Relationship between platelet indices and red cell distribution width and short-term mortality in traumatic brain injury with 30-day mortality

SUMMARY OBJECTIVE: This study aimed at investigating whether there is a relationship between 7- or 30-day mortality and mean platelet volume, platelet distribution width, platelet count-to-total lymphocyte count ratio, or red cell distribution width in patients with traumatic brain injury. METHODS: We retrospectively analyzed intensive care unit patients with traumatic brain injury. We recorded patients' ages; genders; diagnoses; Glasgow Coma Scale scores; length of intensive care unit stay (in days); mean platelet volume, platelet distribution width, platelet count-to-total lymphocyte count ratio, and red cell distribution width values upon hospital admission; and health on the 7th and 30th days of their stays. RESULTS: We analyzed data from 110 patients. Of these, 84 (76.4%) were male and 26 (23.6%) were female. On the 7- and 30-day mortality evaluations, compared to the living patients, the deceased patients had a significantly higher median age and a significantly lower median Glasgow Coma Scale. Thus, increased age and lower Glasgow Coma Scale scores were associated with increased 7- and 30-day mortality rates. mean platelet volume and platelet distribution width values were similar in living and deceased patients. platelet count-to-total lymphocyte count ratio values were lower in deceased patients, but this difference was not statistically significant. Within 30 days after traumatic brain injury, deceased patients' red cell distribution width values were significantly elevated in deceased patients compared to those of living patients. CONCLUSION: Mean platelet volume, platelet distribution width, and platelet count-to-total lymphocyte count ratio values were not associated with 7- and 30-day mortality, whereas only elevated red cell distribution width was associated with 30-day mortality.

Surgical Treatment of Far Lateral Lumbar Disc Herniation: Outcomes of the Safe and Simple Midline Approach.

Objective Surgery for far lateral lumbar disc herniation (FLLDH) hernias is different than surgery for median and paramedian disc hernias. Our study offers a minimally invasive surgical technic for far lateral disc herniations. Methods The results of the midline surgical approach in 18 patients diagnosed with FLLDH were evaluated retrospectively. Results A total of 18 patients (7 females, 11 males), with a mean age of 57.9±9.4 years (range: 35-71 years), were included in the analyses. Three patients (16.7%) had lesions at the left L3-L4 level, six patients (33.3%) on the left L4-L5 level, five patients (27.8%) on the right L3-L4 level, and four patients (22.2%) on the right L4-L5 level. All patients had low back and leg pain. These complaints completely regressed after surgery. Conclusion This study presents a review of a consecutive series of patients who underwent minimally invasive surgery for FLLDH using a midline approach.

Antiangiogenic Molecules Suppressed Meningioma-Induced Neovascularization: A Corneal Angiogenesis Study.

AIM: To investigate the angiogenic effects of bevacizumab and imatinib on different meningioma tissue grades. MATERIAL AND METHODS: In this study, in silico analysis of angiogenesis-related gene expression was carried out using previously reported datasets. Messenger ribonucleic acid expressions of VEGFA, VEGFB, PDGFRA, and PDGFRB genes were obtained from two different meningioma transcriptome datasets. The effect of antiangiogenic drugs, bevacizumab and imatinib, on meningiomainduced vascularization was assessed by using rat corneal angiogenesis assay (CAA). RESULTS: Bevacizumab and imatinib both significantly reduced meningioma-induced neovascularization in the CAA model. CONCLUSION: The angiogenic characteristics of meningiomas may be suppressed by using antiangiogenic drugs to prevent neovascularization, thus improving prognosis.

Measuring the shape and dimensions of normal the bony structures in the craniovertebral junction from computed tomography images of the pediatric age group.

