BACKGROUND Traumatic brain injury (TBI) is a significant public health issue, leading to long-term neurological impairments. Current treatments offer limited recovery, particularly in restoring lost functions. Mesenchymal stem cell-derived exosomes (MSCdE) have shown potential for promoting neuroprotection and regeneration. This study evaluates the safety and efficacy of MSCdE therapy in TBI patients. AIM To evaluate the safety and efficacy of MSCdE therapy in TBI patients. METHODS Five patients (mean age 27.00 ± 4.06 years) with TBI from combat injuries were treated with six rounds of MSCdE therapy (3 mL intrathecally and 3 mL intramuscularly per round). The patients were followed for one year. Adverse events were assessed using the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5.0), and functional outcomes were evaluated with the functional independence measure (FIM), Modified Ashworth Scale (MAS), and Karnofsky Performance Scale (KPS). RESULTS No serious adverse events occurred, and only mild side effects [subfebrile fever (37.5-37.9 ℃), pain] were reported (CTCAE Grade 1). FIM motor scores improved significantly (46.20 ± 16.39 to 64.20 ± 18.20, P < 0.01), and FIM cognitive scores also showed significant improvement (30.60 ± 4.56 to 34.00 ± 1.41, P < 0.001). While MAS scores improved (right/left: 4.60/3.60 to 2.20/1.60), these changes were not statistically significant (P > 0.05), possibly due to low baseline spasticity. KPS scores significantly improved (46.00 ± 11.40 to 72.00 ± 8.37, P < 0.001), indicating enhanced overall functional status and quality of life. CONCLUSION MSCdE therapy is safe and effective in improving motor function, cognition, and quality of life in TBI patients. Larger, controlled trials are needed to further validate these findings and optimize MSCdE therapy for TBI treatment.

AIM:To evaluate the postoperative magnetic resonance imaging (MRI) findings and clinical outcomes of patients who underwent monoportal endoscopic lumbar discectomy. MATERIAL AND METHODS:Preoperative and postoperative 3rd and 6th month MRI features, visual analog scale (VAS), and Oswestry Disability Index (ODI) scores, as well as other clinical features of patients who underwent monoportal endoscopic lumbar discectomy between August 2009 and January 2012 were retrospectively analyzed. RESULTS:A total of 65 patients (37 female, 28 male) were included in the study. VAS and ODI scores showed significant improvement postoperatively (p < 0.001). Intervertebral disc height loss was observed only in two patients. In 31 (48%) of the 64 levels treated, no significant anterior soft tissue mass developed. However, 33 patients (52%) showed anterior epidural edema and tissue formation postoperatively. Contrast enhancement of the nerve root was found in 20 levels (29.4%), nerve root edema in 3 levels (4.41%), and nerve root displacement in 3 levels (4.41%). None of the patients had all 3 aforementioned findings concomitantly. Of the 57 levels evaluated, 36 levels (63%) showed no or minimal changes in the posterior elements, and at the 3rd month, 9 levels (15.8%) demonstrated grade 1+ changes, 9 levels showed grade 2+ changes, and grade 3+ changes were seen in only 3 levels; however, at 6-month follow-up, all vertebral levels showed improvements. CONCLUSION:Endoscopic discectomy is a safe and effective minimally-invasive method. However, owing to the lack of definitive radiological criteria indicating success or failure, the radiological findings should always be interpreted in conjunction with clinical outcomes.

