Anencephaly, the most severe form of neural tube defect, has no known cure, and in most cases, patients die before or shortly after birth. To date, no surgical intervention has been reported in the management of anencephaly. This study presents a case of dichorionic-diamniotic twin pregnancy in which 1 twin was anencephalic and describes the surgical management of this complex case. We aimed to share the problems experienced during the follow up of a patient who survived for a long time after surgery. We also aimed to highlight several clinical issues, including the challenges of managing anencephaly in twin pregnancies, problems experienced during the follow up process in our case, diagnosis of brain death in anencephaly cases, and ethical dilemmas related to organ donation. This case is notable because of the challenging nature of the surgical procedure and complexity of postoperative care. By highlighting the difficulties encountered during the follow up period, we hope to provide insights to health professionals that can inform the management of similar cases in the future.

Objectives: Post-laminectomy syndrome due to epidural fibrosis (EF) is a common cause of persistent low back pain after lumbar spinal surgery and is challenging for both surgeons and patients. The current experimental study aimed to investigate the effect of dehydrated human amnion/chorion membrane (dHACM) allograft for preventing EF formation following lumbar laminectomy. Methods: Sixteen Sprague–Dawley rats equally divided into two groups underwent lumbar laminectomy. Group A, the control group, underwent lumbar laminectomy with standard closure. Group B, the experimental group, additionally received epidural dHACM allografts during the procedure. After 45 days of follow-up, the rats were sacrificed, and the harvested tissues were histopathologically evaluated for EF. Results: Compared with Group A, Group B showed significantly less EF generation (p < 0.001), implying that dHACM allografts effectively prevent EF. Conclusions: This study demonstrated that dHACM can effectively reduce EF formation after spinal laminectomy in rats.

İntrakraniyal tüberkülom, tüberküloza bağlı santral sinir sistemi infeksiyonunun önemli komplikasyonlarından birisidir. İntrakraniyal tüberkülomlar görüntüleme yöntemlerinde beyin tümörleri ile karışabilir. Tanıda etkenin kültürden izolasyonu ve histopatolojik inceleme kullanılabilir. Tedavide cerrahi girişim ve antitüberküloz tedavi uygulanır. Bu yazıda, Cibuti, Afrika’dan gelen ve intrakraniyal kitle nedeni ile opere edilen ancak biyopsi materyalinin histopatolojik incelemesi sonucunda tüberkülom olduğu saptanan 34 yaşında bir kadın hasta sunuldu.

GİRİŞ ve AMAÇ: Bu çalışmanın amacı literatür ışığı altında çoklu epidural hematomların ve klinik özelliklerinin gözden geçirilmesi ve tartışılmasıdır

AIM:To evaluate the effectiveness of lumboperitoneal (LP) shunt procedures in the treatment of normal pressure hydrocephalus (NPH).MATERIAL AND METHODS:A medical record review was conducted to obtain demographic, clinical, laboratory data, as well as pre-, intra, -postoperative details of 65 patients who underwent LP shunt surgery for NPH between January 1, 2001 and January 1, 2014 in the Neurosurgery Clinics of Ankara Training and Research Hospital and Ankara Numune Hospital.RESULTS:At the 3rd month after LP shunt surgery, headache was resolved in almost all patients. At the end of first year, while statistically significant improvements were noted in the Modified Rankin Scale Scores and Mini-Mental State Examination Scores, gait disturbance, urinary incontinence and cognitive functions were improved by 86%, 72% and 65% of the patients, respectively.CONCLUSION:LP shunt surgery is associated with a lower rate of complication in comparison to ventriculoperitoneal shunt surgery and is an effective procedure in the treatment of NPH.

Aim: Intracranial meningiomas are the most common types of brain tumor in patients over 65 years of age. Surgical resection in this group of patients may be at risk of severe complications, due to limited physiological capacities and the presence of comorbidities. This retrospective study aimed to summarise outcome data of patients older than 65 years who underwent surgery for intracranial meningioma at our clinic between Jan 2007 and Dec 2012. Materials and Methods: Medical records of 70 cases diagnosed with intracranial meningioma were retrospectively reviewed. Demographic and clinical data (age, sex, symptoms), tumor localization, histopathologic properties, American Society of Anesthesiology (ASA) class, complications of the early postoperative period were analyzed. Results: Male/female ratio was 0.37 and mean age was 71.3. The most common experienced symptoms were headache (78.5%), motor deficit (18.5%) and seizure (17.1%). Tumors were mostly settled to convexities (34.3%) and parasagittal regions (17.1%). Histopathological diagnoses were classified as follows; Meningothelial (40.0%), transitional (18.6%), fibroblastic (114%) and psammomateous (11.4%). Postoperative complications were manifested in 10 of 70 patients (14.2%) Complication rate was prominently higher in patients with class III and IV of ASA class. Conclusions: Surgery for intracranial meningiomas in selected elderly patients is beneficial. Old age alone should not be used as a selection criterion for treatment.

