The objective of this study is to determine the incidence and degree of anterior clinoid process pneumatization, in addition highlighting to their clinical significance. Multidetector-row CT scans of the skull base were reviewed in 648 subjects between 2007 and 2008. The presence of pneumatized anterior clinoid process and its degree were studied and documented. These data were statistically analyzed. Pneumatization of the ACP was found in 62 of 648 patients (9.6%) including 32 (51.6%) men and 30 (48.4%) women. The age of these patients ranged from 21 to 82 years (mean, 41 +/- 15.7 years). Pneumatization of the ACP occurred only on the left side in 14 cases (22.6%), only on the right side in 11 cases (17.7%), and bilaterally in 37 patients (59.7%). ACP pneumatization Type I, in which less than 50% of the ACP is pneumatized, was found in 47 of 124 sides (38%), Type II, in which more than 50% but not totally pneumatized ACP, was found in 28 of 124 sides (22.6%), and Type III, in which the ACP is totally pneumatized, was found in 22 of 124 sides (17.7%). The incidence of Type I in the general population was 6.6%, Type II was 3.5%, and Type III was 2.5%. Radiologically recognizing the degree of ACP pneumatization is important in decreasing the incidence of surgical complications during anterior clinoidectomy. Proper intraoperative management can be undertaken with special attention to the new classification.
Duraplasty with in situ galeal tissue is a simple, safe, and effective technique to reconstruct dural defects in growing skull fracture, which avoids the risky dissection of the brain tissue. Also, by using Medpor, growing skull fractures can be effectively reconstructed with good cosmetic results.
AIm: Awake craniotomy (AC) with electrical cortical stimulation has become popular during the last ten years although the basic principles were introduced almost 50 years ago. The aim of this paper is to share with the readers our experience in 25 patients who underwent AC with electrical stimulation. mATERIAl and mEThods: Twenty-five patients who underwent AC between 2010 and 2013 are the subjects of this paper. All patients were diagnosed with intraaxial lesions involving the functional area itself or very close to it by preoperative imaging. During surgery, the functional area was demonstrated by cortical electrical stimulation and resection aimed to preserve it in order to avoid an irreversible functional deficit. REsulTs:Total resection was possible in 80% while in 20% subtotal resection had to be performed because of involvement of the functional area itself. The neurological complication rate was found to be 16% (4 patients) and all were transient. No complication regarding anesthesia was noted.CoNClusIoN: Awake craniotomy in selected patients is very effective, safe and practical for supratentorial lesions close to the eloquent area. Complications related to the surgery itself are uncommon and general anesthesia is avoided. The hospital stay including the intensive care unit is short which makes it very economical surgical procedure. soNuÇ: Seçilmiş hastalarda ve bölgelere yakın supratentoriyel lezyonlarda uyanık kraniyotomi etkili, güvenli ve pratiktir. Cerrahiye bağlı komplikasyon oranı düşüktür ve genel anesteziye bağlı komplikasyonlar ortadan kalkmaktadır. Yoğun bakım dahil hastanede kalış süresinin kısa olması nedeniyle uyanık kraniyotomi ekonomik olmaktadır.
Synthetic cannabinoids (spice), which are used frequently worldwide, are more potent than herbal compounds and also have more side effects in comparison. A 23-year-old male was admitted to the emergency unit with altered consciousness. There was no sign of trauma, and his medical history did not reveal any chronic illness. Computed tomography revealed a large frontal hematoma extending to the ventricular system. The outcomes of cerebral angiography were consistent with multiple intracranial arterial stenoses (MIAS) which can also be seen after cannabis usage. The patient made a good recovery with treatment, and during the follow-up, his medical condition was stable. In addition to the psychological symptoms, encephalopathy, ischemia, and seizures have also been described as side effects of synthetic cannabinoids. This paper reports an intracerebral hematoma due to synthetic cannabinoids and its association with MIAS.
Secondary parkinsonism is defined with some symptoms similar to idiopathic Parkinson's disease, but with different etiologies. And cerebral cavernous hemangioma is one of the rare cases. A 51-year-old, male patient was consulted with tremor, rigidity and bradykinesia on the right upper extremity. The Hoehn and Yahr Parkinson's scale was Stage І. Radiological evaluations showed a deep-seated cerebral cavernous hemangioma at the left posterior insular region. The patient received stereotactic radiosurgery (CyberKnife®, Accuray Incorporated, Sunnyvale, CA, USA). Clinical and radiological improvements revealed within follow-up, respectively. Stereotactic radiosurgery may be an alternative treatment for secondary parkinsonism by reducing the risk of re-bleeding and reducing its size.
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