposure of tumor to subarachnoid pathways at the cranial base without damaging these vital structures. In the microsurgical area, iatrogenic lesions of the third ventricle, optic nerve, optic pathways, major arterial structures, and perforating arteries have decreased in transcranial pituitary surgery. An optimal postoperative outcome depends on the preservation of these vital structures, particularly the perforating arteries, using proper microsurgical strategies for these lesions. We examine and discuss in detail the necessary transcranial microneurosurgical strategies to preserve the involved susceptible structures in giant and/or invasive pituitary adenoma surgery.

The cavernous sinus region may be approached through several different corridors. The appropriate choice of surgical approach is dictated mainly by the extent and character of involvement of adjacent structures and by the specific entry corridors to the cavernous sinus expected to be used to resect the lesion. Lesions involving the anteromedial region are approached via the anteromedial and anterolateral triangles. Anterior triangle describes an epidural space that contains the C3 portion of the ICA. It is exposed by removal of the anterior clinoid process either intradurally or extradurally. The boundries of this triangle are the medial wall of the superior orbital fissure, the fibrous dural ring, and the extradural optic nerve. The medial triangle is bound by the intradural carotid artery, the posterior clinoid process, the porus oculomotorius and the siphon angle of the carotid artery. This space is the primary corridor of access to the C4 portion of the carotid artery. Therefore this triangle is used for the direct approach to most intracavernous aneurysms. Anteromedial triangles are also critical in terms of exposure for most intracavernous tumors. After drilling the posterior clinoid process, the expanded anteromedial triangle can be used to reach the C3-C4-C5 segment of the internal carotid artery. This approach is particularly useful for pituitary adenomas that have invaded the cavernous sinus. A thorough knowledge of these triangular entry corridors is a reasonable prerequisite to operating in the region. In this study we evaluate the microanatomical structures that use guidance landmarks by correlation of these structures and operative microsurgical digital video disc images in the expanded anteromedial triangle approach to the cavernous sinus.

Surgical approaches to the sellar region can be broadly categorized into three basic groups: trans-sphenoidal approaches, conventional craniotomy, and alternative skull base approaches. About 96% of all pituitary adenomas can be approached trans-sphenoidally. The remainder require transcranial approaches, consisting of standard pterional or subfrontal craniotomy or various skull base approaches that may be transcranial, extracranial, or a combination of the two. Pituitary tumors are usually treated by trans-sphenoidal approach for several reasons. The trans-sphenoidal route is the preferred approach to the majority of pituitary tumors because of its lesser morbidity and more direct trajectory compared with the transcranial route. In some circumstances, trans-sphenoidal surgery is contraindicated or insufficient. In these situations the alternative transcranial approach is indicated. The aims of transcranial pituitary surgery are ultimately to cure the patient of the tumor without damaging involved cranial nerves or adjacent neural and vascular structures for giant and/or invasive pituitary adenomas. Radical surgery is indicated for a hormone-secreting adenoma such as acromegaly or Cushing's syndrome in which hormonal cure depends on total removal of the tumor. Particularly in these circumstances the aim should be radical excision of the tumor with preservation of all involved vital structures. In this study, the patterns of growth of pituitary adenomas and the criteria for selection of the transcranial microsurgical approach in these cases are examined and discussed in detail.

ObjectThe objective of the investigation was to determine the comparative efficacy of cefoperazone/sulbactam versus cefazoline in the prophylaxis of patients undergoing neurosurgical procedures and to evaluate the choice of appropriate antibiotics for surgical prophylaxis. MethodsConsecutive patients undergoing neurosurgery in 2003 were recruited for the study. Patients undergoing neurosurgical procedures were assigned randomly to groups, one receiving cefoperazone/sulbactam, and the other receiving cefazoline for antimicrobial prophylaxis. All patients were followed for a minimum of 2 weeks postoperatively and all surgical site infections (SSIs) were recorded. ResultsA total of 28 postoperative SSIs were identified from 483 cases, with 13 (5.3%) in the cefoperazone/sulbactam group and 15 (6.4%) in the cefazoline group, with a resulting overall infection rate of 5.8%. The difference between the 2 groups was not statistically significant (P>0.05). The predominantly isolated microorganisms in patients with SSIs were Staphylococcus aureus [21 (75.0%)], Acinetobacter baumanii [4 (14.3%)], and Staphylococcus epidermidis [3 (10.7%)]. ConclusionsAs no single regimen of prophylactic antibiotic agent is appropriate for all neurosurgical procedures at all hospitals, the expected organisms cultured from prior wound infections should determine the appropriate antimicrobial therapy for each institution.

Although the main advantage of the CO, laser lies in the possibility of a less traumatie effeet on the surrounding tissue. its use in neurosurgery still neeessitates a thorough and detailed evaluation of the effeet on surrounding normal central nervous system (CNS)tissue. Therefore this study was undertaken to investigate the ultrastruetural and biochemical effeets of the CO, laser on the application area and the surrounding normal central nervous system tissue . Sodium-potassium aetivated and magnesium-dependent adenosine-S·-triphosphatase (Na+-K + IMg 2+ ATPase E.C.3.6.3.1) . magnesium dependent adenosine -S'-triphosphatase (Mg2+ ATPase E.C.3.6.1.3) and ealoum aetivated magnesium dependent adenosine-S·-triphosphatase (Ca2+/Mg2+ ATPase E.C.3.6.1.3)enzymes. superoxide dismutase.

