AIM:To identify the patterns and types of neuorosurgical injuries sustained by victims of the double earthquakes affected ten cities with a population of 15 million in southern and central Türkiye.MATERIAL AND METHODS:In this descriptive observational study, we retrospectively analyzed the medical records of a university hospital located in one of the ten cities affected by the earthquake.RESULTS:A total of 1,612 patients with earthquake-related injuries were admitted during the study period, of which 139 (8.6%) had neurosurgical injuries. The mean age of the patients was 42.4 ± 21.1 years (median, 42 years), and 53.2% of them were female. Of the 139 patients with neurosurgical injuries, 41 (29.5%) had craniocerebral injuries, 95 (68.3%) had spinal injuries, and three (2.2%) had both craniocerebral and spinal injuries. A total of 31 surgeries were performed (22.3%) (five [3.6%] for craniocerebral injuries and 26 [18.7 %] for spinal injuries). Ninety-eight patients (70.5%) had concomitant systemic traumas. The overall mortality rate was 5.75%, with crush syndrome (n=4, 50%), being the leading cause of death, followed by neurosurgical pathologies (n=3, 37.5%) and pneumonia with septic shock (n=1, 12.5%).CONCLUSION:Neurosurgical injury is an important cause of post-earthquake mortality and morbidity. To ensure efficient medical rescue and judicious resource allocation, it is essential to recognize the characteristics of earthquake-related neurosurgical injuries. This study provides valuable information regarding the incidence, characteristics, and outcomes of neurosurgical injuries in earthquake-affected patients. Our findings highlight the need for prompt diagnosis and management of such injuries, particularly in those with concomitant systemic trauma.

- OBJECTIVE: Basilar invagination is one of the most frequently observed abnormalities at the craniovertebral into the foramen magnum. - METHODS: The current study included 27 patients who -nderwent surgery for basilar invagination between October 2013 and January 2023. The study group was divided into 2 groups according to basilar invagination types; type I (the presence of type A atlantoaxial instability and instability is the main pathology) and type II (the presence of type B and C atlantoaxial instability and skull base dysgenesis is the main pathology). Craniometric parameters included in the study were atlantodental interval, posterior atlantodental interval, Chamberlain's line violation, clivus-canal angle, Welcher's basal angle, and Boogaard angle. - RESULTS: The mean age of the patients was 24.30 +/- 14.36 years (5-57 years). Fourteen patients (51.9%) were female, and 13 patients (48.1%) were male. Ten patients (37%) had type I basilar invagination, and 17 patients (63%) had type II basilar invagination. Preoperative and postoperative atlantodental interval and Boogaard angle were significantly higher in type I basilar invagination, as preoperative and postoperative posterior atlantodental interval and clivus-canal angle were significantly higher in type II basilar invagination. There was a positive strong correlation between Chamberlain's line violation and Boogaard angle. Postoperative Chamberlain's line violation was significantly higher in occipitocervical fixation (P = 0.035). C1 lateral mass screw fixation was found more successful in Chamberlain's line violation correction than occipital plates. Occipitocervical fixation was found to be associated with higher postoperative Nurick scores (P = 0.015) and complication rates (P = 0.020). Cages applied to the C1-C2 joint space were found to be associated with higher fusion rates (P = 0.023) and lower complication rates (P = 0.024). - CONCLUSIONS: In the present study, it was found that C1-C2 fixation was more successful in correcting craniometric parameters and had lower complication rates than occipitocervical fixation. In appropriate patients, it was determined that cage application increased the success rates of the operations.

