The influence of stereotaxic lesions of claustrum on motor movements and behaviour in rats.

BACKGROUND: This study aimed to expand our existing information on changes in the regulation of motor movement and behaviour by investigating the effects of unilateral and bilateral lesions on the claustrum (CL). MATERIAL AND METHODS: 36 Wistar Albino adult male rats were randomly divided into six groups. An electrical lesion was created with a constant current source in the unilateral and bilateral anterior clastrum using a stereotaxic frame in rats. The lesioned groups and the control group underwent an automatic behaviour recording device such as mobilisation, freezing, eating, drinking behaviour, grooming, turning, etc. behaviour was recorded and analysed. Simultaneously, ultrasonic sounds in rats were examined with ultrasonic sound recording program. Anxiety was then reassessed with the elevated plus maze test. Data were compared with the control group. Rats were eventually sacrificed and the brain tissue was post-fixed. Histochemical examination was done and lesions' existence was confirmed. RESULTS: In this study, lesions of ventral of CL can cause increase in spontaneous behaviours such as freezing and rearing. And, it has been shown to cause a statistically significant change. In addition to the behavioural changes, right CL lesions have caused a significant increase in drinking behaviour associated with increased anxiety. All operated groups showed a significant decrease in clockwise and counterclockwise rotation movements. CONCLUSION: Experimental results show that CL lesions influence spontaneous behaviour which indicate the need for new studies to understand the role of CL in anxiety-depression.

A case of atlantoaxial dislocation associated with ipsilateral vertebral and carotid artery dissections: highlighting the injury biomechanics and management strategy.

INTRODUCTION: Traumatic cervical artery dissections carry significant morbidity and mortality among blunt trauma victims. The current paper illustrates a case with a young male who presented with atlantoaxial dislocation associated with ipsilateral carotid and vertebral artery dissections complicated by middle cerebral artery (MCA) infarction. CASE REPORT: We report a young male who presented to the emergency department with ipsilateral carotid and vertebral artery dissections complicated by middle cerebral artery (MCA) stroke associated with atlantoaxial dislocation after jumping into the water from a height. A young patient presented to us 1 year after sustaining an injury. We did posterior C1/2 fusion using the technique described by Harms and Goel to treat his atlantoaxial dislocation. The patient tolerated the surgery well and was discharged on postoperative day 4. CONCLUSIONS: We highlighted the complicated course of the simultaneously traumatic dissections of ipsilateral cervical arteries along with atlantoaxial dislocation, the biomechanics of this combination of injuries, and their management strategy.

A pediatric case of completely thrombosed giant cavernous carotid aneurysm with ipsilateral ICA occlusion mimicking an intra-axial cystic lesion: a case report and review of the literature.

INTRODUCTION: There have been a few cases where completely thrombosed cavernous carotid artery (CCA) aneurysms have resembled neoplasms based on neuroimaging data, but no reports have been documented in children. CASE REPORT: We describe an unusual pediatric case of a huge cavernous sinus mass mimicking a cystic neoplasm with peripheral rim enhancement on magnetic resonance imaging (MRI), where the surgery and subsequent histopathological investigation revealed that this mass was a completely thrombosed giant aneurysm of the CCA. The patient showed postoperatively no new neurological deficits and discharged a week later after surgery. CONCLUSIONS: In this case report, we describe a pediatric case of a completely thrombosed giant CCA aneurysm with ipsilateral internal carotid artery (ICA) occlusion, which imitates an intra-axial cystic lesion on MRI.

Maternal Serum and Fetal Cord Blood Concentrations of Thiol/ Disulfide and Ischemia-Modified Albumin as Predictors of Neural Tube Defects.

AIM: To investigate the predictive role of thiol/ disulfide homeostasis and Ischemia-modified albumin (IMA) levels for NTDs. MATERIAL AND METHODS: A total of 71 pregnant women (31 with NTD and 42 healthy controls) were enrolled in this study. This prospective case-control study included pregnant women with NTDs as the study group and randomly selected age-matched pregnant women with healthy fetuses as the control group. The two groups were compared on the basis of thiol/disulfide and IMA levels in the maternal and fetal samples. RESULTS: No statistically significant difference in native thiol, total thiol, disulfide, and calculated ratios was observed between the groups. However, maternal IMA values were significantly higher in the study group. The IMA was proven to be a predictor with a sensitivity of 77.4% and specificity of 100% for NTDs at a cut-off value of 1.32. CONCLUSION: The examination of the maternal levels of IMA may be useful in the detection of NTDs.

