ObjectiveContrary to popular belief, the cerebellum is involved not only in motor planning, balance, and coordination but also in cognitive processes. The present study aimed to investigate executive functions (EFs), intellectual capacity, and psychiatric disorders in adults with type 1 Chiari malformation, which is defined as a hindbrain anomaly that involves the cerebellum.MethodsThe study included 62 adults, with 29 in the CM group and 33 in the control group. EFs were evaluated using the Stroop test, number sequence learning test, and standardized mini-mental state examination (SMMSE). The intelligence quotient (IQ) was measured using the Kent EGY and Porteus maze tests, and psychiatric disorders were evaluated using the Structured Clinical Interview for DSM-5, Clinician Version (DSM-5-CV).ResultsThe CM group took longer than the control to complete the Stroop test for each section (P < 0.005). Although the mean IQ scores of both groups were within the normal range, the CM group had a lower mean IQ score than the control group (P < 0.005). Although the mean SMMSE scores of both groups were within the normal range, the CM group had a lower mean SMMSE score than the control group (P < 0.005). The CM group had a higher rate of psychiatric comorbidities than the control group (P < 0.005).ConclusionsThe study found that subjects with type 1 Chiari malformation performed worse in EFs than healthy controls and had a higher prevalence of psychiatric disorders.

Chiari malformation type 1 (CM1) is defined as herniation of the cerebellar tonsils from the foramen magnum of more than 5 mm (Tubbs et al. 2007). CM1 is the most common and clinically least severe type of Chiari malformation. Most patients diagnosed with CM1 are asymptomatic and are usually detected incidentally in brain imaging performed for other reasons (Tubbs et al. 2015). Studies show that CM1 is detected in 1% to 3.6% of children (Strahle et al. 2011). The most common symptom of CM1 in both adult and pediatric patients is headache, which is present in approximately 80% of patients. Excepting pain, symptoms including motor and sensory deficits, hand muscular atrophy, lower cranial palsy, cerebellar ataxia, nystagmus, dysphagia, and dysphonia are observed (Ciaramitaro et al. 2019). Psychiatric disorders accompanying CM1 have been mentioned in a few case reports. These cases are generally adult patients diagnosed with anxiety disorders, major depression, panic disorder, and bipolar disorder. In a comprehensive study conducted on adult CM patients, 43.8% of the patients were found to have psychiatric disorders. The most common psychiatric disorders were major depressive disorder and anxiety disorder, with a rate of 18.8% and 12.5%, respectively (Bakim et al. 2013). In a study in which 86 pediatric CM 1 cases were evaluated, at least one psychiatric disorder was found in 47% of these children (Lacy et al. 2018). Here we present a case of CM1 accompanying conversion disorder for the first time in the literature.

Background/Aim: The Coronavirus-19 (COVID-19) pandemic disrupted all planned, elective surgical procedures and appointment-based health services due to the decreased capacity of hospitals, healthcare professionals' focus on fighting the pandemic and efforts to protect patients, society and healthcare workers from the pandemic. The purpose of this study was to ascertain the perspective of patients on elective surgery, who applied to neurosurgery outpatient clinics at two different centers as clean and non-clean hospitals. Methods: This cross-sectional prospective study was performed between March 2021 and July 2021, during the COVID-19 pandemic. 160 patients who were offered elective surgery for various indications in neurosurgery outpatient clinics were enrolled in the study. To this end, a questionnaire was administered to patients that included information about their demographics, pandemic processes and their anxiety levels during this process. Age, level of education, COVID -19 infection and vaccination status were all questioned in the survey. Univariate and multivariate analysis were used to determine the factors that might influence a patient's decision towards surgery. Results: In the univariate analysis of the factors, educational status, pandemic-induced anxiety and whether the hospital is a pandemic hospital or not were identified as statistically significant effective factors in patients' decision to accept surgery (P