AIM: To evaluate the efficacy of percutaneous ventriculoatrial shunting as a salvage method for pediatric patients with abdominal complications. MATERIAL and METHODS: Data obtained from 9 patients with ventriculoperitoneal shunt dysfunctions owing to abdominal complications, who underwent ventriculoatrial shunting as salvage treatment at a single institution between January 2019 and September 2021 were retrospectively analyzed. All operations were conducted under the guidance of intraoperative fluoroscopy and ultrasound. RESULTS: The mean age of the enrolled patients was 8.1 +/- 1.2 years (2-15 years). Six (67%) patients were male and 3 (33%) were female. The mean number of the patients' ventriculoperitoneal shunt revisions until atrial catheter placement was 7.5 times. The reasons for intraperitoneal catheter failure included peritoneal adhesions in 4 (44.5%) patients, pseudocyst formation in 3 (33.3%), and peritonitis in 2 (22.2%). Seven patients from the study cohort had no problem after ventriculoatrial shunt placement. Only 1 patient had shunt dysfunction related to the ventricular catheter, and ventricular catheter and shunt valve revision was performed 26 months after ventriculoatrial shunt placement. The atrial catheter of the patient was intact. One patient died from the progression of her primary disease (medulloblastoma in the 4th ventricle), which was unrelated to the ventriculoatrial shunt. CONCLUSION: Percutaneous ventriculoatrial shunting under the guidance of intraoperative fluoroscopy and ultrasound is a safe, effective, and easy alternative in patients with peritoneal complications and a history of multiple operations.

Objectives Postoperative cerebrospinal fluid (Po-CSF) leak is still a challenging complication of endoscopic endonasal skull base surgery. However, data describing the predictive factors of Po-CSF leak in pure pituitary adenomas is lacking. Aim of this study is to determine the risk factors of Po-CSF leak in a pituitary adenoma group operated via pure transsellar endoscopic approach. Design This is a retrospective cohort study. Setting A single-center academic hospital. Participants Patients operated for a pituitary adenoma between 2015 and 2021 and followed up until June 2022 were included. Main Outcome Measures Demographics, comorbidities, imaging, and outcome were recorded. Univariate and multivariate logistic regression analyses were used to determine the risk factors of Po-CSF leak. Results Of the total 170 patients with a mean age of 47.5 +/- 13.8 (min: 15; max: 80), 11 (6.5%) had Po-CSF leak. Univariate analysis revealed age, diabetes mellitus (DM), and tumor volume as predictors of Po-CSF leak. According to the receiver operating characteristic analysis, 7.5 cm(3) of tumor volume was found to be a good cutoff value with a sensitivity of 82% and a specificity of 75%. Hence, multivariable logistic regression model adjusted by age showed that a tumor volume of > 7.5 cm(3) (odds ratio [OR]: 22.9; 95% confidence interval [CI]: 3.8-135.9, p = 0.001) and DM (OR: 8.9; 95% CI: 1.7-46.5; p = 0.010) are strong independent risk factors of Po-CSF leak in pure endoscopic endonasal pituitary surgery. Conclusion Besides younger age and DM, a cutoff value for tumor volume > 7.5 cm(3) is the most remarkable risk factor for Po-CSF leak in pure endoscopic pituitary surgery. These patients should carefully be assessed preoperatively and potential preemptive surgical strategies should be taken into consideration to avoid complications.

Myxoid glioneuronal tumor of the septum pellucidum is an uncommon clinical entity, previously referred to dysembryoplastic neuroepithelial tumor located in the septum pellucidum. This study was conducted following PRISMA guidelines. A comprehensive literature search was performed in the PubMed/MEDLINE, Web of Science, and Scopus databases. In addition to the literature review, we report a rare case of a 10-year-old male patient with septal myxoid glioneuronal tumor who underwent endoscopic tumor resection as an exemplary case. A total of 10 pediatric patients from 7 published records were included in this review. An analysis encompassing 11 patients, including the present patient, was performed. The mean age of the patients was 11.36 ± 3.35 years, with a male predominance. The most common presenting symptoms were headache (50

