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The aim of this procedure is to widen the spinal canal by using minimally invasive techniques to do hemipartial laminectomy and bilateral flavectomy in patients with cervical spinal stenosis due to ligamentum flavum hypertrophy. A 66-year-old man presented with increasing neck and right shoulder pain for one year to Koç University Hospital. He reported a three-month history of numbness in his hands. The Japanese Orthopedic Association (JOA) and Visual Analogue Scale (VAS) scores were 15 and 8, respectively. Preoperative magnetic resonance imaging (MRI) revealed spinal canal stenosis at the C3-4 level secondary to ligamentum flavum hypertrophy. Hemi-partial laminectomy at the C3 level, flavectomy, and bilateral decompression were performed using the right unilateral approach. The patient's complaints of symptoms considerably decreased three months later. The VAS and JOA scores were 2 and 16, respectively. This minimally invasive approach can be an alternative to classic laminectomy in patients who have radiculopathy and myelopathy due to posterior origin spinal stenosis in order to safely resolve pain and neurologic dysfunction.

Introduction: Although childhood trauma is a major cause of morbidity and mortality, the incidence of spinal trauma is significantly lower in children than in adults. Existing studies on pediatric spinal trauma (PST) largely concern cervical trauma because of its frequency of incidence. We aimed to obtain more information by examining all types of spinal trauma, and evaluating factors such as age, trauma type, injury type, and American Spinal Injury Association score and comparing them with data from the literature. Methods: We retrospectively reviewed 30 pediatric trauma patients with spinal pathology confirmed by spinal imaging. Results: The mean age was 166.4 months. Mean age for each mechanism of injury was: 142.7 months for a simple fall, 149.0 months for injury involving a foreign object, 163.5 months for a fall from a height, and 181.6 months for traffic accidents. There was no statistically significant difference in mean age for different mechanisms of injury (p = 0.372). The levels of the spinal injuries were: lumbar 53.3% (16), thoracic 26.6% (8), and cervical 20.0% (6). Mean age for each level of spinal injury was 113.3 months for the cervical area, 172.2 months for the thoracic area, and 183.3 months for the lumbar area. Mean age was found to be statistically significant (p = 0.000). Discussion: PST is uncommon and the type of trauma and the spinal level affected varies with age. Cervical trauma predominates at younger ages, but adult-like traumas begin to occur with increasing age. It should be considered that the risk of developing neurological deficits is higher in pediatric patients than in adults, and the risk of multisystem injury is also high.

16th World Congress of Neurosurgery of the World-Federation-of-Neurosurgical-Societies (WFNS) -- AUG 20-25, 2017 -- Istanbul, TURKEY BACKGROUND: Verapamil a calcinarn channel blacker, has shown promising results on cerebral vasospasm. However, it has not yet been accepted for treatment or prevention purposes because of the associated side effects, Although the effective results of nimodipine and nicardipine's intrathecal administration are well known, intrathecal verapamil has not been considered earlier. We used an experimental subarachnoid hemorrhage induced vasospasm model for the evaluation of vasodilator and neuroprotective effects of intrathecal verapamil, METHODS: A total of 24 Sprague-Davvley rats were randomly divided into the following 3 groups: group 1 (sham), group 2 (subarachnoid hemorrhage), and group 3 {verapamil). A double hemorrhage method was used. Group 2 did not receive any treatment. Verapamil (Eporon, Hem Ilac, Turkey) at a dose of 1000 mu g/kg was given intrathecally to group 3 rats. The animals were euthanized on day 7 of the procedure. Arterial wall thickness and lumen diameter in the basilar arterial cross-sectional areas, endothelin-1 serum level, oxidative stress index, and apoptosis were measured in all groups. RESULTS: In the verapamil group, wall thickness, endothelin-1 level, oxidative stress index, and apoptosis were found to be significantly lower than the subarachnoid hemorrhage group, but the lumen diameter was found to be greater, Intrathecal verapamil was found to decrease vasospasm parameters and apoptosis and increase the antioxidant and antiapoptotic pathways. CONCLUSIONS: Our findings suggest that intrathecal verapamil can prevent vasospasnt oxidative stress, and apoptosis after experimental subarachnoid hemorrhage. World Federat Neurosurg Soc Bezmialem Vakif University FundBezmialem Vakif University [3.2015/40] This work was supported by the Bezmialem Vakif University Fund (Project Number: 3.2015/40). WOS:000473128300136 30980985 Q3

This study describes a modified technique addressing bony defects and incomplete ossification after endoscopic strip craniectomy (ESC) for SC followed by postoperative helmet therapy (PHT). The study aims to delineate quantitative and qualitative outcomes of this modified ESC technique followed by PHT and discern the optimal duration of PHT following ESC. A secondary aim is to address the effects of the technique on bony defects.Patients undergoing ESC followed by PHT between 2017 and 2021 were included. Patient sex, age at surgery, duration of surgery, red blood cell transfusion, length of hospital stay, PHT duration, cephalic index (CI) at multiple time points, and bony defect information were collected. Descriptive and correlative analysis was done.Thirty-one patients (25 male, 6 female) were operated in study period. Mean age at surgery was 12.81 weeks, mean duration of surgery was 57.50 min, average transfused RBC volume was 32 cc, mean length of hospital stay was 1.84 days, mean PHT duration was 33.16 weeks, and mean follow-up time was 63.42 weeks. Mean preoperative CI was 70.6, and mean CI at the end of PHT was significantly higher, being 77.1. Maximum improvement in CI (CIModified ESC technique is effective in successful correction of sagittal craniosynostosis. CI

