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Aneurysmal bone cysts constitute 1% to 2% of all primary bone tumors. They are rapidly growing benign bone tumors. Nearly 80% of aneurysmal bone cysts occur in the first 20 years of life, and most are primary tumors. Aneurysmal bone cysts are mostly benign, locally aggressive, and highly vascularized tumors. Generally, the period required for postoperative recovery and new bone formation is long. The relapse rate can be up to 50%. Although computed tomo-graphy and magnetic resonance imaging scans are the preferred diagnostic methods, biopsy is the most necessary prerequisite to confirm diagnosis, as aspects of these cysts can show similarity to many other bone lesions. Correct histopathologic diagnosis is important since malignancies may be seen in transplant recipients.

Ependymomas are the most common intramedullary spinal tumors in adults and constitute around 20% of all spinal tumors in adults. There are 3 subgroups of ependymomas according to World Health Organization classification: subependymoma or myxopapillary (grade 1), ependymoma (grade 2), and anaplastic (grade 3). Therapy for patients is aimed at safe and total surgical removal and, in selected cases, postoperative radiotherapy. Bleeding from a spinal ependymoma, with subsequent urgent surgery, is extremely rare. Here, we present a case of a renal transplant patient who had a cervical ependymoma. Although a considerable volume of peritumoral blood was observed during surgery, the patient had no neurologic deficits and no signs of deterioration.

Aim:This study aimed to determine whether there is a significant difference between the results of a standard biopsy and Doppler ultrasonography-guided biopsy of the temporal artery, which showed low preoperative pulse pressure. Material and Methods: Data from 21 patients, who received preliminary diagnosis of temporal arteritis at the neurology clinic were retrospectively investigated. Patients were divided into two groups depending on the method with Doppler ultrasonography and without ultrasonography. Results: Results from a total of 21 patients were evaluated. The first group consisted of 11 patients who underwent standard temporal artery biopsy, while the second group consisted of 10 patients who underwent ultrasonography-guided biopsy. Six patients in the group without the ultrasonography guidance showed insignificant results. Furthermore, the samples were insufficient in four of these six patients. In contrast, four patients from the Doppler ultrasonography-guided group were diagnosed with arteritis, in addition to the fact that an insufficient biopsy sample was not encountered in these patients. Statistical analysis showed that there was no significant difference between the pathology results of the two groups. Conclusion: Although we failed to find a significant difference between the groups, we believe that the Doppler ultrasonography-guided biopsy should be used as a supportive tool rather than diagnostic tool per se, as the Doppler ultrasonography-guided group did not provide insufficient biopsy samples in the pathology results as opposed to the standard group.

Background: Meningiomas are the most frequent benign tumors of the intracranial cavity accounting for around 30% of all intracranial tumors.Great majority of this entity is frankly benign while a certain subset manifest itself with higher incidence of recurrence and unfavorable morbidity and mortality rates. Leptin, the product of the obese (ob) gene, is a 16kDA polypeptide which is located on human chromosome 7. It plays a crucial role in the regulation of body weight by controlling food intake, energy metabolism and neuroendocrine function. Aim : To search for a possible relationship between leptin and intracranial meningioma formation. Study Design: Prospective Control Clinical Study Methods: According to WHO classification of CNS tumors, 20 patients with grade I and 12 patients harboring grade II meningiomas were included in the study. Fasting blood glucose, blood insulin and leptin levels were determined. Leptin staining scores were evaluated immunohistochemically from the parafin blocks of the meningioma patients. Body mass index values and antidiabetic drug treatment were also noted. Results : No statistically significant relation was noted between the grade I and grade II meningioma groups in all the parameters searched (body mass index, blood glucose levels, blood leptin levels, leptin staining score). The use of antidiabetic drug was homogenous between the groups. Conclusion: The present study did not provide an evidence about a possible association between leptin and intracranial meningioma formation. However, research with larger volume of patient groups including grade III meningiomas are needed in order to substantiate such a relation.

