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Aim Red blood cell distribution width (RDW) is a numerical measure of variability in the size of circulating erythrocytes and is routinely reported as a component of a complete blood count panel. It has been shown that higher RDW is associated with increased mortality and morbidity in several types of intoxication. This study was designed to evaluate the prognostic value of RDW for in-hospital mortality and need of invasive mechanical ventilation in patients with methanol poisoning. Methods A retrospective chart review of patients with methanol poisoning was performed using data from Adana City Training and Research Hospital obtained between January 2019 and January 2020. Patients’ demographics, clinical features, the time elapsed between ingestion and presentation, the treatment applied, blood gas analysis, laboratory measures including RDW on admission, and clinical outcome were obtained. Results A total of 42 patients with methanol poisoning were included in the study with a mean age of 45 ± 11 years. The overall mortality was 21.4%. Values of RDW on admission were significantly higher in non-survivors than in survivors. The area under the receiver operating curve of RDW was 0.778 (95% CI: 0.567–0.988) for predicting in-hospital mortality and 0.762 (95% CI: 0.592–0.932) for predicting mechanical ventilator requirement. Conclusion This study suggests that increased RDW on the first admission is associated with mortality and with mechanical ventilator requirement in patients with methanol poisoning.

Objective: To assess live donor nephrectomy for development of hypertension. Study Design: Retrospective observational study. Place and Duration of Study: The study was conducted at Armed Forces Institute of Urology (AFIU) Rawalpindi, from May 2016 to May 2020. Methodology: All consenting kidney donors for live renal transplant were introduced with the process. Baseline blood pressure at time of workup of donation and annually afterwards after transplant on follow up examinations using retrospective data analysis of donor’s workup and follow up was used. Comparison of 1,2,3 and 4-year occurrence of hypertension among (normotensive) donors with 1,2,3 and 4-year of donation using estimates from Framingham Hypertension Risk Score. Results: A total of 79 donors with a completed annual follow-up rate of up to100 % during a 4-year period. The average age at donation was 33.96 ± 10.23 SD years; 50 donors (63.4%) were women. Overall 27% (22 out of 79) of all live donors developed post donation hypertension who were normotensive at the time of donation. Almost 2/3rd of the patients developing hypertension were females. There was a significant increase in blood pressure measurements each year after donation. Increased BMI of the patient was a risk factor for post donation development of hypertension. The donors who continue being normotensive 1-year post donation yielded an analogous risk to that fit Framingham populace. Conclusion: Live organ kidney givers are at augmented risk of development of hypertension post kidney donation. The study ascertains the potential significance of following donors and handling risk factors aggressively................

Background Foramen magnum decompression (FMD) is the first-choice treatment for Chiari malformation (CM). However, it has been suggested that cerebellar herniation and syringomyelia occur as a natural protective event to prevent neural damage caused by atlantoaxial instability. It is argued that treating instability is the main treatment. Positive results of atlantoaxial fusion have been reported in the literature, but there are no studies including the results of atlantoaxial fusion as the second treatment in patients in whom classical decompression failed. In our study, we report the results of these patients to help in the selection of treatment and we present our treatment algorithm for CM with syringomyelia. Methods Thirteen patients who had undergone FMD and duraplasty due to CM and syringomyelia in our clinics and who had recovered clinically and radiologically but had recurrent complaints during long-term follow-up were evaluated. C1–C2 distraction and fusion were performed. We evaluated these patients radiologically and clinically. Results The mean age of the 13 patients was found to be 32.4 years. Male to female ratio was 6:7. The complaints recurred after an average of 2.1 years. Also, 3 cases were presented with their clinical characteristics and radiologic findings. Conclusions FMD may fail even with duraplasty, and treatment of CM in recurrent cases is still controversial. Recently, atlantoaxial instability has been reported to be the main pathology of CM, and the cure for pathology is to treat instability. Recurrent CMs with syringomyelia in which FMD has failed should be treated by atlantoaxial fixation.

Many techniques were used for the treatment of hydrocephalus, and ventriculoperitoneal shunt surgery is a widely used procedure. Ventriculoperitoneal shunt surgery has been associated with several complications like obstruction of the tube, infection, cerebrospinal fluid loculation, intestinal obstruction, migration of the shunt, and perforation of the intestinal organs. Perforation of the bowel owing to protrusion of ventriculoperitoneal shunt catheter from the anus is an extremely rare complication. Mini or exploratory laparotomy and revision of peritoneal part of shunt and repair of bowel perforation, or pulling out the ventriculoperitoneal shunt catheter and using external ventricular drainage and antibiotics, or colonoscopic removal of ventriculoperitoneal shunt catheter and repair of the bowel can be performed. Retrograde contamination of cerebrospinal fluid and meningitis is a very important part of the treatment in these cases. We aimed to present two cases with bowel perforation who treated with endoscopically. We report the cases of 2 patients with transanal protrusion of VPS catheter and the management via endoscopic therapeutic options. Successful treatment of the patients was achieved by endoscopic removal of the catheter and endoscopic repair of the bowel perforation. If peritonitis, bowel obstruction, or abscess does not occur, endoscopic removal of shunt and bowel repairing with endoclips may be enough.

Objective: To compare immediate postoperative results in patients receiving heparin-albumin-coated and non-coated circuits. Methods: A total of 241 patients undergoing on-pump cardiac surgery were divided into two groups: those receiving heparin-coated circuits (Bioline®, Maquet Cardiopulmonary AG., Hirrlingen, Germany) and those receiving non-coated circuits (Maquet Cardiopulmonary AG., Hirrlingen, Germany). Results: Activated clotting times (ACT) during cardiopulmonary bypass (CPB) were significantly shorter in the heparin-albumin-coated group than in the non-coated group (355.64±34.12 vs. 560.38±90.20, respectively, P=0.001). In-hospital mortality and postoperative stroke rates and lengths of intensive care unit stay were similar between the groups; in contrast, in the heparin-albumin-coated group, patients had significantly better outcomes for hospital stay, drainage, and need for erythrocyte transfusion. Conclusion: Heparin-coated circuits and reduced level of systemic heparinization with 300 seconds of target ACT level in cardiac surgery under CPB are safe and result in a very satisfactory clinical course.

