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Background It can sometimes be challenging to find a suitable clip to treat an unusual aneurysm, or when the surrounding anatomy is unusual, especially in resource-limited environments. We describe a method to modify aneurysm clips based on the method originated by Sugita et al in 1985. Herein clip modification (Clip-Mod) is used to treat anatomically difficult anterior communicating artery aneurysms. Methods The Department of Neurological Surgery database was reviewed to find aneurysm patients treated using modified aneurysm clips. Clip-Mod was performed during surgery by shortening the tines of titanium aneurysm clips by abrasion applied from the side of a standard 3-mm surgical diamond drill bit under constant irrigation. Note that the thickness of the tines and the clip spring were not modified or contacted by the drill. Results Four cases used modified aneurysm clips, from 648 total clip-treated aneurysms (0.6%) by 2 surgeons over a 14-year period. Three patients presented with subarachnoid hemorrhages that were determined to be due to anterior communicating artery aneurysms. One patient presented with an incidental unruptured anterior communicating artery aneurysm. All 4 patients were treated with 3-mm titanium clips shortened intraoperatively to 1- to 2-mm lengths, to achieve aneurysm obliteration without stenosing parent or perforating vessels. Conclusions All 4 patients have done well clinically with no reoccurrences after 2–6 years' follow-up, which included angiographic evaluation. The use of this “Clip-Mod” technique thus appears useful for anterior communicating artery aneurysms. Clip-Mod could also be considered for treating other aneurysms when the “perfect” length clip is not available.

Aneurysmal bone cyst is a benign, tumor-like, highly vascular, locally aggressive and relatively rare osteolytic lesion of unknown etiology. Aneurysmal bone cysts of the spine account for 12%–30% of all aneurysmal bone cyst cases. They mostly occur in the lumbar vertebrae, followed by the thoracic, cervical, and sacral vertebrae. Torticollis, a condition characterized by an abnormal tilted position, rotation, and flexion of the head and neck is considered a sign rather than a specific diagnosis. To our knowledge, the presentation of torticollis in children with aneurysmal bone cysts in the thoracic vertebrae has not been reported in the literature. We should keep in mind that acquired torticollis can be a sign of underlying life-threatening conditions. Here we present the case of a 9-year-old boy with muscle spasm, progressively increasing pain, and right torticollis (lasting for 45 days) who presented to the emergency department with paraplegia., Anevrizmal kemik kisti, etiyolojisi bilinmeyen, iyi huylu, tümör benzeri, oldukça vasküler, lokal olarak agresif ve nispeten nadir osteolitik bir lezyondur. Omurganın anevrizmal kemik kistleri, tüm anevrizmal kemik kisti vakalarının% 12 ila 30'unu oluşturur. Çoğunlukla lomber vertebralarda, ardından torasik, servikal ve sakral vertebralarda görülürler. Doğal olmayan bir baş ve boyun eğik pozisyonu, rotasyonu ve fleksiyonu olan tortikolis, spesifik bir tanıdan çok bir işaret olarak kabul edilir. Bildiğimiz kadarıyla, literatürde, çocuklarda torasik vertebrada oluşan anevrizmal kemik kistleri tortikollis ile birlikte bildirilmemiştir. Edinilmiş tortikollisin altta yatan yaşamı tehdit eden koşulların bir işareti olabileceğini aklımızda tutmalıyız. Bu rapor, acil servise parapleji ile başvuran; kas spazmı, giderek artan ağrı ve 45 gündür süren sağ tortikolisi olan 9 yaşında bir erkek çocuğu tanımlamaktadır.

Aim Torticollis can originate from a wide variety of different disorders. Objective We aimed to investigate the underlying conditions in children with torticollis. Material and methods Between May 2016 and December 2019, 24 patients (10 girls and 14 boys; mean age, 8 years) presenting with twisted neck, neck pain, weakness of extremities, imbalance, and gait disorder were evaluated retrospectively. Results Five of the patients had cranial pathologies (cerebellar anaplastic ependymoma and medulloblastoma, brain stem glioma, atypical teratoid rhabdoid tumor, and acute disseminated encephalomyelitis), and five of the patients had spinal pathologies (idiopathic intervertebral disc calcification, vertebral hemangiomatosis, compression fracture, multiple hereditary exostoses, and Langerhans cell histiocytosis at C4). Six of the patients had ocular pathologies (strabismus, Duane syndrome, and Brown syndrome each in two patients). Four patients had otorhinolaryngological infections (Sandifer syndrome, esophageal atresia, reflux, and spasmus nutans, with one patient each). Detailed clinical physical examination and necessary laboratory investigation were performed for all patients. Conclusion Torticollis is a sign that is not always innocent and may herald an underlying severe disease. Misdiagnosis can lead to wrong and unnecessary surgical procedures and treatments, and sometimes, the results can be damaging due to underlying severe conditions if diagnosed late. In addition, we first report a case of vertebral hemangiomatosis and temporomandibular joint ankylosis that presented with torticollis in the English medical literature.