Aim: Intracranial meningiomas are the most common types of brain tumor in patients over 65 years of age. Surgical resection in this group of patients may be at risk of severe complications, due to limited physiological capacities and the presence of comorbidities. This retrospective study aimed to summarise outcome data of patients older than 65 years who underwent surgery for intracranial meningioma at our clinic between Jan 2007 and Dec 2012.

OBJECTIVE: Currently, anterior, posterior, or combined approaches are used in various spinal disorders; however, a single-stage posterolateral transpedicular approach with 360 degrees stabilization and vertebrectomy provides better results for spinal tumors.METHODS: We evaluated the age, sex distribution, presenting symptoms, neurologic examination findings according to the pre- and postoperative Frankel classification, pre- and postoperative VAS pain scores, preoperatively administered medical therapies, pre- and postoperative corset use, level of the lesion, levels of previous surgical interventions, root ligation (if performed), results of the primary disease, hospitalization duration (after the operation), postoperative complications (if any), postoperative follow-up duration, and postoperative survival duration of 22 patients.RESULTS: We observed that primary bone tumors were localized in the lumbar (75%) and thoracic regions (25%) and that metastatic tumors were localized in the thoracic (77.78%) and lumbar regions (22.22%). The VAS and Frankel scores of the 22 patients who were included in the study revealed that this surgical treatment modality was associated with statistically significant improvements in test scores (P < 0.001). No ribcage dislocation was observed. In 1 patient (4.54%), a neurologic deficit developed. Two patients (9.09%) required revision because of screw malposition.CONCLUSIONS: In spinal tumors, 360 degrees fusion performed via a posterolateral approach is a less risky, relatively safe, and less invasive method. This method, which reduces the risks of anesthesia and internal problems and decreases cost, is an essential technique for decreasing hospitalization duration, improving pain levels, and achieving faster mobilization and faster initiation of radiotherapy and chemotherapy.

Double encephalocele is extremely rare. We present an unusual form of double encephalocele including giant supratentorial and small infratentorial encephalocele in a neonate.

AMAC: Bu calismanin amaci literatur isigi altinda coklu epidural hematomlarin ve klinik ozelliklerinin gozden gecirilmesi ve tartisilmasidir. YONTEM VE GERECLER: Bu calismada tibbi literaturde yayinlanan coklu epidural hematom olgulari toplandi ve klinigimizden yayinlanmamis bir olgu eklendi. BULGULAR: Yaptigimiz literatur taramasinda arama kriterlerimizi saglayan 50 adet makale bulundu. Bunlarin 38 tanesi tekli olgu sunumlari iken, 12 makale coklu olgu sunumlari ve klinik serilerden olusmaktaydi. Olgularin buyuk cogunlugunda bilateral epidural hematom saptandi. Sadece 7 olguda ikiden fazla epidural hematom tespit edildi. Iki olgu disinda tum olgularda cerrahi tedavinin uygulandigi goruldu. SONUC: Intrakranyal epidural hematomlar genellikle kafa travmasina sekonder gelisirler ve tek tarafli olusurlar. Cokluepidural hematomlar oldukca nadir olgulardir ve prognozlari genellikle operasyon oncesi norolojik durum ile baglantilidir.

