Bowel perforation of ventriculoperitoneal shunt catheter: endoscopically treated two cases.

PURPOSE: Many techniques were used for the treatment of hydrocephalus, and ventriculoperitoneal shunt surgery is a widely used procedure. Ventriculoperitoneal shunt surgery has been associated with several complications like obstruction of the tube, infection, cerebrospinal fluid loculation, intestinal obstruction, migration of the shunt, and perforation of the intestinal organs. Perforation of the bowel owing to protrusion of ventriculoperitoneal shunt catheter from the anus is an extremely rare complication. Mini or exploratory laparotomy and revision of peritoneal part of shunt and repair of bowel perforation, or pulling out the ventriculoperitoneal shunt catheter and using external ventricular drainage and antibiotics, or colonoscopic removal of ventriculoperitoneal shunt catheter and repair of the bowel can be performed. Retrograde contamination of cerebrospinal fluid and meningitis is a very important part of the treatment in these cases. We aimed to present two cases with bowel perforation who treated with endoscopically. METHODS: We report the cases of 2 patients with transanal protrusion of VPS catheter and the management via endoscopic therapeutic options. RESULTS: Successful treatment of the patients was achieved by endoscopic removal of the catheter and endoscopic repair of the bowel perforation. CONCLUSION: If peritonitis, bowel obstruction, or abscess does not occur, endoscopic removal of shunt and bowel repairing with endoclips may be enough.

Shunt timing in meningomyelocele and clinical results: analysis of 80 cases.

PURPOSE: Meningomyelocele is a serious pathology that requires immediate surgical treatment. Its management is difficult due to accompanying other pathologies and hydrocephalus. Shunt timing is still controversial. Therefore, this study retrospectively assessed 80 patients in order to improve the shunt timing and management of patients with meningomyelocele. METHODS: A total of 80 patients were followed up for 18-48 (average, 23) months. Patients were analyzed for the following variables: delivery method and time, head circumference monitoring, shunt timing, complication rates of patients who underwent shunting, during the early or follow-up period, accompanying pathologies, size, and localization of lesion. RESULTS: Patients including 46 males and 34 females have been operated. In 40% of patients, the accompanying pathology was determined. Approximately 85% of patients had hydrocephalus, and a ventriculoperitoneal shunt was placed on 36 symptomatic and 22 patients with hydrocephalus that developed during the follow-up. Differences in shunt-related and general complications were not significant between patients who underwent shunt placement during the same session and patients who underwent shunt placement during the follow-up. However, the incidence of cerebrospinal fluid fistula formation from the wound in patients who underwent shunt placement during the same session was significantly lower than those who underwent shunt placement during follow-up. CONCLUSIONS: Immediate surgery (within the first 48 h) provides positive results, which is consistent with the existing literature. According to the logistic regression analysis, the placement of the meningomyelocele sac in the lumbosacral region is decisive in shunt insertion. Placing the shunt in the same session for patients with hydrocephalus and later for patients who developed hydrocephalus during the follow-up is recommended as a favorable treatment.

Pediatric Giant Cerebral Candida Abscess: A Case Report.

Fungal infections of the central nervous system and pediatric brain abscess are rare but serious conditions in terms of morbidity and mortality that need immediate diagnosis and treatment. It can be seen in congenital or acquired immunosuppressed patients as opportunistic infections as well as in low-birth-weight, premature infants with ventriculoperitoneal shunt, external ventricular drainage, or with a history of craniotomy. Our aim is to emphasize the giant cerebral Candida abscess of a 13-month-old female infant who previously had eight ventriculoperitoneal shunt operations due to hydrocephalus. The patient was taken to pediatric emergency care with complaints of feeding difficulty and discomfort and was hospitalized due to the detection of an intracranial mass by contrast-enhanced brain tomography. After total excision of the mass with its capsule, the patient was pathologically diagnosed with Candida abscess, and the treatment was started. The patient was discharged by the end of the 6th week.

Pediatric Traumatic Pneumorrhachis: Case Report.