Introduction: Intracranial mesenchymal chondrosarcoma (MSC) is an extremely rare tumour that constitutes only 0.015% of all central nervous system tumours. These tumours usually originate from skull base synchondrosis and are often observed in young adults during their second and third decades of life. Despite the absence of a consensus regarding adjuvant radiotherapy, radical excision remains crucial for the prognosis of MSC. Case Presentation: We herein present the case of a young male patient with intracranial MSC, a malignant tumour, for which no consensus regarding its treatment has yet been established. The patient underwent radical excision followed by adjuvant radiotherapy. Histological analysis revealed a poorly differentiated tumour containing necrotic areas. Notably, no signs of recurrence had been observed after 6 years. Conclusion: The absence of recurrence over a long follow-up duration suggests the importance of radical excision and adjuvant radiotherapy.

OBJECTIVE: Differential diagnosis of idiopathic pulmonary fibrosis (IPF) is important among fibrotic interstitial lung diseases (ILD). This study aimed to evaluate the rate of IPF in patients with fibrotic ILD and to determine the clinical-laboratory features of patients with and without IPF that would provide the differential diagnosis of IPF. MATERIAL AND METHODS: The study included the patients with the usual interstitial pneumonia (UIP) pattern or possible UIP pattern on thorax high-resolution computed tomography, and/or UIP pattern, probable UIP or possible UIP pattern at lung biopsy according to the 2011 ATS/ERS/JRS/ALAT guidelines. Demographics and clinical and radiological data of the patients were recorded. All data recorded by researchers was evaluated by radiology and the clinical decision board. RESULTS: A total of 336 patients (253 men, 83 women, age 65.8±9.0 years) were evaluated. Of the patients with sufficient data for diagnosis (n=300), the diagnosis was IPF in 121 (40.3%), unclassified idiopathic interstitial pneumonia in 50 (16.7%), combined pulmonary fibrosis and emphysema (CPFE) in 40 (13.3%), and lung involvement of connective tissue disease (CTD) in 16 (5.3%). When 29 patients with definite IPF features were added to the patients with CPFE, the total number of IPF patients reached 150 (50%). Rate of male sex (p, Roche, Financial Disclosure: This research received unconditional financial support from the company of Roche.

Purpose: This study aimed to evaluate the efficacy of cervical discectomy with bladed peek cage and differences in clinical outcomes, complication rates, and radiological findings of patients with multiple-level cervical degenerative disc herniation in terms of age, sex, and number of levels.Materials and Methods: The following data were assessed: demographic data, patient complaints, symptoms, neurologic examination and radiologic findings, postoperative outcomes, and complications of surgery. We assessed 156 patients who had level 2, 3, and 4 cervical degenerative disc herniation detected between 2012 and 2018 via radiological examination.Results: Of the patients, 41.6% (n = 65) were men and 58.4% (n = 91) women. The patients were aged 32–76 years, with an average age of 50.68 years. Moreover, 85.2% (n = 133), 13.5% (n = 21), and 1.3% (n = 2) of patients presented with level 2, 3, and 4 cervical degenerative disc herniation, respectively. All patients received medications as a conservative treatment during the preoperative period, and 79.5% (n = 124) underwent physiotherapy. In terms of complications, five patients developed neurological deficit and one developed superficial wound infection during the early postoperative period.Conclusion: The fusion rate may be similar to the stabilization, and cervical region movements may be achieved after performing anterior cervical plaque surgery with cage as well as anterior cervical discectomy and bladed peek cage surgery in patients with level 2 or higher cervical degenerative disc herniation and/or cervical spondylosis.

AIM To evaluate the role of endoscopic third ventriculostomy (ETV) as a primary or secondary treatment for hydrocephalus and factors affecting ETV success. MATERIAL AND METHODS Pediatric and adult patients with symptomatic hydrocephalus treated with ETV during 11 years (2008?2019) in our clinic were retrospectively evaluated. Patients were divided into primary ETV group, in which ETV was the first method of hydrocephalus treatment, and secondary ETV group, in which cerebrospinal fluid (CSF) drainage procedures were initially attempted. Statistical data analyses were performed to compare the outcomes of primary and secondary ETV groups. RESULTS In total, 317 patients treated with ETV [140 (44%) patients aged 3?18 years and 177 (55%) aged 19?80 years] were followed-up for a mean duration of 60 months. Primary and secondary ETV groups comprised 207 and 110 patients, respectively. Further, 170 (82%) patients in the primary ETV group and fifty-nine patients (53%) in the secondary ETV group benefited from ETV. Primary ETV was associated with the highest probability of success (OR: 11.87). Increasing age (OR: 0.97) and male sex (OR: 4.719) increase the probability of achieving success. The overall prediction accuracy of the model was 72.2%. Kaplan?Meier survival analysis showed no significant difference between categorical groups in terms of time to failure (1.3 and 5 years), sex, ETV type, and categorized age (below 18 and above) (p > 0.05). Complications occurred during or after ETV in 14 patients. CONCLUSION Unlike most studies, our study includes both adult and pediatric groups. According to the findings obtained in our study, the recovery rate was higher in the primary ETV group (82%) than in the secondary ETV group (53%). According to the model we created, our prediction rate of recovery was 72%. Primary ETV, male sex, and advanced age are important predictors of success in ETV.

Purpose: The aim of the present study was to analyse endothelin-1 levels in serum and cerebrospinal fluid samples in patients with subarachnoid haemorrhage and evaluated the effects on vasospasm. Material and Methods: The patients were selected among those who referred to intensive care unit of neurosurgery department within several hours following subarachnoid haemorrhage. Subarachnoid haemorrhage was diagnosed through cerebral computed tomography and lumbar punction. First neurological examinations of the patients were evaluated according to Hunt-Hess classification and the blood quantity was detected by cerebral computed tomography according to Fisher classification. Results: Serum and cerebrospinal fluid samples of 20 patients enrolled into the present study were collected at days 1, 3, 5, and 7 after subarachnoid haemorrhage. Ten individuals without any vascular diseases, nervous system trauma or inflammatory disease were enrolled into the study as the control group. Samples were analyzed through micro-ELISA method and endothelin-1 levels in the serum and cerebrospinal fluid were detected. According to Hunt-Hess classification, 6 patients were evaluated as Stage I, 10 patients as Stage II, 2 patients as Stage III and 2 patients as Stage IV. Seventeen patients were detected as Stage II whereas 3 patients were Stage IV according to Fisher classification. Vasospasm was detected in cases 3, 6, 11 and 18 by digital subtraction angiography. Conclusion: It was determined that as the Fisher and Hunt-Hess classifications increased, the risk of cerebral vasospasm increased. The present study revealed that endothelin-1 levels increase after subarachnoid haemorrhage and Endothelin-1 particularly may play an important role in the vasospasm following spontaneous subarachnoid haemorrhage.

