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Background: This study aimed to expand our existing information on changes in the regulation of motor movement and behaviour by investigating the effects of unilateral and bilateral lesions on the claustrum (CL)., Material and Methods: 36 Wistar Albino adult male rats were randomly divided into six groups. An electrical lesion was created with a constant current source in the unilateral and bilateral anterior clastrum using a stereotaxic frame in rats. The lesioned groups and the control group underwent an automatic behaviour recording device such as mobilisation, freezing, eating, drinking behaviour, grooming, turning, etc. behaviour was recorded and analysed. Simultaneously, ultrasonic sounds in rats were examined with ultrasonic sound recording program. Anxiety was then reassessed with the elevated plus maze test. Data were compared with the control group. Rats were eventually sacrificed and the brain tissue was post-fixed. Histochemical examination was done and lesions' existence was confirmed., Results: In this study, lesions of ventral of CL can cause increase in spontaneous behaviours such as freezing and rearing. And, it has been shown to cause a statistically significant change. In addition to the behavioural changes, right CL lesions have caused a significant increase in drinking behaviour associated with increased anxiety. All operated groups showed a significant decrease in clockwise and counterclockwise rotation movements., Conclusion: Experimental results show that CL lesions influence spontaneous behaviour which indicate the need for new studies to understand the role of CL in anxiety-depression.

Background:  The study aimed to evaluate the safety and feasibility of transpedicular instrumentation for the C2 vertebra and to establish the precise anatomical parameters and boundaries within which this procedure can be safely and effectively performed., Methods:  This retrospective study analyzed 66 patients who underwent C2 transpedicular screw fixation. Preoperative and postoperative axial, sagittal, and coronal computed tomography (CT) scans were examined. Anatomical measurements were taken to determine the horizontal and vertical distances from the C2 pedicle projection to the vertebral foramen using CT images. Based on the anatomical location of the vertebral artery within the C2 vertebral foramen, the patients were divided into four subgroups using the horizontal pedicle width (HPW) and vertical pedicle width (VPW) of the C2 spine., Results:  The average age of the patients included in the study was 46.48 years. The patient population comprised 32 (48.5%) males and 34 (51.5%) females. Based on the anatomical measurements, the distribution of C2 vertebra types was as follows: type 1 accounted for 68.9%, type 2 for 3.8%, type 3 for 16.7%, and type 4 for 10.6%. Significantly narrower pedicle widths were observed in types 2 and 4 compared to other vertebra types. Type 2 had the largest medial angle (MA), while type 4 had the narrowest MA. In terms of the sagittal plane, type 4 exhibited the widest MA and type 3 had the narrowest MA, but these differences were not statistically significant. Among the cases, 12 (18.1%) involved the vertebral foramen, with 1 case (8.3%) showing screw-related vertebral artery injury (0.75% of all screws). No vertebral artery injuries were observed with the other transpedicular screws., Conclusion:  Preoperative anatomical measurements for patients undergoing transpedicular instrumentation on the C2 vertebra should include planning CT images on three planes: axial, sagittal, and coronal., Competing Interests: None declared., (Thieme. All rights reserved.)

Background:  Neuroregulation of sexual functions requires coordination of parasympathetic, sympathetic, and somatosensory neuronal pathways. The nerves formed by the lower lumbar plexus provide the innervation of the urogenital organs. Lower lumbar disc hernias (LDHs) might impair the neuroregulation of sexual functions by compressing the neural structures. This prospective study aims to evaluate the effect of lower LDHs on libido and sexual dysfunctions., Methods:  A total of 61 sexually active patients diagnosed with single-level LDH who underwent unilateral microdiscectomy were included in the study. The patients' healthy sex partners were included in study as controls. The International Sexual Function Index-5 (IIEF-5) and Female Sexual Function Index (FSFI) were used for sexual assessment of male and female participants, respectively. Visual Analog Scale (VAS) was used for pain assessment., Results:  According to the FSFI scores, all 20 female patients had preoperative sexual dysfunction, which improved in 15 (75%) patients after surgery ( p  < 0.001). According to the IIEF-5 score for men, 38 of 41 male patients had preoperative sexual dysfunction, which improved in 26 (68.4%) patients postoperatively ( p  < 0.001)., Conclusion:  The preoperative sexual dysfunctions of LDH patients improved significantly after the microdiscectomy., Competing Interests: None declared., (Thieme. All rights reserved.)

Objectives: This study aims to examine the effect of surgical timing on the sphincter function and improvement of motor function in patients with cauda equine syndrome (CES) due to lumbar disc herniation (LDH)., Patients and Methods: Between January 2005 and December 2013, a total of 33 patients (18 males, 15 females; mean age 48.6±2.2 years, range, 24 to 73 years) who underwent lumbar spinal surgery and were diagnosed with CES due to LDH were retrospectively analyzed. Data including demographics, muscle weakness, sensory deficit, sphincter control, LDH level, time from the initiation of symptoms to admission, and time to surgery were documented. The latest muscle weakness, sensory deficits, and sphincter control were also recorded. The patients were divided into two groups according to the rate of muscle strength improvement and data including age, sex, and operation time were compared., Results: The weakness remained unchanged in 11 (33.3%), improved in 13 (39.4%), and returned to normal in nine (27.3%) patients. Sphincter control resolved in five patients. Sensory loss resolved in two patients. While admission duration was shorter in the group with improved muscle strength (p=0.02), there was no significant difference in the time to surgery (p=0.63). Logistic regression analyses revealed that only the admission within 0 to 24 hours was significant for the muscle strength improvement (regression coeeficient [B]=2.83, standard error [SE]=0.86, p=0.006)., Conclusion: A significant improvement in the motor strength can be achieved in patients with CES who are operated within 24 hours. On the other hand, patients with CES should be received surgery immediately when first seen, regardless of the time, since the muscle strength is slightly improved., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2019, Turkish Society of Physical Medicine and Rehabilitation.)

Background: Head trauma is associated with a significant risk of cerebrospinal fluid (CSF) fistula., Methods: In this study, it was aimed to report twenty-two cases subjected to operative intervention for otorrhea, rhinorrhea and oculorrhea with associated traumatic lesions. Majority of the cases had moderate to severe head trauma with a Glascow Coma Scale (GCS) score under 14. The study group included eleven cases with depression fractures, 6 with epidural hematomas and 4 with tension pneumocephalus., Results: Rhinorrhea was the most common presenting symptom encountered in fifteen cases; whereas, otorrhea was prominent in 7 and oculorrhea in 2 cases. Two patients having rhinorrhea also had oculorrhea and otorrhea. The patients were operated with unilateral approaches in twelve and bifrontal approaches in ten of the cases., Conclusion: Early surgical intervention should be performed in cases presenting with CSF fistula and associated traumatic lesions without considering conservative management to provide an effective control of associated complications due to CSF fistulas.

Sphenoidal sinus foreign bodies are very rare entities that are often associated with a cranial and/or orbital trauma. In this paper, a case of a metallic foreign body that pierced the sphenoid sinus and penetrated into the intracranial space due to a work accident is presented. A 29-year-old male was referred to our clinic due to a right orbital penetrating trauma. Skull X-ray and computed tomography (CT) scans demonstrated a foreign body inside the sphenoidal sinus, extending to the left temporal fossa. The foreign body was removed using an endoscopic endonasal technique, and the skull base was reconstructed with a multilayer closure technique. There were no complications during or after the operation. Postoperative result was perfect after three months of follow up.