Background: Over 200 human telomerase reverse transcriptase (hTERT) polymorphism combinations have been implicated in the development of cancer. This study aimed to evaluate hTERT mutations in meningioma tissue and its association with meningioma. Material and Methods: A total of 90 patients who underwent surgery between 2006 and 2015 and were histopathologically diagnosed with meningioma (WHO 2016) were included. Results: Among the 90 participants included herein, 50 (55.5%) and 40 (44.5%) were female and male, respectively, with an average age of 56.2 ± 14 years. Mean Ki-67 values were 10.56% (SD 12.41, range 0-60), while the mean follow-up duration was 39.1 months (SD 26.3). Low- and high-grade patients had a mean Ki-67 score of 4.31% (SD 3.58, range 0-16) and 19.92% (SD 14.91, range 2-60) (p = 0.0001). Our results showed a moderate positive correlation between Ki-67 score and the presence of hTERT mutation (Pearson correlation test, r = 0.5161; p = 0.0001). Patients with an hTERT mutation > 30% had significantly higher risk for reoperation than those with lower levels of mutation (p = 0.016, chi square test). None of the patients requiring reoperation had an hTERT mutation < 10%. Moreover, high-grade patients had a 7.2 times higher risk of reoperation than those with an hTERT mutation > 30%. Conclusion: The presence of hTERT mutation, in addition to high Ki-67, indicated a more aggressive meningioma disease course and potentially increased risk of recurrence.

Katar, Salim (Balikesir Author), AIM: To assess and compare the antioxidant capacities of high-grade gliomas (HGG) according to their grades and the presence of isocitrate dehydrogenase 1 (IDH1) mutation using tissue thiol level measurement. MATERIAL and METHODS: Tissue thiol concentrations were measured in 41 HGG samples and 21 healthy brain tissues obtained from autopsy procedures, which were performed within the first 4 hours of death. All samples were stored at -80 degrees C, and a thiol quantification kit was used in evaluating tissue thiol levels. The Number Cruncher Statistical System was used for statistical analyses to detect the differences between the control group and the HGG group, which was also divided into subgroups according to their grade and IDH1 mutation presence. RESULTS: The tissue thiol levels of HGGs were found to be higher than the control group (p=0.001). Although the median thiol levels of Grade 4 gliomas were higher than those of Grade 3, no statistically significant difference was noted (p=0.076). When all tumors were compared according to the IDH1 mutation presence, IDH1-negative (IDH1-) HGGs had higher thiol contents than IDH1 mutant (IDH1+) HGGs (p=0.001). The thiol levels of Grade 4 IDH1- gliomas were statistically significantly higher than of Grade 3 gliomas (p=0.023), but no statistically significant difference between the thiol levels of Grade 3 and Grade 4 IDH1+ tumors was noted (p=0.459). CONCLUSION: We have demonstrated the higher thiol concentrations of HGGs, particularly IDH1- ones. The sulfhydryl contents of gliomas as an indicator of tumoral antioxidant capacity may be responsible for the treatment resistance of IDH1- gliomas, the mechanism of which is not clear. Thiols can be a novel target for treatment, considering the unsatisfactory results of current modalities for HGGs., Turkish Neurosurgical Society

Objective This study evaluates the relationship between degenerative and Modic changes (MCs) in the cervical spine and compares the results with the cervical sagittal balance parameters. Methods We retrospectively reviewed 275 patients with neck pain who applied to our outpatient clinic and underwent cervical magnetic resonance imaging (MRI) and cervical anteroposterior (AP)/lateral (Lat) X-ray radiography between January 2016 and January 2018. The clinics, demographic information, and radiological findings of the patients were examined. Modic changes, disc degeneration, and facet degeneration (FD) were examined by cervical MRI, and T1 slope and Cobb angle were measured by cervical AP/Lat X-ray radiography. These results were compared to evaluate their relations with each other. Results No relationship between the presence or absence of degenerative changes (Modic changes, facet degeneration, and disc degeneration) and sagittal balance parameters (T1 slope and Cobb angle) was found. However, when each cervical segment was examined separately, facet degeneration at the C4-C5 level and Modic changes at the C3-C4, C4-C5, and C6-C7 levels were statistically significant with the Cobb angles, and the Modic changes at the C3-C4 level and disc degeneration at the C2-C3 level were found to be significant with T1 slope values. Conclusions Our findings indicate that MCs increased with decreased cervical curvature, increasing disc and facet degeneration, although the causal mechanisms are not clear.