The existence of air in the spinal canal is referred to as pneumorrhachis. It is classified as extradural (epidural) or intradural (subdural or subarachnoid) according to the location where it is found. Nontraumatic, traumatic, and iatrogenic causes have been attributed to its occurrence. Traumatic pneumorrhachis is very rare and rarely seen in children. In our article, a 16-year-old male child in which air formation within the spinal canal was detected after an injury by a penetrating and cutting (knife) tool is discussed. Observing air within the spinal canal due to traumatic causes is an important situation rarely seen in the pediatric age group. In general, this situation, which can be seen after multiple trauma, may be encountered following a minor trauma. The correct assessment of the radiologic imaging methods ensures not to miss the manifestation of the disease.

An extraaxially localized intrasellar giant hydatid cyst with hypophyseal insufficiency.

PURPOSE: A hydatid cyst is a parasitic illness that is caused by the larvae of Echinococcus granulosus. Hydatid cysts occur in the liver in 75% and in the lungs in 15% of cases. Central nervous system involvement is rare (perhaps as low as 1%), and the majority of such cases are observed in children. Headache and vomiting are the most frequently observed symptoms. In patients diagnosed with a hydatid cyst, imaging methods and serologic tests are very important for identifying cranial involvement. The most curative method is to remove the unruptured cyst using Dowling's method and to then wash the resulting gap with sodium chloride. METHODS: The patient was a 16-year-old female with previous occasional headaches, progressive loss of vision, and general affective disorder. RESULTS: The patient presented at the emergency department with the above-mentioned complaints. She was hospitalized for a large cystic lesion in an extraaxially intrasellar location based on computerized tomography (CT) of the brain. The cyst was excised, and medical treatment was applied. CONCLUSIONS: Hydatid cysts are rarely located in the central nervous system. Treatment involves surgical and medical interventions. In this article, we present the first published case of a giant hydatid cyst with an extraaxial intrasellar location. This is the first such case to be reported in the literature. The cyst caused somnolence, general affective disorder, panhypopituitarism, and progressive loss of vision.

Optimized high-throughput protocols for comprehensive metabolomic and lipidomic profiling of brain sample.

Establishing direct causal and functional links between genotype and phenotype requires thoroughly analyzing metabolites and lipids in systems biology. Tissue samples, which provide localized and direct information and contain unique compounds, play a significant role in objectively classifying diseases, predicting prognosis, and deciding personalized therapeutic strategies. Comprehensive metabolomic and lipidomic analyses in tissue samples need efficient sample preparation steps, optimized analysis conditions, and the integration of orthogonal analytical platforms because of the physicochemical diversities of biomolecules. Here, we propose simple, rapid, and robust high-throughput analytical protocols based on the design of experiment (DoE) strategies, with the various parameters systematically tested for comprehensively analyzing the heterogeneous brain samples. The suggested protocols present a systematically DoE-based strategy for performing the most comprehensive analysis for integrated GC-MS and LC-qTOF-MS from brain samples. The five different DoE models, including D-optimal, full factorial, fractional, and Box-Behnken, were applied to increase extraction efficiency for metabolites and lipids and optimize instrumental parameters, including sample preparation and chromatographic parameters. The superior simultaneous extraction of metabolites and lipids from brain samples was achieved by the methanol-water-dichloromethane (2:1:3, v/v/v) mixture. For GC-MS based metabolomics analysis, incubation time, temperature, and methoxyamine concentration (10 mg/mL) affected metabolite coverage significantly. For LC-qTOF-MS based metabolomics analysis, the extraction solvent (methanol-water; 2:1, v/v) and the reconstitution solvent (%0.1 FA in acetonitrile) were superior on the metabolite coverage. On the other hand, the ionic strength and column temperature were critical and significant parameters for high throughput metabolomics and lipidomics studies using LC-qTOF-MS. In conclusion, DoE-based optimization strategies for a three-in-one single-step extraction enabled rapid, comprehensive, high-throughput, and simultaneous analysis of metabolites, lipids, and even proteins from a 10 mg brain sample. Under optimized conditions, 475 lipids and 158 metabolites were identified in brain samples.

The Relationship Between Ionized Calcium Levels and Prognosis in Patients with Spontaneous Subarachnoid Hemorrhage.