Objective:This retrospective study aimed to evaluate and compare the clinical efficacy of intradiscal ozone therapy (OT) against a combination therapy of ozone and platelet-rich plasma (PRP) in patients diagnosed with intervertebral disc degeneration (IVDD). Methods:The study included a cohort of 50 patients, divided equally into two groups of 25, who received either intradiscal OT or ozone + PRP combination therapy between February 2022 and February 2023. The sample comprised 20 females and 30 males, with ages ranging from 19 to 76 years (mean age 48.8). Pain intensity was measured using the visual analog scale (VAS), while disability levels were assessed using the oswestry disability index (ODI) prior to treatment and at 1, 3, and 6 months post-treatment. Additionally, lumbar magnetic resonance imaging was conducted at the 3-month mark post-treatment, with evaluations based on the Pfirrmann disc degeneration classification. Results:Significant improvement in both VAS and ODI scores was observed in both treatment groups (P < 0.001). The ozone + PRP combination therapy group exhibited no statistically significant difference in VAS and ODI scores compared to the ozone-only group (P > 0.05). Conclusion:Intradiscal OT and the ozone + PRP combination therapy represent effective minimally invasive treatment options for patients suffering from IVDD, yielding substantial clinical benefits with minimal side effects. That is why it is suggested as a potential preferred therapeutic approach prior to the consideration of surgical interventions.

Objective: This study evaluates the short-to mid-term effectiveness of simultaneous transforaminal anterior epidural injection (TAEE) and facet joint injections (FJI) in patients with acute low back and leg pain and assesses the impact of obesity on treatment outcomes. Methods: Sixty-seven patients (22 males, 45 females) underwent TAEE and FJI. Pain levels were assessed using the visual analog scale (VAS) and Oswestry Disability Index (ODI) before treatment and at the 6-month follow-up. Non-parametric tests and logistic regression were used for statistical analysis. Results: A total of 105 TAEE and 302 FJI procedures were performed. Significant reductions in VAS and ODI scores were observed at 6 months (p<0.05). Obese patients had significantly higher VAS scores at follow-up (p=0.002 for low back pain, p=0.019 for radicular pain). However, logistic regression analysis showed that obesity was not an independent predictor of post-treatment VAS scores (p=0.211, p=0.168). Conclusion: TAEE and FJI effectively reduce pain in patients with low back and leg pain unresponsive to conservative treatment. While obesity may delay pain relief, it does not independently affect treatment success.

BACKGROUND:Traumatic spinal cord injury (SCI) is a life-altering condition that results in long-term complications, including progressive neurodegeneration and cord atrophy. It presents a significant unmet medical need with extensive social and economic burdens. AIM:To evaluate the safety and preliminary efficacy of allogeneic mesenchymal stem cells derived from Wharton's jelly (WJ-MSCs) in patients with chronic complete SCI. The primary objective was to assess whether WJ-MSCs could facilitate neurological recovery and improve the quality of life in this patient population. METHODS:This open-label, multicenter phase I study investigated the effects of administering WJ-MSCs via three delivery routes: Intrathecal (for localized spinal targeting); intramuscular (for targeting end organ); and intravenous (for systemic immunomodulation). While all three routes were used concurrently to enhance therapeutic synergy, neurological, sensory, and functional scales were used to assess overall efficacy. Participants with chronic SCI (duration of at least 6 months) who had significant impairment and disability were eligible for inclusion. WJ-MSCs were administered twice monthly for 2 months, with each route receiving a dose of 1 × 106 cells/kg. Patients were closely monitored for 1 year following treatment. RESULTS:At baseline, participants displayed considerable functional deficits, as indicated by the following scores: Functional independence measure of 77.5 ± 2.26; Modified Ashworth Scale of 15.83 ± 4.83; American Spinal Injury Association (ASIA) Motor score of 1.67 ± 2.66; ASIA Light Touch and Pin-Prick scores of 62 ± 18.42 each; Wexner Incontinence Score of 20; and Qualiveen Short Form, a validated questionnaire specifically designed to assess the impact of urinary dysfunction on quality of life in individuals with SCI, score of 32. Following WJ-MSC therapy, significant improvements were observed in all neurological functions over the 1-year follow-up. Notably, the ASIA Motor score improved significantly (χ 2 = 23.938, P < 0.001), and Qualiveen Short Form scores demonstrated a substantial enhancement in quality of life (z = -2.214, P < 0.05). CONCLUSION:This phase I study, conducted without a control group, suggests that the administration of WJ-MSCs through multiple routes is both safe and potentially effective in patients with chronic complete SCI. However, the observed neurological improvements cannot be solely attributed to WJ-MSC therapy, as concurrent pharmacological and rehabilitative interventions were not controlled. These findings indicated that WJ-MSC therapy may offer a promising approach for enhancing neurological function and quality of life in this challenging patient population. Further research with larger cohorts and extended follow-up is necessary to validate these preliminary results.

