Sella Volume and Posterior Fossa Morphometric Measurements in Chiari Type 1.

AIM: To retrospectively evaluate the relationships between morphometric measurements in craniovertebral junction, and the possible genetic basis of the disease in Chiari 1 malformation patients undergoing surgical treatment. MATERIAL AND METHODS: We included patients who underwent surgical treatment for Chiari 1 malformation with unknown etiology between 2013-2018 in the Neuosurgery Clinic of Eskisehir Osmangazi University. Morphometric and volumetric measurements of the posterior fossa from cranial and cervical radiological imagings of patients with Chiari 1 malformation were performed by a single experienced observer. The results were independently reviewed by two experienced observers who supervised the process and verified the calculations. RESULTS: It was observed that basal angle was greater in the group of patients with Chiari 1 malformation (125.29° ± 9.522° Vs. 112.33° ± 9.09°), and a significant difference was observed (p=0.000). In patient group, it was also found that the basion-dens distance (3.51 mm ± 1.695mm Vs. 5.27 ± 1.695 mm) (p=0.000), and cerebellar hemispher height were shorter (58.47 ± 5.143 mm Vs. 52.05 ± 5,008 mm) (p=0.000). Tentorium angle was greater in the patient group (97.95° ± 11.321° vs. 87.79° ± 9.891°) (p=0.034). In patient group, dens height was found to be longer (13.9 ± 2.46 mm vs. 14.79 ± 1.631mm) (p=0.041). Sella volume was found to be smaller (41.4 mm3 Vs. 53.3 mm3) in the patient group compared to the control group (p=0.034), and foramen magnum plane was larger (64.6° vs. 31.1°) (p=0.000). CONCLUSION: It is concluded that many parameters including BA, FMP, BDD, CHH, TA, DH, and cellar volume are abnormal, suggesting the need for focussing to the hormonal metabolism - related synchondral changes.

Solitary Plasmacytoma of the Frontal Bone.

Extramedullary plasmacytoma and solitary plasmacytoma are localized neoplasms. Solitary plasmacytoma of bone consists about 4% of malignant plasma cell tumors. A plasmacytoma involving the frontal bone is unusual, and a limited number of cases have been reported. We present a rare case of a solitary plasmacytoma of the frontal bone manifesting as a forehead lump.

Misdiagnosed Case of Scalp Arteriovenous Malformation.

Scalp arteriovenous malformations (AVMs) are abnormal vascular lesions that can be treated safely and effectively, with surgical or endovascular approaches. Because of their complex vascularity, the detailed preoperative evaluation must be carefully performed. Here, we present a case of scalp AVM that required two operations as a result of a misdiagnosis because of inadequate preoperative assessment.

Treatment of cervical subaxial injury in the very young child.

INTRODUCTION: Infant's cervical spine has serious differences compared to other pediatric age groups and adults. Anatomical and biomechanical constitution of an infant is unique, and the pediatric spine gradually begins to resemble the structure of the adult spine after age 10. In addition, clinical presentation of the cervical spinal traumas has many distinctions from birth to the end of adolescence. In young children, cervical spine traumas are mainly localized in the upper cervical region. Trauma localized in subaxial cervical region and fracture-dislocations are rare in infants. CASE REPORT: Here, we present a case history of a 7-month-old infant with surgically treated severe subaxial flexion-distraction injury. Neurologic examination revealed complete loss of motor function below C5. A whole-body CT was taken and we observed that C5-6 dislocated anteriorly approximately one vertebra size and also unilateral facet joint was locked. The patient was intubated and closed reduction was attempted with fluoroscopy under general anesthesia, but it was unsuccessful. Whereupon C5-6 microdiscectomy was performed with the anterior approach and fixation was provided with the craniofacial miniplate. Despite anterior stabilization, exact posterior alignment could not been achieved so, posterior approach was added to the surgery. At 12 month follow-up, the patient improved from quadriparesis to paraparesis and we achieved a satisfactory radiological outcome.

COMPARISON OF DIFFERENT ENVIRONMENTAL CONDITIONS IN THE FOLLOW-UP OF SUBARACHNOID HEMORRHAGE: An Experimental Rat Study.

