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Traumatic intracranial aneurysm (TICA) is a rare vascular lesion with various etiologies and a high mortality rate when diagnosed late. In this study, we present our cases of TICA, which we treated with flow-diverter stents due to different etiological factors.Clinical data were recorded for 8 patients: age, gender, etiological factors, aneurysm location, aneurysm type, rupture, main artery status, and postoperative complications.75% (n:6) of the patients were male and 25% (n:2) female. Etiologically, there was intracranial tumor surgery in 3 cases (37.5%), fall from height in 2 (25%), road accident in 2 (25%), and blunt trauma in 1 (12.5%). Reconstruction used a flow-diverting stent in all cases. One patient experienced intraoperative iatrogenic rupture of the distal arterioles due to a microwire. Mean angiographic follow-up was 17.8 months (range, 6-32 months). During follow-up, none of the patients required renewed endovascular treatment.Traumatic aneurysm is a vascular lesion with high mortality when diagnosed late. In case of suspected vascular injury after trauma or intracranial surgery, further evaluation should be performed without delay. TICA can be safely treated with flow-diverter stents, conserving the main artery.

This study aimed to present our series of intracranial infections and to determine the possible locations and risk factors for surgical treatment.Over 13 years, 103 patients with intracranial infection underwent surgical evacuation. Seventy-one (68.9%) patients were men, and the mean age was 38.57 years. For intracranial infections, direct and indirect microbiological identification methods were used. The clinical and radiological data of patients were retrospectively analyzed and compared statistically based on the type of infection, location, history of previous surgery, comorbid diseases, and demographic features of the patients.Forty-six (44.7%) patients had intraparenchymal abscess, 25 (24.3%) had subdural empyema, and 32 (31.0%) had epidural empyema. Emergent surgical evacuation was performed in 60 (58.25%) patients. Microbiological agents were not isolated in 26 (25%) patients, while multiple microorganisms were isolated in 17 (16.5%) patients. Intraparenchymal abscesses are more common in the frontal lobe and cerebellum, while subdural empyemas are located more frequently in the frontoparietal region. There was no significant difference between intracranial infection and age, gender, history of surgery, and preoperative antibiotic use. However, a statistically significant relationship between intracranial infection, history of previous surgery, and the patient's comorbid disease was found. Specifically, intraparenchymal abscesses were more frequently detected in immunocompromised patients, and subdural empyemas were common in patients with previous tumor surgery.Brain abscesses commonly develop in the frontal lobe and cerebellum. Patients who underwent previous cranial surgery and patients with comorbid diseases are more prone to intracranial infections. Large abscesses with significant edema are best candidates for emergent surgical evacuation.

Background The pedicled nasoseptal flap (NSF) constitutes the primary reconstructive option for most skull base defects in endonasal endoscopic approaches. The superior nasal turbinate (ST) has received little attention. We report our preliminary experience with the use of the ST mucosal flap in selected cases. Methods We performed a retrospective review of patients who underwent endonasal endoscopic approaches and identified 9 patients who were reconstructed with vascularized ST mucosal flaps as part of a double-layer or triple-layer reconstruction. When there was no intraoperative cerebrospinal fluid (CSF) leak, we used a double-layer technique. If there was an intraoperative CSF leak, regardless of the quality of leakage, we preferred a triple-layer repair technique. In patients with high-flow leaks, triple-layer repair was performed using only autologous tissue grafts and flaps. Results Intraoperative CSF leaks were noted in 7 of 9 patients. Among them, 4 patients had low-flow CSF leaks (grade 1 and 2) and 3 patients had high-flow CSF leaks (grade 3). All reconstructions had complete defect coverage with the ST flaps and NSFs were preserved. All the flaps were viable at 4 weeks without a CSF leak or complication at the reconstruction site. There was no contraction or partial loss of the flap. After a mean follow-up period of 9 months, none of the patients required a flap revision, developed a mucocele, infection, or other complication. Conclusions An ST flap can be used for the vascularized reconstruction of sellar defects if it is bilaterally available. This option should not be overlooked and wasted.

