Evaluating the Effectiveness of Minimally Invasive Surgery Using External Ventricular Drainage Systems in Draining Chronic Subdural Hematomas.

AIM: To show the effectiveness of minimally invasive surgery with external ventricular drainage systems (EVDS) in the treatment of chronic subdural hematomas by comparing with it with classic surgery with closed drainage system (CDS) with intracranial hematoma volume measurements and predict infection risks by comparing two different surgeries with each other with intracranial air volume measurements. MATERIAL AND METHODS: From 2014 to 2020, the data of 28 patients with chronic subdural hematoma who underwent surgeries two large burr holes, saline irrigation, and CDS or one small burr hole, no saline irrigation, and EVDS were retrospectively who had preoperative computed tomography (CT) postoperative 1st-3rd day CT, and postoperative 7th-10th day CT were included in the study. Pre- and postoperative subdural liquid collection volumes and postoperative intracranial air volumes were measured using Sectra Medical Workstation. Results were compared between these two groups. RESULTS: There were no significant differences in the preoperative and 7th-10th day liquid volumes between these two groups (p > 0.05). There were significant differences in the postoperative 1st-3rd day air volume between these two groups (p < 0.001). CONCLUSION: The statistical results showed that surgeries with EVDS are as effective as surgeries with CDS in draining chronic subdural hematomas. We also determined that the intracranial air volume is significantly less in surgeries with EVDS. For this reason, we believe that EVDS can reduce the risk of postoperative infection.

The Role of Bone Scintigraphy in Determining Spinal Fusion after Spinal Stabilisation Surgery.

AIM: To evaluate the usefulness of bone scintigraphy in spinal fusion surgery. MATERIAL AND METHODS: This retrospective study included 21 patients who had undergone previous anterior or posterior spinal fusion procedures, or both. Implant failure, fusion failure and adjacent segment disease were the evaluated pathological parameters. Scintigraphic data from all patients were evaluated with intraoperative observational data, radiological data and clinical data. RESULTS: Radiological evaluation revealed adjacent segment disease in 5 patients (23.8%), implant failure in 2 (9.5%), and fusion failure in 1 (4.8%). Scintigraphic evaluation of operating segments revealed pseudo-fusion in 3 patients (14.3%) and fusions in 18 (85.7%). Reoperations were performed in 9 patients (42.9%): in 5 (23.8%) because of adjacent segment disease, and in 4 (19.0%) because they requested removal of the implants. Two patients (9.5%) with implant failure did not undergo reoperation because their scintigraphic data were consistent with fusion and they were almost symptom free, with lower Visual Analogue Scale (VAS) scores. The VAS scores of the rest of the patients were significantly reduced after the reoperations (p < 0.001). CONCLUSION: Bone scintigraphy may be helpful for surgeons in planning appropriate surgical revision strategy by giving proper data about spinal fusion at least one year after the initial surgery.

Microsurgical Endoscope-Assisted Gravity-Aided Transfalcine Approach for Contralateral Metastatic Deep Medial Cortical Tumors.

BACKGROUND: Traditional approaches to deep medial cortical tumors utilize transcortical or ipislateral interhemispheric approaches, which can result in cortical damage or retraction injury. To reduce these risks, the microscopic transfalcine approach has been previously described. OBJECTIVE: To describe this approach performed with endoscopic assistance for metastatic tumor resection, demonstrating appropriate and safe tumor resection without injury to the contralateral hemisphere. METHODS: Eleven consecutive patients harboring medial, deep metastatic tumors are reported. Tumor resection was performed with endoscopic assistance with 2 surgeons. Clinical outcomes are recorded. RESULTS: All 11 patients underwent safe tumor resection. Gross total resection was achieved in 73% of patients. The application of the angled endoscope allowed for further tumor resection in 91% of patients. There were no complications in these patients. The contralateral brain did not demonstrate clinical or radiographic injury as well. CONCLUSION: This series suggests that the endoscopic transfalcine approach in the lateral position can be a safe and effective approach for resecting medial interhemispheric metastatic tumors. It allows excellent tumor visualization, eliminates the need for brain retraction, minimizes parenchymal transgression, and improves surgical ergonomics. A familiarity of endoscopy and neuroanesthesia support is helpful when utilizing this approach.

Assessing the effects of lumbar posterior stabilization and fusion to vertebral bone density in stabilized and adjacent segments by using Hounsfield unit.

