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Background/aim We aimed to determine in which cases this procedure may be more effective based on the data of patients who underwent decompressive hemicraniectomy (DHC). Material and methods Overall, 47 patients who underwent DHC due to acute middle cerebral artery (MCA) infarction between January 2014 and january 2019 were retrospectively investigated. These patients were divided into two groups: those who died after DHC (Group A) and those who survived DHC (Group B). The groups were compared in terms of various parameters. We investigated whether the patient’s modified Rankin scale (mRS) status changed depending on age (> 60 and < 60 years). Results The median age of all patients was 65 (37–80) years; groups A and B had median ages of 66.5 (37–80) and 61 (44–79) years (p = 0.111), respectively; 55.3% patients were male. The elapsed times until hospitalization after the onset of symptoms were 4.5 and 3 h in groups A and B, respectively (p = 0.014). The median GCS score at the time of admission was 7 (5–12) and 10 (8–14) in groups A and B, respectively (p = 0.0001). At the time of admission, 63.3% patients in group A had anisocoria, whereas no patient in group B had anisocoria (p = 0.0001). In postoperative period, 40% patients in group A and all patients in group B received AC/AA treatment. The survival of patients aged < 60 and > 60 years who underwent DHC for MCA infraction was 61.5% and 26.5%, respectively (p = 0,041). The median mRS of patients < 60 and > 60 years were 4 (1–6) and 6 (1–6), respectively (p = 0.018). Conclusion Age, DHC timing, and elapsed time until hospitalization or access to treatment directly affect the functional outcome and survival in MCA-infarcted patients who underwent DHC. In patients in whom the medical treatment fails, early DHC administration will increase survival without waiting for neurological worsening once herniation is detected radiologically.

AIM We reevaluated the medulloblastoma cases according to their histomorphological and molecular features and we aimed to investigate the relationship between the prognostic factors of the new WHO classification by applying Beta-catenin, YAP1, GAP1, P53, and INI1 antibodies immunohistochemically. MATERIAL AND METHODS This study includes 41 patients who have been diagnosed as medulloblastoma between 2007-2019 in Pathology Department. Immunohistochemically, P53, Beta-catenin, YAP1, GAP1, and INI1 immune markers were applied and the relationship between the results and the prognostic parameters were evaluated statistically. RESULTS When 41 patients were divided into WHO medulloblastoma histological subtype groups according to histomorphological features:22 (53.7%) patients were classified as classical type, 11 (26.8%) patients as desmoplastic nodular type and 8 (19.5%) patients as large cell/anaplastic type medulloblastoma. According to their molecular characteristics, 14 (34.1%) patients were in the Non-WNT/SHH group, 5 (12.2%) patients were SHH mutant, 17 (41.5%) patients were SHH wild, and 5 (12.2%) patients were in the WNT active group. There was no statistically significant correlation between age, gender, tumor size, recurrence, Ki67 proliferation index with molecular types and histopathological types. CONCLUSION In our study, metastasis at the time of diagnosis, histological large cell anaplastic type, immunohistochemical p53 positivity, molecular SHH mutant type were the statistically significant the indicators of worse prognosis and shorter survival time.

ÖzAmaç: Bu çalışmanın amacı serebral venöz trombozlu (SVT) hastalarda radyolojik görüntüleme ile klinik şiddetin tahmin edilip edilemeyeceğini araştırmaktır. Bu amaçla SVT tanısı konulan hastaların manyetik rezonans görüntüleme (MRG) skoru ile Glasgow koma skorları (GKS) arasında ilişki olup olmadığı araştırılmıştır.Gereç ve Yöntem: Çalışma geriye dönük olarak planlandı. 1 Ocak 2013-31 Aralık 2019 tarihleri arasında SVT tanısı konulan hastaların kayıtları incelendi. Semptom başlangıcından sonraki ilk 5 gün akut, 5-15 gün subakut ve 15 gün sonrası kronik SVT olarak kabul edildi. Tüm hastaların MRG skoru ve GKS’leri kaydedildi ve aralarında istatistiksel anlamlı korelasyon olup olmadığı araştırıldı.Bulgular: Çalışmaya 47 akut, 26 subakut ve 19 kronik olmak üzere toplam 92 SVT’li hasta alındı. Akut gruptaki hastalarda median GKS 13 (çeyreklikler arası değişim (ÇAD)=3), subakut grupta 15 (ÇAD=3) ve kronik grupta ise 15 (ÇAD=1) olarak bulundu. MRG skoru akut SVT grubunda 6 (ÇAD=3), subakut grupta 3 (ÇAD=2,25), kronik grupta ise 3 (ÇAD=1) olarak bulundu. Üç grup arasında hem GKS hem de MRG skoru yönünden istatistiksel anlamlı fark olduğu görüldü (p=0,001 ve p

