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Aim and Background: This study aimed to investigate the relationship between cervical spinal alignment and the center of gravity (COG) of the head in patients with Chiari malformation (CM) compared to healthy individuals. CM is characterized by the herniation of posterior fossa structures through the foramen magnum, potentially affecting head positioning and craniovertebral junction biomechanics. Understanding these biomechanical changes is crucial for improving diagnostic and treatment strategies. Materials and Methods: This retrospective study included 102 CM patients and 71 healthy controls. Radiological measurements were obtained from cervical X-rays, with seven reference points used to calculate angles related to head positioning and cervical curvature. Angular parameters, including cranial incidence (CI), cranial slope (CS), cranial tilt (CT), C7 slope (C7S), and spinocranial angle (SCA), were analyzed to determine correlations with the COG of the head. Statistical analyses were performed using t -tests, ROC analysis, and Pearson/Spearman correlation tests. Results: CM patients had significantly higher CI, CT, STT, and SCA angles compared to controls (P < 0.05), indicating an anterior displacement of the head's COG. The CS angle was lower in CM patients (P < 0.05), reflecting a more flexed head position. No significant differences were found in C7S and C2T angles between groups, suggesting similar cervical curvature. ROC analysis demonstrated high sensitivity and specificity of the angular measurements for diagnosing CM. Conclusion: CM patients exhibit distinct biomechanical alterations, including an anterior shift of the COG and a more flexed head position. These findings highlight the potential of angular measurements as noninvasive diagnostic tools for CM. Future studies should explore the implications of these biomechanical changes on CM progression and treatment outcomes. [ABSTRACT FROM AUTHOR]

Objective The aim this study is to present the results of the minimal invasive neuroendoscopic-assisted system application as an alternative to traditional surgery in patients with Chiari malformation type 1 (CM type 1) with/without syringomyelia. Design, Setting, and Participants In the study, data of 22 symptomatic patients were prospectively collected. Before and after the operation, patient characteristics, computed tomography, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) flow dynamics MRI, and outcome scales scores were recorded. Foramen magnum decompression and C1 total laminectomy were performed. The fibrous band at the craniocervical junction was opened and a durotomy was performed. In patients with a syrinx, the pre- and postoperative axial and sagittal lengths of the syrinx were measured and compared. Results The mean age of the patients was 32 ± 5 years. There were eight male patients. Ten patients had syrinx. The mean visual analog scale (VAS) score before and after surgery was 8 ± 1.06 and 2.18 ± 1.13, respectively. When evaluated according to the Chicago Chiari Outcome Scale, there was improvement in 20 patients, while there was no change in 2 patients. Syrinx resolved completely in 3 of 10 (13.6%) patients with syringomyelia, and the syrinx volume decreased in 3 patients (13.6%). In 4 of 10 (18.1%) patients, there was no significant change in the syrinx volume. The average operation time was 105 minutes (80–150 minutes). The average blood loss was 40 mL (20–110 mL). Conclusion Although the study was limited due to the small number of patients with a short follow-up, endoscopic decompression was a safe and effective technique for surgery in CM type 1 patients. [ABSTRACT FROM AUTHOR]

Aim: This retrospective study aimed to provide a comprehensive analysis of the surgical management of foramen magnum meningiomas (FMMs), focusing on patient characteristics, surgical approaches, complications, and postoperative outcomes. Materials and Methods: The study included 23 patients diagnosed with anterior or anterolateral FMMs who underwent surgical treatment between 2014 and 2022. The study encompassed clinical records, neurological assessments, radiological findings, and surgical approaches, with a focus on the far lateral approach (FLA). Evaluation of outcomes included Karnofsky Performance Scale (KPS) scores and The Neck Disability Index (NDI) scores. Surgical approaches and postoperative care strategies were detailed. The study also examined the relationship between tumor location and surgical techniques. Results: The analysis revealed that patients with FMMs presented with various clinical symptoms, including lower cranial nerve deficits, pyramidal tract syndrome, and sensory disturbances. The retrocondylar far lateral approach was predominantly utilized, resulting in various Simpson resection grades. Postoperative complications were observed, including cranial nerve deficits, cerebrospinal fluid leakage, and infections. Also, the study found patient KPS scores remained stable, and NDI scores showed no significant increases before and after surgery. Conclusion: Surgical management of FMMs is a complex task requiring meticulous planning, individualized approaches, and close attention to neurovascular structures. The study emphasized the diverse clinical presentations and surgical techniques associated with FMMs and highlighted the importance of ongoing research and collaborative efforts to enhance patient care in this challenging field. [ABSTRACT FROM AUTHOR]

