Split cord malformation concomitant with spinal teratoma without open spinal dysraphism.

PURPOSE: Split cord malformation (SCM) presenting concomitant with spinal teratoma without any open spinal dysraphism has rarely been reported in the literature. We aimed to make a systematic review and qualitative analysis of the literature about the topic and present the first case of SCM concomitant with spinal teratoma harboring papillary thyroid carcinoma (PTC) component. METHODS: Two big search tools (Pubmed/MEDLINE) and Scopus were used. The search strategy was compatible to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). An exemplary case of ours was also presented. RESULTS: There were 30 patients (15 pediatric and 15 adult). Female and male distribution was even. Median age of the patients was 18 years (range = 0-66 years). The most common presenting symptoms were back pain and lower limb weakness. Spinal teratoma and SCM mostly presented at thoracic/thoracolumbar region in children and lumbar region in adults. Surgical outcome was better in the children compared to the adults. CONCLUSION: Thoracolumbar region is the most common location for such entity in children, whereas lumbar region for the adults. Surgical resection should be done as much as possible under neuromonitorization. The resected material should be evaluated thoroughly not to miss any malign pathology. Surgical outcome is better when it is done at an early age.

Can Intracranial Vertebral Artery Hypoplasia be an Etiopathogenetic Factor for Barré-Licou Syndrome Other than Arcuate Foramen? A Retrospective Clinical Study and Review of Literature.

AIM: To investigate the co-occurrence of the arcuate foramen (AF) variation of atlas and intracranial vertebral artery (V4) hypoplasia and, therefore, to understand the pathophysiology of Barré-Licou syndrome (BLS). The AF localizes on the vertebral artery (VA) sulcus posterior to the atlas and has incomplete and complete types. Complete-type AF can exert pressure on the VA that passes through it, resulting in vertebrobasilar insufficiency finding, a BLS component. By the surgical decompression of VA at the AF level, complaints could be decreased in some cases. However, a reliable theory regarding BLS has not yet been established; therefore, the cases that do not respond to AF decompression have not been fully elucidated. We assumed that V4 hypoplasia that accompanies AF might be the main factor in the pathophysiology of BLS. MATERIAL AND METHODS: Cervical computed tomography and magnetic resonance angiography images of 139 patients aged 14?88 years with head and neck pain and dizziness were retrospectively evaluated. RESULTS: Of the patients, 19.4% exhibited complete AF and 32.4% exhibited VA hypoplasia (VAH); 10% of the patients with VAH had accompanying contralateral complete AF variation. There was no significant relationship between complete AF and contralateral and ipsilateral VAHs (right side: p=0.527 and p=0.433, respectively; left side: p=1.000 and p=0.740, respectively). CONCLUSION: Our findings indicate that V4 hypoplasia is not the main factor of BLS pathophysiology. Furthermore, the rarity of the relationship suggests why some cases do not respond to decompressive surgery.

Retrospective analysis of 195 surgically treated cases of chronic subdural hematoma.

INTRODUCTION: The incidence of chronic subdural hematoma (CSDH) is increasing. This study evaluates the etiologic causes and findings of CSDH and compared unilateral CSDH with bilateral CSDH. This study aims to draw attention to this increasingly prevalent condition. METHODS: We retrospectively analysed 195 surgically treated cases of CSDH in our clinic between 2008 and 2018. RESULTS: The average age of the patients was 65.7 ± 19.6 years. The most common symptom was headache (53.3%). The case background was the use of anticoagulant (37.9%), head trauma (34.3%). The hematomas were 28.7% right side, 44.6% left side, and 26.7% bilateral. The mean Glasgow Coma Score (GCS) was 13.4 ± 2.9, early postop 13.8 ± 2.5, and late postop was 14.6 ± 1.1. Postoperative complications included acute subdural hematoma (5.1%), cerebral infarction (1.5%), wound infection (0.5%) and others (13.3%). Re-expansion of the brain were statistically significantly less frequent and impaired consciousness, anticoagulant use, early and late postop thickness were statistically significantly more frequent in patients with bilateral CSDH. CONCLUSIONS: CSDH is seen more patients of advanced age, those who use anticoagulants, patients with hypertension and diabetes and in patients with a history of head trauma. Prognosis is worse in bilateral CSDH. We estimate that the incidence of CSDH will go up in the future.

