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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.

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

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.

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.

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.

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.

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.

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

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.

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

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.

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.

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

Chronic subdural hematoma and cranial abscess are two phenomena that are easy to differentiate in daily neurosurgical practice. Although the neurological symptoms may be the same in both, today’s imaging techniques and laboratory facilities are helpful for a definitive diagnosis. In this study, a patient who was operated on for a subdural hematoma came to the emergency room after 1 month with distinct hemiparesis appearing in the right arm and speech difficulties. Hospitalized due to the appearance of an abscess, which had a pachys capsule, keeping the contrast in the left parietal in the cranial CT and MR, the patient was operated on, and the mass was excised, along with the capsule. The lesion of the patient, which showed no reproduction in the culture, was diagnosed as a growing hemorrhagic cystic lesion, covered by a thick capsule. The literature showed no such growing cystic lesion causing a shift like an abscess after chronic subdural hematoma operation. We believe that it would be appropriate to consider a differential diagnosis, besides diagnoses, such as abscess or subdural empyema. Do we evaluate cystic lesion like abscess such as inflammatory response.

Dermoid cysts are uncommon congenital or acquired developmental cystic malformations that were usually seen in the midline of frontal region and the anterior fontanel. Congenital forms develop from the remnants of the epithelium or ectodermal membranous bone growth line. We report here a case of a congenital frontal dermoid cyst that should be considered in the differential diagnosis of lipoma and neurofibroma. Dermoid cysts should be considered in the differential diagnosis of all nodular cyst-like lesions in the head and neck region. Early recognition and accurate diagnosis by means of Computerized Tomography scan or Magnetic Resonance Imaging facilitate successful treatment.

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.

WOS: 000269382200004 We describe the first usage of a double walled carbon nanotube (DWCNT) modified carbon paste electrode as biosensor transducer. Xanthine was chosen as a substrate for evaluation of the electrode performance. Proper amount of DWCNT and xanthine oxidase enzyme were mixed with proper amount of graphite and mineral oil for attaining the xanthine biosensor. Results were compared with previous work that includes multi-walled carbon nanotube and single-wall carbon nanotube based carbon paste electrode xanthine biosensors. A linearity was obtained in the concentration range between 2-50 mu M xanthine under the response time of 150 s with the equation of y = 0.0441x + 0.2013 and RSD value of 4.20%. This system was applied to the determination of xanthine in canned tuna fish samples and recovery was calculated as 99.20% +/- 0.07.

WOS: 000343715000073 The present work is the first that includes the use of glycine (Gly), lysine (Lys) and glutamic acid (Glu) modified clay mineral matrices in the biosensors. For this purpose, initially, Gly, Lys and Glu were intercalated with montmorillonite (Mt), thus, various modified Mts were obtained. These modified materials were then characterized via X-ray diffraction, Fourier transform infrared spectroscopy, zeta potential and thermal gravimetric analysis (TGA/DTG) and scanning electron microscopy (SEM). In order to investigate the applicability of amino acid modified clay minerals in biosensor areas, glucose oxidase (GOx) was selected as the model enzyme and a GOx based biosensor was prepared. After immobilizing the enzyme with amino acid modified Mt onto a glassy carbon electrode, working conditions like pH and modifier type were optimized. Among the modified Mts, Gly-Mt was the optimum clay mineral type and pH 4.0 was the optimum pH value. Then analytical characteristics were examined under optimum experimental conditions. The linear range of optimum sensor design was 0.1-1.0 mM within the kinetic parameters of an immobilized enzyme K-m(app) m = 0.7 mM, I-max = 107.8 nA. Finally, the developed biosensor was applied to real samples where the results were compared with a spectrophotometric reference method.

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.

WOS: 000304327300040 This work constitutes the first biocentri-voltammetric application for acetylcholinesterase (AChE) activity assay. After the optimization of working conditions like reaction time, centrifugation speed and time and enzyme amount, the analytical characteristics were investigated. As a result, the linear range of 1.0-350 mu M was obtained with an equation of y = 0.0004x + 0.0163. The correlation coefficient is equal to (R-2) 0.99 +/- 0.001815 (n = 3) and the RSD value was calculated as 3.6% (n = 4). Then Donepezil-based drug analysis was also conducted by using the developed method and an inhibition of 80% was calculated. Technical and Scientific Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [109T885] The grant from The Technical and Scientific Council of Turkey (TUBITAK) Project no: 109T885 is gratefully acknowledged.

We report on the determination of choline and acetylcholine via biocentrivoltammetry. This method combines centrifugation and voltammetry and is based on a carbon paste electrode modified with acetylcholinesterase and choline oxidase. The electrode was placed at the bottom of a biocentrivoltammetric cell. Acetylcholine and choline are accumulated on the enzyme electrode via centrifugative forces, upon which a direct voltammetric scan is applied. Reaction time, pH values, quantities of enzyme and centrifugation parameters were optimized. A linear response is obtained in the 0.07 to 10 mu M concentration range of acetylcholine, and a limit of detection as low as 0.5 mu M. The linear range is between 0.1 and 500 mu M for choline. The method was applied to the determination of acetylcholine and choline in spiked serum samples.

Trimethylamine (TM) intercalated montmorillonite (Mont) clay was prepared and characterized using X-ray diffraction, Fourier transform infrared spectroscopy, zeta potential and thermal gravimetric measurements. Gluconobacter oxydans cells were immobilized on the micro-structured matrix and used in microbial sensor applications. Sensor responses were based on the respiratory activity of the cells and the consumption of oxygen was monitored at −0.7 V (vs. Ag/AgCl and platinum electrodes) by using glucose as a substrate. Stabilization of the bacteria was performed on the Mont using glutaraldehyde. Optimization of the TM-Mont/G. oxydans sensor and examination of the electrochemical mechanism were carried out in a batch system. Measurements concerning analytical characteristics, operational stability, repeatability and substrate specificity depending on the carbon source in the culture were investigated in a flow injection analysis (FIA) system. Linear ranges were found between 0.15 and 5.0 mM for the batch mode and 0.1 and 5.0 mM for the FIA system, respectively. Finally, real samples were analyzed and were compared with the results of a spectrophotometric method as reference.

anik, ulku/0000-0002-3607-7208; Pumera, Martin/0000-0001-5846-2951 WOS: 000277203500010 PubMed ID: 20672081 The electroanalytic performances of glassy carbon paste electrode (GCPE), multi-walled carbon nanotube (MWCNT)-GCPE and double-walled carbon nanotube (DWCNT)-GCPE, which include HNO3 washed/unwashed materials, were compared by monitoring cyclic voltammograms of potassium ferricyanide and catechol. Electrodes were prepared by introducing proper amount of DWCNT and MWCNT into GCPE. First untreated materials (DWCNT, MWCNT, GC mu-particles) were used in the electrodes and then HNO3-treated materials were utilized for comparing difference in electrochemical performances. The effect of treatment procedure was also examined by applying Raman spectroscopy to treated and untreated materials. Moreover, TEM images were obtained for further investigation of MWCNT and DWCNT. MEXT, JapanMinistry of Education, Culture, Sports, Science and Technology, Japan (MEXT); NIMS ORI This work was supported in part by the World Premier International Research Center (WPI) Initiative on Materials Nanoarchitectonics, MEXT, Japan (M.P.). U. A. and M. P. acknowledge support by NIMS Open Research Institute fund (NIMS ORI).