Background The requirement of brain retraction and difficulty in distinguishing the tumor demarcation are challenging in conventional approaches to intra- and paraventricular malignant tumors (IV-PVMTs). Tubular retractors can minimize the retraction injury, and fluorescein-guided (FG) surgery may promote the resection of tumors. Our aim is to evaluate the feasibility, safety, and effectiveness of fluorescein-guided endoscopic transtubular surgery for the resection of IV-PVMTs. Methods Twenty patients with IV-PVMTs underwent FG endoscopic transtubular tumor resection. Fluorescein sodium was administered before the dural opening. The intraoperative fluorescence staining was classified as “helpful” and “unhelpful” based on surgical observation. Extent of resection was assessed using postoperative magnetic resonance imaging. Karnofsky Performance Status (KPS) score was used to evaluate the general physical condition of patients. Results There were 9 glioblastomas, 4 anaplastic astrocytomas and 7 metastatic tumors. “Helpful” fluorescence staining was observed in 16(80%) of 20 patients. Gross total resection was achieved in 16(80%) cases, near-total in 3(15%) cases, and subtotal in 1 (5%) case. No intra- or postoperative complications related to the fluorescein sodium occurred. The median preoperative KPS score was 83, and the median KPS score 3-month after surgery was 88. Conclusion FG endoscopic transtubular surgery is a feasible technique for the resection of IV-PVMTs. It may be a safe and effective option for patients with these tumors. Future prospective randomized studies with larger samples are needed to confirm these preliminary data.

BACKGROUND AND AIM: Creating potential clinical markers for risk assessment in patients with COVID-19 continues to be an area of interest. In this study, we aimed to evaluate whether serum albumin level and thrombocyte/lymphocyte ratio are related to the severity of the disease. MATERIALS AND METHODS: The patients were divided into two groups according to the severity of disease. Demographic data, serum albumin value, lymphocyte count, TLO-1 values (thrombocyte/lymphocyte ratio-1), the highest thrombocyte count during hospitalization, TLO-2 (thrombocyte/lymphocyte ratio-2) values formed by the highest thrombocyte count, was recorded. RESULTS: There was no statistically significant differences (p> 0.05) in terms of gender, thrombocyte count at the time of admission, and highest thrombocyte count during hospital follow-up. There were statistically significant differences in terms of age, comorbidity, lymphocyte value at the time of hospitalization, lymphocyte count during hospital follow-up, TLO I, TLO II, and serum albumin values between the groups. In the ICU group were found to be older, had higher rates of comorbidity, lower lymphocyte values, higher TLO I- II, and lower serum albumin levels (P

Hydrocephalus is a rare complication of brain involving acute lymphoblastic leukemia (ALL). The standard treatment is ventriculoperitoneal (VP) shunting, while ventriculoatrial (VA) shunting is the second option in a case of VP shunt failure in young children. But the presence of port catheter at the right atrium restricts and makes a VA shunt difficult to place in the same atrium. We presented a 4-year-old boy who had the diagnoses of ALL and underwent chemotherapy through a port-a-cath. He also had hydrocephalus due to the brain invasion of the ALL. He firstly underwent VP shunting for the treatment of hydrocephalus, but it failed due to an intraabdominal cyst. Then, he underwent VA shunting through the left internal jugular vein. This is the first case in the literature showing both catheters in the right atrium.

