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Foraminal and far lateral disc herniations are rarer cause of nerve root compression. There are reports regarding the outcome, however long-term follow-up results of surgically treated patients are few. The purpose of this retrospective study is to analyze the clinical characteristics and long-term surgical outcomes of the foraminal and far lateral disc herniations. The 114 patients who underwent an operation for foraminal and far lateral disc herniaitions were reviewed. Visual analogue scale of back and leg pain, the ocurrence of motor deficit and sensory dysesthesia before and after operations were used to compare the results of early and long-term outcome. A total of 114 telephone interviews were conducted. The mean follow up was 134 months. Complete relief of symptoms were reported by 77 patients (67.1%). The average VAS of radicular leg pain was 7.5 Post-operatively the average VAS of radicular pain decreased to 2.2. Preoperatively, 9 patients (7.6%) had motor deficit and 17 (14.4%) patients had sensory dysesthesia. Post-operatively 9 (100%) of the patients showed motor, and 12 (70.6%) of the patients showed sensory improvement. In 17 patients with hypoesthesia the complaints continued during 2 weeks to 6 months. They were given gabapentin as medical treatment, however 5 of these patients still have sensory dysesthesia. The outcome was: 67.1% excellent (77 patients), 26.3% good (30 patients), 6.1% fair (7 patients). The far lateral approach is a minimally invasive and safe procedure with low complication rates. [ABSTRACT FROM AUTHOR]

Glioblastoma multiforme (GBM) is the most common and the most malignant primary intracranial tumor in adults. GBM extraneural metastases occur in only approximately 0.2–0.4% of patients. We present a case of a cervical metastasis of glioblastoma after cranial tumor resection. In concord with case presentation, we reviewed the metastatic location and metastasis time of the gliablastomas seen in the literature. [ABSTRACT FROM AUTHOR]

Background. This study analyses the transforaminal lumbar steroid injection videos that have the highest views and likes on YouTube, and attempts to reveal the video qualities in order to contribute to the literature. Methods. For review, "transforaminal lumbar steroid injection" was written to the standard YouTube search bar, and the videos with the highest views were ranked using advanced search preferences. The 50 most widely viewed videos were watched and scored by 2 physicians. Results. The mean Modified DISCERN Score of the videos was 2,66+/-1,032 (the lowest: 1; the highest: 4) while the mean GQS score was 2,876+/-1,06 (the lowest: 1; the highest:4). In addition, the mean DISCERN score and the mean GQS value were 3,51 and 3,82, respectively, for the informational videos that were uploaded by health professionals but did not contain actual surgery. Conclusion. We think that medical associations and state authorities in medicine should check the validity and accuracy of the information on the internet and should support the society in access to the most correct information. [ABSTRACT FROM AUTHOR]

Purpose: Lateral supraorbital approach is a simpler and quicker method than pterional approach. It provides a more anterior projection when compared to the pterional approach. There are some minor differences of the modified lateral supraorbital approach when compared to lateral supraorbital approach. It is directed more subfrontally and anterior than the pterional and lateral supraorbital approach. Material and methods: We used modified lateral supraorbital approach in 100 cases between 2012 and 2015 in Medical Park İzmir Hospital/Turkey. The assessed data were as follows: age, gender, Glasgow coma scale at admission, the localization of pathology, the condition of surgical obliteration for aneurysm, excision grade for meningioma, length of stay in the hospital and Glasgow outcoma scale at discharge. Results: Of all patients, 58 (58%) were men and 42 (42%) were women. Our cases were anterior communicating artery aneurysms (41 cases), tuberculum sella and medial sphenoid wing meningiomas (22 cases), middle cerebral artery aneurysms (15 cases), olfactory groove meningiomas (15 cases), anterior choroidal artery aneurysms (4 cases) and posterior communicating artery aneurysms (3 cases). 4 patients died and the mortality rate of the study cohort was 4%. Conclusions: The MLSA is faster, simpler and less invasive than the PA and LSA. [ABSTRACT FROM AUTHOR]

The spontaneous regression of lumbar herniated disc is a common occurrence. However, regression of lumbar disc herniation at one level and occurrence of lumbar disc herniation at another level is not common. A 35 year old man presented with a lumbar disc extrusion at L2-3 level manifesting as a right L3 radiculopathy. Surgery was suggested to him but he refused. 3 months after onset, he suffered right L5 radiculopathy with a new lumbar disc extrusion at L4-5 level and there was a regression of previous L2-3 herniation. The present case suggest the importance of careful clinical examination and the importance of a new radiology accompanied by clinical findings before the surgery. [ABSTRACT FROM AUTHOR]