Fungal infections of the central nervous system and pediatric brain abscess are rare but serious conditions in terms of morbidity and mortality that need immediate diagnosis and treatment. It can be seen in congenital or acquired immunosuppressed patients as opportunistic infections as well as in low-birth-weight, premature infants with ventriculoperitoneal shunt, external ventricular drainage, or with a history of craniotomy. Our aim is to emphasize the giant cerebral Candida abscess of a 13-month-old female infant who previously had eight ventriculoperitoneal shunt operations due to hydrocephalus. The patient was taken to pediatric emergency care with complaints of feeding difficulty and discomfort and was hospitalized due to the detection of an intracranial mass by contrast-enhanced brain tomography. After total excision of the mass with its capsule, the patient was pathologically diagnosed with Candida abscess, and the treatment was started. The patient was discharged by the end of the 6th week.

The existence of air in the spinal canal is referred to as pneumorrhachis. It is classified as extradural (epidural) or intradural (subdural or subarachnoid) according to the location where it is found. Nontraumatic, traumatic, and iatrogenic causes have been attributed to its occurrence. Traumatic pneumorrhachis is very rare and rarely seen in children. In our article, a 16-year-old male child in which air formation within the spinal canal was detected after an injury by a penetrating and cutting (knife) tool is discussed. Observing air within the spinal canal due to traumatic causes is an important situation rarely seen in the pediatric age group. In general, this situation, which can be seen after multiple trauma, may be encountered following a minor trauma. The correct assessment of the radiologic imaging methods ensures not to miss the manifestation of the disease.

Technological innovations in spinal intradural tumor surgery simplify treatment. Surgical treatment of cranial benign and malignant pathologies under microscope with sodium (Na)-fluorescein guidance has often been reported, but few studies have focused on spinal intradural tumors. We aimed to investigate the usefulness of Na-fluorescein under yellow filter in intradural spinal tumor surgery by retrospectively reviewing cases involving intramedullary and extramedullary tumors operated under the guidance of Na-fluorescein. Forty-nine adult patients with a diagnosis of spinal intradural tumor operated under a yellow filter (560 nm) microscope using Na-fluorescein dye were included in the study. Demographic data, such as age and sex, neurological status, extent of tumor resection, histopathological diagnosis, Na-fluorescein staining pattern, and its usefulness during surgery were noted and statistically analyzed. Of all recruited patients, 26 women (53.1%) and 23 men (46.9%), were included for analysis. The age range of the patients was 18–64 years, with a mean age of 41.6 ± 13.9. An intradural intramedullary mass was found in 30.6% (n = 15) of the patients, and an intradural extramedullary mass in 69.4% (n: 34). While Na-fluorescein staining was homogeneous in all intradural extramedullary tumors, 73.3% (n: 11) of intradural intramedullary tumors were homogeneous, and 13.3% (n: 2) moderately heterogeneous. In the whole study group, the Na-fluorescein staining pattern was helpful in surgical resection in 47 cases (95.9%). While 34/34 (100%) found it helpful for extramedullary tumors, 13/15 (86.7%) did in intramedullary tumors, and for 2/15 (13.3%) it was not. In conclusion, Na-fluorescein helps in distinguishing tumor from healthy tissue in intradural extramedullary and intramedullary tumor surgery under a yellow filter microscope in most cases, thus providing convenient assistance to surgeons.

In this study, we aimed to examine the effect of myeloperoxidase on aneurysm rupture in patients with cerebral aneurysms with and without rupture.The study included 53 patients with subarachnoid hemorrhage operated on due to cerebral aneurysm in our clinic, and 49 patients without subarachnoid hemorrhage. After the operation, the domes taken from the aneurysms were embedded in paraffin blocks and scored after hematoxylin and eosin and immunohistochemical staining was carried out.The myeloperoxidase score was 1 in 29.4% of the patients, 2 in 40.2%, 3 in 12.7%, and 4 in 17.6%. Multiple aneurysms were detected in 24.5% of the patients. The median myeloperoxidase score was higher in patients with bleeding aneurysms than those that did not bleed (3 vs. 1; P 0.001). In addition, the ratio of patients with a myeloperoxidase score of 2 or above was higher among patients with bleeding aneurysms.In our study, finding myeloperoxidase scores higher in cases of ruptured aneurysms compared with unruptured aneurysms reveals the relationship of myeloperoxidase with ruptured cerebral aneurysms.

OBJECTIVE The subaxial cervical pedicle screwing technique shows powerful biomechanical properties for posterior cervical fusion. When applying a pedicle screw using the freehand technique, it is essential to analyse cervical computed tomography and plan the surgery accordingly. Normal cervical computed tomography is usually performed in the supine position, whereas during surgery, the patient lies in a prone position. This fact leads us to suppose that radiological evaluations may yield misleading results. Our study aimed to investigate whether there is any superiority between preoperative preparation on computed tomography performed in the prone position and that performed in the supine position. METHODS This study included 17 patients (132 pedicle screws) who were recently operated on with cervical vertebral computed tomography in the prone position and 17 patients (136 pedicle screws) who were operated on by conventional cervical vertebral computed tomography as the control group. The patients in both groups were compared in terms of age, gender, pathological diagnosis, screw malposition and complications. A screw malposition evaluation was made according to the Gertzbein-Robbins scale. RESULTS No statistically significant difference was observed between the two groups regarding age, gender and pathological diagnosis. The screw malposition rate (from 11.1% to 6.9%, p

Objective: This study was carried out to determine whether the rate of abnormal placentation is increasing in concurrence with the cesarean section and to assess risk factors and outcomes with multidisciplinary team interventions and anesthetic practices. Study design: Prospective cohort study. Material & Methods: A study was conducted in the department of anaesthesia from January 2014 to December 2017. All candidates under the spectrum of placenta accreta were observed for maternal age, parity, mode of anesthesia, blood loss, and outcome. Results: Out of 109 patients, the preoperative diagnosis of PAS was made up of 100 (91.74%) and intraoperative diagnosis of 9 (08. 26%) patients. According to the mode of anesthesia, 100 (91.74%) patients received GA, and 09 (08.26%) patients received spinal anesthesia. In 06 (05.49%) patients, spinal was converted to GA. Perioperative CPR was done in 05 (04.58%) cases. Out of 109 cases, 83 survived uneventfully, and 21 developed complications. 05 patients expired in the following days. (01 immediately postoperative period, 02 in 1st 24 hours and 02 in 1st 48 hours. Conclusion The rate of placenta accreta increased in conjunction with cesarean deliveries; the most important risk factors were previous cesarean delivery, placenta previa, and advanced maternal age and outcomes improved in a multidisciplinary team intervention.

