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Giant serpentine aneurysms (GSAs) are a rare subgroup of intracranial aneurysms. Separate inflow and outflow flow due to intraluminal thrombosis is the most distinguishing feature of GSAs. In treating these lesions, surgical clipping and ligation were the main treatments in the past, but bypass for revascularisation and endovascular therapies (EVTs) for deconstructive purposes are more prominent today. A 51-years-old male patient presented with headache and mild right hemiparesis. He had a GSA arising from the left fetal type posterior cerebral artery (fPCA) that was out of follow-up for six years. Radiological images revealed midline shifting and mesencephalon compression. We performed endovascular parent artery coil occlusion. The symptoms of the patient improved at the first-month follow-up. Even if there is a mass effect in GSAs, deconstructive EVT is a safe and feasible method for managing these lesions.

AIM: To define a novel autologous bone graft insertion technique, and to evaluate its effects on bone fusion in patients with lumbar stenosis who underwent laminoplasty. MATERIAL and METHODS: Fifty-six patients and 142 vertebrae that underwent autologous bone graft insertion technique between 2009 and 2018 were analysed retrospectively. Demographic data, comorbidities, and perioperative findings of patients were recorded. The midline anteroposterior (AP) diameter was measured at the bone graft insertion levels, and fusion formation was evaluated with computed tomography (CT) and dynamic X-Ray images. Pain scores were assessed preoperatively with the visual analogue scale (VAS) for both legs and Oswestry Disability Index (ODI) for overall life quality. Scores were re-evaluated on 1st day, at 3rd, and 12th months, postoperatively. RESULTS: Degenerative spinal stenosis was present in 56 patients who underwent autologous bone graft insertion technique. It was found that the diameter of the spinal canal increased by 37% in CT measurements. In postoperative radiological followups, fusion developed in 49 (87.5%) patients. There was a statistically significant decrease in both VAS and ODI scores in the postoperative period when compared to the preoperative evaluations. CONCLUSION: Bone graft insertion technique supports posterior fusion and protects against dural injuries during revision surgery by creating a barrier over the dura. The prevention of epidural fibrosis formation reduces the symptoms of the postlaminectomy syndrome. The fact that this technique does not require fixation material. Therefore, it reduces expenditure and eliminates the risk of complications related to synthetic materials © 2022, Turkish Neurosurgery. All Rights Reserved.

The utilization of endoscope-assisted surgery is becoming a more common modality for the surgical treatment of subdural collections. Considering the inflexible construction of the rigid endoscope, it's not clear where to perform the optimal craniotomy. Twenty four craniotomies (3 cm diameter) were performed in 8 hemicrania. The craniotomies were placed 1 cm front and behind the coronal suture and to the point where the parietal bone was the most convex. The craniotomies in the anterior (C1) and posterior (C2) of the coronal suture were in the mid pupillary line, while the posterior craniotomy (C3) was just lateral to the midpupillary line. At first, subdural distances measured, and then the distances from the craniotomy to the anterior, posterior, medial, and lateral directions in which endoscope could reach the farthest without the damage to the parenchyma were measured. The subdural distance was significantly deeper in C3 than C1 (P = 0.001); however, there was no difference between C3 and C2 (P = 0.312). The distance that could be reached with C3 was higher than C1 in anterior, posterior, lateral, and medial directions (P ≤0.001, 0.037

BACKGROUND: Approaching ambient cistern lesions is still a challenge because of deep location and related white matter tracts (WMTs) and neural structures. OBJECTIVE: To investigate the white matter anatomy in the course of 3 types of transtemporal-transchoroidal fissure approaches (TTcFA) to ambient cistern by using fiber dissection technique with translumination and magnetic resonance imaging fiber tractography. METHODS: Eight formalin-fixed cerebral hemispheres were dissected on surgical corridor from the temporal cortex to the ambient cistern by using Klingler's method. The trans-middle temporal gyrus, trans-inferior temporal sulcus (TITS), and trans-inferior temporal gyrus (TITG) approaches were evaluated. WMTs that were identified during dissection were then reconstructed on the Human Connectome Project 1021 individual template for validation. RESULTS: The trans-middle gyrus approach interrupted the U fibers, arcuate fasciculus (AF), the ventral segment of inferior frontoocipital fasciculus (IFOF), the temporal extensions of the anterior commissure (AC) posterior crura, the tapetum (Tp) fibers, and the anterior loop of the optic radiation (OR). The TITS approach interrupted U fibers, inferior longitudinal fasciculus (ILF), IFOF, and OR. The TITG approach interrupted the U fibers, ILF, and OR. The middle longitudinal fasciculus, ILF, and uncinate fasciculus (UF) were not interrupted in the trans-middle gyrus approach and the AF, UF, AC, and Tp fibers were not interrupted in the TITS/gyrus approaches. CONCLUSION: Surgical planning of the ambient cistern lesions requires detailed knowledge about WMTs. Fiber dissection and tractography techniques improve the orientation during surgery and may help decrease surgical complications. Copyright © 2020 by the Congress of Neurological Surgeons.

