Does the Extent of Rod Bending and Actual Lumbar Lordosis Mismatch Affect Quality of Life?

BACKGROUND: To evaluate any mismatch between rod bending and actual lordosis during posterior lumbar instrumentation and its effects on the quality of life (QOL) of patients. METHODS: Patient records for posterior lumbar fusion in 2018-2023 were retrospectively reviewed. The radiologic parameters consisted of pelvic incidence, sacral slope, L1S1 lumbar lordosis, lumbosacral angle, the distance between the posterior wall of the vertebra and the rod, lordosis of the rod. The postoperative QOL of patients was assessed using Oswestry Disability Index. The patients were grouped postoperative into Group-1 (minimal/moderate disability) and Group-2 (severe disability/crippled/bed bound). RESULTS: Total of 133 patients were included; 99 women, 34 men. The difference was significant for patients with diabetes to be presented in the more disabled Group-2. The distance between the posterior vertebral wall and the rod was found to be short in Group-2. Preoperative and postoperative sagittal lumbar Cobb angles were significantly higher in Group-2. The changing degree of pain was found to score high in Group-2. The postoperative visual analog scale was high in Group-2. The difference between the preoperative and postoperative lumbar sagittal Cobb and rod Cobb-angles was found to be high in Group-2. CONCLUSIONS: The results of our study confirm the importance of considering the preoperative actual lumbar lordosis during bending and maintaining it as much as possible. To our knowledge, this is the first study that evaluated the effect of rod bending on quality of life (QOL) and supports that this might be affected in case of any mismatches.

Common Vertebral Fracture Level After the 2023 Turkey Earthquake: Thoracolumbar Junction - Due to Hyper-Flexed and Fixed Posture - at Triangle of Life Areas.

AIM: Thoracolumbar junction (TLJ) fractures are frequently encountered in spinal trauma occurring during earthquakes. This study aimed to assess the frequency of TLJ fractures (T10-L2) in survivors of the 2023 East Turkey earthquake. MATERIAL AND METHODS: Ten earthquake survivors, who were trapped under the rubble and rescued alive by rescue teams, were assessed for spinal trauma after the earthquake in Eastern Turkey on February 6, 2023. All patients underwent full spinal magnetic resonance imaging and computed tomography examinations to determine the level of spinal fracture and decide the treatment methods. RESULTS: All patients had sustained spinal fractures. Eight underwent surgery, while two were managed conservatively. Nine out of ten patients had TLJ fractures. Five patients had L1 fractures, four of them were treated surgically. Three patients had a T12 level fracture, two of whom were treated surgically. One patient with a T7-level fracture was treated surgically. Only one patient had multiple fractures (T12 and L2 levels) and was treated surgically. CONCLUSION: The TLJ was the commonest vertebral fracture level in the 2023 Turkey earthquake survivors. In the event of an earthquake, people tend to attain a fetal posture (fix and hyperflex the spine) when taking shelter in a narrow area (triangle of life). This position places an excessive load on the TLJ, predisposing it to injuries.

Single-institution comparative analysis for odontoid resection: posterior transaxis versus anterior transnasal approach.