Meningomyelocele is a serious pathology that requires immediate surgical treatment. Its management is difficult due to accompanying other pathologies and hydrocephalus. Shunt timing is still controversial. Therefore, this study retrospectively assessed 80 patients in order to improve the shunt timing and management of patients with meningomyelocele. A total of 80 patients were followed up for 18–48 (average, 23) months. Patients were analyzed for the following variables: delivery method and time, head circumference monitoring, shunt timing, complication rates of patients who underwent shunting, during the early or follow-up period, accompanying pathologies, size, and localization of lesion. Patients including 46 males and 34 females have been operated. In 40% of patients, the accompanying pathology was determined. Approximately 85% of patients had hydrocephalus, and a ventriculoperitoneal shunt was placed on 36 symptomatic and 22 patients with hydrocephalus that developed during the follow-up. Differences in shunt-related and general complications were not significant between patients who underwent shunt placement during the same session and patients who underwent shunt placement during the follow-up. However, the incidence of cerebrospinal fluid fistula formation from the wound in patients who underwent shunt placement during the same session was significantly lower than those who underwent shunt placement during follow-up. Immediate surgery (within the first 48 h) provides positive results, which is consistent with the existing literature. According to the logistic regression analysis, the placement of the meningomyelocele sac in the lumbosacral region is decisive in shunt insertion. Placing the shunt in the same session for patients with hydrocephalus and later for patients who developed hydrocephalus during the follow-up is recommended as a favorable treatment.

Amaç: Önceki makaleler sıklıkla dekompresyonu göstermek için sadece radyolojik veya klinik iyileşmeyi değerlendirmiştir. Ancak literatürde hem yaşam kalitesini hem de fonksiyonel ve radyolojik iyileşmeyi değerlendiren ayrıntılı bir çalışma yoktur. Bu çalışmada dejeneratif lomber spinal stenozda bilateral dekompresyon için mikrocerrahi ile tek taraflı laminotominin etkinliğini araştırmayı amaçladık. Materyal ve Metodlar:80 hastayı ve 116 segmenti retrospektif olarak değerlendirdik. Klinik, fonksiyonel ve radyolojik iyileşmeyi değerlendirdik. Klinik değerlendirme için Vizüel Analog Skala (VAS), Oswestry Disability İndeksi (ODI), Tıbbi Sonuçlar Çalışması 36 Madde Kısa Form Sağlık Araştırması (SF36) kullanıldı. Radyolojik değerlendirme için ön ve arka disk yüksekliği, lateral resses yüksekliği, spinal kanalın ön-arka çapı, spinal kanal kesitsel alanı, preoperatif ve postoperatif radyografik görüntülerde segmental lordotik açıları değerlendirdik. Fonksiyonel değerlendirme için yürüme performansı da 15 Dakika Kendi Hızınızda Yürüyüş Testi ile değerlendirildi.Bulgular:Hastaların ortalama yaşı 58.6 ± 11.3 idi. Kırk ikisi kadındı (% 52.5) ​​ve otuz sekizi erkekti (% 47.5). VAS, ODI ve SF36 ile ölçülen klinik sonuçlar önemli ölçüde iyileşti. Yürüme performansı, dural kese kesit alanı ve diğer radyografik ölçümler de önemli ölçüde iyileşti. Spinal instabilite nedeniyle 8 hasta, dura onarım nedeniyle 4 hasta tekrar ameliyat edildi. Sadece iki yara enfeksiyonu gelişti.Sonuç:Dejeneratif spinal stenozda bilateral dekompresyon için mikrocerrahi ile tek taraflı laminotomi, minimum doku hasarı ve daha az komplikasyon ile yeterli dekompresyon ve tatmin edici klinik sonuçlar sağlar., Purpose: Previous articles have frequently evaluated only radiological or clinical improvement for showing decompression. But there is not a detailed study in the literature assessing both quality of life and functional and radiological improvement. In this study we aimed to investigate the effectiveness of microsurgical unilateral laminotomy for bilateral decompression for degenerative lomber spinal stenosis.Materials and Methods: We assessed 80 patients and 116 segments retrospectively. We evaluated clinical, functional and radiological improvement. For clinical evaluation Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Medical Outcomes Study 36-Item Short- Form Health Survey (SF36) were used. For radiological evalution, we assessed the changes of anterior and posterior disc height, lateral resses heigt, anteior-posterior diameter of spinal canal, spinal canal cross sectional area, segmental lordotic angle on preoperative and postoperative radiographic images. For functional evalution, walking performance was also evaluated by 15 Minutes Self Paced Walking Test.Results: The mean age of the patients was 58.6±11.3 years. Forty-two of them were females (52.5%), and thirty-eight were males (47.5%). Clinical outcomes, measured by VAS, ODI and SF36 were improved significantly. Walking performance, dural sac cross sectional area and other radiographic measurments were also improved significantly. 8 patients were reoperated due to the spinal instability, 4 patients due to the dura repair. Only two wound infection developed.Conclusion: Microsurgical unilateral laminotomy for bilateral decompression for degenerative spinal stenosis achieves adequate decompression and satisfactory clinical outcomes with minimal tissue damage and less complications.

AIM To evaluate surgical treatment options, complications and neurological outcomes of patients with cavernous malformations (CMs) in the pons and medulla oblongata. MATERIAL AND METHODS We retrospectively evaluated 25 brain stem CMs that we operated between 2009 and 2019. We operated all cases in the first month with suboccipital retrosigmoid and paramedian approach. The cases were evaluated concerning their demographic characteristics, lesion characteristics, radiological imaging results, surgical approach and neurological status. RESULTS Overall, 15 patients had CMs in the pons and 10 in the medulla oblongata. The mean age of the patients was 33.48 years, and the cases included 15 male and 10 female patients. The average modified Rankin Score (mRS) score had a mean of 2.36 and median of 2 at the time of admission (Table I). The mean follow-up period was 4.64 years (1?10 years). In the last follow-up assessment, the average mRS score was mean = 1.84 and median = 1. In addition, 14 (56%) patients recovered, 7 (28%) did not show any changes, 3 (12%) got worse, and 1 (4%) died. In our case series, the admission complaints were cranial nerve paralysis (24%) in 6 cases, nausea and vomiting in 1 (4%) and hemiparesis in 17 (68%). CONCLUSION Experience, correct surgical approach and good knowledge of neuroanatomy are important in brainstem CM haemorrhages. Imaging methods, neuronavigation and neuromonitoring use are essential for patients undergoing surgery. In the presence of all these factors, the prognosis of patients will be better.