Objective: The most common used technique for posterolateral cervical disc herniations is anterior approach. However, posterior cervical laminotoforaminomy can provide excellent results in appropriately selected patients with foraminal stenosis in either soft disc prolapse or cervical spondylosis. The purpose of this study was to present the clinical outcomes following posterior laminoforaminotomy in patients with radiculopathy. Materials and Methods: We retrospectively evaluated 35 patients diagnosed with posterolateral cervical disc herniation and cervical spondylosis with foraminal stenosis causing radiculopathy operated by the posterior cervical keyhole laminoforaminotomy between the years 2010 and 2015. Results: The file records and the radiographic images of the 35 patients were assessed retrospectively. The mean age was 46.4 years (range: 34-66 years). Of the patients, 19 were males and 16 were females. In all of the patients, the neurologic deficit observed was radiculopathy. The posterolaterally localized disc herniations and the osteophytic structures were on the left side in 18 cases and on the right in 17 cases. In 10 of the patients, the disc level was at C5-6, in 18 at C6-7, in 2 at C3-4, in 2 at C4-5, in 1 at C7-T1, in 1 patient at both C5-6 and C6-7, and in 1 at both C4-5 and C5-6. In 14 of these 35 patients, both osteophytic structures and protruded disc herniation were present. Intervertebral foramen stenosis was present in all of the patients with osteophytes. Postoperatively, in 31 patients the complaints were relieved completely and four patients had complaints of neck pain and paresthesia radiating to the arm (the success of operation was 88.5%). On control examinations, there was no finding of instability or cervical kyphosis. Conclusion: Posterior cervical laminoforaminotomy is an alternative appropriate choice in both cervical soft disc herniations and cervical stenosis. [ABSTRACT FROM AUTHOR]

Background/aim: Posterior cervical laminoforaminotomy is an effective surgical treatment in selected cases of cervical radiculopathy caused by posterolateral herniated discs or foraminal stenosis. The aim of the present study was to evaluate the surgical techniques, rates of complications, long-term outcomes, advantages, and disadvantages of keyhole foraminotomy retrospectively. Materials and methods: Keyhole foraminotomy was performed in 83 patients. In 51 patients (61.5%) soft disc herniation was removed, and in 32 of them (38.5%) osteophytes were evident. The clinical data were evaluated according to Odom's criteria, and the mean followup time was 6 months. Results: Postoperative results were classed as excellent in 66 patients (79.5%), good in 13 patients (15.7%), fair in 3 patients (3.6%), and poor in only 1 patient (1.2%). Radiculopathy symptoms regressed in 79 patients (95%). Among the 83 patients, surgical complications (dural injury and level error) were noted in 2 patients (2.4%). Conclusion: Posterior laminoforaminotomy is applied to selected patients with a low complication rate. The advantages of this surgery are suitable visualization of the nerve root, preserved motion of the operated segment, avoidance of cervical instability, and a decrease in the length of hospital stay. [ABSTRACT FROM AUTHOR]

Purpose: Repairing of the duramater is one of the major factor that effects the mortality and morbidity of patients after neurosurgical approaches. The gold standard for repairing of duramater is watertight suture or duraplasty with autografts such as pericranium and/or temporal fascia. Sometimes edges of the dura mater generally are shrunken and the watertight suture of the dura becomes impossible especially in emergency conditions. In the present study, we aimed to determine the most effective artificial dural graft in experimental dural defect in rats. Materials and Methods: Twenty eights wistar albino rats weight ranging from 280-320 grams and equal numbers of male and female were used. The animals were divided into four groups. Control (n=7 Group-1), collagen matrix graft (n=7 Group-2), cellulose graft (n=7 Group-3) and teflon graft (n=7 Group-4). Rats were sacrificed after 30 days and their damaged dura were removed and sections were taken. All histological preparations examined using light microscope. Histological analysis focused on fibroblastic activation, new capillary formation, inflammatory reaction, foreign body reaction and capsule formation and results were compared. Results: While fibroblastic activation was observed most frequently in teflon graft group, new capillary formation, inflammatory reactions and capsule formation were most frequently seen in cellulose grafts group. Conclusion: This animal model for artificial dural grafts suggest that cellulose was the most effective dural substitute for repairing of defective dura. [ABSTRACT FROM AUTHOR]

The present study aims to investigate the prophylactic effects of daptomycin and vancomycin in an experimental spinal infection induced by spinal implantation. The study involved inoculation of a bacterial suspension prepared with the MRSA ATCC 43300 strain to the implant bed and to the peripheral tissue immediately the implantation of titanium spinal implants to the bone in adult Winstar rats. The animals were divided into three groups; seven rats in the first group received no antibiotics, while the seven rats in group two and eight rats in group three received daptomycin and vancomycin, respectively. Microbiological and histological assessments were carried out on rats with induced infections. In the swab cultures of deep surgical areas, vancomycin demonstrated inhibition of infection of the surgical site in half of animals (50%) whereas daptomycin exhibited the same effect in more animals (71.4%), which was statistically significant compared to the control group (p<0.05). In the implant and bone culture, a statistically significant superiority was not observed in prophylactically treated with either antibiotic and nontreated control group (p>0.05 ). As a result; comparing control group, preventive effects of daptomycin and vancomycin in infection induced model of spinal implantation with high bacteria inoculums were not found statistically significant whereas daptomycin showed statistically significant inhibition on deep surgical area infection. [ABSTRACT FROM AUTHOR]

