Mehmet Volkan Aydin

Objectives and Background: Chronic subdural hematoma (CSDH) is characterized by the develeopment of a membranous hematoma following mild to moderate head trauma, with its pathophysiology involving posttraumatic inflammatory processes. The aim of our study was to investigate the relationship between peripheral blood cell inflammatory markers and various clinical and radiological parameters in CSDH patients under 65 years. Methods: We conducted a retrospective analysis of 53 patients diagnosed with unilateral CSDH who underwent surgical intervention with a closed drainage system via burrhole. We assessed peripheral blood inflammatory markers, radiological findings based on Nakaguchi classification, clinical status, length of hospital stay, intensive care unit (ICU) admission, and the need for reoperation. Results: Prolonged stays exceeding 6 days was associated with postoperative complications. The majority (86.8%) of patients required ICU treatment, and 15.1% necessitated reoperation. Nakaguchi classification showed heterogeneous distribution, with no statistically significant association observed between classification and the need for reoperation. Preoperative, postoperative, and mean values of neutrophil-to-lymphocyte (N/L), platelet-to-lymphocyte (P/L), and monocyte-to-lymphocyte (M/L) ratios were not significant predictors of recurrence. However, a moderately significant negative correlation was found between the GCS score and preoperative M/L ratio (p = 0.026), while a significant positive correlation was noted between the length of hospital stay and changes in N/L, P/L, and M/L ratios (p = 0.001). Conclusion: Inflammatory markers in peripheral blood cells exhibit potential as accessible indicators for monitoring CSDH prognosis and treatment duration. While Nakaguchi classification did not correlate with the need for reoperation, preoperative and postoperative inflammatory markers, alongside clinical parameters, could aid in predicting patient outcomes.

We present a rare case of Forestier disease with multi-level vertebra involvement from the upper cervical to the thoracic area which has not been reported in the literature before.

Introduction: We present a rare case of traumatic pneumorrhachis with the combination of hemothorax which resolved rapidly after insertion of a chest tube. Case presentation: A 55 year old male was admitted to our emergency department after falling from a ladder. His general condition was well, GCS was 15 with no motor deficits. On his spinal CT a fracture on multiple ribs leading to right sided hemothorax was observed with air in the T6-T8 spinal canal. A chest tube was placed and as he did not have any neurological deficits surgical intervention to the pneumorrhachis was not considered. On the next days a follow-up CT the air in the spinal canal was reduced and on the 5th day resolved completely. Conclusion: Traumatic pneumorrhachis is a rare phenomenon and is not fully understood how the air from the posterior mediastinal wall can spread to the epidural or subarachnoid space. One hypothesis for subarachnoid air is that the high pressure air from a pneumothorax or pneumomediastinum pushes in a one-valve mechanism through the fascial layers of the posterior mediastinum through the neural foramina into the spinal canal. In our case, after the insertion of the chest tube the air in the subarachnoid space resolved and the patients tingling sensation on his legs disappeared. We believe that the negative pressure of the chest tube did a somehow reverse effect of the air flow back from the spinal canal into the chest tube which has not been reported in the literature before.

We present a case with renal cell carcinoma metastatic to cerebral parenchyma. A 72-year-old man was admitted to the emergency service of our hospital with sudden loss of consciousness and left-side hemiplegia. His admission blood pressure was 250/130 mm Hg, his Glasgow coma scale was recorded as 10, and his computed tomography scan of the brain without contrast enhancement showed right frontoparietal intracerebral hematoma with a dimension of 8 cm×6.3 cm×7 cm, surrounded by diffuse parenchymal edema and an 18 mm midline shift, and led to a presumed diagnosis of a hypertensive intracerebral hemorrhage. He was taken to the intensive care unit for conservative treatment. However, on posthemorrhagic day 3, his Glasgow coma scale was recorded as 7 and the control computed tomgrphy scan showed hematoma enlargement. He underwent right frontoparietal craniotomy and hematoma removal on the same day. During surgery, hematoma surrounded by a thick and partially ruptured capsule was detected. His pathologic report was renal cell carcinoma with intracerebral hemorrhage. The retrospective review of his medical history showed that he had undergone a nephrectomy because of renal cell carcinoma 11 years ago.