AIM: We questioned the effect of different environmental conditions on the brain in rats with subarachnoid haemorrhage. MATERIAL AND METHODS: Microtubules in neurons mediate both the consciousness and memory and regulate firing. Microtubule-associated proteins (MAPs) promote microtubule organisation and dynamics. We investigated MAP2, tau and amyloid beta levels in the hippocampus and the frontal cortex after experimental subarachnoid haemorrhage in rats. Subjects were divided into subgroups and were housed either in an enriched, standard or isolated environment. Tissue levels were measured on day 7 for short-term outcomes and on day 14 for long-term outcomes after SAH. RESULTS: After SAH, the results showed that decreased MAP2 levels, a trend in pathologic tau accumulation and increased amyloid beta levels in different brain regions of rats kept in an isolated environment. Frontal lobe MAP2 levels were increased in rats kept in an enriched environment for 7 days. Pathological hippocampal tau and frontal lobe amyloid beta levels were increased in rats kept in an isolated environment for 7 days. Increased MAP2 levels in the hippocampus, decreased frontal and hippocampal amyloid beta were seen in rats kept in an enriched environment for 14 days. CONCLUSION: Although it would be too early to offer recommendations, results of the present study support that an enriched environment may be more valuable in the follow-up of SAH. Further experimental studies would provide more reliable results to facilitate discussions about how to optimise the patient\'s environmental conditions.

Calvarial-orbital Metastasis of Prostate Carcinoma which was Diagnosed with Sixth Cranial Nerve Palsy.

Sixth nerve palsy is frequently due to infectious orbital lesions, trauma, elevated intracranial pressure, brainstem lesions, and vasculopathies. Here, we describe a rare cause of sixth cranial nerve (CN) palsy secondary to calvarial and orbital metastasis of prostate carcinoma. The diagnosis of the prostate carcinoma with sixth CN palsy is a very rare condition. A 66-year-old male patient presented with complaints of blurred vision, double vision, and inability to move outward in the right eye for 3 weeks. Magnetic resonance imaging revealed a right orbitocalvarial mass and the mass surgically removed completely. Pathologic findings were compatible with prostate adenocarcinoma metastasis. After surgical removal, significant improvement in sixth CN palsy was observed.

Treatment of Unstable Thoracolumbar Fractures: Does Fracture-Level Fixation Accelerate the Bone Healing?

OBJECTIVE: To investigate the effect of fusion on short segment including fractured level (SSIFL) and long segment (LS) transpedicular fixation after acute thoracolumbar junction burst fractures. The 2-year clinical and radiologic follow-up results of the 2 groups also were compared. METHODS: Seventy-four patients were randomized into one of 2 groups: SSIFL (n = 39) or LS (n = 35). The SSIFL group included one level above and one level below, including the fracture level, whereas the LS group included 2 levels above and 2 levels below, excluding the fracture level, for the transpedicular fixation. Fusion was assessed by technetium 99m-methylendiphosphonate, bone scintigraphy, and single-photon emission computed tomography. The 2-year follow-up results were compared clinically (Oswestry Disability Index and visual analog scale) and radiologically (kyphosis angle, sagittal index, anterior vertebral body height loss) at regular intervals. The clinical scores and radiologic parameters of patients with and without fusion also were compared. RESULTS: The number of patients with fusion was significantly greater in the SSIFL group compared with the LS group. There was a significant reduction of the clinical scores of patients who had fusion compared with the fusion-free group; however, there was no radiologically significant difference. Furthermore, there was no significant difference between the SSIFL and LS groups in terms of the 2-year radiologic and clinical follow-up results. CONCLUSIONS: Fusion occurred sooner and patients experienced earlier clinical recovery in the SSIFL group compared with the LS group.

Nerve Tissue Prefabrication Inside the Rat Femoral Bone: Does It Work?

AIM: To investigate whether nerve regeneration can be induced in the tubular bone between distal and proximal cut nerve ends. MATERIAL AND METHODS: Twenty adult Wistar rats were used for the study. Rats were divided into three groups; femoral bone conduit group, nerve transection group, sham group. The sciatic nerve was surgically cut and from both ends inserted into the adjacent femoral bone tunnel in the femoral bone conduit group. The sciatic nerve was cut transversely in the nerve transection group. In the Sham group, only sciatic nerve exploration was performed, without a nerve cut. The groups were evaluated functionally and morphologically. RESULTS: All results showed that axonal growth existed through the osseous canal. CONCLUSION: To the best of our knowledge, this is the first study to evaluate neural regeneration inside the bone. We can speculate that the bone marrow provides a convenient microenvironment for peripheral nerve regeneration. In addition to prefabricating peripheral nerves, this novel model may help to establish further strategies for engineering of other tissues in the bone marrow.

Comparison of the Effects and Mechanism of the Curcumin with Different Drugs in Experimental Vasospasm After Subarachnoid Hemorrhage.