Background Deep-seated intracranial lesions are challenging to resect completely and safely. Fluorescence-guided surgery (FGS) promotes the resection of malignant brain tumors (MBTs). Classically, FGS is performed using microscope equipped with a special filter. Fluorescence-guided neuroendoscopic resection of deep-seated brain tumors has not been reported yet. Objective To evaluate the feasibility, safety, and effectiveness of the fluorescence-guided neuroendoscopic surgery in deep-seated MBTs. Methods A total of 18 patients with high-grade glioma (HGG) and metastatic tumor (MT) underwent fluorescein sodium (FS)-guided neuroendoscopic surgery. Tumor removal was carried out using bimanual microsurgical techniques under endoscopic view. The degree of fluorescence staining was classified as "helpful" and "unhelpful" based on surgical observation. Extent of resection was determined using magnetic resonance imaging (MRI). Karnofsky Performance Status (KPS) score was used for evaluation of general physical performances of patients. Results A total of 11 patients had HGG, and 7 had MT. No technical difficulty was encountered regarding the use of endoscopic technique. "Helpful" fluorescence staining was observed in 16 patients and fluorescent tissue was completely removed. Postoperative MRI confirmed gross total resection (88.9%). In 2 patients, FS enhancement was not helpful enough for tumor demarcation and postoperative MRI revealed near total resection (11.1%). No complication, adverse events, or side effects were encountered regarding the use of FS. KPS score of patients was improved at 3-mo follow-up. Conclusion FS-guided endoscopic resection is a feasible technique for deep-seated MBTs. It is safe, effective, and allows for a high rate of resection. Future prospective randomized studies are needed to confirm these preliminary data.

Introduction: Intraoperative electrophysiological studies are increasingly used in spinal surgery. However, its use in myelomeningocele (MMC) surgery is still not widespread. The aim of this study was to present our experience in neural placode (NP) and nerve root stimulations in newborns with open MMC. Methods: Eight newborns underwent surgical treatment for thoracolumbar and lumbosacral MMCs. Intraoperative neuromonitoring including free-running electromyography and stimulation of NP, nerve roots, and spinal cord were performed in all cases. Stimulation sites and intensities and distal response’s amplitudes and latencies were recorded. Results: Five patients had thoracolumbar and 3 patients had lumbosacral MMC. Two patients had no movements at the lower extremities while the other had some movements. No response on the lower extremities was obtained in only 1 patient. Responses from the nerve root stimulations were more robust and significant than the placode stimulations. Conclusions: It is clear that the NP and nerve roots originating from the placode are mostly functional and should be preserved during the surgery. Intraoperative neuromonitoring and direct stimulation should be performed during the MMC repair in order to obtain a better neurological outcome.

Lhermitte-Duclos disease (LDD) is a rare, slow-growing, benign lesion of the cerebellum. It is often seen in the second and fourth decades. This disease is extremely rare in childhood. A 6-year-old girl presented with loss of balance. A mass lesion in the right cerebellum was detected by magnetic resonance imaging. The patient underwent surgical removal of the lesion, and the histological diagnosis was dysplastic gangliocytoma (LDD). The patient was discharged without complication, and her balance improved in the follow-up period. In this report, we present this rare occurrence in childhood and discuss the clinical course and management. LDD is very rare in early childhood and should be considered in the differential diagnosis of posterior fossa lesions.

Aim One challenge of malignant intracranial tumor (ICT) management is chemoresistance. Glutathione S-transferase (GST) and cytochrome p450 (CYP) are featured medicine degradation agents. MDR1, an outflow carrier, reduces drug accumulation into the multidrug-resistant cells. Our study aims to analyze the GSTP, GSTM, CYP1A1, CYP1B1, and MDR1 expressions in malignant ICTs and to elicit their role on patient survival. Material and methods GSTP, GSTM, CYP1A1, CYP1B1, and MDR1 expressions were analyzed using immunostaining in 149 samples from 141 patients with preoperative ICT diagnosis. The case characteristics were reviewed, and the enzyme expressions were equated based on the age, gender, and tumor type. Then, 77 of 141 patients with malignant ICT and complete medical records postoperative were also investigated in detail for the relationship between the diagnosis, enzyme expression, and overall survival. Results The average age was 49.44 years, with 83 (58.45%) male patients. Among the 77 malignant ICTs, 38 (49.3%) and 29 were glial tumors and metastases, respectively, with a 13.35-month overall survival. Patients with metastatic tumor have approximately threefold higher GSTP level than those with glial tumors. MDR1 expression was approximately twofold higher in 60-year-old patients. No statistically significant association was found between patients' smoking behaviors, alcohol consumption, and overall survival. Only MDR1 expression was correlated with overall survival. Better overall survival was observed in patients with a negative MDR1 expression than those with a positive one. Conclusion MDR1 is an important indicator of survival in malignant intracranial tumor patients. Longer survival is associated with negative MDR1 expression.

