26 research outputs found
Ruptured distal anterior choroidal artery aneurysm
No full textThis report describes a patient with a rare distal anterior choroidal artery (AChoA) aneurysm that developed a right intracerebral haematoma and intraventricular haemorrhage and was treated by surgical exploration and clipping via a transtemporal/ventricular approach. The patient was discharged neurologically intact. We review the literature related to these rare aneurysms within the temporal horn, and the surgical anatomy of the AChoA. Crown Copyright (C) 2008 Published by Elsevier Ltd. All rights reserved
Microsurgical Perspective for Uncommon Variations Associated with the Vertebrobasilar Junction: An Anatomical and Radiologic Investigation
No full textCerrahpaşa Medical JournalObjective: Anatomic variations of the vertebrobasilar junction have been described as uncommon, but may have important neurosurgical implications. The aim of this study is to emphasize the importance of the variations during the surgery and report the frequency of detected uncommon variations through cadaver dissection and computed tomography angiography. Methods: A combined cadaveric and radiologic study was performed to assess for basilar artery fenestration, intervertebral transversal anastomosis, and persistent primitive lateral vertebrobasilar anastomosis. Thirteen formalin-fixed human cadaveric heads were perfused with red- and blue-colored silicone and dissected in a stepwise manner through an endoscopic endonasal transclival approach. Radiologic data from 887 subjects were retrospectively analyzed for the presence of intervertebral transversal anastomosis. Results: Basilar artery fenestration was found in 7 patients (0.8), intervertebral transversal anastomosis in 1 (0.1), and persistent primitive lateral vertebrobasilar anastomosis in 1 (0.1) by CTA analysis. Conclusion: Anatomic variations of the vertebrobasilar junction are a rare, but important, finding in vascular neurosurgery practice. We also report the first case of intervertebral transversal anastomosis discovered through human brain dissection
Glycogen synthase kinase-3 inhibition in glioblastoma multiforme cells induces apoptosis, cell cycle arrest and changing biomolecular structure
No full textGlioblastoma multiforme (GBM) is the most malignant and aggressive primary human brain tumors. The regulatory pathways of apoptosis are altered in GBMs, leading to a survival advantage of the tumor cells. Thus, identification of target molecules, which are effective in triggering of the cell death mechanisms in GBM, is an essential strategy for therapeutic purposes. Glycogen synthase kinase-3 (GSK-3) plays an important role in apoptosis, proliferation and cell cycle. This study focused on the effect of GSK-3 inhibitor IX in the GBM cells. Apoptosis induction was determined by Annexin-V assay, multicaspase activity and immunofluorescence analyses. Concentration-dependent effects of GSK-3 inhibitor IX on the cell cycle were also evaluated. Moreover, the effect of GSK inhibitor on the cellular biomolecules was assessed by using ATR-FTIR spectroscopy. Our assay results indicated that GSK-3 inhibitor IX induces apoptosis, resulting in a significant increase in the expression of caspase-3 and caspase-8 proteins. Cell cycle analyses revealed that GSK-3 inhibitor IX leads to dose -dependent G2/M-phase cell cycle arrest. Based on the FTIR data, treatment of GBM cells causes dysregulation in the carbohydrate metabolism and induces apoptotic cell death which was characterized by the spectral alterations in nucleic acids, an increment in the lipid amount with disordering state and compositional changes in the cellular proteins. These findings suggest that GSK-3 inhibitor IX exhibits anti-cancer effects by inducing apoptosis and changing biomolecular structure of membrane lipids, carbohydrates, nucleic acids and proteins, and thus, may be further evaluated as a potential effective candidate agent for the GBM combination therapies. (C) 2018 Elsevier B.V. All rights reserved
The diagnostic value of complete blood count parameters in patients with subarachnoid hemorrhage
No full textObjectives: Diagnosis of subarachnoid hemorrhage (SAH) in patients presenting with headache is challenging and there has been any biomarker studied for excluding of SAH in those patients. We aim to determine the sensitivity of leukocytosis or left shift to exclude the diagnosis of SAH in ED patients presenting with headache. Method: Adult patients with headache who received a computed tomography (CT) with the diagnosis of SAH and had a complete blood count (CBC) represent the case group, headache patients with normal CT and had a CBC represent the control group. The white blood cell (WBC) count and percentage of polymorphonuclear cells (PMNs%) taken during admission and within the first 6 and 12Â h of admission were recorded. Results: A hundred ninety seven patients with SAH and 197 patients without SAH were enrolled in to study. Sensitivity, specificity, NPV and PPV of leukocytosis or increase in PMNs% (left shift) in the diagnosis of SAH was 89.8% (84.5â93.5, 95% CI), 46.7% (39.6â53.9, 95% CI), 82.1% (73.5â88.4, 95% CI) and 62.8% (56.8â68.4, 95% CI) respectively on initial emergency department (ED) admission. Conclusion: CBC should be considered as a noninvasive test for the exclusion of SAH in ED patients with 6Â h observation. Keywords: Complete blood count, Subarachnoid hemorrhage, Emergency medicin
