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1.  A extremely rare case of cervical intramedullary granuloma due to Brucella accompanied by Chiari Type-1 malformation 
Asian Journal of Neurosurgery  2014;9(3):173-176.
Chiari Type-1 malformation is displacement of the cerebellar tonsils through the foramen magnum into the cervical spine and usually does not exceed the level of C2. It is 50-70% associated with syringomyelia. Nervous system involvement due to brucellosis is called neurobrucellosis, and neurological involvement rate has been reported an average of 3-5%, ranging between 3% and 25% at different series. Intramedullary abscess or granuloma due to Brucella is extremely rare. Hence far, six cases have been reported in the literature and only two of these cases were reported as intramedullary granuloma. This case is presented in order to remind the importance of the cervical cord granuloma which was presented once before in the literature and to emphasize the importance of evaluation of patient history, clinical and radiological findings together in the evaluation of a patient.
doi:10.4103/1793-5482.142740
PMCID: PMC4323904
Brucella; cervical region; Chiari Type-1 malformation; spinal intramedullary granuloma
2.  Tuberculoma in the Medulla Oblongata and Medulla Spinalis: Two Case Reports 
Balkan medical journal  2013;30(4):442-445.
Background:
Central nervous system tuberculosis remains a prevalent problem in developing countries. Also, this disease has been an important problem in developed countries due to the increased incidence of acquired immunodeficiency syndrome. Tuberculosis of the central nervous system is seen in 10% of immunocompetent patients with primary tuberculosis.
Case Report:
We report two patients with tuberculoma in the central nervous system. The first case had a lesion located in the medulla oblongata, and the second case had a lesion in the medulla spinalis between the 5th cervical and 1st thoracic vertebral level. Both of these patients underwent surgery.
Conclusion:
CNS tuberculomas may not always show typical magnetic resonance imaging (MRI) signs, but when a neurosurgeon encounters a brown-yellow rubber-like lesion that is easily extirpated from the glial tissue, tuberculoma should be considered; anti-tuberculous and corticosteroid therapy should be initiated as soon as possible to prevent meningitis and the immune-mediated destructive effects of tuberculosis on the CNS. Whether or not anti-tuberculous therapy is continued can be decided upon by following definitive pathologic diagnosis.
doi:10.5152/balkanmedj.2013.8985
PMCID: PMC4115947  PMID: 25207157
Medulla oblongata; spinal cord; meningitis; oedema; tuberculomas
3.  Osteoblastoma of C2 Corpus: 4 Years Follow-up 
Asian Spine Journal  2012;6(2):136-139.
Osteoblastomas are rare neoplasms of the spine. The majority of the spinal lesions arise from the posterior elements and involvement of the corpus is usually by extension through the pedicles. An extremely rare case of isolated C2 corpus osteoblastoma is presented herein. A 9-year-old boy who presented with neck pain and spasmodic torticollis was shown to have a lesion within the corpus of C2. He underwent surgery via an anterior cervical approach and the completely-resected mass was reported to be an osteoblastoma. The pain resolved immediately after surgery and he had radiologic assessments on a yearly basis. He was symptom-free 4 years post-operatively with benign radiologic findings. Although rare, an osteoblastoma should be considered in the differential diagnosis of neck pain and torticollis, especially in patients during the first two decades of life. The standard treatment for osteoblastomas is radical surgical excision because the recurrence rate is high following incomplete resection.
doi:10.4184/asj.2012.6.2.136
PMCID: PMC3372549  PMID: 22708018
Osteoblastoma; Osteoid osteoma; C2 corpus; Anterior cervical approach
4.  Spontaneous supratentorial intracerebral hemorrhage: Does surgery benefit comatose patients? 
Introduction:
Treatment of spontaneous supratentorial intracerebral hemorrhage (SICH) is still controversial. We therefore analyzed the comatose patients diagnosed as having spontaneous SICH and treated by surgery.
