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Purpose Myelomeningocele (MMC) is one of the commonest congenital malformations. Hydrocephalus develops in 65-85% of cases with MMC. Only 3-10% of MMC patients have normal urinary continence. We aim to investigate the effects of early and late operation in MMC patients in terms of development of hydrocephalus, motor deficits, and bladder functions. Methods Medical records of MMC patients operated between January 2008 and December 2014 were reviewed retrospectively. Results We retrospectively investigated patients' records of 43 patients. Twenty of the patients were operated within the first 48 h after the delivery (early repair group), while 23 of the patients were operated after 48 h of delivery (late repair group). In the early repair group, 15 patients were operated due to hydrocephalus. Urodynamic problems were detected in 17 (85%) patients. In the late repair group, shunts were placed in 14 (61%) patients during follow-up period and urodynamic problems were detected in 19 (82.6%) patients. Mean operation time for the late group was 4.6 months. There was no statistical difference between the early and late group in terms of neurological and urodynamic deficits. The mean follow-up period was 45.5 months. Conclusion In the literature, surgery in the first 48 h of life is recommended for MMC patients. There was no difference between the early- and late-operated groups by means of hydrocephalus, urodynamic functions, and motor deficits in our study. Late surgery of intact sacs may avoid complications related to surgery in the neonatal period.

Unmethylated O6-methylguanine-DNA-methyltransferase (MGMT) promoter leads to Temozolomide (TMZ) resistance in most of the glioblastoma multiforme (GBM) patients. We previously investigated the synergistic effect of Olea europaea leaf extract (OLE) on TMZ cytotoxicity through modulating microRNA expression. To date, knowledge about the effect of OLE on MGMT methylation is insufficient. The aim of the current study was to evaluate the potential modulating effect of OLE on the TMZ response of GBM tumors through MGMT methylation. Exposure to 1mg/mL OLE caused a significant induction of CpG island methylation in the MGMT gene using Methyl quantitative PCR assay (P < 0.001). In WST-1 analysis, the use of 350 mu M TMZ plus 1mg/mL OLE significantly increased the TMZ response of MGMT unmethylated cells (P = 0.003). Using the comet assay, the impact of 1mg/mL OLE plus 350 mu M TMZ on the formation of DNA strand breaks was significantly higher than that of 450 mu M TMZ alone (P < 0.001) and Western blot analysis revealed that, when cells are treated with 1-mg/mL OLE, the total p53 protein levels tended to decrease. The results presented in this study uniquely demonstrated that OLE synergistically increased the TMZ response of GBM tumors by regulating MGMT gene methylation and p53 expression. However, further studies to validate our findings are required.

In this study, histologic and electromyographic (EMG) evaluation of neuroregenerative effect of stromal vascular fraction (SVF) following periferal nerve anastomosis was aimed. Totally, 31 Wistar Albino, male rats (weighing about 300 g) were studied, and these rats were grouped according to surgical techniques performed on the right sciatic nerve: group I (GRI) micro suture (n=7), group II (GRII) micro suture + SVF (n=7), group III (GRIII) fibrin glue (n=7) and group IV (GRIV) fibrin glue + SVF (n=7). Fat tissue was taken from 3 rats to prepare SVF, and SVF was produced by non-enzymatic method. The left sciatic nerve of all rats was evaluated for EMG as control. Under general anesthesia, after transversal incision of the sciatic nerve, microsurgical epineural repair technique was performed with 10/0 nonabsorbable suture. EMG examinations were performed in terms of conduction rate, amplitude, distal latency and spontaneous muscle activity at 0th day and postoperative (PO) 1st and 8th weeks. EMG results between and within the groups were statistically evaluated by one-way analysis of variance. Rats in all groups were sacrificed by decapitation at PO 8th week and histological examinations of the sciatic nerves were performed following preparation of the neural tissues. EMG examination results showed the highest nerve conduction in GRI, the highest amplitude in GRIII, normal latency in GRII and longer distal latency in GRIV at PO 8th week. Amplitude and conduction velocity increased gradually in all groups. In needle EMG, the best muscle membrane stabilization was achieved in GRII and GRIV at PO 8th week. Statistically, the values of amplitude, distal latency, conduction velocity, and spontaneous muscle activity were found to be at normal levels at PO 8th week in all groups (P>0.05). In the histological results, although fibroconnective tissue reactions in the anastomosis area had similar scores in GRII and GRIV, maximum fibroconnective tissue reaction and the best axonal regeneration was seen in GRI and GRIII, respectively. In addition, GRI and GRII had the most inflammatory cells accumulation in the suture region, and less inflammatory cells were seen in the anastomosis area of GRIII and GRIV. As a conclusion, fibrin glue presents good electrophysiological and histological results; however, it is clear that local SVF usage on the nerve anastomosis area can be a good choice to decrease fibroconnective tissue reaction and inflammation.

