Effect of decompressive hemicraniectomy in patients with acute middle cerebral artery infarction

Background/aim: We aimed to determine in which cases this procedure may be more effective based on the data of patients who underwent decompressive hemicraniectomy (DHC). Material and methods: Overall, 47 patients who underwent DHC due to acute middle cerebral artery (MCA) infarction between January 2014 and january 2019 were retrospectively investigated. These patients were divided into two groups: those who died after DHC (Group A) and those who survived DHC (Group B). The groups were compared in terms of various parameters. We investigated whether the patient's modified Rankin scale (mRS) status changed depending on age (> 60 and < 60 years). Results: The median age of all patients was 65 (37­80) years; groups A and B had median ages of 66.5 (37­80) and 61 (44­79) years (p = 0.111), respectively; 55.3% patients were male. The elapsed times until hospitalization after the onset of symptoms were 4.5 and 3 h in groups A and B, respectively (p = 0.014). The median GCS score at the time of admission was 7 (5­12) and 10 (8­14) in groups A and B, respectively (p = 0.0001). At the time of admission, 63.3% patients in group A had anisocoria, whereas no patient in group B had anisocoria (p = 0.0001). In postoperative period, 40% patients in group A and all patients in group B received AC/AA treatment. The survival of patients aged < 60 and > 60 years who underwent DHC for MCA infraction was 61.5% and 26.5%, respectively (p = 0,041). The median mRS of patients < 60 and > 60 years were 4 (1­6) and 6 (1­6), respectively (p = 0.018). Conclusion: Age, DHC timing, and elapsed time until hospitalization or access to treatment directly affect the functional outcome and survival in MCA-infarcted patients who underwent DHC. In patients in whom the medical treatment fails, early DHC administration will increase survival without waiting for neurological worsening once herniation is detected radiologically.

Lumbosacral discitis as a rare complication of laparoscopic sacrocolpopexy.

INTRODUCTION AND HYPOTHESIS: Sacrocolpopexy is considered to be the gold-standard procedure for apical compartment prolapse. However, complications such as sacral hemorrhage, small bowel obstruction, port site herniation, mesh erosion, mesh exposure, and occasionally discitis may occur. The aim of this study is to show laparoscopic treatment of L5-S1 discitis 3 months following laparoscopic sacrocolpopexy. METHODS: Two surgical interventions of a case with narrated video footage is presented. RESULTS: Laparoscopic sacrocolpopexy following hysterectomy in the first part and re-laparoscopy because of a diagnosis of discitis refractory to medical treatment, and removal of mesh along with anterior L5-S1 discectomy for curative debridement in the second part is demonstrated. CONCLUSION: Frequency of postoperative discitis has been increased by the widespread use of a laparoscopic approach. In order to reduce the complication rate, surgical technique allowing the needle to penetrate only the depth of the anterior longitudinal ligament and usage of monofilament suture for mesh attachment is recommended. In treatment, removal of the sacral mesh, and even extensive tissue debridement, may be necessary.

Pathological evaluation of the filum terminale tissue after surgical excision.

PURPOSE: Tethered cord syndrome (TCS) is an important disease and can produce progressive neurological symptoms. Studies about the filum terminale (FT) have drawn attention to the importance of histopathological investigation of this structure. The most interesting of these subtypes is the FT that incorporates peripheral nerve fibers (PNF). Our study aimed to analyze the frequency of PNF in the FT of 40 cases diagnosed with TCS. METHODS: We performed a retrospective histopathological investigation of FT excised during surgery of patients with TCS who underwent de-tethering. Neurologic and other types of postoperative complications were also revised. RESULTS: Analysis of the samples showed six dominant histopathological subtypes in the FT: fibroadipose tissues including peripheral nerve bundles (n = 14, 37 %), fibroadipose tissue (n = 10, 25 %), fibrous or adipose tissue (n = 7, 17 %), glial tissues including peripheral nerve sections (n = 4, 10 %), and ependymal and glial tissues (n = 4, 10 %). None of the patients presented with neurologic postoperative complications. CONCLUSION: Embryologic studies revealed that it is common to encounter different histological subtypes of FT pathology. However, the presence of peripheral nerve cells in the FT is important for neurosurgical practice due to the risk of sectioning a functional structure during surgery. In our analysis, we demonstrated the high frequency of PNF in FT pathology. However, since none of the patients showed any symptoms of neurologic deterioration, we considered that these fibers were probably not functional. Our findings emphasize the importance of neuromonitoring in TCS surgery. Although we consider that most of the fibers are probably not functional, neuromonitoring after surgery may prevent serious complications.