OBJECTIVE: The resection of an upwardly migrated odontoid is most widely performed via an anterior endoscopic endonasal approach after the addition of posterior occipitocervical instrumentation. In patients with craniovertebral junction (CVJ) anomalies like basilar invagination (BI), surgery is usually achieved in two separate stages. However, the authors have recently introduced a novel posterior transaxis approach in which all the therapeutic goals of the surgery can be safely and effectively accomplished in a single-stage procedure. The aim of the current study was to compare the widely used anterior and the recently introduced posterior approaches on the basis of objective clinical results in patients who underwent odontoid resection for BI. METHODS: Patients with BI who had undergone odontoid resection were retrospectively reviewed in two groups. The first group (n = 7) consisted of patients who underwent anterior odontoidectomy via the standard anterior transnasal route, and the second group (n = 6) included patients in whom the novel transaxis approach was performed. Patient characteristics, neurological conditions, and modified Rankin Scale (mRS) scores at admission were evaluated. Operative time, changes in intraoperative neurophysiological monitoring, blood loss during surgery, odontoid resection rate, postoperative complications, and mortality were compared between the patient groups. RESULTS: Data were retrospectively reviewed for 13 patients who underwent odontoid resection, posterior CVJ decompression, and occipitocervical instrumentation at the Ankara University School of Medicine Department of Neurosurgery between 2009 and 2022. In the first group (n = 7), patients who underwent anterior odontoidectomy via the standard endonasal route, two serious complications were observed, pneumocephaly and basilar artery injury. In the second group (n = 6), patients in whom the novel transaxis approach was performed, only one complication was observed, occipital plate malposition. CONCLUSIONS: This study represents the results of what is to the authors' knowledge the first comparison of a novel approach with a widely used surgical approach to odontoid resection in patients with BI. The preliminary data support the successful utility of the transaxis approach for odontoid resection that meets all the operative therapeutic demands in a single-stage operation. Considering the diminished surgical risks and operative time, the transaxis approach may be regarded as a primary approach for the treatment of BI.

Posterior midline approach to odontoidectomy: A novel method to treat basilar invagination.

Background: Basilar invagination (BI) is a common malformation of the craniocervical region where the odontoid process protrudes into the foramen magnum. Surgery in this region is difficult because of the complex anatomy of the craniocervical junction. Serious life-threatening complications have been observed with previously described approaches. Therefore, we conceived a novel surgical approach that can be implemented by neurosurgeons with different skill levels to facilitate better outcomes. Methods: We describe a new surgical technique for the treatment of BI that we used in two patients in whom cervical myelopathy and direct ventral compression of the cervicomedullary junction were confirmed through clinical and radiological findings. We present the technique of posterior odontoidectomy in a step-by-step, didactic, and practical manner with surgical tips and tricks. Results: The resection was completed without intraoperative or postoperative complications in both cases. The patients experienced substantial neurological improvements, and full recovery was observed during the 9-month and 12-month follow-up visits after discharge. Compared with the transoral approach, our technique provides a larger decompression area. Conclusions: We describe a novel method for the treatment of BI that was applied in two patients and suggest that the posterior approach might be a safe and effective method for ventral decompression of the craniocervical junction. Posterior odontoidectomy followed by craniocervical fixation helped achieve complete cervicomedullary decompression.

Changes in Callosal Angle and Evans' Index After Placing a Lumboperitoneal Shunt in Patients with Idiopathic-Normal- Pressure Hydrocephalus.

AIM: To evaluate changes in the Evans? index (EI) and callosal angle (CA) in patients who underwent lumboperitoneal (LP) shunting for idiopathic normal pressure hydrocephalus (INPH) and whose symptoms improved post-operatively. MATERIAL AND METHODS: We retrospectively analysed patients who were clinically and radiologically diagnosed with INPH and treated with an LP shunt between 2010 and 2020. In all patients, we performed radiological imaging with EI and CA measurements and completed clinical assessments, including Mini-Mental State Examination (MMSE) and cognitive, urinary continence, balance and 10-m walking tests, preoperatively and post-operatively (less than 1 year later). Results were compared by statistical analyses. RESULTS: We evaluated 42 patients who received an LP shunt for INPH and had cranial magnetic resonance imaging (MRI) performed within the first 2 months after surgery. When the pre-operative and post-operative MRIs of the patients were compared, a statistically significant decrease was found in EI and CA measurements (p < .001, for each). A statistically significant improvement was found in clinical tests. Post-op early radiological images predicted recovery of the gait-balance function and urinary incontinence (p < .001) but did not predict recovery of dementia (p=.06). CONCLUSION: Radiological and clinical improvements are expected after the placement of ventriculoperitoneal (VP) or LP shunts in patients with INPH. Radiological measurements after an LP shunt in patients with INPH have not been reported in the literature. In the current study, radiological measurements after LP shunt placement were evaluated for the first time in patients with INPH. Significant changes in EI and CA after LP shunt placement may indicate whether patients will benefit clinically from an LP shunt during follow-up. A significant decrease in CA and EI measurements in the early period may be a marker for whether patients with INPH will show signs of clinical improvement and benefit from an LP shunt.

