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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. [ABSTRACT FROM AUTHOR]

Graft failure is a common complication of cranioplasty. Revision cranioplasty is required to overcome this complication. However, no previous studies have reported outcomes in revision cranioplasty with 3-dimensional (3D) custom-made titanium implants. We describe our experience with 3D titanium implants in patients with revision cranioplasty. We evaluated 43 consecutive patients between January 2011 and December 2019 who underwent revision cranioplasty using 3D custom-made titanium implants. The 3D image of the patient's cranium and the plan to close the cranium defect were created in a virtual environment using software programs. Demographic and radiologic features were compared based on the materials used in the initial cranioplasty. Previous material was autologous graft (AG) in 27 patients and polymethyl methacrylate (PMMA) in 16 patients. The mean time without revision cranioplasty is longer in patients with PMMA implants than in patients with AG. There was no statistically significant difference in the length of hospital stay between patients with PMMA implants and patients with AG. There were no postoperative adverse events such as infection, wound dehiscence, convulsions, or epidural hematoma in 38 patients during hospitalization. Wound dehiscence developed in 5 patients and surgical repair was required in one. Initial cranioplasty with PMMA provides a longer time period than the AG before the revision. However, both of them have similar outcomes based on length of hospital stay and cranial defect area. Custom-made 3D titanium implant is a good option for revision cranioplasty to prevent implant failure and reduce patients' cosmetic concerns. [ABSTRACT FROM AUTHOR]

Objective: Giant intracranial meningiomas are a challenge for neurosurgeons because of their size and location in the cranium. Difficult tumor dissection and encasement of important neurovascular structures make them a horrible nightmare. The aims of this study are to present our giant intracranial meningioma series and to compare our experience using advanced surgical technology with the current literature. Materials and Methods: The data of patients with the diagnosis of giant intracranial meningioma between 2014 and 2020 who underwent surgical treatment were retrospectively reviewed. The demographic, radiological, and surgical characteristics of patients were documented. The size and location of tumors as well as surgical technique were analyzed in detail. Results: A total of 61 patients with intracranial meningioma underwent surgical treatment over a 7-year period, and 10 (16.4%) tumors were larger than 5 cm in diameter, which were classified as giant meningioma. Seven patients were male and 3 were female, with a mean age of 64.9 years. Four tumors were located at the skull base. Histological diagnosis was meningioma World Health Organization grade I in 7 patients and grade II in 3 patients. Simpson grade 1 resection was achieved in 6 patients and grade 2 resection in 4 patients. No mortality was observed. Conclusion: Careful surgical planning should be made for giant intracranial meningiomas. Their location, adjacent neurovascular structures, and vascular supply affect the resection level of these giant tumors. Simpson grade 1 resection is seldom possible for skull base meningiomas. [ABSTRACT FROM AUTHOR]

Aims: To present our spinal intradural tumor series and to evaluate the reliability of electrophysiological assessment in patients treated for these tumors. Methods: We retrospectively evaluated the data of patients treated for spinal intradural tumor between 2010 and 2019. The demographic, surgical and histological features of patients were evaluated and compared with their pre- and postoperative electrophysiological data. Somatosensory evoked potentials (SEP) were used as electrophysiological test. Results: A total of 69 patients with spinal intradural tumor was evaluated. Thirty-one of them had extramedullary and 38 had intramedullary tumor. The mean age was 48.3 years for extramedullary and 26.3 years for intramedullary tumors. In preoperative period, SEP was prolonged in 25 patients with intramedullary tumor while it was prolonged in 8 patients with extramedullary tumor. In postoperative period, recovery in SEP values was detected in 5 of 25 patients with intramedullary tumor but it was observed in 7 of 8 patients with extramedullary tumor. Conclusions: Electrophysiological evaluation is a safe and reliable method to assess the patients surgically treated for spinal intradural tumor. It is an objective method to evaluate the neurological recovery of patients with extramedullary tumor. [ABSTRACT FROM AUTHOR]