Aim of the study. Among subarachnoid haemorrhage (SAH) patients, delayed cerebral injury (DCI) and infarction are the most important causes of death and major disability. Cerebral vasospasm (cVS) and DCI remain the major cause of death and disability. Thymoquinone (TQ) is the substance most responsible for the biological activity of nigella sativa (NS) and is useful in the treatment of ischaemic and neurodegenerative diseases, oxidative stress, inflammatory events, cardiovascular and neurological diseases. We conducted an experimental study aimed to investigate the preventive and corrective effects of TQ. Materials and methods. 24 Sprague-Dawley rats were randomly divided into three groups. The first was the control group which was a sham surgery group. The second group was the SAH group where the double haemorrage SAH protocol was used to induce vasospasm. The third group was the SAH+TQ group, where cVS was induced by the SAH protocol and the animals received oral 2 cc thymoquinone solution for seven days at a dose of 10 mg/kg, after the induction of SAH. The rats were euthanised seven days after the first procedure. The degree of cerebral vasospasm was evaluated by measuring the basilar artery luminal area and arterial wall thickness. Apoptosis was measured by the western blot method at brainstem neural tissue. Oxidative stress was measured by the Erel Method. Endothelin-1 was measured with ELISA analysis at blood. Statistical analysis was performed. Results. Endothelin-1 values were found to be statistically significantly lower in the control and SAH+TQ groups compared to the SAH group (P < 0.001). Mean lumen area values were significantly higher in the control and SAH+TQ groups than in the SAH group (P < 0.001). In the control and SAH+TQ groups, wall thickness values decreased significantly compared to the SAH group (P < 0.001). OSI values were significantly lower in the control and SAH+TQ groups than in the SAH group (P < 0.001). Apoptosis was significantly lower in the control and SAH+TQ groups than in the SAH group (P < 0.001). Conclusion. Our results show that post-SAH TQ inhibits/improves DCI and cVS with positive effects on oxidative stress, apoptosis, ET-1, lumen area, and vessel wall thickness, probably due to its anti-ischaemic, antispasmodic, antioxidant, anti-inflammatory, anti-apoptotic and neuroprotective effects.

Idiopathic intracranial hypertension (IIH) is a condition with increased intracranial pressure (ICP) without mass lesion or a known etiology with normal cerebrospinal fluid (CSF) composition. With optical coherence tomography (OCT), which is a noninvasive imaging technique, cross-sectional scans of the retina, choroid, and optic nerve head can be obtained with a resolution that is close to histological resolution.The study aimed to evaluate the efficacy of OCT in providing practical and sensitive measurements to follow-up patients with IIH.This retrospective study included 22 patients with IIH and 22 healthy controls. OCT was used to measure peripapillary retinal nerve fiber layer thickness (RNFLT), ganglion cell layer (GCL) thickness and inner plexiform layer (IPL) thickness, and subfoveal choroidal thickness (CT). Lumbar puncture (LP) was performed to evaluate ICP. An association between subfoveal CT and ICP was noted in patients with IIH-a finding that has not been reported previously.Patients with IIH had increased RNFLT (P0.000) and CT (P0.000) compared with healthy controls. In addition, subfoveal CT was significantly correlated with ICP (rMeasurement of CT by OCT, which reflects ICP, allows for the follow-up of patients with IIH. In addition, it can be used to monitor other diseases with high ICP.

Objective Meningiomas are among the most common intracranial tumors, accounting for 30% of all tumors of the central nervous system. Recent studies analyzing microRNA (miRNA) profiles and functions in cancer have provided valuable information about the molecular pathogenesis of several tumor types, including glioblastoma multiforme (GBM), hepatocellular carcinoma, and breast, lung, colon, and prostate cancer. miRNAs are a family of small, endogenous, noncoding RNAs of 18–25 nucleotides. In this study, we carried out a genome-wide array screen comparing miRNA-21, miRNA-107, miRNA-137 and miRNA-29b expression in meningiomas. Patients and methods A total of 50 meningioma patients (16 men and 34 women) aged between 32 and 80 years were included. The study was conducted at Istanbul Research and Training Hospital Neurosurgery Clinic. Results Our results have shown a significant increase in miRNA-21 expression with increasing histopathologic grade, while there was a significant reduction in miRNA-107 expression with the increasing histopathological grade. miRNA-137 and miRNA-29b expression did not differ significantly according to histopathologic grade. Conclusion The subject of our study, i.e. the association between miRNA expression and meningioma, is continuously gaining more importance in the wider context of the recent developments in genetic treatments.

Purpose: Non-synostotic positional deformities are currently diagnosed in nearly half of the newborns, however not any evidence-based guidelines are available for management. The aim of this study is to assess the effect of active repositioning treatment at infants with positional skull deformities. Method: A retrospective data of 158 infants treated with active repositioning as a conservative treatment for at least 2 months were analyzed in this study. Anthropometric 3D scanner measurements of pre-and post-treatment diagonal difference, cranial vault asymmetry index, cranial ratio were evaluated for each patient. Infants were separated to 4 different groups according to their morphologic deformation types as plagiocephaly, brachycephaly, scaphocephaly and combined (brachycephaly+plagiocephaly), and 2 groups according to age at onset of treatment. Results: In combined group, pre-treatment mean diagonal difference and cranial vault asymmetry index values decreased from 9.38 mm and 6.9% to 6.94 mm and 4.9% respectively. In plagiocephaly group, mean pre-treatment results changed from 10.32 mm and 7.5% to 7.83 mm and 5.5% respectively after treatment. All these changes were statistically significant. Effectiveness of timing of repositioning treatment on different positional skull deformities was analyzed and outcome was found significantly improved when the active repositioning treatment was started before 4 months of age. Conclusion: Improvement rates of the asymmetry decrease with age due to decreasing skull enlargement rate. Early diagnosis, especially before 4 months of age, more parental education, and close follow-up are important for babies with this condition who may benefit just from repositioning treatment.

