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Purpose: The aim of this study is to reveal the effect of external ventricular drainage system on mortality, potential complications and management of complications. Materials and Methods: Data of 128 patients undergoing external ventricular drain placement procedure at XXX University Department of Neurosurgery between January 2016 and November 2018 were screened retrospectively. Age, sex, indication, level of consciousness at the time of admission, presence of systemic infection, and secondary complications of the patients were examined. The effects of external ventricular drainage on clinical outcome were evaluated. Results: A total of 176 ventriculostomies were performed in 128 patients during the study. There were 73 male and 55 female patients with an age range of 1-88 years. The mean Glasgow Coma Scale at admission was ≤7 in 64 patients. Ventriculitis developed in a total of 38 patients. Systemic infection and antibiotic use history were detected in eight patients at admission. Fifty-two patients died during the follow-up period. Conclusion: External ventricular drainage is a system applied to reduce intracranial pressure under emergency conditions and has positive effects on clinical survival rate. Infection is the most common and most mortal complication. The drainage should only be applied in cases where it is absolutely necessary and in accordance with certain protocols. Furthermore, ventriculostomy should be kept only for the required period of time, and patients should be followed closely considering the exponential increase in infection after five days.

AIM To examine foramen magnum morphometry and shape of Chiari malformation in comparison with a control group, and to contribute to the literature on whether Chiari malformation affects foramen magnum morphometry. MATERIAL AND METHODS In this study, cranial magnetic resonance images of 71 people with Chiari malformation and 61 people as controls were examined. The anteroposterior diameter, transverse diameter, and area of the foramen magnum were measured, and the shape of the foramen magnum was determined. RESULTS In the Chiari malformation group, the anteroposterior diameter of the foramen magnum was 39.11 ± 4.29 mm, the transverse diameter was 34.25 ± 3.27 mm, and its area was 969.21 ± 199.57 mm 2 . These results were statistically higher in female patients in the Chiari malformation group than in the control group. No significant difference was found between male patients in the Chiari malformation group and those in the control group. Round-shaped foramen magnum was predominant in both groups, but this was not statistically significant. CONCLUSION In Chiari malformation, the foramen magnum is affected. This effect can be a factor that influences development of a malformation. As a result of a malformation, the foramen magnum may have expanded due to the pressure effect. More detailed and extensive research is needed to explain this phenomenon.

Lomber disc hernias (LDH) are one of the mostbasic illnesses that affect many people today.Surgical treatment is planned in patients whodo not benefit from conservative treatment.One of the common complications after surgeryis spinal infections. Spinal infections canaffect disc spacing and vertebral body, and maycreate lumbar abscesses. Infection beginsclinically with low back and back pain, thenmovement limitation, leg pain and fever areseen. We wanted to draw attention to theapproach to spinal infections by presenting apatient who had undergone a lomberoperation twice in our present circumstanceand who was followed up for 2 years despitemedical abcess and fistula formation., Lomber disk hernileri (LDH) günümüzde birçokinsanı etkileyen, yaşam kalitesini bozan en temelhastalıklardan biridir. Konservatif tedavilerdenfayda görmeyen hastalarda cerrahi tedaviplanlanır. Cerrahi sonrası görülen sık komplikasyonlardanbir tanesi spinal enfeksiyonlardır.Spinal enfeksiyonlar disk mesafesini ve vertebragövdesini etkileyebilir, lomber abse oluşturabilir.Enfeksiyon klinik olarak bel ve sırt ağrısı ilebaşlar, daha sonra hareket kısıtlılığı, bacak ağrısıve ateş görülür. Bu olgumuzda daha önce 2 kezlomber operasyon geçiren, abse ve fistül oluşmasınarağmen 2 yıl boyunca medikal olarak takipedilen hasta sunarak spinal enfeksiyonlarayaklaşım konusuna dikkat çekmek istedik

Aim Transpedicular screw fixation is widely used because this method stabilises three columns of the vertebrae. However, upper cervical vertebrae implantation surgery is a difficult procedure. Applied instrumented surgery training includes animal and cadaver studies; however, every surgical residency programme cannot provide equal requirements. Augmented Reality (AR) is a technology that allows computer-generated virtual imagery information to be overlaid onto a live, direct or indirect, real-world environment in real time. We investigated the use of this technology as it contributes to spinal surgery education with the free-hand technique, and might reduce the error ratio. Material and methods Ten candidates, with anatomy education but no surgical experience, applied 36 pedicle screws with C2-C3 posterior transpedicular fixation technique to nine vertebrae models produced via a 3D printer. Results Using AR to apply pedicle screws to the experimental vertebrae model increased the safety screw ratio significantly. In comparison of Grade 0 screws to other grades: 6/18 screws (33.3%) in the free-hand technique Group (n=18), and 14/18 screws (77.8%) in the AR Group (n=18), were measured for screw insertion safety ratios. The difference was statistically significant (p=0.018). The resemblance between our results and the results of previous studies researching supportive systems indicates our 3D printed vertebra model might be a helpful educational material. Conclusion AR increases the safety ratio of cervical pedicle screw fixation significantly. The parameters investigated and used for the production of vertebrae models in this study can be used for experimental material production for future studies to investigate pedicle screw positioning.