Is Placing Prophylactic Dural Tenting Sutures a Dogma?

OBJECTIVE: In this study, we investigated if and when dural tenting sutures are necessary during craniotomy. METHODS: Results from 437 patients 18-91 years of age (average, 43.5 years) who underwent supratentorial craniotomy between 2014 and 2019 were evaluated. The patients were categorized into 1 of 3 groups: patients who had at least 3 prophylactic dural tenting sutures placed before opening of the dura (group 1); patients who had at least 3 dural tenting sutures placed after surgery was completed, during closure (group 2); or patients who had no dural tenting sutures (group 3 [control]). All such sutures in groups 1 and 2 were placed in the circumference of the craniotomy and dural junction. No central dural tenting sutures were placed in any of the patients. RESULTS: Among the 437 patients, 344 underwent surgery for the first time and 93 were undergoing a second surgery. Cranial computed tomography imaging was performed for each patient 1 hour, 3 days, and 1 month after surgery. In group 1, 3 patients had a cerebral cortex contusion and 2 patients had acute subdural hematoma after the sutures were placed. In groups 2 and 3, none of the patients had a cerebral cortex contusion or acute subdural hematoma. Fewer complications were observed when dural tenting sutures were placed during postsurgical closure. CONCLUSIONS: Placing dural tenting sutures is an important technique for ensuring hemostasis. However, when not needed, they seem to cause inadvertent complications. As our results suggest, knowing when and where to use them is equally important.

Possible Early Examples of Medical Tourism.

Health tourism has hundreds of years of history, most notably in visitors traveling to thermal baths. Medical tourism, a type of health tourism, has rapidly expanded in the last quarter century by patients travelling abroad to health centers for medical treatment. Because of lack of records in ancient times, the history of tourism for actual medical treatment is unknown. In Ottoman archives, medical treatment consent forms of patients were officially documented. We analyzed these existing records to identify foreign citizens who came to the Ottoman Empire for medical treatment. In our screening of Konya Ser'iye registration records, we found medical consent forms for three non-Ottoman foreign citizens. All three patients had the same medical illness and came to Konya for medical treatment. Therefore we emphasized that those patients searched for the name of doctor who was an authority on that illness. This study indicates that medical tourism may have occurred well before the 20th century.

Neuroactive Peptide Nanofibers for Regeneration of Spinal Cord after Injury.

The highly complex nature of spinal cord injuries (SCIs) requires design of novel biomaterials that can stimulate cellular regeneration and functional recovery. Promising SCI treatments use biomaterial scaffolds, which provide bioactive cues to the cells in order to trigger neural regeneration in the spinal cord. In this work, the use of peptide nanofibers is demonstrated, presenting protein binding and cellular adhesion epitopes in a rat model of SCI. The self-assembling peptide molecules are designed to form nanofibers, which display heparan sulfate mimetic and laminin mimetic epitopes to the cells in the spinal cord. These neuroactive nanofibers are found to support adhesion and viability of dorsal root ganglion neurons as well as neurite outgrowth in vitro and enhance tissue integrity after 6 weeks of injury in vivo. Treatment with the peptide nanofiber scaffolds also show significant behavioral improvement. These results demonstrate that it is possible to facilitate regeneration especially in the white matter of the spinal cord, which is usually damaged during the accidents using bioactive 3D nanostructures displaying high densities of laminin and heparan sulfate-mimetic epitopes on their surfaces.

Contralateral Subfrontal Supraorbital Approach for Microsurgical Resection of Optic Canal Meningioma.

