Objectives: The Goel-Harms technique provides rapid stabilization and high fusion rates for atlantoaxial instability but carries a risk of neurovascular injury during lateral mass and pedicle screw insertion. Recently, 3D printing has emerged as a cost-effective and increasingly accessible tool in various surgical fields. This study aimed to compare the clinical and radiological outcomes of C1-C2 fixation using a 3D-printed template versus the free-hand technique. Methods: This retrospective cohort study included patients who underwent C1-C2 fixation with the Goel-Harms technique at two tertiary neurosurgical centers between 2021 and 2023. Operative, radiological, and functional outcomes were reviewed in 21 patients who were operated using either a patient-specific 3D-printed template applied intraoperatively (Group 1; n = 10) or the free-hand technique (Group 2; n = 11). Postoperative screw accuracy was assessed using the Gertzbein-Robbins classification. Results: A total of 84 screws were placed (Group 1: 40; Group 2: 44). In Group 1, 38 of 40 screws (95%) were accurately placed, compared with 41 of 44 screws (93.1%) in Group 2. The mean fluoroscopy and operative times were significantly shorter in Group 1 than in Group 2 (21.90 ± 4.33 s vs. 27.09 ± 13.48 s, p = 0.012; 126.60 ± 28.70 min vs. 171.36 ± 40.44 min, p = 0.010, respectively). Conclusions: The 3D-printed template technique significantly reduced operative and fluoroscopy times compared with the free-hand technique. Three-dimensional printing offers a cost-effective alternative to conventional navigation systems by eliminating their time-consuming preoperative setup in the operating room.

OBJECTIVE This retrospective study, spanning from 2012 to 2022 at Dokuz Eylul University Radiation Oncology Institution, aims to analyze outcomes in vestibular schwannoma (VS) patients undergoing various treatments. METHODS Thirty-two adult patients (?18 years) who received stereotactic radiosurgery (SRS), stereotactic radiotherapy (SRT), or fractionated radiotherapy (FRT) at DEU and had a minimum follow-up of six months were included. The Koos Grading Scale for VS lesions, Gardner-Robertson Grading for hearing, and House-Brackmann Scale for facial nerve functions were used. Statistical analyses employed SPSS v24, Kaplan-Meier methodology, and the log-rank test. RESULTS The median age of the patients was 56, predominantly exhibiting Koos 4 lesions (43.8%). The median VS volume was 3.5 cm(3), and the Planned Target Volume (PTV) was 5.4 cm(3). Common fractionation schemes were 5x4.5/5 Gy (46.9%) and 1x12/13 Gy (43.8%). At two years, overall survival (OS) reached 96.9%, with lesion stability in 46.9% and regression in 53.1%. CONCLUSION This study underscores the importance of considering treatment fractionation, cochlear sparing, and lesion grading to achieve favorable outcomes and effectively manage toxicity in patients with vestibular schwannomas (VS). The Koos score has been identified as a significant factor influencing lesion regression. Further investigation involving a larger patient number is recommended to delineate the factors influencing treatment response.

This study aims to compare the effects of osteoplastic craniotomy on temporalis muscle and bone graft atrophy in patients operated on with a pterional approach to the standard technique. Patients operated on for an intracranial aneurysm with a pterional approach between 2014 and 2018 were studied. Following the exclusion criteria, 36 patients were included in this retrospective study. Temporalis muscle volume and bone graft volume were calculated. The volumes were compared from preoperative and postoperative computed tomography images for temporalis muscle and from early and late postoperative computed tomography images for the bone graft. The osteoplastic craniotomy group (group I) had 17 patients, and the standard craniotomy group had 19 patients (group II). Temporalis muscle volume and bone graft volume decreased statistically significantly in group II after surgery. However, no significant volume difference was found in group I measurements. When compared with the standard technique, osteoplastic craniotomy reduces the likelihood of postoperative temporalis muscle and bone graft atrophy in patients undergoing pterional craniotomy. As a result, the patients' cosmetic and functional well-being is improved.