Background Neuroregulation of sexual functions requires coordination of parasympathetic, sympathetic, and somatosensory neuronal pathways. The nerves formed by the lower lumbar plexus provide the innervation of the urogenital organs. Lower lumbar disc hernias (LDHs) might impair the neuroregulation of sexual functions by compressing the neural structures. This prospective study aims to evaluate the effect of lower LDHs on libido and sexual dysfunctions. Methods A total of 61 sexually active patients diagnosed with single-level LDH who underwent unilateral microdiscectomy were included in the study. The patients' healthy sex partners were included in study as controls. The International Sexual Function Index-5 (IIEF-5) and Female Sexual Function Index (FSFI) were used for sexual assessment of male and female participants, respectively. Visual Analog Scale (VAS) was used for pain assessment. Results According to the FSFI scores, all 20 female patients had preoperative sexual dysfunction, which improved in 15 (75%) patients after surgery (p < 0.001). According to the IIEF-5 score for men, 38 of 41 male patients had preoperative sexual dysfunction, which improved in 26 (68.4%) patients postoperatively (p < 0.001). Conclusion The preoperative sexual dysfunctions of LDH patients improved significantly after the microdiscectomy. [ABSTRACT FROM AUTHOR]

This study aimed to explore the potential association between oxidative stress markers and Moyamoya Disease (MMD), a complex cerebrovascular disorder characterized by vascular constriction and collateral vessel formation. The study focused on thiol-disulfide homeostasis and ischemia-modified albumin (IMA) levels as indicators of oxidative stress. A total of 23 MMD patients and 23 control subjects were included in the study. Clinical assessments and comprehensive blood analyses were conducted to evaluate factors including age, gender, disease duration, treatment history, and biochemical parameters. Thiol-disulfide homeostasis parameters were measured using an automated method. Ischemia-modified albumin levels were also analyzed. Statistical analyses, including chi -square tests and ROC curve analysis, were performed to determine differences and potential diagnostic cut -off points. Elevated levels of native thiol, total thiol, and disulfide were observed in the MMD patient group compared to the control group, statistical ly significant. Ischemia-modified albumin levels were notably higher in the patient group, corroborating the association between oxidative stress and ischemic events. ROC curve analysis identified potential diagnostic cut-off points for these markers. The study also highlighted clinical differences, including BMI, CRP levels, and the frequency of various symptoms, between the patien t and control groups. Our study offers insights into the intricate interplay between oxidative stress and Moyamoya Disease. The statistically significant elevated levels of thiol-disulfide markers and ischemia-modified albumin suggest potential links to oxidative stress dynamics within MMD. These findings contribute to our understanding of oxidative stress in cerebrovascular diseases and open avenues for further research. [ABSTRACT FROM AUTHOR]