ABSTRACT: Meningiomas are mostly benign tumors of the central nervous system. Recurrence can be seen in clinoidal meningiomas especially extending into optic canal. We present a patient with a history of left clinoidal meningioma excision via pterional approach and recurrence purely in left optic canal. Optic canal drilling is necessary for complete removal of these type of tumors. Contralateral subfrontal approach with an eyebrow incision and a keyhole supraorbital craniotomy was used for this patient. Contralateral viewing of the surgical area provided direct angles and created better workspace for the surgeon. Total excision was achieved with no additional neurological deficits in the postoperative period. This approach can be used with its wide exposure of surgical site, potential space usage without need of retraction and better postoperative scar healing.

Assesment of Functional Results for the Lesions Located in Eloquent Areas with Using Intraoperative Cortical-Subcortical Stimulation and Cortical Mapping.

AIM: To assess the classical and functional imaging features of patients with pathology located in the eloquent areas of the brain who were admitted to our centre between October 2012 and February 2018. We also studied intraoperative somatosensory evoked potential (SEP), motor evoked potentials (MEP), phase reversal, cortical mapping, the extent of resection and the calculation of postoperative morbidity. MATERIAL AND METHODS: We compared our results with previous studies in which this technique was not used. The patient records of 163 patients were reviewed retrospectively after approval by the institutional ethics committee and comparisons were made with reports in the literature. RESULTS: The lesion was localised in the visual cortex in eight of the 163 patients. We did not encounter any abnormality in the VEP recordings, so the surgeries were continued. The remaining 155 cases were followed by intraoperative SEP and MEP monitoring. We observed a greater than 50% decrease in the amplitude and an increase in latencies that was greater than 10% in intraoperative MEP and SEP monitoring in 24 patients of 155. Although 8 of 24 patients with abnormal SEP and MEP values were corrected with manuveurs, 6 patients developed increased neurological deficits postoperatively. CONCLUSION: In conclusion, all of these methods should not be seen as competitive with each other; they could be considered as complementary. All of these methods are helpful for a surgical team regarding loss of neurological function. The rate of loss might be up to 100% and irreversible despite corrective maneveurs.

Microsurgical Management of Ventral Intradural-Extramedullary Cervical Meningiomas: Technical Considerations and Outcomes.

OBJECTIVE: Cervical meningiomas are uncommon intradural-extramedullary tumors that have a tendency to be situated anterior to the spinal cord. The optimal surgical corridor to reach purely ventral cervical meningiomas has not been established. This article presents a series of patients with ventral cervical meningiomas treated via 1 of 2 microneurosurgical approaches: the anterior approach with corpectomy and fusion or the posterolateral approach. METHODS: Eight patients who underwent surgical resection of solitary, histopathologically confirmed, intradural-extramedullary cervical meningiomas of purely ventral location were retrospectively examined. Preoperative and postoperative Nurick scores quantified the degree of ambulatory function. Patients were followed for an average of 2.1 years after surgery. Postoperative imaging was performed to determine the extent of resection and to assess for tumor recurrence. RESULTS: Two patients with lower cervical meningiomas underwent resection via an anterior approach with single-level corpectomy and fusion. Six patients were treated via a posterolateral approach including ipsilateral hemilaminectomy and partial facetectomy without fusion. No intraoperative or postoperative complications were observed. Gross total resection was achieved in 8 of 8 patients, although 1 patient exhibited tumor recurrence. Improvement in ambulatory function was observed in all patients. CONCLUSIONS: Purely ventral cervical meningiomas are uncommon and pose unique technical challenges for neurosurgeons. We document favorable outcomes from 2 cases of lower cervical meningioma treated via an anterior approach and 6 cases of upper cervical tumors treated via a posterolateral approach. This series demonstrates operative considerations for effectively managing ventral cervical meningiomas.

Retroclival epidural hematoma: A rare location of epidural hematoma, case report, and review of literature.