Challenges in Using the Posterior Inferior Cerebellar Artery for Revascularization of the Anterior Inferior Cerebellar Artery: A Microsurgical Anatomic Study.

BACKGROUND: A bypass is usually required to prevent ischemia during the treatment of anterior inferior cerebellar artery (AICA) aneurysms. The intracranial (IC)-to-IC bypass provides several advantages over the extracranial-to-IC bypass in the posterior fossa. However, there are only 2 case reports about AICA revascularization with the posterior inferior cerebellar artery (PICA). We aimed to investigate the microsurgical anatomical challenges for PICA to AICA anastomosis. METHODS: Ten cadaveric heads injected with colored silicone were inspected on both sides using a lateral transcondylar approach. After the donor and recipient arteries were examined from the posterior side, neurovascular contents of the posterior fossa were excised and the origin, course, and variations of both arteries were investigated from the anterior view. The diameters of the AICA and PICA segments and the intersegment distance were measured. RESULTS: PICA variations and posteromedial origins from the vertebral artery were identified in 8 of the 20 right and 6 of the 20 left sides, and the first segment of the PICA was not present in 7 sides. Furthermore, in 18 sides, the PICA was trapped between the lower cranial nerves and dentate ligaments. Therefore the donor artery could not be brought closer than 1 cm to the recipient artery in 19 sides. Moreover, AICA variations were identified in 6 sides, and in 12 sides, the diameter of the recipient artery was <1 mm. CONCLUSIONS: The mostly PICA-related issues made PICA-to-AICA anastomosis unfeasible in all cadaveric heads included in the study.

Prevalence of Anomalously Originating Occipital Artery in a Group of Turkish Individuals: A Retrospective Study using Angiography.

AIM: To investigated the prevalence of anomalously originating occipital artery (OA) using angiography in a group of Turkish individuals. MATERIAL AND METHODS: The images recorded in the picture archiving and communication system for a total of 114 patients, in which the whole vertebral artery, as well as the external carotid artery (ECA) and its branches, were visualized, were retrospectively reviewed. Images were obtained using a Toshiba INFNX-i 8000V (Canon Medical Systems, Otawara, Tochigi, Japan) angiography device. RESULTS: We diagnosed 11 cases (12 arteries) with anomalously originating OA, representing a prevalence of 9.64%. In 7 cases, the ascending pharyngeal artery and OA originated with a common root from the ECA (8 arteries); and in 4 patients, OA originated from the distal part of the ECA (C1 vertebral level). CONCLUSION: As for many vascular structures, the prevalence of OA variations may vary according to the population under question and the examination method used. Our study has shown that in a sample from the Turkish population, the prevalence of anomalously originating OA was much higher than that stated in the literature, which used magnetic resonance angiography. To avoid complications, the high prevalence of this anomaly must be taken into account during surgeries that require the use of OA, endarterectomies, and endovascular interventions.

Familial Chiari Type 1: A Molecular Karyotyping Study in a Turkish Family and Review of the Literature.

BACKGROUND: The etiology of Chiari I malformation (CMI) has not been fully elucidated. Therefore, we performed a genetic study of a Turkish family in which 3 sisters had a diagnosis of CMI with or without syringomyelia. METHODS: In a family with 7 children, 4 daughters complained of occipital headaches. In 2 of these daughters, CMI had been diagnosed during their 30s, and CMI plus syrinx had been diagnosed in the other daughter in her 40s. Cranial magnetic resonance imaging of the fourth daughter who had developed headaches during her 30s showed normal findings. Because the other siblings in the family were asymptomatic, radiological examinations were not performed. The family had a history of distant consanguineous marriage between parents. Additionally, the father had died, and the mother was asymptomatic, with radiologically normal findings. Array comparative genome hybridization studies were performed for 12 persons from 3 generations of this family. RESULTS: None of the 12 cases examined harbored copy number variations. CONCLUSIONS: This family with 3 sisters having CMI suggested a possible autosomal recessive single-gene etiology. Cases of familial CMI are unusual but important to study because they could reveal the specific genes involved in posterior fossa/foramen magnum structure and function and provide insights into the cause of sporadic cases.