AIM: To retrospectively evaluate the overall survival (OS) of patients with brain metastases (BMs) who had been treated with whole brain radiotherapy (WBRT) and Gamma Knife (GK) according to prognostic factors and prognostic index scores. MATERIAL and METHODS: The study included 91 patients with BMs who had been treated with WBRT and/or GK between 2014 and 2017. The patients with BMs were retrospectively evaluated regarding age, sex, Karnofsky Performance Status (KPS), recursive partitioning analysis (RPA) class, basic score for BM (BS-BM), Graded Prognostic Assessment (DS-GPA) index, primary tumour type, extracranial metastases, primary tumour control, number of BMs, and brain metastasectomy. A univariate analysis of the OS was performed using the Kaplan-Meier method, supplemented by the log-rank test. We also applied a multivariate survival analysis using the Cox regression model.RESULTS: The median OS for all patients with BMs was 6 months. Meanwhile, the median OSs for those with WBRT, GK, and WBRT-GK treatment were 6, 4, and 15 months, respectively (p=0.00). In the multivariate analysis, the female sex (p=0.030), brain metastasectomy (p=0.047), treatment with WBRT-GK (p=0.001), and the controlled primary tumour (p=0.007) significantly correlated with the OS. Furthermore, the BS-BM (p=0.022) was closely related with the OS compared to the RPA and DS-GPA in the multivariate analysis.CONCLUSION: The BS-BM was found to better predict the survival of patients with BMs according to the prognostic index scores in the multivariate analysis. Thus, our data suggest that the BS-BM is the most appropriate prognostic index.

Aim In patients with poor medical conditions, awake procedures can help avoid the complications of general anesthesia. We aim to report and discuss our experience of awake craniotomy for the treatment of supratentorial lesions. Material and methods We included patients who underwent awake craniotomy for supratentorial tumors between 2007 and 2018. A bipolar stimulation probe was used for patients with eloquent area lesions. The demographic features, presenting symptoms, comorbidities, localization, histopathology, pre- and postoperative Karnofsky performance status, mean operation length, mean length of hospital stay, and intraoperative and postoperative complications were recorded. Results We included 250 patients (age, 53.5 ± 15.3 years; range, 15-90 years; 105 females and 145 males) mostly with metastasis (46%). The tumor resection rate was 90 ± 3.6%. Of 30 patients (12%) who experienced an increase in weakness, 26 experienced improvements within three days, and the remainder had permanent symptoms. Intraoperative and postoperative seizures occurred in three (1.2%) and seven (2.8%) patients, respectively, which were controlled by antiepileptic drugs. Dysphasia occurred intraoperatively in seven patients (2.8%) but improved in a month. The mean follow-up duration was 31.8 ± 11.9 months (range, 7-70 months). No mortality was seen during hospitalization. Conclusion Awake procedures are a good option in supratentorial lesions to avoid the complications of general anesthesia in patients with a poor medical condition. To obtain maximal tumor resection and maintain a patient\'s quality of life, neurosurgeons should opt for awake craniotomy often.

Aim To retrospectively evaluate the overall survival (OS) of patients with brain metastases (BMs) who had been treated with whole brain radiotherapy (WBRT) and Gamma Knife (GK) according to prognostic factors and prognostic index scores. Material and methods The study included 91 patients with BMs who had been treated with WBRT and/or GK between 2014 and 2017. The patients with BMs were retrospectively evaluated regarding age, sex, Karnofsky Performance Status (KPS), recursive partitioning analysis (RPA) class, basic score for BM (BS-BM), Graded Prognostic Assessment (DS-GPA) index, primary tumour type, extracranial metastases, primary tumour control, number of BMs, and brain metastasectomy. A univariate analysis of the OS was performed using the Kaplan-Meier method, supplemented by the log-rank test. We also applied a multivariate survival analysis using the Cox regression model. Results The median OS for all patients with BMs was 6 months. Meanwhile, the median OSs for those with WBRT, GK, and WBRT-GK treatment were 6, 4, and 15 months, respectively (p=0.00). In the multivariate analysis, the female sex (p=0.030), brain metastasectomy (p=0.047), treatment with WBRT-GK (p=0.001), and the controlled primary tumour (p=0.007) significantly correlated with the OS. Furthermore, the BS-BM (p=0.022) was closely related with the OS compared to the RPA and DS-GPA in the multivariate analysis. Conclusion The BS-BM was found to better predict the survival of patients with BMs according to the prognostic index scores in the multivariate analysis. Thus, our data suggest that the BS-BM is the most appropriate prognostic index.

OBJECTIVENeurosurgery training programs aim to train specialists. In addition, they are expected to equip the residents with necessary knowledge and skills for academic development. This study aims to gain insights into academic productivity after neurosurgeons graduated from residency training in Turkey.METHODSAn electronic survey was sent to all Turkish Neurosurgical Society members (n = 1662 neurosurgeons) between September and November 2019. The number of participants was 289 (17.4%). Participants were divided into subgroups based on three main factors: training institution type (university hospital [UH] vs training and research hospital [TRH]), training institution annual case volume (low [< 1000 or inadequate cranial/spinal case numbers] vs high [> 1000 and adequate cranial/spinal case numbers]), and training program accreditation status (accredited vs nonaccredited).RESULTSThe majority of the participants (64.7%) graduated from the UHs. Those trained at UHs (vs TRHs) and high- (vs low-) volume centers had their dissertations more frequently published in Science Citation Index/Science Citation Index–Expanded journals, gave more oral presentations after residency, had higher h-indices, had higher rates of reviewership for academic journals, and had greater participation in projects with grant support. In addition, graduates of accredited programs reported more PhD degrees than those of nonaccredited programs.CONCLUSIONSNeurosurgeons trained in higher-case-volume, accredited programs, mostly in the UHs, performed better in terms of scientific activities and productivity in Turkey. Strong research emphasis and supportive measures should be instituted to increase academic performance during and after residency training.