Aim: Thrombocyte activation is one of the mechanisms blamed for emerging of early brain injury(EBI) soon after subarachnoid hemorrhage(SAH). It is wondered by researching to what extend neuron injury is prevented by making thrombocyte inhibition in SAH model. It shows that the role of trombocyte activation on EBI. Material and Method: 21 rabbits weighting 3-5 kg are divided in 3 groups 7 each. After ether anesthesia, 0.2 cc arterial blood taking from group 1 and 2 was injected into cysterna magna and created SAH. After SAH, at regular intervals antithrombocyte drug (tirofiban) was given to group 2 intraperitoneally; no treatment was carried on group 1. 0.2 cc SF was injected into cysterna magna in group 3. Decapitation was done in 72nd hour and then ischemic brain map was done at hippocampus level. The amount of ischemic neuron was scored and statistically analyzed. Results: SAH was detected in all rabbits of group 1 and 2. There are meaningful difference between the group 1 and group 3 of scoring ischemic neuron of hippocampus's CA-3 and CA- 4 areas. Whereas in group 2 ,which is a ischemic neuron treatment group, there is a decline in each area, this decline has reached to a statistical means only in CA-4 area. Conclusion: There can be neuronal loss due to EBI even in the area which is free from blood in experimental SAH. Decreasing the injury of neuron with an antithrombocyte medicine shows that thrombocyte activation plays a great role in pathogenesis of EBI. [ABSTRACT FROM AUTHOR]

Aim: To investigate the neuroprotective effect of shilajit extract in experimental head trauma., Material and Methods: Three groups of 33 Sprague Dawley Albino strain male rats were included in the study. Group 1 (n=11): trauma but not treated. Group 2 (n=11): trauma and treated with 0.5 mL / rat saline Group 3 (n=11): 150 mg / kg shilajit extract was administered intraperitoneally in the treatment of trauma. Following the head trauma, the indicated treatments were applied to the 2nd and 3rd groups at the first, twenty-four and forty-eighth hours. Brain tissues and blood samples were taken after the control animals were sacrificed at the 72nd hour in all groups after trauma. Sections prepared from cerebral cortex and ca1 region were examined with hematoxylin eosin and luxol fast blue staining. Total antioxidant capacity, total oxidant capacity and oxidative stress index were measured from blood samples taken after routine procedures., Results: The number of red neurons and the severity of edema were significantly higher in both the cerebral cortex and the ca1 region in the group treated with trauma only and in the group administered saline after trauma compared to the group that received shilajit extract after trauma. The total antioxidant capacity increased significantly in blood samples taken only from the group treated with trauma and saline in post-trauma treatment compared to the group given post-traumatic shilajit extract, while shilajit extract given due to traumatic brain injury significantly decreased the total oxidant capacity and oxidative stress index values compared to the other groups., Conclusion: Shilajit extract has been shown to have a neuroprotective effect in the treatment of acute traumatic brain injury. Our study showed that shilajit may be a useful option in the treatment of secondary brain injury, in humans.

Aim: We have evaluated the anatomic measurements on sellar area of patients who were radiologically diagnosed with empty sella to determine the relation between the amount of pressure on the adenohypophysis and hormonal imbalances., Materials and Methods: Sixty-one cases were diagnosed with empty sella and had hormone tests and hypophysis magnetic resonance (MR). The cases were categorized into two groups - patients with hypophyseal hormone anomaly and patients without hormone anomaly. We have measured interclinoid distance, anteroposterior distance from the anterior diaphragm sella to the pituitary stalk, depth of the sella turcica, craniocaudal distance of the optic chiasm from the diaphragm sella, the heights of the right and left adenohypophysis, subcutaneous fat thickness measured orthogonal to the coronal suture and posteriorly at the level of C2-C3 for two groups on hypophysis and cranial MR imaging MRI., Results: Twenty-five hormone-positive cases (40.9%) (hormone test were abnormal) and 36 hormone-negative cases (59.1%) (hormone tests were normal) were included in the study. The most common hormone abnormality was thyroid-stimulating hormone, T3 and T4 deficiency in 12 cases (48%) and increase in prolactin level in 7 cases (28%). Right adenohypophysis height was 1.54 ± 0.840 mm for the 1 st group, and 1.96 ± 0.83 mm for the 2 nd group. The left adenohypophysis height was 1.66 ± 0.80 mm for the 1 st group, and 1.94 ± 0.94 mm for the 2 nd group. It was found out that the thickness at right and left side in the hormone-positive group diminished significantly., Conclusion: Adenohypophysis height and distance between stalk and optic nerve were good determiner for hormone defect., Competing Interests: There are no conflicts of interest.