Patients with glioblastoma multiforme (GBM) that are cancer stem-cell-positive (GSC [+]) essentially cannot benefit from anti-angiogenic or anti-invasive therapy. In the present study, the potential anti-angiogenic and anti-invasive effects of Olea europaea (olive) leaf extract (OLE) were tested using GSC (+) tumours. OLE (2 mg/mL) caused a significant reduction in tumour weight, vascularisation, invasiveness and migration (p = 0.0001, p < 0.001, p = 0.004; respectively) that was associated with reducing the expression of VEGFA, MMP-2 and MMP-9. This effect was synergistically increased in combination with bevacizumab. Therefore, our current findings may contribute to research on drugs that inhibit the invasiveness of GBM.

Aim To evaluate the safety and effectiveness of computed tomography-guided high-level percutaneous selective cervical cordotomy (CT-guided HPSCC). Material and methods CT-guided percutaneous procedures were performed in fifty-nine patients between the years 2004- 2013 for cancer pain. Forty-eight patients with cancer-related body pain were treated with CT-guided HPSCC was evaluated retrospectively. Results CT-guided HPSCC was performed in 33 male and 15 female patients. The mean age was 49.93 years. The distance between skin-dura, anteroposterior diameter and mediolateral diameter was measured as 40 to 71.1 mm, 8 to 88 mm and 8 to 99 mm respectively. The mean postoperative Karnofsky Performance Score (KPS) was 95. Mean preoperative Visual Analog Scale (VAS) score was 9.6, and 3.6 on postoperative day 1. The 6 th month follow-up VAS score was 6.8. Preoperative total sleeping hours in a 24-hour period were 5.5 hours, which increased in the immediate postoperative period to 8.5 hours. The most common pathology treated was bronchogenic carcinoma. Six of the procedures were bilateral and there were no permanent complication due to the procedure. Conclusion CT-guided HPSCC is still very effective, cheap and repetitive procedure for cancer pain. The procedure should be performed by experienced surgeons and although there is a hegemony of opioids, the number of surgeons that perform the procedure must be increased.

AIM: To demonstrate the effect of glatiramer acetate (GA) in chick embryos on neural tube (NT) development, and to explore its effects of FOXP1, apoptosis, and N-cadherin. MATERIAL and METHODS: One hundred fertile, specific pathogen free eggs were divided into 5 groups for this study. The eggshell was windowed specifically at 24 hours of incubation. The embryos in Group 1 (n=20) were treated with 10 mu l physiological saline; in Group 2 the embryos (n=20) were given 10 mu l GA (equal to daily human therapeutic dose); 20 mu l GA (equal to twice daily human therapeutic dose) was injected to embryos in Group 3 (n=20); in Group 4 and 5, 30 mu l and 40 mu l GA were administered to the embryos (n=20) (equal to x3 and x4 daily human therapeutic dose, respectively). Each egg was re-incubated for 24 hours more. Then, histological and immunohistochemical evaluation of the subjects were done. RESULTS: The embryos with NT defect showed FOXP1 expression without N-cadherin or staining with N-cadherin in another location in our study. We interpreted this result as GA leading to an NT closure defect by increasing FOXP expression. Moreover, we also showed the reverse relation between FOXP1 and N-cadherin at the immunohistochemical level for the first time. CONCLUSION: GA affects the spinal cord development through FOXP in the chick embryo model at high doses.

Glioblastoma represents extreme anaplasia in astrocytic tumors. In spite of this aggressiveness, extracranial metastasis of glioblastoma is very rare and has been documented in only a few patients in the literature. In this article, a 30-year-old woman with secondary glioblastoma associated with extracranial distant metastasis was presented. In September 2008, an intracranial lesion in the left frontal region was diagnosed by magnetic resonance imaging (MRI) after admission to the hospital by headache and seizure and subsequently resected. The histology of the lesion revealed an anaplastic astrocytoma (grade III). Upon recurrence of the tumor 7 months later, the patient underwent a second craniotomy for recurrence tumor resection. The histological diagnosis was glioblastoma. After radiotherapy and chemotherapy, cranial computerized tomography (CT) and whole body scintigraphy revealed metastatic lesions in the right cervical lymph nodes and the left ischium. A neck dissection and parathyroidectomy on the right side was performed. The cytomorphological and histological features of the tumor supported the diagnosis of metastatic glioblastoma. Glioblastom astrositik tümörler içerisinde en fazla anaplaziyi gösterenidir. Bu agresif davranışı yanında ekstrakraniyal metastazları oldukça nadirdir ve literatürde çok az hastada bildirilmiştir. Bu makalede, 30 yaşında sekonder glioblastoma bağlı ekstrakraniyal uzak metastazları bulunan bir bayan hasta sunulmuştur. Eylül 2008 tarihinde baş ağrısı ve nöbet şikayeti ile hastaneye başvuran hastanın çekilen kraniyal manyetik rezonans görüntülemesinde sol frontal bölgede intrakraniyal kitle saptanmıştı. Hasta opere edildi. Patoloji tanısı anaplastik astrositom (grade III)olarak raporlandı. 7 ay sonra rekürrens nedeniyle hasta tekrar opere edildi. Histolojik tanısı glioblastom olarak raporlandı. Radyoterapi ve kemoterapiden sonra çektirilen bilgisayarlı tomografi ve tüm vücut sintigrafisinde sağ servikal lenf nodları ve sol iskiumda metastatik lezyonlar saptandı. Sağ taraflı boyun diseksiyonu ve paratiroidektomi uygulandı. Sitomorfolojik ve histolojik çalışmalar metastatik glioblastomla uyumlu olarak bildirildi.