The aim of the study was to determine the effect of direct application of rifampin, povidone-iodine, and hydrogen peroxide on the formation of epidural fibrosis in rats. Forty-eight adult male Wistar albino rats were equally and randomly divided into four groups (laminectomy, topical rifampin, topical povidone-iodine, and topical hydrogen peroxide). Laminectomy was performed at the T12 level in all rats. Four weeks later, the extent of epidural fibrosis was assessed both macroscopically and histopathologically. ANOVA test was used for the evaluation of dural thickness. Kruskal-Wallis test was used for the pathology and macroscopic evaluation. Chi-square test was used for evaluation of the arachnoid involvement. p value

AIM: There are many trials concerning peripheral nerve damage causes and treatment options. Unfortunately, nerve damage is still a major problem regarding health, social and economic issues. On this study, we used vascular graft and human cord blood derived stem cells to find an alternative treatment solution to this problem. MATERIAL AND METHODS: We used 21 female Wistar rats on our study. They were anesthetized with ketamine and we studied right hind limbs. On Group 1, we did a full layer cut on the right sciatic nerve. On Group 2, we did a full layer cut on the right sciatic nerve, and we covered synthetic vascular graft on cut area. On Group 3, we did a full layer cut on right sciatic nerve, and we covered the area with stem cell applied vascular graft. RESULTS: At the end of postoperative 8. weeks, we performed EMG on the rats. When we compared healthy and degenerated areas as a result of EMG, we found significant amplitude differences between the groups on healthy areas whereas there was no significant difference on degenerated areas between the groups. Then we re-opened the operated area again to reveal the sciatic nerve cut area, and we performed electron microscope evaluation. On the stem cell group, we observed that both the axon and the myelin sheet prevented degeneration. CONCLUSION: This study is a first on using synthetic vascular graft and cord blood derived CD34+ cells in peripheral nerve degeneration. On the tissues that were examined with electron microscope, we observed that CD34+ cells prevented both axonal and myelin sheath degeneration. Nerve tissue showed similar results to the control group, and the damage was minimal. © 2018 Ali Yilmaz, Abdullah Topcu, Cagdas Erdogan, Levent Sinan Bir, Barbaros Sahin, Gulcin Abban, Erdal Coskun, Ayca Ozkul.

The aim of the present report was to present the patient with an anterior cranial base fracture who developed post-traumatic cerebrospinal fluid rhinorrhea, which recovered after onset of meningitis complication. A 26-year-old male patient who had a traffic accident one week ago was sent to our clinic because of his rhinorrhea persisting for 4 days. On cranial computed tomography, fracture of the left frontal skull base and sinus walls, a fracture line on temporal bone, parenchymal bleeding in the vicinity of the frontal sinus, subarachnoidal bleeding and left temporal extradural hematoma were detected. Then he underwent sinus wall repair and extradural hematoma was drained through bifrontal craniotomy. However, rhinorrhea persisted which resulted a deterioration in consciousness and he entered into a deep somnolent state. When his symptoms of meningitis became apparent, rhinorrhea of the patient disappeared. The patient transferred in intensive care unit and re-connected to a lumbar drainage system. On cerebral magnetic resonance imaging, regression of contrast-enhanced lesions localized in the left anterotemporal and frontal and in the regions lateral to the right trigon and medial to the right thalamus and in the right posteroparietal regions was observed. Despite repair of the anterior cranial fracture and lumbar drainage, rhinorrhea may persist. Herein, development of meningitis caused disappearing of rhinorrhea symptoms without any need for surgical intervention.

Study Design: A retrospective study. Purpose: The aim of this study was to evalute the effects of mitomycin-C, sodium hyaluronate and human amniotic fluid on preventing spinal epidural fibrosis. Overview of Literature: The role of scar tissue in pain formation is not exactly known, but it is reported that scar tissue causes adhesions between anatomic structures. Intensive fibrotic tissue compresses on anatomic structures and increases the sensitivity of the nerve root for recurrent herniation and lateral spinal stenosis via limiting movements of the root. Also, neuronal atrophy and axonal degeneration occur under scar tissue. Methods: The study design included 4 groups of rats: group 1 was the control group, groups 2, 3, and 4 receieved antifibrotic agents, mitomycin-C (group 2), sodium hyaluronate (group 3), and human amniotic fluid (group 4). Midline incision for all animals were done on L5 for total laminectomy. Four weeks after the surgery, the rats were sacrificed and specimens were stained with hematoxylineosin and photos of the slides were taken for quantitive assesment of the scar tissue. Results: There was no significant scar tissue in the experimental animals of groups 2, 3, and 4. It was found that there was no significant difference between drug groups, but there was a statistically significant difference between the drug groups and the control group. Conclusions: This experimental study shows that implantation of mitomycin-C, sodium hyaluronate and human amniotic fluid reduces epidural fibrosis and adhesions after spinal laminectomy in rat models. Further studies in humans are needed to determine the complications of the agents researched. © 2013 by Korean Society of Spine Surgery.