Objective Surgery is the first-line treatment in acromegaly but it takes months to confirm remission. It is crucial to determine remission early in order to inform the patient and plan further treatment options. We aimed to evaluate the predictors of remission at the early phase after endoscopic endonasal pituitary surgery in acromegaly patients. Methods Fifty-four growth hormone (GH)-adenoma patients operated via pure endoscopic endonasal approach were analyzed in this observational study. We compared the basic clinical, radiological characteristics, and the preoperative and postoperative hormone levels in terms of remission according to current guidelines. Results The surgical remission rate was 61.1%. When the patients were compared according to surgical remission, the age, gender, and immunohistochemical granulation type were found to be nonsignificant, while diabetes mellitus was more common (55.6 vs. 44.4%). The preoperative tumor volume (1.2 +/- 0.9 vs. 4.1 +/- 4.2 cm(-3)) and postoperative GH and insulin-like growth factor-1 (IGF-1) levels were higher in the nonremission group (p < 0.05). We defined a number of cut-off values of both GH and IGF-1 levels to predict remission at the postoperative phase. Age standardized regression analyses showed that postoperative day 1 (POD-1) GH levels (odds ratio [OR]: 8.9; 95% confidence interval [CI]: 1.99-40.0, p = 0.004) and tumor volume (OR: 3.14; 95% CI: 1.09-9.0, p = 0.034) were found to be significant independent predictors for remission. Conclusion We demonstrated that tumor volume and POD-1 GH levels are independent predictors of remission in acromegaly patients operated via the pure endoscopic endonasal technique and may be used as an early marker of remission, and this may lead to taking adjuvant medical therapies early into account to improve prognosis.

Aim: This study aimed to asses the efficacy of enhanced recovery after surgery (ERAS) protocols in the lumbar discectomy surgeries. Methods: Data obtained from 92 patients who underwent lumbar microdiscectomy surgery at a single institution between January 2021 and January 2023. Then, the patients were divided into two groups: ERAS protocol group (n=60), and conventional surgery group (n=32). Results: The mean age of the patients was 49.4±14 years. Among these, 31 were females, and 61 were males. The demographic, surgical and outcome parameters of two groups were compared. There were statistically significant decreases in length of stay and spondylodiscitis rates in the ERAS protocol group. Length of stay was found 25.52±12.53 hours in ERAS group, and 34±20.06 hours in conventional surgery group (p=0.002). Spondylodiscitis rates were 3.3% and 15.6% in the ERAS and conventional surgery groups, respectively (p=0.034). Conclusions: This study revealed that ERAS protocol reduces length of stay in hospital, and spondylodiscitis rates in lumbar microdiscectomy surgery. We conclude that ERAS protocols should be encouraged and applied more widely in spine surgeries.

Introduction: Extraskeletal myxoid chondrosarcoma of the jugular foramen is a rare clinical entity, especially in the pediatric population. Thus, it can be confused with other pathologies. Case Presentation: We report an extremely rare case of a 14-year-old female patient with jugular foramen myxoid chondrosarcoma that was completely removed through microsurgical resection. Conclusion: The primary purpose of the treatment is gross total resection of the chondrosarcomas. However, adjuvant methods such as radiotherapy should additionally be applied in patients who have high-grade diseases or cannot undergo gross total resection because of anatomic localization.

Purpose Sellar metastases are rare lesions. Recent improvements in diagnosis and treatment strategies have prolonged survival but increased the probability of metastatic tumors. Evaluation with clinical symptomatology and meticulous laboratory examination is crucial. We present our multicenter national study on sellar metastases to evaluate and underline the main clinical, endocrine, and radiological considerations regarding the diagnosis and endonasal endoscopic management of such rare lesions. Methods A medical literature-based retrospective study was planned across 13 neurosurgical centers in Turkey, where a data survey was conducted to collect information regarding sellar metastases surgically treated using the endoscopic endonasal approach, including clinical presentation, radiographic features, primary tumor origin, histopathological confirmation, time to metastasis, treatment, and patient outcomes. Results Between 2010 and 2020, 54 patients (22 women [40.7%] and 32 men [59.3%]) who underwent surgery with the endonasal endoscopic approach and had pathologically proven sellar metastases (overall incidence, 0.54%) were included. Of the patients, 59.3% had no known malignancy and presented with new-onset symptoms, 79.6% reported headache, 51.9% complained of some degree of visual deficits, and 50% had cranial nerve symptoms. Tissue biopsy was performed in 7.4% of the patients, whereas gross or subtotal resection was achieved in the remaining patients. Conclusion To our knowledge, this is the largest series of patients surgically treated with the endonasal endoscopic approach for sellar metastases. For these patients, the treatment focus should be on management modalities for increasing quality of life instead radical treatment options with survival benefit.