In this research, we produced a plasma-based surgical device for operations for spine discectomy. It covers the details of the hardware of focused plasma-based (gas plasma, plasma jet) surgical prototype device manufacturing which will be used in spine discectomy surgery, identification of active device operating conditions with the in vitro tests and evaluation of performance. Human spinal discs material between the vertebra bones may degenerate because of a series of biomechanical and biochemical changes over time. This degeneration and its further state which known as herniation cause nerve compression, pain, sensory deficits, power reduction, and lack of reflexes in humans. Conditions caused by intervertebral disc herniation are a common health problem and cause significant work loss. Low sensitivities of mechanical methods and control challenges, cause recurrence which is one of the biggest problem (to be re-herniation) for this surgery. In this study, the first generation of a portable atmospheric "focused plasma probe" was designed, implemented and its performance has been evaluated for the view of spine discectomy surgery. In the research, primarily, production of a prototype device consisting of high-voltage power supply, bipolar plasma probe, gas supply control unit has been made. High voltage power supply is one of the critical parts of this study and this power supply has been realized by using transformer and MOSFETs connected according to the half-bridge topology. Its power can easily adjustable up to 150 watts by changing its duty cycle and voltage. Then, the effect of power (watt) has been tested at in vitro conditions. A newly designed in-vitro model was developed due to the requirements of spine discectomy. Finally, we developed a new prototype device which has a controllable destruction area with a synthetic polymer which is presented as a tissue model.

Purpose: The purpose of this report is to describe the Global Spine Care Initiative (GSCI) contributors, disclosures, and methods for reporting transparency on the development of the recommendations. Methods: World Spine Care convened the GSCI to develop an evidence-based, practical, and sustainable healthcare model for spinal care. The initiative aims to improve the management, prevention, and public health for spine-related disorders worldwide; thus, global representation was essential. A series of meetings established the initiative’s mission and goals. Electronic surveys collected contributorship and demographic information, and experiences with spinal conditions to better understand perceptions and potential biases that were contributing to the model of care. Results: Sixty-eight clinicians and scientists participated in the deliberations and are authors of one or more of the GSCI articles. Of these experts, 57 reported providing spine care in 34 countries, (i.e., low-, middle-, and high-income countries, as well as underserved communities in high-income countries.) The majority reported personally experiencing or having a close family member with one or more spinal concerns including: spine-related trauma or injury, spinal problems that required emergency or surgical intervention, spinal pain referred from non-spine sources, spinal deformity, spinal pathology or disease, neurological problems, and/or mild, moderate, or severe back or neck pain. There were no substantial reported conflicts of interest. Conclusion: The GSCI participants have broad professional experience and wide international distribution with no discipline dominating the deliberations. The GSCI believes this set of papers has the potential to inform and improve spine care globally. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.]

The purpose of this systematic literature review was to develop recommendations for the assessment of spine-related complaints in medically underserved areas with limited resources. We conducted a systematic review and best evidence synthesis of guidelines on the assessment of spine-related complaints. Independent reviewers critically appraised eligible guidelines using the Appraisal of Guidelines for Research and Evaluation-II criteria. Low risk of bias clinical practice guidelines was used to develop recommendations. In accordance with the mandate of the Global Spinal Care Initiative (GSCI), recommendations were selected that could be applied to medically underserved areas and low- and middle-income countries by considering the limited access and costs of diagnostic technologies. We screened 3069 citations; 20 guidelines were eligible for critical appraisal. We used 13 that had a low risk of bias that targeted neck and back pain. When assessing patients with spine-related complaints in medically underserved areas and low- and middle-income countries, we recommend that clinicians should: (1) take a clinical history to determine signs or symptoms suggesting serious pathology (red flags) and psychological factors (yellow flags); (2) perform a physical examination (musculoskeletal and neurological); (3) do not routinely obtain diagnostic imaging; (4) obtain diagnostic imaging and/or laboratory tests when serious pathologies are suspected, and/or presence of progressive neurologic deficits, and/or disabling persistent pain; (5) do not perform electromyography or nerve conduction studies for diagnosis of intervertebral disc disease with radiculopathy; and (6) do not perform discography for the assessment of spinal disorders. This information can be used to inform the GSCI care pathway and model of care. These slides can be retrieved under Electronic Supplementary Material.