Aims: Intracerebral hemorrhages (ICH) are usually seen in patients with stroke. In this pathology; ICH volume, location of the hemorrhage and hemorrhage expanding into the ventricular system are the main factors affecting the mortality respectively. Increase in ICH volume often results in neurological deterioration. Our aim is to determine the prognostic factors in patients who underwent surgical treatment for ICH. Methods: We retrospectively evaluated 52 patients operated in our department due to ICH which occurred spontaneously or were caused by the other etiological factors between 2017 and 2019. The parameters were the Glasgow Coma Scale (GCS) score, ICH volume in computed tomography scan, and ventricular expansion of the hemorrhage. Results: The mortality rate in our series was 61.5%. Mortality was significantly increased in patients with hematoma larger than 60 cm3. Nineteen of 24 (46%) patients with GCS scores between 3 and 8 died in the postoperative period. The mean duration of hospital stay was 33 days. 73% of the hematomas were seen in the lobar region. Conclusions: Low GCS score at admission and high ICH volume are prognostic factors for patients who have undergone surgery for ICH. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Aims: Split cord malformations (SCM) are congenital anomalies of the spine. The spinal cord is divided into two hemicords in the vertical plane. With foot and spine deformities, the skin lesions on the midline, even at the level of the lesion, at the back are the main signs of SCM. It is divided into two types as Type I (Diastometamyelia) and Type 2 (Diplomyelia). We retrospectively reviewed our cases with SCM and presented our results. Methods: In our department, 27 cases of SCM in 2012-2018 were surgically treated. Of these, 23 were Type I, 4 were Type II. In type I SCM, the bone septum was removed, the hemicords were assembled in a single dura, and the spinal cord was released. In type II SCM, fibrous band was removed and spinal cord was released. Results: All patients were recovered well after surgery. No mortality had been occured. Cerebrospinal fluid (CSF) fistula was seen in 4 patients. The complications such as CSF fistula, infection or wound problems were properly managed. Conclusions: In this paper, we tried to mention about preoperative preparation, intraoperative surgical steps and postoperative period of SCMs. Surgical technique and steps were especially emphasized. SCMs should be treated surgically as soon as possible after the birth in order to avoid neurological and urological deterioration. [ABSTRACT FROM AUTHOR]

Objective: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy caused by compression of the median nerve in carpal tunnel. It is viewed common especially among women, middle-age group and some specific occupational groups. In our study, we investigated whether lipid profile disorders are risk factors for CTS or not. Methods: 52 patients applied to neurosurgery outpatient clinic were accepted to our study between August 2009 and July 2010. After taking medical history, physical examination, laboratory parameters and evaluation of electrophysiological research, patients were diagnosed as "Idiopathic Carpal Tunnel Syndrome" and only the patients taking a surgery indication were accepted to study. 52 healthy individuals without risk factors for CTS evaluated as control group. Questionnaire evaluating medical histories of patients, routine biochemistry analysis and CBC levels were recorded. Results: The mean age was 56.69±12.36 years in CTS group, 50.04±9.40 years in control group. The mean level of lipid parameters in CTS group; total cholesterol (TC) was 225.31±42.64 mg/dL, triglycerides (TG) was 182.85±81.65 mg/dL, LDL cholesterol was 142.77±36.23 mg/dL, HDL cholesterol was 47.71±10.68 mg/dL, respectively. Comparing lipid parameters levels of control group in terms of TC and LDL, statistically significant difference was detected between two groups (p=0.020, p=0.035). Examining the occupational factors that influence to develop for disease, it was found that 80.8% (n=42) of patient group comprised with majority of women was a housewife. Conclusions: In our study, it has been concluded that high TC and LDL values may be a risk factor in etiopathogenesis of CTS. In this sense, in addition to appropriate history and physical examination, hypercholesterolemia should not be forgotten as one of the major modifiable risk factors in women especially housewives that CTS is seen frequently. [ABSTRACT FROM AUTHOR]