Mortality Factors in Crush Syndrome.

BACKGROUND: Crush Syndrome is a major cause of morbidity and mortality following large-scale catastrophic earthquakes. Since there are no randomized controlled studies on Crush Syndrome, knowledge on this subject is limited to expert experience. The primary objective is to analyze the epidemiological and demographic characteristics, clinical outcomes, and mortality factors of earthquake victims after the Pazarcik and Elbistan earthquakes on February 6, 2023. METHODS: This cross-sectional and observational retrospective study evaluated 610 earthquake victims who presented to our center between February 6 and April 30, 2023. Among these patients, 128 with Crush Syndrome were included in the study. Patient information was gathered from hospital records during their stay and from national registries upon referral. The primary outcome was to identify risk factors for mortality. Demographic and laboratory data were analyzed by acute kidney injury (AKI) stages; mortality-affecting factors were identified through regression analysis. RESULTS: Of the 128 Crush Syndrome patients (100 adults, 28 children), 64 were female. The AKI rate was 32.8%. Among patients with AKI, the frequency of hemodialysis requirement was 69%, and the mortality rate was 14.2%. The overall mortality rate for patients with Crush Syndrome was 4.6%, compared to 3.9% (19/482) in earthquake victims without Crush Syndrome (p=0.705). Notably, low systolic blood pressure at admission was the only factor significantly affecting mortality in Crush Syndrome patients (Hazard Ratio [HR]: 1.088, p=0.021, 95% Confidence Interval [CI]). CONCLUSION: Our study highlights low systolic blood pressure upon admission as a significant risk factor for increased mortality in Crush Syndrome patients. This finding may contribute to the literature by emphasizing the importance of monitoring blood pressure under rubble and administering more aggressive fluid therapy to patients with low systolic blood pressure.

Diagnostic clues in a stem cell transplant patient manifested with chronic central nervous system GVHD and IRIS.

Transplant physicians should be aware of the immune deviation-related clinical conditions as allogeneic hematopoietic stem cell transplantation is widely used for the treatment of patients with malignant and non-malignant disorders. Neurological manifestations and graft-versus-host disease (GVHD) may commonly develop in transplant recipients. However, overlapping clinical immunological conditions may lead to diagnostic challenges. Herein, we discussed the differential diagnosis of a patient with immune reconstitution inflammatory syndrome (IRIS) developing on the basis of chronic GVHD.

Anti-apoptotic and neuroprotective effects of α-lipoic acid on spinal cord ischemia-reperfusion injury in rabbits.