Objective: The most common ventriculoperitoneal shunt (VPS) complications in pediatric patients include shunt infectionsand obstructions. This study evaluated the relationship between shunt infection and obstruction in pediatric patients undergoing VPS placement for hydrocephalus at our clinic.Materials and Methods: Altogether, 210 patients ≤16 years old who were diagnosed with hydrocephalus and who receivedVPS placement by the same surgeon between January 2012 and June 2017 were followed up for at least one year and wereevaluated retrospectively. Patients’ clinical and laboratory findings were evaluated, and computed tomography and magnetic resonance imaging were performed. Pearson’s chi-squared and Fisher–Freeman–Halton tests were used for statistical data analysis.Results: Among the 210 patients, shunt complications developed in 86; of these 86 patients, shunt infections, shuntobstructions, and other complications developed in 41, 53 (non-infection-related: 31 and infection-related: 22), and 14 patients, respectively. The infection rate in patients in whom VPS placement was performed from the frontal region was lowerthan those patients in whom it was performed from the occipitoparietal region. The obstruction rate was significantly higherin patients with shunt infection than in those without. Obstruction occurred in one-third of the patients with Staphylococcusepidermidis infection among patients with shunt infection.Conclusion: The obstruction rate in patients with shunt infection was three times higher than those without. Consideringthat shunt infection may accompany obstruction, making the decisions regarding the treatment method for patients withshunt obstruction is appropriate, after determining whether a shunt infection exists.Keywords: Hydrocephalus, infection, ventriculoperitoneal shunt

AIM To assess the effectiveness and reliability of hemilaminectomy and bilateral decompression (HLBD) for the treatment of thoracic spinal stenosis (TSS) in selected patients. MATERIAL AND METHODS Clinical data of 21 consecutive adult patients who underwent HLBD were investigated. Patients diagnosed with TSS by computed tomography or magnetic resonance imaging, with stenosis secondary to posterior element hypertrophy, and who underwent HLBD for the treatment of narrow spinal canal were included in this study. Patients were evaluated based on their pre- and postoperative modified Japanese Orthopedic Association (JOA) scores using their medical records. Recovery rates were evaluated using the Hirabayashi?s method. RESULTS The mean follow-up period, age, and preoperative JOA score were 37.6 months, 61.6 years, and 5.0 (range: 1?10), respectively. The mean JOA score improved postoperatively, i.e., 10.0 (range: 7?11), during follow-up. The recovery rate was 83.3%. Operation-related transfusion, neurological deterioration, and postoperative instability did not occur during the follow-up examination. CONCLUSION HLBD is a suitable surgical technique for patients with stenosis primarily caused by posterior element hypertrophy, such as ligamentum flavum (LF) and facet joints because it has a relatively less complication ratio, protects the posterior anatomical structures, prevents post-laminectomy kyphosis and postoperative instability, and promotes successful clinical improvement.

Brainstem cavernous malformations (CMs) pose significant challenges to neurosurgeons because of their deep locations and high surgical risks. Most patients with brainstem CMs present with sudden-onset cranial nerve deficits or ataxia, but uncommonly patients can present in extremis from an acute hemorrhage, requiring surgical intervention. However, the timing of surgery for brainstem CMs has been a controversial topic. Although many authors propose delaying surgery into the subacute phase, some patients may not tolerate waiting until surgery. To the best of the authors’ knowledge, emergency surgery after a brainstem CM hemorrhage has not been described. In cases of rapidly progressive neurological deterioration, emergency resection may often be the only option. In this retrospectively reviewed small series of patients, the authors report favorable outcomes after emergency surgery for resection of brainstem CMs.