AIM: Cerebral vasospasm following subarachnoid hemorrhage (SAH) is the most important complication that effects the mortality and morbidity of patients with intracranial aneurysm. Today, the mechanisms of vasospasm are not understood in spite of experimental and clinical researches. The aim of our study was to investigate the effects of curcumin on vasospasm following SAH. MATERIAL AND METHODS: In this study, 64 rats (200-250 g weight) were divided into 7 groups. Group 1: having no treatment after SAH; Group 2: treatment with nimodipine after SAH; Group 3: treatment with nicorandil after SAH; Group 4: treatment with sildenafil citrate after SAH; Group 5: treatment with 150 mg/kg curcumin after SAH; Group 6: treatment with 300 mg/kg curcumin after SAH, Group 7: treatment with 600 mg/kg curcumin after SAH. The experimental SAH was induced by injection of autologous blood into the cisterna magna. After medical treatment, in the first hour, blood was taken for quantified the levels of TNF-α, IL-1ß and IL-6. Then, cerebrum and cerebellum were removed for analysis. Basilar artery luminal diameter was measured and apoptotic cell count was performed with tissue samples. RESULTS: Histopathological findings showed that, in sufficient dose, curcumin dilated the basilar artery beside anti-oxidant effect. CONCLUSION: Curcumin can be used for the treatment of vasospasm as a new medical drug.

Neuroprotective Effect of Genistein in Peripheral Nerve Injury.

AIM: To investigate the effects of genistein in a rat model of sciatic nerve crush injury and complete sciatic nerve transection. The effects of genistein were compared with those of gabapentin, which is widely used in clinical practice for peripheral nerve injury. MATERIAL AND METHODS: Forty-eight rats were randomly divided into six groups (8 rats in each group): group 1 (sham); group 2, sciatic nerve crush injury (control); group 3, sciatic nerve crush injury+genistein 20 mg/kg; group 4, sciatic nerve crush injury+gabapentin 90 mg/kg; group 5, sciatic nerve transection+genistein 20 mg/kg; group 6, sciatic nerve transection+gabapentin 90 mg/kg. The effects of genistein and gabapentin were assessed with immunohistochemical staining for growth associated protein-43 (GAP-43) and myelin basic protein (MBP). Interleukin-1ß and tumor necrosis factor α levels in the injured nerve specimens were assessed as a measure of inflammatory response; walking track analysis and sciatic function index for neurological recovery and the paw mechanical withdrawal threshold were examined for neuropathic pain. RESULTS: On histopathological examination, genistein use was associated with a greater immunoreactivity for GAP-43 and MBP compared with that associated with gabapentin. Genistein and gabapentin had similar effects on anti-inflammatory activity, functional recovery, and neuropathic pain. CONCLUSION: Genistein and gabapentin exhibit positive effects on histopathology, inflammation, and clinical findings of peripheral nerve injury. When the systemic side effects of gabapentin are considered, genistein (a basic soy isoflavone that has no side effects) can be used as an alternative to medical treatment in peripheral nerve injury.

Implant Migration in Cervical Disk Arthroplasty.

OBJECTIVE: The purpose of this study is to discuss the causes of implant migration after cervical arthroplasty with clinical cases. METHODS: The patients who underwent cervical arthroplasty operations in our department between 2006 and 2015 because of cervical disk disease were retrospectively analyzed. The patients who were determined to be symptomatic of implant migration were evaluated. RESULTS: Symptomatic implant migration was detected in 5 of 163 (0.3%) patients who underwent cervical disk arthroplasty, and these patients also underwent reoperation. In 4 patients who underwent reoperation, the prosthesis was removed, and an anterior fusion was made. The prosthesis was only removed in 1 patient. CONCLUSIONS: The following situations should be considered in the prevention of dislocation and migration of the implant in cervical arthroplasty: protection of the structure of the end plate, selection of the appropriate implant size, and proper surgical construction. In the preoperative period, computed tomography scan may be useful for determining the implant size and details of the bone structure. Foreign body reactions or postoperative trauma may be a rare and unpreventable reason for prosthesis dislocation despite all of the preoperative and perioperative measures and well-made prosthesis designs.

Effectiveness of GFAP in Determining Neuronal Damage in Rats with Induced Head Trauma.