Locally Used Antibiotics for Spinal Infection Prophylaxis and Their Effects on Epidural Fibrosis: an Experimental Laminectomy Study in Rats Using Rifamycin and Gentamycin.

The study aims to assess the effects of antibiotics (ABs), which are typically used in spinal infection prophylaxis, on the formation of epidural fibrosis (EF). Specifically, we investigated the effect of rifamycin and gentamycin on EF formation in laminectomized rats. Thirty-two rats were randomly and equally divided into four groups as follows: laminectomy and physiological saline (0.9% NaCl) solution (control); laminectomy and rifamycin; laminectomy and gentamicin; and laminectomy and a mixture of rifamycin and gentamicin. Laminectomy was performed on L1 and L2 vertebrae in all rats. One month after spinal surgery, spinal tissue samples surrounding the laminectomy were cut with a microtome and stained with hematoxylin-eosin and Masson's trichrome. The histopathological analysis included examining the extent of EF, fibroblast cell density, and cartilage and bone regeneration. Statistical analysis was performed using the IBM SPSS Statistics 22 program (SPSS IBM, Turkey). A value of p < 0.05 was considered statistically significant. EF value differences between the AB treatment groups and the control group were statistically significant (p = 0.030). Specifically, binary comparisons indicated that the EF value was significantly higher in the rifamycin group than that in the control group (p = 0.003; p < 0.05). Our study suggests that locally applied ABs, especially rifamycin, should be diluted before administration to the epidural space.

Irreversible Footdrop as a Consequence of Neglected Knee Pain in an Adolescent with a Peroneal Intraneural Ganglion Cyst.

BACKGROUND: Peroneal intraneural ganglion cysts (IGCs) are nonneoplastic lesions. They are responsible for a small number of footdrop cases, which occur after additional nerve damage. The earliest patient symptom related to IGCs is knee pain. CASE DESCRIPTION: A 17-year-old boy developed pain in the left knee, which progressively worsened over 14 months. He did not seek any medical assistance during this time. The patient subsequently was involved in a bicycle accident, and 3 months later he was unable to raise his left foot and was referred to our clinic for footdrop. Surgery was performed, but the weakness persisted. We could not detect any functional reinnervation on electromyography 12 months after surgery. CONCLUSIONS: The most important factors in determining the prognosis of IGCs are the extent of the nerve trauma and the early diagnosis and treatment of the IGC. Detection of almost complete functional denervation on electromyography may indicate that it is too late for surgery.

Is the Thoracolumbar Injury Classification and Severity Score (TLICS) Superior to the AO Thoracolumbar Injury Classification System for Guiding the Surgical Management of Unstable Thoracolumbar Burst Fractures without Neurological Deficit?

AIM: To determine whether the Thoracolumbar Injury Classification and Severity Score (TLICS) and the Arbeitsgemeinschaft für Osteosynthesefragen (AO) Spine Thoracolumbar Injury Classification System have any superiority to each other regarding the reliability of their recommendations in the surgical management of unstable thoracolumbar burst fractures. MATERIAL AND METHODS: Fifty-five consecutive patients with thoracolumbar burst fractures undergoing instrumentation between 2010 and 2015 were analyzed retrospectively. TLICS and AO systems were compared based on patients" American Spinal Injury Association (ASIA) scores and they were analyzed for their safety and reliability. RESULTS: A total of 55 patients were studied. Neurological deficits were detected in 18 patients and the remaining 37 patients had normal neurological functions. All the patients with neurological deficits received > 4 points according to TLICS. There were 14 patients with incomplete spinal cord injury and all of them received > 4 points according to TLICS (p < 0.01). On the other hand; 8 of these 14 patients received 4 points according to the AO system. None of the 37 patients without neurological deficit received < 4 points of TLICS whereas 18 of these 37 patients received 3 AO points, to whom AO recommends conservative treatment despite the fact that they had unstable burst fractures (p < 0.01). CONCLUSION: Recommendations of TLICS might be more reliable than those of AO particularly for guiding the surgical management of unstable thoracolumbar burst fractures without neurological deficit. However, this conclusion needs to be verified with further multicenter prospective studies.