Gerec ve Yontem: Kronik boyun agrisi nedeniyle tek seviyede servikal disk protez cerrahisi uygulanan 15 hasta ve “peek cage” uygulamasi yapilan 15 hasta degerlendirildi. Demografik ozelliklerin yani sira agri siddeti Gorsel Agri Skalasi ile, ozur durumu Boyun Ozurluluk Gostergesi ve yasam kalitesi SF-36 Yasam Kalitesi Anketi ile degerlendirildi. Degerlendirmeler cerrahi oncesi ve cerrahi sonrasinda 3. ayda tekrar edildi.

ObjectEven though there have been many efforts to recover neuronal dysfunction following spinal cord injuries, there are limitations to the treatment of these injuries. The purpose of this laboratory investigation was to determine the clinical and neurophysiological effects of human umbilical cord blood (HUCB) transplantation in a rat hemisection model of spinal cord injury.MethodsIn this study, experimental hemisection of the thoracic spinal cord was performed in rats. The rats were divided into 4 groups (6 rats in each group). One group of rats (Group 1) underwent thoracic laminectomy only. Rats in Group 2 underwent laminectomy and right hemisection of the thoracic spinal cord. Rats in Group 3 underwent right hemisection and implantation of freshly obtained HUCB on Day 0 postinjury. Rats in Group 4 underwent hemisection and implantation of freshly obtained HUCB on Day 4 postinjury. Clinical evaluations of rat motor function included the following: neurological examination, Rotarod performance, and inclined plane tests. Rats also underwent reflex evaluation.ResultsThe neurological examinations revealed that the frequency of plegic rats was 70.8% at the beginning of the study across all 4 groups; this value decreased to 20.8% by the end of the study. The percentage of rats with a normal examination increased from 25% to 50%. The results of Rotarod performance and 8-week inclined plane performance tests showed statistical significance (p < 0.05) in an overall group comparison across all time points. At the end of the 8 weeks, a statistically significant difference was found in the inclined plane test results between rats in Groups 1 and 2. There were no statistically significant differences between Groups 1, 3, and 4 (p < 0.05). When the reflex responses of the hemisectioned sides were compared, statistically significant differences were detected between groups (p < 0.05). All groups were significantly different with regard to the right-side reflex response score (p < 0.05). Spinal cord preparations of rats in all groups were examined for histopathological changes.ConclusionsHuman umbilical cord blood is stem cell rich and easily available, and it carries less risk of inducing a graft-versus-host reaction in the recipient. Human umbilical cord blood serum is also noted to contain stem cell–promoting factors, which is why cell isolation was not used in this study. Freshly obtained cord blood was also used because storage of cord blood has been reported to have some negative effects on stem cells. Transplantation of freshly obtained HUCB into the hemisectioned spinal cord experimental model demonstrated clinical and neurophysiological improvement.

Objective: Although the endovascular technique represents an important, minimally invasive approach to cerebrovascular diseases, only a few neurosurgeons are trained in both endovascular and surgical management of intracranial vascular pathologies. Our aim was to emphasize the importance of the endovascular approach in neurosurgery by analysing the cerebral digital subtraction angiography findings in our patients. Materials and, Methods: We analysed 207 patients who underwent cerebral angiography between February 2011 and June 2014. They had previously been diagnosed with cerebral vascular pathology including aneurysm, arteriovenous malformation (AVM), carotid cavernous fistula, vasculitis and Moyamoya disease according to computed tomographic angiography/magnetic resonance angiography findings. Demographic data, indications for cerebral angiography, endovascular and surgical treatments, complications and results were analyzed., Results: This study included a total of 207 patients (108 males and 99 females) with a mean age of 57.43 +/- 11.14 (17-83) years. A total of 234 selective angiographies were performed. The indications for procedures were as follows: cerebral aneurysm (n= 118, 57%), Moyamoya disease (n= 3, 1.4%), AVM (n= 13, 6.3%), carotid cavernous fistula (n= 2, 1%), and intracranial vascular stenosis (n= 2, 1%). No pathology was found in 69 patients (33.3%)., Conclusion: Cerebral angiography is important not only in the diagnosis but also in the treatment of cerebrovascular diseases. Neurointerventional surgery is a safe and minimally invasive treatment option based on meticulous protocols, however, it has not been included in the neurosurgery residency program yet. Developing training programs for endovascular neurosurgeons provididing comprehensive patient care should be considered.

Many complications related to the resection of an ossified posterior longitudinal ligament via the anterior approach have been reported. Postoperative neurological deterioration is one such complication that may appear due to massive anterior spinal cord herniation related to a dural defect following resection of the ossified posterior longitudinal ligament. Specifically, spinal cord herniations have been reported to be associated with posterior approaches, and a large number of theories regarding this association have been offered by various authors. However, anterior spinal cord herniation is extremely rare, and its pathophysiology has not yet been explained. In this case report, we report a male patient who experienced anterior spinal cord herniation following anterior surgery. Spinal cord herniation may develop following the removal of the anterior cervical corpectomy. Therefore, surgeons should be aware of this condition when planning treatments for cervical spondylotic myelopathy via the anterior approach. © 2016 Polish Neurological Society.