BACKGROUND: Computed tomography (CT) with Hounsfield unit (HU) is being used with increasing frequency for determining bone density. Established correlations between HU and bone density have been shown in the literature. The aim of this retrospective study was to determine the bone density changes of the stabilized and adjacent segment vertebral bodies by comparing HU values before and after lumbar posterior stabilization. METHODS: Sixteen patients who had similar diagnosis of lumbar spondylosis and stenosis were evaluated in this study. Same surgical procedures were performed to all of the patients with L2-3-4-5 transpedicular screw fixation, fusion and L3-4 total laminectomy. Bone mineral density measurements were obtained with clinical CT. Measurements were obtained from stabilized and adjacent segment vertebral bodies. Densities of vertebral bodies were evaluated with HU before the surgeries and approximately one year after the surgeries. The preoperative HU value of each vertebra was compared with postoperative HU value of the same vertebrae by using statistical analysis. RESULTS: The HU values of vertebra in the stabilized and adjacent segments consistently decreased after the operations. There were significant differences between the preoperative HU values and the postoperative HU values of the all evaluated vertebral bodies in the stabilized and adjacent segments. Additionally first sacral vertebra HU values were found to be significantly higher than lumbar vertebra HU values in the preoperative group and postoperative group. CONCLUSIONS: Decrease in the bone density of the adjacent segment vertebral bodies may be one of the major predisposing factors for adjacent segment disease (ASD).

Which Biomarker is most Effective to Determine Severity of Acute Head Trauma in the Experimental Animal Head Trauma Model?

AIM: Because of the need for effective method to determine the severity of head trauma, the importance of biomarkers is recognized recently. This study aims to analyze the values of sera levels of some biomarkers and the relation with their tissue levels in acute head injury. MATERIAL AND METHODS: In this study, rats were divided into three groups (mild head trauma, severe head trauma and control group). All rats were anaesthetized. Weightdrop method was used as trauma method. Blood samples were obtained five minutes after trauma when the acute effects of trauma occurred. Then whole brains of rats were excised. Levels of biomarkers were investigated in the sera samples and homogenized brain tissues biochemically. RESULTS: Significant differences in the sera GFAP (p=0.015) and insulin (p=0.011) levels were observed. Very significant difference in the sera nNOS level was observed. Extremely significant difference in the tissue IL-6 (p < 0.001) level was observed between all groups. CONCLUSION: Sera nNOS and tissue IL-6 are the best biomarkers to predict trauma severity. Sera GFAP and insulin are also capable to show trauma severity in the very acute period of postinjury. Tissue levels of the biomarkers except insulin are higher than their sera levels.

Which method is the most effective for preventing postoperative infection in spinal surgery?

BACKGROUND: Several methods have been used to reduce the infection rate in spinal surgeries with instrumentation. PURPOSE: Which method is the most effective for preventing postoperative infection? STUDY DESIGN: Basic science, animal model. OBJECTIVE: In the present study, the efficiency of antibiotic prophylaxis, silver-plated screws, and local rifamycin application to the surgical site was investigated in an experimental animal model. Staphylococcus aureus was used as the pathogen. METHODS: Fifty 6-month-old female Wistar albino rats were used. The animals were randomly numbered and divided into five groups of ten rats each (Group 1, control group; Group 2, titanium screw and S. aureus inoculation; Group 3, titanium screw, 0.1 ml rifamycin application to the surgical area, and bacterial inoculation; Group 4, titanium screw, single preoperative dose of IM cefazolin, and bacterial inoculation; Group 5, silver-plated screw and bacterial inoculation). Titanium micro-screws were placed into the pedicles. The control group received a sterile isotonic solution, and the other four groups received bacterial suspensions containing S. aureus. The animals were killed 15 days later. RESULTS: Intensive S. aureus growth was observed in all tissue and screw samples from Group 2. The results for Group 3 were similar to those for Group 1, no growth was observed in the screw cultures. Intensive growth was observed in the five screw samples in Group 4 and in the eight samples in Group 5. CONCLUSION: Our study suggests that rifamycin application to the surgical area in spinal operations with instrumentation is an effective method to prevent S. aureus infections.

[Atypical teratoid rhabdoid tumor: case report]. / Atipik teratoid rabdoid tümör: olgu sunumu.

Atypical teratoid rhabdoid tumor is a rare highly malignant embryonal tumor of the central nervous system that is often seen in early childhood. It is very important to distinguish it from other brain tumors because it has a very poor prognosis and there are differences in its treatment. A case of atypical teratoid rhabdoid tumor in a six-week-old male baby is presented. The tumor was located at posterior fossa. Histopathologically, the tumor has rhabdoid tumor cells and mesenchymal components beside the undifferentiated small cells. While EMA, vimentin, synaptophysin and smooth muscle actin have been stained with immunohistochemical staining, desmin, chromogranin, CD 99 and CD 56 have not been stained. The patient died four months after surgery despite the chemotherapy given. In conclusion, morphological characteristics can vary to a large extent that it is difficult to recognize atypical teratoid rhabdoid tumor. Immunohistochemical panel and molecular genetic study will help to establish the correct diagnosis.