PURPOSE: Radical oxygen species produced after injury counteracts antioxidant activity and frequently causes severe oxidative stress for the tissues. Alpha-lipoic acid is a powerful metabolic antioxidant with immunomodulatory effects which provides neuroprotection. The aim of this study is to investigate the neuroprotective and anti-apoptotic effects of alpha-lipoic acid on spinal cord ischemia-reperfusion. METHODS: Twenty-four adult, male, New Zealand rabbits were divided into sham (n = 8), control (n = 8), and treatment groups (n = 8). The abdominal aorta was clamped for 30 min by an aneurysm clip, approximately 1 cm below the renal artery and 1 cm above the iliac bifurcation in control and treatment groups. Only laparotomy was performed in the sham group. Twenty-five cubic centimeters of saline in control group and 100 mg/kg lipoic acid were administered intraperitoneally in the treatment group after closure of the incision. The animals were killed 48 h later. Spinal cord segments between L2 and S1 were harvested for analysis. Levels of nitric oxide, glutathione, malondialdehyde, advanced oxidation protein products, and superoxide dismutase were analyzed as markers of oxidative stress and inflammation. Caspase-3 activity was analyzed to detect the effect of lipoic acid on apoptosis. RESULTS: In all measured parameters of oxidative stress, administration of lipoic acid significantly demonstrated favorable effects. Both plasma and tissue levels of nitric oxide, glutathione, malondialdehyde, and advanced oxidation protein products significantly changed in favor of antioxidant activity. There was no significant difference between the plasma superoxide dismutase levels of the groups. Histopathological evaluation of the tissues also demonstrated significant decrease in cellular degeneration and infiltration parameters after lipoic acid administration. However, lipoic acid has no effect on caspase-3 activity. CONCLUSIONS: Although further studies considering different dose regimens and time intervals are required, the results of the present study prove that alpha-lipoic acid has favorable effects on experimental spinal cord ischemia-reperfusion injury.

Radiological and histopathological comparison of microporous polysaccharide hemospheres and oxidized regenerated cellulose in the rabbit brain: a study of efficacy and safety.

AIM: Topical hemostatic agents are widely used in brain surgery but they have some disadvantages such as foreign body reaction, being a focus for infection and causing artifacts in radiological examinations. The purpose of this study is to compare the effectiveness and safety of microporous polysaccharide hemospheres (MPH) with a well known agent, oxidized regenerated cellulose (ORC), histopathologically and radiologically. MATERIAL AND METHODS: Standard brain lesions (4x1mm) were created in 24 hemispheres in 12 New-Zealand rabbits. Animals were divided into three groups; control, ORC and MPH. Twenty-four hours later, all rabbits magnetic resonance brain imaging. After imaging, the animals were sacrificed and the brains were removed for histopathological analysis. RESULTS: Histopathological analysis showed no significant difference between the groups. Radiological examination showed no significant difference between the MPH and ORC groups in terms of edema but the edema in control group was significantly prominent than MPH and ORC groups (p < 0.001). CONCLUSION: A new agent (MPH) provides safe and effective hemostasis in the brain in this study. The most important advantage of microporous polysaccharide hemospheres is their rapid clearance from the surgical field and therefore having the potential of causing less imaging artifacts.

Intracerebral tension pneumocephalus complicating endoscopic sinus surgery: case report.

BACKGROUND: Various forms of intracranial air have been described in the literature. AIM: This report aims to present clinical, radiological and intraoperative findings of a rare intracranial air entrapment case after endoscopic sinus surgery.

The role of FloSeal in reducing epidural fibrosis in a rat laminectomy model.

BACKGROUND AND PURPOSE: An increased amount of fibrosis formed after lumbar surgery may be the underlying cause of the failed back surgery syndrome in most cases. Various materials have been used to prevent epidural fibrosis, but only limited success has been achieved. In this study, the authors investigated the effect of FloSeal (a gelatine-containing thrombin-based haemostatic agent) on spinal epidural fibrosis in a rat laminectomy model. MATERIAL AND METHODS: Sixteen Wistar rats underwent laminectomy at L4 and L5 levels. In 8 rats, 0.5 mL of FloSeal was locally applied to the laminectomy site. The laminectomy site was irrigated with saline in the control group of 8 other rats. The rats were sacrificed four weeks later. Each specimen was examined for density of fibrosis, and both fibroblast and inflammatory cell density. RESULTS: Epidural fibrosis density differed significantly between the FloSeal group and the control group. Evaluation of the fibroblast density and the inflammatory cell density showed a statistically significant difference between the FloSeal group and the control group. CONCLUSION: Application of FloSeal at a laminectomy site may be useful to decrease adhesion at the interface between the dura mater and epidural fibrosis.

