Osteomas of the paranasal sinuses are usually asymptomatic. When enlarged, they could give rise to intracranial manifestations and serious complications. Osteomas most commonly affect the fronto-ethmoid sinuses. They rarely show intra-orbital extension or cause intracranial complications such as CSF rhinorrhea, pneumocephalus and intracranial infection. We report two unusual cases of frontal osteomas complicated by rare manifestations such as intracranial mucocele, CSF leak, pneumocephalus and bacterial meningitis. We demonstrate the importance of these intracranial manifestations when these lesions are accompanied by neurological symptoms and signs with special emphasis on the importance of early treatment.

Traumatic injury to central nervous system results in the production of inflammatory cytokines via intrinsic mechanisms by neurons, astrocytes and microglia, and extrinsic mechanisms by infiltrating macrophages, lymphocytes and other leukocytes. Interleukin-1 beta is the key mediator of the acute inflammatory host response. While this response is necessary for resolution of the pathologic event, the toxic nature of many of its products can cause significant tissue damage. We analyzed serum interleukin-1 beta levels by enzyme-linked immunosorbent assay in 48 patients with solitary head injury who were transported to our clinic immediately after trauma. We categorized the patients according to their initial Glasgow coma scores in three groups, and compared their serum interleukin-1 beta values both with their Glasgow coma initial and outcome scores. This study helped to provide quantitative data to estimate clinical impressions and prognosis after head injury.

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With its neuroprotective effect, as demonstrated in this experimental peripheral nerve injury, melatonin might be used successfully in clinical practice. Further studies on the correct dosage and possible side effects are necessary.

Objective : To evaluate the potential effects of risedronate (RIS) which shows a higher anti-resorptive effect among bisphosphonates, after a posterolateral lumbar intertransverse process spinal fusion using both autograft and allograft in a rat model. Methods : A totoal of 28 Sprague-Dawley rats were randomized into 2 study groups. A posterolateral lumbar intertransverse process spinal fusion was peformed using both autograft and allograft in a rat model. Group I (control) received 0.1 mL of steril saline (placebo) and Group II (treatment) received risedronate, equivalent to human dose (10 µg/kg/week) for 10-weeks period.Results : The fusion rates as determined by manual palpation were 69% in the group I and 46% in the group II (p = 0.251). According to radiographic score, the spinal segment was considered to be fused radiographically in 7 (53%) of the 13 controls and 9 (69%) of the 13 rats treated with RIS (p = 0.851). The mean histological scores were 5.69 ± 0.13 and 3.84 ± 0.43 for the control and treatment groups, respectively. There was a significant difference between the both groups (p = 0.001). The mean bone density of the fusion masses was 86.9 ± 2.34 in the control group and 106.0 ± 3.54 in the RIS treatment group. There was a statistical difference in mean bone densities of the fusion masses comparing the two groups (p = 0.001). Conclusion : In this study, risedronate appears to delay bone fusion in a rat model. This occurs as a result of uncoupling the balanced osteoclastic and osteoblastic activity inherent to bone healing. These findings suggest that a discontinuation of risedronate postoperatively during acute fusion period may be warranted.