BACKGROUND: The aim of this study is to contribute to the literature by determining the morphometric reference values of the bony structures in the craniovertebral junction (CVJ) from computer tomography (CT) images of the pediatric age group. METHODS: In this study, CT's of 151 simple trauma patients aged between 3 and 15 years between 2016 and 2020 were evaluated. All CT examinations were performed using a 32-slice CT and included images of the skull base and C1-C2 junction. A total of 10 measurements were obtained from these images, including Wachenheim clivus canal angle (WCA), Welcher basal angle (WBA), Cran-iocervical tilt angle (CCT), power ratio (PR), Atlantodens interval, McRae Line (MRL), McRae - Dens distance, basion-dens interval (BDI), basion-axis interval (BAI), and atlantooccipital measurement (AOM). RESULTS: In comparison between gender groups, MRL (p=0.011) and AOM (p<0.001) measurements were found to be significantly higher in males. McRae-Dens distance, BDI, and AOM were significantly higher in patients aged 3-9 years (respectively, p=0005, p=0.003, p<0.001), and BAI (p=0.001) was significantly higher in patients aged 10-15 years. The McRae - Dens distance (p=0.119) was similar between patients with and without terminal ossicle in odontoid apex. But BDI of patients without terminal ossicle was significantly higher (p=0.048). All parameters, except the WCA, WBA, CCT, and PR, were statistically significantly correlated with the patient age (respectively, p=0.21, p=0.13, p=0.70, p=0.99). CONCLUSION: In this study, the morphometric reference values of the bone structures at the CVJ were determined from the CT images of the pediatric age group.

In vivo effect of pregnancy on angiogenesis potential of arteriovenous malformation tissue samples: an experimental study.

BACKGROUND: Increased angiogenic potential of cerebrovascular malformations during pregnancy may help to explain the complications of arteriovenous malformations (AVMs) in this group of patients. This experimental study investigated the effect of pregnancy on angiogenic activity of implanted AVM tissue samples. METHODS: A subject group of 10 pregnant rats and 10 non-pregnant rats as controls were used. Surgical AVM resection samples were implanted into the micropocket created in both eyes of each animal. Vascular development was assessed by vessel count throughout the study period. In addition, immunohistochemical studies were done for vascular endothelial growth factor (VEGF), platelet derived growth factor (PDGF), and their receptors (VEGFR, PDGFR). RESULTS: Statistically significant increase in the number of vessels was found in both groups (P<0.0001); however, the increase in the pregnant group was greater (P=0.0032). The difference between the two groups was evident at the 25th day of the experiment. Despite both groups showed increased level, there was no difference with the level of VEGF, VEGF receptor, PDGF, or PDGF receptor (P>0.05 for all comparisons). CONCLUSIONS: Findings of this study suggest that angiogenic activity of AVM tissues may increase during late pregnancy, hence physicians should inform pregnant patients with AVM of the potential risk.

Comparison of Anterior Cervical Discectomy Fusion Techniques: Bladed and Non Bladed PEEK Cages.

AIM: The aim of this study is to compare the different types of fusion materials known as PEEK cages used during anterior cervical discectomy (ACD) surgery. MATERIAL AND METHODS: A total of 67 patients were operated and evaluated retrospectively under two groups (group A: 35 PEEK cage patients, group B: 32 bladed PEEK cage patients) between 2009 and 2013. Preoperative and postoperative (postoperative first day, postoperative 1st, 3rd and 12-24th mo) images were obtained. The cervical disc heights, cervical and segmental lordotic angles of the operated levels were calculated. Pain assessment was performed and fusion rates were also compared. Mann-Whitney U test was applied to compare the outcomes. RESULTS: The pain scores (especially for arm pain) were decreased significantly in both groups after surgery regardless of the type of operation technique (P < 0.05). There were no significant differences between both groups at the disc height measurements of operated levels in postoperative periods (P > 0.05). In addition to these; there was no significant difference between both groups of segmental and cervical lordodic angles in postoperative periods (P > 0.05). There was no statistically significant difference between the fusion rates and pain scores of both groups (P > 0.05). CONCLUSION: The PEEK cage and bladed PEEK cages can be used safely to obtain fusion after ACD.

Effect of Using High-Speed Drill in Anterior Cervical Discectomy and Fusion.

AIM: The objective of this study was to investigate the effect of using 2 different surgical techniques (curette or high-speed drill) in anterior cervical discectomy surgery on the healing of cases. MATERIAL AND METHODS: Fifty-four operated cervical disc hernia cases were retrospectively examined in 2 groups. Discectomy and osteophytectomy were carried out in Group A by using a high-speed drill, while a curette was used for group B. Preoperative and postoperative computerized tomography and direct radiography were performed. Cervical disc height, cervical and segmental lordotic angles were calculated. The visual analogue scale and Odom's criteria were used in the assessment of pain and clinical healing. The fusion ratio of both groups was compared. The Mann-Whitney U test was used to compare data from the groups. RESULTS: Satisfactory results were obtained in the groups where high-speed drill and curette were used. Independently from the surgical technique, pain scores were significantly reduced in both groups after surgery. No radiologically significant differences were identified between the two groups within the postoperative period. CONCLUSION: Either high-speed drill or curette can be chosen for the osteophytectomy and discectomy stages of anterior cervical discectomy operations.