Background/Aim: There is no consensus on the optimal treatment for intracranial aneurysm rupture due to subarachnoid hemorrhage (SAH). In this study, we analyzed a series of ruptured intracranial aneurysms treated with the clipping method at our center. Methods: In this retrospective cohort study; we searched our patient database for patients who developed SAH due to ruptured intracranial aneurysm treated at the Neurosurgery Clinic of Sivas Cumhuriyet University. A total of 304 patients who underwent the clipping operation due to aneurysmal SAH between 2010 and 2020 were included in the study. Cases with aneurysmal SAH who underwent endovascular coiling which is consisted of 22 patients were excluded. Results: A significant inverse correlation was found between age and Glasgow coma scores (GCS) (r=−0.137, P=0.017). Hunt–Hess and Fisher grades increased significantly with increasing age (r=0.187, P 0.05). No significant differences were observed in GCS scores and Hunt–Hess and Fisher grades between genders (P>0.05). There were no significant effects of aneurysm locations on mortality (P>0.05). Conversely, GCS scores were significantly lower and Hunt–Hess and Fisher grades were significantly higher in the surviving group than in the deceased group (P<0.001). Conclusion: Our study presented the outcomes of patients treated in our clinic with surgical clipping. Based on our findings, we believe that surgical clipping is still a safe and valid treatment method.

AIM:To investigate whether fourth ventricle dimensions and tentorial angulation differ in a healthy control population in our evaluation of patients with CM-1 malformation using MRI.MATERIAL AND METHODS:The radiological and demographic data from 251 patients with CM-1 followed in our clinic between 2014 and 2019 were compared with data from 273 persons in a healthy control group. Fourth ventricle dimensions, amount of cerebellar tonsillar herniation, and tentorium twinning angle were measured. Statistical analysis was performed.RESULTS:The mean tentorial twinning angle, craniocaudal length, and anteroposterior length of the fourth ventricle were significantly greater than the mean of the same measurements in the healthy control group. In addition, in a subgroup analysis conducted according to treatment modalities of patients with CM-1, the length between the bilateral recesses of the fourth ventricle was found to be statistically significantly greater in the subgroup of patients who underwent surgery compared with those in the nonsurgical subgroup.CONCLUSION:Fourth ventricle enlargement is a radiographic finding in patients with CM-1. Studies evaluating clinical presentation, severity, and outcome after treatment will be useful in revealing the importance of this entity.

Introduction: The co-existence of primary intracranial tumors originating from different cell types is rare. While the association of meningioma and glioma is frequently reported in the literature, the number of cases with meningiomas and epidermoid cysts is relatively low. We report a unique case because the association of supra-sellar meningioma and the epidermoid cyst has not been reported before in the literature. Case Presentation: A 50-year-old female presented to the clinic with a headache and progressive vision loss. In cranial Magnetic Resonance (MR) images, a T1A hypointense, T2A iso-hyper intense heterogenous contrasting suprasellar mass lesion was observed. The patient was operated on with a diagnosis of suprasellar meningioma. At the suprasellar region, a mass that macroscopic view and consistency compatible with epidermoid cyst ex-plored intraoperative incidentally. Two different pathological specimens were sent to pathology. The patient's pathology was reported as WHO 2021, Transitional type grade 1 Meningioma, and Epidermoid cyst content. Conclusion: The number of cases with meningiomas and epidermoid cysts is very low in the literature. Despite advanced MR imaging techniques, cystic lesions can be overlooked in the diagnosis. The occurrence of two different histopathological types of tumors in the same localization can be explained by the local paracrine effects of the tumors.

, Department of Pathology were evaluated. Disease-free median survival of 7 (13%) GBM patients with IDH mutation was 2 months (2-year survival 14%), disease-free median survival 9 months (2-year survival 24 %) in GBM IDH-wild type cases. In cases with a higher Ki-67 proliferation index, the median disease-free survival were shorter. In conclusion statistically significant results could not be obtained between disease-free survival in GBM IDH-mutant type and GBM IDH-wild type. However, the mean Ki-67 proliferation index of GBM IDH-wild type cases was found to be much higher than GBM IDH-mutant cases. High Ki-67 proliferation index was found to be associated with a significantly shorter survival.