BACKGROUND: The serum calcium plays a role as a cofactor in critical steps such as cardiac contractility, vascular tone, and the coagulation cascade. This study aimed to determine if the level of ionized calcium can predict outcomes in patients with spontaneous subarachnoid hemorrhage (SAH) in the emergency department. METHODS: The study was a retrospective cross-sectional case series. Patients aged 18 and over diagnosed with spontaneous SAH in the emergency department were included in the study. Patients' demographic characteristics, comorbidities, vital signs, laboratory parameters, World Federation of Neurosurgical Societies score, SAH grading according to the Fisher scale, needs of mechanical ventilation and inotropic treatment, administered treatments, complications, Rankin scores at discharge, and outcome were recorded in a standard data form. RESULTS: A total of 267 patients were studied, with a mean age of 55.5 ± 13.4 years, and 53.9% (n = 144) were female. Hydrocephalus was present in 16.5% of patients. The average hospital stay was 20.4 ± 19.8 days. Mortality rate was 34.8% (n = 93). Mortality was significantly higher in patients with low calcium levels upon admission (P = 0.024). Ionized calcium levels during complication development independently predicted mortality (OR: 0.945, 95% CI: 0.898-0.996, P = 0.034). Patients with poor neurologic outcomes (Rankin: 3-6) had significantly lower initial ionized calcium levels (P = 0.002). CONCLUSIONS: The ionized calcium level is a readily accessible blood gas parameter that assists clinicians in predicting functional independence and mortality at discharge in patients presenting to the emergency department with spontaneous SAH.

The Role of miR-26a, miR-29a and miR-448-3p in the Development of Cerebral Aneurysm.

AIM: To elucidate the role of microRNAs (miRNAs) in the development of cerebral aneurysms. MATERIAL AND METHODS: This study compared the expression levels of miR-26a, miR-29a and miR-448-3p in 50 samples each of cerebral aneurysm tissues and normal superficial temporal artery tissues. The miRNA expression levels were also compared in terms of aneurysm location and rupture status, i.e., presence or absence of rupture. RESULTS: Expression levels of miR-26a, miR-29a and miR-448-3p were increased in aneurysm tissues compared with normal vascular tissues. No significant difference was found in the miRNA expression levels with respect to aneurysm location or rupture status. CONCLUSION: This study showed that miR-26a, miR-29a and miR-448-3p overexpression could play an important role in intracranial aneurysm development independent of aneurysm location and rupture status. miR-26a, miR-29a and miR-448-3p could act as potential therapeutic targets in patients with intracranial aneurysms; however, further studies are needed on this issue.

Management and Outcome of Intracranial Dural Arteriovenous Fistulas That Have Caused a Hemorrhage in the Posterior Fossa : A Clinical Study.

OBJECTIVE: We evaluated the diagnosis, treatment, and long-term results of patients with dural arteriovenous fistula (dAVF), which is a very rare cause of posterior fossa hemorrhage. METHODS: This study included 15 patients who underwent endovascular, surgical, combined, or Gamma Knife treatments between 2012 and 2020. Demographics and clinical features, angiographic features, treatment modalities, and outcomes were analyzed. RESULTS: The mean age of the patients was 40±17 years (range, 17-68), and 68% were men (11/15). Seven of the patients (46.6%) were in the age group of 50 years and older. While the mean Glasgow coma scale was 11.5±3.9 (range, 4-15), 46.3% presented with headache and 53.7% had stupor/coma. Four patients (26.6%) had only cerebellar hematoma and headache. All dAVFs had cortical venous drainage. In 11 patients (73.3%), the fistula was located in the tentorium and was the most common localization. Three patients (20%) had transverse and sigmoid sinus localizations, while one patient (6.7%) had dAVF located in the foramen magnum. Eighteen sessions were performed on the patients during endovascular treatment. Sixteen sessions (88.8%) were performed with the transarterial (TA) route, one session (5.5%) with the transvenous (TV) route, and one session (5.5%) with the TA+TV route. Surgery was performed in two patients (14.2%). One patient (7.1%) passed away. While there were nine patients (64.2%) with a Rankin score between 0 and 2, the total closure rate was 69.2% in the first year of control angiograms. CONCLUSION: In the differential diagnosis of posterior fossa hemorrhages, the differential diagnosis of dAVFs, which is a very rare entity, should be considered, even in the middle and elderly age groups, in patients presenting with good clinical status and pure hematoma. The treatment of such patients can be done safely and effectively in a multidisciplinary manner with a good understanding of pathological vascular anatomy and appropriate endovascular treatment approaches.