Thoracolumbar burst fractures requiring instrumented fusion: Should reducted bone fragments be removed? A retrospective study.

BACKGROUND: Thoracolumbar burst fractures are common clinical entity encountered in neurosurgical practice, accounting for 10-20% of all spinal fractures. Clinical picture could be devastating due to severe neurological deficits which lead the patients dependent both socially and emotionally. MATERIALS AND METHODS: This study compared two groups of patients who were operated because of thoracolumbar burst fracture secondary to spinal trauma in terms of neurologic deficits, degree of improvement, and radiologic measurements at one-year follow-up. The first group (group I) included the patients who underwent posterior total laminectomy, peroperative reduction of intracanal bone fragments, and posterior spinal instrumentation and the second group (group II) included the patients who underwent total laminectomy, and spinal instrumentation without reduction of free bone fragments. RESULTS: Neither group showed significant correlation with any measurement parameter. Radiological assessments and clinical improvements did not disclosed significant difference between the two groups at one-year follow-up. CONCLUSION: Retropulsion of free bone fragments extend the time of surgery and causes complications. This study found that there is no need to retropulse the bone fragments in the spinal canal in patients with unstable burst fractures who underwent total laminectomy and posterior long segment stabilization.

Intraoperative antepulsion of a posterior lumbar interbody fusion cage: three case reports.

Spinal fusion surgery techniques develop together with technologic advancements. New complications are seen as the result of new techniques and these may be very severe due to spinal cord and vascular structures in the lumbar region. The posterior lumbar interbody fusion cage (PLIFC) was shown to enhance spinal fusion and to prevent pseudoarthrosis due to its basic dynamic characteristics. PLIFC migrations are usually observed during the postoperative period, just after the mobilization of the patient and usually toward spinal canal. Migration to the retroperitoneal region is a extremely rare condition in the literature. In this article we discussed three cases of PLIFC antepulsion into the retroperitoneal region during the intraoperative period.

Retrospective, Demographic, and Clinical Investigation of the Causes of Postoperative Infection in Patients With Lumbar Spinal Stenosis Who Underwent Posterior Stabilization.

Owing to the increasing population of elderly patients, a large number of patients with degenerative spondylosis are currently being surgically treated. Although basic measures for decreasing postoperative surgical infections (PSIs) are considered, it still remains among the leading causes of morbidity and mortality. The aim of this retrospective analysis is to present possible causes leading to PSI in patients who underwent surgery for lumbar degenerative spondylosis and highlight how it can be avoided to decrease morbidity and mortality. The study included 540 patients who underwent posterior stabilization due to degenerative lumbar stenosis between January 2013 and January 2014. The data before and after surgery was retrieved from the hospital charts. Patients with degenerative lumbar stenosis who were operated upon in this study had >2 levels of laminectomy and facetectomy. For this reason, posterior stabilization was performed for all the patients included in this study. Determining the causes of postoperative infection (PI) following spinal surgeries performed with instrumentation is a struggle. Seventeen different parameters that may be related to PI were evaluated in this study. The presence of systemic diseases, unknown glove perforations, and perioperative blood transfusions were among the parameters that increased the prevalence of PI. Alternatively, prolene sutures, double-layered gloves, and the use of rifampicin Sv (RIS) decreased the incidence of PI. Although the presence of systemic diseases, unnoticed glove perforations, and perioperative blood transfusions increased PIs, prolene suture material, double-layered gloves, and the use of RIS decreased PIs.

The Supraorbital Keyhole Approach.

