Diagnostic Efficacy of Posterior Epidural Fat Interposition on Magnetic Resonance T1-Weighted Sequence in the Diagnosis of Spondylolysis.

OBJECTIVE: Supportive radiologic signs may be needed to diagnose spondylolysis (SL) via lumbar magnetic resonance imaging (MRI). In SL, the slight displacement of the corpus forward and lamina posteriorly can cause the interposition of posterior epidural fat (EFI), which is normally segmental. This study aimed to determine the diagnostic value of EFI, an indirect sign of SL, on lumbar mid-sagittal T1-weighted MRI. METHODS: The lumbar MRI of 115 randomly selected patients with SL and degenerative disc disease (DDD) was randomized and assessed for the presence or absence of EFI by 2 masked observers. These observers were not permitted to examine the pars region. Interobserver agreement was tested using Cohen's kappa coefficient. RESULTS: EFI was positive in 98 (85%) of 115 patients with SL, 14 (12%) in the DDD group, and 6 (5%) with an upper vertebral level adjacent to the SL. The difference was statistically significant (P < 0.01). In patients with SL, the EFI positivity rate was highest at lumbar 5 vertebrae (94%) and lowest at lumbar 3 vertebrae (33%). The specificity, sensitivity, positive predictive value, negative predictive value, and accuracy of EFI in diagnosing SL were mean 64%, 97%, 80%, 97%, and 95%, respectively. The highest diagnostic value of EFI was at the lumbar 5 vertebrae level, where intraobserver and interobserver reliability were nearly perfect. CONCLUSIONS: EFI is an indirect radiological finding with high reliability in diagnosing SL with mid-sagittal T1-weighted images in lumbar MRI.

Neurodegeneration: Effects of calorie restriction on the brain sirtuin protein levels.

BACKGROUND: Calorie restriction (CR) is suggested to activate protective mechanisms in neurodegenerative diseases (NDDs). Despite existing literature highlighting the protective role of Sirtuin (SIRT) proteins against age-related neurodegeneration (ND), no study has explored the total levels of SIRT 1, 3, and 6 proteins simultaneously in brain homogenates by ELISA following intermittent calorie restriction. Applying CR protocols in mice to induce stress, we aimed to determine whether ND would be more pronounced with ad libitum (AL) or with CR. METHODS: Mice were randomly assigned to ad libitum (AL), Chronic CR (CCR), or Intermittent CR (ICR) groups at 10 weeks of baseline age (BL). SIRT 1, 3, and 6 protein levels were measured in the homogenized whole-brain supernatants of 49/50 weeks old mice by the ELISA method. Neuronal morphology was evaluated by the cresyl violet on the hippocampus. Neurodegeneration (ND) was assessed by the fluoro-jade and ImageJ was used for quantifications. RESULTS: In the ICR group, SIRT1 levels were elevated compared to both the AL and BL groups. Similarly, the CCR group exhibited higher SIRT1 values compared to the AL and BL groups. While SIRT3 levels were higher in both the ICR and CCR groups compared to the AL and BL groups, this disparity did not reach statistical significance. SIRT6 levels were also higher in the ICR group compared to both the BL and AL groups, with the CCR group showing higher values compared to the BL and AL groups as well. Image quantification demonstrated significant neurodegeneration in the AL group compared to the CCR and ICR group, with no observed alterations in nerve cell morphology and number. CONCLUSION: This study revealed that the levels of SIRT 1, SIRT 3, and SIRT 6 in brain tissue were notably elevated, and there was less evidence of ND at the 50-week mark in groups undergoing continuous calorie restriction and intermittent calorie restriction compared to baseline and ad libitum groups. Our findings illustrate that CR promotes increased SIRT expression in the mouse brain, thereby potentially mitigating neurodegeneration.

Anatomical Parameters of Percutaneous, Minimally Invasive, Direct Intralaminar Pars Screw Fixation of Spondylolysis.