Is there a relationship between blood lipids and lumbar disc herniation in young Turkish adults?

INTRODUCTION: Atherosclerosis might diminish the nutrient supply to intervertebral discs (IVD), leading to disc herniation. Therefore, there is interest in determining the possible association between the blood lipid profile and lumbar disc herniation (LDH). We aimed to evaluate the association between blood lipids and LDH in a homogeneous group of patients, controlling for age- and sex-specific effects. MATERIAL AND METHODS: This is a case-control study which consisted of 100 individuals (mean age: 41.25 ±9.09; 50 men and 50 women), classified into two groups, as follows. Group I (G-I) consisted of 50 patients who underwent surgery for symptomatic LDH, while group II (G-II) consisted of 50 patients with nonspecific complaints of a headache, but with no previous history of back and/or leg pain, recruited among patients admitted to the outpatient clinic at the time of the study, and whose age and sex were matched to the study group. Total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose, and hemoglobin A1c levels were measured. The TC/HDL-C ratio was calculated. Blood pressure, waist circumference, body mass index, and the history of smoking were included in the analysis. RESULTS: The mean values of the TC, TG, LDL-C, HDL-C levels and TC/HDL-C ratio were 198.38, 132.76, 131.9, 40.38 mg/dl and 5.09, respectively. No statistically significant relationship between the blood lipid profile and LDH was identified in this population. CONCLUSIONS: Blood lipid levels in this young adult Turkish population did not predict LDH, and may not be a leading cause of IVD ischemia and IVD degeneration.

Comparison of clinical features and surgical outcome in focal cortical dysplasia type 1 and type 2.

INTRODUCTION: Recent ILAE classification defined focal cortical dysplasia (FCD) patients with accompanying epileptic lesions as a separate group. We investigated data of patients with sole FCD lesions regarding long-term seizure outcome and different characteristics of FCD type 1 and type 2 patients. METHODS: Eighty children and adult patients underwent surgery for FCD were included to the analysis of factors differentiating FCD type 1 and type 2 groups and their effect on long-term outcome. RESULTS: FCD type 2 patients had earlier epilepsy onset (8.1 vs. 6.1 years. p=0.019) and underwent surgery younger than type 1 (18.2 vs. 23.7 years. p=0.034). FCD type 2 patients were more prominently MR positive (77.8% vs. 53.8%. p=0.029), which increased within FCD type 2 group as patients become younger (p=0.028). FCD Type 1 lesions showed mostly multilobar extension and FCD type 2 mostly located in frontal lobe. Seizure freedom was achieved in 65.4% of FCD type 1 patients and 70.4% of FCD type 2 patients. Seven patients had permanent de novo neurological deficits. Mean follow-up time was 5.5 years (Range: 1-11 years). CONCLUSION: Surgical intervention in carefully selected patients may facilitate favorable seizure outcome leading to better quality of life. FCD type 1 and type 2 groups present with evident differences, which may promote medical and surgical management of these pathologies.

Semivertical Incision: An Aesthetically and Electrophysiologically Effective Mini-Incision Technique for Carpal Tunnel Decompression.