OBJECTIVE: To create a reusable and inexpensive training model with technological tools that simulates cerebral bypass surgery and a sensor system that provides tactile feedback to the surgeon. Furthermore, we aimed to evaluate the anastomotic stability and contribution to the surgeon's learning curve. METHODS: We created a superficial temporal artery- middle cerebral artery bypass simulation model using chicken and turkey brachial arteries. A cranium model was printed with a three-dimensional printer for craniotomy and cerebral parenchyma was created by pouring silicone into the cranial mold. A blood flow simulation system was also prepared. Pressure-sensitive sensors were placed on parenchyma and tactile conditioning was performed via audible warning from the sensors. Twenty-four anastomosis were performed with different sutures and hand tools. Anastomosis completion times and durability and the number of touches and pressures applied to the parenchyma were recorded. The stability of the anastomoses was evaluated by increasing the pressure in the blood flow simulation system, so usefulness of the training model was evaluated. RESULTS: The time required for anastomosis completion decreased as the number of practices increased (P< P < 0.05). As the number of practices increased, the number of parenchymal touches decreased (P< P < 0.05). CONCLUSIONS: With practice, the time required for anastomosis completion and number of parenchymal touches decreased. Thus, the model is useful, inexpensive, reusable, easily accessible, and contributes to the surgeon's learning curve. Our model with pressure-sensitive sensors can be used for microsurgery practice, enabling the surgeons to gain tactile conditioning and evaluate anastomotic stability and leakage.

Background: During the course of primary malignant brain tumors, there is an increased tendency for both intracerebral hemorrhage and venous sinus thrombosis. Case Report: A 63-year-old man presented with a headache, and a brain computed tomography (CT) scan showed a hematoma in the right occipital lobe. Magnetic resonance imaging (MRI) revealed almost complete rim enhancement, and CT perfusion showed increased cerebral blood volume values. A new bleeding focus and a thrombus extending from the superior sagittal sinus to the cortical vein were seen on CT and MRI scans performed due to the headache that developed the day before surgery. After surgical evacuation of the hematoma, a giant cell glioblastoma diagnosis was made as a result of pathological examination of the lesion. Conclusion: In challenging cases like this, perfusion techniques are useful. Cerebral venous sinus thrombosis should also be kept in mind during the perioperative and postoperative periods to avoid complications.

Objective: Coexistence of lumbar spine disorder with hip diseases is defined as Hip-Spine syndrome, there might be a relation between torsional deformities of the hip and lumbar disc disease. Purpose of the present study was to find whether hip torsional parameters (femur, acetabular anteversion) and clinical findings (hip range of motion, hip score) differ in patients with lumbar disc disease. Method: Patients with lomber disc herniation (n: 20) and control subjects (n: 20) without any lumbar spine or hip disease were enrolled in the study. Femoral anteversion (FeAv), acetabular anteversion (AA), center of edge angle (CE), degree of hip flexion, extension, Harris Hip scores (HHS) were evaluated bilaterally. Results: HHS score, degree of extension plus flexion was lower at diseased side when it is compared to the control subjects (p < 0.001). Unilaterally affected patients had lower AA than control subjects (AA: 13 ± 40 vs16 ± 20 p: 0.01). Conclusion: As there is a link between hip and spine disorders, present study aims to find whether there is a causal relation between hip torsional deviations and lumbar disc disease. Partially supporting the hypothesis, diseased side had lower degrees of acetabular anteversion compared to control subjects at unilaterally affected patients. Mechanical and /or hip torsional parameters especially the acetabular retroversion may have an etiopathogenetic role in unilateral lumbar disc disease.

The aim of this study was to evaluate the clinical outcomes of cerebrospinal fluid (CSF) rhinorrhea in patients treated with transcranial surgery. Here, we retrospectively reviewed 23 patients with CSF rhinorrhea between 2008 and 2015 at our university hospital. Nine (39.1%) patients were treated conservatively, whereas 12 (52.2%) patients were treated with a transcranial approach. Our results showed that 7 (30.4%), 11 (47.8%), and 5 (21.7%) patients had spontaneous, traumatic, and iatrogenic CSF leakage, respectively. In our study, the cribriform plate was the most common site of leakage, and it was found to be involved in 5 (21.7%) patients. The mean diameter defect of the fistula was 130.40 +/- 190.47mm(2) and there was no significant difference between this defect and the different etiology types. In our study, meningitis, third nerve palsy, and vasospasm were the main complications that arose during the treatment of CSF rhinorrhea. Moreover, 6 (26.1%) of 7 (30.4%) patients had spontaneous CSF leaks that were treated with surgery. Notably, spontaneous CSF leaks did not stop when treated with conservative measures. In addition, there were no significant differences between etiology types and CSF leaks. The primary surgical repair rate was 78.3% and the secondary surgery repair rate was 91.6%. Importantly, as we preferred using this type of transcranial surgery in our clinic, there has been a higher success rate with endoscopic treatments and fewer major complications from CSF rhinorrhea in the literature.