Purpose The aim of this study was to evaluate the association between changes in the type of Modic change (MC) and newly developed MCs and low back symptoms. Methods This retrospective study includes all the patients suffering from low back pain who has at least two magnetic resonance studies between 2013 and 2016. Patients with MC in at least one vertebra in magnetic resonance imaging (MRI) images were included in the study. The patients who have periods of two MRIs less than six months were excluded. Results A total of 129 patients were included in the study and 774 vertebrae were evaluated. At the time of the first admission, MC was observed in 283 out of the 774 vertebrae (37%), whereas in the second admission, MC was observed in 343 of 774 (43%) vertebrae. New MCs were observed in 59 vertebrae. Two patients showed complete resolution of MC in the second admission. It was observed that patients with type 1 change were more associated with pain than other types (p=0.001). Conclusion In our retrospective case-control study, we have found that MCs can transform into different types or disappear completely over time. A significant positive correlation was found between the presence of MC type 1 changes in the visual analog scale(VAS).

Aim To investigate the relationship between the distribution of ABO or Rhesus (Rh) blood group antigens and the incidence of myelomeningocele. Material and methods A retrospective data was reviewed for all myelomeningocele patients operated at a tertiary academic hospital between years 2014 and 2019. Age, sex, delivery method, physical and neurological examination findings, and radiological findings alongside with blood type of each patient were recorded. The data of blood group distribution among the study patients was compared to the data of healthy individuals in the same region. Results Patients with group B and AB showed a higher chance of developing myelomeningocele. Rh-positive blood group was associated with high incidence of myelomeningocele (93.5%), whereas Rh-negative blood group showed least association (6.5%). Rh-positive blood group was also found to be more frequent in patients with myelomeningocele with hydrocephalus and Chiari malformation. Conclusion The findings of this study show that ABO and Rh blood groups have an effect on the development of myelomeningocele under the influence of environmental or genetic factors.

Objective: We aimed to investigate the effectiveness of the amount of polymethylmethacrylate used in pain control and maintenance of long-term vertebra corpus height in patients undergoing percutaneous vertebroplasty due to osteoporotic compression fracture of the lumbar vertebra. Method: A total of 60 patients who underwent unilateral percutaneous vertebroplasty between 2014 and 2019 due to osteoporotic compression fracture of the lumbar vertebrae were included in the study. Patients who received 5 ml and 3 ml cement injection were retrospectively analyzed. Of patients, postoperative visual analogue scale (VAS) score and anterior vertebral height of the patients at 1st-year control were evaluated. Results: In the postoperative period, the mean visual analogue scale score was 2.3±0.46 in the 5 ml injected group and 2.2±0.4 in the 3 ml injected group (p5 ml=0.001, p3 ml= 0.001). There was a statistically significant decline in pain control in both groups. The mean anterior vertebral height loss (AVHL) in the 5 ml injected group was 31.5±0.40%, and 32.6±0.47% in the 3 ml injected group (p5 ml=0.820, p3ml= 0.870). There was no statistically significant alteration in both groups. Conclusion: Our results indicate that the 3 ml polymethylmethacrylate injection during the percutaneous vertebroplasty procedure provides adequate pain control and stabilization in patients with lumbar vertebral osteoporotic fracture. Therefore we think that small amount of polymethylmethacrylate (3 ml) is sufficient to avoid undesirable complications in this patient group.

Aim To evaluate the relationship between the time from termination of anticoagulant/antiplatelet medication to surgery and the risk of acute postoperative hemorrhage in CSDH patients. Material and methods A retrospective study of patients who underwent bur hole craniotomy for CSDH between December 2014 and December 2019 was performed. Demographic and clinical data of age, gender, medication (antithrombotic therapy), smoking, daily alcohol consumption, history of head trauma, presenting symptoms and neurological examination were collected from medical records. Patients were divided into 3 groups according to the time of surgery from referral; 1st group: within 24 hours; 2nd group: between 24 to 72 hours; 3rd group: after 72 hours. Results In the 5-year period, 117 patients underwent CSDH surgery. 72 of 117 patients were male (61.5%) and 45 of 117 patients were female (38.5%). The mean age was 70.5 ± 7.2 years. Postoperative ASDH was observed in 2 of 32 patients (6.3%) without any antithrombotic medication history and 6 of 85 patients (7.1%) with previous antithrombotic medication history. Preoperative antithrombotic drug usage was not statistically significant in terms of acute complication development (p = 0.797). Conclusion In this study, we found that the risk of acute hemorrhage due to antithrombotic medication did not differ from those who were not under the medication. Although it is reported in the literature that antiaggregant and anticoagulant drugs should be discontinued between 5 and 7 days before the surgical procedure, our results showed that acute hemorrhage was not detected in any of the patients operated 72 hours after referral.