AIM: To determine whether the serum level of glial fibrillary acidic protein (GFAP), an important indicator of neuron damage, correlates with the extent of tissue damage in the rat with induced head trauma and to obtain data in order to avoid unnecessary cranial computed tomography analyses. MATERIAL AND METHODS: Three-month-old male Sprague-Dawley rats were used. Rats were divided into 5 groups. The experimental head trauma model was examined in five groups (n=8) as follows: The control group had no intervention; Group 1: Head trauma was induced by dropping a 25 mg ball from a height of 20 cm; Group 2: Head trauma was induced by dropping a 50 mg ball from a height of 20 cm; Group 3: Head trauma was induced by dropping a 50 mg ball from a height of 80 cm; Group 4: Head trauma was induced by dropping a 100 mg ball from a height of 80 cm. Thus, according to the Newton's Law, respectively 0.05, 0.1, 0.2 and 0.4 N trauma was created. Serum GFAP levels were analyzed and the damage to cerebral tissues was evaluated in all groups. RESULTS: We determined that number of apoptotic cells and particularly the number of GFAP (+) protoplasmic astrocytes at the perilesional region of the cortex increased in association with the increased serum GFAP level as long as the severity of the trauma increased. CONCLUSION: Serum GFAP concentration can be used as a marker of the severity of head trauma and traumatic brain injury. However, more animal studies are required to reflect this result in clinical practice.

Histopathological Evaluation of the Effects of CAPE in Experimental Spinal Cord Injury.

AIM: < /B > Spinal cord injuries negatively affect the individuals and the life quality of their families due to neurological deficits caused by trauma. The prevalence of spinal cord injury is 15-45/1 million in the world. Caffeic acid phenethyl ester (CAPE) is the most active component of propolis and has neuroprotective, anti-oxidant and anti-apoptotic effects. Our aim was to determine the effects of CAPE on the prevention of secondary injury and to compare with methylprednisolone. MATERIAL AND METHODS: Forty rats were divided into 4 groups. The control group did not undergo surgery (Group I), only trauma group (Group II), trauma+CAPE treatment group (Group III), and trauma+methylprednisolone treatment group (Group IV). Histopathological assessment was performed with two staining methods as hematoxylin-eosin (HE) and terminal deoxynucleotidyl Transferase Biotin - dUTP Nick End Labeling (TUNEL). The groups were statistically compared. RESULTS: The apoptotic cells decreased in treatment groups compared with the trauma. CAPE has more anti-apoptotic effect than methylprednisolone. The histological difference between the Group II, and Groups III and IV was statistically significant. CONCLUSION: CAPE has a positive effect on spinal cord injuries by preventing apoptosis.

True aneurysm of superficial temporal artery accompanying multiple intracranial aneurysm.

Superficial temporal artery (STA) aneurysms are very infrequent. Moreover, true aneurysms, which are not pseudoaneurysms associated with trauma or previous surgery are even rarer. With this manuscript, authors present a case of a 79-year-old woman suffering from subarachnoid hemorrhage whose radiological examinations revealed multiple intracranial aneurysms along with an STA aneurysm. This very rare case, to the best of our knowledge, the second case reported so far, might contribute to the literature and lead further investigations toward the rare association between intracranial aneurysms and STA aneurysms.

Therapeutic efficacy of tadalafil and eriythropoietin in experimental spinal cord injury.

BACKGROUND: This experimental study was an investigation of the efficacy of erythropoietin and tadalafil in rats with induced spinal cord injury (SCI). METHODS: Thirty-five Sprague Dawley rats were distributed into 5 groups. First group was used for normal biochemical values. Spinal cord injury was induced in 4 remaining groups with clip compression technique after laminectomy process to T10 vertebra. Second group was designated solvent group and received 1 cc physiological serum after injury. Third group was medicated with intraperitoneal 2000 u/kg single dose erythropoietin after injury. Orogastric 2 mg/kg single dose tadalafil was administered to fourth group after injury. Fifth group did not receive any treatment and was used for biochemical values with injury. All subjects were sacrificed 48 hours after application. Malondialdehyde (MDA) and total antioxidant capacity (TAOC) values were evaluated using blood and tissue samples. RESULTS: Lowest serum and tissue MDA values were found in group with erythropoietin intake. While highest serum TAOC values of all groups were seen in tadalafil group, highest tissue TAOC values were observed in group given erythropoietin. CONCLUSION: It was concluded that by decreasing oxidative stress, tadalafil and erythropoietin can inhibit secondary damage in SCI.

Application of lumbar drainage in vasospasm after spontaneous subarachnoid hemorrhage and prevention of late cerebral infarction.