Özet: Bu çalışmanın amacı, C1 lateral mass -C2 pedikül vidalama kullanılarak posterior C1 -C2 füzyon yapılacak olan hastaların 3 boyutlu (3B) yazıcı ile oluşturulan preoperatif modelleri üzerinde cerrahi planlama ve uygulamasının klinik sonuçlara etkisini araştırmaktır.Kliniklerimize atlantoaksiyel dislokasyon nedeniyle başvuran 11 hasta bu çalışmaya alınmıştır.Üç boyutlu baskı materyalinin üretimi için özel tasarımlı katmanlı üretim teknolojisi olan üç boyutlu yazıcı kullanıldı.Preoperatif modeller üzerinde cerrahi planlama yapıldı ve uygulandı.Hastaların yaş ortalaması 52.54±20.45yaş (24-75) idi.11 hastanın 7'si erkek (%63.6), 4'ü kadındı (%36.4).Bu hastaların 2'si (%18.2) konjenital anomali nedenli, 9'u (%81.8)travma nedeniyle kliniğimize başvurdu.Hastaların operasyon süresi ortalama 260.90±79.17dakika idi.Preoperatif atlantodental aralık ortalaması 3.44±1.38mm, postoperatif atlantodental aralık ortalaması 2.20±0.89mm olarak bulundu.Preoperatif üç boyutlu modellemenin yardımı ile yapılan C1-C2 füzyonu atlantoaksiyel dislokasyonun tedavisinde etkili bir yöntemdir.Bu modellerin kullanımı, ameliyat öncesi simülasyon yapma becerisini artırarak cerrahlara avantajlar sunar.

We report imaging findings of a 64-year-old male patient with a ruptured epidermoid cyst (EC) known to be constant over the 23-year follow-up and showing malignant transformation to squamous cell carcinoma (SCC).Computed tomography (CT) and magnetic resonance imaging (MRI) findings including diffusion weighted imaging (DWI), 1H + MR spectroscopy (MRS), dynamic susceptibility contrast perfusion (DSC) MRI of EC, and its rare complications are presented together with a review of the literature.Fluid-lowattenuated-inversion-recovery (FLAIR) and T1-weighted images with gadolinium are the best sequences together with DWI to show the relationship of the EC, the SCC and the border between.Primary brain SCC enhances mostly ring-like or peripherally, but diffuse enhancement is also possible.To our knowledge, no MRS and DSC findings have been reported in the literature yet.

Schizencephaly is an uncommon congenital structural disorder of cerebral cortex caused by abnormal neuronal migration. Patients usually present with seizure disorders, hemiparesis, quadriparesis, cognitive deficits and mental troubles. Very rarely, schizencephaly is also associated with subdural fluid collection, and may present with mass effect. In this study we present a schizencephaly case with chronic subdural fluid collection. In our view, clefts may promote subdural fluid collection in schizencephaly patients and careful follow up of these patients is needed.

Lumbar disc herniation (LDH) associated with a contralateral neurological deficit is sometimes encountered by surgeons. Compression against the opposite pedicle in case of a large discal herniation and prominent stenotic changes of contralateral side are held responsible for contralateral symptoms and findings. In this study, we report a case of LDH associated with a painless contralateral neurological deficit. Prominent venous engorgement and congestion at the contralateral side of discal herniation were detected during the operation. It's treatment with bipolar coagulation and significant improvement was seen after the operation.