OBJECTIVE: Many factors determine the approach towards cervical disc hernias from the anterior or posterior. Nowadays, the posterior approach is less preferable compared to the anterior intervention. In this study, we evaluated the post-operative results of patients with cervical disc hernias and cervical foraminal stenosis who were suitable for posterior intervention and were operated on by this method.MATERIAL AND METHODS: The clinical and post-operative results of 28 patients, who underwent surgery with the posterior cervical approach between June 2014 and June 2018, were discussed.RESULTS: The 28 patients who underwent surgery with the posterior approach, 16 were male, 12 were female, and the mean age was 47.8 years (age range 40-66 years). All patients had a complaint of unilateral radiculopathy, with 18 of them on the left side and 10 of them on the right side. Sixteen of the patients had a soft ruptured cervical disc, and 12 were diagnosed with foraminal stenosis.CONCLUSIONS: Posterior level laminoforaminotomy is one of the most suitable options in cervical disc hernias and cervical foraminal stenosis in the selected patients. This method provides better clinical results in soft ruptured disc patients., AMAÇ: Servikal disk hernilerine anterior veya posteriordan yaklaşımı belirleyen birçok faktör vardır. Günümüzde posterior yaklaşım anterior girişime oranla daha az tercih edilmektedir. Bu çalışmamızda servikal disk hernisi ve servikal foraminal stenozu bulunan ve posterior girişime uygun olup bu yöntemle opere edilen hastaların post-operatif sonuçlarını değerlendirdik.GEREÇ VE YÖNTEM: Haziran 2014 ve Haziran 2018 seneleri arasında posterior servikal yaklaşımla ameliyat edilmiş 28 hastanın, klinik ve post-operatif sonuçları tartışıldı.BULGULAR: Posterior yaklaşımla ameliyat edilmiş 28 hastanın 16 tanesi erkek, 12 tanesi kadındı ve ortalama yaş 47.8 (yaş aralığı 40-66 yıl) idi. Hastaların hepsinde tek taraflı radikülopati şikayeti mevcuttu. 18 tanesi sol, 10 tanesi sağ taraf kaynaklıydı. Hastaların 16 tanesi yumuşak rüptüre servikal disk, 12 tanesi foraminal stenoz tanılı idi.SONUÇ: Posterior servikal laminoforaminotomi seçilmiş hastalarda servikal disk hernisinde ve servikal foraminal stenozda en uygun seçeneklerden birisidir. Bu yöntem yumuşak rüptüre disk hastalarında daha iyi klinik sonuç vermektedir.

Traumatic injuries of the subaxial cervical spine (C3-7); considered among the most common and most damaging injuries to the axial skeleton. Decompression of the spine is standard approach after cervical spinal cord injury.In this study, 72 patients who underwent early decompression with the decision of surgery according to the classification system with the Subaxial Injury Classification and Severity Scale (SLICS) among 212 patients who developed spine fractures as a result of acute traumatic subaxial cervical trauma were examined.ASIA scoring system was used for neurological examination evaluation.Patients were included in the rehabilitation program, which lasted at least six months after the operation.Neurological recovery results were evaluated with ASIA scores obtained after the rehabilitation program.It has been shown that early surgery for subaxial cervical spine fractures contributes significantly to the patient's neurological recovery.