Aim In recent years, extended endoscopic endonasal approach (EEEA) has been used as an alternative to transcranial approaches in the treatment of anterior midline skull base lesions. We retrospectively reviewed our cases operated using this technique and compared the results with current literature. Method The data of 24 patients who were operated using EEEA in our department between 2010–2018 were retrospectively analyzed. The lesions were located in the midline between the posterior wall of the frontal sinus and tuberculum sella. Tumor locations, histopathological diagnoses, surgical techniques, outcomes and complications were documented. Results Eleven patients were female and 13 were male. Their ages ranged between 18–75 years (mean 40.5 years). Considering their locations; 12 were in the anterior fossa (50 %), 7 were in the tuberculum sella (29.1 %), and 5 were in both anatomic sites (20.8 %). Histopathologically, our series consisted of 15 meningiomas, 6 osteomas, 2 dermoid tumors and 1 metastatic carcinoma. We achieved gross total resection in 75 % of our patients. Ten patients presented with visual complaints and 7 of them improved postoperatively. Postoperative cerebrospinal fluid leakage (CSF) was observed in 3 patients and one of them developed meningitis and subsequently died of sepsis. Conclusion Although the number of cases is low, EEEA seems like a safe, effective and well-tolerated treatment modality for anterior midline skull base lesions. But strict preventive measures should be taken for a possible CSF leak.

OBJECTIVEIntracranial infections are serious and life-threatening health problems. They may present as subdural empyemas or intracerebral abscesses. Surgical drainage and subsequent antibiotic treatment is the main technique for a satisfactory clinical outcome. The aims of this study were to present a 10-year intracranial infection series and discuss the surgical characteristics in the light of literature.METHODSFifty-two patients with intracranial infection underwent surgical treatment between 2008 and 2018. Eleven patients were female and 41 patients were male. The mean age was 40.46 years (range 10–75 years). Eighteen patients had intracerebral abscesses, and 34 had subdural empyemas. All patients underwent surgical treatment as well as an antibiotic regimen.RESULTSNo etiological agent was isolated in 29 (56%) cases. Bacterial agents were detected in 20 cases, while fungi were observed in 3 cases. Staphylococci species were the most common agents and were isolated in 8 (15%) cases. Endoscopic aspiration was performed in 3 cases, while surgical drainage and capsule resection via craniotomy was performed in 49 cases. An associated intracranial tumor was diagnosed in 2 patients with brain abscesses. Four (8%) patients died despite surgical and medical treatments.CONCLUSIONSSurgical treatment via craniotomy is an older method, but it is still the best to treat the intracranial infections not only for decompression of the brain but also to attain an accurate diagnosis. The abscess wall should always be histologically examined after surgery to rule out any intracranial tumor.

BACKGROUND The procedure of reconstruction after the removal of cranial fibrous dysplasia (FD) must be precise to achieve good functional and aesthetic results. Intraoperative modeling of implants is difficult and may cause cosmetic disturbances. OBJECTIVE To present our experience with the treatment of cranial FD using preoperative computer-based surgical planning of tumor removal with reconstruction of the cranium with custom-made titanium implants. METHODS Four patients underwent surgical treatment for cranial FD over a 2-year period. All patients were male with a mean age of 25.25 years and had monostotic-type FD. Computed tomography (CT) with 0.5-mm slices was obtained preoperatively. Computer-based planning of the tumor removal was performed, and a template was created by the computer to determine the margins of tumor removal. After this procedure, the preoperative computer-based construction of the titanium implant was performed. The patients underwent surgical treatment, and the tumor was removed with the use of this template. Then, the titanium implant was inserted onto the bone defect and fixed with mini-screws. Patients were followed up by periodic CT scans. RESULTS The histological diagnosis of all patients was FD. No intraoperative or postoperative complications have occurred. Postoperative CT scans showed complete tumor removal and confirmed appropriate cosmetic reconstruction. The mean follow-up period was 15.25 months. CONCLUSION Computer-based surgical planning associated with the production of custom-made titanium implants is a highly promising method for the treatment of cranial FD. Better radiological and cosmetic outcomes could be obtained by this technique with interdisciplinary work with medical designers.