AIM:Obstruction of superior sagittal sinus (SSS) and collateral bridging veins is a well-known reason of postoperative brain edema and brain infarct, however, morphometric anatomic studies done in the light of surgical landmarks aren't sufficient in number. Object of this study is to describe venous structures related to SSS with silicon injected cadaveric models.MATERIAL AND METHODS:This study was on 6 silicon injected cadaveric heads at Anatomy Department. Duramater was removed and veins on parasagittal area were examined. SSS morphology, veins draining into SSS, their size, number and distance were evaluated.RESULTS:Mean vein number draining into SSS is 2.9±1.5 at anterior to coronal suture (CS), between CS and vertex is 3.2±0.8, between vertex and lambdoid suture (LS) is 2.3±0.9, between LS and confluens sinuum 0.3±0.5. There was no statically difference between right and left sides (p=0.140, p > 0.05). Diameter of veins was 2.4±1.0 mm at anterior to CS, 3.0±1.2 mm at between CS and vertex, 2.4±0.7 mm at between vertex and LS, and 2.2±0.5 mm at between LS and confluens sinuum.CONCLUSION:Knowing details of anatomic structures of SSS and venous structures draining into it may protect the patients from many surgical complications. SSS and related structures with surgical landmarks are valuable for neurosurgeons.

Objective: The sphenopetroclival region (SPCR) and cavernous sinus are among the most difficult-to-access areas in the surgery of the skullbase due to the narrow operation corridors and its proximity to eloquent and important neurovascular structures. Oculomotor (CN3), trochlear (CN4), trigeminal (CN5) and abducent (CN6) nerves can be traumatized during the approaches because of their localizations in the SPCR. The aim of our study is to determine the relative localizations of CN3, CN4, CN5 and CN6 in SCPR Methods: On 20 basis cranii, which were obtained from adult human cadavers fixed in formaline, the entrance points of CN3, CN4, CN5 and CN6 into the dura mater of the cavernous sinus (CS) were dissected under Carl Zeiss OPMI. The distances between the entrance points of the CNs to dura mater and the distances between the CNs and the PCP were measured. Results: The mean distances between the entrance points of CN3, CN4, CN5 and CN6 to the dura mater of CS were measured as, CN3 to the CN4 2.94 +/- 0.91 mm, CN4 to the CN5 4.59 +/- 2.04 mm, CN5 to the CN6 6.50 +/- 1.74 mm. The minimum distance values of CN3 and CN4 to the PCP was 1,69 mm and 3,82 mm, respectively. Conclusion: During the surgical approaches, conserving the eloquent neurovascular structures in the SPCR is important with regard to postoperative complications. The data revealed in our study may help in determining a safe approach in SPCR surgery.

Objective: To investigate the effect of health locus of control beliefs, disability level, and pain intensity on static and dynamic postural control in patients with chronic low back pain (CLBP).Methods: Visual analog scale for pain intensity, Oswestry Disability Index (ODI) for disability level, and Multidimensional Health Locus of Control questionnaire for health control of individuals over his/her own health was used. Postural control during static and dynamic balance was evaluated by Balance Master Equipment in CLBP patients and healthy subjects.Results: Patients had moderate disability according to ODI scores. Postural sway was higher in CLBP patients compared to healthy subjects in static balance tests (p < 0.05). CLBP patients showed poorer performance assessed on balance tests compared to healthy subjects. Parameters of maximum excursion and directional control in dynamic balance test were associated with ODI and low back pain at activity (p < 0.05). Correlation between reaction time and scores of chance health locus of control was significant (p < 0.05).Conclusion: In CLBP patients, postural control was decreased in static balance test. Dynamic test parameters indicated some limitations in movement of patients with LBP. Dynamic balance was mostly influenced by disability level and pain intensity. Chance factors had negative effects on reaction time of movement.

Allodynia is the sensation of pain due to non-painful stimuli. It usually occurs due to destructive lesions of the spinal cord or peripheral nerves. Allodynia following intradural lipoma surgery has been reported previously. We herein report a case of allodynia developed after microsurgical caudal lipoma excision without associated spinal cord injury.

The Morphometrical Evaluation of the Localizations of Oculomotor, Trochlear, Trigeminal and Abducent Nerves in the Sphenopetroclival Region: A Microanatomical Study Çiğdem İÇKE, Ercan ÖZER, Süleyman İÇKE Dokuz Eylül University Medical Faculty, Anatomy, İzmir, Türkiye Dokuz Eylül University Medical Faculty, Neurosurgery, İzmir, Türkiye Turkan Ozilhan Emergency and Traumatology Hospital , Neurosurgery, İzmir, Türkiye