In order to improve their bacterial antifouling property, silicone surfaces were functionalized through the plasma polymerization (PP) technique using diethyl phosphite as the precursor. The functionalized surfaces were characterized using contact angle measurements, contact angle titration, Fourier transform infrared-Attenuated total reflection spectroscopy and in vitro cytotoxicity assay. The amount of non-specific protein adsorption and the conformational changes of surface-Adsorbed proteins were investigated. Antifouling properties of the surfaces were evaluated in vitro and in vivo. PP functionalization generated a hydrophilic and amphoteric surface with a very good protein and bacterial antifouling property and caused less conformational changes on the secondary structure of surface-Adsorbed proteins. In in vivo conditions, no slime layer was formed around bacteria that adhered on the PP-functionalized surface. It is concluded that the amphoteric nature of the PP-functionalized surface is the reason for the good antifouling property., Turkish Ministry of Industry and Technology [0035.STZ.2009-1] ; Deltamed Life Sciences and Plasma Technologies R&D Inc.

Case report.This case report is unique since this is the first vertebral lipom case that was treated by kyphoplasty alone.Vertebral lipoma is extremely rare and our search of the English literature has revealed 20 patients in 16 reports.A 32-year-old female patient was admitted to our neurosurgery department with the chief complaint of low back pain that had lasted nearly 1 year. A lumbar MR suggested a hemangioma and the patient was operated on.On microscopic examination, the lesion was seen to have a widely infiltrating appearance of mature fat tissue between bone trabeculae diagnosis was intraosseous lipoma.We believe that the management should be surgical total removal of the lesion even in incidentally found cases in order to obtain histologic diagnosis and pain relief.5.

Purpose: Spinal disorders, including back and neck pain, are major causes of disability, economic hardship, and morbidity, especially in underserved communities and low- and middle-income countries. Currently, there is no model of care to address this issue. This paper provides an overview of the papers from the Global Spine Care Initiative (GSCI), which was convened to develop an evidence-based, practical, and sustainable, spinal healthcare model for communities around the world with various levels of resources. Methods: Leading spine clinicians and scientists around the world were invited to participate. The interprofessional, international team consisted of 68 members from 24 countries, representing most disciplines that study or care for patients with spinal symptoms, including family physicians, spine surgeons, rheumatologists, chiropractors, physical therapists, epidemiologists, research methodologists, and other stakeholders. Results: Literature reviews on the burden of spinal disorders and six categories of evidence-based interventions for spinal disorders (assessment, public health, psychosocial, noninvasive, invasive, and the management of osteoporosis) were completed. In addition, participants developed a stratification system for surgical intervention, a classification system for spinal disorders, an evidence-based care pathway, and lists of resources and recommendations to implement the GSCI model of care. Conclusion: The GSCI proposes an evidence-based model that is consistent with recent calls for action to reduce the global burden of spinal disorders. The model requires testing to determine feasibility. If it proves to be implementable, this model holds great promise to reduce the tremendous global burden of spinal disorders. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].

Purpose: The purpose of this report is to describe the development of a classification system that would apply to anyone with a spine-related concern and that can be used in an evidence-based spine care pathway. Methods: Existing classification systems for spinal disorders were assembled. A seed document was developed through round-table discussions followed by a modified Delphi process. International and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. Results: Thirty-six experts from 15 countries participated. After the second round, there was 95% agreement of the proposed classification system. The six major classifications included: no or minimal symptoms (class 0); mild symptoms (i.e., neck or back pain) but no interference with activities (class I); moderate or severe symptoms with interference of activities (class II); spine-related neurological signs or symptoms (class III); severe bony spine deformity, trauma or pathology (class IV); and spine-related symptoms or destructive lesions associated with systemic pathology (class V). Subclasses for each major class included chronicity and severity when different interventions were anticipated or recommended. Conclusions: An international and interprofessional group developed a comprehensive classification system for all potential presentations of people who may seek care or advice at a spine care program. This classification can be used in the development of a spine care pathway, in clinical practice, and for research purposes. This classification needs to be tested for validity, reliability, and consistency among clinicians from different specialties and in different communities and cultures. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].