Tumors of the lateral and third ventricles are cradled on all sides by vital vascular and eloquent neural structures. Microsurgical resection, which always requires attentive planning, plays a critical role in the contemporary management of these lesions. This article provides an overview of the open microsurgical approaches to the region highlighting key clinical perspectives. Electronic supplementary material The online version of this article (doi:10.1007/s11060-016-2126-9) contains supplementary material, which is available to authorized users.

AIM: To compare the clinical and radiological results of dural splitting and duraplasty in patients with Chiari Type I Malformation. MATERIAL and METHODS: This study includes 113 adult patients with Chiari Type I malformation treated between 2009 and 2013. The patients were divided into two groups according to the surgical method (Group 1: dural splitting, Group 2: duraplasty). Neurological examinations and magnetic resonance imaging (MRI) scans were recorded periodically on 3rd, 6th,and 12th months at the postoperative period. The tonsillo-dural distance (TDD) and regression rate of the syrinx cavity were measured on T1 and T2 weighted sagittal MRI scans at the postoperative period. RESULTS: The ratio of syrinx regression was %49.6 in the Group 1 and %54.6 in the Group 2. This result was statistically significant. The TDD increased in Group 2 and this result was statistically significant (p

A 14-year-old male with a neck pain and hypoesthesia in the upper extremities was diagnosed with Chiari type I malformation (CMI) and syringomyelia. The posterior part of the occipital bone was removed via cranio-cervical decompression. The accuracy of measuring the posterior cranial fossa (PCF) and foramen magnum (FM) dimensions were evaluated and compared with the literature. The linear PCF and FM dimensions as well as volumes were measured using computed tomography (CT) images with different techniques. The volume data were compared with similar data from literature. Use of the posterior fossa approach remains controversial when treating patients with minor little brain stem dislocation, small PCF, and or incomplete C1, but the approach can easily be applied if FM and PCF sizes are known. Linear measurements that were assessed for concordance with CT measurements had the best agreement. Quantification of PCF volume and high FM should be taken into consideration for differential diagnosis of tonsillar herniation and prediction of surgical outcome in CMI.

The aim of this study is to investigate the spectrum of underlying disease in children with torticollis. We investigated the spectrum of underlying disease and to evaluate the clinical features of the children presented with torticollis in the last 2 years. Of the 20 children (13 girls and 7 boys with the mean age of 8 years, ranging 2 months–12 years), eight of them have craniospinal pathologies (cerebellar tumors in three, exophytic brain stem glioma, eosinophilic granuloma of C2 vertebra, neuroenteric cyst of the spinal cord, Chiari type 3 malformation, arachnoid cysts causing brainstem compression, and cerebellar empyema), followed by osseous origin in five (congenital vertebral anomalies including hemivertebrae, blocked vertebra, and segmentation anomalies), two muscular torticollis (soft tissue inflammation due to subclavian artery catheterization, myositis ossificans with sternocleidomastoid muscle atrophy), and ocular (congenital cataract and microphthalmia), Sandifer syndrome, paroxysmal torticollis, retropharyngeal abscess each in one patients were detected. Ten patients underwent surgery; two patients received medical therapy for reflux and benign paroxysmal torticollis; and one patient with torticollis due to muscle spasm and soft tissue inflammation was treated with physiotherapy. Various underlying disorders from relatively benign to life-threatening conditions may present with torticollis. The first step should be always a careful and complete physical examination, which must include all systems. Imaging must be performed for ruling out underlying life-threatening diseases in children with torticollis, particularly, if acquired neurological symptoms exist. Besides craniospinal tumors, ophthalmological problems and central nervous system infections should also be kept in mind. Moreover, early diagnosis of these disorders will reduce mortality and morbidity. Therefore, alertness of clinicians in pediatric and pediatric neurosurgery practice must be increased about this alert symptom.