BACKGROUND: Head trauma is a health problem that may be observed in all age groups, and it may cause significant losses in terms of health and economy. The purpose of our study is to evaluate the abnormal computerized brain tomography (CBT) prevalence and the rate of admission to brain surgery clinics in patients who applied to the Emergency Service Department for CBT due to minor head trauma. METHODS: In the present study, the patients who were admitted to Afyonkarahisar Health Sciences University, Faculty of Medicine Hospital, Emergency Service Department between January 1st, 2017, and December 31st, 2017, due to head trauma and in who CBT was performed were examined retrospectively. The electronic files, CBTs, and consultation notes of these patients were accessed in the information system of the hospital. RESULTS: A total of 43,389 patients who applied to the Emergency Service Department in 1 years’ time (2017) were examined retrospectively. As a result of the examination, it was determined that a total of 2,515 (5.7%) patients received CBT. The reason for a total of 1,152 (45%) of these patients was traumatic injury. It was determined that 618 (53.6%) of the patients in who CBT was performed due to trauma were aged

Neural fibrolipoma is characterized by infiltration of the epineurium by adipose and fibrous tissue. Intradural spinal cases are extremely rare. We report an unusual case of spinal neural fibrolipoma. A 31-year-old pregnant woman presented due to weakness of right leg (muscle strength 2/5). Magnetic resonance (MR) evaluation of the spine revealed an extramedullary intradural mass at the T1-T4 level. MR findings were suggesting a dermoid cyst or a lipoma. Subtotal surgical excision of the tumor was done. Histopathological examination showed enlarged nerve bundles infiltrated by fibroadipose tissue. Thus, the diagnosis of neural fibrolipoma was established. One month after surgery, lumbar MR showed residual tumor tissue, but successful decompression of the spinal cord. Six months after surgery, the neurological examination, muscle strength 4/5 evaluated. Neural fibrolipoma is characterized by infiltration of the epineurium by adipose and fibrous tissue. The tissue grows between and around nerve bundles thereby causing enlargement of the affected nerve. Neural fibrolipoma is a benign lesion with no effective therapy. Surgical excision usually causes severe damage of the involved nerve. Although spinal cases are extremely rare, it should be included in the differential diagnosis of extramedullary intradural masses.

Şimşek, Nejdet (Balikesir Author), PURPOSE: To evaluate the central nervous system toxicity of cisplatin and neuroprotective effect of selenium. METHODS: Twenty-one male Wistar albino rats were divided into three groups: control (C), cisplatin (CS), cisplatin and selenium (CSE, n=7 in each group). Cisplatin (12 mg/kg/day, i.p.) was administered to CS and CSE groups for three days. Furthermore, CSE group received 3mg/kg/day (twice-a-day as 1.5 mg/kg) selenium via oral gavage five days before cisplatin injection and continued for 11 consecutive days. The same volumes of saline were administered to C group intraperitoneally and orally at same time. RESULTS: Heterochromatic and vacuolated neurons and dilated capillary vessels in the brain were observed in the histochemical examinations of cisplatin treated group. Rats that were given a dose of 3mg/kg/day selenium decreased the cisplatin induced histopathological changes in the brain, indicating a protective effect. In addition, cytoplasmic staining of the cell for bcl-2, both cytoplasmic and nuclear staining for bax were determined to be positive in the all groups. Bax positive cells were increased in the CS group compared to C group, in contrast to decreased bcl-2 positivity. CONCLUSION: Selenium limited apototic activity and histological changes due to the cisplatin related central neurotoxicity.

Introduction: Spondylodiscitis (SD) is an uncommon but important infection. The aim of this work was to study the risk factors, bacteriological features, clinical, laboratory and radiological findings of SD, and to shed light on the initial treatment. Methodology: A total of 107 patients who underwent treatment for SD were evaluated. The diagnosis of SD was defined by clinical findings, complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum tube agglutination (STA) test, Ziehl-Neelsen staining, culture, histopathology, and radiological methods such as magnetic resonance imaging (MRI) and computed tomography (CT) scans. Results: Of the 107 cases, ranging between 17 to 83 years of age, 64 (59.8%) were male. Twenty-seven (25.2%) patients had diabetes mellitus. Laboratory investigations revealed elevated CRP in 70 (65%) patients, elevated ESR in 65 (61%) patients, and elevated white blood cell (WBC) counts in 41 (38.3%) patients. Thirty-six (33.6%) patients were identified as having brucellar SD, and 5 (4.7%) patients were identified as having tuberculous SD. A total of 66 (61.6%) patients were determined to have pyogenic SD. The most frequently isolated microorganism was Staphylococcus aureus. Antibiotic therapy was given intravenously to all pyogenic SD patients. Conclusions: The incidence of SD has increased as a result of the higher life expectancy of older patients with chronic debilitating diseases and the increase of spinal surgical procedures. In patients with low back pain, SD should be considered as a diagnosis. For effective treatment, it is important to determine the etiology of the disease.