Tumor-to-tumor metastasis is a well recognized phenomenon. Although any tumor may be potential recipient of metastasis, renal cell carcinoma and meningioma are the most common malignant and benign recipients, respectively, whereas the lung and breast are the most common metastatic donors respectively, in both settings. Patients with hereditary cancer syndromes may be at higher risk for the development of tumor-to-tumor metastases. The most common pattern of tumor-to-tumor metastasis for intracranial neoplasms is the type in which an aggressive high-grade malignancy serves as the source of tumor and a more indolent neoplasm serves as the recipient tumor. The development of tumor metastasis from a second primary malignancy is uncommon and remains biologically puzzling. Its low incidence has made its full biological characterization evasive. Although rare, neurosurgeons should be aware of the entity of tumor-to-tumor metastasis.

Spondylolisthesis is the forward displacement of a lumbar vertebra relative to the adjacent vertebra, occurs as result degeneration or surgery and is a special type of lumbar instability. There is no consensus about which radiologic modality or findings truly reflect the lumbar instability and the exact incidence after single level disk surgery is unknown. In this prospective study, we have included 90 patients who were operated by the same surgeon with single level disk herniation. We aimed at evaluating the post-operative lumbar spondylolisthesis, with flexion and extension lateral radiographs in addition to standard magnetic resonance imaging (MRI). We have seen spondylolisthesis in six of 90 cases with standing lateral flexion-extension radiographs, which were undefinable with MRI. Pain intensity and functional-economic rating scale (Prolo scale) were unremarkable. We have concluded that standing flexion-extension radiographs should be routinely combined in patients with failed back surgery syndrome and even if lumbar instability is clinically suspected, especially when conventional MR examination is normal. When the MR examination showed spondylolisthesis, standing flexion-extension radiographs could not give additional information.

The role of apoptosis in etiopathogenesis of vasospasm is not clearly understood yet. It is widely accepted that protection of the endothelial cells from the process of apoptosis could have beneficial effects on cerebral vasospasm after subarachnoid hemorrhage (SAH). Mexiletine blocks sodium and calcium channels and activates ATP-sensitive K(+) channels. Moreover, mexiletine is known to have potent antioxidant effects through inhibiting free-radical production. Twenty-one rabbits were allocated into three groups randomly. Group I was sham operated group (n=7). SAH occurred but no medication was given to the Group II rabbits (SAH only group) (n=7). Mexiletine (50 mg/kg, b.i.d., i.p.) was administered just before SAH and continued until 48 hours following SAH to the Group III rabbits (Mexiletine treated group) (n=7). The ApopTag peroxidase in situ apoptosis detection kit (Serologicals Corporation, former Intergen) was used to demonstrate apoptosis in a cross section of basillary arteries. Thiobarbituric acid reactive material was used to determine the lipid peroxidation levels. There was a statistically significant difference between lipid peroxidation product levels of the control and SAH only groups (p0.05). In the present study we investigated the antioxidant action of mexiletine on apoptosis of endothelium following a rabbit SAH model. This experimental study directly suggested that lipid peroxidation is an important step in development of apoptosis in endothelial cells and prevention of structural integrity of endothelial cell should play a beneficial role in attenuation of cerebral vasospasm. Mexiletine treatment prevented the increase in lipid peroxidation and cerebral vasospasm. Examination of endothelial cells by staining specific for apoptosis demonstrated significant protection of cell integrity in the treated group.

Amyloidoma is a nodular mass of amyloid with no evidence of generalized amyloidosis. Primary amyloidoma of the spine is very rare and has a predilection for the thoracic region. The tumor-like appearance and behavior make it difficult to diagnose on imaging studies. Despite its rarity and nonspecific radiologic findings, primary spinal amyloidoma should be included in the differential diagnosis of an osteolytic and calcified mass of the spine. We report the case of a 38-year-old woman with amyloidoma involving the thoracic spine and describe the main characteristics of this condition.