OBJECTIVE: To investigate the anatomical parameters of the ideal screw trajectory for percutaneous intralaminar screw fixation of a pars defect in lumbar spondylolysis using computed tomography scans. METHODS: Using advanced radiological software, the ideal intralaminar screw trajectory was determined. The anatomical parameters of this trajectory were analyzed using a total of 80 single-level lumbar tomography scans in patients with spondylolysis at the lumbar 4 vertebrae and lumbar 5 vertebrae levels. The ideal intralaminar screw trajectory started from the inferolateral edge of the lamina and was between the intralaminar region, pars defect, and defective pars neck and pedicle. Along this trajectory, the skin-lamina distance, intralaminar screw length, isthmic lamina length and width, defective pars neck width, lateral entry distance of the screw to the center of the spinous process, and sagittal and coronal screw application angles were analyzed. RESULTS: When comparing the lumbar 4 vertebrae and lumbar 5 vertebrae parameters, the mean skin-to-lamina distances were 11-9 cm (P = 0.000), intralaminar screw lengths 3.5-3.6 cm (P = 0.067), isthmic lamina lengths 2-2 cm (P = 0.698), mid-lamina widths 1-1 cm (P = 0.941), defective pars neck widths 1-1 cm (P = 0.674), screw lateral entry distances according to the spinous process 1-1.5 cm (P = 0.000), sagittal screw angles 45°-45° (P = 0.870), and coronal screw angles 10°-20° (P = 0.000), respectively. There were no differences based on age and gender (P < 0.05). CONCLUSIONS: Percutaneous intralaminar rigid screw fixation of a pars defect in spondylolysis provides minimally invasive, low-profile instrumentation. In spondylolysis, a screw length of 3-4 cm and a screw diameter of 4-5 mm may be sufficient for pars fixation with intralaminar screws.

Study of the neuroprotective effect of ginseng on superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels in experimental diffuse head trauma.

BACKGROUND: The purpose of our study was to investigate the effect of ginseng on antioxidant enzyme levels in brain damage following experimental diffuse head trauma in rats. The neuroprotective effect of ginseng was also studied. METHODS: In this study, rats were divided into four groups, and the rats in group 1 received no intervention. In group 2, the rats were administered 50 mg/kg ginseng, injected intraperitoneally at 1, 24 and 48 h, and the effect of ginseng on normal tissues was studied. No drugs were administered to the rats in group 3 who had previously experienced diffuse head trauma using Feeney's falling weight method. In group 4, rats underwent Feeney's falling weight method, leading to diffuse head trauma, and they were given 50 mg/kg ginseng intraperitoneally 1, 24 and 48 h after head trauma. Rats were killed 72 h after head trauma and their brain tissues extracted for histopathological and biochemical studies. RESULTS: Histopathological study of brain cross sections in the trauma group demonstrated neurons in the trauma region and surrounding area, which generally had a dark-colored eosinophilic cytoplasm and a pyknotic nucleus, while the nuclei of neurons were located peripherally. However, brain cross sections in group 4 from rats given ginseng after head trauma showed fewer neurons with eosinophilic cytoplasm, pyknotic and peripheral nuclei in the trauma region and surrounding area. No statistically significant difference in the tissue SOD level was observed; however, the GSH Px level in group 4 was significantly reduced compared to that in group 3. CONCLUSIONS: After affecting the GSH Px level and reducing histopathological scores, ginseng was found to display antioxidant and neuroprotective activity.

Clinical Results of Restoration of Pars Interarticularis Defect in Adults with Percutaneous Intralaminar Screw Fixation.

OBJECTIVE: This study aims to report the clinical outcomes associated with the percutaneous intralaminar screw repair performed for pars defects in adults. METHODS: Adult patients who got their lumbar L5 spondylolysis repaired via modified Buck's procedure between 2017 and 2020 were retrospectively evaluated. The preoperative and postoperative clinical outcomes at 1, 3, 6, and 12 months were evaluated for patients with and without fusion using the visual analog scale, Oswestry Disability Index, and the Short-Form Health Survey 36 (SF-36). At 12 months, the fusion status of all the patients was assessed using bilateral direct X-rays. RESULTS: Thirty patients with spondylolysis were identified (11 men and 19 women). All patients had bilateral L5 pars defects, and at 12 months, the fusion rate was 60% (18/30). There was no difference between the fusion and nonfusion groups in terms of their visual analog scale, Oswestry Disability Index, and SF-36 physical component summary and SF-36 mental component summary scores (P > 0.05). Within-group comparisons of the 2 groups revealed significant changes at follow-up (P < 0.05). CONCLUSIONS: Minimally invasive repair of lumbar spondylolysis with percutaneous intralaminar screw fixation restores the motion segment and can provide early resumption of physical activity with minimal muscle damage, smaller skin incision, and less soft tissue dissection.