Aim: Glioma, particularly glioblastoma (GBM), represents a prevalent and aggressive primary brain tumor with limited curative options. Epileptic seizures often manifest as a common clinical symptom in these patients, but their prognostic significance remains debated. This study aimed to retrospectively analyze the clinical presentations, tumor characteristics, and the impact of seizures on the prognosis of GBM patients. Materials and Methods: A total of 113 adult patients with histologically confirmed GBM treated between April 2018 and January 2022 were included in this retrospective analysis. Data encompassed clinical symptoms, preoperative and postoperative seizures, tumor localization, overall survival (OS), and other relevant factors. Statistical analysis was performed to assess the relationships between seizures and various prognostic parameters. Results: Seizures were present in 39.8% of GBM patients, with 20 patients experiencing both preoperative and postoperative seizures. Preoperative and postoperative seizures were not significantly associated with differences in prognosis (p>0.05). Tumor localization, OS, Karnofsky performance score, and length of hospital stay showed significant differences between patients with and without seizures (p<0.05). Complete resection was achieved in 90.3% of patients, leading to a relatively lower incidence of postoperative seizures. Conclusion: Seizures in GBM patients are associated with OS, Karnofsky performance score, and hospitalization duration, independently of other factors. The presence of seizures serves as a valuable prognostic indicator for GBM, prompting further investigation into its influence on patient outcomes, quality of life, and socioeconomic aspects of survival. These findings emphasize the importance of early seizure management in GBM patients and the need for tailored treatment strategies. [ABSTRACT FROM AUTHOR]

We presented a unique case of infantile type hemangioma corresponding with aortic stenosis. Therefore, we accepted this case as a PHACES syndrome. This case will be the 4th case of the literature. The most remarkable feature of PHACES syndrome is infantile hemangioma, but abnormalities in the arteries which are not obvious on the clinical examination have considerable potential morbidity. We have certain diagnosis with pathology and no conflicts of interest disclosure. [ABSTRACT FROM AUTHOR]

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The article discusses the surgery of head traumas which is associated with the risk factor of cerebrospinal fluid (CSF) fistula. Several cases relating to otorrhea, rhinorrhea and oculorrhea patients associated with traumatic lesions were studied and operated through surgery along with other cases. The results of the study were found with rhinorrhea, oculorrhea and otorrhea as the most common symptom for the disease found in patients.

Aim: To report our experience with the 2.5-mm Surpass EvolveTM flow diverter (FD) in the treatment of distal small cerebral artery aneurysms., Material and Methods: This study included 41 patients with 52 aneurysms. Clinical and radiological records and procedural and follow-up outcomes were reviewed retrospectively., Results: The aneurysm morphology was saccular in 45 patients, dissecting in five patients, and fusiform in two patients. Fifty-two aneurysms were treated with 41 Surpass Evolve FDs. The mean diameters of the proximal and distal parent arteries were 2.56 and 2.17 mm, respectively. The mean duration of follow-up was 16.2 ± 6.6 (6-28) months. Four (10%) patients had acute subarachnoid hemorrhage. In the same session, two patients with two tandem aneurysms and one patient with four tandem aneurysms were treated using a single FD. Intraprocedural hemorrhage and femoral artery pseudoaneurysm occurred in two patients during the procedure. Digital subtraction angiography was performed on 38/41 (92%) patients with 47/52 (88%) having aneurysms. Complete occlusion (OKM D) was observed in 39/47 (82%) aneurysms, and near complete-complete occlusion (OKM C-D) was observed in 46/47 (98%) aneurysms., Conclusion: Endovascular treatment of distal cerebral artery aneurysms with the 2.5-mm Surpass Evolve < sup > TM < /sup > FD provides a high rate of aneurysm occlusion with low periprocedural complications, even in ruptured and tandem aneurysms.

Aim: To investigate the predictive role of thiol/ disulfide homeostasis and Ischemia-modified albumin (IMA) levels for NTDs., Material and Methods: A total of 71 pregnant women (31 with NTD and 42 healthy controls) were enrolled in this study. This prospective case-control study included pregnant women with NTDs as the study group and randomly selected age-matched pregnant women with healthy fetuses as the control group. The two groups were compared on the basis of thiol/disulfide and IMA levels in the maternal and fetal samples., Results: No statistically significant difference in native thiol, total thiol, disulfide, and calculated ratios was observed between the groups. However, maternal IMA values were significantly higher in the study group. The IMA was proven to be a predictor with a sensitivity of 77.4% and specificity of 100% for NTDs at a cut-off value of 1.32., Conclusion: The examination of the maternal levels of IMA may be useful in the detection of NTDs.