Amaç: Bu çalışmanın amacı, düşük ayak gelişiminden sinir dekompresyonuna kadar geçen sürenin düşük ayak kliniğinde iyileşme oranı ve derecesi üzerine olan etkilerini değerlendirmektir.Gereç ve Yöntemler: Nisan 2014 ve Şubat 2019 arasında düşük ayak kliniği (ayak bileği dorsifleksiyonu 0/5 parazik) nedeniyle mikrodiskektomi geçirmiş olan ardışık 30 hasta retrospektif olarak incelendi. Hastalar düşük ayak gelişiminden ameliyata kadar geçen süreye göre 1 hafta olmak üzere göre 3 gruba ayrıldı. Gruplar arasında ameliyat sonrası ayak bileği dorsifleksiyon kas kuvvetlerinin iyileşme oranlarını ve derecesini değerlendirmek için Kruskal-Wallis ve Bonferroni düzeltmeli Mann Whitney U testi kullanıldı.Bulgular: Bu çalışmada, düşük ayak nedeniyle ameliyat edilen 30 hasta (18 kadın ve 12 erkek) değerlendirilmiştir. Hastaların ameliyat sırasındaki ortalama yaşı 46,5±13,5 (aralık 18-72) idi. Ameliyat sonrası ayak bileği dorsifleksiyonu kas gücü 1 hafta grubunda 1,0±1,3 (aralık, 0-3) idi. 1 hafta grubundan (p=0,002) anlamlı şekilde farklılık göstermekteydi. 72 saat - 1 hafta grubu ve >1 hafta grubu arasında istatistiksel olarak anlamlı bir farklılık görülmedi (p=0,427).Sonuç: Düşük ayak kliniğinde semptomların başlangıcından cerrahi dekompresyona kadar geçen sürenin, ameliyat sonrası iyileşme oranlarında istatistiksel olarak anlamlı bir prediktör olduğu görüldü., Aim: The aim of this study was to evaluate the effect of the duration from foot drop development to nerve decompression on the rate and degree of recovery in foot drop clinic.Material and Methods: We retrospectively reviewed 30 consecutive patients who had undergone microdiscectomy for foot drop clinic (ankle dorsiflexion 0/5 paresis) between April 2014 and February 2019. Patients were divided into three groups according to the time from foot drop development to surgery, as 1 week. Kruskal-Wallis and Bonferroni corrected Mann Whitney U test were used to evaluate the rate and degree of recovery of ankle dorsiflexion muscle strength between groups.Results: In this study, 30 patients (18 females and 12 males) who underwent surgery for foot drop were evaluated. Mean age at the time of surgery was 46.5±13.5 (range, 18-72) years. Postoperative ankle dorsiflexion strength was 4.2±1.6 (range, 0-5) in 1 week group. Postoperative muscle strength improvement level of 1 week group (p=0.002). There was no statistically significant difference between 72 hours - 1 week group and >1 week group (p=0.427).Conclusion: In foot drop clinic, the duration from onset of symptoms to surgical decompression was a statistically significant predictor of postoperative recovery rates.

Purpose This study aimed to investigate the effect of age at helmet therapy onset on treatment efficacy in moderate-to-severe deformational plagiocephaly (DP) and combined DP and asymmetrical brachycephaly (AB) in infants. Methods Ninety-eight infants who were referred to our institution and who underwent helmet therapy between 2014 and 2018 were retrospectively reviewed. Patients with DP [cranial vault asymmetry index (CVAI) > 7% and DD > 10 mm] and AB [CVAI > 7% and cephalic ratio (CR) ≥ 94] were included. Pre- and post-treatment calvarial asymmetries (difference among DD, CVAI, and CR) were measured using 3D screening systems (SmartSoc and Omega Scanner 3D). Infants were classified according to age at treatment onset: group 1 (age, < 6 months) and group 2 (age, ≥ 6 months). Results CVAI was statistically different between treatment onset and end in subgroups. Moreover, the regression of CVAI between groups DP1 (− 7.5% ± 1.2%) versus DP2 (− 5.4% ± 1.5%; p = 0.001) and groups AB1 (− 6.6% ± 1.4%) versus AB2 (− 4.4 ± 2.5; p = 0.0013) was statistically significant. CVAI was < 3.5% and CR was ≤ 89 (assumed as normal cranial shape) after treatment in 48%, 40%, 32%, and 6% of infants in groups DP1, DP2, AB1, and AB2, respectively. Conclusion These findings emphasize the efficacy of helmet therapy for DP and AB. Helmet is an appropriate treatment option particularly for infants with severe DP and AB, and early onset of helmet therapy before the age of 6 months is advised.

Bow hunter's syndrome (BHS) is characterized with repeating paroxysmal vertigo, nystagmus and ataxia caused by mechanical compression of the vertebral arteries. There is no definite diagnostic and treatment protocol. 26-year-old female patient admitted to the outpatient clinic with complaints of dizziness and seldom falls. Stenosis in the right vertebral artery at the level of C1 and C2 was discovered by the diagnostic modalities. In our patient, we first performed hemilaminectomy by posterior approach. But the symptoms of the patient did not recede, thus we performed decompression with the anterolateral approach by opening the foramens atlas and axis without disrupting the dynamics of the vertebrae and without the need for stabilization. The symptoms of the patient disappeared after this intervention. The patient had complete relief of symptoms at the first year follow up. Surgery must be planned to preserve the life quality of the patient and relieve complaints of the patients. To achieve these goals anterolateral approach must be tried before attempting posterior stabilization.