Cerebral revascularization procedures, such as the external carotid-internal carotid bypass, have been used in the clinical management of cerebral ischemic states. Among the most commonly performed bypasses is the superficial temporal artery-middle cerebral artery (STA-MCA) bypass to restore cerebral blood flow. In cases of a foreshortened STA donor vessel, a radial artery (RA) graft is often used as an interposition graft between the STA and MCA. However, addressing the vessel size mismatch between the radial artery and donor can be problematic and challenging. We present the case of an 80-year-old male presenting with positional-onset expressive aphasia and right-sided hemiparesis. Computed tomography perfusion demonstrated a diffusion-perfusion mismatch in a left MCA distribution. Angiography showed a complete left internal cerebral artery occlusion and poor distal filling of the STA. We performed an external carotid artery-to-internal carotid artery bypass through interposing an RA graft to the STA proximally with an end-to-end anastomosis and to the MCA distally using an end-to-side anastomosis. The mismatch between 2 bypass vessel sizes was corrected by removing a small piece from the RA graft at 1 margin and suturing it to itself to reduce the size of the RA vessel diameter opening on the side used to sew to the STA. The patient did well clinically with improved right-sided strength, a patent graft, and no postoperative complications. Addressing vessel mismatch when using RA interposition grafts for bypass is challenging. Various operative approaches to address mismatch should be individualized on the basis of the particular vascular anatomy and needs of the case. Nevertheless, our method of cutting and suturing 1 side of the RA graft into a semiblind end to match donor vessel diameter may be of use to cerebrovascular surgeons in select cases.

Vitamin K deficiency bleeding is one of the most common causes of acquired hemostatic disorder in early infancy. Although vitamin K is practiced routinely after every birth in Turkey, children with type of vitamin K deficiency bleedings (L-VKDB) can be encountered. We aimed to evaluate the clinical features of the children with L-VKDB reported from Turkey. Between 1995 and 2013, 48 studies reporting 534 children with L-VKDB were evaluated in this study. Of the 534 reported children (178 girls, 356 boys), 486 (91 %) were extremely breastfed. The most common bleeding sites were intracranial hemorrhage, gastrointestinal, and umbilical in 414 (77.4 %), 33 (6.2 %), and 33 (6.2 %) children, respectively, and 35 (6.6 %) children had been diagnosed incidentally without any bleeding. The etiology of 399 (74.7 %) children were classified as idiopathic, whereas 135 (25.3 %) were secondary. Intramuscular vitamin K was administered in 248 (46.4 %), not administered in 228 (42.7 %), and the administration of vitamin K were not determined in 58 (10.9 %) children. The outcomes of Turkish cohort showed that 111 (20.8) children died, 257 (48.1 %) cases developed neurologic deficit (mainly epilepsy and psychomotor retardation), and only 166 (31.1 %) patients recovered without squeal. The compliance of prophylactic measures in Turkey does not seem to be satisfactory. As a further measure of tomorrow, we vigorously emphasize that a national surveillance program may be initiated. An additional intramuscular dose or oral supplementation of vitamin K especially for exclusively breast-fed infants may reduce this catastrophic problem in our country.

AIM: Television tip overs and head traumas in children showed an increase in the recent years in Turkey and throughout the World. In this study, the injury types, the surgical interventions and the children exposed to head trauma due to an accident caused by a falling television were investigated retrospectively. Some cautions were suggested in order to prevent these injuries. MATERIAL AND METHODS: In the study, the gender, age, Pediatric Glasgow Coma Scale, radiologic findings, the need for intensive care unit, the period spent in the hospital, the applied surgical treatments, the accompanied treatment and pathology of 36 children's case treated in the neurosurgery department of the Erciyes University School of Medicine were evaluated. RESULTS: Eighteen of the patients were male and 18 were female. The number of cases under 3 years was 21 while the number of cases over the age of 3 was 14. In 32 of the cases was full head trauma. Three female patients died. The patients' mean Pediatric Glasgow Coma Scale score was 12,7. While surgical treatment was applied to four of the patients in our department, facial nerve exploration was applied to the patient who suffered facial nerve damages in the Ear Nose and Throat Department. CONCLUSION: Each year many children are injured or even die due to this trauma which can be easily prevented. The parents, television producers, doctors, health personnel, academic institutions, governments, legislators, national and international organizations are responsible for this trauma. Language: en

Astrogliosis following hypoxia/ischemia (HI)-related brain injury plays a role in increased morbidity and mortality in neonates. Recent clinical studies indicate that the severity of brain injury appear to be sex dependent, and that the male neonates are more susceptible to the effects of HI-related brain injury, resulting in more severe neurological outcomes as compared to females with comparable brain injuries. The development of reliable methods to isolate and maintain highly enriched populations of sexed hippocampal astrocytes is essential to understand the cellular basis of sex differences in the pathological consequences of neonatal HI. In this study, we describe a method for creating sex specific hippocampal astrocyte cultures that are subjected to a model of in-vitro ischemia, oxygen-glucose deprivation, followed by reoxygenation. Subsequent reactive astrogliosis was examined by immunostaining for the Glial Fibrillary Acidic Protein (GFAP) and S100B. This method provides a useful tool to study the role of male and female hippocampal astrocytes following neonatal HI, separately.