Objective Spinal cord injuries generate the most negative response to medical treatment among all general body injuries. This important morbidity is thought to be caused by a complex secondary damage mechanism. In the present study, we examined the neuroprotective effects of alemtuzumab in a spinal cord trauma model. Methods We divided 24 Long-Evans male rats into 4 groups (n = 6 per group). Laminectomy was performed at T5–T8 in all groups. Trauma was applied using the Yasargil temporary aneurysm clip for 60 seconds at these spinal cord levels in all groups, except for group 1. Next, 1 mg/kg of alemtuzumab was administered to each rat in groups 3 and 4. A functional evaluation was performed on days 1, 3, and 5 in groups 1, 2, and 4, and the rats were then sacrificed. The rats in group 3 were sacrificed on the third postoperative day to observe the early effects of alemtuzumab. The biochemical examination findings of malondialdehyde and glutathione in plasma and tissue samples and histopathological findings of the spinal cord were evaluated and compared by statistical analysis. Results The inflammatory findings in the trauma group were not seen in either group treated with alemtuzumab. The clinical motor examination and inclined plane test results were also significantly better in these groups. Conclusion Our results have shown that alemtuzumab might prevent spinal cord injury after trauma and is a histopathologically and biochemically strong anti-inflammatory, antioxidant, and neuroprotective agent.

Giris:Stereotaksik biyopsi noroonkolojide klinisyeni taniya goturen onemli bir cerrahi prosedurdur. Derin yerlesimli ve kritik lokalizasyonlu lezyonlarda minimal invaziv olarak tani elde etmek mumkun hale gelmistir. Literaturde genis vaka serileri bulunmaktadir. Bu calismamizda 310 vakalik manyetik rezonans goruntuleme (MRG) kilavuzlu stereotaksik biyopsi deneyimimizin sunulmasi amaclanmistir. Yontem:Klinigimizde 2012 -2018 yillari arasinda gerceklestirilen, hedefin belirlenmesi icin MRG yontemi kullanilan, 310vakanin, yas ve cinsiyet dagilimlari,stereotaktik biyopsi uygulanan lezyonlari yerleri, materyallerinin histopatolojik sonuclari,ve gelisen komplikasyonlariretrospektif olarak degerlendirilmistir. Ayrica teknik ile ilgili de bilgi verilmistir. Bulgular:Lokal anestezi altinda stereotaktik cercevenin takilmasini takiben yapilan MRG ile hesaplamalar sonrasi, ameliyathane sartlarinda genel anestezi uygulanilarak stereotaktik biyopsi islemi uygulanmistir. Hastalarin ortalama yaslari 57.28 (3-87) olarak saptandi. Hastalarin 169’u erkek (%55), 141’i kadindi (%45). Lezyonlarin 184’unun hemisferik yerlesimli oldugu (%59), en sik saptanan taninin glioblastoma multiforme oldugu (%34.19) goruldu. 8 hastada tani koyulamadigi goruldu (%2). Toplam 13 olguda komplikasyon gelistigi (%4), 2 hastanin isleme bagli erken donemde eksitus oldugu goruldu (%0.6). Hastalarin 307’sinde tani elde edildigi (%99) goruldu. Sonuc:Calismamizin sonuclari, tedavi planlamasi icin kesin histopatolojik sonuclarin gerekli oldugu olgularda, MRGkilavuzlugunda uygulanan stereotaktik biyopsi isleminin, dusuk komplikasyon orani ve etkinligi nedeniyle, guvenilir ve uygulanabilir oldugunu gostermektedir.

Objective: Carpal Tunnel Syndrome (CTS) is the most frequently encountered entrapment neuropathy. Surgical treatment is usually suggested to patients with severe symptoms. In this study, we aimed to examine the effect of the dominant hand on the clinical results of CTS decompression surgery.