Objective : Traumatic spondylolisthesis of the axis, also known as hangman fractures, all cervical it accounts for 4-7% of all traumas and is the second most common axis after odontoid fractures. trauma. There are unstable fractures and the treatment options are immobilization with halo or surgery. is stabilization. By most authors, it is primarily associated with halo in patients with Type 1 and Type 2 fractures.Although external fixation and immobilization are recommended, halon is a difficult orthosis to use. Because of this, segmental motion sparing surgery provides rapid recovery in suitable patients may be an option. In the case we presented, the treatment approach in Hangman's fractures was reviewed in the literature. has been reviewed and discussed. Clinical Presentation: Our case, after AITC, with Levin Edwards Type 1A Hangman fracture, A 40-year-old female patient with no neurological deficits. The patient does not prefer to use a halo orthosis C2 transpedicular surgery was performed with a lag screw for motion-sparing surgery to a young patient fixation is planned. Technique: C2 transpedicular lag screw was applied to the patient with intraoperative fluoroscopy. Conclusion: C2 transpedicular fixation with Lag screw, according to posterior segmental stabilization a more minimally invasive and motion-sparing surgery, faster recovery time may be preferred to traditional posterior stabilization methods in selected patient groups due to The patient who did not prefer the use of orthoses due to the social disadvantages of immobilization with Halo it is a quick and cost-effective surgical option in groups with a rapid recovery time.

Objective: Neural tube defects are a heterogeneous and complex group of congenital central nervous system anomalies involving that involve the failed closure of the vertebral column. The spinal cord is frequently affected, and neural tube defects substantially increase the risk of disability and death within the first year of life. Neural malformations are often associated with abnormalities in other organ systems. This study presents our clinical experiences regarding the development and comorbidities of infants with neural tube defect and compares them with the literature. Materials and Methods: This retrospective study included 47 patients (24 females, 23 males) who underwent surgical treatment for neural tube defect in the neurosurgery department of Sivas Cumhuriyet University Faculty of Medicine Training and Research Hospital between 2000 and 2020. Results: Of the 47 patients, 34 (72.34%) had myelomeningocele and 13 (27.65%) had meningocele. Lesion location was thoracolumbar in 38 patients (80.85%), lumbar in 5 (10.63%), lumbosacral in 3 (6.38%), and cervical in 1 patient (2.12%). Twenty-seven patients (57.44%) underwent ventriculoperitoneal shunting due to hydrocephalus. Thirty patients (63.82%) had Chiari malformation type II, 13 (27.65%) had cranial anomalies, and 1 (2.12%) had Down syndrome. In 9 patients, the conus medullaris terminated at or below the L3 vertebral body (19.14%). Two patients (4.25%) died. Conclusion: Because of their multidimensional nature, neural tube defects have various effects on individuals, families, society, and the field of medicine. This study represents a small group of patients with neural tube defects. Cases should be included from other centers to compile more comprehensive data about patients with neural tube defects in Turkey.

PURPOSE:In the last two decades, the non-motor functions of the cerebellum have become the centre of attention for researchers. Anecdotal observations of cognitive and psychiatric manifestations of cerebellar lesions have increased this interest. We aimed to investigate the executive function (EF), intellectual capacity, and comorbid psychiatric disorders in adolescents with Chiari malformation type 1 (CM1), which is a pathological manifestation of posterior cranial fossa structures include the cerebellum.METHODS:The Chiari group consisted of ten adolescents aged 12-18 years old, and the control group consisted of 13 healthy adolescents with similar age and sex with patients. Stroop test (ST), trail making test (TMT), and Behaviour Rating Inventory of Executive Function-Parent form (BRIEF) were used to evaluate EF; Kent EGY and Porteus Maze Test was used to measuring the intelligence quotient (IQ), and a semi-structured interview was used to determine the psychiatric disorders.RESULTS:EF test scores were found comparable between the two groups. IQ scores of the Chiari group were found in the normal range, but significantly lower than controls. No significant difference was revealed in terms of comorbid psychiatric disorders between the two groups.CONCLUSION:In this study, we did not observe an impairing effect of CM1 on EF and intelligence. Also, we found that CM1 did not cause more psychiatric disorders compared to controls. Further studies need to support our findings in adolescents diagnosed with CM1.

