The aim of this study is to describe patients who represent spontaneous regression of lumbar disc herniations (LDHs) subsequent to conservative treatments. In this retrospective study, medical records of 862 patients who had presented to our neurosurgery department with LDHs between May 2014 and May 2016 were studied. All of these patients had a history of low back pain and radiculopathy. Lumbar magnetic resonance imaging (MRI) scans were performed to diagnose them.LDHs were categorized into four subtypes including disc bulging, protrusion, extrusion, and sequestration. Five patients developed spontaneous regression of LDHs according to spinal MRI scans. All patients relieved radiculopathy symptoms in 2 to 4 weeks and low back pain symptoms in 3 to 8 weeks except one patient. In one patient hypoesthesia symptom, in one patient motor deficit, and in one patient low back painremained after the regression. The clinical and diagnostic imaging characteristics and outcomes of these five patients are described and the pertinent literature regarding spontaneous regression of LDHs is reviewed. Sequestrated disc herniations represent the main candidates for spontaneous regression according to our clinical research and the pertinent literature. Dehydration and inflammation-related resorption are the main mechanisms for this event. Conservative treatment modalities should not be underestimated for the treatment of such patients in the absence of definitive surgical indications.

Objective:Since the evaluation of the microsurgery techniques, intraoperative diagnosis of the central nervous system (CNS) lesions has gained importance. Squash smear (SS) preparation, imprint cytology, and frozen sections are the main diagnostic techniques. SS is challenging for the pathologist with various traps. The present study was undertaken to assess the diagnostic accuracy, pitfalls of the intraoperative SSs of the 545 CNS lesions, and compare it with the final paraffin diagnosis. Study Design:Intraoperative diagnosis of 545 CNS lesions were analyzed retrospectively from the files of the Pathology Department of Cukurova University, Medical Faculty, between the years of 2004 and 2012. The SSs were prepared at the time of intraoperative consultation and stained by hematoxylin and eosin. Results:Diagnostic accuracy was 94.4%. The overall sensitivity was 99.4% and the specificity was 91.5%. In addition, positive predictive value was 98.2%. Discussion:We have evaluated the discordant cases in our series and discussed the diagnostic pitfalls of SSs of CNS lesions. Awareness of the potential sources of misinterpreted cases together with the combination of radiology, clinical history, and location may increase the diagnostic accuracy.

This report evaluated the short and midterm results of the safety and effectiveness of the treatment technique with hybrid and non-hybrid Y-configured, dual stent-assisted coil embolization of wide-neck intracranial aneurysms, and reviewed the literature concerning this technique. Nine patients, eight with unruptured and one with ruptured aneurysms were included in the study. Of aneurysms embolized with a hybrid (with two different stents) and non-hybrid (with two identical stents) technique, three were located in the anterior communicating artery, three at the tip and one at the distal site of basilar artery, and two in the middle cerebral artery. All aneurysms included the orifices of bifurcation vessels. All aneurysms were stented and embolized during the same session. While Neuroform and Enterprise stents were used in the hybrid technique, two Enterprise stents were used in the non-hybrid technique. Dual Y-stent assisted coil embolization was performed successfully in eight of nine patients (88.9%), including five patients (55.6%) with hybrid and three patients (33.3%) with non-hybrid technique. No procedural complication, no mortality and no minor or major neurological complications were seen during the angiographic or clinical follow-up. When an attempt was made at passing the second stent through the first Enterprise stent, the stent protruded inside the aneurysm in one patient (11.1%). Hybrid or non-hybrid dual Y-stent-assisted coil embolization in the treatment of ruptured or unruptured wide-neck and complex intracranial aneurysms is a safe and effective method from the viewpoint of short and midterm results.

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.

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.

Objective: Congenital intracranial tumors are very rare and only account for 0.5-1.5% of all childhood brain tumors. The most common type of these tumors present at birth is teratomas, which represent 0.5% of all intracranial tumors. Most teratomas are midline tumors located predominantly in the sellar and pineal regions. In this study, we report a neonatal intracranial immature teratoma at the lateral ventricle because of its rare location.Case Report: A 3-day-old female neonate presented with a history of irritability, vomiting, and recurrent generalized clonic seizures since birth. A head computed tomographic scan and magnetic resonance imaging disclosed a large tumor filling the right lateral ventricle and extending into the ipsilateral posterior fossa. With right parieto-occipital craniotomy, large grayish-white lobulated vascular mass was encountered and total removal of tumor was performed. Histological examination revealed the diagnosis of immature teratoma.Conclusion: The prognosis of congenital intracranial immature teratoma is usually poor because the lesions are extensive when they are identified. Prenatal ultrasonography is necessary for the prenatal diagnosis. Fetal magnetic resonance imaging should be made for the evaluation of intracranial tumor. If the tumor is detected before the 24 week of gestation, termination of the pregnancy should be considered.