Cervical spinal dysraphism.

OBJECTIVE: Cervical spinal dysraphism is a rare congenital spinal pathology. The results obtained from our series are compared with the results obtained from other series of studies in the literature. METHODS: Seven patients with cervical myelomeningocele and meningocele who underwent surgery between January 1996 and March 2009 at the YYU Faculty of Medicine in the Department of Neurosurgery were retrospectively studied. RESULTS: The referral ages of the patients (6 females and 1 male) varied between 4 days and 4 months (median 1 month). A stalk lesion covered with a dysplastic skin formed as a sac and located at the cervical midline was demonstrated in all of the patients. Cervical myelomeningocele was present in 4 patients, while cervical meningocele was present in 3 patients; however, Chiari type II malformation and hydrocephaly were present in 3 patients with myelomeningoceles. Diastematomyelia and a filum terminal lipoma were present in 1 of the patients. CONCLUSION: In this series, in contrast to the literature, we noted that the number of girls with spinal dysraphism with a cervical myelomeningocele and meningocele was greater than the number of boys. Chiari type II malformation, hydrocephaly and motor weakness in patients with cervical spinal dysraphism are less frequent when compared to patients with caudal spinal dysraphism. The structure of the sac is also more durable and, accordingly, a cerebrospinal fluid leakage is uncommon.

Cavernous hemangioma presenting as a giant cervical mass: a case report.

Intramuscular hemangiomas of the head and neck are rare congenital vascular tumors and are sparsely reported. Hemangiomas account for approximately 7% of benign tumors and usually present as a mass that suddenly enlarges. Hemangiomas are mostly seen on the trunk and extremities, but can also appear on the head and neck region. A10-year-old boy was referred to our clinic for puffiness and swelling on the right side of his neck. Neurological examination was normal, but we observed an advanced degree of restriction in neck movement. An MRI study showed a soft tissue mass 9 x 8 x 5 in size. The mass was totally extracted by surgical intervention and pathological analysis revealed that it was a cavernous hemangioma. The patient's neck movement returned to normal after surgery. No relapse occurred during 1-year follow-up.

Volumetric Muscle Measurements Indicate Significant Muscle Degeneration in Single-Level Disc Herniation Patients.

BACKGROUND: There is a strong relationship between lower back pain and paraspinal muscle atrophy. In this study, we aimed to investigate the prevalence of lumbar paravertebral muscle atrophy in patients with and without single-level disc herniation. METHODS: The 110 retrospectively analyzed patients in this study were divided into 2 groups. Group A included 55 patients with radiologically confirmed single-level disc herniation with back pain and radiculopathy. Group B included 55 patients with back pain without radiologic lumbar disc herniation. The paravertebral muscle cross-sectional areas were measured in both groups by 2 independent observers. RESULTS: In total, 68 women and 42 men were examined. Their mean age was 40.85 years old. The mean ages of groups A and B were 42.49 and 39.22 years, respectively. The cross-sectional areas of the multifidus muscles (MM) and erector spinae muscles were significantly greater in group B than in group A (P < 0.0001). However, there were no statistically significant differences in the psoas major cross-sectional areas, disc heights, and perpendicular distances between the MM and the laminae. CONCLUSIONS: The MM and erector spinae muscle groups are innervated by the dorsal root of the spinal nerve arising from the same level; therefore, long-term pressure on the root caused by disc herniation can cause atrophy and degeneration of that muscle group.

A craniocervical teratoma with an encephalocele-like appearance.

Teratomas are rare congenital tumors. Teratomas frequently occur in adult ovaries, but can be located primarily in the sacrococcygeal zone and intracranial compartment in newborns. Teratomas are rare in the head and neck region. Teratomas arise following a sequence of cells derived from more than one germ layer at different regions of the body due to a change in location of germ cells, and contain ectodermic, endodermic, and mesodermic tissues. Herein we detail the follow-up and treatment of a newborn with a mass that was located at the back of the head and was referred to our Neurosurgery Clinic with a pathologic diagnosis of a grade II-III immature teratoma resembling an encephalocele.