Comparison of the diagnostic utility of electromyography, ultrasonography, computed tomography, and magnetic resonance imaging in idiopathic carpal tunnel syndrome determined by clinical findings.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome. It is sometimes difficult to diagnose, and a late diagnosis may result in permanent nerve damage. Electromyography (EMG), ultrasonography (US), magnetic resonance imaging (MRI), and computed tomography (CT) may be performed for the diagnosis. The diagnostic accuracy of these tests is well documented, but most of these studies accept EMG as the gold standard. OBJECTIVE: To evaluate the diagnostic accuracy of EMG, MRI, CT, and US for the diagnosis of carpal tunnel syndrome with the use of clinical findings as the gold standard. METHODS: Patients suspected to have CTS on presentation to the outpatient clinic were evaluated. The tests were performed after a detailed physical examination. Both wrists of the 69 patients in the study were investigated. RESULTS: : The diagnostic accuracies of all the tests were found to be sufficient. Although EMG seemed to have the highest sensitivity and specificity, there was no statistically significant difference between the tests. CONCLUSION: EMG or US could be used as the first-step test in most cases. If they are both available, EMG should be the first choice. They may be performed together when diagnosis is challenging. CT may especially be preferred for bone-related pathological conditions, whereas MRI may be preferred for soft tissue-related pathological conditions. Even though imaging studies have been proven to be powerful diagnostic tools for CTS, no conclusive information currently exists to support replacing EMG with imaging studies.

Bell's palsy and choreiform movements during peginterferon alpha and ribavirin therapy.

Neuropsychiatric side effects of long-term recombinant interferon-alpha therapy consist of a large spectrum of symptoms. In the literature, cranial neuropathy, especially Bell's palsy, and movement disorders, have been reported much less often than other neurotoxic effects. We report a case of Bell's palsy in a patient with chronic hepatitis C during peginterferon-alpha and ribavirin therapy. The patient subsequently developed clinically inapparent facial nerve involvement on the contralateral side and showed an increase in choreic movements related to Huntington's disease during treatment.

Spontaneous syringomyelia resolution at an adult Chiari type 1 malformation.

We present a 41-year-old man with Chiari type 1 malformation and cervical syringomyelia. Although the tonsillar herniation persisted, his syringomyelia was almost completely resolved during an eleven-year time period without surgery.

Chronic migraine associated with the Chiari type 1 malformation.

OBJECTIVE: Our objective was to assess the frequency and clinical characteristics of migraine in the patients with CM-1. METHODS: We analyzed migraine in 73 patients with CM-1. Migraine was classified according to the new International Headache Society criteria. We did not include patients who had intracranial, parenchymal, or cervical lesions other than CM-1 on brain and cervical magnetic resonance imaging. RESULTS: Of the 73 patients diagnosed as having CM-1, 11 (15.06%) had migraines; of them, 8 (10.95%) had chronic migraines, 2 (2.73%) had migraines with auras, and 1 (1.36%) had migraines without auras. The patients who had both migraines and CM-1 (group 1) were compared regarding clinical characteristics and demographic features to the control group having chronic migraines. The control group comprised subjects free of CM-1. Onset age of pain was earlier and the frequency of headache days per month, baseline pain intensity, exacerbation of pain intensity, nausea, vomiting, and pain aggravated by physical activity were significantly higher in group 1. CONCLUSIONS: Although we found the frequency of migraine to be similar to that in population-based studies, we detected a threefold increased frequency of chronic migraine in this special population. We believe that CM-1 may be a factor associated with chronic migraine.

Association between restless legs syndrome and Chiari type 1 malformation.

Chiari type 1 malformations (CM-1) consist of the downward displacement of the cerebellar tonsils out of the inferior opening of the skull and into the spinal canal. In relation to this, a few studies in the literature have drawn attention to the possible role of the upper brainstem, diencephalon, red nucleus, and cerebellum in the pathogenesis of restless legs syndrome (RLS). Herein, we present five cases of RLS who were also found to have CM-1 malformations. The cases were notable for an early onset of RLS and a poor response to dopaminergic treatment. The patients fulfilled the diagnostic criteria for RLS according to the International RLS Study Group. None of the patients had a family history of RLS or any other condition known to be associated to RLS. The patients ranged in age from 20 to 31 years old. Four of the patients indicated occasional pain in the occipital-suboccipital area upon questioning about CM-1-related symptoms. All cases had used at least two different drugs known to be effective in RLS treatment. Our opinion is that CM-1-related involvement of the cerebellum and/or connections of the cerebellum with the basal ganglia may have contributed to the development of RLS in these cases.