Neuroprotective Effects of Vigabatrin on Spinal Cord Ischemia-Reperfusion Injury.

OBJECTIVE: Spinal cord ischemia is a serious and catastrophic clinicopathologic condition. Despite studies reported over the last 20 years, alternative and efficient treatment options remain unclear. We examined the neuroprotective effects of vigabatrin on a spinal ischemia-reperfusion model. METHODS: We divided 24 New Zealand rabbits into 4 groups (control, ischemia reperfusion, and low-dose and high-dose vigabatrin). The control group underwent only abdominal surgery, whereas an abdominal aortic cross-clamp model of spinal ischemia was performed in the other groups. Clips were removed after 30 minutes and 50 and 150 mg/kg vigabatrin was administered intraperitoneally to the low-dose and high-dose groups, respectively. Neurologic examination was performed for 48 hours, after which the rabbits were sacrificed and a blood sample obtained. Biochemical examination of malondialdehyde, advanced oxidation protein products, total nitric oxide, and glutathione levels and superoxide dismutase activities in plasma and tissue sample, and histopathologic examination of the spinal cord were performed and statistical results compared between the groups. RESULTS: Low-dose vigabatrin had statistically significant effects of neuroprotection on spinal ischemia. Although high-dose vigabatrin had similar effects, the results were not statistically significant for all parameters of biochemical analysis. In addition, histopathologic examination showed some toxic effects of high-dose vigabatrin. CONCLUSIONS: Neuroprotective effects of vigabatrin are shown. For clinical use, further studies are needed.

Effect of gabapentin on primary surgical treatment of experimental sciatic nerve injury in rats.

BACKGROUND: The aim of our study is to minimize the morbidity related to nerve injury by determining the protective effects of gabapentin in experimental sciatic nerve injury and end-to-end anastomosis model in rats and to guide clinical studies on this subject. METHODS: In our study, 40 adult male Sprague-Dawley rats were randomly divided into the following five groups: I: Only surgical intervention was applied; II: The sciatic nerve was cut properly and was repaired by end-to-end anastomosis. No additional procedure was performed; III: A single dose of gabapentin at 30 mg/kg was given after anastomosis; IV: 30 mg/kg gabapentin was given for 3 days after anastomosis; and V: 30 mg/kg gabapentin was given for 7 days after anastomosis. The experiment was terminated with high-dose thiopental (50 mg/kg) 60 days after the surgical intervention. The right sciatic nerve was taken from all animals. The obtained sections were examined immunohistopathologically. RESULTS: Immunohistochemical properties and Schwann cell proliferation were found to be statistically significantly lower in the control group than in the other groups. Schwann cell proliferation was higher in Group 3 than in Group 5. Immunohistochemical changes were significantly lower in Group 4 than in Group 3. Axonal degeneration was also higher in Group 4 than in Group 3. CONCLUSION: Gabapentin promotes neurological recovery histopathologically in peripheral nerve injury due to its neuroprotective properties. Our study results show that gabapentin can be used as an adjunctive therapy to primary surgical treatment after peripheral nerve injury.

The effects of infusion of perineural pregabalin in the experimentally created sciatic nerve anastomosis in rats.