Aim: Ovarian cancer metastasis to the spinal cord is extremely rare. To our knowledge, our case is one of only seventh such cases in the literature. Case: We present the case of cervical spinal intramedullary metastasis of ovarian adenocarcinoma in a 56-year-old woman who presented with neck pain. The cervical spinal intramedullary lesion was eradicated with C5-C6-C7 total laminectomy gross under monitorization somatosensorial evoked potential (SEP) and motor evoked potential (MEP). The follow-up of the patient, who was operated on in 2017, continues, and there have been no recurrences. Conclusion: To our knowledge, our case is one of the seventh cases of spinal special cervical intramedullary metastasis of ovarian carcinoma and only the fourth cases with no CNS and external CNS metastasis in the literature.

Objective: Pituitary tumors (PT) constitute 10-15% of intracranial tumors, and 90% of surgically treated PTs are pituitary adenoma (PA). PA can be treated using pharmacologic, surgical, and radiotherapeutic methods. Today, endoscopic endonasal transsphenoidal surgery (EETS) is more commonly performed because it is less invasive, provides a panoramic image, enables better evaluation of anatomic structures and adjacencies, and reduces hospital length of stay compared to other surgical methods. In this study, we evaluated the results of 21 patients who underwent EETS in our clinic. Methods: A total of 21 patients who underwent EETS between 2016 and 2020 in our clinic were evaluated retrospectively. Thirteen (61.90%) of the patients were women, 8 (38.09%) were men, and the mean age was 53.71 (24-73) years. Results: Pathology reports indicated pituitary adenoma in 17 patients, Rathke's cleft cyst in 3 patients, and hypophysitis in 1 patient. Rhinorrhea occurred in 3 patients, transient diabetes insipidus (DI) in 1 patient, and hypopituitarism in 2 patients. Two of the patients died. Conclusion: The acquisition of endoscopic experience involves a learning curve in which there is initially a temporary high incidence of perioperative complications. Compared with the literature, our results are consistent with the beginning of the learning curve.

Ochronosis is the black discoloration of connective tissues seen with alkaptonuria, a metabolic disorder. Alkaptonuria is a rare autosomal recessive metabolic disorder caused by the lack of homogentisic acid oxidase enzyme. Alkaptonuria causes degenerative changes in cartilage, intervertebral disc and other tissues. The patients operated due to lumbar disc herniation in alkatonuria are very few. In this article a case of ochronosis in which the patient was determined after lumbar discectomy is presented.

Globicatella sanguinis is catalase-negative, alpha-hemolytic, nonmotile, facultative anaerobic grampositive cocci, identified as a new species in 1992. Since the colony morphology in blood agar and microscopic appearance resembles streptococci, it is thought that some of the isolates previously identified in the Streptococcus viridans group were G.sanguinis species. G.sanguinis has been isolated from various clinical specimens, its species identification and antibiotic susceptibility have been tested since the year it was identified. Clinical specimens in which it is isolated include various mucosal surfaces, blood, urine, wound and cerebrospinal fluid. In this report, considering also the literature information, a case of G.sanguinis which is thought to cause meningitis was presented. Our case is a 39-year-old female patient with a lumboperitoneal shunt. The patient was admitted to the neurosurgery clinic with a headache and vision loss and was hospitalized in the service with a pre-diagnosis of pseudotumor cerebri. Neurological examination revealed no pathological findings. Eye examination revealed mild papillary edema, local retinal hemorrhage, and bilateral expansion in retinal vascularization. There was no pathologic findings in the brain magnetic resonance imaging. The colonies resembling alpha hemolytic streptococci were isolated from the cerebrospinal fluid taken upon the development of neck stiffness, fever, and tachycardia on the 10th day of hospitalization of the lumbo-peritoneal shunt administered patient. The identification of the isolate was determined in Bruker IVD MALDI Biotyper 2.3 (Bruker Daltonik GmbH, Bremen, Germany), available in our laboratory and it was identified as G.sanguinis (KJ680157.1) with a score of > 2. The definite identification of the isolate at the species level was made by 16S rDNA sequence analysis and it was determined that the bacterium was G.sanguinis with 100% similarity and coverage. The minimum inhibitory concentration (MIC) for some of the antibiotics was determined by the agar gradient method. The MIC values were found as; linezolid 0.50 µg/ml, vancomycin 0.75 µg/ ml, imipenem 0.75 µg/ml, meropenem 3 µg/ml, penicillin G 6 µg/ml and cefotaxime > 32 µg/ml. It is known that these rare isolates can be isolated in greater numbers along with the introduction of MALDITOF MS-based devices in many laboratories. Following greater numbers of isolation of this rare species of bacteria, our knowledge about its clinical significance, placement in the flora and antibiotic susceptibility will also be expanded.