Astrogliosis following hypoxia/ischemia (HI)-related brain injury plays a role in increased morbidity and mortality in neonates. Recent clinical studies indicate that the severity of brain injury appear to be sex dependent, and that the male neonates are more susceptible to the effects of HI-related brain injury, resulting in more severe neurological outcomes as compared to females with comparable brain injuries. The development of reliable methods to isolate and maintain highly enriched populations of sexed hippocampal astrocytes is essential to understand the cellular basis of sex differences in the pathological consequences of neonatal HI. In this study, we describe a method for creating sex specific hippocampal astrocyte cultures that are subjected to a model of in-vitro ischemia, oxygen-glucose deprivation, followed by reoxygenation. Subsequent reactive astrogliosis was examined by immunostaining for the Glial Fibrillary Acidic Protein (GFAP) and S100B. This method provides a useful tool to study the role of male and female hippocampal astrocytes following neonatal HI, separately.

Aim Barrel stave osteotomy is a widely used procedure in neurosurgery for the majority of craniosynostosis patients. Both in the intraoperative and postoperative periods, there is inevitable leakage type bleeding from the bones undergoing osteotomy. A number of studies have been performed in order to prevent this complication but a concise procedure is still lacking. Material and methods Synostectomy and parietotemporal barrel stave osteotomy were applied to 143 patients who were operated on with a diagnosis of craniosynostosis between the years 2005-2013. At the beginning to osteotomy, 5 ml/kg erythrocyte suspension (ES) was given for probable blood loss. Whole blood count was performed at the postoperative 1st and 6th hours and cases with hemoglobin levels below 10 or with hematocrit levels which had decreased more than 5% between the 1st and 6th hours were administered erythrocyte transfusion. Results Of the patients, 100 were boys and 43 were girls. Of these, 98 had metopic, 30 had sagittal, 9 had metopic+sagittal, 4 had unilateral, 2 had bilateral and 6 had coronal synostosis. All the cases were administered intraoperative erythrocyte suspension. The preoperative amount of administered mean erythrocyte was 8.61 ml/kg. In the postoperative period, 92 patients were administered erythrocyte suspension. The postoperative amount of administered mean erythrocyte suspension was 7.98 ml/kg. Conclusion For an operated infant with craniosynostosis who is operated on in the first year of life, undergoing osteotomy and inevitable bone-borne blood losses are very important and these have to be replaced immediately.

Aim Hypervascular intracranial tumors may cause serious bleeding in surgery. Though pre-operative endovascular embolization of tumor is a widely accepted method, sometimes despite embolization, an effective and safer intraoperative hemostatic technique is needed to prevent or at least decrease the massive bleeding from the tumors. The aim of this study was to investigate the effect of the ethyl alcohol (EA) injection in hypervascular tumors and find out whether it is likely to be an alternative method to prevent massive bleeding from tumor. Material and methods Fifty-five cases that had hypervascular intracranial tumor and underwent EA injections into their tumors were included in the study. A small amount (0.1-0.2 ml) of EA was used in every injection. Total EA amount differed from 1.2 to 18 ml for each patient. Results Most of the tumors were removed with less bleeding, because bleedings stopped or decreased during resection after EA injections. No serious complication that might be related to EA was observed. Conclusion EA injection into the tumor is an easy, cheap and less invasive method to obtain effective and safe tumor devascularization. It may be an alternative method for tumor devascularization when preoperative embolization cannot be performed due to any reason or severe bleeding despite embolization.