INTRODUCTION AND OBJECT: The aim of our study was to assess the effect of perineural pregabalin administration on the success of coaptation in experimental rat sciatic nerve anastomosis by measuring the expression of anti-inflammatory cytokine TGF-ß. It is thus to provide alternative solutions to this problem which we often see in clinical practice and whose results are not satisfactory. METHODS: In our study, 40 adult, male, Sprague-Dawley rats; 5 groups were randomly assigned. Group 1: This group's sciatic nerves were dissected and the surgical site was sutured. Group 2: Rats whose sciatic nerves are sectioned transversely through the full-thickness and end-to-end anastomosis is performed and no additional procedure is performed. Group 3: Intraperitoneal administration of 30 mg / kg pregabalin for 7 days with anastomosis. Group 4: 30 mg/kg pregabalin given orally for 7 days with anastomosis. Group 5: Given 10 microliters / h pregabalin subcutaneous perineural infusion for 7 days with anastomosis. After 60 days of surgery, the experiment was terminated with high dose thiopental (50 mg/kg). The right sciatic nerves of all animals were taken and sections obtained were examined immunohistopathologically. RESULTS: Inflammation was significantly less in the 5th group than in the other groups. TGF-ß expression in Groups 3, 4, and 5 is significantly higher than Groups 1 and 2, which also supports this situation. Although the expression in group 5 was not statistically significant, the number of TGF-ß expression was higher than Groups 3 and 4. In terms of immunohistochemical properties; 1 to 3, 1 to 4, 1 to 5, 2 to 5 groups were statistically significant (p <0,05). CONCLUSIONS: In conclusion, perinural infusion of pregabalin into the anastomotic region has not been previously tried in the literature and it has been found that immunohistochemistry provides positive contributions to healing of anastomosis. More research is needed to demonstrate that this effect is superior to other methods of administration of the drug. KEY WORDS: Anastomosis, Peripheral nerve, Perineural, Pregabalin, Sciatic nerve.

Brain Metastasis Of Penile Angiosarcoma.

Angiosarcoma is a rare malignancy originating from vascular endothelial cells. Brain metastasis of aniosarcomas are uncommon up to the literature. Penile angiosarcomas are also seldom among all anjiosarcomas. A case with penile angiosarcoma with confirmed brain metastasis is aimed to be reported and contribute to the literature for similar cases.

Efficacy of endovascular treatment and feasibility of stent-assisted coiling in the presence of severe and symptomatic vasospasm.

BACKGROUND AND PURPOSE: In patients with aneurysmal subarachnoid hemorrhage, deciding the optimal treatment strategy is challenging in the presence of severe and symptomatic vasospasm and the existing literature is limited. The purpose of this study was to evaluate the safety and effectiveness of endovascular treatment of intracranial aneurysms and the feasibility of stent-assisted coiling during severe and symptomatic vasospasm. MATERIALS AND METHODS: Fifteen consecutive patients with 18 aneurysms who underwent endovascular treatment during severe and symptomatic vasospasm were included in the study. Patient and aneurysm characteristics, treatment technique, and clinical and angiographic outcomes were retrospectively evaluated. RESULTS: Aneurysms were treated by the following techniques: single catheter coiling in 9, stent-assisted coiling in 8 (3 aneurysms with Y-configuration double stents), and balloon-assisted coiling in 1. All patients showed angiographic improvement of vasospasm after treatment including a noticeable dilation of the spastic parent arteries following deployment of the stents. According to the immediate post-treatment angiography results, 14 aneurysms (77.8%) had class I occlusion and 4 (22.2%) had class II occlusion. Three patients died during the course of subarachnoid hemorrhage. Mortality was related to the poor grade (Hunt and Hess grade V) and cardiovascular complications in two and refractory vasospasm one patient. The remaining patients had favorable clinical outcomes at follow-up (modified Rankin Scale 0-2). CONCLUSIONS: Endovascular treatment of intracranial aneurysms during severe and symptomatic vasospasm is safe and effective. Stent-assisted coiling in the presence of severe vasospasm is also feasible in wide-necked aneurysms with the additional benefits of mechanical vasodilation.

Safety and Efficacy of Ventriculostomy Procedures under Dual Antiplatelet Therapy in Patients Treated With Stent Assisted Coiling In Subarachnoid Hemorrhage.