AIM: Abusive head trauma (AHT) is the most common cause of death as the result of child abuse. A task force is planned to provide training on AHT to professionals in different disciplines on clinical presentation, diagnostic workup, and organization of multidisciplinary evaluation at the hospital and community levels. This study reports on the preliminary findings of the pre-intervention phase of a larger study. Materials and Methods: This is a descriptive, retrospective study exploring the rates of documentation of relevant data in charts, including risk factors for abuse, family demographics, completeness of diagnostic workup, and case finding. Results: Overall, 345 cases were found in hospital databases that were eligible for the retrospective study from 10 participating hospitals. In total, 305 cases (88.4%) were younger than 2 years of age. The most common documented risk factors were low parental education level in 82 families (23.8%), more than three children under 7 years of age in 76 families (22.0%), and bad child temper in 16 families (4.6%), among others. The rate of complete diagnostic workup in hospitals with a multidisciplinary team (MDT) (25.7%) was statistically significantly higher than in hospitals without an MDT (2.9%) (p=0.001). Etiology was identified as inflicted in 78 cases (22.6%), possibly inflicted in 24 (7.0%), undetermined in 79 (22.9%), and accidental in 164 (47.5%) by the researchers, compared to only three cases (0.8%) diagnosed as inflicted by the treating physicians (p Conclusion: Clinicians' knowledge of the diagnosis of AHT should be increased to improve case finding, which will allow determination of more accurate incidence/prevalence. This can be accomplished via the establishment of an MDT in teaching hospitals as well as staff training on how to recognize suspicious cases, how to utilize MDT services, and how to report and manage cases on a community level multidisciplinary basis. Language: en

Background: Klippel-Feil syndrome (KFS) is characterized by the developmental failure of the cervical spine and has two dominantly inherited subtypes. Affected individuals who are the children of a consanguineous marriage are extremely rare in the medical literature, but the gene responsible for this recessive trait subtype of KFS has recently been reported.Results: We identified a family with the KFS phenotype in which their parents have a consanguineous marriage. Radiological examinations revealed that they carry fusion defects and numerical abnormalities in the cervical spine, scoliosis, malformations of the cranial base, and Sprengel's deformity. We applied whole genome linkage and whole-exome sequencing analysis to identify the chromosomal locus and gene mutated in this family. Whole genome linkage analysis revealed a significant linkage to chromosome 17q12-q33 with a LOD score of 4.2. Exome sequencing identified the G > A p.Q84X mutation in the MEOX1 gene, which is segregated based on pedigree status. Homozygous MEOX1 mutations have reportedly caused a similar phenotype in knockout mice.Conclusions: Here, we report a truncating mutation in the MEOX1 gene in a KFS family with an autosomal recessive trait. Together with another recently reported study and the knockout mouse model, our results suggest that mutations in MEOX1 cause a recessive KFS phenotype in humans.