The purpose of this report is to describe the development of an evidence-based care pathway that can be implemented globally. The Global Spine Care Initiative (GSCI) care pathway development team extracted interventions recommended for the management of spinal disorders from six GSCI articles that synthesized the available evidence from guidelines and relevant literature. Sixty-eight international and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. An iterative consensus process was used. After three rounds of review, 46 experts from 16 countries reached consensus for the care pathway that includes five decision steps: awareness, initial triage, provider assessment, interventions (e.g., non-invasive treatment; invasive treatment; psychological and social intervention; prevention and public health; specialty care and interprofessional management), and outcomes. The care pathway can be used to guide the management of patients with any spine-related concern (e.g., back and neck pain, deformity, spinal injury, neurological conditions, pathology, spinal diseases). The pathway is simple and can be incorporated into educational tools, decision-making trees, and electronic medical records. A care pathway for the management of individuals presenting with spine-related concerns includes evidence-based recommendations to guide health care providers in the management of common spinal disorders. The proposed pathway is person-centered and evidence-based. The acceptability and utility of this care pathway will need to be evaluated in various communities, especially in low- and middle-income countries, with different cultural background and resources. These slides can be retrieved under Electronic Supplementary Material. The Global Spine Care Initiative and this study were funded by grants from the Skoll Foundation and NCMIC Foundation. World Spine Care provided financial management for this project. The funders had no role in study design, analysis, or preparation of this paper. Sí

AIM: Intervertebral disc degeneration can cause severe low back pain. Intradiscal electrothermal therapy (IDET) is a minimally invasive treatment option for patients with symptomatic internal disc disruption unresponsive to conservative medical care. We aimed to evaluate 12-month pain and functional outcomes and predictors of clinical success in patients with discogenic back pain treated with IDET with respect to the Dallas Discogram Scale (DDS). MATERIAL and METHODS: This was a retrospective analysis of patients undergoing IDET for low back pain from 2009 through 2014 at Baskent University, Department of Neurosurgery. A total number of 120 consecutive patients data were collected retrospectively. The degree of disc degeneration was graded using the DDS during discography, and the presence of a high intensity zone (HIZ) on magnetic resonance (MR) imaging was noted. The primary outcome measure was assessment of back pain severity based on the Visual Analogue Scale (VAS); function was assessed by the Oswestry Disability Index (ODI). Follow-up examinations for ODI and VAS scores were assessed at 1, 6, and 12 months post-treatment. Outcomes were discussed with respect to morphological changes in intervertebral discs on discogram. RESULTS: There was an average 57.39% and 47.16% improvement in VAS and ODI scores, respectively, between pretreatment and 12 months follow-up (p

Study design A prospective, randomized experimental research. Objective To evaluate the short- and long-term neuroprotective effects of minocycline on the secondary injury process of an experimental traumatic spinal cord injury (SCI) model. Summary of background data Traumatic SCI is a devastating problem of health that results in high morbidity and mortality rates. The loss of function after SCI results from both the primary mechanical insult and the subsequent, multifaceted secondary response. Methods A total of 80 adult male Spraque-Dawley rats (breeded by the Baskent University Animal Research Center) were randomly divided into 4 groups. A T10 contusion injury was produced by using modified Allen technique in all groups except the control group. No medication was administered to the rats in the trauma group. Minocycline was administered intraperitoneally and intravenously to the treatment groups. Short-term and/or long-term neuroprotective effects of minocycline on the lipid peroxidation (malondialdehyde, glutathione), apoptosis (terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate-biotin nick end labeling), ultrastructure of spinal cord (tissue electron microscopy), and behavioral assessments (Basso-Beattie-Bresnahan) were evaluated. Results As compared with the trauma group, tissue malondialdehyde and glutathione levels demonstrated that minocycline significantly diminishes lipid peroxidation. Electromicroscopic study showed that minocycline preserves the ultrastructure of spinal cord tissue in the early post-traumatic period. Minocycline treatment significantly reduced the number of terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate-biotin nick end labeling positive cells both 1 day and 28 days after SCI. Behavioral assessments showed significant improvement in the hind limb functions of minocycline receiving rats starting 7 days after the SCI. Any statistically significant difference was not found between intraperitoneal or intravenous routes for minocycline injection. Conclusion Minocycline is neuroprotective and contributes to functional improvement after traumatic SCI by eliminating the destructive process of secondary injury. Having both satisfying anti-inflammatory and antiapoptotic effects in experimental models, it promises to be of therapeutic use in human SCI.