Tension pneumocephalus (TP) which produces increased intracranial pressure and leads to neurological deterioration is a rare but life-threatening complication. A 59-year-old male patient who had undergone endoscopic sinus surgery was admitted to the emergency room with severe headache, nausea, and vomiting. Cranial computed tomography revealed pneumocephalus. Endoscopic surgery under general anesthesia was performed again, and a dural tear at the crista galli was identified and repaired using an autograft and fibrin glue. In same session, burr-hole drainage was also performed. He recovered after few days and was discharged. Therefore, following endoscopic sinus surgery, surgeons should be aware of the development of pneumocephalus, a rare but life-threatening complication. WOS:000414779400006

Introduction: Estrogen helps to maintain the health of collagen-containing tissues including the intervertebral disc. Estrogen deficiency after menopause negatively affects the quality of vertebral end plates and induces development of degenerative disc disease (DDD). However, there is no study examining the relationship between parity and spinal degeneration in young women. The aim of this study was to define the relationship between parity and development of vertebral endplate signal changes and DDD in young premenopausal women. Materials and methods: This case-control case study included 224 patients aged 20–40 years with a history of low back pain for at least 3 months. Pfirrmann’s grade, Modic changes (MCs), and Schmorl’s nodes (SNs) were graded based on magnetic resonance images. Patients’ parity, demographics, body mass index, physical activity level, and disability scores were assessed using a questionnaire. Results: The prevalence of abnormal total Pfirrmann’s score (>10) and MCs was higher in primiparous patients than multiparous and grand-multiparous; however, it was not statistically significant. The presence of SN was statistically significantly associated with low parity. According to multivariate logistic regression analysis, it was found that the number of births increases by 1 unit, the abnormality in Pfirrmann’s score decreases by 1.36 times. Conclusions: This cross-sectional study shows that parity is associated with DDD and vertebral end plate changes. SNs were significantly associated with parity. Modic changes and DDD were less common in grand multipara and multipara young women than in primipara women. These results indicate that low parity may possibly be associated with the development of spinal degeneration. © 2019, © 2019 The Neurosurgical Foundation.

Aim: The aim of this study was to evaluate the effect of the duration from foot drop development to nerve decompression on the rate and degree of recovery in foot drop clinic. Material and Methods: We retrospectively reviewed 30 consecutive patients who had undergone microdiscectomy for foot drop clinic (ankle dorsiflexion 0/5 paresis) between April 2014 and February 2019. Patients were divided into three groups according to the time from foot drop development to surgery, as 1 week. Kruskal-Wallis and Bonferroni corrected Mann Whitney U test were used to evaluate the rate and degree of recovery of ankle dorsiflexion muscle strength between groups. Results: In this study, 30 patients (18 females and 12 males) who underwent surgery for foot drop were evaluated. Mean age at the time of surgery was 46.5±13.5 (range, 18-72) years. Postoperative ankle dorsiflexion strength was 4.2±1.6 (range, 0-5) in 1 week group. Postoperative muscle strength improvement level of 1 week group (p=0.002). There was no statistically significant difference between 72 hours-1 week group and >1 week group (p=0.427). Conclusion: In foot drop clinic, the duration from onset of symptoms to surgical decompression was a statistically significant predictor of postoperative recovery rates. © 2019, Duzce University Medical School. All rights reserved. Medical Research Council, MRC: Table1 A total of consecutive thirty patients, who had undergone microdiscectomy due to foot drop clinic (ADF 0/5 paresis) by the same surgical team in two different state hospitals between April 2014 and February 2019, were retrospectively reviewed. Clinical records, radiological imaging reports and surgical reports were reviewed. Data on patient demographics and clinical features, the time elapsed between the development of foot drop and surgery, duration of surgery, and muscle strength of ADF in the early post-operative period were reached. The evaluation of muscle strength of the ADF was carried out by the assessment of the tibialis anterior muscle in accordance with the muscle strength scale of Medical Research Council (Table1). Comorbidities, including diabetes mellitus (DM), smokers, coronary artery disease, chronic obstructive pulmonary disease (COPD) and hypertension were ascertained from the medical records. All procedures carried out in studies including human participants were conducted in compliance with the ethical standards of institutional and/or national research committee, the Helsinki Declaration and its amendments or comparable ethical standards. Ethical approval for the study was obtained from the institutional review board of Namık Kemal University (01.08.2019, 2019/21). Informed and written consent was obtained from all patients. The patients were divided into three groups as regards the time elapsed from the development of foot drop to surgery, as 1 week. Statistical Analysis Normality assumption for continuous data were examined by Shapiro-Wilk test. The differences between the groups were analyzed by Kruskal-Wallis test followed by Mann Whitney U test with Bonferroni correction, since variables not showing normal distribution. Descriptive statistics given as mean±standard deviation and median (minimum-maximum). Categorical data were analyzed with Fisher-Freeman-Halton test and summarized as frequency and percentage. All statistical analyses were performed using MedCalc v.12.7.7 (MedCalc Software, Ostend, Belgium), and p

