Turk Neurosurg
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A retrospective study was conducted to assess the surgical outcomes of degenerative lumbar spinal stenosis. Thirty-four patients treated with decompressive surgery in Departments of III. Neurosurgery, Bakirkoy Hospital for Psychiatric and Neurological Diseases between 2000-2004 were reviewed. ⋯ Only one patient (%3) with two level laminectomy and 17 degrees postoperative sagittal rotation angle showed a significantly poorer clinical outcome and accepted instable. This study showed that, treatment of degenerative lumbar stenosis can be safely and effectively performed with standard laminectomy alone, resulting no significant sagittal plane instability. We concluded that single decompressive surgery offers satisfactory results in degenerative lumbar stenosis.
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Biochemical and radiological properties of sellar and parasellar lesions are quite similar in some instances. This leads to a difficulty in preoperative diagnosis. Here, a pituitary adenoma and a suprasellar arachnoid cyst in the same patient is presented, and possible etiopathogenetic mechanisms and surgical treatment are discussed. ⋯ A slow-growing mass lesion beneath the defective mesencephalic leaf of the Liliequist membrane may lead to a one-way valve system on its surface. It might be speculated that CSF will become trapped in the cyst during tumor growth. The other possible mechanism to explain the coexistence is discussed. In light of these comments and intraoperative observations, we suggest a third type of suprasellar arachnoid cyst. a semi-communicative type.
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Review Case Reports
Subcutaneous granuloma annulare of the scalp in childhood: a case report and review of the literature.
Granuloma annulare is a benign inflammatory skin lesion of unknown etiology that is usually seen in adults and children and subtypes of it includes localized granuloma annulare, generalized granuloma annulare, subcutaneous granuloma annulare and arcuate dermal erythema. Etiology and pathogenesis of granuloma annulare are obscure, although there is much evidence for an immunologic mechanism. Precipitating factors are insect bites, sunburn, photochemotherapy, drugs, physical trauma, acute phlebitis and sepsis after surgery. ⋯ Subcutaneous granuloma annulare of the scalp is rare lesion in childhood and nodules on the scalp are usually non-, or slightly mobile, whereas lesions on the extremities are freely mobile. For definitive diagnosis, a biopsy should be performed but wide surgical intervention or medical treatment is not indicated. In case of recurrence, no additional diagnostic studies are necessary.
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Cavernous malformations are benign vascular lesions of the central nervous system that lack intervening normal brain parenchyma. They can be seen almost anywhere that normal vasculature is available. Lesions are raspberry-like, thin-walled vascular sinusoids without smooth muscles containing hemosiderin deposits. ⋯ Giant cases are rare. Also referred to as cavernoma, these lesions rarely lead to intracerebral hematomas that threaten life. In this report, we have presented a 14-year-old patient with a giant cavernoma leading to a life-threatening massive intracerebral hematoma.
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Hunterian ligation of the internal carotid artery is an acceptable treatment modality for inoperable intracranial carotid aneurysms. Despite the risk of thrombo-embolic complications, ligation together with superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery is vital in some patients. Our aim is to present our experience in five patients in whom STA-MCA bypass and balloon occlusion were performed due to inoperable intracranial carotid artery aneurysms. ⋯ Hunterian ligation associated with bypass surgery is an effective treatment method in selected patients. The following points should be considered for a good outcome: (1) experienced surgeon for bypass surgery, (2) experienced neuroradiologist for endovascular occlusion of the parent vessel as close to the aneurysm neck as possible, and (3) judicious postoperative management by means of anticoagulation, fluid replacement, and pressure control.