Aim: To report the clinical outcomes of microdiscectomy (MD) and endoscope assisted discectomy (EAD) techniques via the posterior approach in patients with cervical disc herniations (CDHs)., Material and Methods: The data were obtained from retrospective review of the patient?s charts and the latest follow-up examination., Results: A total of 83 cases with CDH who were treated by posterior cervical discectomy (PCD), between 2010 and 2019, were reviewed. MD was used in 42 patients (male: 20, female: 22) with a mean age of 51.1 years. In MD group, all patients had pain, and 26 of them had additional weakness. Visual analogue scale (VAS) neck score was 7.72, VAS arm score was 8.83; PROLO score was 7.41. EAD was used in 41 patients (male: 26, female: 15) with a mean age of 38.7 years. In EAD group, all patients had pain, and 20 of them had additional weakness. VAS neck and arm scores were 7.75, and 8.72, respectively; PROLO score was 7.44. Mean follow-up time was 24.7 months. The scores at the latest exam are as follows: in MD group, VAS score for neck was 2.32, for arm 1.11; PROLO score was 9.58; in EAD group, VAS score for neck was 2.18 and for arm 0.97; PROLO score was 9.66. Both surgical techniques were success with statically significance (p?0.05) according to the scores.The techniques were equally effective while postoperative VAS (p > 0.412) and PROLO (p > 0.980) scores were similar in both groups., Conclusion: Both approaches are effective for selected patients with soft cervical disc herniation in which settled lateral location. Both techniques allow working with two handle, therefore facilitating the gentle manipulation that can obtain for avoiding hazardous effect to spinal cord and nerve root.

Aim: To investigate the safety and efficacy of Derivo® embolisation device (DED), a new-generation flow diverter designed to treat cerebrovascular aneurysms, and its long-term clinical outcomes., Material and Methods: In total, 146 patients with 182 aneurysms were treated with DED. The mean age of the participants was 51.5 years; among them, 46 (31.5%) presented with acute subarachnoid haemorrhage. The mean aneurysm size was 8.3 mm, and 12 aneurysms were involved the vertebrobasilar system. Ophthalmic aneurysms account for most internal carotid artery (ICA) aneurysms., Results: The Glasgow Coma Scale (GCS) score of 12 patients was < 15. DED was associated with a mortality rate of 2.7% and permanent morbidity rate of 3.4%, and a complete aneurysm occlusion rate was achieved in 78.7% of cases after 7.02 months., Conclusion: The DED device is a new-generation flow diverter with excellent opening behaviour and navigational benefits. Our results indicated a safe aneurysm occlusion with optimum morbidity and mortality values despite the fact that almost one-third of the patients presented with subarachnoid haemorrhage.

Background: Since understanding the fact that traumatic brain injury includes an inflammatory process, the number of studies of cytokines has increased. The objective of this study was to analyze and discuss the association of interleukin (IL)-8 level with the clinical and radiological status of patients with head trauma., Methods: Patients who were admitted to our hospital due to head trauma were included in the study. Findings of clinical and laboratory examinations were analyzed. Data regarding patient age, gender, available clinical findings, Glasgow Coma Scale (GCS) score, trauma cause, brain tomography findings, and biochemical laboratory test results were recorded. The patients were divided into 3 groups according to their GCS score: Group I: GCS ≥13, Group II: GCS = 9-12, and Group III: GCS = 3-8., Results: A total of 23 (76.7%) patients were male and 7 (23.3%) were female. Overall, 17 (56.7%) patients were admitted due to a fall, 8 (26.7%) due to a traffic accident, and 5 (16.7%) due to assault. Each group comprised 10 patients. As the GCS score increased, the IL-8 level decreased. The mean IL-8 level was 1.2 pg/mL in Group I, 6.6 pg/mL in Group II, and 4.7 pg/mL in Group III; however, there was no statistically significant difference between the groups (p=0.147). Moreover, the IL-8 level was significantly greater in patients who demonstrated an abnormal tomography finding (p=0.023)., Conclusion: IL-8 may be a beneficial indicator for monitoring the clinical and radiological status of traumatic brain injury. Nonetheless, studies of larger cohorts in which IL-8 levels are measured at all stages of brain injury and follow-up of long-term prognosis are warranted.