Spinal cord stimulation (SCS), also known as dorsal column stimulation, is a novel technique used widely in pain surgery. However, its effect on other pathologies such as epileptic disorders is unknown. The aim of this study is to evaluate the influence of electrical epidural stimulation of the upper cervical region on epileptic cortical discharges. The long term goal is to elucidate and evaluate a therapeutic central nervous system (CNS) electrical stimulation methodology to treat epilepsy. Twelve Wistar female rats were randomly divided into two groups. In group 1 (six rats under general anesthesia), C2-3 laminectomies were performed and epidural electrodes were placed to perform SCS. To induce epileptic discharges, 1 ml (200 IU) penicillin G was microinjected into the left somatomotor cortex via left stereotactic parietal craniotomies, 0.01 to 0.1 mA at 2 Hz was used to stimulate the spinal cord. In group 2 (the control group, six rats under general anesthesia), C2-3 laminectomies were performed without electrode placement and epileptic discharges were induced with penicillin G microinjections, as described above. Both groups were monitored with digital electroencencephalography (EEG) for 70 min in seven stages and recordings analyzed with power spectral analysis. Spinal cord stimulation decreased penicillin-induced median values of epileptic discharges. Epileptic wave frequencies decreased significantly with increasing intensities of SCS. The results of this study suggest that SCS used for drug resistant epilepsies may be a viable alternative treatment modal. © 2006 Elsevier B.V. All rights reserved.

Whipple's disease confined exclusively to the CNS without systemic involvement appears to be very rare, with only 8 cases reported in the literature. We present here a further case of primary cerebral Whipple's disease in which the neurological symptoms were seen in the absence of systemic involvement and emphasize the importance of diagnosing this treatable disease.

Objective: Neurological injury due to transient cerebral ischemia is a potential complication of cardiovascular surgery. The neuroprotective effect of magnesium, when given subcutaneously before the ischemia, was assessed in a rat model of transient global cerebral ischemia. Methods: Thirty-six male Wistar albino rats were included to this randomized, controlled, prospective study. In 24 animals, ischemia was induced with four-vessel occlusion technique with the duration of 15 min. MgSO4 was given 600 mg/kg subcutaneously 48 h before the procedure in group 1 (n = 12). Similar volume of saline solution was used in animals of control group (group 2, n = 12). The animals in group 3 (sham group, n = 12) were anesthetized and subjected to operative dissections without vascular occlusion. Physiological parameters and somatosensory evoked-potentials (SEP) were monitored in animals before ischemia, during ischemia and in the first 30 min of reperfusion. Their neurological outcome had been clinically evaluated and scored up to 4 days postischemia. The intergroup differences were compared. Then the animals were sacrificed and their brains were processed for histopathological examination. Results: In group 3, SEP amplitudes did not change during the procedures, and all animals recovered without neurologic deficits. At the end of ischemic period, the average amplitude was reduced to 5 ∠ 3% of the baseline in all ischemic animals. This was followed by a gradual return to 87 ∠ 10% and 83 ∠ 8% of the initial amplitude after 30 min of reperfusion in group 1 and group 2, respectively (P . 0.05). The average neurological score was significantly higher in group 1 than in group 2 at 48, 72 and 96 h after the ischemic insult (P , 0.05). Histological observations were clearly correlated with the neurological findings. Conclusion: The results suggest that subcutaneous MgSO4 reduces cerebral injury and preserves neurologic function when given two days before the transient global ischemia in rats. © 1998 Elsevier Science B.V. All rights reserved

The article entitled "Investigation of Efficacy of Mitomycin-C, Sodium Hyaluronate and Human Amniotic Fluid in Preventing Epidural Fibrosis and Adhesion Using a Rat Laminectomy Model" published in the Asian Spine Journal highlights an important problem for spinal surgeons [1]. We are thankful to the authors for their comments and informative letter, which highlights the doses which might be helpful in further research. The authors are right because using different dissolving methods can affect the results, but we didn't add any dissolving solution. Regarding the second point about dosage and density, we used a 0.01% mitomycin C solution [2] (an instant preparation that is usually used for ophthalmologic disorders) and 0.1 mL sodium hyaluronate [3]. Referring to the last question about the duration time, all of the drugs were applied 3 minutes. We hope those information are helpful and may encourage further research.

WOS: 000329598700009, PubMed ID: 24310458, AIM:To evaluate the effectiveness of invasive procedures in medically intractable genitofemoral and ilioingunal neuralgia. MATERIAL and METHODS: This is a prospective study of 20 patients with genitofemoral and ilioinguinal neuralgias who were treated at our medical center between 2007 and 2011. Genitofemoral and ilioinguinal nerve blocks were performed in all cases after medical treatment had failed to alleviate the patients' pain. Neurectomy was performed for the patients whose pain did not improve. Patient histories, physical examinations and visual analogue scale scores before and after treatments were analyzed. RESULTS: Fourteen (70%) of the patients were treated with nerve blocks and six (30%) of the patients whose pain did not improve with nerve block application underwent neurectomy which resulted in pain relief. CONCLUSION: For patients with medically intractable genitofemoral and ilioinguinal neuralgias, nerve blocks and neurectomies can be applied safely for pain control.