AIM:To evaluate the effects of cerebroventricular administration of hyperoncotic/hyperosmotic agents on edematous brain tissue in rats with experimental head trauma.MATERIAL AND METHODS:The study included 54 female Sprague-Dawley rats with weights ranging between 200 and 250 g. Six experimental groups were examined with each group containing 9 rats. All rats were exposed to head trauma, and treatment groups were administered 2 µl of one of the drugs (albumin, mannitol, hypertonic sodium chloride (NaCl), glycerin and dextran) 6, 12 and 24 hours after the trauma via the cerebroventricular route and using a stereotactic device. Rats were sacrificed 48 hours after the trauma, and brain tissues were extracted without damage. Biochemical analyses including reduced glutathione (GSH), nitric oxide (NO), malondialdehyde (MDA), tumor necrosis factor alpha (TNF-α), and interleukin 1 beta (IL-1β) were performed on the injured left hemisphere.RESULTS:Compared with the control group, the albumin, mannitol, 3% NaCl and glycerin treatment groups revealed dramatic increases in GSH levels (p < 0.001). Levels of MDA, which is the end-product of brain edema and lipid peroxidation, failed to show a statistically significant decrease, but there was a decreasing trend observed in the inter-group comparisons. NO levels were also decreased in the 3% NaCl treatment group. An analysis of TNF-α and IL-1β, two proinflammatory cytokines associated with the trauma, revealed that IL-1β decreased significantly in all treatment groups (p=0.001), whereas no significant difference was detected in TNF-α levels.CONCLUSION:Cerebroventricular administration of hyperoncotic/hyperosmotic agents provides substantial effects on the treatment of brain edema.

Understanding the anatomy of temporal lobe sulci and their variations can allow for safer neurosurgical approaches. Although the inferior temporal sulci and their relations to each other has been described by several authors, the nomenclature used has not been universal. The aim of this study was to investigate the anatomic features of the three main sulci of the inferior temporal lobe and provide a simple description of complex patterns among these sulci. Sulcal variations and their relations were examined in seventy formalin‐fixed, adult cadaveric cerebral hemispheres. We recommend a simple but modified classification specifically for anatomic variations of the rhinal and collateral sulci. Furthermore, we describe the frequency of occipitotemporal sulci that contain 5 and 6 segments, not previously mentioned. The length and depth of all sulci were measured in all samples. Additionally, more detailed results regarding the patterns, courses, connections, relationships and measurements were given. Understanding of the complex anatomy of this clinically important region is of benefit to neurosurgeons, providing necessary guidance for neurosurgical approaches to the inferior surface of the temporal lobe. Clin. Anat. 29:932–942, 2016. © 2016 Wiley Periodicals, Inc.

AIM:The aim of this retrospective study was to evaluate the follow-up results of patients who received late-term surgical treatment for peripheral nerve lesions caused by penetrating injuries.MATERIAL AND METHODS:The study included 25 patients who underwent surgery for peripheral nerve injuries in our clinic between 2007 and 2013. The patients were evaluated with respect to age, gender, etiology of the trauma, the affected nerve, clinical examinations, electrophysiological findings, surgical techniques and functional outcomes.RESULTS:The study included 30 nerves of 25 patients (19 male, 6 female; mean age 30.1 years). The mean time between the initial injury and admission to our clinic was 11.5 months (range, 3 to 30 months). Cuts caused by glass were the most common cause of injury (68.5%). The most commonly injured nerves in our patients were the median nerve (43.4%) and ulnar nerve (26.6%). External neurolysis and decompression were performed in eleven patients, epineurotomy and internal neurolysis were performed in eight patients, epineural repair was performed in fourteen patients, fascicular repair was performed in three patients, and interfascicular anastomosis using sural nerve grafting was performed in five patients. Postoperative motor strength and electrophysiological analyses showed significant improvements. Better outcomes were obtained in cases with median nerve injuries rather than other nerve injuries. Additionally, patients undergoing external neurolysis and decompression exhibited better outcomes than those undergoing other surgical approaches.CONCLUSION:Although surgical treatment is recommended as early as possible for peripheral nerve injuries, late-term surgical treatments may provide positive outcomes.