BACKGROUND The purpose of this study was to present the clinical results of our retrospective series of carpal tunnel release (CTR) operations. For these operations we used a unique type of incision, for the first time, for treatment of carpal tunnel syndrome (CTS) consisting of a 1-cm semi-vertical (SV) incision made into the wrist crease for macroscopic open CTR. MATERIAL AND METHODS This retrospective study included 114 patients (101 females and 13 males) with CTR who were operated upon in our neurosurgery clinic between December 2010 and June 2015. Patient ages ranged from 35 to 83 years (mean 55.05±12.04 years). In total, 127 hands (73 right and 54 left) were operated upon using the SV skin incision technique. After an average follow-up of 18 months (ranging from 6 to 30 months), clinical and electrophysiological (EP) evaluations were performed. RESULTS A review of the English language literature published since 1957, when Phalen first popularised the diagnosis and treatment of this disease, determined that no previous reports of the mini-open incision technique as described in our study have been published. In our retrospective patient case review, we found that after operations using the SV incision technique, statistically significant differences were detected in electromyography (EMG) improvements (p<0.01). In addition, patients who showed improvement in EMG studies (n=90) were satisfied with the result of their surgery. CONCLUSIONS Our study demonstrated that 1-cm skin SV incision was a cosmetically satisfying, fast, and safe approach to CTR that was not only clinically effective but also electrophysiologically effective.

Vascular Variations Associated with Intracranial Aneurysms.

AIM: To investigate the vascular variations in patients with intracranial aneurysm in circle of Willis. MATERIAL AND METHODS: We used the data on 128 consecutive intracranial aneurysm cases. Cerebral angiography images were analyzed retrospectively. Arteries were grouped as anterior cerebral arterial system (ACS), posterior cerebral arterial system (PCS) and middle cerebral arterial system (MCS) for grouping vascular variations. Lateralization, being single/multiple, gender; and also any connection with accompanying aneurysms" number, localization, dimension, whether bleeding/incidental aneurysm has been inspected. RESULTS: Variations were demonstrated in 57.8% of the cases. The most common variation was A1 variation (34.4%). The rate of variations was 36.7%, 24.2% and 10.2% respectively in ACS, PCS and MCS. MCS variations were significantly higher in males. Anterior communicating artery (ACoA) aneurysm observance rates were significantly higher and posterior communicating artery (PCoA) aneurysm and middle cerebral artery (MCA) aneurysm observance rates were significantly lower when compared to "no ACS variation detected" cases. In "PCS variation detected" cases, PCoA aneurysm observance rates and coexistence of multiple variations were significantly higher. CONCLUSION: The rate of vascular variations in patients with aneurysms was 57.8%. Arterial hypoplasia and aplasia were the most common variations. ACS was the most common region that variations were located in; they were mostly detected on the right side. Coexistence of ACoA aneurysm was higher than PCoA and MCA aneurysms. In the PCS variations group, PCoA aneurysms were the most common aneurysms that accompanying the variation and multiple variations were more common than in the other two groups. The variations in MCS were most common in males.

Pre-operative measurement of the morphometry and angles of the anterior clinoid process (ACP) for aneurysm surgery / Medición preoperatoria de la morfometría y los ángulos del proceso clinoide anterior (PCA) para la cirugía de aneurisma

The anterior clinoid process (ACP) is proximal to vital structures, such as the optic nerve, internal carotid artery and ophthalmic artery; therefore, study of its anatomy is important in guiding and defining surgery. We studied the anatomical structure of the ACP, including the angle formed by the apex of the ACP triangle, and its orientation, to provide information for easier and safer surgery. The measurement was performed on the axial planes of 242 cranial computerized tomography (CT) scans and 27 adult Turkish skulls of both sexes. The length of the ACP, width of the ACP at its base, the angle formed by the apical angle of the ACP triangle and the orientation of the ACP defined according to the sagittal midline were examined. In the Turkish skulls, the length and width of the ACP were similar to previous studies. Our study was the first to measure the angle and orientation of the ACP. The mean angle was 39.67±12.64 (16.6-89.5) and 135 posterior (55 %) and 107 medial (45 %) orientations. Surgical complications can be avoided by pre-operative radiological planning using axial CT scans and by determining whether the morphology is Type 2 (long, narrow, acute-angled), which requires total resection.