BACKGROUND Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with multifaceted origins. In recent studies, neuroinflammation and immune dysregulation have come to the forefront in its pathogenesis. There are studies suggesting that stem cell therapy may be effective in the treatment of ASD. AIM To evolve the landscape of ASD treatment, focusing on the potential benefits and safety of stem cell transplantation. METHODS A detailed case report is presented, displaying the positive outcomes observed in a child who underwent intrathecal and intravenous Wharton’s jelly-derived mesenchymal stem cells (WJ-MSCs) transplantation combined with neurorehabilitation. RESULTS The study demonstrates a significant improvement in the child’s functional outcomes (Childhood Autism Rating Scale, Denver 2 Developmental Screening Test), especially in language and gross motor skills. No serious side effects were encountered during the 2-year follow-up. CONCLUSION The findings support the safety and effectiveness of WJ-MSC transplantation in managing ASD.

Backgroud: Traumatic spinal cord injury (SCI) is a pathological condition characterized by neurological impairments, the severity of which is contingent upon the level and extent of the injury. In addition to these impairments, SCI is frequently associated with autonomic dysfunctions and complications affecting the cardiovascular and gastrointestinal systems, leading to debilitating consequences such as urinary and bowel incontinence and spasticity, significantly diminishing patients’ quality of life. Aim:This study aimed to evaluate the safety and therapeutic efficacy of mesenchymal stem cell-derived exosomes (MSCdE) in patients with SCI. Methods: Sixteen patients (mean age: 26.25 ± 4.89 years) with SCI resulting from combat-related injuries were enrolled. Of these, 2 patients (12.5%) had lumbar injuries, 11 (68.75%) had thoracic injuries, and 3 (18.75%) had cervical injuries. Exosome administration was performed in 6 treatment cycles over a 4.5-month period. Each cycle involved the intrathecal injection of 3 ml (30 billion) and intramuscular injection of 10 ml (30 billion) of exosomes. Patients were monitored for 1 year following the intervention. Adverse events were assessed according to the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5.0). Neurological function was evaluated using the American Spinal Injury Association Impairment Scale (ASIA), spasticity using the Modified Ashworth Scale (MAS), motor and cognitive function using the Functional Independence Measure (FIM), and urinary and bowel incontinence using the Wexner Incontinence Score and Qualiveen Short Form (SFQ). All assessments were conducted by a multidisciplinary team comprising a neurosurgeon and a specialist in physical therapy and rehabilitation. Results: No serious adverse events were reported throughout the treatment and follow-up period. Minor side effects, such as low-grade fever and localized pain, were observed, classified as CTCAE v5.0 Grade 1, and resolved spontaneously within 24 hours without medical intervention. Statistically significant improvements were noted in all clinical parameters. FIM motor scores increased from 26.75 ± 9.81 pre-treatment to 43.88 ± 17.01 post-treatment (p < 0.01). ASIA motor scores improved significantly from 47.00 ± 21.15 to 56.00 ± 18.74 (p < 0.001), and ASIA sensory scores (light touch/pin-prick) increased from 66.06/66.25 to 77.56/79.75 (p < 0.001). MAS values (right/left) decreased from 7.00/6.94