Intracranial aspergillosis is a rare infectious disease of the central nervous system with high mortality rates. Our aim is to present 3 cases of intracranial aspergillosis who were surgically treated with intracavitary amphotericin B administration. First case was a 21-year-old male patient. Allogeneic stem cell transplantation treatment was performed because of aplastic anemia and vocal cord paralysis developed 10 days after treatment. Multiple aspergillosis abscesses were observed in the cranial magnetic resonance imaging (MRI). Cerebral lesions were excised and 0.3 cc of amphotericin B was applied locally. Second case was a 18-year-old male patient treated for acute lymphocytic leukemia. MRI was performed on the development of consciousness change during treatment and right frontal abscess was detected. The abscess was excised and amphotericin B was applied locally. Third case was a 45-year-old woman with mastectomy. She had chemotherapy after surgery and had blood stem cell transplantation because of pancytopenia. Two months after treatments, MRI was performed on the development of ataxia and a cerebellar abscess was detected. The abscess was surgically excised and local amphotericin B was applied. The first case deceased 2 weeks after surgery and the second case died 2.5 years later due to multi-organ failure. The third case is stil alive and neurologically stable after 14 years of surgical treatment. In intracranial aspergillosis, intracavitary amphotericin B therapy may be used as an adjunct after the surgical excision of abscess. This procedure may contributes to the regression of abscess or prevention of the recurrence. But comparative clinical studies are needed for more accurate conclusions.

Aim To investigate whether sleep quality and sleepiness of patients who undergo surgery for pituitary adenomas differ from healthy individuals. Material and methods Forty-four patients who were operated for pituitary adenomas and 44 healthy individuals, 88 subjects in total, were evaluated by a questionnaire. All questionnaires and scales were applied by the same researcher without the name of the participant in order to maintain consistency. Statistical analyses were conducted with the SPSS for Windows 23.00 package program. Results Of the 88 participants, 44 (50%) were patients who were operated for pituitary adenomas, while 44 (50%) were control subjects. 38 (43.2%) of the participants were male, 50 (56.8%) were female. The average age of the participants was 37 ± 12.24 years. The best sleep quality was found in 41-50 years group (7 patients). In the control group, 23 patients (52.3%) had a sleep quality index above 5 and 21 patients (47.7%) had a value below 5. In the control group, 8 patients (21.2%) between 21-30 years were found to have poor sleep quality by age. Conclusion Sleepiness and sleep quality have physiological, social and psychological effects on individuals. There is no statistically significant difference in sleep quality and sleepiness scales between patients operated for pituitary adenomas and healthy individuals. However, it is recommended that polysomnography should be used to examine these patients in more detail.

AIM Perception, definition and tolerance of pain vary individually because of its subjective character. This study aimed to determine the perception differences between patients with mechanical low back pain (MLBP) and their physicians regarding the assessments of the patients' pain severity. MATERIAL AND METHODS 181 patients with MLBP and 2 physicians took part in the study. Before the initial examination, the patients filled out a questionnaire consisting of demographic data, pain characteristics, Modified Oswestry Disability Questionnaire (MODQ) and Visual Analog Scale (VAS). The patients' forms were concealed from the physicians. Then physicians examined their patients and rated their pain severity using a different VAS form. RESULTS The mean age of the patients was 36.2 ± 12.3 years. 64.6% (n:117) were female, 71.9% (n:13) were highly educated and 57.1% (n:103) were obese. Physicians always rated the patients' pain severity significantly lower than the patients rated their own pain regardless of all demographic data (p < 0.001). Correlation between the VAS scores of patients and physicians were detected as 0.41 (p < 0.001) and the power of the study was calculated as 91.5%. The mean MODQ score of the patients was calculated as 54.4 ± 21.1. Reliability of the questions in MODQ was calculated as alpha:0.87. A moderate correlation between VAS ratings and MODQ was observed (r:0.52, p < 0.001). CONCLUSION As a main factor directly affecting many outcomes, good communication between patient and physician, is essential to assess the patients' pain more accurately.