Objective: The aim of this study was to determine pain, disability status and psychological factors in patients with chronic low back pain. Material and Methods: The study included 167 participants (41 with chronic low back pain; 126 healthy controls). Demographic data of the patients were recorded. Visual Analog Scale, Oswestry Disability Index and The Minnesota Multiphasic Personality Inventory (MMPI) were used to assess pain intensity, disability level and psychological factors, respectively. Results: The mean age of the patients (group I) and healthy controls (group II) were 39.90±10.41 years and 37.67±11.17 years, respectively. The mean duration of pain was 4.73±5.63 years, and the mean intensity level of pain was 6.39±1.59 in group I. The mean score in the Oswestry Disability Index was 35.75±7.46 in the patient group. The difference between group I and group II regarding the results of hypochondriasis (p=0.006), depression (p=0.003) and dissimulation (p=0.040) was significant. The MMPI test scores were higher in the patient group than in healthy controls. The pain scores showed a positive correlation with depression (p=0.001), hypochondriasis (p

To investigate the possible therapeutic effects of clenbuterol on cerebral vasospasm after subarachnoid hemorrhage (SAH) in rats.Eighteen male albino Wistar rats, each weighing 200-250 g, were randomized into three groups; Group 1 (Control group) (n = 6) having no SAH and no treatment; Group 2 (Sham group) (n = 6) having only SAH and Group 3 (Experimental group) (n = 6) having SAH treated with clenbuterol. Group 2 has been accepted as sham group to the experimental group. Experimental SAH was induced using a modified rat double hemorrhage model. Clenbuterol was administered twice daily in 12-hour intervals for three days at a dose of 0,1 mg/kg/day. The luminal diameter of the basilar artery was measured on each section with an optic micrometer by an experienced pathologist blinded to the groups.Mean basilar artery diameters were found to be different between the three groups (p0.001). Mean value of Group 2 was significantly lower than that of Group 1 (p0.001). While mean value of Group 3 was significantly greater than that of Group 2 (p = 0.001), Groups1 and 3 were found to be similar (p = 0242).Clenbuterol has favorable effects in the treatment of rat cerebral vasospasm (CVS). Further investigations are needed to evaluate both molecular effects and to find out effective treatment dose of clenbuterol on CVS.

Background. Idiopathic intracranial hypertension can cause rapid deterioration of visual acuity in some severe cases, and these cases are usually thought to have “malignant” form of this disease.Case. In this paper, we report on a 16-year-old girl who is a typical example for malignant idiopathic intracranial hypertension with a rapid recovery of visual acuity after lumboperitoneal shunt operation.Observations and Conclusions. Malignant form of idiopathic intracranial hypertension must be kept in mind in selected patients to avoid irreversible visual loss.

Even though there have been many efforts to recover neuronal dysfunction following spinal cord injuries, there are limitations to the treatment of these injuries. The purpose of this laboratory investigation was to determine the clinical and neurophysiological effects of human umbilical cord blood (HUCB) transplantation in a rat hemisection model of spinal cord injury.In this study, experimental hemisection of the thoracic spinal cord was performed in rats. The rats were divided into 4 groups (6 rats in each group). One group of rats (Group 1) underwent thoracic laminectomy only. Rats in Group 2 underwent laminectomy and right hemisection of the thoracic spinal cord. Rats in Group 3 underwent right hemisection and implantation of freshly obtained HUCB on Day 0 postinjury. Rats in Group 4 underwent hemisection and implantation of freshly obtained HUCB on Day 4 postinjury. Clinical evaluations of rat motor function included the following: neurological examination, Rotarod performance, and inclined plane tests. Rats also underwent reflex evaluation.The neurological examinations revealed that the frequency of plegic rats was 70.8% at the beginning of the study across all 4 groups; this value decreased to 20.8% by the end of the study. The percentage of rats with a normal examination increased from 25% to 50%. The results of Rotarod performance and 8-week inclined plane performance tests showed statistical significance (p0.05) in an overall group comparison across all time points. At the end of the 8 weeks, a statistically significant difference was found in the inclined plane test results between rats in Groups 1 and 2. There were no statistically significant differences between Groups 1, 3, and 4 (p0.05). When the reflex responses of the hemisectioned sides were compared, statistically significant differences were detected between groups (p0.05). All groups were significantly different with regard to the right-side reflex response score (p0.05). Spinal cord preparations of rats in all groups were examined for histopathological changes.Human umbilical cord blood is stem cell rich and easily available, and it carries less risk of inducing a graft-versus-host reaction in the recipient. Human umbilical cord blood serum is also noted to contain stem cell–promoting factors, which is why cell isolation was not used in this study. Freshly obtained cord blood was also used because storage of cord blood has been reported to have some negative effects on stem cells. Transplantation of freshly obtained HUCB into the hemisectioned spinal cord experimental model demonstrated clinical and neurophysiological improvement.

Background: Acinetobacter baumannii is a major cause of nosocomial infections in many hospitals and appears to have a propensity for developing multiple antimicrobial resistance rapidly. Cases: We report two cases with post-surgical meningitis due to multidrug resistant A. baumannii which were successfully treated with high-dose intravenous meropenem therapy. Conclusions: Multidrug resistant Acinetobacter spp. in intensive care units are a growing concern. High-dose meropenem is used in the treatment of these infections.

Background. Neurological injury because of transient cerebral ischemia is a potential complication of cardiovascular surgery. In this study, the neuroprotective effects of l-carnitine, vitamin E, and the combination of these agents on ischemia/reperfusion (I/R) injury were determined in a rat model of transient global cerebral I/R. Methods. Rats were pretreated with l-carnitine (100 mg/kg, i.v.) and vitamin E (50 mg/kg, i. v.), alone or in combination and then subjected to cerebral I/R induced by a four-vessel-occlusion technique for a duration of 15 min followed by 15 min of reperfusion. Malondialdehyde (MDA) levels, superoxide dismutase (SOD) activity, and glutathione (GSH) levels were measured in the cerebral tissues. Histopathological examinations were also carried out under light and electron microscopy. Results. The results showed that I/R elevated MDA levels, which were accompanied by a reduction in SOD activities and GSH levels. Surviving neurons was markedly decreased in CA1 and CA3 subfield of hippocampus in I/R animals. l-carnitine, vitamin E, and their combination restored MDA levels and SOD activities, with a tendency to increase surviving neurons in CA1 and CA3 subfield. Combined treatment of l-carnitine and vitamin E had better GSH levels than individual treatment of these agents. Conclusions. The results suggest that l-carnitine has a potent neuroprotective effect against cerebral-I/R-induced injury in rat brain that is comparable to that of vitamin E. However, the combined use of l-carnitine and vitamin E does not further protect from neuronal injury, although it provides an increase in GSH levels. © 2006 Elsevier Inc. All rights reserved.