BACKGROUND Peripheral nerve injury can result in significant clinical complications that have uncertain prognoses. Currently, there is a lack of effective pharmacological interventions for nerve damage, despite the existence of several small compounds, peptides, hormones, and growth factors that have been suggested as potential enhancers of neuron regeneration. Despite the objective of achieving full functional restoration by surgical intervention, the persistent challenge of inadequate functional recovery remains a significant concern in the context of peripheral nerve injuries. AIM To examine the impact of exosomes on the process of functional recovery following a complete radial nerve damage. METHODS A male individual, aged 24, who is right-hand dominant and an immigrant, arrived with an injury caused by a knife assault. The cut is located on the left arm, specifically below the elbow. The neurological examination and electrodiagnostic testing reveal evidence of left radial nerve damage. The sural autograft was utilized for repair, followed by the application of 1 mL of mesenchymal stem cell-derived exosome, comprising 5 billion microvesicles. This exosome was split into four equal volumes of 0.25 mL each and delivered microsurgically to both the proximal and distal stumps using the subepineural pathway. The patient was subjected to a period of 180 d during which they had neurological examination and electrodiagnostic testing. RESULTS The duration of the patient’s follow-up period was 180 d. An increasing Tinel’s sign and sensory-motor recovery were detected even at the 10th wk following nerve grafting. Upon the conclusion of the 6-mo post-treatment period, an evaluation was conducted to measure the extent of improvement in motor and sensory functions of the nerve. This assessment was based on the British Medical Research Council scale and the Mackinnon-Dellon scale. The results indicated that the level of improvement in motor function was classified as M5, denoting an excellent outcome. Additionally, the level of improvement in sensory function was classified as S3+, indicating a good outcome. It is noteworthy that these assessments were conducted in the absence of physical therapy. At the 10th wk post-injury, despite the persistence of substantial axonal damage, the nerve exhibited indications of nerve re-innervation as evidenced by control electromyography (EMG). In contrast to the preceding. EMG analysis revealed a significant electrophysiological enhancement in the EMG conducted at the 6th-mo follow-up, indicating ongoing regeneration. CONCLUSION Enhanced comprehension of the neurobiological ramifications associated with peripheral nerve damage, as well as the experimental and therapy approaches delineated in this investigation, holds the potential to catalyze future clinical progress.

Intramedullary spinal cord glioblastoma (ISCG) is lethal due to lack of effective treatment. We previously established a rat C6-ISCG model and the antitumor effect of F3.CD-TK, an hNSC line expressing CD and TK, via producing cytocidal 5FU and GCV-TP. However, the neurotherapeutic potential of this hNSC approach has remained uninvestigated. Here for the first time, cultured F3.CD-TK cells were found to have a markedly higher oncolytic effect, which was GJIC-dependent, and BDNF expression but less VEGF secretion than F3.CD. In Rowett athymic rats, F3.CD-TK (1.5 × 106 cells/10 µL × 2), injected near C6-ISCG (G55 seeding 7 days earlier: 10 K/each) and followed by q.d. (×5/each repeat; i.p.) of 5FC (500 mg/kg/5 mL/day) and GCV (25 mg/kg/1 mL/day), robustly mitigated cardiorespiratory, locomotor, and sensory deficits to improve neurofunction and overall survival compared to animals receiving either F3.CD or F3.CD-TK+F3.CD debris formula. The F3.CD-TK regimen exerted greater tumor penetration and neural inflammation/immune modulation, reshaped C6-ISCG topology to increase the tumor’s surface area/volume ratio to spare/repair host axons (e.g., vGlut1+ neurites), and had higher post-prodrug donor self-clearance. The multimodal data and mechanistic leads from this proof-of-principle study suggest that the overall stronger anti-ISCG benefit of our hNSC-based GDEPT is derived from its concurrent oncolytic and neurotherapeutic effects.