Aim To evaluate the patient groups with ankylosing spinal disorder (ASD) in terms of patients? characteristics, applied surgical approaches, and the outcomes. Material and methods Between 2008-2019, 50 ASD patients (35?80 years) were operated on subaxial cervical fracture. The mean follow-up time was 48 months. According to the surgical approach, the patients were divided into three groups: patients who only underwent anterior fusion [AF], patients who only underwent posterior fusion [PF], and patients who underwent anteroposterior fusion [APF]. In this retrospective study, we examined the patients? files and outpatient checks to evaluate the history, operations, neurological results, and complications in cases. Results After undergoing respective surgical interventions, 1 of the 7 patients in the AF group (14%), 2 of the 18 patients in the PF group (18%), and 3 of the 25 patients in the APF group (12%) died. The postoperative American Spinal Injury Association scores were statistically better in all groups than in the preoperative scores. Among the surgical interventions, improvement in the APF group was significantly better than in other groups. Conclusion Although there is a higher amount of surgery related complications in the APF group, the biomechanical and clinical results are better than the other two surgical interventions.

Objective Currently, the optimal surgical approach for bilateral aneurysms remains controversial. Alternative interventional methods, such as unilateral or bilateral approaches, have been used during a single session or 2 different sessions. The unilateral approach can be used successfully to treat contralateral aneurysms that develop in a paramedian location. However, such an approach is more difficult for treating contralateral aneurysms in more distant locations. The unilateral approach can decrease complication rates, operation time, and length of hospital stay. In this study, we aimed to identify when the unilateral approach should be chosen in patients with bilateral middle cerebral artery (MCA) aneurysms and to compare the effect of each approach on the operation time and duration of hospital stay. Methods Between March 2003 and May 2016, 17 bilateral MCA aneurysms were diagnosed in patients who presented to our clinic with complaints of headache and a diagnosis of subarachnoid hemorrhage. The extent of the cerebral edema, A1 + M1 distance on the opposite site, and configuration of the contralateral aneurysm were determined by preoperative radiologic studies. Based on these findings, 7 patients underwent unilateral surgery, and 10 patients received the bilateral approach. Results The 2 groups had a very similar postoperative course. Nonetheless, the operation time and hospital stay were significantly longer for patients who underwent bilateral surgery than those treated with the unilateral approach. Conclusions In selected patients with bilateral MCA aneurysms, the unilateral approach is a favorable alternative that is less invasive, decreases the operation time and hospital stay, and leads to fewer complications.

Currently, anterior, posterior, or combined approaches are used in various spinal disorders; however, a single-stage posterolateral transpedicular approach with 360° stabilization and vertebrectomy provides better results for spinal tumors.We evaluated the age, sex distribution, presenting symptoms, neurologic examination findings according to the pre- and postoperative Frankel classification, pre- and postoperative VAS pain scores, preoperatively administered medical therapies, pre- and postoperative corset use, level of the lesion, levels of previous surgical interventions, root ligation (if performed), results of the primary disease, hospitalization duration (after the operation), postoperative complications (if any), postoperative follow-up duration, and postoperative survival duration of 22 patients.We observed that primary bone tumors were localized in the lumbar (75%) and thoracic regions (25%) and that metastatic tumors were localized in the thoracic (77.78%) and lumbar regions (22.22%). The VAS and Frankel scores of the 22 patients who were included in the study revealed that this surgical treatment modality was associated with statistically significant improvements in test scores (P0.001). No ribcage dislocation was observed. In 1 patient (4.54%), a neurologic deficit developed. Two patients (9.09%) required revision because of screw malposition.In spinal tumors, 360° fusion performed via a posterolateral approach is a less risky, relatively safe, and less invasive method. This method, which reduces the risks of anesthesia and internal problems and decreases cost, is an essential technique for decreasing hospitalization duration, improving pain levels, and achieving faster mobilization and faster initiation of radiotherapy and chemotherapy.

Background Atlantoaxial subluxation caused by Brucella infection is rarely seen in children. Case Description C1-C2 dislocation, erosion in the odontoid bone, and compression to the brainstem were detected on cervical computed tomography and magnetic resonance imaging in a 6-year-old patient who suffered neck pain, deviation to the right in the neck, fever, and pain in his extremities. He was hospitalized in the Clinic of Pediatric Infectious Diseases. Positive Brucella agglutination tests were obtained, so C1-C2 stabilization and fusion were performed. Antibrucellosis antibiotic treatment was administered for 6 months. It was suggested that the dislocation was related to odontoid erosion and laxity of the atlantoaxial ligamentous structures during Brucella infection. Conclusions Atlantoaxial dislocation and instability develops secondarily to paravertebral abscesses, only rarely. Like brucellosis of childhood, granulomatous infectious diseases rarely cause atlantoaxial subluxation or dislocation. Torticollis and neck pains should be taken seriously for the purpose of early diagnosis of patients at risk in endemic regions. Stabilization and fusion should be performed when instability is detected, and these patients should be assessed with both pediatric infectious diseases and neurosurgery clinics. Our case is the first one in the literature in which atlantoaxial instability developed due to Brucella infection and stabilization was performed.

Introduction:we aimed to discuss surgical approaches and results that we applied foramen magnum meningiomas. Methods:we retrospectively investigated 11 foramen magnum meningioma cases, who had been operated between the dates of February 2012 and March 2017. Results:eight of the patients were females and 3 of the patients were males, the age range was 32-75 and the age average was 60.8. 5 of the tumors were anatomically localized as posterolateral, 2 of them were localized as anterolateral, 2 of them were localized as lateral and 2 of them were localized as anterior according to the brain stem or spinal cord. Posterior far lateral (4 patients) approach including C1 laminoplasty (7 patients) and 1/3 condyle resection was surgically applied to the patients with median suboccipital craniotomy. Gross total excision was applied to 82% of the patients (9 patients) and subtotal mass excision was applied to 18% (2 patients) of the patients. The most frequent post-operative complications were temporary lower cranial nerve (CN IX and X ) palsy in our 2 anterior localized cases (18%) and also cerebrospinal fluid (CSF) fistula in our 1 anterior localized case with difficulty in swallowing (dysphagia). Karnofsky scores of the patients, who were followed for 18 months in post-operative 12 and 48 months of average, in the last follow-up were 80 and no post-operative mortality occurred. Conclusion:posterior midline suboccipital and far lateral approaches that we apply in our own series were appropriate approaches for foramen magnum meningiomas.

