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Coronavirus disease 2019 (COVID-19) emerged in Wuhan, China, and was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Throughout the pandemic period, numerous countries around the world have implemented nationwide isolation measures to control the spread and transmission of COVID-19. During this period, the prevalence of some physical and mental diseases have increased due to prolonged home isolation measures. In the present study, we aimed to examine the effect of the COVID-19 isolation measures imposed in Turkey on patients admitted to our neurosurgery outpatient clinic.

Objective Discogenic low back pain is a widespread disorder around the world. Numerous methods have been developed and continue to be developed in the treatment of discogenic low back pain. In this study, we aimed to examine the effect of epidural steroid administration (ESI) on disc bulging and disc protrusion in patients with discogenic low back pain. Materials and Methods The prospective randomized study reviewed medical records of 71 patients with discogenic low back pain who were radiologically proven as disc bulging and disc protrusion with or without radicular pain and did not require surgery at Neurosurgery Department between June 2021 and June 2022. All the patients underwent ESI and attended regular follow-up visits for a period of 6 months. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores were assessed before the procedure, one week after the procedure, one month after the procedure, and six months after the procedure. Results There was no significant difference between patients with disc bulging and disc protrusion in terms of demographic characteristics. In both groups, both VAS and ODI scores showed a significant decrease in the post-procedure period compared to the pre-procedure period. However, there was no significant difference between the two groups with regard to the reduction rate between post-procedure 1st week VAS scores and pre-procedure VAS scores. Conclusion The results indicated that lumbar interlaminar steroid injection is an effective treatment for disc bulging and discogenic pain due to protrusion and that both groups benefited from ESI administration. Additionally, except for the first week of injection, relief due to the use of epidural steroids was observed to be greater in the Disc Protrusion group compared to the Disc Bulging group.

Background: Complex underlying mechanisms consisting of cytotoxic, excitotoxic, and inflammatory effects of intraparenchymal hemorrhage (ICH) are responsible for the highly detrimental effects on brain tissue. Oxidative stress also plays a significant role in brain damage after ICH; however, it is less important than other factors. In this study, we aimed to evaluate the oxidative stress parameters malondialdehyde (MDA) and the antioxidant reduced glutathione (GSH), superoxide dismutase (SOD) and catalase activities in operated and non-operated patients with spontaneous intracranial hematoma. Methods: One hunderd patients with spontaneous intracranial hemorrhage and 100 healthy control subjects were included in this study. Within the indication, 50 of the 100 patients underwent decompressive surgery. MDA, GSH, SOD, and catalase activities were measured in the serum obtained from the patients. Results: SOD and CAT levels were lower in the non-operated group than in the operated and control groups. GSH was not different between the operated and non-operated groups, but it was lower in the control group. However, MDA was higher in those who did not undergo surgery than in the other groups. Conclusions: In our study, MDA, an indicator of oxidative stress, was found to be lower in the blood, and CAT and SOD activities were found to be higher in ICH patients who underwent decompression than in those who did not. This is the first study to present the correlations of MDA, SOD, CAT, and GSH in operated and non-operated patients with spontaneous intracranial hematoma.

Traumatic brain injury (TBI) is an essential and common health problem worldwide. Levosimendan is an inotropic and vasodilator drug used to treat heart failure. Moreover, it exerts pleiotropic effects and, thus, protective effects on many organs. The present study aimed to investigate the effect of levosimendan on necrosis, apoptosis, and reactive oxygen species in rats with TBI.The study included 28 female Wistar-Albino rats weighing 200-250 g. The rats were divided into 4 groups with 7 rats each as follows: Group 1: No trauma group (Control), Group 2: Traumatized, untreated group (T), Group 3: Levosimendan was administered at a dose of 12 μg/kg intraperitoneally 1 hour after the trauma (L1), Group 4: Levosimendan was administered at a dose of 12 μg/kg intraperitoneally 2 hours after the concussion (L2). After the experiment, the rats were decapitated, and the brain tissue was removed. Necrosis was assessed with Cresyl violet staining, apoptosis was assessed with immunohistochemical analysis, superoxide dismutase and catalase levels were measured with the spectrophotometric method, and malondialdehyde (MDA) levels were assessed by High-Performance Liquid Chromatography.The number of necrotic cells in the L1 and L2 groups was significantly lower than in the K and T groups (P = 0.015 and P = 0.03, respectively). Although the active caspase-3 level was signified considerably in the T, L1, and L2 groups compared to the K group, no significant difference was found among these 3 groups (P0.05). The results of superoxide dismutase levels were similar to those of active caspase-3. catalase level was significantly higher in the K group than in the T and L2 groups (P = 0.045). Malondialdehyde activity was considerably higher in the L1 and L2 groups compared to the K group (P = 0.023).Our results indicated that levosimendan may exert a neuroprotective effect by reducing necrosis in TBI and that levosimendan does not affect apoptosis and antioxidant levels in TBI. Comprehensive studies are needed to elucidate the effect of levosimendan on TBI fully.

AimTo evaluate operative and prognostic parameters associated with elective versus emergency surgery in a retrospective cohort of elderly patients.MethodsA total of 533 geriatric patients (aged65 years, median age: 73.0 years, 50.7% were females) who underwent either elective surgery (n=285) or emergency surgery (n=248) were included in this study. Data on patient demographics, co-morbid disorders, type of surgery and anesthesia, American Society of Anesthesiologists (ASA) physical status (PS) classification, length of hospital stay, length of ICU stay, hospitalization outcome, prognosis (survivor, non-survivor) were obtained from medical records.ResultsEmergency surgery group was associated with higher prevalence of ASA-PS III (48.8 vs. 25.6%, p

Though medulloblastoma is considered as a childhood brain tumor, it may occur less frequently in adolescents and rarely in adults. While desmoplastic medulloblastoma histologic variant is observed in approximately 15% of childhood cases, it constitutes more than 50% of adult cases. In this article, we discuss a desmoplastic medulloblastoma case in view of the current literature.