Transorbital orbitocranial penetrating injury caused by a metal bar.

Transorbital intracranial injury is uncommon, representing 0.04% of penetrating head trauma with a high mortality rate. Orbital penetrating injuries may cause severe brain injury if the cranium is entered, typically via the orbital roof, the superior orbital fissure, or the optic canal. A 13-year-old male sustained a severe brain injury due to penetration of the right orbit with an iron bar. The bar entered the inferiomedial aspect of the orbit and emerged from the left occipital bone. Neurological examination revealed deep coma (GCS: E1M2V1) with fixed, dilated, and non-reactive pupils. The bar followed an intracranial trajectory, through the third ventricle and suprasellar cistern. The patient underwent an immediate exploration with removal of the bar. Unfortunately, he died 10 days postoperatively due to severe diencephalic injury with brainstem herniation. In this case report, we discuss the radiologic diagnosis and surgical management of transorbital orbitocranial injury by foreign body penetration.

Spontaneous migration of a retained bullet within the brain: a case report.

Gunshot injury to the head is usually mortal, and spontaneous migration of a retained bullet is rare. We report the case of a 23-year-old man with a spontaneously migrated bullet within the brain. Cranial computerized tomography (CT) indicated that the bullet was lodged deeply in the left parietal region. The patient was conscious and had right homonymous hemianopsia. The bullet was close to the vital structures and deep-seated; therefore, surgical intervention was not considered. Two months after the injury, repeat CT revealed that the bullet had migrated posteriorly and caudally due to gravitational factors. Management of the retained bullet was controversial. Removal of a deep-seated bullet may cause additional neurological deficit, but migration of a retained bullet may cause damage to vital structures, producing significant neurological damage. We proposed that the bullet in the brain should be removed if it could be reasonably accessed without causing additional neurological damage.

Relationship of antioxidant enzyme activities with myelomeningocele.

AIM: To investigate the role of erythrocyte free radical scavenging enzyme activities (FRSE), carbonic anhydrase (CA) activity and malondialdehyde (MDA) in infants with myelomeningocele (MM). MATERIAL AND METHODS: We compared antioxidant enzyme activities and MDA level in 40 individuals (10 infants with MM, 10 healthy infants; and mothers of these two groups) with age-matched subjects. Erythrocyte FRSE included catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPX) and glutathione-S- transferase (GST). RESULTS: CA, CAT, SOD, GPX and GST concentrations were lower in all of the infants with MM compared to healthy infants. The mothers of infants with MM also had lower CA, CAT, SOD, GPX and GST activities than healthy mothers. It was also found out that the MDA level as a marker of oxidative damage was higher in infants with MM and their mothers than in healthy infants and their mothers. CONCLUSION: Lower FRSE activities indicate an increased frequency of MM. Free radicals (FRs) such as MDA may play a significant role in the etiology of MM.

Comparison of simultaneous shunting to delayed shunting in infants with myelomeningocele in terms of shunt infection rate.

AIM: Timing of shunt insertion in infants with myelomeningocele (MM) and hydrocephalus (HCP) has been debated. Many authors have suggested to perform the repair of MM and shunt insertion during same operation. However, there is also an opposite view. MATERIAL AND METHODS: We analyzed retrospectively 166 patients who underwent MM Sac repair to evaluate whether there are difference between these two methods in terms of shunt infection rate. RESULTS: In the same session, V-P (ventriculoperitoneal) shunt placement was performed onto 65 infants within the first 48 hours of postnatal and 36 infants were operated 48 hours after birth. In separate sessions, repair of MM were performed onto 29 infants within the first 48 hours of postnatal and shunting was peformed 7 days after sac repair. 14 infants were performed MM sac repair 48 hours after birth, then shunt was applied 7 days after closure of MM. Shunt infection rate in concurrently operated groups was markedly high (12.3 % in early surgery, 33.3% in late surgery); in separatedly operated groups' shunt infection rate was lower (3.44% in early surgery, 14.29% in late surgery). CONCLUSION: We propose to perform V-P shunt placement and MM repair in separate sessions.