SummaryOrbital penetrating injuries may cause significant harm to the optic nerves and eyeball as well as to the brain and cerebral vessels. Management of orbital foreign bodies should include prompt recognition of the extent of the injury, broad-spectrum parenteral antibiotics, tetanus prophylaxis, anticonvulsant medication and early surgical intervention under direct vision to remove the foreign body and to avoid immediate and long-term complications. We report a penetrating orbital injury caused by a bread knife that extended from the orbit to the tegmental dura mater of the temporal bone. The knife's main trajectory coursed through the temporal lobe. Adjacent cerebral structures were explored before removal of the knife.KEY WORDS: Cerebrum. Eyeball. Orbit. Cranial penetrating injury. Knife. Traumatismo perforante orbito-craneal por un cuchillo de pan. Presentación de un caso ResumenLos traumatismos perforantes orbitarios suelen causar un daño importante al nervio óptico y globo ocular, así como al cerebro y vasos cerebrales. La órbita permite un acceso fácil hacia la cavidad craneal debido a que tiene una pared ósea delgada y a la presencia del agujero óptico. El enfoque terapéutico de los traumatismos orbitarios por cuerpo extraño depende fundamentalmente del tipo de traumatismo y del cuerpo extraño. El tratamiento de este tipo de lesiones incluirá un rápido diagnostico de la magnitud del daño ocasionado, el empleo por vía parenteral de antibióticos de amplio espectro, profilaxis del tétanos, medicación anticonvulsivante y cirugía urgente que permita, bajo visión directa, la extracción del cuerpo extraño, a fin de evitar complicaciones inmediatas o a largo plazo. Presentamos el caso de un traumatismo perforante ocular ocasionado por un cuchillo de pan que se extendía desde la órbita hasta el tegmentum del hueso temporal. El cuchillo seguía una trayectoria directa a través del lóbulo temporal. Se practicó una exploración quirúr-gica de las estructuras cerebrales adyacentes para poder extirpar el cuchillo. Se revisan y analizan las opciones de tratamiento de los traumatismos perforantes de la órbita.

A unilateral approach with bilateral decompression and bilateral approach with bilateral hemilaminotomy are both minimal invasive, adequate and safe approaches with excellent prognosis. However, BLH leads to a bigger expansion of DSA.

AIM:Lateral orbitotomy is a well-known approach for lesions of the lateral orbital cone. It is still appropriate for laterally situated tumors although contemporary cranial base approaches were defined and developed within the last decades. MATERIAL and METHODS:Here we report 10 orbital lesions operated with lateral orbitotomy, nine of which were extraconal. Cholesterol granuloma, arachnoid cyst, pleomorphic adenoma, malign epithelial tumor, dermoid cyst, inflammatory granuloma and cavernoma were the pathologies encountered. RESULTS:The extent of lateral orbitotomy should depend on the size, consistency and nature of the lesion for easy removal and less bony resection. In this regard, contrast enhanced CT scans give useful information for operative strategy. The success of surgery can be improved and cosmetic problems can be minimized if meticulous care is taken during orbital rim resection. CONCLUSION:Although there is a wide range of histopathological diagnosis for orbital tumors, lateral orbitotomy is a safe approach, particularly if the lesions are extraconal. KEYWORDS:Arachnoid cyst, Cholesterol granuloma, Extraconal, Lateral orbitotomy, Orbital tumor ÖZ AMAÇ: Lateral orbitotomi lateral orbita yerleşimli lezyonlar için iyi bilinen bir yaklaşımdır. Kaide tümörlerine yönelik güncel yaklaşımlar son yıllarda oldukça iyi tanımlanmış olsa da lateral orbitotomi yaklaşımı halen önemini korumaktadır. YÖNTEM ve GEREÇ:Bu makalede 9'u ekstrakonal yerleşimli olan ve lateral orbitotomi ile ameliyat edilen 10 olgu sunulmaktadır. Kaydedilen patolojiler kolesterol granülomu, araknoid kist, pleomorfik adenom, malign epitelyal tümor, dermoid kist, enflamatuar granülom ve kavernomdur. BULGULAR:Lateral orbitotominin sınırı lezyonun boyutu, kıvamı ve natürü ile ilişkili olacak şekilde planlanmalı ve böylece eksizyon kolay bir şekilde ve daha az kemik rezeksiyonu ile yapılmalıdır. Bu anlamda kontrastlı BT görüntüleri operatif planlama için oldukça yararlı bilgiler sunmaktadır. Özellikle orbital rimin rezeksiyonu sırasında dikkatli olunduğu takdirde, cerrahi başarı oranı yükselirken kozmetik problemler minimale indirgenir. SONUÇ:Orbital tümörlerin histopatolojik tanısı için geniş bir tanı spektrumu olmakla birlikte, lateral orbitotomi özellikle ekstrakonal lezyonlarda güvenli bir yaklaşımdır.