Background The craniocervical junction is a complex anatomic location that contains the occipital bone, atlas, axis, and important complex ligamentous structures. The stability of this region is ensured only with the help of ligaments. Case Description A 6-year-old boy was admitted to our clinic for neck pain. Computed tomography and magnetic resonance imaging revealed a lytic bone lesion involving the C2 vertebral body and pedicle without odontoid tip. The tumor was resected using an anterior retropharyngeal approach and a wide marginal resection method. The odontoid tip and alar ligaments were protected, and the costal autografts were located between the C1-odontoid tip and the C3 body. The costal graft was stabilized in the C3 body with a miniplate. Then, C1-C3 posterior fixation with fusion was performed. The craniocervical junction was not considered unstable because the occipital bone was not involved in the fusion. Histologic examination confirmed the diagnosis of eosinophilic granuloma. Fusion was detected on a 1-year postoperative cervical computed tomography scan. Conclusions The occiput should not be involved in the fusion area when the alar ligaments are preserved during surgery for a C2 lesion.

AIM To share the results of conventional surgery in rhinorrhea and the contribution of computerized tomography (CT) cisternography to determination of the site of cerebrospinal fluid (CSF) leak. MATERIAL AND METHODS Twelve cases treated for spontaneous rhinorrhea were included in this study. All the cases underwent cranial CT and magnetic resonance imaging (MRI). CT cisternography was performed in four patients whose bone defect or leakage site could not be detected by CT and MRI. In order to repair the defect, either the galea or galea together with collagen matrix was used and the procedure was supported with fibrin glue. RESULTS In the cases, postoperative rhinorrhea was seen in neither the early nor the late follow up period. We observed no complications related to CT cisternography or craniotomy. The leakage area was successfully detected with CT cisternography when the other methods failed. CONCLUSION Bone defect can usually be shown by means of CT. However, when bone-defect cannot be shown or the dura in the defective area is intact, CT cisternography is useful to show the CSF leak. Conventional surgery was very succesful in the treatment of spontaneous rhinorrhea but it was cosmetically problematic. In the patients both treated with galea and galea together with collagen matrix, the repair of the defect was successful.

The aim of this study is to describe the relationship of pre-operative complete blood count parameters [mean platelet volume (MPV), neutrophil/lymphocyte count ratio (NLCR), and white blood cell count (WBC)], with the clinical, radiological, and histopathological features and the management options for patients under 3 years of age with a newly diagnosed central nervous system tumors. Children with central nervous system (CNS) tumors in the first 3 years of life admitted in the Erciyes University Hospital between April 2004 and April 2014 were enrolled in this study. The CBC parameters were compared with those of an age- and sex-matched normal control group. In the study group, the means of MPV and WBC were 8.00 ± 1.24 fl, and 10,855 ± 3642/mm3 respectively; the median (25–75%) of NLCR was 0.98 (0.66–1.46). For the control group, the means of MPV and WBC were 6.8 ± 0.73 fl and 8565 ± 2522/mm3; the median (25–75%) of NLCR was 0.52 (0.36–0.70). The MPV, WBC, and NLCR were higher in the study group. The median overall survival (OS) of the patients was 60 months (range 0–81.6 months); and median event free survival (EFS) was 24 months (range 0–70.1 months). The formulation of MPV, NLCR, and WBC was found to be predictive for the diagnosis of CNS tumor in children with nonspecific symptoms. The univariate and multiple binary regression analyses showed a positive association of MPV, NLCR, and WBC and the risk of a diagnosis of CNS tumor. There was no relationship between MPV, WBC, NLCR, and histological subgroups. However, there were no associations between CBC parameters and OS or EFS of the patients. By causing suspicion, MPV, NLCR, and WBC may provide both an earlier radiological investigation decision and thereby an early diagnosis of CNS tumor in children with nonspecific symptoms in the first 3 years of life.

Aim To evaluate the clinical success of the en bloc laminoplasty and impact of the arcocristectomy on postoperative axial pain of the patients with cervical spondylotic myelopathy (CSM). Material and methods A retrospective review of 81 patients with CSM who underwent en bloc cervical laminoplasty while preserving posterior structure of the cervical spine during the period from 2007 to 2014 was performed. Arcocristectomy was performed if the C6-7 level was included in the surgery. The posterior spinal elements and muscles attached to the spinous process of C2 and C7 were preserved. Thus, postoperative deformity of the cervical spine could be avoided. The neurological status of the patients was assessed using the modified Japanese Orthopedic Association (JOA) scale. The neurological recovery rate was calculated according to the Hirabayashi method. Results The mean modified JOA scale score was 11.4±2.4 preoperatively and 15.0±3.9 postoperatively. The neurological recovery rate was 68.6%. C7 arcocristectomy was performed in 19 patients. No axial pain was noted in the first 2 postoperative months. Keyhole foraminotomies were performed in 11 patients and radicular pain completely resolved after surgery. Temporary C5 nerve root palsy was observed in 3 patients. Mean cervical spine lordosis was 10.6o±10.5o preoperatively and 8.6o±9.5o postoperatively. No postoperative spinal instability or kyphotic deformity was noted. Conclusion En bloc cervical laminoplasty while preserving posterior structure is useful in preventing postoperative spinal malalignment and axial pain. Arcocristectomy is an effective technique for the prevention of postoperative axial pain in patients with C6-7 spinal stenosis.

