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To compare the posterior cranial fossa (PCF) dimensions together with the measurements related to basilar invagination and platybasia of craniovertebral junction anomalies (CVJA) in CVJA (+) and CVJA (-) Chiari malformation Type 1 (CM1) patient groups with each other and with healthy control subjects.The study group was formed of 43 CM1 and 9 tonsillar ectopia (TE) patients.A decrease was determined in the PCF vertical length (clivus and supraocciput line) and PCF volume and an increase in the transverse length (McRae and Twining line) in the CM1 cases compared to the healthy control group. There was no difference between the CVJA (+) and (-) CM1 groups in respect of the vertical and transverse length and PCF volume values. An increase in the classic and modified skull base angles was observed in the CVJA (+) CM1 group compared to the CVJA (-) CM1 group. The Wackenheim clivus angle was determined to be smaller in the CVJA (+) CM1 group compared to the CVJA (-) CM1 group.The PCF is flattened and smaller in CM1 cases compared to normal control subjects. In the planning of CM1 operations, the angle parameters may be more useful than the PCF and CVJA length parameters between CVJA (+) and (-) CM1 groups. The significant decrease in postoperative recovery in the CVJA (+) CM1 group compared to the CVJA (-) CM1 group supports the need for additional operations and/or a different surgical technique in the treatment of CVJA (+) CM1 patients.

AIM To compare the complications and surgical outcomes between bilateral rotation flaps and dorsal intercostal artery perforator (DICAP) flaps in the soft tissue reconstruction of myelomeningocele defects. MATERIAL AND METHODS Between January 2005 and February 2017, we studied 47 patients who underwent reconstruction of myelomeningocele defects. Patient demographics, operative data, and postoperative data were reviewed retrospectively and are included in the study. RESULTS We found no statistically significant differences in patient demographics and surgical complications between these two groups; this may be due to small sample size. With regard to complications-partial flap necrosis, cerebrospinal fluid (CSF) leakage, necessity for reoperation, and wound infection-DICAP propeller flaps were clinically superior to rotation flaps. Partial flap necrosis was associated with CSF leakage and wound infection, and CSF leakage was associated with wound dehiscence. CONCLUSION Although surgical outcomes obtained with DICAP propeller flaps were clinically superior to those obtained with rotation flaps, there was no statistically significant difference between the two patient groups. A well-designed comparative study with adequate sample size is needed. Nonetheless, we suggest using DICAP propeller flaps for reconstruction of large myelomeningocele defects.

Aim Whether the macular lesions associated with spinal dysraphism should be preserved is controversial. This area is usually excised during reconstruction. This study aims to characterize the macular lesions associated with spinal dysraphism and to determine the outcomes of cases in which macular lesions are not excised. Material and methods The patient cohort comprised 17 patients with spinal dysraphism who were treated at Mersin University Hospital from 2005 through 2007. Blood and tissue samples were obtained from these patients. Results Electron microscopy results of tissue samples obtained from macular lesions are not consistent with those of hemangiomas. Increased numbers of vessels and significant dilatation was noted upon examination by light microscopy. The number of mast cell numbers, blood estradiol levels, expression of tissue inhibitor matrix metalloproteinase-1 (TIMP-1) and vascular endothelial growth factor (VEGF), and dermal collagen fiber diameter were within normal range. Estrogen receptor-β was not expressed. The number of endothelial cells expressing von-Willebrand factor was higher in the macular lesions. Conclusion The characteristics of macular lesions associated with spinal dysraphism are consistent with those of capillary malformations. We believe that the preservation of these macular lesions during soft tissue reconstruction of spinal dysraphism defects, either by mobilization on a flap or primary closure, does not compromise the viability of the macular region. By preserving these macular lesions, the creation of larger defects during excision is avoided.

Grisel's syndrome designates subluxation of atlanto-axial joint unrelated to trauma or bone disease. Atlanto-axial subluxation is seen after the upper neck inflammatory processes of head and neck region. Moreover, this rare clinical entity has been observed after various otolaryngological surgical approaches including adenoidectomy, tonsillectomy and mastoidectomy. An 8-year-old girl and 14 year-old boy presented with complaints of painful torticollis. The first patient was operated on at another health center due to adenoid hypertrophy. She was referred to our clinic on the postoperative 5th day with painful torticollis. The diagnosis was established by computerized tomography and three-dimensional reconstructions. The second patient had a history of throat infection. Radiological investigation demonstrated atlantoaxial subluxation. The patients were treated with external fixation, antibiotic therapy, muscle relaxants, and anti-inflammatory therapy. Early diagnosis and appropriate treatment resulted in a good outcome in our patients. Grisel's syndrome must be considered in the differential diagnosis in children with painful torticollis associated with upper respiratory tract infection and after various otolaryngological surgical procedures. We report two cases of Grisel's syndrome which emphasize on the importance of early diagnosis for appropriate and successful treatment.