El proceso clinoide anterior (PCA) está próximo a estructuras vitales, como el nervio óptico, la arteria carótida interna y la arteria oftálmica, por tanto el estudio de su anatomía es importante en la orientación y la definición de la cirugía de base de cráneo. Se estudió la estructura anatómica de la PCA, incluyendo el ángulo formado por el vértice del triángulo PCA, y su orientación, para proporcionar información para una cirugía más fácil y más segura. La medición se realizó en los planos axiales de 242 exploraciones craneales de tomografía computarizada (TC) y 27 cráneos de individuos adultos turcos de ambos sexos. Se examinó la longitud del PCA, el ancho del PCA en su base, el ángulo formado por el ángulo apical del triángulo PCA y la orientación del PCA definido de acuerdo con la línea mediana sagital. En cráneos turcos, la longitud y el ancho del PCA fueron similares a estudios anteriores. Nuestro estudio fue el primero en medir el ángulo y la orientación del PCA. El ángulo promedio fue de 39,67 ± 12,64 (16,6 a 89,5) y, la orientación fue posterior en 135 cráneos (55 %) y medial en 107 cráneos (45 %). Las complicaciones quirúrgicas pueden evitarse mediante la planificación radiológica preoperatoria através de cortes axiales de tomografía computarizada y determinando si la morfología del PCA es de tipo 2 (larga, estrecha y aguda en ángulo recto), lo que requiere la resección total.

The Association between Sagittal Index, Canal Compromise, Loss of Vertebral Body Height, and Severity of Spinal Cord Injury in Thoracolumbar Burst Fractures.

AIM: Our aim was to determine whether a combination of sagittal index (SI), canal compromise (CC), and loss of vertebral body height (LVBH) is associated with the severity of neurological injury in patients with thoracolumbar burst fractures. MATERIALS AND METHODS: Seventy-four patients with thoracolumbar burst fracture undergoing instrumentation between 2010 and 2015 were analyzed retrospectively. The degree of neurological injury was determined using the American Spinal Injury Association (ASIA) scoring system. The association between the morphology of the fracture and the severity of neurological injury was analyzed. RESULTS: There was a strong association between fracture morphology and the severity of neurological injury. Of the patients, 77.5% with SI ≥20°, 81.6% with CC ≥40%, and 100% with LVBH ≥50% had lesion according to ASIA. All of 7 patients with ASIA A had SI ≥20°, CC ≥40%, and LVBH ≥50%. On the other hand, 79% of the patients with ASIA E had SI <20°, 83.7% of the patients with ASIA E had CC <40%, and all of the patients with ASIA E had LVBH <50%. SI, CC, and LVBH were lower in neurologically intact patients (ASIA E), whereas they were higher in patients with neurological deficits (ASIA A, B, C, D) (P = 0.001; P < 0.01). These measurements had 100% negative predictive values and relatively high positive predictive values. CONCLUSION: SI, CC, and LVBH are significantly associated with the severity of neurological injury in patients with thoracolumbar burst fractures. The patients with SI >25°, the patients with CC >40%, and the patients with LVBH >50% are likely to have a more severe neurological injury.

Superior medullary velum: anatomical-histological study in the sheep brain and a preliminary tractographic study in the human brain.

AIM: To study the anatomy, histology and fiber relations of the superior medullary velum. MATERIAL AND METHODS: Ten previously frozen and formalin-fixed sheep brains were used. The fiber dissection was done using the operating microscope at the Rhoton Anatomy Laboratory of Marmara Faculty of Medicine. A tractographic study was conducted on five volunteer patients to see the fiber anatomy of the superior medullary velum. RESULTS: The average thickness and length was found to be 0.296 mm (range 0.09-1 mm) and 4.25 mm (range 3.25-4.5 mm) respectively. Histologically, the superior medullary velum consisted of cuboidal layer of ependymal cells on the anterior surface related to fourth ventricle. The subependymal layer contained hypocellular fibrillary zone with few glial cells, and the outer layer consisted of thin layer of fibroblasts. Under the hypocellular fibrillary zone, abundant axons and organized structures were observed. Tractographically, only a few fibers were identified on diffusion-tensor imaging (DTI). CONCLUSION: We could not identify a distinct tract anatomically and neuron cells histologically. Neuron-like cells and organized structures were observed on immunohistochemical analysis. Also a few tracts were observed on DTI study as an ascending pathway from spinal tracts to the superior medullary velum. Further studies including human cadaveric, histologic and fiber tractographic investigations are needed to say that it is harmless to divide this anatomical structure.