AIM:To investigate the recurrence rate of atypical meningiomas after surgery (with or without adjuvant radiotherapy), and to determine which factors were related with recurrence. MATERIAL AND METHODS:Data obtained from 83 patients who underwent surgery and histopathologically diagnosed with atypical meningioma at a single institution between January 2009 and June 2019 were retrospectively reviewed. Then, the patients were divided into two groups: the surgery-only (n=43) and surgery + adjuvant radiotherapy (n = 40) groups. RESULTS:The mean age of the patients was 53.5 ± 14.6 years. Among them, 51 (61.4%) were female and 32 (38.6%) were male. The recurrence rates were 30.2% (n=13) in the surgery-only group and 17.5% (n=7) in the surgery + adjuvant radiotherapy group. A statistically significant decrease in the recurrence rate was observed after adjuvant radiotherapy application (p=0.046). Moreover, adjuvant radiotherapy significantly increased progression-free survival (p=0.042). Peritumoral edema, sinus invasion, brain invasion, subtotal tumor resection, and complications were significant predictors of tumor recurrence, and the main risk factors for the recurrence of atypical meningiomas were brain invasion (p=0.019) and subtotal tumor resection (p=0.006). Progression-free survival and overall survival of the study group were 45.50 ± 27.56 and 56.69 ± 28.17 months, respectively. The parameters examined in the study, except for tumor recurrence, did not show a statistically significant influence on overall survival. CONCLUSION:This study revealed that the important prognostic factors for tumor recurrence are subtotal tumor resection and brain invasion. Moreover, adjuvant radiotherapy in addition to surgical resection reduces the recurrence rate of atypical meningiomas and improves progression-free survival of the patients. However, adjuvant radiotherapy did not show a significant influence on overall survival.

Objective This study aimed to determine the efficacy of prophylactic use of vancomycin powder against surgical site infections in patients with high-risk conditions who underwent posterior spinal instrumentation. Methods Data obtained from 209 patients who underwent posterior spinal instrumentation at a single institution from 2014 to 2017 were retrospectively reviewed. Patients were then divided into two groups: control group, including 107 patients (61 females, 46 males; mean age=54 years; age range=16-85 years), and treatment group, including 102 patients (63 females, 39 males; mean age=53 years; age range=14-90 years). All patients received the same standard prophylactic antibiotic regimen. In addition to the prophylactic antibiotic, vancomycin powder was applied locally to the surgical site in the treatment group. All patients were followed up for at least 90 days postoperatively. Infections were categorized as superficial and deep infections. Subgroup analysis of high-risk patients (Syrian refugees) was also performed. Results The infection rates were 1.96% (two patients) in the treatment group and 6.54% (seven patients) in the control group. A significant decrease in the infection rates was observed with local vancomycin powder application. Advanced age (>46 years) and prolonged surgical duration (>140 min) were found to be the main risk factors for surgical site infections (p=0.004 and p=0.028, respectively). The infection rates were 3.22% and 8.11% in the treatment and control groups of refugees, respectively. There were three superficial and four deep infections in the control group and one superficial and one deep infection in the treatment group. A dominance of staphylococcus infections was observed in the control group, whereas no significant dominance was observed in the treatment group. Three patients in the control group and one patient in the treatment group received implant removal. Conclusion Evidence from this study has revealed that local application of vancomycin powder reduces the rate of surgical site infections after instrumented spinal surgery. The benefit of vancomycin application may be most appreciated in higher risk populations or in clinics with high baseline rates of infection. Level of evidence Level III, Therapeutic Study.