AIM: Stent assisted coilling (SAC) is an alternative in the treatment of ruptured aneurysms. Stenting requires the use of dual antiplatelet agents. Hydrocephaly is a complication of subarachnoid hemorrhage (SAH) requiring ventriculostomy. Antiplatelet treatment reveal a risk of hemorrhage in ventriculostomy. Anti-aggregant effect starts at least four hours after the initial doses of treatment. However, in many studies, ventriculostomy was performed before antiplatelet treatment and the hemorrhagic complications were related to the procedure. The aim of this study was to determine the risk of ventriculostomy related hemorrhage in patients with impaired thrombocyte function and to contribute to the literature. MATERIAL AND METHODS: Between 2011 and 2016, 53 patients treated with SAC due to SAH in our clinic were retrospectively evaluated. Hemorrhagic complication risks due to antiplatelet therapy related to ventriculostomy were retrospectively evaluated Results: All of the ventricular catheter procedures were performed at least 1 day after the dual therapy (in average 4,3 days after SAC). On 5 patients 1 ventriculostomy was performed, on 2 patients 2, and on 1 patient 6 ventriculostomies were performed. Although radiological hemorrhage was present on the catheter tract in 4 patients, no temporary or permanent neruologic deficit was observed. CONCLUSION: Impaired thrombocyte functions pose a risk in ventriculostomy. Also, evaluating the risk of hemorrhage before the antiplatelet treatment reaches its full effect may lead to false results. Studies with small patient groups with antiagregant therapy and impaired thrombocyte functions also contribute to the literature. Larger studies regarding this subject are needed.

Usefulness of End-to-Side Bridging Anastomosis of Sural Nerve to Tibial Nerve: An Experimental Research.

OBJECTIVE: Repair of sensorial nerve defect is an important issue on peripheric nerve surgery. The aim of the present study was to determine the effects of sensory-motor nerve bridging on the denervated dermatomal area, in rats with sensory nerve defects, using a neural cell adhesion molecule (NCAM). METHODS: We compared the efficacy of end-to-side (ETS) coaptation of the tibial nerve for sural nerve defect repair, in 32 Sprague-Dawley rats. Rats were assigned to 1 of 4 groups: group A was the sham operated group, group B rats had sural nerves sectioned and buried in neighboring muscles, group C experienced nerve sectioning and end-to-end (ETE) anastomosis, and group D had sural nerves sectioned and ETS anastomosis was performed using atibial nerve bridge. Neurological evaluation included the skin pinch test and histological evaluation was performed by assessing NCAM expression in nerve terminals. RESULTS: Rats in the denervated group yielded negative results for the skin pinch tests, while animals in the surgical intervention groups (group C and D) demonstrated positive results. As predicted, there were no positively stained skin specimens in the denervated group (group B); however, the surgery groups demonstrated significant staining. NCAM expression was also significantly higher in the surgery groups. However, the mean NCAM values were not significantly different between group C and group D. CONCLUSION: Previous research indicates that ETE nerve repair is the gold standard for peripheral nerve defect repair. However, ETS repair is an effective alternative method in cases of sensorial nerve defect when ETE repair is not possible.

Surgical management of recurrent disc herniations with microdiscectomy and long-term results on life quality: Detailed analysis of 70 cases.