Aim: In the present study, we evaluated the association of the Glasgow Coma Scale (GCS) score and amount of blood loss with mortality in patients presenting with traumatic acute subdural hematoma (ASDH)., Material and Methods: This retrospective study was performed on 99 patients who were operated for traumatic acute subdural hematoma (ASDH) without any systemic association at a single center. Epidural hematoma was reported to be the most common additional pathology. Age, sex, mechanism of trauma, time interval between onset of trauma and admission to the emergency ward, associated problems, thickness of hematoma and Glasgow Coma Scale (GCS) score at the time of admission and on discharge were all studied., Results: The GCS score was inversely proportional to the thickness of hematoma and interval between onset of trauma and surgery (p < 0.05). Although the mortality rate was reported to be high in traffic accidents, the rate was low in patients with head trauma only (p < 0.05). The mortality rate was high in patients with associated pathologies (p < 0.05). Lost patients were reported to be older patients with more extensive ASDH or those who presented earlier with a low GCS (p < 0.05)., Conclusion: ASDH is associated with high mortality. GCS score and the thickness of the ASDH are important predictors of mortality. Age, additional trauma, and interval between trauma and hospital admission are major predictive factors for mortality.

Background: Head trauma is associated with a significant risk of cerebrospinal fluid (CSF) fistula., Methods: In this study, it was aimed to report twenty-two cases subjected to operative intervention for otorrhea, rhinorrhea and oculorrhea with associated traumatic lesions. Majority of the cases had moderate to severe head trauma with a Glascow Coma Scale (GCS) score under 14. The study group included eleven cases with depression fractures, 6 with epidural hematomas and 4 with tension pneumocephalus., Results: Rhinorrhea was the most common presenting symptom encountered in fifteen cases; whereas, otorrhea was prominent in 7 and oculorrhea in 2 cases. Two patients having rhinorrhea also had oculorrhea and otorrhea. The patients were operated with unilateral approaches in twelve and bifrontal approaches in ten of the cases., Conclusion: Early surgical intervention should be performed in cases presenting with CSF fistula and associated traumatic lesions without considering conservative management to provide an effective control of associated complications due to CSF fistulas.

Aim: Surgical approaches to the pituitary have undergone numerous refinements over the last 100 years. The fully endoscopic transsphenoidal approach has gained widespread use all around the world. We report the results of a consecutive series of patients who underwent pituitary surgery using a pure endoscopic endonasal approach and the results of the evaluation of the efficacy and safety of this procedure., Material and Methods: We retrospectively reviewed the hospital database of 80 consecutive pituitary adenomas that were resected with the purely endoscopic endonasal transsphenoidal technique., Results: The preoperative clinical condition of the patients, hormone profile, visual field, computed tomography and magnetic resonance imaging findings, and the Hardy-Vezina and Knosp scores were evaluated and revealed the importance of the parameters for surgery. Surgical technique, postoperative clinical condition of the patients, hormone profile, complications and follow-up period were reviewed., Concusion: Endonasal endoscopic pituitary surgery is a safe and effective surgical technique.

Aim: Deep venous thrombosis (DVT) and pulmonary embolism (PE) are the most frequent surgical problems and associated with high morbidity and mortality. Neurosurgical patients constitute a unique group where prophylaxis with anticoagulant and antiaggregant agents are relatively contraindicated due to the natural course of vascular problems such as aneurysms, hemorrhagic tumors or hematomas or increased vulnerability to complex spinal surgeries and trauma., Material and Methods: We included 67 patients predicted to be immobilized for 2 or more months in this retrospective analysis. A vena cava filter was inserted between the first and seventh postoperative day in 40 patients in a prophylactic manner whereas 27 patients received low dose heparin for the same purpose. The patients were evaluated for symptomatic DVT or PE., Results: Percutaneous insertion was performed for all filters without any complication. DVT occurred in two patients of the filter group and 1 patient of the heparin group. There was no PE recorded in any patient of either group. Patients were followed up for 22 months in the filter and 16 months in the heparin group., Conclusion: We conclude that prophylactic filter use in high risk neurosurgical patients is not beneficial and not superior to low-molecular-weight heparin use. Nevertheless, it is reasonable to prevent PE in patients with proven DVT who have no contraindication for anticoagulant drugs.