Aim: Lumbar discectomy is a common surgical intervention in neurosurgical practice. Iatrogenic vascular injury during this surgery is a rare, but serious complication. In this study, our aim was to review the average safe depth of discectomy for both sexes., Material and Methods: This study involved a total of 56 patients between 21 and 79 years old (28 male and 28 female) who had no surgical pathology as documented by lumbar magnetic resonance imaging study. Measurements at L3-4, L4-5, and L5-S1 were performed for both sexes as follows: 1 < sup > st < /sup > measurement, from the furthest lateral part of the dura to the end of the disc (right-left); 2 < sup > nd < /sup > measurement, the anteroposterior length of the cross-section passing through the midline of the disc; 3rd measurement; from the furthest lateral part of the dura to the furthest lateral part of the disc (right-left); 4th measurement, the length from right to left of the cross-section passing through the midline of the disc., Results: Measurement 1 at L3-4, L4-5, and L5-S1, this value was estimated to be 35.9 and 36.7 mm, 35.9 and 36.9, and 34 and 34.9 mm in the right and left sides respectively, for female subjects. The corresponding values for males were 41.4 and 42.1, 40.6 and 40.9, and 37.4 and 37.7 mm at L3-4, L4-5, and L5-S1, respectively. Measurement 3 in L3-4, L4-5, and L5-S1 disc spaces on the right and left sides in female subjects were 14.8 and 16.3 mm, 15.7 and 17.2 mm, and 14.9 and 17.1 mm, respectively, with corresponding figures of 18.6 and 19.5, 19.7 and 20.6, and 18.2 and 18.6 mm among male participants. Measurement 2 and 4 in females for L3-4, L4-5, and L5-S1 were 38.4 and 52.3 mm, 38.9 and 53.4 mm, and 37 and 51.8 mm, respectively. The corresponding figures for males were 43.2 and 57.6 mm, 43.2 and 58.9 mm, and 40.1 and 56.7 mm, respectively., Conclusion: Determination of the safe discectomy depth in both males and females, as well as the use of marking disc punches to indicate the safe margins may help clinicians to avoid this unwanted complication.

Aim: Cases of failed back and spine surgery have increased significantly recently, which leads to patient hesitation in deciding about whether to be operated on. In this article, we present a survey investigating refusal reasons for spinal surgery, and we emphasize the effect of failed back surgery., Material and Methods: A survey was conducted among 100 patients who were admitted to the outpatient clinic of neurosurgery at the Elazığ Training and Research Hospital. All of the patients were recommended spinal surgery for various reasons, but did not want to be operated on. Demographic data for the patients, indication of the recommended surgery, the reason for the patient's refusal of the operation, information about previous neurosurgical operations and the history of dissatisfaction with the surgery of an acquaintance were recorded. The data obtained were evaluated statistically and analyzed by percentage., Results: 46 patients stated they had distrust of surgery, and 54 patients did not want to be operated on for personal reasons. When the two groups were compared, neurosurgical operations and the history of dissatisfaction of the patient or an acquaintance was significantly higher in the first group (p < 0.001). It was found that 40% of all the patients (n = 40) had a past unpleasant neurosurgical experience that was either personal or relevant., Conclusion: Spinal surgery is a preferred subspecialty of neurosurgery. However, patients' discontent with spinal surgery has been rising gradually in recent years. An accurate indication and proper surgical technique is essential for increasing satisfaction with spinal surgery. Minimally invasive interventions must be considered if necessary. The postoperative expectations of the physician and the patient must also be carefully defined.

The knowledge of minimal invasive spinal surgery has increased greatly in recent years. A current issue is the hydrogel implant inserted through nucleus pulposus. In this paper we present a case in which the hydrogel implant was found to be fragmented into the spinal canal at follow up. The patient was a 40-year-old female. She was examined at another clinic because of low back pain about four months ago, and a hydrogel implant was inserted at the L5-S1 level. She was admitted to our clinic due to severe radicular pain. Magnetic resonance imaging (MRI) showed a posterolateral annular tear only and she was explored microneurosurgically as she did not benefit from a foraminal injection. A fragmented hydrogel implant that compressed the spinal root was seen peroperatively and it was excised. Postoperatively the radicular complaints of the patient disappeared and she was discharged with total recovery. Although rare, complications causing compression of neural structures can be seen after placing implants into the disc. In this case, the assessment of the patient according to the clinical presentation and microsurgical exploration if necessary are important.