Objective: Upper disk herniation levels (L1-L2, L2-L3, L3-L4) are different from those at lower levels of the lumbar spine (L4-L5, L5-S1) with regard to clinical and anatomic characteristics and surgical outcome. In the upper lumbar region, the spinal canal is narrower and it may compromise more spinal nerve roots or the conus medullaris. The aim of this study was to evaluate the surgical outcomes and clinical characteristics of upper lumbar disk herniations. Methods: We diagnosed 272 upper lumbar disk herniations of 3045 patients who had undergone surgical treatment for lumbar disk herniations from 2006 to 2011. This retrospective study reviewed 127 patients with complete records. We divided upper lumbar disk herniations into 2 groups: L1-L2+L2-L3 levels as group I and L3-L4 level as group II. Patient’s age, sex, presenting symptoms and signs, clinical characteristics, radiologic findings, operative methods, and surgical outcomes were investigated. Prolo economic and functional scale was used to evaluate patient’s satisfaction results. Results: Of the 127 patients, 55% were male and aged from 22 to 80 years (mean 51 y). Of the 127 patients, 102 (80%) were at L3-L4, 17 (13%) at L2-L3, and 8 (6%) at L1-L2 levels. Most of the patients complain of back pain (84% in group I and 84.3% in group II) and leg pain (88% in group I and 90.2% in group II). Weakness of lower extremities were observed in 56% of patients in group I and 61.8% of patients in group II, sensory disturbance in 80% in group I and in 75.5% in group II, loss of reflex in 36% in group I and in 32.4% in group II, sphincter dysfunction in 8% in group I and in 6.9% in group II, cauda equine syndrome in 8% in group I and in 2.9% in group II, and neurological claudication in 38% in group I and in 27.5% of patients in group II. Discectomy was performed using these 3 methods: unilateral microdiscectomy in 72% of patients, bilateral microdiscectomy in 17% of patients, and total laminectomy and discectomy in 11% of patients. The mean follow-up period was 17 months (range, 1 to 48). According to Prolo economic and functional scale, preoperative symptoms improved in 65.4% of patients, partially in 27.5% of patients, and were poor in quality in 7.1% of patients. The outcomes of patients in groups I and II were similar. Conclusions: In upper lumbar disk herniation clinical features, weakness, pain, and sensory disturbance are the main complaints and are different from those of lower levels of the lumbar spine. Furthermore, loss of reflex is less seen according to lower lumbar disk herniations. The L3-L4 level is excluded from the upper lumbar disk in some reports; however, in our study, clinical characteristics and outcomes in both the groups were statistically similar (P>0.05). Therefore, the upper lumbar disk term for L1-L2, L2-L3, and L3-L4 disk levels is appropriate.

Study Design. Prospective study Objective. To evaluate contamination in spinal implants using a liquid culture medium and the effect of covering an implant set on contamination. Summary of Background Data. Postoperative infection rates increase with the use of spinal implants. Because implant contamination may be an important origin for postoperative infections, investigation, evaluation, and taking required precautions to prevent these contaminations are critical. Methods. Patients operated on for various spinal pathologies were randomized. The patients were divided into groups of covered and uncovered implant sets. The screw samples were placed in liquid culture medium immediately after opening the implant set. The implant set in the covered group was immediately covered with a sterile surgical towel. A new screw was taken from the implant set and cultured in the liquid culture medium every 30 minutes. At the end of 24 hours, swabs with samples from the liquid culture medium were used to culture blood agar. At the end of 48 hours, the samples with growth were considered contaminated. Results. Growth started after 30 minutes in the uncovered group, whereas only a single growth was noted after 60 minutes in the covered group. Contamination increased with time in both groups, but more so in the open group. A statistically significant difference in contamination was found between the groups at and after 30 minutes. Conclusion. Contamination increases with time in all implant materials. Contamination rates can be reduced by using simple precautions, such as covering the implant set. Culturing the entire implant samples in liquid culture medium is accepted as a safe and more effective method in evaluating contamination. Level of Evidence: 2

Background: Epidural scar adhesion following posterior spinal surgery is an important complication that remains a challenging problem during postoperative recovery. The aim of this experimental study was to evaluate the favorable efficacy of topical application of Contractubex (R) gel in reducing epidural scar adhesion following laminectomy in rats using a microsurgical dissection technique and histopathological examinationMaterials and Methods: In this study, forty rats were randomly divided into two groups, a control group and a treatment group. Laminectomy was performed between the L3 and L5 levels. In the control group, only laminectomy was performed, and no treatment was administered. In the treatment group, Contractubex gel was applied in the epidural space. After four weeks, ten rats were selected from each group and anesthetized for morphological evaluation; the surgical sites were then reopened using a surgical microscope. The epidural scar adhesion was assessed by a neurosurgeon blinded to the treatment groups using the Rydell classification system. Histopathological analysis was performed on the remaining ten rats in each group. The extent of epidural scar adhesion and fibroblast density were histopathologically evaluated and graded.Results: Epidural scar adhesion was significantly reduced in the group treated with Contractubex compared with the control group.Conclusion: Our study demonstrated that topical application of Contractubex significantly inhibits fibroblast infiltration and reduces the formation of epidural fibrosis and adhesions, based on macroscopic evaluation and histopathological analysis following laminectomy in rats. However, further research on the clinical use of Contractubex is needed.