Objectives Solid-organ transplant recipients are at great risk for osteoporotic vertebral compression fractures because of both underlying pretransplant bone diseases and posttransplant immunosuppressive treatments. Balloon kyphoplasty is a minimally invasive procedure that is used to treat painful osteoporotic vertebral compression fractures. It involves injection of polymethylmethacrylate into the vertebral body to stabilize the fracture and to alleviate the pain immediately. In this study, we report the results of balloon kyphoplasty for treatment of vertebral compression fractures in solid-organ transplant recipients. Materials and methods We retrospectively reviewed 512 liver transplant and 2248 kidney transplant procedures that were performed in our center between 1985 and 2015. Seven transplant recipients with a total of 10 acute, symptomatic vertebral compression fractures who were unresponsive to conservative treatment for 3 weeks underwent balloon kyphoplasty. Clinical outcome was graded using the visual analog scale. Radiographic evaluation included measurement of the segmental kyphosis by the Cobb method. Results There were 4 female and 3 male patients in our study group. Ages of patients ranged from 56 to 63 years with an average age of 58.8 years. The affected vertebral levels varied from T12 to L4. Mean follow-up after balloon kyphoplasty was 3.4 years, and mean time interval from transplant to balloon kyphoplasty was 8.6 years. Statistically significant difference is evident 3 years after transplant surgery (P 5 degrees) in 2 of 7 patients (28%). Conclusions Transplant recipients are at great risk in terms of vertebral compression fracture development, especially within 1 year after transplant. Although conservative treatment has been the first treatment choice for vertebral compression fracture, long treatment time and high costs may be needed to achieve cure. Experience with our small patient population showed that balloon kyphoplasty was effective and safe for obtaining rapid pain relief and earlier mobilization with fewer complications.

AIM: To evaluate the contribution of Turkish scientists to four journals published by Journal of Neurosurgery (JNS) Publishing Group and to Acta Neurochirurgica (AN) and to its Supplement (ANS). MATERIAL AND METHODS: We reviewed every issue of those journals to December 2015 for the total number of articles, articles produced from studies performed entirely in Turkey, and for publications overseas co-authored by the Turkish scientists using the websites of these journals. Citations were searched using "Web of Science" and "Google Scholar" databases. RESULTS: The total number of articles published was 19822 for JNS, 3227 for JNS Spine, 2526 for JNS Pediatrics and 2997 for Neurosurgical Focus. Turkish contribution was 556 articles. 337 (60.61%) articles were the products of studies performed entirely in Turkey, while 219 (39.38%) articles came from overseas, co-authored by Turkish scientists. Overall contribution was 1.94%. A total of 6469 articles were published in AN. 340 papers were the products of studies performed entirely in Turkey. Turkish scientists working overseas co-authored 37 articles. Total contribution was 377 articles (5.82%). 4134 papers had been published in ANS. Contribution was 69 articles (1.66%). CONCLUSION: Turkish contribution to these journals has started late. The gap has been compensated with publications in the last two decades. Manuscripts of higher scientific level with greater number of citations are needed to increase Turkish contribution to such journals.

A 26-year-old construction worker presented with a nail settled in the C-7 corpus. He had no neurological or physical abnormalities. Preoperative evaluation of the vascular, neural, and aerodigestive structures with cervical radiography, computed tomography (CT), CT angiography, and contrast esophagography found no damage. The nail was completely exposed surgically and removed. The patient recovered with no deficits. Penetrating neck injury may be associated with significant morbidity and mortality due to vascular, neural, and aerodigestive tract injury. Patients in stable clinical condition should be evaluated by CT angiography, esophagography, and chest and cervical radiography.

Brown tumors also called as osteoclastomas, are rare nonneoplastic lesions that arise in the setting of primary or secondary hyperparathyroidism. Parathyroid adenomas or hyperplasia constitute the major Brown tumor source in primary hyperparathyroidism while chronic renal failure is the leading cause in secondary hyperparathyroidism. Most of the patients with the diagnosis of primary hyperparathyroidism present with kidney stones or isolated hypercalcemia. However, nearly one third of patients are asymptomatic and hypercalcemia is found incidentally. Skeletal involvement such as generalized osteopenia, bone resorption, bone cysts and Brown tumors are seen on the late phase of hyperparathyroidism. The symptoms include axial pain, radiculopathy, myelopathy and myeloradiculopathy according to their locations. Plasmocytoma, lymphoma, giant cell tumors and metastates should be ruled out in the differential diagnosis of Brown tumors. Treatment of Brown tumors involve both the management of hyperparathyroidism and neural decompression. The authors report a very rare spinal Brown tumor case, arisen as the initial manifestation of primary hyperparathyroidism that leads to acute paraparesis.