Cerebral vasospasm, especially delayed cerebral ischemia following subarachnoid hemorrhage (SAH) is the most important complication that effects mortality and morbidity of patients with intracranial aneurysms. The presence of cerebral vasospasm has been correlated with an increase in mortality in the first 2 weeks after SAH. Despite clinical studies and research, the etiopathogenesis of cerebral vasospasm is not understood exactly and there is not yet an effective therapy. The aim of our study was to investigate the effect of application of lumber drainage on vasospasm and delayed cerebral infarction following SAH and to examine the incidence of complications. Patient groups were determined by retrospective screening of 70 patients who underwent a surgical operation at the Osmangazi University Medical Faculty Department of Neurosurgery between 2009 and 2013 after a diagnosis of ruptured aneurysmal SAH. After the application of lumbar drainage, the complications and mortality after aneurysm surgery was significantly decreased and correlated with the amount of hemorrhagic cerebrospinal fluid drainage.

Early decompressive surgery after combined intra-venous thrombolysis and endovascular stroke treatment.

BACKGROUND AND PURPOSE: The prognosis of malignant middle cerebral artery infarctions (MCA) is poor. The poor prognosis is attributable to the severe cerebral edema that causes a brain herniation and death. Decompressive surgery reduces mortality and may further improve patient outcomes. However, the safety and effectiveness of decompressive surgery in patients who underwent combined intravenous (IV) thrombolysis and endovascular stroke treatment are not certain. Moreover, the evidence on the timing of decompressive surgery is lacking. METHODS: The purpose of the open, prospective and non-randomized study was to compare the outcome and complication rates of patients with malignant MCA strokes who underwent early decompressive surgery after combined intravenous thrombolysis and endovascular treatment with those of decompressive surgery patients without prior recanalization treatment strategy. All patients underwent decompressive surgery within 24h of symptom onset. RESULTS: Thirty patients were included in the study. Twelve of the 30 patients were treated with combined IV thrombolysis and endovascular approach and 18 patients received standard treatment. The proportion of patients with a modified Rankin score ≤3 at the sixth month follow-up was 33% in the standard group and 44% in the combined treatment group (p=0.712). Mortality, and major and minor complications including symptomatic intracerebral hemorrhage after decompressive surgery did not differ between the two groups (p>0.05). CONCLUSION: Early decompressive surgery can be safely performed in patients who received combined IV thrombolysis and endovascular treatment and there was no difference in outcome of these patients compared with patients who did receive the standard medical treatment before early decompressive surgery.

Collapsed L4 vertebral body caused by brucellosis.

Brucellosis is caused by gram-negative, aerobic, non-motile, facultative, intracellular coccobacilli belonging to the genus Brucella. A 50-year-old man working as an employee was admitted to neurosurgery clinic with severe low back, radicular right leg pain and hypoesthesia in right L4-5 dermatomes for 2 months. Brucella tube agglutination (Wright) test was positive in serum sample of the patient with a titer of 1/640. Brucella melitensis was isolated from blood culture. X-ray and MRI of the lomber spine showed massive collapse of L4 vertebral body. Neural tissue was decompressed and then posterior L3-5 short segment transpedicular screw fixation and stabilization was performed. Brucella melitensis was isolated from microbiologic culture of pathologic specimen. Antibiotic therapy was given as doxycycline 200 mg/day and rifampicin 600 mg/day for 6 months. Brucellosis is a systemic zoonotic infection and still an important public health problem in many geographical parts of the world. Vertebral body collapse caused by brucellosis occurs very rarely but represents a neurosurgical emergency because of its potential for causing rapidly progressive spinal cord compression and permanent paralysis. Neurosurgeons, emergency department personnel as well as infectious disease specialists should always keep a high index of suspicion and include brucellosis in the differential diagnosis of vertebral body collapse.

Headache and its effects on health-related quality of life among adults.

AIM: This study was conducted with aim of determining prevalence of headache and evaluating its effects on health-related quality of life (HRQoL) in Beylikova town of Eskisehir city in the west of Turkey. MATERIAL AND METHODS: This study was conducted on adults aged 20 years and over aged between May 11 and June 04 2009 in Beylikova town of Eskisehir city in the west of Turkey. A total of 587 people were selected by simple randomized method. The International Headache Society criteria were used for the determination of severity of headache. The 36-item short-form (SF-36) was used for the assessment of healthrelated quality of life. RESULTS: The number of men and women was 302 (51.4%), and 285 (48.6%), respectively. The mean age was 46.70 ± 15.26 years (range, 20-87 years). Headache prevalence was found to be 78.2% (n=459). Decreased headache prevalence was found in the ages older than 30-44 age group (p < 0.05). All domains of SF-36, the mean scores were higher in individuals without headache than those with headache (for each, p < 0.05). Migraine prevalence was found to be 7.2% (n=33). CONCLUSION: In accordance with the literature, this study found the presence of headache in adults at high frequency (78.2%). Particularly the presence of migraine and increased severity of headache were found to decrease the quality of life.