Brucellosis is still an important public health problem in the Mediterranean countries, including Turkey, and is most probably underdiagnosed or underreported. Two rare cases of extradural brucellar granuloma causing spinal cord compression in the thoracic and cervical regions were identified by magnetic resonance imaging. The abscesses were totally excised surgically. Medical treatment was given immediately after diagnosis, but delayed neurosurgical intervention resulted in partial neurological recovery in one patient although the other showed complete neurological recovery. Abscess formation may cause myelopathy due to extradural compression of the spinal cord. Failure to correct this condition may cause irreversible impairment of motor functions. Magnetic resonance imaging should be performed periodically in patients with brucellosis and suspected vertebral involvement to monitor for epidural granuloma formation and prevent extradural cord compression.
A 30-year-old man presented with an intradural spinal teratoma with thickened filum terminale manifesting as urinary and sexual disturbances, and low back pain persisting for 4 years. Spinal magnetic resonance imaging revealed thickened filum terminale containing a heterogeneously enhanced intradural lesion extending from the L-3 to L-4 levels and in contact with the conus medullaris. The filum terminale was incised and the tumor was totally resected. The histological diagnosis was mature teratoma consisting of three germ cell layers. The patient’s complaints had completely resolved 6 months later.
Orbital roof fractures are uncommon, and traumatic intraorbital encephalocele formation is a very rare complication of this type of injury. We treated 43 pediatric patients with orbital roof fractures at our center over a 4-year period. The aim of this study was to retrospectively investigate conditions that may lead to intraorbital encephalocele formation in children with orbital roof fractures. Each case was reviewed, and the cause of injury, associated clinical and computerized tomography findings, the Glasgow Coma Scale score on admission, neurological status, other bodily injuries, hospitalization time and type and width of the orbital roof fracture were recorded. The findings in 6 patients who developed encephaloceles were compared to corresponding findings in the 37 patients who did not develop this complication. A total of 44 orbital roof fractures were diagnosed by axial and coronal computed tomography scanning. Six of the 43 children developed intraorbital encephaloceles in the first month after head trauma. In each of these cases, magnetic resonance imaging demonstrated the intraorbital cystic lesion in communication with the subarachnoid space. The width of each orbital roof fracture was measured on axial and coronal computed tomography slices and was confirmed by measurements during surgery. The width of the fractures in the encephalocele cases ranged from 2-4 mm. Duraplasty and orbitoplasty were performed in all the patients with encephalocele. Pediatric patients with orbital roof fractures that exhibit more than 2 mm diastasis and are associated with frontal cerebral contusion may be at greater risk for developing intraorbital encephalocele. All such cases should be monitored closely and investigated further with magnetic resonance imaging.
OBJECTIVE AND IMPORTANCE Intracranial solitary fibrous tumors have been described previously, but intraventricular solitary fibrous tumors are extremely rare. We present what is, to our knowledge, the first reported case of solitary fibrous tumor in the third ventricle. CLINICAL PRESENTATION A 63-year-old man presented with weakness of his lower extremities and headaches. Computed tomography and magnetic resonance imaging of the brain revealed an enhancing mass in the posterior part of the third ventricle. INTERVENTION The tumor originated from the wall of the left internal cerebral vein and extended to the posterior part of the third ventricle. Nearly total excision was performed via an infratentorial-supracerebellar approach. CONCLUSION The differential diagnosis of intracranial solitary fibrous tumors includes fibroblastic meningioma, meningeal hemangiopericytoma, neurofibroma, and schwannoma. The differential diagnosis in the present case was greatly helped by the immunohistochemical and ultrastructural findings, along with a disease-free 3.5-year follow-up. These findings are presented with reference to previous reports.
Aim: The scope of this study is to investigate the correlation between the clinical and radiological findings of high level lomber disc hernia (L1-2, L2-3, L3-4) and surgical outcome. Material and Method: 23 high level lomber disc hernia out of 262 lomber disc cases operated between January1996 and November 2001 at the department of Neurosurgery , Faculty of Medicine, Inonu University (Malatya Turkey) were retrospectively reviewed. Results: 39.1% of the cases were male and 60.9% were female. The mean age was 49.6. The mean interval between the initial complaint and the admittance was 3.7 months. The incidence of high level lumbar disc hernia was 8.8% and were mostly seen on L3-L4 level (78.3%). CT and myelography were performed in 13% of the cases and MRI and CT on the rest (87%). Only one case having the initial operation in our clinic required a second surgery with the diagnosis of recurrent disc hernia. Conclusion: None of the patients after surgery declared preoperative pain. Postoperative early evaluation using Prolo scale revealeed 56% good and 44% fair results. Reevaluation on the postoperative sixth month disclosed 87% good and 13% fair results. All of the patients benefited from surgery. Key words: Magnetic Resonance Imaging, Lumbar, Disc, High Level Disc Hernia