Background: Solitary brain stem abscess is a rare condition with high mortality and morbidity. These lesions were considered to be invariably fatal before 1974 when advanced diagnostic tools were not available. Recently, the diagnosis and prognosis of brain stem abscesses have been modified by the introduction of modern radiological tools, and several patients with a favorable outcome have been reported since then. Because the pons is the most common site of the abscesses, involvement of the sixth and seventh nerves is frequent. The midbrain is the second most likely location, and medullary abscesses are distinctly rare. Treatment of a brain stem abscess includes medical therapy alone, open microsurgical intervention, or stereotactic aspiration. Case report. We report a case of a 7-year-old girl with a solitary brain stem abscess. Her neurological examination revealed involvement of the cranial nerves and pyramidal tracts. Microsurgical exposure and aspiration of the abscess resulted in rapid improvement in her neurological condition and radiological resolution of the lesion. We discuss this uncommon case to draw attention to the importance of early diagnosis and adequate treatment, and we review the relevant literature. C1 Pamukkale Univ Hosp, Dept Neurosurg, TR-20100 Denizli, Turkey. Pamukkale Univ Hosp, Dept Radiol, TR-20100 Denizli, Turkey.

Failed back surgery syndrome (FBSS) is an important complication of lumbar disc surgery. Epidural fibrosis is one of the major causes of FBSS. However, most patients with epidural fibrosis do not develop symptomatic complaints from scarring. The purpose of this prospective study was to evaluate the relationships among the severity of epidural fibrosis, psychological factors, back pain and disability after lumbar disc surgery. Twenty-nine surgically managed patients (13 women, 16 men) were included in this study. In all patients, the presence and severity of epidural fibrosis was determined with contrast-enhanced magnetic resonance imaging (MRI). A pain visual analog scale (VAS) and Oswestry Disability Questionnaire (ODQ) were completed before and after surgery. Subjects were grouped by their type of herniation (protrusion, free fragment), MRI findings and results of the mini form of the Minnesota Multiphasic Personality Inventory (MMPI), and the groups were compared for their VAS and ODQ scores. Our results disclosed that neither the postoperative VAS scores nor the postoperative ODQ scores differed significantly among the epidural fibrosis severity groups. Moreover, postoperative VAS scores were positively correlated with the scores of the mini MMPI. These findings indicate that epidural fibrosis may be considered as a radiological entity independent of patients’ complaints. Furthermore, the mini MMPI should be included in the assessment and planning of the reoperations in FBSS patients, because of the importance of psychological factors in postoperative pain and disability.

The neuroprotective effect of trimetazidine (TMZ) on ischemic- reperfusion injury was tested by randomized, controlled, prospective study in a rat model of transient global cerebral ischemia. Thirty wistar albino rats were used for study. Animals in TMZ group (n = 10) received trimetazidine (3 mg/kg IV bolus) before the occlusion of carotid arteries. A similar volume of saline solution was used in the control group (n = 10). The sham group (n = 10) were anaesthetized and subjected to operative dissections without vascular occlusion. Physiological parameters, somatosensory evoked potentials (SEP's) were monitored. The neurological outcomes had been clinically evaluated and scored up to 4 days post ischemia. the intergroup differences were compared. Histological observations were clearly correlated with the neurological findings. the percentage of damaged neurons in CA1 and CA3 in subfield of hypochampus 34 ± 6% and 16 ± 6% in the TMZ group, whereas it was 44 ± 5% and 24 ± 5% in the control group (p < 0.05). The average neurologic score was significantly better in animals which received TMZ than in the controls at postoperative 24 hours (17.9 ± 1.4 in the TMZ group and 14.9 ± 1.6 in the control group, p < 0.05). The results suggest that trimetazidine reduces cerebral injury and preserves neurological function in transient global ischemia in rats.

Study design: An experimental study examining the neuroprotective effect of magnesium on axonal function and lipid peroxidation in a rat model of acute traumatic spinal cord injury. Objective: To determine the effectiveness of postinjury treatment with magnesium on evoked potentials and lipid peroxidation after spinal cord injury (SCI). Setting: Pamukkale University, Denizli, Turkey. Methods: Spinal cord injury occurred in 30 rats with an aneurysm clip at T9 and the rats were randomly assigned to undergo subcutaneous administration of one of the following at 1 h after injury: (1) Physiological saline (n = 10); (2) MgSO4, 300 mg/kg (n = 10) and (3) MgSO4, 600 mg/kg (n = 10). Spinal somatosensory evoked potentials (SSEPs) were recorded before injury, 30 min after injury and 3 h after injections. Rats were killed 24 h after the injury, and malondialdehyde (MDA) levels were measured. Results: Following SCI, there were significant decreases in the amplitudes of P1 and N1 (P 0.001) and only high-dose magnesium improved the SSEPs (P < 0.01). On the other hand, there was significant difference in lipid peroxide content between high-dose magnesium treated group and both of saline treated and low-dose magnesium treated groups (P < 0.01). Conclusion: These results suggest that magnesium has a dose-dependent neuroprotective effect on SSEPs and lipid peroxidation after experimental spinal cord injury.