BACKGROUND Cerebral palsy (CP) describes a group of disorders affecting movement, balance, and posture. Disturbances in motor functions constitute the main body of CP symptoms. These symptoms surface in early childhood and patients are affected for the rest of their lives. Currently, treatment involves various pharmacotherapies for different types of CP, including antiepileptics for epilepsy and Botox A for focal spasticity. However, none of these methods can provide full symptom relief. This has prompted researchers to look for new treatment modalities, one of which is mesenchymal stem cell therapy (MSCT). Despite being a promising tool and offering a wide array of possibilities, mesenchymal stem cells (MSCs) still need to be investigated for their efficacy and safety. AIM To analyze the efficacy and safety of MSCT in CP patients. METHODS Our sample consists of four CP patients who cannot stand or walk without external support. All of these cases received allogeneic MSCT six times as 1 × 106/kg intrathecally, intravenously, and intramuscularly using umbilical cord-derived MSCs (UC-MSC). We monitored and assessed the patients pre- and post-treatment using the Wee Functional Independence Measure (WeeFIM), Gross Motor Function Classification System (GMFCS), and Manual Ability Classification Scale (MACS) instruments. We utilized the Modified Ashworth Scale (MAS) to measure spasticity. RESULTS We found significant improvements in MAS scores after the intervention on both sides. Two months: Right χ 2 = 4000, P = 0.046, left χ 2 = 4000, P = 0.046; four months: Right χ 2 = 4000, P = 0.046, left χ 2 = 4000, P = 0.046; 12 months: Right χ 2 = 4000, P = 0.046, left χ 2 = 4000, P = 0.046. However, there was no significant difference in motor functions based on WeeFIM results (P > 0.05). GMFCS and MACS scores differed significantly at 12 months after the intervention (P = 0.046, P = 0.046). Finally, there was no significant change in cognitive functions (P > 0.05). CONCLUSION In light of our findings, we believe that UC-MSC therapy has a positive effect on spasticity, and it partially improves motor functions.

Background: Pituitary abscess (PA), a rare complication following transsphenoidal (TS) surgery for pituitary adenoma with an incidence of 0.2%, poses a significant risk; carrying potential morbidity, recurrence, and the necessity for reoperation. Timely suspicion, diagnosis, and treatment are imperative. Patients and Methods: We present two cases and provide a literature review on the symptoms, risk factors, diagnosis, treatment, and outcomes associated with secondary PAs following TS surgery for adenoma. Results: We identified 12 articles reporting a total of 45 cases, in addition to our 2 cases. The primary symptoms were headache and visual impairment, with no fever or specific infectious parameters observed. Predominant risk factors identified included cerebrospinal fluid (CSF) leakage and prior radiotherapy (RT). Our first patient, a 45-year-old male, presented 10 weeks after TS surgery with sudden-onset symptoms, whereas our second patient, a 64-year-old female, presented 22 years postoperatively. In the first case, intraoperative CSF leakage, with the patient's history of allergic rhinitis and frequent nasal irrigation possibly contributed to the development of abscess. In the second case, RT was considered a potential risk factor. Severe headache and subclinical signs of infection associated with a cystic lesion of the pituitary gland were common findings. Both patients underwent endoscopic TS drainage and received appropriate antibiotic therapy, resulting in complete recovery without recurrence. Conclusions: When faced with severe headaches in a patient with a history of TS surgery for a pituitary adenoma, coupled with radiological evidence showing a cystic appearance with peripheral enhancement, taking a proactive approach to promptly identify and intervene in secondary PAs is essential for mitigating potential complications and optimizing patient outcomes.

BACKGROUND Traumatic brain injury (TBI) is characterized by a disruption in the normal function of the brain due to an injury following a trauma, which can potentially cause severe physical, cognitive, and emotional impairment. Stem cell transplantation has evolved as a novel treatment modality in the management of TBI, as it has the potential to arrest the degeneration and promote regeneration of new cells in the brain. Wharton’s Jelly-derived mesenchymal stem cells (WJ-MSCs) have recently shown beneficial effects in the functional recovery of neurological deficits. AIM To evaluate the safety and efficiency of MSC therapy in TBI. METHODS We present 6 patients, 4 male and 2 female aged between 21 and 27 years who suffered a TBI. These 6 patients underwent 6 doses of intrathecal, intramuscular (i.m.) and intravenous transplantation of WJ-MSCs at a target dose of 1 × 106/kg for each application route. Spasticity was assessed using the Modified Ashworth scale (MAS), motor function according to the Medical Research Council Muscle Strength Scale, quality of life was assessed by the Functional Independence Measure (FIM) scale and Karnofsky Performance Status scale. RESULTS Our patients showed only early, transient complications, such as subfebrile fever, mild headache, and muscle pain due to i.m. injection, which resolved within 24 h. During the one year follow-up, no other safety issues or adverse events were reported. These 6 patients showed improvements in their cognitive abilities, muscle spasticity, muscle strength, performance scores and fine motor skills when compared before and after the intervention. MAS values, which we used to assess spasticity, were observed to statistically significantly decrease for both left and right sides (P < 0.001). The FIM scale includes both motor scores (P < 0.05) and cognitive scores (P < 0.001) and showed a significant increase in pretest posttest analyses. The difference observed in the participants’ Karnofsky Performance Scale values pre and post the intervention was statistically significant (P < 0.001). CONCLUSION This study showed that cell transplantation has a safe, effective and promising future in the management of TBI.