Aim Total surgical resection of pituitary macroadenomas is difficult due to the location of the adenoma and the propensity to invade surrounding tissues. The purpose of this study was to evaluate the risk factors for invasive and aggressive pituitary macroadenomas using radiological, hormonal, clinical, and immunohistochemical markers. Material and methods Seventy cases of pituitary macroadenoma were examined. Age, gender, symptoms, the presence of fibrosis within the adenoma, hormonal levels, radiological findings, pathological results and immunohistochemical staining of the patients were evaluated using statistical methods. Results We observed that the patients with macroadenomas in our study most frequently presented during their 5th decade. The most frequent pituitary adenomas were non-functional, GH-secreting and PRL-secreting macroadenomas. The most frequent complaint was vision loss, headache and acral growth. Based on Magnetic Resonance Imaging (MRI) results, it was observed that the degree of invasion into surrounding tissues increased as the size of the macroadenoma increased. Macroadenomas that had invaded into the cavernous sinus invasion or that had a fibrotic tumor structure had a low probability of being resectable. There were no significant relationships between invasive behavior and p53, telomerase, ghrelin and CD46. Conclusion It is not possible to identify only one factor that affects the prognosis of patients with pituitary macroadenomas. The contribution of the experience of surgeon to the treatment is surely beyond dispute. Fibrotic tumor structure, the surgical technique, the type of hormone, and cavernous sinus invasion affect the ability to perform a total resection and the overall prognosis.

Chiari Malformation type 1 (CMI) is a congenital anomaly of the hindbrain, in which cerebellar tonsils herniate into the spinal canal. A 47-year-old male patient, who never had an additional disease up to that time sat on a dentist's chair for approximately half an hour with his neck extended for a tooth extraction. While getting up from the chair, the patient developed clinical symptoms. CMI may be undetected for years. Clinical symptoms may have appeared because of keeping the neck in the flexion or extended position for a very long duration of time.

Childhood brain abscesses are a rare and potentially life-threatening condition requiring urgent diagnosis and treatment. This retrospective study analyzed the clinical and radiologic findings of 24 (7 girl, 17 boys) cases with brain abscess. Mean age was 92.98 ± 68.04 months. The most common presenting symptoms were nausea-vomiting (45.8%) and headache (41.7%). Brain abscess was most commonly located in the frontal region. Diffusion restriction was determined in 78.4% of lesions. The mean apparent diffusion coefficient value in these lesions was 0.511 ± 0.23 × 10–3 mm2/s. Cultures were sterile in 40% of cases. Antimicrobial therapy was given to only 16.7% of cases. Predisposing factors were identified in 91.6% of cases (congenital heart disease in 20.8% and immunosuppression in 20.8%). Mortality level was 12.5%. In conclusion, immunocompromised states, and congenital heart disease have become an important predisposing factor for brain abscesses. Effective and prompt management should ensure better outcome in childhood.