AIM: In this study, factors affecting survival, local failure, distant brain failure, whole brain failure and whole-brain radiation therapy (WBRT) free survival according to histological subtypes were investigated in patients with brain metastases from non-small cell lung cancer (NSCLC). MATERIAL and METHODS: Patients with positive pathology reports for adenocarcinoma (ACA) and squamous cell carcinoma (SCC) were included in the study. Seventy-eight ACA and 26 SCC patients were included in the study. Patients with previous history of cerebral metastasis surgery and WBRT were excluded from the study. RESULTS: The median survival was calculated as 12.6 months for patients with ACA and 5.9 months for patients with SCC. One-year distant brain failure was calculated as 65.1\% in ACA patients and 39.6\% in SCC patients. One-year whole brain failure was calculated as 58.1\% in ACA patients and 39.6\% in SCC patients. The one-year freedom from WBRT rate was calculated as 72.8\% in ACA patients and 56.3\% in SCC patients. SCC histology was considered as a significant factor in deterioration of overall survival in multivariate analysis. SCC histology, the increase in the number of metastases and RPA class were factors that caused an increase in distant brain failure. Also, SCC histology, the increase in the number of metastases and RPA class were factors that caused an increase in whole brain failure. CONCLUSION: SCC histology may be an important prognostic factor for overall survival. Also, due to high distant brain failure rate in SCC histology, WBRT can be added to treatment early.

Spinal bronchogenic cysts are rare congenital lesions. The authors describe their experience in the treatment of a 17-year-old boy who presented with back pain and paresthesia in both lower extremities. Lumbar MR imaging revealed the presence of an intramedullary cystic lesion at the conus medullaris and histopathological analysis revealed a bronchogenic cyst. To the best of the authors' knowledge, this is the first report of an intramedullary spinal bronchogenic cyst arising at the conus; all previously reported spinal bronchogenic cysts were either intradural extramedullary or not located at the conus.

Aim To compare the clinical and radiological outcomes of recurrent disk disease in patients who underwent unilateral and bilateral percutaneous pedicle screw instrumentation with Mis-TLIF. Material and methods 10 patients treated with unilateral percutaneous instrumentation plus Mis-TLIF formed Group 1 while the other 10 patients treated with bilateral percutaneous instrumentation plus Mis-TLIF formed Group 2. Clinical outcomes were graded using the visual analog scale (VAS) and the Oswestry disability index (ODI) scores. Peroperative and 2-year follow-up scores were obtained. Postoperative imaging techniques were used for the assessment of fusion, subsidence and spinal alignment. Results According to preoperative and postoperative VAS/ODI scores, statistically significant differences were noted in the unilaterally and bilaterally instrumented group. However, a statistically significant difference was not observed between the unilateral and bilateral groups. Radiological evidence of successful arthrodesis was noted in 8 of 10 patients (80%) in the unilaterally instrumented group and in 9 of 10 patients (90%) in the bilaterally instrumented group at the 2 years follow-up. No metal failure, cage migration, vertebral fracture, subsidence or adjacent level disease was experienced. Conclusion Mis-TLIF with unilateral percutaneous pedicle screw instrumentation is an excellent option in the treatment of selected recurrent disk disease patients.

Objectives: Surgical outcome of the patients undergoing decompression and minimal medial epicondylectomy were retrospectively evaluated. Methods: 16 patients who underwent decompression and minimal medial epicondylectomy for the treatment of cubital tunnel syndrome (CTS) were retrospectively evaluated. 11 female (68.75%) and 5 male (31.25%) patients suffering from unilateral CTS that is unresponsive to conservative treatment were included to the study. Average age was 39.18±14.36 years. Left side involvement occurred in 12 patients (75%), while right side involvement occurred in 4 patients (%25). McGowan classification of ulnar nerve injury was used for the surgical grading. Grade 1 in four patients (25%), grade 2 in 11 patients (68.75%), and grade 3 in 1 patient (6.25%). Cervical disc herniation, thoracic outlet syndrome and other entrapment neuropathies were ruled out preoperatively. Results of surgical treatment were evaluated according to Wilson–Krout criteria. Patients were followed during 18 – 64 months in average. Findings: Symptomatic relief was achieved in all of the patients. Postoperative controls in the 1st, 6th and 12th months revealed excellent results for 12 patients (75%), good results for 3 patients (18.75%), and a medium result for 1 patient (6.25%). No patient experienced ulnar nerve paralysis, medial elbow instability and impairment in the pronator – flexor muscle group in the postoperative period. Pain and sensitivity in the osteotomy site of 3 patients (75%) who underwent minimal medial epicondylectomy disappeared three months later. Results: Minimal medial epicondylectomy and decompression are reliable and effective methods for the treatment of cubital tunnel syndrome with less complication rates.