Retroclival epidural hematoma in adults is uncommon. Although most cases are associated with craniocervical trauma, other mechanisms have been reported, such as coagulopathy, vascular lesions, and pituitary apoplexy. We report two adults diagnosed with retroclival epidural hematoma. One patient was an 89-year-old male with leukemia and thrombocytopenia who sustained a fall and developed a traumatic retroclival epidural hematoma with brainstem compression; surgery could not be performed due to his clinical condition and he died 5 days later. The other patient was a 78-year-old female with atrial fibrillation who developed a spontaneous retroclival epidural hematoma as a result of warfarin use; she was treated conservatively with anticoagulant reversal and methylprednisolone and was subsequently discharged without neurological deficit. Retroclival hematomas are primarily treated conservatively due to the difficulty of surgical approach. The bleeding mechanism and dural and venous anatomy of this region tend to limit hematoma expansion.

Aortic Injury by Thoracic Pedicle Screw. When Is Aortic Repair Required? Literature Review and Three New Cases.

PURPOSE: Aortic injury by pedicle screw is rare but can cause serious complications. It has not been clearly determined when aortic repair is necessary in cases of screw impingement without perforation of the aortic wall. In this article, we review the treatment and clinical course of pedicle screw aortic impingement and attempt to clarify this issue. METHODS: Cases of aortic injury during thoracic screw procedures were found using a MEDLINE search and analyzed together with 3 new cases that we present. RESULTS: Nineteen cases collected from the literature and 3 new cases were included in the study. In 7 of the cases, aortic impingement by the pedicle screw was detected during postoperative follow-up (day 1) radiologic examinations. In the other cases, time to presentation of aortic impingement ranged between 2 weeks and 60 months after fixation. The main indications for thoracic spinal fixation were post-traumatic vertebral fracture and kyphoscoliosis/scoliosis. Repair of the aortic damage ranged from primary repair to stent and tube graft placement by the thoracic endovascular aortic repair method. CONCLUSIONS: In cases in which the screw impinges less than 5 mm into the aortic wall, hardware revision without aortic repair may be sufficient if recognized early and there are no sign of aortic leakage in vascular imaging. However, cases with more than 5 mm of screw impingement should undergo aortic repair first, even in the absence of aortic leakage, following by screw revision.

Spinal Hydatid Cyst Disease : Challenging Surgery - an Institutional Experience.

OBJECTIVE: Hydatid cyst disease is caused by the parasite Echinococcus granulosus. It is rarely seen in the vertebral system, occurring at a rate of 0.2-1%. The aim of this study is to present 12 spinal hydatid cyst cases, and propose a new type of drainage of the cyst. METHODS: Twelve cases of spinal hydatid cysts, surgical operations, multiple operations, chronic recurrences, and spinal hydatic cyst excision methods are discussed in the context of the literature. Patients are operated between 2005 and 2016. All the patients are kept under routine follow up. Patient demographic data and clinicopathologic characteristics are examined. RESULTS: Six male and six female patients with a median age of 38.6 at the time of surgery were included in the study. Spinal cyst hydatid infection sites were one odontoid, one cervical, five thoracic, two lumbar, and three sacral. In all cases, surgery was performed, with the aim of total excision of the cyst, decompression of the spinal cord, and if necessary, stabilization of the spinal column. Mean follow up was 61.3 months (10-156). All the patients were prescribed Albendazole. Three patients had secondary hydatid cyst infection (one lung and two hepatic). CONCLUSION: The two-way drainage catheter placed inside a cyst provides post-operative chlorhexidine washing inside the cavity. Although a spinal hydatid cyst is a benign pathology and seen rarely, it is extremely difficult to achieve a real cure for patients with this disease. Treatment modalities should be aggressive and include total excision of cyst without rupture, decompression of spinal cord, flushing of the area with scolicidal drugs, and ensuring spinal stabilization. After the operation the patients should be kept under routine follow up. Radiological and clinical examinations are useful in spotting a recurrence.

Collagen Peptide Presenting Nanofibrous Scaffold for Intervertebral Disc Regeneration.