Effects of Glycogen Synthase Kinase Inhibitor on Glioblastoma Multiforme Cell Line via Apoptosis and Cell Signaling Pathways
No full textAIM: To investigate the apoptotic and molecular effects of glycogen synthase kinase-3 (GSK-3) in glioblastoma multiforme (GBM). MATERIAL and METHODS: Human primary glioblastoma cell line (U-87 MG) and the human fetal glial cell line (SVGp12) were used. The cells were exposed to the different doses of GSK inhibitor for 24, 48 and 72 hours. Induction of apoptosis was assessed by DNA fragmentation (TUNEL) assay. EGFR and NF-kB expression was evaluated by immunofluorescence analyses. RESULTS: GSK-3 inhibitor IX induced cytotoxicity and apoptosis in dose-dependent manner in GBM cells. Our results indicated that GSK-3 inhibitor IX induces apoptosis, resulting in a significant decrease in the expression of NF-kB and EGF. CONCLUSION: Inhibition through GSK-3 has been found promising in creating therapeutic management of GBM cells. Proliferation, differentiation, cell cycle regulation, and apoptosis are mechanisms that must be interpreted as a whole. Components associated with EGFR, NF-kB, and apoptosis affect the mechanism solely and collectively. Our collective data suggest that GSK-3 inhibitor IX inhibited cellular proliferation and induced apoptotic events by modulating EGFR and NF-kB expression in GBM cells. GSK-3 inhibition holds promise for the development of new approaches for the therapeutic management of GBM cells.World Federat Neurosurg SocEge University scientific research project fundingEge University [16 TIP 039]This experimental study was supported by Ege University scientific research project funding (Project number: 16 TIP 039)
Clinical Outcomes and Complication Rates of Ventriculoperitoneal Shunts in Hydrocephalic Infants with Meningomyelocele: A Ten-Year Review at a Single Institution
No full textBackground/Objectives: This study aimed to investigate the surgical treatment and management of hydrocephalus in infants with meningomyelocele and compare the single-center experience with the previous studies. Methods: This retrospective study included 81 infants (47 females and 34 males) who underwent meningomyelocele closure surgery and subsequent ventriculoperitoneal (VP) shunt surgery for hydrocephalus. Clinical and demographic data were retrospectively collected from hospital records, focusing on variables such as the timing of VP shunt placement relative to MMC closure, postoperative complications, and the need for shunt revisions. Patients were followed for a mean duration of 58.11 months to monitor long-term outcomes and identify factors associated with shunt failures and infections. Results: The mean follow-up period since birth was 58.11 (33.72) months. Shunt problems affected 30% (25/81) of patients with mechanical causes (8/25) and infections (6/25). A proximal mechanical malfunction/dysfunction was seen in 32% (8/25) of the shunts. Shunt infections occurred in 23% (19/81) of infants, and the mean time for shunt infection onset following the VP shunt procedure was 0 (0-39) median (min-max) months. Overall, 8 (9.9%) infants had short-term shunt infections, whereas 11 (13.6%) had long-term shunt infections. The mean length of the intensive care unit stay was 35.75 (25.28) days. Significant difference was seen in the number of shunt reoperations for short- and long-term infections (p < 0.001). All infants had at least one operation before the infection of their shunt system. Male gender was significantly associated with long-term shunt infections (p = 0.021). The study revealed methicillin-resistant coagulase-negative staphylococcus to be the most common isolated organism from infected shunts at 72.7% (6/11). Conclusions: This study demonstrates that hydrocephalic infants with meningomyelocele undergoing VP shunt surgery face notable risks of infection and mechanical complications, with methicillin-resistant coagulase-negative staphylococcus identified as the most common pathogen. The findings emphasize the importance of comprehensive postoperative care and targeted infection management to improve outcomes in this vulnerable population
Effects of Lutein on Brain Damage and Vasospasm in an Experimental Subarachnoid Hemorrhage Model