BACKGROUND: The aim of our study is to minimize the morbidity related to nerve injury by determining the protective effects of gabapentin in experimental sciatic nerve injury and end-to-end anastomosis model in rats and to guide clinical studies on this subject. METHOD: In our study, 40 adult male Sprague-Dawley rats were randomly divided into the following five groups: I: Only surgical intervention was applied; II: The sciatic nerve was cut properly and was repaired by end-to-end anastomosis. No additional procedure was performed; III: A single dose of gabapentin at 30 mg/kg was given after anastomosis; IV: 30 mg/kg gabapentin was given for 3 days after anastomosis; and V: 30 mg/kg gabapentin was given for 7 days after anastomosis. The experiment was terminated with high-dose thiopental (50 mg/kg) 60 days after the surgical intervention. The right sciatic nerve was taken from all animals. The obtained sections were examined immunohistopathologically. RESULT: Immunohistochemical properties and Schwann cell proliferation were found to be statistically significantly lower in the control group than in the other groups. Schwann cell proliferation was higher in Group 3 than in Group 5. Immunohistochemical changes were significantly lower in Group 4 than in Group 3. Axonal degeneration was also higher in Group 4 than in Group 3. CONCLUSION: Gabapentin promotes neurological recovery histopathologically in peripheral nerve injury due to its neuroprotective properties. Our study results show that gabapentin can be used as an adjunctive therapy to primary surgical treatment after peripheral nerve injury.

Seckel syndrome and Moyamoya diseases are different entities that rarely associated with each other. Several cases presenting with both these diseases were reported. Intracerebral artery aneurysms and collateral vessels can be seen with Moyamoya. They are commonly treated with medical treatment. We present a 12-years old patient with both Seckel syndrome and Moyamoya disease presented with middle cerebral artery aneurysm which was treated with endovascular modalities.

AIM: Stent assisted coiling (SAC) is an alternative in the treatment of ruptured aneurysms. Stenting requires the use of dual antiplatelet agents. Hydrocephalus is a complication of subarachnoid hemorrhage (SAH) and may require ventriculostomy. Antiplatelet treatment carries a risk of hemorrhage in ventriculostomy. The anti-aggregant effect starts at least four hours after the initial doses of treatment. However, in many studies, ventriculostomy was performed before antiplatelet treatment and hemorrhagic complications were related to the procedure. The aim of this study was to determine the risk of ventriculostomy related hemorrhage in patients with impaired thrombocyte function and to contribute to the literature. MATERIAL and METHODS: Between 2011 and 2016, 53 patients treated with SAC due to SAH in our clinic were retrospectively evaluated. Hemorrhagic complication risks due to antiplatelet therapy related to ventriculostomy were also evaluated. RESULTS: All of the ventricular catheter procedures were performed at least 1 day after the dual therapy (in average 4.3 days after SAC). In 5 patients 1 ventriculostomy was performed, in 2 patients 2, and in 1 patient 6 ventriculostomies were performed. Although radiological hemorrhage was present on the catheter tract in 4 patients, no temporary or permanent neurological deficit was observed. CONCLUSION: Impaired thrombocyte functions pose a risk in ventriculostomy. Also, evaluating the risk of hemorrhage before the antiplatelet treatment reaches its full effect may lead to false results. Studies with small patient groups with anti-aggregant therapy and impaired thrombocyte functions also contribute to the literature. Larger studies regarding this subject are needed.

AIM To demonstrate the incidence of screw misplacement and revision rates in a group of 72 patients that underwent pedicle screw fixation for spinal pathologies using the conventional, fluoroscopy-guided open technique. MATERIAL AND METHODS Data from 72 consecutive patients with spinal instability that received 472 screws between April 2011 and May 2013 were reviewed and pedicle wall breach was graded as mild ( 6 mm). Direction of misplacement was also assessed in reformatted images as medial, lateral, superior and inferior (or in combinations). RESULTS The indications for pedicle screw placement were as follows: degenerative (59.7%), trauma (13%) and tumor (9.7%). Pedicle screws were inserted between T9 and S1. In this series of the 472 screws, 29 (6.1%) screws were implanted with minimal pedicle wall violation (≤ 3 mm) and 16 screws (3.4%) were implanted with moderate (3-6 mm) violations. There were no severe violations (more than 6 mm) in this series. Pedicle violations were significantly higher in thoracic pedicles and in trauma patients when compared to other groups. Only two patients required pedicle screw repositioning after their index surgery. CONCLUSION Conventional open technique in pedicle screw placement is a safe and sound method with its low and acceptable complication rates.