Lower back pain (LBP) is a prevalent spinal symptom at the lumbar region of the spine, which severely effects quality of life and constitutes the number one cause of occupational disability. Degeneration of the intervertebral disc (IVD) is one of the well-known causes contributing to the LBP. Therapeutic biomaterials inducing IVD regeneration are promising candidates for IVD degeneration treatments. Here, we demonstrate a collagen peptide presenting nanofiber scaffold to mimic the structure and function of the natural extracellular matrix of the tissue for IVD regeneration. The collagen peptide presenting nanofiber was designed by using a Pro-Hyp-Gly (POG) peptide sequence on a self-assembling peptide amphiphile molecule, which assembled into nanofibers forming scaffolds. Injection of collagen peptide presenting peptide nanofiber scaffold into the degenerated rabbit IVDs induced more glycosaminoglycan and collagen deposition compared to controls. Functional recovery of the tissue was evaluated by degeneration index score, where the bioactive scaffold was shown to provide functional recovery of the IVD degeneration. These results showed that the collagen peptide presenting nanofiber scaffold can prevent the progression of IVD degeneration and provide further functional recovery of the tissue.

Osteogenesis Imperfecta and Extra-/Intradural Hematomas: A Case Report and Review of the Literature.

Osteogenesis imperfecta, also named as brittle bone disease, is characterized by fragile bones and short stature caused by mutations in the collagen gene. Subdural and intraparenchymal hematomas are defined and associated with trauma, vascular causes, and systemic bleeding diathesis. Skull fragility may lead to epidural hematoma, which is a life-threatening situation. Vascular fragility and intrinsic platelet defects are the causes of bleeding in patients with osteogenesis imperfecta, which is a major management challenge for neurosurgeons. Here, we reported on a 5-year-old boy with osteogenesis imperfecta with epidural hematoma and skull fracture following a trivial trauma, and made a literature review of 28 cases with extra-/intradural hematoma.

Is a Unilateral Surgical Approach Effective in Patients with Bilateral Leg Pain with Unilateral Lumbar Disc Herniation? A Prospective Nonrandomized Clinical and Surgical Study.

OBJECTIVE: To examine the surgical results of unilateral lumbar discectomy in patients with bilateral leg pain and discuss short- and long-term outcomes within the limits of lumbar decompression. METHODS: We analyzed 60 patients with unilateral disc herniation who underwent unilateral lumbar discectomy and hemipartial laminectomy between 2014 and 2017. Group 1 (30 patients) had bilateral leg pain and unilateral lumbar disc herniation. Pain lateralization was determined radiologically. Group 2 (30 patients) had unilateral leg pain and unilateral lumbar disc herniation. Pain scores were preoperatively evaluated with visual analog scale (VAS) for both legs and Oswestry Disability Index (ODI) for overall life quality. In both groups, surgery was performed on the ipsilateral side of the herniated disc. Scores were repeated on postoperative day 1 and 1, 3, 6, 12, and 24 months later. VAS score differences for pain lateralization and disc levels were compared in group 1. ODI score differences were compared between both groups. Results were statistically analyzed. RESULTS: VAS score differences were statistically significant at all follow-up time points in patients with ipsilateral and contralateral pain. VAS score differences between L4-L5 and L5-S1 level discopathies were statistically insignificant for all time points in both groups. All postoperative ODI score decreases for all time points were statistically significant (P < 0.001) for both groups, whereas the differences between groups 1 and 2 were statistically insignificant. CONCLUSIONS: Conventional lumbar disc surgery alone is sufficient for the ipsilateral side of radiologically demonstrated disc herniation in patients with bilateral leg pain.

Revisiting Ligament-Sparing Lumbar Microdiscectomy: When to Preserve Ligamentum Flavum and How to Evaluate Radiological Results for Epidural Fibrosis.