AIM In this study, we aimed to show the neuroprotective effects of AT III and Enoxaparin after severe traumatic brain injury. MATERIAL AND METHODS The animals were divided into four groups as Group 1; control group, Group 2; trauma group, Group 3; AT III group and Group 4; Enoxaparin group. Severe trauma was performed by the weight dropping technique. These animals were killed 48 hours after injury. Histopathological and immunohistochemical analysis were performed. Specimens were graded for cell death, inflammation, hemorrhage and apoptosis. RESULTS The control group showed normal ultrastructure of brain tissue. Trauma produced obvious damage. 8 rats (80%) in the trauma group demonstrated minimal inflammation and grade 5 cell death. Trauma increased hemorrhage and apoptosis scores to statistically significant levels (p < 0.001). Enoxaparin was found to reduce neuronal cell death but not as effectively as AT III. A statistically significant difference was observed between the AT III and Enoxaparin group according to inflammation grades. Significant antiapoptotic properties of AT III were observed while hemorrhage was more common in the Enoxaparin group. CONCLUSION Anticoagulants such as AT III and enoxaparin are promising drugs in the treatment of traumatic brain injuries.

The authors report the case of an adult female patient who developed a thoracic paraspinous desmoid tumor (aggressive fibromatosis) located just cranially to the incision scar of the previous surgery for resection of a spinal schwannoma. To the best of the authors' knowledge, this is the first report of an extraabdominal desmoid tumor occurring after resection of a spinal schwannoma. Desmoid tumors develop from muscle connective tissue, fasciae and aponeuroses. They are known to occur in association with surgical scars or implants. Incidence of this tumor is low. The etiology is still uncertain. Although rare, this distinctive tumor should be kept in mind in the differential diagnosis of palpable masses and especially those occurring around the previous skin incisions.

Non-missile intracranial injuries caused by foreign bodies are quite uncommon in civilian practice. Nails, knives, screwdrivers and sewing needles are the most commonly reported agents. The authors report a unique case of an adult male patient who suffered a penetrating craniocerebral injury caused by a falling concrete reinforcing iron (rebar) from the fourth floor of a building under construction. The foreign body was safely removed by a right parietal craniectomy as a result of detailed radiological evaluation and preoperative planning. To the best of authors' knowledge, the successful surgical treatment of a penetrating brain injury caused by a rebar has not been reported previously.

Vestibular schwannomas, meningiomas and epidermoids account for a vast majority of the lesions occurring in the cerebellopontine angle (CPA). Neoplastic and non-neoplastic pathologies other than these tumors constitute 1% of all lesions located in the CPA. The aim of this study was to reveal our experience in the treatment of the rare lesions of the CPA. We have retrospectively reviewed the medical files and radiological data of all patients who underwent surgery involving any kind of pathology in the CPA. We have excluded those patients with a histopathological diagnosis of meningioma, schwannoma and epidermoids. Our research revealed a case of craniopharyngioma, a case of chloroma, a case of solitary fibrous tumor, a case of pinealoblastoma, a case of atypical teratoid rhabdoid tumor, a case of an aneurysm, a case of hemorrhage and a case of abscess.

A 26-year-old female patient under albendazole treatment because of multiple liver and lung hydatid cysts was admitted with headache and convulsions. Bilateral papilloedema and slight right hemiparesis were observed in neurological examination. Neuroradiological evaluation revealed a cystic lesion causing midline shift and oedema in the left frontal lobe. The cyst was removed unruptured using Dowling's technique and postoperative outcome was uneventful. Albendazole therapy was continued due to systemic infection. In her second month of follow-up, she suffered from severe headache and abundant haemoptysis. Control cranial magnetic resonance imaging (MRI) revealed a ring-shaped slightly contrast-enhancing lesion including heterogeneous fibrillary ingredient with surrounding oedema in the left frontal lobe. The further follow-up cranial MRI suggested brain abscess.We present a complicated case of brain hydatid cyst and its management with a successful outcome.