Aim Despite different surgical treatment protocols at different centers for spondylodiscitis due to lumbar surgery, there is no consensus on its surgical indications. In this study, we aimed to clarify the steps to be followed in the management and treatment of postoperative spondylodiscitis. Material and methods The data of 20 cases with postoperative spondylodiscitis were evaluated. C-reactive protein (CRP) was used for diagnosis and follow-up. According to culture results of the infected material obtained from the operated cases, appropriate antibiotic treatment was initiated. In non-operated cases, parenteral empirical antibiotic treatment was implemented. Surgical treatment was planned for cases with clinical and radiological instability, abscess on imaging and those who were nonrespondent to empirical antibiotic treatment. For the cases that clinically recovered and had normal CRP levels, oral antibiotic treatment was continued after parenteral antibiotic treatment. Results Of the cases; 13 were male (65%) and 7 were femals (35%). The mean age was 56.3 years (32-74). The most prevalent complaints in referral were waist and leg pain. Except one, all cases had increased CRP levels. All patients had spondylodiscitis on magnetic resonance imaging. Seven had radiological and clinical instability and 3 had epidural abscess. The most commonly growing microorganism in culture was Staphylococcus aureus. Surgical treatment was applied to seven cases and medical treatment to 13 cases. Conclusion In cases with waist pain in the postoperative period, the first potential diagnosis to be considered is spondylodiscitis. Surgical treatment should be implemented for cases resistant to empirical antibiotic treatment, with abscess on imaging, or with lumbar instability.

The surgical approaches for spinal tumors, to a great extent, have been developed in accordance with the developments in medical technology. Today, many surgical techniques are implemented as anterior, anterolateral, posterior, posterolateral and combined approaches. Due to its low morbidity, the posterior approach is the more preferred one. Laminectomy is a widely used technique, especially in neoplastic lesions. However, following laminectomy, there are numerous complications such as instability, kyphotic deformity and scar formation. In this paper, the excision of a tumor that was located intradural-extramedullary at the C3-C7 level with the cervical hemilaminoplasty technique is described. A 47-year-old female patient presented to our clinic with increasing complaints of neck and left arm pain, left arm numbness and searing pain for the last 10 years. On examination, hypoesthesia at the C4-7 dermatomes in the left upper extremity, an increase in deep tendon reflexes, and bilateral positive Hoffmann reflexes were observed. C3-C7 laminae were opened unilaterally on the right side with a midline skin incision. The laminae were drilled with a high-speed drill to provide a wide opening, both on the midline obliquely and from the border of the lamina-facet joint. After the tumor was totally excised, hemilaminae were placed into the previous position and reconstructed with mini-plates and screws. Cervical hemilaminoplasty provides a wide field of vision in tumor surgery of this region. Besides, the reconstruction of hemilaminae is important for stability. As the integrity of the spinal canal is preserved during reoperations of this region, the risk of complications is decreased.

Objective: To investigate the contribution of the use of neuronavigation together with intraoperative ultrasonography in the surgical treatment of cavernous hemangiomas to the decrease of mortality and morbidity. Materials and Methods: A total of 73 cases with cavernous hemangiomas, operated on under the guidance of neuronavigation and intraoperative ultrasonography between June 2000 and September 2010 in the Neurosurgery Department of the University of Erciyes, were investigated retrospectively. The cases were evaluated from the point of neurological deterioration due to surgery. Results: The lesions were mostly located supratentorially, especially in the temporal region. The most common complaint of supratentorially located lesions was epilepsy. Such findings and symptoms as bleeding, headache, and focal neurological deficits were observed mostly in the lesions of infratentorial region; 80 cavernous hemangiomas in 73 cases were removed in total. In 3 of the cases, a temporary increase in the neurological deficits was observed; however, in the late periods, no persistent morbidity or mortality due to surgery was observed. Conclusion: By using neuronavigation together with intraoperative ultrasonography, the inconsistency between real location and the navigation image of the lesion resulting from the brain shift due to cerebrospinal fluid drainage can be restored; so, the morbidity and mortality can be decreased.

Objective Torticollis is an abnormal head posture that occurs at all ages, seen in childhood with an estimated incidence of 1.3%. Clinical presentation includes ipsilateral tilt and controlateral rotation and translation. The purpose of this studyis to better understand the spectrum of disease in torticollis except congenital muscular torticollis. Methods 17 patients presented with complaints of twisted neck, neck pain, weakness of extremity, esotropia and gait disorder between May 2012 and November 2014 were enrolled in this study. Cranial and/or spinal MR, CT imaging, ultrasound and ph meter studies were performed in order to reveal etiology. Results Nine patient underwent surgery, two patientes received medical therapy for reflux and benign paroxysmal torticollis. For six patients only clinical follow-up was sufficient. Conclusion There is a wide differential diagnosis for a patient with torticollis, not just neurological in etiology which should be considered in any patient with torticollis. Moreover, early diagnosis of etiological disease will reduce mortality and morbidity. Therefore, clinicians managing children with torticollis must be vigilant about underlying neurological complications.