AIM:To evaluate the efficacy of percutaneous pain interventions in patients who previously underwent lumbar disc herniation surgery.MATERIAL AND METHODS:We retrospectively analyzed 48 patients with persistent / recurring complaints who underwent lumbar disc surgery (LDS) and were treated with percutaneous interventions. They were grouped into recurrent disc herniations (RDHs) and other discovertebral pathologies (ODVP). Moreover, patients were evaluated as those who received transforaminal injection (TFI) with facet blockage (FB) and who received both caudal injection (CI) and TFI in addition to FB. Patients were evaluated using Oswestry Disability Index (ODI) and visual analog scale (VAS).RESULTS:Between the recurrent and ODVP groups, preoperative, at 1-hour postoperative, and at 6-month postoperative ODI (p=0.867, p=0.055, p=0.892) and VAS (p=0.902, p=0.136, p=0.462) scores did not show a statistically significant difference, respectively. Additionally, in the comparison of patients who underwent FB+TFI+CI and only FB+TFI, there was no statistically significant correlation between preoperative and 6-month postoperative ODI (p = 0.284) and VAS (p=0.248) scores in both recurrent and ODVP groups, respectively. The success rates at the 3rd and 6th months of patients with RDH and ODVP were 47.61% (10/21) and 42.85% (9/21) and 70.37% (19/27) and 63.96% (17/27), respectively.CONCLUSION:There was no statistically significant difference in ODI and VAS scores between recurrent and ODVP groups. The clinical success rate was numerically better in the ODVP group. Thus, we suggest that co-administration of TFI and CI did not significantly contribute to our clinical outcome.

Objective: This study aims at comparing the patients with spinal trauma in the Coronavirus disease-2019 pandemic era and pre-pandemic era. Materials and Methods: Patient records for a 9-month period of pandemic (April 1, 2020 - December 31, 2020) and the same period of the previous year (April 1, 2019 - December 31, 2019) were retrospectively collected. These 2 periods were compared in terms of the total number of patients with spinal trauma, the type of injuries, the level of injuries in the spine, the treatment methods applied, and whether there was a neurological deficit. The first group was called as pandemic group (PG) and the latter as control group (CG). The differences between them were statistically examined. Results: The study sampled 278 patients (CG: 203 patients, PG: 75 patients). It was detected that the number of patients with spinal trauma in the PG dropped by 60% compared to the CG. The most frequent cause of spinal trauma for both groups was traffic accidents. No statistically significant difference was detected in terms of the type, level and severity of injuries, neurological examination findings and method of treatment (p>0.05). However, the rate of indoor or outdoor falls were significantly different between the two groups (p=0.002). Conclusion: It has been determined that the pandemic-induced social isolation and lockdown process is an important factor in the primordial prevention of spinal trauma. With the result obtained, we think that if adequate and correct measures are taken, the number of spinal traumas will continue to remain low in the post-pandemic period as well. © Copyright 2022 by the Turkish Spine Society/The Journal of Turkish Spinal Surgery published by Galenos Publishing House.