Materials and Methods:
We retrospectively analyzed the collected data of 25 comatose patients with initial Glasgow Coma Scale (GCS) ≤ 8 diagnosed as having spontaneous SICH and they had been treated by surgical evacuation between 1996 and 2008. The outcome was assessed using Glasgow outcome scale (GOS). The side and location of the hematoma and ventricular extension of the hematoma were recorded. The hematoma volume was graded as mild (<30 cc), moderate (30–60 cc) and massive (>60 cc).
Results:
Age of the patients ranged from 25 to 78 years (mean: 59.6 ± 15.14 years). Among the 25 patients studied, 11 (44%) were females and 14 (56%) were males. GCS before surgery was <5 in 8 (32%) patients and between 5 and 8 in 17 (68%) patients. The hematoma volume was less than 30 cc in 2 patients, between 30 and 60 cc in 9 patients and more than 60 cc in 14 patients. Fourteen of the patients had no ventricular connection and 11 of the hematomas were connected to ventricle. All the 25 patients were treated with craniotomy and evacuation of the hematoma was done within an average of 2 hours on admission to the emergency department. Postoperatively, no rebleeding occurred in our patients. The most important complication was infection in 14 of the patients. The mortality of our surgical series was 56%. GCS before surgery was one of the strongest factors affecting outcome GCS (oGCS) (P = 0.017). Income GCS (iGCS), however, did not affect GOS (P = 0.64). The volume of the hematoma also affected the outcome (P = 0.037). Ventricular extension of the hematoma did affect the oGCS and GOS (P = 0.002), but not the iGCS of the patients (P = 0.139).
Conclusion:
Our data suggest that being surgically oriented is very important to achieve successful outcomes in a select group of patients with SICH.
doi:10.4103/0972-2327.70881
PMCID: PMC2981755  PMID: 21085528
Mortality; outcome; spontaneous supratentorial intracerebral hemorrhage; surgery; treatment
5.  An Anatomical Variant : Low-Lying Bifurcation of the Common Carotid Artery, and Its Surgical Implications in Anterior Cervical Discectomy 
Objective
The common carotid artery generally bifurcates into the internal and external carotid arteries at the level of C3-4. Injury to the common carotid artery during anterior cervical discectomy is a complication that is very much feared but encountered rarely. Knowing the anatomic variations of the common carotid artery and using an operating microscope during the anterior cervical approach for cases with low-lying bifurcation of the common carotid artery would prevent injuries to this artery. We present a 42-year-old female who has successfully undergone anterior cervical discectomy at the level of C5-6 and C6-7. She had a low-lying bifurcation of the common carotid artery.
doi:10.3340/jkns.2009.45.1.32
PMCID: PMC2640820  PMID: 19242568
Anterior cervical discectomy; Common carotid artery; Low bifurcation
6.  The role of closed-suction drainage in preventing epidural fibrosis and its correlation with a new grading system of epidural fibrosis on the basis of MRI 
European Spine Journal  2004;14(4):409-414.
In this study we aimed to evaluate the role of closed-suction drainage on the extent of epidural fibrosis (EF) after lumbar disc surgery and to define a new grading system of epidural fibrosis in these patients, based on magnetic resonance imaging. Seventy-nine patients (34 women, 45 men) with a unilateral, single-level lumbar disc herniation were included in this study. Forty-one patients in whom closed-suction drainage was implanted were compared with 38 patients in whom the drain was not implanted. We have used a new grading system for the extent of epidural fibrosis, on the basis of follow-up magnetic resonance imaging findings. Pain intensity was evaluated by visual analog scale (VAS), and the patients’ function and working ability were measured according to the Prolo functional-economic scale. We conclude that, in patients operated on for unilateral, single-level lumbar disc hernias, implantation of closed-suction drainage into the operation site results in less formation of EF radiologically and yields better clinical outcome.
doi:10.1007/s00586-004-0801-6
PMCID: PMC3489202  PMID: 15526220
Epidural fibrosis; Closed-suction drainage; Lumbar disc surgery; Magnetic resonance imaging

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