Eser, Olcay (Balikesir Author), Kronik subdural hematom genellikle erişkin hastalığı olmakla birlikte çocuklarda nadirdir.Bu yazıda 9 yaşında erkek hastada futbol oynarken kafasına top çarpmasına bağlı gelişen araknoid kist ile ilişkili kronik subdural hematom olgusunu sunduk. Mental durum değişikliği veya nörolojik bozukluk gözlenmedi.Tek burr hole ile hematom drenajı yapıldı. Bir hafta sonra, hasta saçlı deride şişlik şikayetiyle kliniğimize başvurdu. Fizik muayenede verteksten başlayan subkütanöz fluktuasyon mevcuttu. Yazarlar kronik subdural hematomun ameliyat sonrası döneminde gelişen nadir bir komplikasyonunu ve araknoid kist ile ilişkili spora bağlı kronik subdural hematom olgusu bildirmektedir., Chronic subdural hematoma is predominantly a disease of the elderly and is rare in children. We report here a rare case of chronic subdural hematoma associated with arachnoid cyst in a 9-year-old child due to ball struck to his head while he was playing football. No altered mental state or focal neurological deficits were observed. The hematoma drainage was performed with one burr-hole. One week later, the patient was admitted to our clinic with complaint of scalp swelling. Physical examination revealed subcutaneous fluctuation beginning from the vertex. The authors reported a case of sports related chronic subdural hematoma in association with arachnoid cyst and a rare complication of subdural hematoma during postoperative period.

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by anterior and lateral ossification of the vertebral body. We present a case report of central cord syndrome in a patient with DISH after minor trauma. The patient was treated surgically. We also discuss symptomatology and the common mechanism of cord injury in DISH.

Osteomlar membranöz kemiklerin yavaş büyüyen benign tümörleridir. Osteomlar kalvaryumun en sık primer benign tümörleridir. Kalvaryum osteomları genellikle dış tabuladan kaynaklanırlar. Asemptomatik lezyonlarda tedavi gerekmemektedir. Kozmetik nedenlerle cerrahi eksizyon yapılabilir. Çalışmamızda 51 yaşında bir erkek hasta temporoparyetal bölgede şişlik nedeniyle opere edildi. Histopatolojik inceleme sonucu osteom tanısı konuldu. Olgu literatür gözden geçirilerek sunuldu., Osteomas are slowly growing benign tumors of membranous bone. Osteomas are the most common primary benign tumors of the calvaria. Osteomas of the calvaria usually arise from the external table. No treatment is required for asymptomatic lesions. Surgical excision is possible for cosmetic reasons. In our study a 51 years-old male patient was operated for swelling in temporoparietal region. Osteoma was diagnosed by histopathological examination. Case was presented with literature review.

This study aimed to investigate the 677CT and 1298AC MTHFR gene polymorphisms and their metabolic effects on the levels of folate, vitamin B12 and homocysteine in the serum of Turkish spina bifida occulta (SBO) patients and healthy individuals in disease.A case-control study was performed to detect 677CT and 1298AC MTHFR gene polymorphisms in 39 SBO patients and 34 healthy individuals. The folate, vitamin B12 and homocysteine concentrations in the serum of SBO and healthy individuals were evaluated and compared with MTHFR gene polymorphisms.677 CC/CT/TT MTHFR genotype frequency differences between the SBO patients and controls were not significant (x(2)=3.325, P=0.068; x(2)=1.479, P=0.224; x(2)=0.275, P=0.600; respectively). 1298AC MTHFR genotype frequency differences between the SBO patients and controls were significant (x(2)=8.477, P=0.004). The frequencies of the Aand C alleles of the 1298AC polymorphism did not differ in a statistically significant manner between the groups (x(2)=0.576, P=0.448). The biochemical parameters were not significantly different between SBO patients and healthy individuals (P0.05).The 677CT and 1298AC polymorphisms of the MTHFR gene cannot be regarded as major risk factors for SBO in the Turkish patients 677TT homozygosity may affect the metabolism of homocysteine.

A pneumatocyst in the cervical spine is extremely rare and to our knowledge only a few reports have been published in the English literature. Although the etiology and natural course of vertebral body pneumatocyst is unclear, nitrogen gas accumulation is claimed. A 65-year-old-man was admitted to the emergency department with neck pain and numbness and incapacity in his both hands and fingers. The radiological images revealed a vertebral located pneumatocyst in the C4 cervical vertebra. In this report, we present a case of cervical pneumatocyst located in the C4 vertebral body. The clinical and radiological features and natural course of the pneumatocyst were evaluated.

We report a rare case in which a metallic foreign object migrated to cervical intervertebral foramina. Only two cases have been reported.Plain films films and Computed Tomography of the cervical spine showed a foraminal metallic object