PubMedID: 30687902 Purpose: Ventriculitis is known to develop after chronic inflammation and bacterial invasion of the ventricular surface with a recurrence of shunt infections. The aim of this study is to evaluate the diagnostic value of elevation in cerebrospinal fluid (CSF) interleukin-1 beta (IL-1ß) and tumor necrosis factor alpha (TNF-?) together with CSF culture and laboratory test results in the diagnosis of ventriculoperitoneal (VP) shunt-related ventriculitis, which is known to be more problematic than conventional shunt infection. Methods: The study included a total of 34 patients with a VP shunt due to hydrocephalus, who presented with a headache, fever, and shunt infection at the Emergency Department and had a pre-diagnosis of ventriculitis. Nineteen patients were diagnosed with shunt-related infection or ventriculitis using the CSF obtained from the shunt pump. The IL-1ß and TNF-? levels from the CSF samples of all patients were measured using the Micro ELISA immunoassay method. Results: CSF direct microscopic observation revealed that the mean cell count, IL-1ß level, CRP level, and blood leukocyte level were higher in patients with ventriculitis compared to those diagnosed with shunt infection (p = 0.02, p = 0.009, p = 0.004, and p = 0.009, respectively). The probability of predicting positive culture outcome was 92.7% with 90.9% sensitivity and 82.6% specificity when IL-1ß values exceeded 4.0 pg/ml. TNF-? values did not show a significant, reliable pattern compared to IL-1ß. Conclusions: IL-1ß is a reliable parameter which shall be used in the diagnosis of ventriculitis by predicting positive culture outcome with high sensitivity and specificity. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

Background: In elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alternative to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study reports our single-center experience regarding the early outcomes of sutureless aortic valve implantation. Methods: Between October 2012 and June 2015, 65 patients scheduled for surgical valve replacement with symptomatic aortic valve disease and New York Heart Association function of class II or higher were included to this study. Perceval S (Sorin Biomedica Cardio Srl, Sallugia, Italy) and Edwards Intuity (Edwards Lifesciences, Irvine, CA, USA) valves were used. Results: The mean age of the patients was 71.15±8.60 years. Forty-four patients (67.7%) were female. The average preoperative left ventricular ejection fraction was 56.9±9.93. The CPB time was 96.51±41.27 minutes and the cross-clamping time was 60.85±27.08 minutes. The intubation time was 8.95±4.19 hours, and the intensive care unit and hospital stays were 2.89±1.42 days and 7.86±1.42 days, respectively. The mean quantity of drainage from chest tubes was 407.69±149.28 mL. The hospital mortality rate was 3.1%. A total of five patients (7.69%) died during follow-up. The mean follow-up time was 687.24±24.76 days. The one-year survival rate was over 90%. Conclusion: In the last few years, several models of valvular sutureless bioprostheses have been developed. The present study evaluating the single-center early outcomes of sutureless aortic valve implantation presents the results of an innovative surgical technique, finding that it resulted in appropriate hemodynamic conditions with acceptable ischemic time.

Introduction: The study aimed to discuss the clinical presentation of radiological findings, surgical treatments, and postoperative complications as well as the radiotherapy and chemotherapy options for adult patients with medulloblastoma. Materials and Methods: A total of 25 patients (14 males and 11 females) between the ages of 17 and 63 who underwent an operation at our clinic between 2006-2016 are discussed in this article. The degree of resection in the patients and tumor sizes after radiotherapy (RT) and chemotherapy (Cht) was compared using the patients’ preoperative and postoperative magnetic resonance (MR) images. Results: The average age of the patients was 30.9 years. Gross total resection was achieved in 20 patients, whereas subtotal resection was achieved in the remaining 5 patients. Three patients developed hydrocephalus during the 6th month after resection, which was treated with a V-P shunt. Another four patients developed a cerebrospinal fluid (CSF) fistula. Among the five patients who only achieved subtotal resection, two died during the 24th month of the post-operative period, and the other three died during the 18th month. Eleven patients presented pathology of the desmoplastic type, and 14 patients presented classical medulloblastoma. Spinal metastasis was detected in three patients during the pre-operative follow-up and in three patients during the post-operative follow-up. The average survival rate of the cohort was 60% during the 3 to 5-year follow-up period. Conclusion: Medulloblastoma development is a risk not only for children and adolescents but also for adults. Maximum tumor removal during treatment affects patient outcomes, and RT and Cht administration during the post-operative period can extend the life span of these patients.

Objective To review the results of fetal reduction procedures in our institution, evaluate its effects on the pregnancy outcome in terms of miscarriage, preterm delivery, taking home healthy babies and discuss the factors that may have contributed to the outcome. Study design This is a retrospective study performed at the Fetal Medicine Unit of the Sisli Memorial Hospital in Istanbul after ART therapies in our unit from 2000 to 2011. Results The sample comprised 151 triplets, 35 quadruplets, 11 quintuplets, 3 twins, 1 sextuplet and 1 septuplet. The average maternal age was 30 ± 4.4 and the average week of interventions was 11.7 ± 1.3 weeks. In 40 cases two or more needle insertions were necessary. The two-week post-procedure loss rate, defined as ‘the procedure related loss rate’, was 0.7%; however, for the whole sample, the losses were 6.9% when they occured before 24 completed weeks and was defined as ‘the total loss rate’. 184 of the remaining 188 cases had at least one baby to take home (91.1% of 202 patients). The average birth week for those healthy babies discharged home was 35.5 ± 2.4. The rate of early preterm birth before gestational weeks of 32 was 9%. The mean birthweight of this “take-home” group was 2302 ± 525 g. Conclusion Fetal reduction in multifetal pregnancy is associated with low miscarriage rate and preterm delivery rates. Fetal reduction in multifetal pregnancy should be considered for better pregnancy outcomes and the results of this study can be used in prenatal counseling.

In elderly, high-risk surgical patients, sutureless aortic valve replacement (AVR) can often be an alternative to conventional AVR; shorter aortic cross-clamp and cardiopulmonary bypass times are the chief advantages. We compared the outcomes of sutureless AVR with those of conventional AVR in 70 elderly patients who underwent concomitant cardiac surgical procedures. We retrospectively analyzed the cases of 42 men and 28 women (mean age, 70.4 ± 10.3 yr; range, 34–93 yr) who underwent cardiac operations plus AVR with either a sutureless valve (group 1, n=38) or a conventional bioprosthetic or mechanical valve (group 2, n=32). Baseline patient characteristics were similar except for worse New York Heart Association functional status and the prevalence of diabetes mellitus in group 1. In group 1, the operative, cross-clamp, and cardiopulmonary bypass times were shorter (all P=0.001), postoperative drainage amounts were lower (P=0.009), hospital stays were shorter (P=0.004), and less red blood cell transfusion was needed (P=0.037). Echocardiograms before patients' discharge from the hospital showed lower peak and mean aortic gradients in group 1 (mean transvalvular gradient, 8.4 ± 2.8 vs 12.2 ± 5.2 mmHg; P=0.012). We found that elderly, high-risk patients who underwent multiple cardiac surgical procedures and sutureless AVR had better hemodynamic outcomes and shorter ischemic times than did patients who underwent conventional AVR.