BACKGROUND: Aim of this paper is to recall the surgical technique used in the recurrent lumbar disc herniations (LDHs) and to share our experiences. MATERIALS AND METHODS: Out of series of 1115 patients who underwent operations for LDH between 2006 and 2013, 70 patients underwent re-operations, which were included in this study. During surgery, lateral decompression performed over the medial facet joint to the superior facet joint border was seen after widening the laminectomy defect, and microdiscectomy was performed. The demographic findings of the patients, their complaints in admission to hospital, the level of operation, the condition of dural injury, the first admission in the prospective analysis, and their quality of life were evaluated through the Oswestry scoring during their postoperative 1(st), 3(rd), 6(th)-month and 1(st), 3(rd), 5(th) and 7(th)-year follow-up. In the statical analysis, Friedman test was performed for the comparison of the Oswestry scores and Siegel Castellan test was used for the paired nonparametrical data. A P < 0.05 was considered statistically significant. RESULTS: Considering the Oswestry Index during the follow-ups, the values in the postoperative early period and follow-ups were seen to be significantly lower than those at the time of admission to hospital (P < 0.05). None of the patients, who re-operated by microdiscectomy, presented with iatrogenic instability in 7 years follow-up period. CONCLUSION: Microdiscectomy performed through a proper technique in the re-operation of recurrent disc herniations eases complaints and improves the quality of life. Long-term follow-ups are required for more accurate results.

Postdural puncture subdural hematoma or postdural puncture headache?: two cases report.

Spinal anesthesia is widely used for many obstetric, gynecological, orthopedic, and urological operations. Subdural hematomas may occur after trauma and are associated with high morbidity and mortality rates. Postdural puncture headache (PDPH) is a benign condition and the most frequent complication of spinal anesthesia. The high rate of headache after spinal anesthesia may mask or delay the diagnosis of subdural hematoma. The true incidence of postdural puncture subdural hematoma (PDPSH) is unknown because most affected patients are probably managed without investigation. Therefore, the true incidence of PDPSH may be greater than suggested by previous reports. The differentiation of headache associated with subdural hematoma from PDPH is crucial. We herein report two cases of bilateral subdural hematoma after epidural anesthesia and emphasize the importance of suspicion for PDPSH and careful evaluation of patients with headache after spinal anesthesia.

Why do the patients reject spinal operations? A preliminary study.

AIM: Cases of failed back and spine surgery have increased significantly recently, which leads to patient hesitation in deciding about whether to be operated on. In this article, we present a survey investigating refusal reasons for spinal surgery, and we emphasize the effect of failed back surgery. MATERIAL AND METHODS: A survey was conducted among 100 patients who were admitted to the outpatient clinic of neurosurgery at the Elazig Training and Research Hospital. All of the patients were recommended spinal surgery for various reasons, but did not want to be operated on. Demographic data for the patients, indication of the recommended surgery, the reason for the patient's refusal of the operation, information about previous neurosurgical operations and the history of dissatisfaction with the surgery of an acquaintance were recorded. The data obtained were evaluated statistically and analyzed by percentage. RESULTS: 46 patients stated they had distrust of surgery, and 54 patients did not want to be operated on for personal reasons. When the two groups were compared, neurosurgical operations and the history of dissatisfaction of the patient or an acquaintance was significantly higher in the first group (p < 0.001). It was found that 40% of all the patients (n = 40) had a past unpleasant neurosurgical experience that was either personal or relevant. CONCLUSION: Spinal surgery is a preferred subspecialty of neurosurgery. However, patients' discontent with spinal surgery has been rising gradually in recent years. An accurate indication and proper surgical technique is essential for increasing satisfaction with spinal surgery. Minimally invasive interventions must be considered if necessary. The postoperative expectations of the physician and the patient must also be carefully defined.

Spinal arteriovenous malformation: use of intraoperative color Doppler ultrasonography guidance for surgical resection. Case report.

Spinal arteriovenous malformations (AVMs) may be associated with sensory and motor deficits, bowel or bladder dysfunction, radicular pain or deficit, and back pain. Hemorrhage can occur in the parenchyma leading to the acute onset of symptoms. Neurosurgical resection is one of the way of treatment. Several techniques including intraoperative angiography, dye-injection and the micro Doppler method have proven to be useful during the surgical resection of spinal vascular lesions. Herein, we report our experience with intraoperative ultrasonography (IOUS) and color Doppler ultrasonography guidance for visualizing a spinal cord AVM during surgery. IOUS is a time-saving and noninvasive method for intraoperative imaging of spinal AVM.