Background: Shaving before cranial surgery has been a common practice for many decades. Most of the studies were about the infection rates, but there is a few data about the effect of shaving on patient mood. The aim of this study was to determine the effects of not shaving when performing a craniotomy on the mood of the patients. Methods: Patients who underwent a craniotomy between September 2010 and September 2011 and agreed to complete a questionnaire after the surgery were included in the study. Results: 207 patients included in the study. The mean age of the patients was 44.51 +/- 18.00 years. 114 patients (55.07%) did not think about shaving when they first learned they would undergo a craniotomy; 133 (64.2%) did not ask their surgeons about being shaved during the craniotomy. 30 patients (14.4%) pointed out that not being shaved was an important factor in choosing the surgeon. Nineteen (9.1%) patients complained about the wide scar tissue and alopecia. Conclusion: Not shaving is a strong factor that affects the time necessary to get back to one's routine and orientation to social life after craniotomy without increasing infection rates. However, it is not a factor that affects the patient's choice of doctors. Kraniyal ameliyatlardan önce hastanın saçlarının kesilmesi çok uzun yıllardan beri uygulanan genel bir uygulamadır. Bu konuda yapılan çalışmaların çoğu enfeksiyon oranı üzerinedir; ancak hastaların duygu durumlarına yönelik çok az çalışma bulunmaktadır. Bu çalışmanın amacı saç kesilmeden yapılan kraniyotomilerin hasta duygu durumu üzerine etkilerini araştırmaktır. Yöntem: Eylül 2010 ve Eylül 2011 tarihleri arasında kraniyotomi uygulanan ve cerrahi sonrası anket formunu doldurmayı kabul eden hastalar çalışmaya dahil edilmiştir. Bulgular: 207 hasta çalışmaya dahil edilmiştir. Hastaların ortalama yaşı 44.51±18.00 yıl idi. 114 hasta (55.07%) ilk olarak kraniyotomi uygulanacağını öğrendiğinde saç kesilmesi hakkında düşünmemişti; 133 (64.2%) kişi cerrahlarına kraniyotomi sırasında saçlarının kesilip kesilmeyeceğini sormamışdı. 30 hasta (14.4%) saç kesilmemesinin cerrahlarını seçmede önemli bir etken olduğunu belirtti. On dokuz (9.1%) hasta geniş skar dokusu ve alopesiden şikayetçiydi. Sonuç: Saç kesilmemesi kraniyotomiden sonra enfeksiyon oranlarını arttırmadan kişinin sosyal hayata oryantasyonunu ve rutin hayatına dönme süresini kısaltan önemli bir faktördür. Bununla beraber hastaların doktor seçimini etkileyen bir faktör değildir.

The objective of this study was to investigate the effect of citicoline administration on epidural fibrosis which is a frequent complication of lumbar disc surgery with no effective treatment or preventive surgical technique.Sixty Sprague-Dawley female rats undergoing L4-5 right hemilaminotomy and annular fenestration were arranged in three groups: rats in Group 1 (control group) and Group 2 (topical citicoline group) were applied 0,9% saline and 100 μM citicoline on surgical area, respectively, while rats in Group 3 (systemic citicoline group) received 600 μmol/kg citicoline intraperitoneally. Rats were sacrificed four weeks later and their vertebral colons were removed en bloc. Groups were evaluated according to histological criteria and results were compared using statistical tools.Compared with control group, significantly less epidural fibrosis, dural adhesion, fibroblast cell density, foreign body reaction, and medulla spinalis retraction were observed in groups treated with topical and systemic citicoline (groups 2 and 3) (p0,001). No significant difference was found with regard to measured parameters between two treatment groups (p0,05).Our study demonstrates for the first time in the literature that citicoline may be effective for preventing postoperative epidural fibrosis. However, its mechanism of action and clinical effectiveness must be further investigated.