Craniovertebral junction aneurysms.

OBJECTIVE: The course of the vertebral artery and its relationship to the C0-1-2 structures render it particularly vulnerable to mechanical trauma. In the present study, we investigated the course of vertebral arteries along the craniovertebral junction (CJ) to cast light on the biomechanical aspects of aneurysm formation, focusing mainly on the relation of the vertebral artery injuries to the CJ bony landmarks. Herein, we report our experience with fourteen cases of craniovertebral junction vertebral artery (CJVA) aneurysms and their presentations, management, and outcomes. MATERIALS AND METHODS: We extracted from 83 vertebral artery aneurysms only those 14 cases whose aneurysms were located at the C0-1-2. We reviewed all medical records, including operative reports and radiologic images. We divided the CJVA into 5 segments and then carefully reviewed the cases, largely focusing on the CJVA segments involved in the aneurysm. Angiographic outcomes were determined by angiography, which was scheduled at 3-6 months, 1, 2.5, and 5 years postoperatively. RESULTS: A total of 14 patients with CJVA aneurysms were included in the present study. 35.7 % had cerebrovascular risk factors, while 23.5 % had other predisposing factors such as an AVM, an AVF, or a foramen magnum tumor. Predisposing factors in the form of neck trauma, both direct and indirect, were identified in 50 % of cases. The segmental distribution of aneurysms was as follows: three (21.4 %) at CJV 1, one (7.1 %) at CJV 2, four (28.6 %) at CJV 3, two (14.3 %) at CJV 4, and four (28.6 %) isolated to the CJV 5 segment. Of the 6 indirect traumatic aneurysms, 1 (16.7 %) was located at CJV 1, 4 (66.7 %) were located at CJV 3 and 1 (16.7 %) was located at CJV 5. The 1/1 direct traumatic aneurysm (100 %) from the penetrating injury was located at CJV 1. 100 % of cases with cerebrovascular risk factors, the affected vessels were on the dominant side. 42.9 % of cases presented symptoms of a vertebrobasilar stroke. All 14 aneurysms were managed only endovascularly. 85.8 % of patients we implemented flow diverters only. 57.1 % of follow-up cases were completely occluded angiographically, and 42.9 % of cases were near-completely or incompletely occluded at 1, 2.5, and 5-year follow-ups. CONCLUSIONS: The current article is the first report of a series of vertebral artery aneurysms located in CJ. Herein, the association of vertebral artery aneurysm, hemodynamics, and trauma is well established. We clarified all segments of the CJVA and showed that the segmental distribution of CJVA aneurysms significantly differs between traumatic and spontaneous cases. We showed that treatment with flow diverters should be the mainstay of CJVA aneurysm treatment.

PMMA Cranioplasty Making by Using Оpen-Source CAD Software, PLA Printers, and Silicone Rubber Molds: Technical Note with Two Illustrative Cases.

In this technical report, we discuss the design and production of polymethyl methacrylate (PMMA) implants, which we successfully applied in two patients using silicone molds, and a retrospective review of these patients at 1- and 6-month intervals. By using open-source computer-assisted design software, three-dimensional printers, and the patient's thin-sliced computed tomography data, we designed and produced the implant template and used it to make silicone rubber mоlds for intraoperative PMMA casting with good results. As a negative of the implant, we created a silicon mold, which can be autoclaved. Two patients underwent PMMA cranioplasty using this method. Both implants were fitted into the defect without manipulation and good aesthetic аppеаrance of all patients was achieved. At follow-up 1 and 6 months after the operation, no complication was noted and the patients tolerated the cranioplasty platе wеll.

The Feasibility of Creating Image-Based Patient-Specific Drill Guides for the Atlantoaxial Instabilities Using Open-Source CAD Software and Desktop 3D Printers.

