Turk Neurosurg
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Case Reports
Chronic ossified epidural hematoma after ventriculoperitoneal shunt insertion: a case report.
Chronic calcified/ossified epidural hematoma is an uncommon complication of ventricular shunt surgery. There are only 4 cases related to valve-regulated shunt operations in the literature. It may be seen especially in young patients with chronic hydrocephalus, probably due to craniocerebral disproportion. ⋯ She was admitted with a complaint of severe headache after three years and a bifrontal calcified/ossified epidural hematoma was seen. The calcifying hematoma was removed and the patient's headache resolved. Although the use of high or medium pressure valves, valves with an antisiphon device, adjustable pressure valves or flow control valves have been recommended to prevent this complication in previous reports, it was seen that our case had been treated with a medium pressure flow control valve.
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We examined the clinical progress of low back pain and radicular pain during the premenstrual period in patients with lumbar disc protrusion and discussed the probable effective physiopathological mechanisms and laboratory results reported in the literature. ⋯ All the criteria that we chose from the modified "Low Back Outcome Scale of Greenough and Fraser" to assess the pain showed a significant difference between the premenstrual period and the normal period in our patients. This difference should be considered in the treatment strategies in the clinical setting. Patients should be re-evaluated for surgical decisions after the premenstrual period if possible.
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The microanatomy of the abducens nerve (AN) is important for clinical reasons and surgical approaches as it is located in the petroclival region. The incidence of branching and duplication of the abducens nerve are unknown and mechanisms relating to paralysis of the nerve in indirect conditions are yet to be clarified. ⋯ Branching of the AN was present in a significant number of specimens; the branching pattern at the cavernous segment may be called "pseudobranching". The AN is at risk for paresis in indirect conditions because of its angles and fixations on its course.
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Cauda equina syndrome (CES) is a serious neurological condition and the most common cause is a central disc herniation. Migration of a bullet down the spinal canal is uncommon. In this report, the authors present an unusual case of cauda equina syndrome caused by a migrated bullet in dural sac. ⋯ The patient's symptoms and neurological deficits resolved considerably after surgery. In our opinion, it is important to pay attention to diversity of injury when confronted with a gunshot wound. It is essential to perform early and sufficient surgical decompression of the cauda equina to provide a better postoperative neurological recovery.
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Comparative Study
Comparison of the effects of an adhesion barrier and chitin on experimental epidural fibrosis.
Epidural fibrosis is an important factor for postoperative failed back syndrome development and causes clinical complaints in 6-25% of cases. An effective treatment modality has not been found yet. The aim of this study is to investigate the anti-adhesive effects of a novel agent chitin and compare these effects with a popular adhesion barrier collagen matrix. ⋯ The novel agent chitin was found effective for preventing epidural fibrosis and this effect was not significantly different from the collagen matrix. In light of our findings we suggest that chitin is an effective alternative for adhesion barriers.