Anatomic variations of sphenoid sinus pneumatization in a sample of Turkish population: MRI study / Variaciones anatómicas de la neumatización del seno esfenoidal en una muestra de población turca: estudio por resonancia magnética

There are a number of variations regarding morphometric anatomy and degree of pneumatization of the sphenoid sinus. In our study, we planned to examine and show the differences of pneumatization of the sphenoid sinus particularly to guide the neurosurgeon during transsphenoidal surgery. Sagittal T1-weighed spin-echo Magnetic Resonance Images (MRIs) of 616 adult individuals (406 women and 210 men) were analyzed, retrospectively. According to the collected data from our study, the most common type of the sphenoid sinus was the sellar type (83%; n=511) for the whole study group. Of the 616 individuals 16.6% (n=102) had presellar type and 0.5% (n=3) had conchal type of sphenoid sinus. Preoperative detailed detection of the anatomical characteristics of sphenoid sinus is essential. A thorough information obtained from studies of the regional anatomy and awareness of its variability can provide a safe and accurate transsphenoidal and extended endoscopic skull base approaches.

Existen variaciones respecto a la anatomía morfométrica y el grado de neumatización del seno esfenoidal. En nuestro estudio, se examinaron las diferencias de neumatización del seno esfenoidal, especialmente para guiar al neurocirujano durante la cirugía transesfenoidal. Fueron analizadas las imágenes sagitales T1-spin de resonancia magnética (RM) de 616 individuos adultos (406 mujeres y 210 hombres). De acuerdo con los datos obtenidos a partir de nuestro estudio, el tipo más común de seno esfenoidal fue el de silla turca (83%, n=511) para todo el grupo de estudio, 16,6% (n=102) corresponden al tipo presellar y 0,5% (n=3) al tipo conchal. Una detección preoperatoria detallada de las características anatómicas del seno esfenoidal es esencial. Información exhaustiva obtenida de los estudios de la anatomía y el conocimiento de su variabilidad regional puede proporcionar un abordaje endoscópico transesfenoidal extenso, seguro y preciso, de la base de cráneo.

The surgical treatment of far lateral lumbar disc herniation: 33 cases.

Surgical approaches to far lateral disc herniation are challenging because of the anatomical limitations in the region. We describe an extraforaminal approach for far lateral lumbar disc herniation (FLLDH) in a group of patients and discuss the results in patients with far lateral disc protrusion or extrusion operated on by an approach to the extraforaminal region via an intertransverse route with median or paramedian incisions. The two methods are compared in terms of the pre- and postoperative visual analogue scale (VAS) pain scores, duration of the operation, amount of bleeding, and long-term functional recovery. In addition, data on age, incidence, radiological features and clinical signs and symptoms are compared with reported series. Between January 2006 and January 2011, 33 patients (18 females, 15 males; mean age, 51.2 years) underwent surgery for FLLDH. The majority of patients had herniation at disc levels L3-4 (12 patients) or L4-5 (15 patients). All patients were operated on via either median-paramuscular (20 patients, 61%) or paramedian-intermuscular (13 patients, 39%) approaches. Overall, the mean VAS score improved from 7.3 preoperatively to 2.8 in the short-term. Analyzing the long-term functional outcome of surgery according to the MacNab Criteria, the recovery was excellent, good, fair, and poor in 18, 11, 4, and 0 patients, respectively. The far-lateral approach for FLLDH is a safe, effective procedure that avoids the risk of secondary spinal instability. In treating FLLDH, the use of a long median incision together with an extraforaminal approach is safer and less invasive than a laminectomy together with a medial or total facetectomy.

