Three-years-old-boy with a history of ventriculo-peritoneal shunt placement was admitted to our neurosurgery department with headache, vomiting and sunset eye phenomena. Direct X-ray examination of the shunt system was completely normal. The palpation of the shunt dome resulted the unfilling of pumping device. Computerised Tomography (CT) of the head revealed ventricular enlargement and periventricular oedema. The patient was hospitalised for shunt revision. The symptoms were spontaneously disappeared within 48 hours. The pumping device returned to normal refilling. Follow up CT showed small ventricular size and shape. This case indicates that the symptomatic intermittent occlusion of the proximal shunt catheter can be seen in the paediatric age group and the obstruction may continue for a certain period and spontaneously return to normal function with correlated clinical response.

Keywords:Nonanastomotic by-pass Methotrexate Brain parenchyma Encephalo-myo-synangiosis Brain Operation Indirect by-pass ARTICLE INFO ABSTRACTThe aim of this experimental study was to investigate the penetration of methotrexate into the brain parenchyma after indirect nonanastomotic by-pass surgery (encephalomyo-synangiosis) in rats. The fourteen rats were divided into two groups as control and operated rats. Control rats were not operated but received methotrexate treatment (50 mg/ kg). The operation of indirect nonanastomotic by-pass was done on operated group. After four weeks from the operation, methotrexate (50 mg/kg) was injected via intravenous route one hour before the decapitation. Parenchymal methotrexate level was estimated by using biochemical methods. The mean methotrexate level in the brain parenchyma of control group was estimated as 1.16 ± 0.93 µmol/L. The mean methotrexate level in the brain parenchyma of operated group was found as 2.5 ± 0.98 µmol/L. The operation of pial synangiosis enhanced the penetration of methodrexate into the brain parenchyma in comparison with unoperated subjects. The differences between these two groups were statistically meaningful (p=0.0221). In this experimental study, we used the operation of encephalo-myo-synangiosis (EMS) for enhancing of the penetration of methotrexate into the brain. According to our results the operation of EMS enhanced the penetration of methotrexate into the brain parenchyma in the rats.

Previously, some different techniques had been presented in terms of precise dissection and separation of tumors from surrounding brain. Purpose of this study was to describe the effect of vibration in the surgical dissection and separation of malignant brain tumors. We recently developed an instrument for micro-dissection and separation of brain lesions from brain tissue. This instrument was produced by a medical instrument producing factory in Samsun. This instrument has the capability of producing mechanical vibration. The holding and using of this instrument was described. In this study, we used this instrument in four high grade glial tumors for dissection and separation of these lesions from surrounding brain tissue. Dissection and separation were graded as poor, moderate and good. Vibrato-dissection technique was superior to those of conventional technique in the aspect of dissection and separation of brain tissue. The capability of dissection and separation with this instrument during surgical treatment of brain tumors may enhance dissection and separation of lesions.

The primary treatment of malignant glial tumors is surgical intervention for maximally reducing and/or total removing of tumors. The purpose of this report was to describe pial sinangiosis or indirect nonanastomotic bypass surgery for diversion of blood brain barrier for enhancing of systemic blood-brain tissue penetration in the enhancing of the effect of chemotherapy. The other purposes are the increasing of oxygen and metabolic product providing, enhancing of radiation sensitivity, and stabilization of brain tissue around the tumor bed for reducing of malignant transformation. We used the technique of indirect non anastamotic by-pass surgery technique during the surgical treatment of malignant glial tumors. Preoperative and postoperative magnetic resonance images were obtained to evaluate peri-lesional edema and residual complications. This technique was used in three cases of malignant glial tumors. There were no operative mortality and morbidity related to this technique. This technique may be used during the surgical treatment of malignant glial tumors to enhance penetration of chemotherapeutic agents, increasing of radiation sensitivity and providing of tissue stability.

The aim of this experimental study was to evaluate the effect of omega-3 fatty acids solution in the prevention of the forming of peridural fibrotic tissue and adhesion in a rabbit hemilaminotomy model. This new experimental model was previously developed by the first author of this study. Twenty-one New Zealand white rabbits were used for this experiment. Seven of them were randomly selected as Control group and was named as Group I rabbits. The rabbits in this group were not operated and treated. The second group was Group II including 7 rabbits. This group was named as hemilaminotomy and untreated rabbits. Group III included 7 rabbits and named as Omega-3 treated group after hemilaminotomy procedure. In this group (Group III), 250 mg omega-3 solution was put in the hemilaminotomy area before closing the skin and fascia. Four weeks later from the operation rabbits were sacrificied by perfusion with 10% neutral buffered formalin solution. The lumbar spines were removed and immersed in 10% neutral buffered formalin for approximately 24 hours. Then each specimen was decalcified in 5% formic acid for approximately 3 weeks. Specimens were cut coronally for gross inspection. Peridural scar tissue on gross inspection in coronal sectioned specimens was graded into three grades. Grade I epidural scar tissue was scored with 1 point, Grade II with 2 point and Grade III with 3 point. The average score of hemilaminotomy sites without treatment was found as 2, 6 ± 0, 51. In the other hand the average score of hemilaminotomy sites with omega-3 fatty acids treatment was found as 1, 9 ± 0, 56. The difference between the treatment and non-treatment group was statistically significant. Omega-3 fatty acids solution seems an effective treatment modality in the prevention of peridural excessive scar tissue formation in the rabbit hemilaminotomy model.