Background: Silent pituitary adenomas are clinically non-functional (i.e., without clinically evident pituitary hormone production). Introduction: The aim of this study was to investigate subjects with silent pituitary adenomas for possible variations in their clinical status. Methods: A total of 102 patients who had undergone surgery for pituitary adenoma and had been diagnosed with silent pituitary adenoma was included in the study. The patients’ preoperative and postoperative hormonal parameters and magnetic resonance imaging (MRI) features were collected, and pathological specimens were re-evaluated. Results: Immunohistochemistry results of the 102 patients were as follows: hormone-negative adenomas (n=35) 35.5%; FSH+LH-positivity (n=32) 31.3%; ACTH-positivity (n=11) 10.7%; α-subunit- positivity (n= 9) 8.8%; prolactin-positivity (n=8) 7.8%; GH-positivity (n=6) 5.4%; and plurihormonal adenoma (n=1). The mean sizes of SGA, SGHA, and SCA were 28.0±12.7, 30.0±16.0, and 27.7±8.9mm (p>0.05), respectively. With the exception of silent gonadotroph adenomas (SGAs), female gender dominance was shown in patients with silent growth hormone adenoma (SGHA) and silent corticotroph adenoma (SCA). Although no clinical relevance was observed in relation to hormonal excess, preoperative GH (4.21±4.6, vs. 0.27±0.36 p=0.00) was slightly more elevated in SGHA than in GH-negative adenomas. Additionally, preoperative basal ACTH values (47.3±28.7 vs. 23.9±14.4, p=0.003) were also higher in SCA compared to the other types. Our findings revealed SCAs to be of more aggressive behaviour than SGHAs and SGAs due to invasiveness in radiological imaging, their elevated re-operation, and postoperative ACTH values. Conclusion: Silent pituitary adenomas represent a challenging diagnostic tumour group. Careful initial evaluation of patients with pituitary adenomas should consider any mild signs and symptoms of functionality, particularly in cases of GH- and ACTH-secreting adenomas.

INTRODUCTION:Central nervous system xanthogranulomas are uncommon clinical entities, and symptomatic bilateral choroid plexus xanthogranulomas are rare.CASE PRESENTATION:We present the case of a 15-year-old male patient with bilateral choroid plexus xanthogranulomas with symptoms of increased intracranial pressure. Gross total resection of the tumor in the left lateral ventricle was performed. The patient improved, and asymptomatic right-sided tumor was monitored at follow-up.CONCLUSION:The main treatment objective in these tumors is gross total resection. Asymptomatic tumors can be followed without intervention. However, surgery should be performed for symptomatic tumors that cause hydrocephalus or symptoms of increased intracranial pressure.

Introduction: Extraneural metastases of glioblastoma are very rare clinical entities, especially in pediatric patients. Because of their rarity, they can be confused with other pathological processes. Case Presentation: We report a case of 16-year-old boy with extensive extraneural metastases of glioblastoma. Lung, liver, cervical lymph nodes, skin, and bone metastases were detected in the patient. Conclusion: We describe the presentation, evaluation, and diagnosis of this rare condition with regard to pertinent literature.

BACKGROUND:Measurement of the optic nerve sheath diameter (ONSD) with point-of-care ultrasound (POCUS) is a non-invasive and radiation-free technique that can be used to assess increased intracranial pressure (ICP). Ophthalmic artery and central retinal artery Doppler indices can be used like transcranial Doppler to evaluate increased ICP. This study aims to examine the diagnostic value of ONSD measurements and central retinal artery Doppler indices in the evaluation of pediatric patients with increased ICP.METHODS:This was a prospective, case-controlled single center study. The study group was comprised of a total of 38 pediatric patients with increased ICP and the control group included 19 healthy children. Ophthalmic ultrasound was performed and ONSD and central retinal artery Doppler indices were measured.RESULTS:The mean age of the study group was 80.84 ± 65.12 months. The mean ONSD was 5.9 ± 0.8 (3.6-8.1) mm in the study group and the mean resistive index (RI) was 0.71 ± 0.08 (min:0,55-max:1) and was significantly greater than the control group (p < 0.001 and p < 0.001, respectively). In terms of predicting increased ICP, the ONSD measurement was the strongest parameter, with its area under the curve: 0.767 (95 percent confidence interval: 0.68-0.85). In the study group, the cut-off value for ONSD was 5.8 mm (66 percent sensitivity, 100 percent specificity) and the cut-off value for RI was 0.68 (63 percent sensitivity, 83 percent specificity).CONCLUSIONS:Point-of-care ultrasound is a noninvasive and important tool in pediatric intensive care units. Our study is significant as one of the few pediatric studies where central retinal artery Doppler indices are evaluated in addition to OSND, in patients with increased ICP.