Extramedullary hematopoiesis associated with thalassemia causing spinal cord compression is an extremely rare event in the course of the disease. Documentation with an imaging technique, such as MRI, is mandatory. A patient with thalassemia intermedia, who developed paraparesis in spite of transfusion, underwent surgical decompression. Rapid neurological improvement was observed postoperatively and this neurological condition was protected with adequate hemoglobin level. Management of these patients remains controversial. Various modes of therapy such as surgical decompression, radiotherapy, and transfusion are discussed and the related literature is reviewed.

Intramedullary spinal tuberculoma is a rare form of central nervous system tuberculosis. Although tuberculosis is unusual in the west, it is still prevalent in Asia and Africa. We report a case in which the diagnosis was made histologically without evidence of symptoms of systemic tuberculosis. The lesion, located in the conus medullaris, mimicked a conus tumor. The patient was a 20-year-old man who presented with a history of progressive leg weakness, urinary urgency, and impotence. There was no history of, or recent contact with, tuberculosis. A diagnosis of an intramedullary tumor in the conus medullaris was made by MRI. The patient underwent a T11-L1 laminectomy and total resection of the lesion with microsurgical technique. Histologic examination revealed a granulomatous lesion containing Langhans' giant cells, inflammatory cells, and caseating necrosis. Antituberculous medication was instituted as soon as the diagnosis was made. Neurologic symptoms and signs slowly improved postoperatively. A combination of microsurgical resection and antituberculous chemotherapy should be the choice of treatment for intramedullary tuberculomas.

A rare case of extradural brucellosis granuloma in the thoracic region is presented. In spite of medical treatment, total paraplegia with sphincter disturbance developed. Delayed neurosurgical intervention resulted in significant clinical recovery. Magnetic resonance imaging was useful in obtaining detailed information and to decide on surgery.

OBJECTIVE AND IMPORTANCE: Intradural or intraradicular herniation of a lumbar disc is a rare complication of disc disease. The mechanism of the tearing of the dura mater by a herniated disc is not known with certainty. Only six cases of intraradicular disc herniation have been reported. By reporting the seventh case of this rare neurosurgical entity, we emphasize its importance and review the literature on intraradicular disc herniation. CLINICAL PRESENTATION: A 41-year-old man was admitted with a 3-year history of low back pain and sciatica. A neurological examination revealed motor weakness during plantar flexion, positive Lasègue's sign, sensory deficit on the S1 dermatoma, and loss of Achilles reflex. Magnetic resonance imaging revealed disc protrusion at the L5-S1 level. Therefore, we decided to operate on the patient having made a diagnosis of lumbar disc disease. INTERVENTION: The patient underwent a standard hemilaminotomy and foraminotomy for a removal of the L5-S1 disc. There was no disc protrusion or extruded fragment. The left S1 nerve root was observed to be swollen and immobile. A longitudinal incision was made on the radicular sheet of the S1 root, and a free disc fragment, approximately 2 x 1 x 1 cm, was extirpated in one piece. CONCLUSION: The patient was immediately relieved of pain and was discharged on the 7th day after the operation with normal muscle strength. It seems probable that in some patients with "failed back syndrome," intraradicular or intradural disc herniation is the cause of failure.

PubMed ID: 9489880, Objective: The protective effect of aprotinin, which is a protease inhibitor, was assessed in a rabbit spinal cord ischemia model. Design: Randomized, controlled, prospective study. Setting: University research laboratory. Subjects: New Zealand white rabbits (36) of both sexes. Methods: In 24 animals, ischemia was induced with midline laparotomy and clamping the aorta just distal to left renal artery and proximal to aortic bifurcation for 20 min. Aprotinin was given 30 000 KIU as a short intravenous injection after anesthesia, and was followed by 10 000 KIU/h by continuous infusion in group 1 (n = 12). Similar volume of saline solution was used in control group of animals (group 2, n = 12). Group 3 of animals (sham group, n = 12) were anesthetized and subjected to laparotomy without aortic occlusion. Physiological parameters and somatosensory evoked-potentials (SEP) were monitored in animals before ischemia, during ischemia and in the first 60 min of reperfusion. Their neurological outcome was clinically evaluated up to 48 h postischemia. Their motor function was scored, and the intergroup differences were compared. The animals were sacrificed after two days of postischemia. Their spinal cord, abdominal aorta, and its branches were processed for histopathological examination. Results: In group 3, SEP amplitudes did not change during the procedures, and all animals recovered without neurologic deficits. At the end of ischemic period, the average amplitude was reduced to 53 ± 7% of the baseline in all ischemic animals. This was followed by a gradual return to 89 ± 8 and 81 ± 13% of the initial amplitude after 60 min of reperfusion in group 1 and group 2 correspondingly (P > 0.05). The average motor function score was significantly higher in group 1 than group 2 at 24 and 48 h after the ischemic insult (P < 0.05). Histological observations were dearly correlated with the neurological findings. Conclusion: The results suggest that aprotinin reduces spinal cord injury and preserves neurologic function in transient spinal cord ischemia in rabbits.