A retrospective study of 28 patients identified with subdural empyema (SE) at the Department of Neurosurgery between the years 1995 and 2005 was carried out. SE occurred in all patients following bacterial meningitis. The six most frequently encountered clinical features included: (1) fever in 22 (79%) patients; (2) disturbed consciousness in 16 (57%) patients; (3) papilledema in 11 (39%) patients; (4) hemiparesis in 4 (14%) patients; (5) meningismus or meningeal signs in 4 (14%) patients, and (6) seizures in 3 (11%) patients. In the majority of cases, the most frequent causative pathogen of SE was Staphylococcus aureus. Surgery was performed on all patients, which included craniotomy in a group of 20 patients and burr hole drainage in a group of 8 patients. In conclusion, we believe that infants and young children should be carefully monitored following meningitis, in case of SE development, and that surgical intervention in patients presenting with meningitis may facilitate the development of SE. Furthermore, from a surgical point of view, our experience has led us to believe that craniotomy in comparison with burr hole surgery is the best surgical modality for management of SE as the recurrence rate of SE associated with burr hole surgery is high.

Prospective study of the neuroprotective activity of sildenafil in a rat spinal ischemia model. The present study involved 21 male Sprague-Dawley rats. The animals were divided into 3 groups. Physiological serum was administered intraperitoneally to the 8 rats in the control group at the beginning of reperfusion for a period of 20 min after abdominal aortal occlusion. Sildenafil (Viagra®) was administered as a single 10-mg/kg/day intraperitoneal dose to the 8 rats in the sildenafil group at the beginning of reperfusion after 20 min of abdominal aortal occlusion. No occlusion was performed and no agent was administered to the 5 rats in the sham group, but the abdominal aorta was reached by means of surgical intervention. Before the animals were sacrificed, several physiological and biochemical parameters were investigated, preoperative and postoperative motor functions were also assessed, and somatosensory evoked potential (SEP) monitoring and histopathological examinations were carried out. No differences were found between the physiological and biochemical parameters in each of the 3 groups. Neurological scoring performed after reperfusion demonstrated a significant improvement in the neurological results relative to those of the control group over 48 h in subjects that received sildenafil. These animals also showed better 24-hour SEP results, measured in terms of extended latency and decreased amplitude, than the control animals. A histopathological study showed reduced ischemic symptoms in rats that received sildenafil compared with those in the control group. However, no anomalies were observed in the sham group with respect to the histopathological and neurological findings. These results indicate that neurological damage due to spinal-cord ischemia-reperfusion injury can be reduced by sildenafil.

A giant solitary osteochondroma in 17-year-old-boy was reported. Osteocondromas usually involves the long bones, scapulae, pelvic bones and seldom occurs in the axial skeleton. A 17-year-old boy presented with a swelling at the rear of the neck and an advanced degree of limitation in the movements of his neck. A hard mass sized approximately 7x8 cm was revealed in this region. Cervical x-ray and CT revealed the mass involving the sixth cervical vertebrae. Giant cervical osteochondroma operated and the mass was successfully excised. Osteochondromas that consists the largest portion of benign bone tumors at the spine is seldom. Therefore we are introducing a osteochondroma case located at the lower cervical region where an advance degree of limitation in neck movements that displays no any neurological symptoms and that reaches a very wide mass in size, and which is assumed as unusual.

No abstract

Intradural disc herniation (IDH) is a rare pathology. Intradural disc herniations comprise 0.26-0.30% of all herniated discs. The preoperative knowledge of an intradural herniation is important because it has an influence on the operative strategy. A 55-year-old man suffered from decrease in the motor function of the lower extremities and urinary incontinence. Noncontrast MRI exam showed the intradural disc with caudal migration of an excluded fragment at the L3-4 level. At surgery, the L3 and L4 laminas were removed and after dura had been openned, a nucleus pulposus was seen which compressed the conus medullaris to the right and left of the spinal canal. Every neurosurgeuon involved in spinal surgery must be aware of this rare patology which, when overseen during the intervention, could have disastrous consequences for the patient.