Objective: Surgical resection is the most important part of glioblastoma treatment. The objective of this study was to determine the effect of reoperation on survival of patients with glioblastoma. Methods: Records of the glioblastoma patients operated between 2001 and 2010 by the senior author were analyzed retrospectively. Comparisons were made between patients who received ( Reoperation group, n=50) and who did not receive (Monooperation group, n=111) reoperation with regard to age, gender, tumor localization, number of operations and length of survival. Results: No significant difference was found between two groups in terms of age, gender, and tumor localization. Mean follow-up duration was 12.7 months (range: 1-96 month). Mean lengths of survival after the first operation were 26.7 +/- 4.0 months and 12.2 +/- 1.6 months in the reoperation and monooperation groups, respectively (p

We report a case of a 33 year-old-man who presented with a left frontal intracerebral abscess which was associated with a frontoethmoidal orbital osteoma. Erosion of the frontobasal dura mater by the expanding osteoma caused this rare presentation. The patient underwent evacuation of the abscess followed by resection of the osteoma. Although osteomas tend to remain quiscent in most of the patients, they rarely become symptomatic to such an extent that, as in the present case, they deserve to be considered in the differential diagnosis of intracerebral abscesses.

AIM: Apoptosis after cerebral ischemia/reperfusion (I/R) injury leads to the process of cell death. The deal therapeutic approach would target the apoptosis after I/R. Ischemic postconditioning is a recently discovered neuroprotective strategy that involves the application of brief mechanical reperfusion with a specific algorithm at the onset of reperfusion following an ischemic period. MATERIAL and METHODS: Transient MCAo was performed on male SD (275 +/- 25g) rats with intraluminal thread insertion for 2hrs. Rats (n:36) were treated with postconditioning after 60 minutes of occlusion. The postconditioning algorithm was 30 secs of brief reperfusion followed by 30 secs of MCAo and this cycle was repeated 3 times at the onset of reperfusion. RESULTS: After I/R injury, % change of the malonyldialdehyde (MDA) levels in the cortex, which is an index of lipid peroxidation, was found significantly higher in the I/R group. On the other hand postconditioning upregulated Bcl-2 and Bax translocation to the mitochondria, and caspase-3 activity and also reduced oxidative stress levels. CONCLUSION: These findings indicated this neuroprotective effect is most likely achieved by antiapoptotic mechanisms through caspase pathways.

We investigated the neuroprotective effects of pre- and postconditioning on infarct volume in the transient middle cerebral artery occlusion (MCAo) model in rats. Thirty-two male rats were divided into occlusion, preconditioning, postconditioning and both pre- and postconditioning groups. MCAo (120 minutes) was monitored with continuous cerebral tissue oxygen (O-2) pressure (PtiO(2)). Pre-conditioning comprised 10 minutes of MC-Ao, 24 hours prior to the 120 minute MCAo. The postconditioning algorithm was 30 seconds of reperfusion followed by 30 seconds of MCAo. This cycle was repeated 3 times at the onset of reperfusion. Comparison of infarct volumes showed a significant difference between the conditioned groups and occlusion group. Although there was better protection in the preconditioning group compared with the other two conditioned groups, the results did not reach statistically significant levels. The results suggest that preconditioning, postconditioning and pre/post conditioning have protective effects on cerebral ischemia. (C) 2008 Elsevier Ltd. All rights reserved.

Background: As in all diffuse gliomas, recurrence is an inherent feature of oligodendrogliomas, either as the same or higher grade neoplasm at the primary site. The rate of remote recurrence after surgery for the primary tumor cannot be estimated from the scarce literature, but delayed treatment of the primary tumor and genetic alterations may be associated with this phenomenon. Case Description: A 40-year-old man presented with generalized seizures. A magnetic resonance imaging scan disclosed a right frontal mass lesion showing features of a low-grade glioma for which he refused any treatment. Seven months after diagnosis upon uncontrollable seizures, he underwent a stereotactic biopsy, which was followed by a right frontal craniotomy, both of which confirmed the lesion as a grade 2 oligodendroglioma. Six months after surgery, the patient presented with a left frontal lobe GBM without evidence of recurrence at the primary site. The genetic analysis of the primary and recurrent tumors showed trisomy 7, monosomy 10, but not 1p or 19q deletions, which have been proposed as markers for favorable prognosis. Conclusion: Recurrence of a frontal lobe oligodendroglioma remote from the primary site as a GBM is a rare occurrence. Single-cell invasion across the corpus callosum with subsequent or simultaneous malignant degeneration into a secondary GBM is the likely mechanism. As the genetic analysis suggests, conversion of oligodendroglioma to GBM may be associated with gain of chromosome 7, loss of chromosome 10, and other genetic markers that may represent late events in the oncogenesis of oligodendroglial tumors.