Objective: It was aimed to evaluate the patients who underwent laminoplasty for the various pathologies that were located in the spinal canal. Materials and Methods:The records of the patients who underwent osteoplastic laminoplasty for various pathologies between 2014 and 2019 were analyzed retrospectively.Patient data including age, gender, preoperative and postoperative neurological conditions, type and radiographic localization of their pathologies, preoperative and postoperative deformities, involved segments, hospitalization periods and postoperative complications were gathered.Results: Sixty-two patients were included in the study.The mean age of the patients was 44.3 years (9-80 years).Fifty-two patients had tumoral and 10 patients had non-tumoral pathologies.Grade 3 and 4 patients were predominant in the preoperative period, while grade 1 and 2 patients were predominant in the postoperative period according to Modified McCormick Scale classification of the patients.Twenty-three patients had preoperative deformity.A total of 138 laminae were reconstructed.One patient had cerebrospinal fluid leak in the long-term period and 1 patient had quadriplegia and respiratory deficiency in the postoperative period.In only 1 patient, a new-onset deformity developed and in 1 patient, progression of previous deformity was seen.However, the deformities of these patients did not require corrective surgery. Conclusion:Laminoplasty technique has recently gained popularity and begun to replace traditional laminectomy technique.Laminoplasty is a preferred technique with the low complication rates and high patient-comfort in the postoperative period.

Amac: Bu calismada retrospektif olarak kendi klinigimizde takip edilen sessiz kortikotrof adenomu (SKA) olan hastalar ile belirgin kortizol sekrete eden adenomu (Cushing Hastaligi (CH)) olan hastalari klinik, radyolojik, immunohistokimyasal ve cerrahi sonuclarina gore karsilastirilmasi amaclanmistir. Gerec ve Yontem: Retrospektif olarak takip edilmis 17 hastanin 10 tanesi SKA; diger 7 tanesi asikar CH olan bireyleri klinik, biyokimyasal, nororadyolojik ve patolojik verilerine gore toplayip karsilastirdik. Bulgular: CH olan hastalar ile SKA’si olan hastalarin preoperatif ACTH degerleri (60.4±29.5, 45.5±34.6 pg/mL) birbirine benzer olup, preoperatif kortizol degerleri (21.2±4.4 vs 11.5±4.0 mcg/dL) arasinda anlamli farklilik vardi. SKA’si olan hastalarin ortalama hipofiz adenom boyutlari (20.4±4.5 mm), CH olan bireylerin ortalama adenom boyutlarindan (8.8±4.0 mm) daha fazla idi. Ayni sekilde kavernoz sinus invazyonu SKA’si olan hastalarda daha fazla gorulmekte idi. Her iki grupta immunohistokimyasal olarak seyrek granullu boyanma paterni (SKA 7/10, CH 4/7) daha fazla gorulmekte idi. Sonuc: Sessiz kortikotrof adenomlar klinik ve postoperatif sonuclari itibari ile asikar CH olan bireylerden tamami ile farklidir. Bu yonu ile sessiz kortikotrof adenomlari pituiter adenomlarin farkli bir sub-grubu gibi degerlendirmek daha dogru olacaktir.