OBJECTIVE: C1/2 cervical pedicle screw fixation is a well-known procedure for treating severely damaged and unstable C1/2 fractures. On the other hand, C1/C2 screw fixation is not safe and can lead to potentially disastrous consequences. The importance of personalized 3-dimensional (3D) printed navigational guides in avoiding these consequences cannot be overstated. METHODS: We retrospectively reviewed the neuroimaging data of 16 patients who had undergone fixation for treatment of C1/2 diseases. We created patient-specific C1/2 models and drill guide models using open-source 3D editing software and a desktop 3D printer. The drill guides were then placed over the respective vertebrae models and fixated with 3.5-mm screws. Following fixation, the parts were scanned with a thin-slice (01 mm) computed tomography scan, and the screw trajectories in the transverse and sagittal planes were measured at each level. RESULTS: Of the total of 62 screws, 58 were type I (93.54%), 4 were type II (6.45%), and no screws were type III. The results showed that there was no significant deviation in the screw trajectories and the accuracy of the drill guides was 93.54%. In our study, type I and type II screws were deemed acceptable, and the acceptable rates of C1/2 screw fixation were 100%. CONCLUSIONS: In this preclinical study, we demonstrated that it is possible to create patient-specific pedicle drill guides using open-source editing software and a commercially available desktop polylactic acid printer, resulting in high accuracy rates in pedicle screw placement in C1/2 patient models.

Accuracy of Axis Drill Guides in the Cases of Atlantoaxial Instabilities Associated With High-Riding Vertebral Arteries, Narrow Pedicles, and Complex Deformities: Comparison of 3 Fixation Methods.

OBJECTIVE: To contrast the accuracy of C2 navigation template-assisted versus freehand pedicle and/or pars screw fixation in high-risk cases where a high-riding vertebral artery (VA) or narrow pedicle and complex deformities were associated. METHODS: In our hospital, computed tomography (CT) data of 30 patients with pathology on C0-1-2, who had risk factors for VA injury, that were complex cervical deformities, atlantoaxial instabilities with narrow C2 pedicle and/or HRVA variations were retrospectively reviewed. Using computer-aided design software and desktop printer we printed 3 sets of high cervical models per case. We divided them into 3 groups using 3 different C2 screw fixation techniques: the freehand pars screw fixation group, the freehand pedicle screw fixation group, and the navigation template-assisted pedicle screw fixation group. After 180 screw placements were finished, the parts underwent a CT scan. Then the breach rates on postoperative scans were measured. RESULTS: Our results showed that the accurate placement rate is not noticeably different between navigation template-assisted and freehand pedicle screws, where the high-riding vertebral artery and narrow pedicles were associated, but was better in the navigational template group with complex deformities. Pars screws were found to be superior in terms of accuracy. CONCLUSIONS: The current study suggests that navigational template-assisted pedicle screws are risky for high-risk individuals with abnormal anatomy, such as those with a high-riding vertebral artery, a narrow pedicle, and complex abnormalities, and alternative C2 pars screws may be a reliable option for such individuals.

Establishment of a primary pleomorphic xanthoastrocytoma cell line: in vitro responsiveness to some chemotherapeutics.

BACKGROUND: Anaplastic pleomorphic xanthoastrocytoma is an aggressively growing, malignant, and eventually fatal tumor of the central nervous system. Testing chemotherapeutic drug sensitivity under in vitro conditions would be a useful strategy to determine sensitive or resistant drugs for fatal brain cancers. OBJECTIVE: To establish primary cell cultures of excised tumor tissue from pleomorphic xanthoastrocytoma-bearing patients and to test their sensitivity against various anticancer chemotherapy drugs. METHODS: Prepared suspensions of the excised tumor tissue from a patient who had a recurrent grade 3 pleomorphic xanthoastrocytoma was cultured in culture dishes until cells began to grow. Immunofluorescent and immunohistochemical visualizations were performed using confocal and light microscopy. MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay in comparison with ³H-thymidine incorporation assay was used to test cellular toxicity of several anticancer drugs. RESULTS: We established vigorously growing primary cells of the tumor. Drug sensitivity testing was conducted successfully. CONCLUSION: Primary cell cultures of surgically removed tumor tissues may be useful in studies of cancer biology and chemotherapeutic drug sensitivity for recurrent malignant brain tumors, particularly for anaplastic pleomorphic xanthoastrocytoma.