No full text© 2020 Elsevier Inc.Objective: Vasospasm developing after subarachnoid hemorrhage (SAH) is an important cause of mortality and morbidity. Lutein is a carotenoid with antioxidant and anti-inflammatory properties. The aim of present study was to investigate effects of lutein on the basilar artery and nerve tissues. Methods: Wistar rats were randomly divided into 3 groups: control (group 1), SAH (group 2), and SAH treated with lutein (group 3). Lutein was administered for 3 days by means of orogastric gavage. Basilar artery lumen area, wall thickness, serum total antioxidant status, serum total oxidant status, and oxidative stress index were calculated. Histopathologic and immunohistochemical analyses were conducted. Results: No statistically significant difference was found between groups in terms of wall thickness; lumen area; and serum total antioxidant status, serum total oxidant status, and oxidative stress index values. A statistically significant difference was found between groups colored with terminal deoxynucleotidyl transferase dUTP nick end labeling (P < 0.005). Post hoc analysis was used to examine the results between groups. Results of group 1 and group 3 were equal (P = 1) and lower than group 2 (P = 0.04 and P = 0.006, respectively). Conclusions: Lutein was found to have a positive effect on width of the basilar artery lumen area. Therefore, positive effects of lutein on vasospasm might be statistically significant if lutein is administered at higher doses. Lutein was found to be effective in preventing brain damage after SAH. To our knowledge, this study is the first in the literature to examine the effect of lutein on vasospasm and brain damage after SAH
Does Decompressive Duraplasty Have a Neuroprotective Effect on Spinal Trauma?: An Experimental Study
No full textBACKGROUND: Spinal cord injury (SCI) may result in neuromotor, sensory, and autonomic function damages. Edema because of spinal cord trauma can reach serious dimensions. The aim of this study was to histologically evaluate the effects of duraplasty on neural tissues
Ventriculoperitoneal shunt infections and re-infections in children: a multicentre retrospective study
No full textPurpose: Ventriculoperitoneal shunt (VPS) is the most common treatment modality for hydrocephalus. However, VPS infection is a common and serious complication with high rates of mortality and morbidity. The objective of this study was to investigate causative agents and the management of VPS infections and to identify risk factors for re-infection in children. Materials and methods: Retrospective, multicentre study on patients with VPS infection at paediatric and neurosurgery departments in four tertiary medical centres in Turkey between January 2011 and September 2014. Results: A total of 290 patients with VPS infections were identified during the study period. The aetiology of hydrocephalus was congenital malformations in 190 patients (65.5%). The most common symptom of shunt infection was fever in 108 (37.2%) cases. At least one pathogen was identified in 148 VPS infections (51%). The most commonly isolated pathogen was coagulase-negative staphylococci, which grew in 63 cases (42.5%), followed by Pseudomonas aeruginosa in 22 cases (14.9%), Klebsiella pneumoniae in 15 cases (10.1%), and Staphylococcus aureus in 15 cases (10.1). The median duration of VPS infection was 2 months (range, 15 days to 60 months) after insertion of the shunt, with half (49.8%) occurring during the first month. VPS infection was treated by antibiotics and shunt removal in 211 cases (76.4%) and antibiotics alone without shunt removal in 65 patients (23.5%). Among the risk factors, CSF protein level greater than 100mg/dL prior to VPS insertion was associated with a potential risk of re-infection (OR, 1.65; p = .01). Conclusion: High protein levels (>100 mg/dL) before the re-insertion of a VPS may be a risk factor for VPS re-infection
Neurosurgical treatment of Cushing disease in pediatric patients: case series and review of literature
No full textAim Pituitary adenomas are rare in childhood in contrast with adults. Adrenocorticotropic hormone (ACTH)-secreting adenomas account for Cushing's disease (CD) which is the most common form of ACTH-dependent Cushing's syndrome (CS). Treatment strategies are generally based on data of adult CD patients, although some difficulties and differences exist in pediatric patients. The aim of this study is to share our experience of 10 children and adolescents with CD. Patients and method Medical records, images, and operative notes of 10 consecutive children and adolescents who underwent transsphenoidal surgery for CD between 1999 and 2014 in Cerrahpasa Faculty of Medicine were retrospectively reviewed. Mean age at operation was 14.8 +/- 4.2 years (range 5-18). The mean length of symptoms was 24.2 months. The mean follow-up period was 11 years (range 4 to 19 years). Results Mean preoperative cortisol level was 23.435 mu g/dl (range 8.81-59.8 mu g/dl). Mean preoperative ACTH level was 57.358 mu g/dl (range 28.9-139.9 mu g/dl). MR images localized microadenoma in three patients (30%), macroadenoma in four patients (40%) in our series. Transsphenoidal microsurgery and endoscopic transsphenoidal surgery were performed in 8 and 2 patients respectively. Remission was provided in 8 patients (80%). Five patients (50%) met remission criteria after initial operations. Three patients (30%) underwent additional operations to meet remission criteria. Conclusion Transsphenoidal surgery remains the mainstay therapy for CD in pediatric patients as well as adults. It is an effective treatment option with low rate of complications. Both endoscopic and microscopic approaches provide safe access to sella and satisfactory surgical results