Objective: Most of the acromegaly cases are caused by growth hormone-secreting pituitary adenoma. Pituitary adenomas are classified histologically into sparsely granulated adenoma (SGA) and densely granulated adenoma (DGA). SGAs have been reported to elicit a more aggressive clinical course and therapy resistance. The aim of this study was to investigate the immunohistochemical subtype of patients with pituitary adenoma and their relationship with the clinical course of the disease. Material and Methods: In the period between 2000 and 2016, about 40 (F21, M19) patients with acromegaly who were diagnosed and operated for pituitary adenoma at our university hospital were included in this study. The medical history of patients, duration of the disease, and comorbidities were assessed. Based on current guidelines for acromegaly management, we determined the serum growth hormone [with 75 g "oral glucose tolerance test" (OGTT)], insulin-like growth factor 1 (IGF-1) levels, as well as computed tomography (CT) or magnetic resonance imaging of the pituitary gland. Immunohistochemical staining of postoperative tissue materials and subtypes of pituitary adenomas were evaluated by an experienced cytopathologist. Results: Of the 40 acromegaly patients included in the study, 25 patients were evaluated as sparsely granulated and the remaining 15 patients were evaluated as densely granulated. The mean age of SG adenomas (40.6 +/- 9.7 vs. 48.6 +/- 5.7, p=0.04) was significantly lower. At the first visit, 64% of SG adenomas were macroadenoma while only 35% of DG adenomas were macroadenoma and the difference was not statistically significant (p=0.43). SG adenomas' pre-treatment GH, IGF1 values (29.2 ng/mL, 800 ng/mL versus 8.4 ng/mL, 445 ng/mL, p=0.02) and post-treatment GH, IGF1 values (4.1 ng/mL, 440 ng/mL versus 0.4 ng/mL, 152 ng/mL, p=0.03) were significantly higher. While endocrine remission is more common in DG adenomas; organomegaly, abnormal echocardiographic findings (left ventricular hypertrophy) and multinodular goiter were more common in SG adenomas. Malignancy (renal cell Ca, thyroid Ca, larynx Ca) was detected in four patients and histopathological diagnosis of these patients was detected as SG adenoma. Conclusion: The immunohistochemical subtype of the pituitary adenoma may have the potential to affect the clinical course and therapy of acromegaly. SGA is more prone to cavernous sinus invasion, comorbidity and resistance to therapy. Carcinogenesis associated with malignancy was more common in patients with SGA. However, further studies are needed to confirm our findings.

Purpose: The aim of the study was to review our clinical 7 years experiences with silent corticotroph adenoma (SCA) and Cushing disease (CD) with regard to clinical, radiological features, immunohistochemical and surgical outcomes and compare the results between two groups. Material and Methods: We retrospectively reviewed a series of patients (n=17; SCA 10, CD 7) with corticotroph adenomas and collected biochemical, neuroradiological and pathological data of those during follow-up time. Results: Mean pre-operative ACTH values of the patients with CD and SCA were 60.4±29.5, 45.5±34.6 pg/mL, respectively. Mean preoperative cortisol of the patient with CD (21.2±4.4 vs 11.5±4.0 mcg/dL) was increased than the patients with SCA measurements’. Patients with SCA had larger pituitary mass (20.4±4.5 vs 8.8±4.0 mm) than the patients with CD. And cavernous sinus invasion also was determined in all patients with SCA. Sparsely granulation staining was more common in all patients with SCA (7/10) or CD (4/7). Conclusion: SCAs are totally different from functional CD adenomas related with clinical characteristics and postoperative outcomes. SCA can be thought of as a diverse group of pituitary adenomas.

The aim of this study is to describe patients who represent spontaneous regression of lumbar disc herniations (LDHs) subsequent to conservative treatments. In this retrospective study, medical records of 862 patients who had presented to our neurosurgery department with LDHs between May 2014 and May 2016 were studied. All of these patients had a history of low back pain and radiculopathy. Lumbar magnetic resonance imaging (MRI) scans were performed to diagnose them.LDHs were categorized into four subtypes including disc bulging, protrusion, extrusion, and sequestration. Five patients developed spontaneous regression of LDHs according to spinal MRI scans. All patients relieved radiculopathy symptoms in 2 to 4 weeks and low back pain symptoms in 3 to 8 weeks except one patient. In one patient hypoesthesia symptom, in one patient motor deficit, and in one patient low back painremained after the regression. The clinical and diagnostic imaging characteristics and outcomes of these five patients are described and the pertinent literature regarding spontaneous regression of LDHs is reviewed. Sequestrated disc herniations represent the main candidates for spontaneous regression according to our clinical research and the pertinent literature. Dehydration and inflammation-related resorption are the main mechanisms for this event. Conservative treatment modalities should not be underestimated for the treatment of such patients in the absence of definitive surgical indications.