A cross-sectional study analyzing the quality of YouTube videos as a source of information for COVID-19 intubation.

INTRODUCTION: There are many possible sources of medical information; however, the quality of the information varies. Poor quality or inaccurate resources may be harmful if they are trusted by providers. This study aimed to analyze the quality of coronavirus disease 2019 (COVID-19)-related intubation videos on YouTube. METHODS: The term "COVID-19 intubation" was searched on YouTube. The top 100 videos retrieved were sorted by relevance and 37 videos were included. The video demographics were recorded. The quality of the videos was analyzed using an 18-point checklist, which was designed for evaluating COVID-19 intubation. Videos were also evaluated using general video quality scores and the modified Journal of the American Medical Association score. RESULTS: The educational quality was graded as good for eight (21.6%) videos, moderate for 13 (35.1%) videos, and poor for 16 (43.2%) videos. The median safe COVID-19 intubation score (SCIS) was 11 (IQR = 5-13). The SCISs indicated that videos prepared in an intensive care unit were higher in quality than videos from other sources (p < 0.05). The length of the video was predictive of quality (area under the curve = 0.802, 95% CI = 0.658-0.945, p = 0.10). CONCLUSIONS: The quality of YouTube videos for COVID-19 intubation is substandard. Poor quality videos may provide inaccurate knowledge to viewers and potentially cause harm.

Surgical Outcomes of C1-2 Posterior Stabilization in Patients With Chiari Malformation Type 1.

STUDY DESIGN: Retrospective chart review. OBJECTIVES: Chiari malformation (CM) is characterized by a downward displacement of the cerebellar tonsils through the foramen magnum. This tonsillar herniation may sometimes be accompanied by syringomyelia and/or basilar invagination (BI). In this study, we examined the surgical outcomes of patients by underwent C1-2 reduction + fixation (C1-2RF), which is a new method defined by Goel, in the literature. METHODS: Between 2015 and 2018, 21 patients (mean age and duration of follow-up: 39 years and 20 months, respectively) with CM were treated with atlantoaxial fixation. We found syringomyelia in all patients and BI in 9 of them. In all cases, radiography, computed tomography, and magnetic resonance imaging were performed radiologically. C1-2RF was performed in all patients. Preoperative and postoperative clinical Japanese Orthopaedic Association scores were obtained. Syrinx size and cerebrospinal fluid flow rate were compared radiologically. RESULTS: All patients were treated with C1-2RF. None of the patients underwent foramen magnum decompression or intervention for the syrinx. Occipital bone and subaxial spinal structures were not included in the fixation. In addition to significant clinical improvement, significant improvement in syringomyelia and cerebrospinal fluid flow rate was seen on the radiographs of all patients. CONCLUSIONS: Although posterior fossa decompression and/or duraplasty is a common treatment modality in CM, we propose that the C1-2RF method described by Goel is a radiologically and clinically effective treatment method, whether or not BI and/or syringomyelia in CM are present. This article is the first article of central and axial atlantoaxial dislocation, except for Goel's writings in the literature.

The prognostic value of red cell distribution width for in-hospital mortality in patients with methanol poisoning.

AIM: Red blood cell distribution width (RDW) is a numerical measure of variability in the size of circulating erythrocytes and is routinely reported as a component of a complete blood count panel. It has been shown that higher RDW is associated with increased mortality and morbidity in several types of intoxication. This study was designed to evaluate the prognostic value of RDW for in-hospital mortality and need of invasive mechanical ventilation in patients with methanol poisoning. METHODS: A retrospective chart review of patients with methanol poisoning was performed using data from Adana City Training and Research Hospital obtained between January 2019 and January 2020. Patients' demographics, clinical features, the time elapsed between ingestion and presentation, the treatment applied, blood gas analysis, laboratory measures including RDW on admission, and clinical outcome were obtained. RESULTS: A total of 42 patients with methanol poisoning were included in the study with a mean age of 45 ± 11 years. The overall mortality was 21.4%. Values of RDW on admission were significantly higher in non-survivors than in survivors. The area under the receiver operating curve of RDW was 0.778 (95% CI: 0.567-0.988) for predicting in-hospital mortality and 0.762 (95% CI: 0.592-0.932) for predicting mechanical ventilator requirement. CONCLUSION: This study suggests that increased RDW on the first admission is associated with mortality and with mechanical ventilator requirement in patients with methanol poisoning.