Tuberculosis is a common disease worldwide that is caused by Mycobacterium tuberculosis. Tuberculosis is primarily a pulmonary disease, but extrapulmonary manifestations are not uncommon, especially in children and adolescents. We present two pediatric patients who underwent surgery in our clinic for Pott’s disease in the upper thoracic region. The patients were investigated to describe their age, complaints, neurological examination results, disease location, surgical procedure, and complications. The patients were 2 and 14 years old and exhibited disease located in the upper thoracic region (T2–T3 and T1–T2). Both patients displayed severe neurological deficits (Frankel B and C). The kyphotic angles were 82.2° and 43.2°. The patients were stabilized by applying fusion using transpedicular screws via a posterior approach. They also underwent anti-tuberculosis treatment for approximately 1 year. One year later, neither patient exhibited any neurological deficit, and their kyphotic angles were measured as 11° and 1°, respectively. The recommended treatment approach for unstable cases of Pott’s disease located in the upper thoracic region who exhibit neurological deficit and severe kyphotic angling or the development of kyphosis on the thoracic vertebrae is surgical. Decompression, stabilization, and fusion and kyphotic correction can be safely performed via a posterior approach. One of the present cases is the youngest patient described in the literature to undergo transpedicular surgery as a result of Pott’s disease. Our other case is the first described in the literature who developed ptosis as a result of tuberculosis and underwent a procedure via posterior transpedicular screw.

AIM: The aim of this retrospective study was to evaluate the follow-up results of patients who received late-term surgical treatment for peripheral nerve lesions caused by penetrating injuries. MATERIAl and METhODS: The study included 25 patients who underwent surgery for peripheral nerve injuries in our clinic between 2007 and 2013. The patients were evaluated with respect to age, gender, etiology of the trauma, the affected nerve, clinical examinations, electrophysiological findings, surgical techniques and functional outcomes.RESulTS: The study included 30 nerves of 25 patients (19 male, 6 female; mean age 30.1 years). The mean time between the initial injury and admission to our clinic was 11.5 months (range, 3 to 30 months). Cuts caused by glass were the most common cause of injury (68.5%). The most commonly injured nerves in our patients were the median nerve (43.4%) and ulnar nerve (26.6%). External neurolysis and decompression were performed in eleven patients, epineurotomy and internal neurolysis were performed in eight patients, epineural repair was performed in fourteen patients, fascicular repair was performed in three patients, and interfascicular anastomosis using sural nerve grafting was performed in five patients. Postoperative motor strength and electrophysiological analyses showed significant improvements. Better outcomes were obtained in cases with median nerve injuries rather than other nerve injuries. Additionally, patients undergoing external neurolysis and decompression exhibited better outcomes than those undergoing other surgical approaches. COnCluSIOn: Although surgical treatment is recommended as early as possible for peripheral nerve injuries, late-term surgical treatments may provide positive outcomes AIM: The aim of this retrospective study was to evaluate the follow-up results of patients who received late-term surgical treatment for peripheral nerve lesions caused by penetrating injuries. MATERIAl and METhODS: The study included 25 patients who underwent surgery for peripheral nerve injuries in our clinic between 2007 and 2013. The patients were evaluated with respect to age, gender, etiology of the trauma, the affected nerve, clinical examinations, electrophysiological findings, surgical techniques and functional outcomes.RESulTS: The study included 30 nerves of 25 patients (19 male, 6 female; mean age 30.1 years). The mean time between the initial injury and admission to our clinic was 11.5 months (range, 3 to 30 months). Cuts caused by glass were the most common cause of injury (68.5%). The most commonly injured nerves in our patients were the median nerve (43.4%) and ulnar nerve (26.6%). External neurolysis and decompression were performed in eleven patients, epineurotomy and internal neurolysis were performed in eight patients, epineural repair was performed in fourteen patients, fascicular repair was performed in three patients, and interfascicular anastomosis using sural nerve grafting was performed in five patients. Postoperative motor strength and electrophysiological analyses showed significant improvements. Better outcomes were obtained in cases with median nerve injuries rather than other nerve injuries. Additionally, patients undergoing external neurolysis and decompression exhibited better outcomes than those undergoing other surgical approaches. COnCluSIOn: Although surgical treatment is recommended as early as possible for peripheral nerve injuries, late-term surgical treatments may provide positive outcomes

OBJECT: The purpose was to investigate the effect of neutralizing interleukin (IL)-6 antibody treatment on the activity levels of Na-K/Mg adenosine-5'-triphosphatase (ATPase) and superoxide dismutase (SOD) in brain after experimental subarachnoid hemorrhage (SAH) in the rat. METHODS: Seventy adult male Wistar rats weighing 280 to 310 g were used in this study. The animals were randomly allocated to groups: group 1 (n=10) consisted of normal controls; group 2 (n=20) underwent microsurgical exposure of the atlantooccipital membrane and normal saline injection into the cisterna magna, but no blood injection; and the remaining 40 rats were subjected to injection of the blood-cerebrospinal fluid mixture into the cisterna magna. Immediately after mixture injection, each of these 40 rats was randomly assigned to either the mixture injection-only group (group 3, n=20) or the mixture injection plus IL-6 antibody treatment group (group 4, n=20). RESULTS: Two doses of IL-6 antibody affected the levels of SOD and Na-K/Mg ATPase when testing was carried out on day 2 after mixture injection. On the other hand, administering 5 doses of the antibody resulted in a significant decrease in SOD level and a significant increase in Na-K/Mg-ATPase activity compared with those seen in the mixture injection-only subgroup on day 5 after experimental SAH. CONCLUSIONS: The results of this study show that IL-6 antibody may be a beneficial treatment for peroxidation damage in long term after experimental SAH. © 2009 Lippincott Williams & Wilkins, Inc.