AIM:The microanatomy of the abducens nerve (AN) is important for clinical reasons and surgical approaches as it is located in the petroclival region. The incidence of branching and duplication of the abducens nerve are unknown and mechanisms relating to paralysis of the nerve in indirect conditions are yet to be clarified.MATERIAL AND METHODS:Microanatomical details (anatomical observations and morphometric measurements) of the AN were obtained from 20 cadaveric skull bases (40 specimens).RESULTS:55% of the intracranial abducens nerves had branching, with type 2 and 3 branching occurring in 10%. The nerve coursed below the petrosphenoidal ligament in all but one, and was located at the lateral third below the ligament in 82.5% of the specimens. The mean AN diameter was 1.3±0.2 mm, and the mean diameter of the dural entrance pore was 1.8±0.3 mm, the right being significantly larger than the left. The mean distance of the AN from the posterior clinoid process was 8.4±2.5 mm and from the petrous apex 3.6±2.1 mm.CONCLUSION:Branching of the AN was present in a significant number of specimens; the branching pattern at the cavernous segment may be called "pseudobranching". The AN is at risk for paresis in indirect conditions because of its angles and fixations on its course.

AIM: The petrosphenoidal ligament (PSL, or Gruber's ligament) is located between the petrous apex (PA) and posterior clinoid process (PCP). Details of its anatomy are conflicting in the few studies that exist in the literature. We performed this study to describe in detail the microanatomical characteristics of Gruber's ligament.MATERIAL and METHODS: 20 human cadaveric heads (40 specimens) were used to make morphometric measurements and qualitative evaluations of the microanatomy of the petrosphenoidal ligament.RESULTS: The anatomy of the PSL was predominately butterfly (78%) in shape, with the remaining being triangular (22%). The structure of the PSL was complete in 52% of cases and incomplete (fragmented or hypoplastic) in 38%. A second, smaller ligament was seen in 10% of cases. Mean length of the PSL was 13.4+/-3.2 mm, mean width was 6.1+/-3.2 mm at the PCP and 4.2+/-1.6 mm at the petrous apex. Butterfly-shaped ligaments were narrowest in the middle (mean 2.0+/-0.9 mm), while triangle-shaped ligaments were narrowest (mean 2.8+/-2.3 mm) at its end, at its insertion on the PA or PCP.CONCLUSION: The PSL (Gruber's ligament) is an important structure in the petroclival region. In this study, microanatomical characteristics were described in detail, along with new descriptions of its shape.

AIM: The petrosphenoidal ligament (PSL, or Gruber’s ligament) is located between the petrous apex (PA) and posterior clinoid process (PCP). Details of its anatomy are conflicting in the few studies that exist in the literature. We performed this study to describe in detail the microanatomical characteristics of Gruber’s ligament. MATERIAL and METHODS: 20 human cadaveric heads (40 specimens) were used to make morphometric measurements and qualitative evaluations of the microanatomy of the petrosphenoidal ligament. RESULTS: The anatomy of the PSL was predominately butterfly (78%) in shape, with the remaining being triangular (22%). The structure of the PSL was complete in 52% of cases and incomplete (fragmented or hypoplastic) in 38%. A second, smaller ligament was seen in 10% of cases. Mean length of the PSL was 13.4±3.2 mm, mean width was 6.1±3.2 mm at the PCP and 4.2±1.6 mm at the petrous apex. Butterfly-shaped ligaments were narrowest in the middle (mean 2.0±0.9 mm), while triangle-shaped ligaments were narrowest (mean 2.8±2.3 mm) at its end, at its insertion on the PA or PCP. CONCLUSION: The PSL (Gruber’s ligament) is an important structure in the petroclival region. In this study, microanatomical characteristics were described in detail, along with new descriptions of its shape.

BACKGROUND CONTEXT:Intraradicular lumbar disc herniation is rare, having been reported to date in only three postoperative patients. The diagnosis is typically made intraoperatively.PURPOSE:To report a fourth case of intraradicular disc herniation, to emphasize its radiological characteristics and operative findings.STUDY DESIGN:Case report.PATIENT SAMPLE:A 41-year-old female.METHODS:Retrospective case review.RESULTS:The patient underwent a second operation and intraradicular disc fragment was removed. She was completely well at her 9-month check up.CONCLUSIONS:The diagnosis, mechanism, and surgical treatment of intraradicular lumbar disc herniation are reviewed. The round shape of the sequestrated fragment, as seen on magnetic resonance imaging, may help to establish the correct diagnosis.