Aim: Spongostan™ is a sterile, water-insoluble, porcine gelatin absorbable sponge, which is widely used as a hemostatic material. The aim of this study is to test the anti-fibrotic capacity of Spongostan™, using a craniotomy model in an experimental rabbit model., Material and Methods: Eighteen rabbits were divided into two groups: Each group consisted of 9 rabbits, duratomy plus Spongostan™ (group 1), and duratomy without Spongostan™ (group 2). Right parietal bone was removed via trephine and low speed drill and dura was opened. On the group 1 rabbits, an appropriate piece of Spongostan™ was meticulously placed under dural layer. On group 2 rabbits, same procedures were repeated without Spongostan™. Histological sections were taken from each group and evaluated for degree of fibrosis and collagen fibers., Results: There was marked increase in number of fibroblasts and collagen fibers in group 2 rabbits, however most of the rabbits in Spongostan™ group demonstrate scarce histopathological findings for fibrosis., Conclusion: We conclude that an appropriately placed subdural Spongostan™ over cerebral tissue may prevent postoperative surgical adhesions after neurosurgical operations.

Aim: Spinal cord injury (SCI) is characterized by posttraumatic inflammatory cascades including excitotoxicity, oxidative stress, and apoptosis. Agents against neuroinflammation are the current scope of studies on experimental SCI with promising results., Material and Methods: Thirty-two male Sprague-Dawley rats weighing 250-320 gram were used. They were randomized and divided into four groups with eight animals in each as sham, control, SCI+PEG (polyethylene glycol) and SCI+atorvastatin group. Rats were anesthetized with intraperitoneal ketamine (80 mg/kg) and xylazine (10 mg/kg) and SCI was induced by the weight-drop model. A single level laminectomy was performed at T10 and the spinal column was immobilized with a stereotactic device. Rats in the treatment group received ip atorvastatin at 0.2 mg/kg. Neurological impairments were examined through Modified Tarlov's and inclined angle scores. The SCI section was resected for electron-microscopic analysis, IL-1β and IL-6 level. All data were analyzed using one-way ANOVA and Dunnet T3 test., Results: Atorvastatin improved locomotor recovery after rat SCI. The results were further confirmed with a statistically significant decrease of IL-1β, IL-6 and lipid peroxide levels. This finding revealed the anti-inflammatory and beneficial effect of atorvastatin on rat SCI., Conclusion: The present study focused on both B and T cell mediated immunity and confirmed the beneficial effect of atorvastatin with decreased expressions of IL-1β and IL-6.

Aim: In the present study, we investigate the neuroprotective effects of rituximab, a monoclonal antibody directed towards B cell mediated humoral immunity, on a rat spinal cord injury (SCI) model with immunohistochemical methods., Material and Methods: Twenty-four rats were used for the study. Rats were divided as control, SCI, and rituximab-treated SCI groups. Intraperitoneal rituximab administration was performed on days 0, 3 and 5 in the third group. Rats were sacrificed 7 days after trauma. Antibodies against IL-1β, IL-6, TNF-α and CD20 were studied with the ELISA method together with electron microscopic analysis., Results: It was found that rituximab suppressed oligodendrocytes at the phagocytic stage but was still inefficient for the regenerative phase. TNF-α expression was markedly increased in rats subjected to SCI and suppressed after rituximab treatment. Decreased CD20 expression was another prominent finding in rats under rituximab therapy. However, expressions of IL-1β and IL-6 were both increased in glial cells without significant change after rituximab administration., Conclusion: TNF-α expression was augmented at the level of SCI both in neuronal and glial cells, particularly in oligodendrocytes. All were suppressed after rituximab administration and rituximab reduced CD20 expression both in neuronal and supportive glial cells which may be related to neural healing.