OBJECTIVE: Preserving the ligamentum flavum (LF) during lumbar spine surgery can help to limit the extent of postoperative epidural fibrosis (EF), which is a potential cause of persistent leg pain. We present a retrospective analysis of microdiscectomy with preservation of the LF to evaluate the effects of the two LF mobilizing techniques (reflecting inferiorly or medially vs. removing completely) on EF and clinical outcomes. METHODS: Microdiscectomy was performed through a unilateral laminotomy in 93 patients (52 male, 41 female; mean age, 46 years; range, 25-65 years) with L3-L4 (n = 3), L4-L5 (n = 40), and L5-S1 (n = 50) lumbar disc herniation. Patients whose LF was removed were assigned to group 1 (n=42), and patients whose LF was preserved by mobilizing it medially (n = 31) or inferiorly (n = 20) were assigned to groups 2 and 3, respectively. Follow-up visual analog scale (VAS) scores and magnetic resonance images were evaluated. RESULTS: EF scores, particularly for the anterior quadrants, were significantly higher in group 1 than in groups 2 (P = 0.012) and 3 (P = 0.001). Likewise, postoperative VAS scores in group 1 were also significantly higher than in groups 2 (P = 0.009) and 3 (P = 0.044). CONCLUSIONS: Our results demonstrate that 1) preserving the LF during lumbar microdiscectomy reduces the formation of postoperative EF and improves clinical outcomes; 2) EF in the anterior, rather than the posterior epidural space, is correlated with clinical results; and 3) the ligament mobilizing technique used should be individually tailored on the basis of the features of disc herniation.

Effect of Riluzole on Spinal Cord Regeneration with Hemisection Method Before Injury.

OBJECTIVE: The pathophysiology of spinal cord injury (SCI) with the information obtained to date has not been elucidated fully. A safe drug or treatment protocol that results in cell regeneration for SCI remains unknown. Neuroprotective and neuroregenerative effects of riluzole, administered after a SCI, have been shown in experimental studies. This study aimed to investigate the effect of riluzole on neural regeneration in a rat SCI model. METHODS: Thirty-two rats were divided into 8 groups, with 4 rats in each group. Hemisection method was performed after T7-T9 laminectomy. Rats were intraperitoneally aministered with riluzole (6 mg/kg). Locomotor recovery of the rats was assessed at 1 day, and 1, 2, 3, and 4 weeks after the 21-point Basso, Beattie, and Bresnahan test. Subsequently, the spinal cords of the rats were scored according to a semiquantitative grading system using a light microscope, and the numbers of myelinated axons, neurons, and glial cells were calculated. RESULTS: Basso, Beattie, and Bresnahan test changes were statistically significant when groups 4-6 and 8 were compared with the other groups (P < 0.05, P < 0.00625). The results of the numbers of neurons, glial cells, and myelinated axons were statistically significant. Especially group 8, in which riluzole was administered 5 days before injury, more positive clinical and histopathologic results were obtained. CONCLUSIONS: Riluzole treatment is more effective when provided before injury. Riluzole may contribute to functional recovery when used in the preoperative period in patients who are at a high risk for permanent neurologic deficit.

Endoscopic Endonasal Approaches to Craniovertebral Junction Pathologies: A Single-Center Experience.

AIM: The craniovertebral junction is a remarkable anatomical area with unique anatomical and functional relationships, which present difficult challenges for surgeons. The traditional approach to addressing pathologies in this area is microscopic transoral resection with posterior fixation; however, endoscopic endonasal clivus and odontoid surgeries now currently gaining interest as alternative approaches. We reviewed our experience of using the endoscopic endonasal approach at our institution. MATERIAL AND METHODS: We retrospectively evaluated 41 patients (21 male, 20 female; age range, 2-65 years) who underwent endoscopic endonasal procedures for craniovertebral junction pathologies between 2008 and 2017. RESULTS: Of the 41 patients, 27 had clivus lesions, 7 had odontoid lesions, 6 had basilar invagination and 1 had rhinorrhea repair. Six patients underwent an additional posterior decompression/fusion either before or after the endonasal procedure. None of the patients required tracheostomy and cerebrospinal fluid leakage was detected in one patient postoperatively. The patients' mean modified Rankin scale and visual analog scale scores were 3 and 4 respectively. The follow-up period ranged from 12 to 50 months. CONCLUSION: Although the microscopic transoral approach has been considered the gold standard for craniovertebral junction surgical management, endoscopic approaches are feasible, safe, and effective for addressing pathologies in this region, with developing technique and experience.