Is C1-C2 Reduction and Fixation A Good Choice in the Treatment of Recurrent Chiari-Like Symptoms With Syringomyelia?

BACKGROUND: Foramen magnum decompression (FMD) is the first-choice treatment for Chiari malformation (CM). However, it has been suggested that cerebellar herniation and syringomyelia occur as a natural protective event to prevent neural damage caused by atlantoaxial instability. It is argued that treating instability is the main treatment. Positive results of atlantoaxial fusion have been reported in the literature, but there are no studies including the results of atlantoaxial fusion as the second treatment in patients in whom classical decompression failed. In our study, we report the results of these patients to help in the selection of treatment and we present our treatment algorithm for CM with syringomyelia. METHODS: Thirteen patients who had undergone FMD and duraplasty due to CM and syringomyelia in our clinics and who had recovered clinically and radiologically but had recurrent complaints during long-term follow-up were evaluated. C1-C2 distraction and fusion were performed. We evaluated these patients radiologically and clinically. RESULTS: The mean age of the 13 patients was found to be 32.4 years. Male to female ratio was 6:7. The complaints recurred after an average of 2.1 years. Also, 3 cases were presented with their clinical characteristics and radiologic findings. CONCLUSIONS: FMD may fail even with duraplasty, and treatment of CM in recurrent cases is still controversial. Recently, atlantoaxial instability has been reported to be the main pathology of CM, and the cure for pathology is to treat instability. Recurrent CMs with syringomyelia in which FMD has failed should be treated by atlantoaxial fixation.

The Impact of Myeloperoxidase in the Rupturing of Cerebral Aneurysms.

OBJECTIVE: In this study, we aimed to examine the effect of myeloperoxidase on aneurysm rupture in patients with cerebral aneurysms with and without rupture. METHODS: The study included 53 patients with subarachnoid hemorrhage operated on due to cerebral aneurysm in our clinic, and 49 patients without subarachnoid hemorrhage. After the operation, the domes taken from the aneurysms were embedded in paraffin blocks and scored after hematoxylin and eosin and immunohistochemical staining was carried out. RESULTS: The myeloperoxidase score was 1 in 29.4% of the patients, 2 in 40.2%, 3 in 12.7%, and 4 in 17.6%. Multiple aneurysms were detected in 24.5% of the patients. The median myeloperoxidase score was higher in patients with bleeding aneurysms than those that did not bleed (3 vs. 1; P < 0.001). In addition, the ratio of patients with a myeloperoxidase score of 2 or above was higher among patients with bleeding aneurysms. CONCLUSIONS: In our study, finding myeloperoxidase scores higher in cases of ruptured aneurysms compared with unruptured aneurysms reveals the relationship of myeloperoxidase with ruptured cerebral aneurysms.

Extracranial Metastasis of IDH-1 Wild Type Glioblastomas.

AIM: To identify the effects of different immunohistochemical features of glioblastomas with spinal metastases based on the metastatic spread and survival rate. MATERIAL AND METHODS: A total of 214 patients who were diagnosed with and operated for brain tumor in our clinic between 2007 and 2018, and pathologically diagnosed with glioblastoma were retrospectively evaluated. Among them, 141 medical records were reviewed, and 23 of them underwent spinal magnetic resonance imaging postoperatively due to various complaints. RESULTS: All patients with glioblastoma with spinal metastases had negative isocitrate dehydrogenase 1 (IDH-1) in the immunohistochemical examination. The incidence of spinal metastasis is 1.91%. The median Ki-67 index is 30 (range, 4-90; median Ki-67 index: 30+/-18.5). IDH mutation is wild in 55%, mutant in 33%, and not otherwise specified in 12%. Four patients with spinal metastasis has wild-type IDH with mean Ki-67 index of 60, and one of them was a woman (25%) and the remaining three were men (%75), with mean age of 32 years. CONCLUSION: Gliomas with high immunohistochemical proliferation indexes and wild-type IDH with poor prognostic features based on the new classification tended to metastasize to the spine in the early disease stage; therefore, early spinal scanning and radiation therapy might extend the life expectancy. High Ki-67 index and the presence of wild-type isocitrate dehydrogenase may be the predictive factors for spinal screening.