BACKGROUND:Two different techniques of short-segment instrumentation, with and without a pedicle screw at the fracture level, were compared in thoracolumbar burst fractures in neurologically intact (ASIA-E) patients. The sagittal index, kyphosis angle (Cobb), canal compromise ratio, and compression ratio of the anterior vertebral height were analyzed.METHODS:Seventy patients who underwent short-segment stabilization for thoracolumbar (T11-L2) burst fractures in our clinic between 2008 and 2012 were included in this retrospective study. In 35 patients (group 1), a pedicle screw was placed only one level down and one level up from the fracture level. In another 35 patients (group 2), a screw was placed at the fracture level in addition to the short segment. Only neurologically intact patients with burst fractures according to the Denis classification were included. The patients were evaluated according to their age/gender, trauma etiology, and fracture level. Their preoperative and most recent postoperative follow-up radiographs and CTs were evaluated in terms of the sagittal index, kyphosis angle (Cobb), ratio of canal compromise, and anterior vertebral height.RESULTS:The two groups were similar in their ages, follow-up periods, and severity of the deformity and fracture. When the pedicle screw was placed at the fracture level in addition to short-segment stabilization, statistically significant improvements in the sagittal index (p < 0.001), local kyphosis (Cobb) angle (p = 0.006), and compression ratio of the anterior vertebral height (p = 0.002) were observed. Concerning the ratio of canal compromise according to the CT findings (p = 0.189), moderate differences were found.CONCLUSIONS:Short-segment stabilization in thoracolumbar burst fractures with additional screws at the level of the fracture results in an improved kyphosis correction, sagittal index, and compression ratio of the anterior vertebral height. However, long-term follow-up is needed to determine the clinical significance of these findings.

Children with medulloblastomas most commonly present with signs and symptoms of elevated intracranial pressure due to obstructive hydrocephalus, especially headaches and vomiting. However, some pediatric patients present with sudden neurological deterioration due to intracerebellar hemorrhage associated with medulloblastoma, although very few reports exist that document this phenomenon. An 8-year-old girl was admitted to our emergency department who presented with sudden loss of consciousness, vomiting, and bradycardia. The neuroradiological evaluation revealed a hemorrhagic mass lesion in the posterior fossa. Urgent evacuation of the hematoma was performed. The postoperative course was uneventful, and the postoperative histopathological examination revealed the lesion to be a medulloblastoma. This report presents an unusual case of a medulloblastoma presenting with fatal intracranial hemorrhage in a child. The clinical features and intraoperative and pathologic findings of the case are discussed.

AIM To evaluate the neuroprotective effects of adalimumab in an experimental spinal cord injury model and compare them with those of the widely-used methylprednisolone. MATERIAL AND METHODS Forty male Wistar rats were divided into 5 as the sham, trauma, adalimumab, methylprednisolone, and adalimumab+methylprednisolone groups. Only laminectomy was performed in the sham group. Laminectomy and trauma was performed to the trauma group but no treatment was given. A single dose of 40 mg/kg subcutaneous adalimumab was administered after the laminectomy and trauma to group 3. A single dose of intravenous 30 mg/kg methylprednisolone was administered right after laminectomy and trauma to group 4. Single doses of 40 mg/kg adalimumab and 30 mg/kg methylprednisolone were administered together after laminectomy and trauma to group 5. Serum malondialdehyde (MDA), TNF-α, IL-1β and IL-6 levels were measured and sections were obtained for histopathological study at the end of the 7 < sup > th < /sup > day. RESULTS MDA, TNF-α, IL-1β and IL-6 levels in serum were significantly decreased in the adalimumab group with clinical and histopathological improvement not less than the methylprednisolone group. The serum MDA levels were similar when the two drugs were given together or separately but there was a statistically quite significant decrease in TNF-α, IL-1β and IL-6 levels with concurrent use. Statistically significantly better results were obtained on histopathological evaluation with the use of both drugs together. CONCLUSION This study revealed that adalimumab is as effective as methylprednisolone in compressive spinal cord injury in rats.