Objective: The purpose of this retrospective study was to clarify the relationship of shunt infection to childhood hydrocephalus etiology

Background and Objective Spinal bone metastases are common. They are mostly localized to the lumbar, thoracic, and cervical spine. The most common primaries to result in spinal metastases include lung, breast, and prostate carcinomas in adults as opposed to leukemia, Ewing sarcoma, rhabdomyosarcoma, and neuroblastoma in children. In patients diagnosed with cancer, bone metastases are found in 40% and spinal metastases in 10%. In this study, we reviewed 25 patients diagnosed with a spinal metastasis of unknown primary who presented with low back pain or acute-onset neurologic deficits and underwent operative treatment. Methods The retrospective study included 25 patients with a spinal metastasis of unknown primary who presented to our clinic with acute-onset vertebral fracture or neurologic deficit. Statistical descriptions were obtained for each patient. Survival analysis was performed using the Kaplan-Meier method. Results The 25 patients included 17 men (68%) and 8 women (32%), with a mean age of 55 years (range, 14–81 years). Eleven patients (44%) presented with varying degrees of motor deficits ranging from flaccid paralysis to paraplegia. Motor deficits were completely reversed in 4 patients postoperatively. The tumors were localized to the upper thoracic spine (T1-4) in 2 patients, in the midthoracic spine (T5-8) in 2 patients, in the lower thoracic spine (T9-12) in 8 patients, in the cervical 7 in 1 patient, and in the lumbar spine in 12 patients. In 10 patients, the tumor affected multiple spinal regions. Nonosseous tumors were not present in 10 patients. Ten patients had an extradural tumor. Costal involvement was detected in 2 patients. The tumors were pathologically identified as lung cancer (n = 3), lymphoma (n = 5), breast cancer (n = 3), gastric cancer (n = 2), liver cancer (n = 2), prostate cancer (n = 2), renal cell carcinoma (n = 2), malignant melanoma (n = 1), plasmacytoma (n = 1), bladder cancer (n = 1), paraganglioma (n = 1), Ewing sarcoma (n = 1), and yolk sac carcinoma (n = 1). Posterior instrumentation was performed in patients with instability. In addition, decompression was performed in patients with neurologic deficit. Conclusions Considering that 10% of patients with cancer are diagnosed by vertebral metastasis, presence of malignancy should be suspected and a detailed examination should be performed in patients presenting with vertebral fractures caused by no or minor trauma. Moreover, in patients presenting with neurologic deficit, soft tissue metastases leading to spinal cord compression should be kept in mind and further examinations should be promptly administered.

Objective Prehospital and hospital care during incidents of mass violence and civil conflict involve a number of aspects that distinguish it from care during times of peace. We aimed to analyze the dynamics and outcomes of prehospital and hospital care during ongoing conflicts. Study design Multicentric prospective observational study. Method Patients enrolled in the study, which was conducted in Turkey, were all injured in armed conflict and taken to level 1 trauma centers. On admittance, patients were requested to complete a semistructured questionnaire containing questions on patient demographics, transport type, weapons used, injury severity score (ISS), and other incident-related factors. We analyzed patient outcomes (mortality, morbidity, complications, and length of hospital stay) and transfers of patients between hospitals. The present study evaluated the cases of 390 victims enrolled over a 9-month period and followed up for 6 months. Results The majority of patients were transported by ambulances (n = 334, 85.6%); other transport modes were helicopters (n = 32, 8.2%) and private vehicles (n = 24, 6.2%). Nearly half of patients (48.7%) did not benefit by changing hospitals. During transport to hospitals, 4.1% of the vehicles in the study were involved in accidents. Using multiple regression analysis, only ISS (odds ratio [OR]: 1.098, 95% confidence interval [CI]: 1.044–1.156) and the Glasgow Coma Scale (OR: 0.744, 95% CI: 0.639–0.866) were found to affect mortality. In Receiver-operator characteristic analysis, a cutoff value of 22.5 for ISS had a sensitivity of 100% and a specificity of 89.6% for mortality. Conclusions Despite lower ISS values, patient outcomes were worse in terror incidents/civil conflicts. Transport modes did not significantly affect outcomes, whereas hospital transport was found to be inefficiently used.

Amac: Kafa travmalari, ozellikle kentlerde ve genc nufusta en sik gorulen morbidite ve mortalite sebeplerinden biridir. Bu retrospektif calismayla, kafa travmalari ile ilgili ulkemiz epidemiyolojik veritabanina katkida bulunmayi amacladik. Materyal ve Metod: Mayis 2013-Eylul 2015 tarihleri arasinda, Van Yuzuncu Yil Universitesi Dursun Odabas Tip Merkezinde Norosirurji kliniginde tedavi ameliyat edilen 226 hasta retrospektif olarak incelendi. Bulgular: Calismaya 185 erkek 41 kadin hasta dahil oldu. Kafa travmasinin en sik nedeni dusmeler olarak tesbit edildi. En sik acil ameliyat nedeni travmatik epidural hematom idi. Mortalite orani %21,3 olarak tespit edildi. Mortalite ile akut subdural hematom arasinda anlamli iliski varligi saptandi. Sonuc: Norosirurji kliniklerinde travma disi nedenlerle yapilan acil operasyonlar azimsanamayacak bir orani olusturmakta ve calismamizda oldugu gibi yuksek mortaliteye katkida bulunmaktadir. Anahtar Kelimeler: Epidemiyoloji, kafa travmasi, mortalite