Surgical Outcomes of Subaxial Cervical Fractures in Patients with Ankylosing Spinal Disorder.

AIM: To evaluate the patient groups with ankylosing spinal disorder (ASD) in terms of patients? characteristics, applied surgical approaches, and the outcomes. MATERIAL AND METHODS: Between 2008-2019, 50 ASD patients (35?80 years) were operated on subaxial cervical fracture. The mean follow-up time was 48 months. According to the surgical approach, the patients were divided into three groups: patients who only underwent anterior fusion [AF], patients who only underwent posterior fusion [PF], and patients who underwent anteroposterior fusion [APF]. In this retrospective study, we examined the patients? files and outpatient checks to evaluate the history, operations, neurological results, and complications in cases. RESULTS: After undergoing respective surgical interventions, 1 of the 7 patients in the AF group (14%), 2 of the 18 patients in the PF group (18%), and 3 of the 25 patients in the APF group (12%) died. The postoperative American Spinal Injury Association scores were statistically better in all groups than in the preoperative scores. Among the surgical interventions, improvement in the APF group was significantly better than in other groups. CONCLUSION: Although there is a higher amount of surgery related complications in the APF group, the biomechanical and clinical results are better than the other two surgical interventions.

The Outcomes of Endoscopic Third Ventriculostomy in the Treatment of Hydrocephalus: 317 Pediatric and Adult Cases.

AIM: To evaluate the role of endoscopic third ventriculostomy (ETV) as a primary or secondary treatment for hydrocephalus and factors affecting ETV success. MATERIAL AND METHODS: Pediatric and adult patients with symptomatic hydrocephalus treated with ETV during 11 years (2008?2019) in our clinic were retrospectively evaluated. Patients were divided into primary ETV group, in which ETV was the first method of hydrocephalus treatment, and secondary ETV group, in which cerebrospinal fluid (CSF) drainage procedures were initially attempted. Statistical data analyses were performed to compare the outcomes of primary and secondary ETV groups. RESULTS: In total, 317 patients treated with ETV [140 (44%) patients aged 3?18 years and 177 (55%) aged 19?80 years] were followed-up for a mean duration of 60 months. Primary and secondary ETV groups comprised 207 and 110 patients, respectively. Further, 170 (82%) patients in the primary ETV group and fifty-nine patients (53%) in the secondary ETV group benefited from ETV. Primary ETV was associated with the highest probability of success (OR: 11.87). Increasing age (OR: 0.97) and male sex (OR: 4.719) increase the probability of achieving success. The overall prediction accuracy of the model was 72.2%. Kaplan?Meier survival analysis showed no significant difference between categorical groups in terms of time to failure (1.3 and 5 years), sex, ETV type, and categorized age (below 18 and above) (p > 0.05). Complications occurred during or after ETV in 14 patients. CONCLUSION: Unlike most studies, our study includes both adult and pediatric groups. According to the findings obtained in our study, the recovery rate was higher in the primary ETV group (82%) than in the secondary ETV group (53%). According to the model we created, our prediction rate of recovery was 72%. Primary ETV, male sex, and advanced age are important predictors of success in ETV.

Significance of Preoperative Prone Position Computed Tomography in Free Hand Subaxial Cervical Pedicular Screwing.