AIM:We encountered no study conducted on the evaluation of prevertebral soft tissue (PVST) thickness by magnetic resonance imaging (MRI) during our literature search. Measuring PVST thickness by MRI in the cervical region of adult cases was aimed in the present retrospective study.MATERIAL AND METHODS:For the intended purpose, a total of 136 patients, composed of both males and females, with ages ranging from 20 to 69 years, in whom no pathology in the cervical prevertebral region was revealed by MRI modality implemented for various reasons, were included in the study.RESULTS:The upper limit of normal for PVST thickness was measured in our study to be 10 mm, 7 mm and 20 mm at C1, C2-C3 and C6-C7 vertebral levels, respectively. The least variation in the measurements and standard deviations were obtained at C3-C4 vertebral levels. Upon making a comparison between the measured PVST thicknesses on the basis of gender, the measurements at C2,C4 and C7 were found to display significant difference, whereas that was not the case for the measurements obtained at the other levels.CONCLUSION:Progressively widespread use of MRI for the traumas inflicting the cervical region makes it obligatory to specify normal values for the thickness of PVST measured by MRI.

Ozet Amac. Nitrik Oksit (NO) sentezi, 3 izoformu bulunan nitrik oksit sentaz enzimi tarafindan duzenlenmektedir. Bunlar Endotelyal Nitrik Oksit Sentaz (eNOS), noronal nitrik oksit sentaz (nNOS) ve induklenebilir nitrik oksit sentaz (iNOS). ENOS, arter damar capini duzenlemektedir, Islevsel etkinligi disinda yapisal etkinligi de tespit edilmistir. Bu calismada eNOS genindeki iki polimorfizmle bir yapisal damar patolojisi olan kanamis kafa ici anevrizma varligi arasindaki iliski arastirildi. Yontem. Kanamis kafa ici anevrizmasi olan 43 hasta ve 46 saglikli bireyin DNA'larinda eNOS geni intron 4 (27 baz cifti tekrari) ve promoter T786C polimorfizmi jel elektroforez ve dizileme teknigi ile incelendi. Bulgular. CC homozigot genotip varligi kanamis kafa ici anevrizmasi olan hasta grubunda anlamli olarak yuksek olarak tespit edilmistir (p 0,05). Sonuc. Homozigot T786C genotip varligi calismaya aldigimiz yoresel hasta grubunda kanamis kafa ici anevrizma varligi acisindan risk sebebi olarak gorulmektedir. Intron 4 (27 baz cifti tekrari) polimorfizminin varligi ise risk teskil etmemektedir. Anahtar sozcukler: eNOS, nitrik oksit, anevrizma, SAK, polimorfizm Abstract Aim. Nitric oxide synthesis, 3-isoform in the nitric oxide synthase is regulated by the enzyme. These endothelial nitric oxide synthase (eNOS), neuronal nitric oxide synthase (nNOS) and inducible nitric oxide synthase (iNOS). eNOS, regulates the diameter of arterial vessels. Functional activity is outside the structural activity. In this study, eNOS gene, a structural vascular pathology of the two polymorphisms which compared the relationship between ruptured intracranial aneurysm. Method. Endothelial nitric oxide synthase gene intron 4 (27 base pair repeat) and promoter T786C polymorphism of 43 patients with ruptured intracranial aneurysms and 46 control subjects were analysed by polymerase chain reaction and DNA sequencing method. Genotype distribution and allele frequencies of endothelial nitric oxide synthase gene polymorphism in patients with ruptured intracranial aneurysm and healthy subjects were compared. Result. CC genotype frequency was significantly higher in patients with ruptured intracranial aneurysm. It was also found that presence of eNOS 786 CC genotype was significantly associated with risk of intracranial aneurysm rupture (p 0.05). Conclusion. T786C polymorphism in endothelial nitric oxide synthase gene seems to be a possible risk factor for intracranial aneurysm rupture Keywords: eNOS, Nitric oxide, intracranial aneurysm, SAH, polymorphism