Evaluation of the lateral wall of the nasal cavity in relation to septal deviation / Evaluación de la pared lateral de la cavidad nasal en relación con la desviación septal

The objective of this study was to evaluate the relationship between variations of the lateral wall of the nasal cavity and septal deviation (SD). Coronal and axial paranasal sinus CT images of 115 individuals (65 females, 50 males) were reviewed and the presence of pneumatisation and hypertrophy of the conchae was evaluated. Pneumatisation of the concha was classified as lamellar concha bullosa (LCB), bulbous concha bullosa (BCB), or extensive concha bullosa (ECB). If bulbous and extensive conchae and hypertrophic conchae were bilateral the side on which it was greatest was accepted as the dominant concha. The relationship between these variations and nasal septum deviation was also taken into account. Eighty-six (74.8 percent) of the 115 subjects had SD. Of these, 20 were not affected by the size of the middle nasal concha (MNC) or inferior nasal concha (INC). Thirty-four cases had dominant MNC, 20 had dominant INC, and 11 had both dominant MNC and dominant INC, and all of which had SD towards the opposite side. In one case there was SD towards the side in which the MNC was dominant. Our data indicate that coexistence of pneumatisation or hypertrophy of the conchae and SD was more common in adults compared to the results of similar studies conducted with a wide range of age groups, including children. Thus the presence of SD together with a large concha increases with age. A prospective study, which will include infants, will elucidate the relationship between conchae and SD.

El objetivo del estudio fue evaluar la relación existente entre las variaciones de la pared lateral de la cavidad nasal y la desviación septal. Se revisaron los senos paranasales en imágenes de TC de 115 individuos (65 mujeres, 50 varones) coronales y axiales y se evaluó en ellas la presencia de neumatización e hipertrofia de los conchas nasales. La neumatización de la concha fue clasificada como concha laminar bulosa (CLB), concha bulbosa bulosa (CBB), o concha extensa bulosa (ECB). Conchas nasales bulbosa y extensa y conchas hipertróficas eran bilaterales siendo el lado en que esta era más grande como la concha dominante. También se tuvo en consideración la relación entre estas variacio nes y la desviación del tabique nasal. Ochenta y seis (74,8 por ciento) de los 115 sujetos tenían desviación septal. De éstos, 20 no se vieron afectados por el tamaño de la concha nasal media (CNM) o concha nasal inferior (CNI). Treinta y cuatro de los casos tenía CNM dominante, 20 tenían CNI dominante, y 11 tenían tanto CNM dominante y CNI dominante, todos los cuales tenían desviación septal hacia el lado opuesto. En un caso hubo desviación septal hacia el lado en el que el CNM era dominante. Nuestros datos indican que la coexistencia de neumatización o hipertrofia de conchas nasales y la desviación septal es más común en adultos en comparación con los resultados de estudios similares realizados con una amplia gama de grupos etarios, incluidos los niños. Así, la presencia de desviación septal, junto con una gran concha aumenta con la edad. Un estudio prospectivo, que incluirá los bebés, aclarará la relación entre concha nasal y desviación septal.

[Effects of anti-edema drugs on diffuse cerebral edema in rats: experimental study]. / Siçanlarda, antiödem olarak kullanilan ilaçlarin diffüz beyin ödemine etkileri: Deneysel çalisma.

BACKGROUND: Traumatic brain edema is one of the most common problems encountered in neurosurgical practice and it leads to morbidity and mortality via increased intracranial pressure. The aim of this study was to examine the effect of hypertonic saline on traumatic brain edema in comparison to mannitol. METHODS: Eighty adult male Sprauge-Dawley rats weighting 300-350 g were used in this experimental study. Rats were randomly divided into control (C); trauma (T); mannitol only trauma+mannitol; NaCl 3% only; Trauma+NaCl 3%; NaCl 7.5% only; trauma+NaCl 7.5%; NaCl 23.4% only and trauma+NaCl 23.4% groups. All medications were given intraperitoneally. Rats were sacrificed and decapitated 24 hours after trauma with or without medications and the brains were examined histopatologically. RESULTS: Although no difference was observed with regard to hemorrhage between trauma only and trauma+NaCl 23.4% groups, there was a statistically significant difference in brain edema within these two groups (p=0.003). There were no statistically significant differences within groups with respect to plasma osmolarity and serum sodium levels. CONCLUSION: This study demonstrates that 23.4% NaCl is more effective than other concentrations of hypertonic saline or mannitol in the prevention of posttraumatic brain edema. Further clinical studies with different dosages and concentrations of hypertonic saline are required.