Objective: To determine whether serum neurogranin (NRGN), glial fibrillary acidic protein (GFAP), and calciumbinding protein S100 beta (S100B) levels are associated with traumatic intracranial lesions compared to computed tomography (CT) findings of patients with mild traumatic brain injury (mTBI). Patients and Methods: The cross-sectional study cohort included 48 patients who were admitted to the Emergency Department with a complaint of mTBI, a Glasgow Coma Scale score of 14–15, and at least one symptom of head trauma (i.e., post-traumatic amnesia, nausea or vomiting, post-traumatic seizures, persistent headache, and transient loss of consciousness). Blood samples and CT scans were obtained for all patients within 4 h of injury. Age-matched patients without intracranial traumatic pathology (CT-) were recruited as a control group. Blood samples were measured for NRGN, GFAP, and S100B levels. Results: Of 48 patients, 24 were CT + and had significantly higher serum NRGN (5.79 vs. 2.95 ng/mL), GFAP (0.59 vs.0.36 ng/mL), and S100B (1.72 vs.0.73 μg/L) levels than those who were CT- (p = 0.001, p = 0.026, and p < 0.001, respectively). ROC curves showed that NRGN, GFAP, and S100B levels were sufficient to distinguish traumatic brain injury in patients with mTBI. At the cut-off value for NRGN of 1.87 ng/mL, sensivity was 83.3%, and specificity was 58.3%. At the cut-off value for GFAP of 0.23 ng/mL, sensivity was 75% and specificity was 62.5%. The optimal cut-off value for S100B was 0.47 μg/L (95.8% sensitivity and 62.5% specificity). Conclusion: This is the first study to evaluate NRGN in human serum after mTBI. We confirmed that NRGN levels were significantly higher in CT + patients than CT- patients in the mTBI patient population. Future studies of larger populations and different age groups (especially pediatric) can help reduce the number of CT scans as a reliable and noninvasive diagnostic tool for evaluating NRGN protein levels in mTBI patients with a low probability of intracranial lesions.

WOS: 000452897000053, PubMed: 30267950, OBJECTIVE: The present study examined the physical extent of Modic type 1 (MT1) changes and other phenotypic magnetic resonance imaging (MRI) findings in the vertebrae of patients with low back pain (LBP) and MT1 changes. We also identified any correlations of these findings with the severity of pain and the Oswestry Disability Index (ODI). The relationship between the presence of pain and MT1 changes has been examined in several studies. However, to the best of our knowledge, no study has assessed the relationships between pain severity and ODI and the total vertebral area of MT1 involvement. METHODS: After excluding any patient with MT2 or MT3 changes, 49 patients with a diagnosis of LBP and MT1 changes demonstrated on MRI were included. MT1 involvement area, disc height, number of Schmorl's nodes, disc degeneration (Pfirrmann grade), and cross-sectional area of the lumbar muscles were obtained via MRI. Additionally, patient demographic data, body mass index, physical activity level, and disability (ODI) scores were assessed. RESULTS: The total vertebral area of MT1 involvement correlated significantly and positively with the ODI (P = 0.001). In the multivariate linear regression model, with ODI as the dependent variable and age, mean Pfirrmann grade, total vertebral area of MT1 involvement, and sex as independent variables, only the total vertebral area of MT1 involvement was significantly associated with the ODI. CONCLUSIONS: A significant positive correlation was noted between the vertebral MT1 involvement extent and changes in the ODI. Other MRI features of patients with LBP were not related to pain severity or ODI.

A new xanthine (X) biosensors based on a hybrid nanocomposite containing multi-walled carbon nanotubes (MWCNT), Pt nanoparticles (PtNP) and gold nanoparticle (AuNP) was presented. X biosensor was fabricated by dropping AuNP/PtNP/MWCNT onto xanthine oxidase (XO) modified glassy carbon paste electrode (GCPE). Resulted XO/AuNP/PtNP/MWCNT/GCPE biosensor showed two linearity between 2.0 and 50 µM and 0.25 and 6.0 mM for X. RSD value was calculated as 2.46 (n = 5). Finally, the biosensor was applied to the X detection in synthetic serum samples and good recovery value was obtained.

In this study, we aimed to evaluate patients who develop ventriculostomy requirements and to evaluate the external ventricular drainage infection rates retrospectively at our clinic. In the study, dates between January 2012 and 2014, patients who were inserted external ventricular drainage with different indications were examined retrospectively. By using the medical record system, patients’ demographics (age, sex), diagnostic, ventriculostomy indications and ventriculostomy time had been reached. By accessing laboratory data, the patients’ cultures of cerebrospinal fluids biochemical tests were analyzed retrospectively. Within the period of the study, 20 in 117 patients with external ventricular drainage were not included the study because of shunt infection and shunt occlusion of extracted patients. During the treatment period 148 EVD were inserted to 97 patients. The number of male patients was 53; the number of female patients was 44. When the reason of the examined patients’ using external ventricular drainage was analyzed, 55% hemorrhagic cerebrovascular diseases, (subarachnoid hemorrhage, intraventricular hemorrhage, intracerebral hemorrhage, cerebellar hemorrhage, traumatic intracranial injury), 24.7% tumor induced use, 7.4% central nervous system infections (menengitis, apse), and 12.4% occlusive cerebrovascular diseases (hydrocephalus or brain edema that were developed after the infarct) were seen. During the course of our study, 23% of the surveyed 97 patients had leukocytosis. CFT culture of 12 patients found positive. In CFT cultures mostly coagulase-negative staphylococcus growth took place. Eventually, when we compare our infection proportions to the international literature, very large differences were not observed. Except for revisioned patients, no other criteria were found that increased the rate of infection. We think that a rigorous pre-operative preparation and a regular maintenance of external ventricular drainage may reduce the rate of infection.