OBJECTIVE: The subaxial cervical pedicle screwing technique shows powerful biomechanical properties for posterior cervical fusion. When applying a pedicle screw using the freehand technique, it is essential to analyse cervical computed tomography and plan the surgery accordingly. Normal cervical computed tomography is usually performed in the supine position, whereas during surgery, the patient lies in a prone position. This fact leads us to suppose that radiological evaluations may yield misleading results. Our study aimed to investigate whether there is any superiority between preoperative preparation on computed tomography performed in the prone position and that performed in the supine position. METHODS: This study included 17 patients (132 pedicle screws) who were recently operated on with cervical vertebral computed tomography in the prone position and 17 patients (136 pedicle screws) who were operated on by conventional cervical vertebral computed tomography as the control group. The patients in both groups were compared in terms of age, gender, pathological diagnosis, screw malposition and complications. A screw malposition evaluation was made according to the Gertzbein-Robbins scale. RESULTS: No statistically significant difference was observed between the two groups regarding age, gender and pathological diagnosis. The screw malposition rate (from 11.1% to 6.9%, p<0.05), mean malposition distance (from 2.18 mm to 1.86 mm, p <0.05), and complications statistically significantly decreased in the prone position computed tomography group. CONCLUSION: Preoperative surgical planning by performing cervical vertebral computed tomography in the prone position reduces screw malposition and complications. Our surgical success increased with a simple modification that can be applied by all clinicians without creating additional radiation exposure or additional costs.

Grisel`s syndrome presenting with neck pain: an atypical case.

Grisel`s syndrome is non-traumatic inflammatory subluxation of the atlantoaxial joints presenting clinically as torticollis, neck pain, and reduced neck mobility. Several pathogens have been implicated in its etiology. Early diagnosis and treatment are vital for Grisel`s syndrome to avoid serious neurological complications. This study reports the case of a 6-year-old girl who complained of pain and curvature of the neck following an upper respiratory tract influenza infection. Notably, the patient`s neck pain and curvature worsened toward the end of her normal day for a week. This pattern is rare, but it represents an important example of Grisel`s syndrome as a condition that varies through the day.

Relationship of spontaneous subarachnoid haemorrhage and cerebral aneurysm to serum Visfatin and Nesfatin-1 levels.

OBJECTIVES: Visfatin and nesfatin are recently discovered peptides that play a role in various metabolic reactions exhibiting inflammatory and neuroprotective effects, and their levels are known to increase in cerebral ischaemia and haematomas. Inflammation plays a role in the development of aneurysm, and spontaneous subarachnoid haemorrhage (SAH) is typically caused by rupture of the aneurysmal sac because of the increased inflammation. In the present study, we investigated the relationship between serum visfatin and nesfatin levels and the clinical and radiological findings in patients with SAH. PATIENTS AND METHOD: Overall, 62 patients with spontaneous SAH who were followed-up in our clinic between September 2018 and July 2019 and 35 healthy patients who presented to our outpatient clinic with complaints of back, lumbar and neck pain were included in the study. ELISA method was used to study the visfatin and nesfatin levels in the serum samples of both groups. The visfatin and nesfatin levels of patients with spontaneous SAH were compared with the healthy population. In addition, the relationship between visfatin and nesfatin levels and the radiological and clinical findings of patients with spontaneous SAH were also investigated. All findings were evaluated statistically. RESULTS: The median nesfatin and mean visfatin levels were higher in patients with SAH compared with the control group. The median nesfatin and mean visfatin levels were higher in patients with aneurysm than those without aneurysm. A positive correlation was observed between aneurysm length and nesfatin and visfatin levels. In patients with perimesencephalic haemorrhage, the mean visfatin level was determined to be lower compared with patients with classical aneurysmatic SAH, and the median nesfatin level did not differ significantly. The cut-off value of nesfatin for predicting SAH in patients compared with controls was >598.4 with 82.8 % sensitivity and 80 % specificity (P <  0.001). The cut-off value of visfatin for predicting SAH was >10.3 with 85.3 % sensitivity and 91.4 % specificity (P <  0.001). The diagnostic performance of visfatin and nesfatin levels was similar in predicting SAH. CONCLUSION: In the present study, we demonstrated that the presence of aneurysm, size of aneurysm, number of aneurysms correlate with visfatin and nesfatin levels in patients with SAH, and visfatin and nesfatin may be biomarkers for predicting SAH and presence of aneurysm. Nonetheless, future studies can include patients with unruptured aneurysm and investigate their serum visfatin and nesfatin levels to prove whether visfatin and nesfatin can serve as biomarkers in the follow-up of these patients.