Study Design. A case report and review of the literature. Objective. To describe an extremely rare case, development of lumbar disc herniation after percutaneous vertebroplasty complicated with intradiscal cement leakage. Summary of Background Data. Intradiscal cement leakages are frequently seen during vertebroplasty operations. They are generally asymptomatic. To the best of authors' knowledge, this is the first case describing development of lumbar disc herniation after percutaneous vertebroplasty complicated with intradiscal cement leakage. Methods. A 74-year-old woman with the 2-week history of percutaneous vertebroplasty of L4 vertebrae was admitted to our emergency unit. She was suffering from an excruciating low back pain radiating to her right leg. Neurologic examination and lumbar MRI revealed right L5 radiculopathy due to a sequestrated disc fragment. She underwent microlumbar discectomy. Results. Free disc fragment on the L5 root was removed. She was pain free and her neurologic deficit immediately improved after surgery. Conclusion. Although extremely rare, intradiscal cement leakage during percutaneous vertebroplasty may promote development of lumbar disc herniation.

The authors report the case of an adult female patient who developed a thoracic paraspinous desmoid tumor (aggressive fibromatosis) located just cranially to the incision scar of the previous surgery for resection of a spinal schwannoma. To the best of the authors' knowledge, this is the first report of an extraabdominal desmoid tumor occurring after resection of a spinal schwannoma. Desmoid tumors develop from muscle connective tissue, fasciae and aponeuroses. They are known to occur in association with surgical scars or implants. Incidence of this tumor is low. The etiology is still uncertain. Although rare, this distinctive tumor should be kept in mind in the differential diagnosis of palpable masses and especially those occurring around the previous skin incisions.

A 32-year-old man was treated with a ventriculo-peritoneal shunt for acute panventricular hydrocephalus. On the third postoperative day, an ascending tetraparesis and subsequent respiratory failure developed. Based on the clinical findings, cerebrospinal fluid study and electrophysiological results, a diagnosis of Guillain-Barre syndrome (GBS) was made. Despite plasmaphoresis and immunoglobulin infusion, the patient was ventilator dependent and bed-bound for 4 months. One year later, he was able to walk without assistance and had only slightly wasting of the intrinsic hand muscles. This is the first report of acute hydrocephalus preceding the symptoms of GBS.

✓The authors report the first description since 1957 of a lumbar disc herniation as a cause of stump pain. Most amputees frequently experience stump pain or phantom pain. The pathophysiology of phantom pain is not clearly defined; however, there are well-defined reasons for stump pain such as infection, tissue necrosis, hematoma, wound breakdown, bone spur, neuroma, and so on. During the differential diagnosis, radiculopathy due to lumbar disc herniation must also be evaluated.

Posterior cranial fossa subdural hematomas and extension of the subdural hematoma to the cerebellopontine angle is rarely seen and the concurrent development of acute peripheral facial palsy and the management strategy have not previously been reported in this pathology because of its rarity. We present this case to emphasize that minor head trauma may lead to a posterior cranial fossa hematoma extending to the cerebellopontine angle and cause peripheral facial palsy in patients using aspirin (acetylsalicylic acid). In addition, partial evacuation and waiting for the resorption of the hematoma may help to prevent damage to the 7th and 8th cranial nerves.

Cyclopentolate is a synthetic anti-cholinergic agent widely used in ophthalmology clinics. It can cause cardiovascular side-effects such as hypertension, ventricular arrhythmias and tachycardias. A 55-year-old male lost his consciousness after topical cyclopentolate hydrocloride (1%) administration for routine fundoscopic examination in another center. An urgent cranial magnetic resonance imaging examination revealed a midbrain hemorrhage and he was transferred to our hospital. The Glasgow Coma Scale score was at 4 points at admission. The patient was transferred to the intensive care unit and mechanically ventilated. Despite vigorous medical treatment, spontaneous respiration and brainstem reflexes disappeared 12 h after his administration. A control cranial computerized tomography showed enlargement and opening of the hemorrhage into the ventricular system. The patient died on the 12th day of his administration. Systemic side-effects of topical ocular cyclopentolate administration and prevention methods were discussed with regard to the current literature.