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.

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.

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.

The purpose of this study is to evaluate the distribution, clinical features, and treatment modalities of arachnoid cysts (ACs) in our clinic. The study was carried out between January 1, 1996 and November 31, 2002 at the Neurosurgery Department of Cukurova University Hospital, Adana, Turkey. Thirty-five patients (13 female and 22 male) with ACs demonstrated by cranial magnetic resonance imaging or computed tomography during this period were enrolled and discussed in this study. The middle cranial fossa was the most common location of ACs; ACs were located in the middle cranial fossa in 22 (62.9%) cases, followed by the cerebellopontine angle in 4 (11.4%) cases, the cerebral convexity in 3 (8.6%) cases, the suprasellar region in 2 (5.7%) cases, the quadrigeminal cisterns in 2 (5.7%) cases, and the retrocerebellar region in 2 (5.7%) cases. All cysts were unilateral: 25 (71.4%) were located on the left side, and 10 (28.6%) were located on the right side. The mean age at onset of clinical manifestations was 3 years, 6 months (range: 1 month to 12 years). The mean age at diagnosis was 8 years (range: 1-32 years). The most frequent clinical features on presentation were epileptic seizures (42.9%) and headache (28.6%). A few patients (9 [25.7%]) underwent surgery. Surgical intervention with microsurgical excision and fenestration was performed in 7 patients, and cystoperitoneal shunting was performed in 2 patients. The major indications for surgery of ACs are intractable seizures, intracranial hypertension, and compression of neuronal tissues. Headache only is not a surgical indication. Microsurgical excision and fenestration are safe and effective for the surgical treatment of ACs.

A 22-year-old woman who had headache and numbness on the right side of the face, arm, and leg (transient ischemic attack–like) was admitted to the clinic. She had given birth by epidural anesthesia 8 days previously. A subdural hematoma was detected by means of neuroimaging. Spontaneous remission was followed up clinically and radiologically. The complications of epidural anesthesia were discussed, and the awareness of clinicians regarding this matter is pointed out.

Shunt malfunction caused by fracture of the distal tube is a common complication of ventriculoperitoneal shunts. Functionality of the fractured distal shunt tube must be evaluated before its removal, because a connective tissue sheath or subcutaneous fibrous channel around the peritoneal catheter may be patent. Although an accurate assessment of shunt function is made by invasive tests such as radioisotope or radiopaque injection via tapping the reservoir, these methods have risks. In our case, patency of a subcutaneous fibrous tunnel that had developed around the distal catheter before the fracture was demonstrated noninvasively by real-time ultrasonography.

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.

Medulloblastoma is an invasive embryonal tumor of the cerebellum with predominant neuronal differentiation. Although several hereditary cancer syndromes have been implicated in medulloblastoma formation, such as Turcot, Gorlin, and Li Fraumeni syndrome, the majority of these tumors cannot be explained by mutations in genes and most medulloblastomas appear sporadically. A 6-year-old girl previously diagnosed with Turner syndrome presented with ataxia and symptoms of raised intracranial pressure. Diagnostic workup disclosed a posterior fossa tumor. Histopathologic study of the excised neoplasm showed a medulloblastoma. The current literature was reviewed; no case of medulloblastoma and Turner syndrome that has been verified on pathologic examination has been reported to date.

Summary. Background: Choroid plexus papillomas are rare, accounting for less than 1% of all intracranial tumours in adults. However, they are relatively more common in childhood and constitute 1.5 to 4% of intracranial tumours. They are most often located in the lateral ventricle, followed by the fourth and third ventricles and, rarely, in the cerebellopontine angle. Bilateral lateral ventricle choroid plexus papilloma is very rare and only a few cases has been reported. Clinical presentation: A 3-year-old boy was admitted to our hospital with a history of irritability and vomiting. Neurological examination on admission was normal. A head computed tomographic scan and magnetic resonance imaging showed tumours in both lateral ventricles, hydrocephalus and a left temporal arachnoid cyst. The bilateral intraventricular mass enhanced densely and homogeneously. A presumptive diagnosis of choroid plexus papillomas was made. Intervention: The initial surgery was performed for removal of the lesion in the right lateral ventricle, and 20 days later removal of the left lateral ventricle tumour was carried out. Bilateral temporoparietal craniotomy and total removal of tumours was performed. Hydrocephalus was controlled by total tumour resection from both sides. The histology of these tumours was the same and revealed choroid plexus papilloma. Interpretation: Bilateral choroid plexus papilloma is extremely rare and distinct from diffuse villous hypertrophy and their surgical approaches are different from each other. Differential diagnosis should be made by MRI preoperatively. If bilateral choroid plexus papilloma is detected, total surgical resection should be performed. Total surgical removal of the neoplasm not only cures the tumour but also may lead to complete resolution of the hydrocephalus.