Objective: This study aims at evaluating the factors affecting prognosis in patients with aneurysmal subarachnoid hemorrhage (SAH).Methods: The charts and 6th month outpatient clinic records of the patients who were treated with the diagnosis of SAH between 2016 and 2020 were retrospectively reviewed. Post-discharge clinical status, adaptation to life, and disability status of 44 patients with aneurysmal SAH who were treated with endovascular or microsurgical techniques in our clinic were evaluated with the Glasgow Outcome Scale Extended (GOSE). The relationship between the patient's age, gender, timing of treatment, the location of the aneurysm, the World Federation of Neurological Surgeons (WFNS) scale score, Hunt-Hess scale (HHS) score, Fisher scale score and preoperative evaluations that might affect the GOSE score after discharge were examined.Results: Forty-four patients who met the criteria were included in the study. The mean age of the patients was 49.1 +/- 10.3 (minimum-maximum: 29-77). Of those, 54.5% were females while 45.5% were males. Comorbidity was present in 54.5% of the patients. The most common aneurysm was the middle cerebral artery aneurysm with the rate of 27.3%. Of the aneurysmal SAHs, 45.5% were treated with microsurgical clipping and 27.3% with endovascular treatment. A statistically significant correlation was found between GOSE score and timing of treatment days (p=0.014), WFNS (p=0.002) and HHS scores (p<0.001). No statistically significant correlation was found between GOSE score and patient's age (p=0.47) and Fisher scale score (p=0.465).Conclusion: In our study, the effects of early surgery, WFNS, and HHS scores on clinical outcome in cerebral aneurysmatic SAH were shown.

Objective: Surgical treatment of extracranial meningiomas is challenging. In this study, we present an illustrated case series to share our experience in the treatment of meningiomas with extracranial extension. Method: We retrospectively reviewed the data of 11 patients with meningiomas who underwent surgical treatment between 2008 and 2020. The intracranial and extracranial components were radiologically and intraoperatively confirmed for all patients. Results: The patients included seven men and four women with a mean age of 55.4 years. Most patients presented with facial disfigurement or asymmetrical skull growth. The most common symptom at presentation was headache. The most common location of the meningiomas was the frontal region and those of extracranial growth were the paranasal sinuses and parietal bone invasion. We recognized two distinct modalities of bone destruction: hyperostosis (n=3) and osteolysis (n=8). Pathological investigation revealed atypical features in six patients. Preoperative embolization was attempted in four patients but it proved to be difficult; proper embolization could be achieved only in one patient. The most commonly encountered challenges during surgery were large calvarial and cranial base defects due to bone erosion, dural defects, and managing the superior sagittal sinus with parietal tumors. Excessive blood loss was also of particular concern, which was managed using simple scalp clips, intraoperative transfusion, and other conservative approaches of tumor extensions into paranasal sinuses. No perioperative mortality occurred. Calvarial reconstruction was performed with polymethyl methacrylate cement where needed. Conclusion: Meningiomas with extracranial extension are surgically challenging but treatable. It contains fine neurosurgical trics in its treatment and follow-up.

Background: It is known that interactions between programmable Ventriculoperitoneal Shunt (VPS) valves and electromagnetic and hearing devices may change the valve settings. We reported a patient using programmable VPS valves and hearing devices and reviewed the literature. Case Description: A 71-year-old man was implanted with a programmable VPS valve with the diagnosis of Normal Pressure Hydrocephalus. A hearing device (behind-the-ear) was proposed because of hearing difficulties, but it was suggested that it be discontinued because it did not help. However, the patient used it twice because of his current dementia, forgetting the doctor’s recommendations. The setting of the valve has changed in these two different times that this behind-the-ear hearing device is used. Long-term follow-ups showed no change in valve settings except those two situations. Conclusion: It is important to note that patients using hearing devices and programmable VPS valves are a unique group of patients. There are not enough studies showing the relationship between the behind-the-ear hearing devices and programmable VPS. It should be kept in mind that hearing devices with magnetic field strength may change the setting of the valves.