This report is of a patient with an isolated seiiar tuberculoma with supraseiiar extension in association with thickening of the pituitary stalk who presented with signs and symptoms of hypopituitarism. Magnetic resonance imaging showed a seiiar mass with supraseiiar extension associated with thickening of the pituitary stalk. Endocrinological parameters indicated hypopituitarism. The patient underwent a transsphenoidal procedure. The pathological diagnosis was of a typical structure of tuberculoma. if a pituitary tumor with suprasellar extension in association with the thickening of the pituitary stalk is suspected, the possibility of seiiar tuberculoma must be considered in the differential diagnosis of nonsecreting sellar masses, even when no history of tuberculosis exists.

Objectives Lhermitte-Duclos disease (LDD), or dysplastic gangliocytoma of the cerebellum is a rare benign unilateral mass of the cerebellar cortex, characterized by a disarrangement of the normal cerebellar laminar cytoarchitecture and circumscribed enlargement of cerebellar folia. LDD was recently considered to be part of a multiple hamartoma-neoplasia syndrome [Cowden disease (CD)]. The debate whether LDD represents a neoplastic or hamartomatous lesion is still in progress. Methods The aim of the present study is to answer this question with review of the literature emphasize on clinical presentation, radiologic findings, surgical procedures, and histopathologic features of LDD. Results LDD most frequently presents in the third and fourth decades of life, but the age at clinical manifestation ranges from the neonatal period to the seventh decade. The initial presentation of LDD, similar to other posterior fossa tumors, includes increased intracranial pressure, vomiting, intermittent headache, cerebellar dysfunction, and noncommunicating hydrocephalus. Magnetic resonance imaging is the diagnostic modality and reveals characteristic usually nonenhancing gyriform patterns with enlargement of cerebellar folia. Surgical excision is a therapeutic procedure generally performed. The histopathologic findings of LDD include thickening of the molecular layer, which is occupied by abnormal ganglion cells, absence of the Purkinje cell layer, and hypertrophy of the granule cell layer. Conclusions LDD is an unusual hamartomatous lesion of the cerebellar cortex, which can be associated with CD. When the diagnosis of either one of these 2 disorders is established, it is imperative to search for the other disease, to detect early malignant lesions that occur in CD.

Intracranial chondromas usually arise from the base of the skull. They rarely originate from the convexity dura and falx. Here we describe two cases of intracranial chondroma located at the convexity dura and falx, discuss the genesis, radiologic, histologic features and review the literature.

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.

Experiments were carried out to compare the effectiveness of dexamethasone, a barbiturate, and hypothermy on experimental cerebral edema caused by CO2 laser in dogs. Experimental brain lesions were created over the right frontal cortex of the dogs through the intact dura mater with CO2 laser energy (40 W impact, 0.5 second duration, for a total time of 4 seconds on a 12.5 mm surface). Animals were divided into four groups and treated with dexamethasone, a barbiturate, hypothermy, and a crystalloid (control group). The brains were examined 48 hours after injury. Histologically all brain lesions showed three distinct layers with a vaporized center bordered by a zone of coagulation necrosis surrounded by edema. The main finding in the surrounding coagulation and edematous layers was dilatation of the vessels. Hemorrhage was sometimes observed mainly in the edematous layer. The effect of these therapies on the laser lesion and the effectiveness of these therapies on surrounding cerebral edema were evaluated by both light and electron microscopy. The control group showed significantly greater edema than the dexamethasone group. There was only a minimal difference between the control group and the barbiturate group, and there was no significant difference in amount of edema between control group and the hypothermy group. There was less edema in the dexamethasone group than in the other ones. These data suggest that dexamethasone inhibits edema in CO2 laser lesions with the same efficacy as shown in the treatment of vasogenic edema.

Endorphins have been implicated in the pathophysiology of spinal cord injury (SCI). Although some possible mechanisms for the therapeutic actions of naloxone have been Postulated, the exact mechanism of these favorable actions is not yet known with certainty. The benefit of naloxone in the recovery of neurologic function has generally been attributed to its action at the opiate receptors. The effect of naloxone on the inducible nitric oxide synthase (iNOS) immuno reactivity, superoxide dismutase (SOD) level, and ultrastructural findings were studied in rats at the early and late stages of SCI, produced with an aneurysm clip on the T2 to T7 segments. Severity rats were randomly allocated to 4 groups. The animals in group I (10 rats) were killed to provide normal spinal cord tissue for testing. Group 2 (20 rats) underwent 6-segment laminectomy so that the effects of total laminectomy Could be determined. Group 3 (20 rats) underwent 6-segment T2 to T7 laminectomy, and SCI was produced by extradural compression of the exposed cord. The same procedures were performed in the 20 rats in group 4, but these rats also received 1 (2 mg/kg) intraperitoneal injection of naloxone immediately after the injury, a second dose 24 hours after trauma, and a third dose 48 hours after trauma. Half of the animals from groups 3 and 4 were killed 2 hours after trauma, and the other half were killed 48 hours after trauma. The exposed cord segments were immediately removed and processed for analysis. The results showed that naloxone treatment reduces secondary structural changes in damaged rat spinal cord tissue by affecting iNOS and SOD activity.

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.