OBJECT: The objective of the investigation was to determine the comparative efficacy of cefoperazone/sulbactam versus cefazoline in the prophylaxis of patients undergoing neurosurgical procedures and to evaluate the choice of appropriate antibiotics for surgical prophylaxis. METHODS: Consecutive patients undergoing neurosurgery in 2003 were recruited for the study. Patients undergoing neurosurgical procedures were assigned randomly to groups, one receiving cefoperazone/sulbactam, and the other receiving cefazoline for antimicrobial prophylaxis. All patients were followed for a minimum of 2 weeks postoperatively and all surgical site infections (SSIs) were recorded. RESULTS: A total of 28 postoperative SSIs were identified from 483 cases, with 13 (5.3%) in the cefoperazone/sulbactam group and 15 (6.4%) in the cefazoline group, with a resulting overall infection rate of 5.8%. The difference between the 2 groups was not statistically significant (P>0.05). The predominantly isolated microorganisms in patients with SSIs were Staphylococcus aureus [21 (75.0%)], Acinetobacter baumanii [4 (14.3%)], and Staphylococcus epidermidis [3 (10.7%)]. CONCLUSIONS: As no single regimen of prophylactic antibiotic agent is appropriate for all neurosurgical procedures at all hospitals, the expected organisms cultured from prior wound infections should determine the appropriate antimicrobial therapy for each institution. © 2007 Lippincott Williams & Wilkins, Inc.

ObjectMagnesium has recently become a material of interest as a biocompatible and biodegradable implant metal. Authors of several reports have noted the potential bone-cell activating or bone-healing effect of high Mg ion concentrations. The classic method for achieving intertransverse process fusion involves using an autologous iliac crest bone graft. Several studies have been performed to investigate enhancement of this type of autograft fusion. To the authors’ knowledge, no research has been conducted in which the efficacy of pure Mg particles in posterolateral spinal fusion has been investigated. The objective of this study was to determine whether Mg particles enhance the effectiveness of intertransverse process lumbar fusion in a sheep model.MethodsSixteen skeletally mature female sheep were subjected to intertransverse process spinal fusions with pedicle screw fixation at L2–3 and L5–6. Each animal was given a 5-cm3bone autograft at one fusion level, and a combined 5-cm3bone autograft with the addition of 1 cm3Mg at the other level. Six months after surgery, bone formation was evaluated by gross inspection and palpation, and by radiological, histological, scanning electron microscopic, and x-ray diffraction analyses. Radiological results were graded from 0 to 4 according to the status of the bridging bone, which was determined by evaluating both x-ray films and computed tomography scans. The quality of the spinal fusion was assigned a histological score of 0 to 7, in which a score of 0 represented an empty cleft and a score of 7 represented complete bridging of bone between the transverse processes. The trabecular bone formation at each fusion level and the Ca hydroxyapatite crystalline structure in core biopsy specimens were evaluated using scanning electron microscopy and x-ray diffraction analyses, respectively.The rate of rigid bone fusion, according to both palpation and radiological assessment, in the combined Mg and autologous bone treatment group was higher (81.25%) than in the autograft bone treatment group (62.5%), but this difference was not statistically significant. The quality of bone fusion, according to the histological grading system and scanning electron microscopy inspection, was higher in the bone fusion segments of the Mg and autologous graft combined group than in the group with autograft-only arthrodesis, and this difference was statistically significant. The x-ray diffraction analyses further confirmed the effect of Mg in promoting the formation of the crystalline portion of the bone (hydroxyapatite).ConclusionsBased on the results of this study, adding Mg particles to autologous corticocancellous bone in a posterolateral intertransverse process fusion enhances the quality of bone formation. However, radiological findings did not reveal a statistically significant effect of Mg on the rate of solid bone fusion formation between the two transverse processes.

Aim: Colloid cysts are benign tumors originating from primitive neuroepithelial or endodermic origin in the third ventricle. Asymptomatic, as well as paroxysmal headache, gait disturbance, nausea, vomiting, learning difficulty and death may occur. Computed tomography (CT) is also seen as a round or oval, non-contrasting lesion. Magnetic resonance imaging (MRI) also shows hyperintense at T1 weighed and isointens at T2 weighed sequences. Stereotactic aspiration, microscopic or endoscopic approaches, shunt can be applied. Total excision should be targeted.Materials and Methods: We aimed to investigate the age, sex, complaint, hydrocephalus presence, neurological examination findings, surgical method and results of 19 cases of colloid cyst in our clinic between 2012-2017.Results: Eleven of 19 cases were female (57.9%) and 8 were male (42.1%).The average age was 27.2 (2-62). The most common complaint was headache. Ptosis due to visual disturbance was seen in 5.3% (1 patient), ataxia in 10.5% (2 patients), hydrocephalus with memory loss in 31.5% (6 patients). Six patients underwent cystectomy with endoscopic third ventriculostomy (ETV) and transcranial surgery in 13 patients. Ventriculoperitoneal shunt was performed to one patient at eight months after surgery. Rhinorrhea and menengitis was seen in one patient. Medical theraphy was given to this patient. One patient died because of acute cerebral anfarct.Conclusion: Asymptomatic old patients must be followed periodically. Symptomatic patients must be treated surgically and it must be combined by V-P shunt if patients had hydrocephalus. One of the surgical endoscopic or transcranial technique can be selected. Transcortical or interhemispheric techniques may be preferred to transcranial techniques.Keywords: Colloid Cyst; Total Resection; Hydrocephalus; Endoscopic Third Ventriculostomy.

Dermoid cysts are rare benign congenital tumors comprising 1.1 % of the spinal tumors, with lumbosacral region and cauda equina being the common sites. Many cranial cases with spillage of cyst contents into the subarachnoid space have been reported. We report an extremely unusual case of symptomatic spinal dermoid cyst that ruptured into the syrinx cavity. The gold standard treatment is complete resection of both cyst wall and content in dermoid cysts. However, there is no consensus for the treatment of the syrinx cavity. Observation of similar cases would give us more information about treatment options and the progression of these lesions.

Publisher Summary The posterior pituitary contains a strong uterotonic activity known as the nonapeptide oxytocin (OT). It has been determined that uterus itself represents a major site of OT production. Therefore, the activation of uterine contractions by circulating OT is only one aspect of OT action. A significant portion of OT activity originates from within the uterus and, therfore, acts via autocrine and paracrine mechanisms. This chapter provides an overview of the role of circulating oxytocin and its receptors. The uterus contains its own intrinsic OT system. The ligand and its cognate receptor are both expressed in the same organ and, to some extent, in the same cells. The experiments described in the chapter showed that the genes for the receptor and its cognate ligand were subject to strict and very dramatic regulation during gestation and also, to a lesser extent, during the estrous cycle.