In this study, manganese(IV) oxide (MnO2) nanoparticle (np)-modified glassy carbon paste electrode is used for ascorbic acid (AA) detection in fruit juice samples. The experimental parameters like MnO2 np amount and pH were optimized by using modified full factorial design model. By means of this model, the number of experiments has been reduced. Under optimal conditions, the linear range for AA was obtained between 2.64 × 10−6 and −1.5 × 10−3 M. Limit of detection (LOD) (3 s/m) and relative standard deviation (RSD) were calculated as 8 × 10−7 M and 4.56 %, respectively. Developed sensor was applied to AA detection in fruit juice samples.

Isolated brain stem hemorrhages are rare but have a high mortality rate after blunt head trauma. 56-year-old male admitted to the emergency room with weakness on the right side of his body, one day after the blunt head trauma. Right hemiparesis which is near to plegia (lower extremity motor weakness level was higher than upper extremity) was found on his neurological examination. T2-weighted images and susceptibility weighted images (SWI) of the magnetic resonance revealed heterogenous hyperintense lesion with hemorrhage at the left side of the pons. The patient was managed with conservative treatment; at three-month follow-up, near total recovery was observed on his neurological examination. As a conclusion, it could be said that brain stem contusion with hemorrhage could be kept in mind in patient with hemiparesis if the neurological deficit of the patient cannot be explained by supratentorial or spinal cord lesions. WOS:000432442900006

Peripheral aneurysms of the lateral posterior choroidal artery are rare and mostly in association with vascular and occlusive pathologies such as moyamoya disease. To the best of our knowledge, pure lateral posterior choroidal artery aneurysms without association of any other vascular diseases are unique and only 3 cases have been reported in the literature. © 2017 Elsevier Inc. 29277533

Aim: Vertebral compression fractures lead to pain, significant spinal deformity and functional disability that severely limit the health-related quality of life. Although most patients respond to conservative treatment, it has been shown that more than 40% of patients do not achieve the desired reduction in pain within 1 year of onset of symptoms. Percutaneous balloon kyphoplasty is often used to relieve symptoms and accelerate the recovery of function. The aim of this study is to evaluate the pain and functional outcomes of patients treated with percutaneous balloon kyphoplasty. Material and Methods: Data of 113 patients who underwent percutaneous balloon kyphoplasty with the diagnosis of vertebra compression fracture between January 2015 and June 2019 were scanned. Preoperative and postoperative Numeric Rating Scale scores and Oswestry Disability Index (ODI) scores with complications were evaluated.Results: 113 patients with 154 vertebral fractures were treated. 86 were female and 27 were male. The mean age was 76.8 years. L1 (n=29) and Th12 (n=31) vertebral fractures were the most common. The mean duration of the procedure was 65.93 minutes, and the mean volume of cement was 5.02 ml. Cement leakage was observed at 12 cases. Permanent neuromotor deficits or mortality was not observed at any of the patients. Following percutaneous balloon kyphoplasty, the NRS and ODI scores significantly improved at the 6th month follow-up compared with preoperative scores, the NRS and ODI scores before the procedure were 8.8 and 49.2 whereas the postoperative NRS and ODI were 2.2 and 18.1, which is.Conclusion: Percutaneous balloon kyphoplasty is an effective procedure to control pain and improve health related quality of life. This method has the advantage of improving and restoring the vertebral height and kyphotic deformity in osteoporotic or pathological vertebral compression fractures.

Air guns and rifles are usually considered to be harmless. Even though these firearms are categorized as toys, injuries with these are quite common in children and adolescents. The most common reason for these types of injuries is accidents and negligence. In this case report we present a 17-year-old male, admitted to the emergency department with a 5 mm incision below his left eye. In the CT imaging a pellet was seen lodged in the cribriform plate. It pierced through the ethmoid sinus. The patient was admitted to the inpatient clinic and managed conservatively with antibiotherapy. A review of literature was performed to find out the best strategy to reach an optimized outcome and evaluate probable complications.

Object: To evaluate the use of neuronavigation with vascular micro-doppler in transsphenoidal pituitary surgery. Methods: 141 cases having done transsphenoidal pituitary surgery are evaluated from 2005 to 2014. Fluoroscopy was used in 69 cases and vascular micro-doppler with neuronavigation were used in 72 cases. Results: Transsphenoidal surgery has a lot of risks due to sella’s deep location, and position of the carotid artery and the optic nerve. Clasically the fluoroscopy and microscopic anatomical markers were used in order to minimize the risk of carotid artery and optic nerve damage. Additional devices such as neuronavigation and vascular micro-doppler are needed to decrease the morbidity and mortality arising from these injuries. Conclusion: Neurovascular complications such as carotid artery and optic nerve injuries owing to disorientation in transsphenoidal surgery will reduce the use of neuronavigation with vascular micro-doppler.

Acute subdural hematoma is one of the neurosurgical emergencies that could lead to mortality, thus needing urgent surgical intervention in most of the cases. A 1-year-old female patient was admitted to the emergency department after she fell from a 2-m height. She had 5 x 2-cm acute traumatic subdural hematoma diagnosed with computed tomographic (CT) scan of the head. She was rushed to the operating room for a need of possible surgical intervention. Her vital signs improved before she was operated on. A new CT scan was obtained. The CT scan revealed complete resolution of the subdural hematoma. Spontaneous resolution is rarely seen in acute traumatic subdural hematoma patients, and complete resolution could take several weeks. In the presented case report, complete resolution occurred in approximately an hour.