AIM: The major aim of the present anatomical study was to demonstrate the anatomical structures that can be visualized using the supraorbital keyhole approach, both endoscopically and microscopically, from an eyebrow incision to intracranial structures. Furthermore, it defines an optimal craniotomy for surgery. METHODS: Fine dissection was performed on each side of 5 formalin-fixed adult cadavers according to the surgical procedures of the supraorbital keyhole approach, and each step was documented both endoscopically and microscopically. Furthermore, the distance between the superior temporal line and the supraorbital notch/foramen was measured from the 10 total sides of the 5 cadavers and from the 118 sides of the 59 autopsies. RESULTS: Tumors and aneurysms of the anterior cranial fossa can be visualized during the supraorbital keyhole approach. The average distance between the superior temporal line and the supraorbital notch/foramen was measured. The distance obtained from the autopsies on the 25 females was 31.56 ±â€Š4.03  mm on the right side and 31.04 ±â€Š5.40  mm on the left side. The average distance obtained from the autopsies on the 34 males was 34.00 ±â€Š4.59  mm on the right side and 33.59 ±â€Š5.41  mm on the left side. There was no statistically significant difference between right and left in the female and male autopsies or between sexes. CONCLUSIONS: This anatomical study showed that structures in the anterior and middle cranial fossa can be reached via the supraorbital keyhole craniotomy approach with minimal brain retraction and adequate exposure and with minimal craniotomy size.

Thoracic extraosseous epidural cavernous hemangioma.

Cavernous hemangiomas were first reported in 1929 by Globus and Doshay, and are defined as benign vascular structures developed between the neural tissues occurring in the central nervous system, consisting of a dilated vascular bed. Cavernous hemangiomas comprise nearly 5-12% of all spinal vascular malformations; however, existence in the epidural space without bone involvement is rare. Only 4% of all cavernous hemangiomas (0.22/1.000.000) are purely epidural cavernous hemangiomas. In this case report, we removed a hemorrhagic thoracic mass presenting with progressive neurological deficits in a 55-year-old male patient. We found this case to be appropriate for presentation due to the rare occurrence of this type of cavernous hemangioma.

Anatomy of the spinal dorsal root entry zone: its clinical significance.

BACKGROUND: The posterolateral sulcus (PLS) is an important surgical landmark, especially for DREZ (dorsal root entry zone) operations. METHODS: The present study aimed to show the variations of the PLS using human spinal cord histological sections and report the variability in the number of dorsal rootlets of the spinal nerves in each the spinal cord segment. Further, measure the height and width of the dorsal horn on histological sections for cervical, thoracic, and lumbar levels. RESULTS: The results of the present study showed various patterns of PLS 1.clearly present PLS, 2. short PLS, 3. absent PLS or 4. irregular PLS. Height and width measurements of the dorsal horn showed that the average width was greatest at lower cervical (0.48 ± 0.04 mm) and least at lower thoracic levels (0.41 ± 0.04 mm), whereas the average height was greatest at upper cervical (3.0 ± 0.06 mm) and smallest at lower lumbar levels (1.8 ± 0.08 mm). The average number of rootlets varied considerably, at cervical level it was 7.6 ± 1.4 mm, at thoracic 6.6 ± 0.8 mm and at lumbar 6.1 ± 0.4 mm. CONCLUSIONS: The detailed anatomy of the variations of the PLS and the average number of rootlets at each spinal level can increase the success of regional surgery. Further, fine measurements on histological sections can give detailed knowledge on the size necessary for lesioning in DREZ operations.

Accuracy of fluoroscopically-assisted pedicle screw placement: analysis of 1,218 screws in 198 patients.

BACKGROUND CONTEXT: We retrospectively analyzed a total of 1,218 pedicle screws for accuracy, with postoperative computed tomography (CT), in 198 patients who were operated on between March 2004 and September 2012. PURPOSE: To determine the incidence of screw misplacement in patients who received a transpedicular screw fixation, with intraoperative fluoroscopy in the lateral and lateral with anteroposterior (AP) positions. The results are compared between the two groups. STUDY DESIGN: Retrospective comparative study of accuracy of pedicle screw placement in thoracic and lumbar spine. PATIENT SAMPLE: The sample consists of 198 consecutive patients who underwent transpedicular screw fixation. OUTCOME MEASURES: Accuracy of screw placement was evaluated by postoperative CT scan. Misplacement was defined in cases where more than 25% of the screw size was residing outside the pedicle. METHODS: The indications for hardware placement, radiologic studies, patient demographics, and reoperation rates were recorded. Five hundred twenty-eight screws (Group A, n=81) were inserted into the vertebral body with the assistance of lateral fluoroscopy only, whereas 690 screws (Group B, n=117) were inserted with the assistance of lateral fluoroscopy, and the final positions of the screws were checked with AP fluoroscopy. RESULTS: A total of 1,218 screws were analyzed, with 962 screws placed at the lumbosacral region and 256 screws at the thoracic region. According to the postoperative CT scan, 27 screws (2.2%) were identified as breaching the pedicle. Nineteen of them (3.6%) were in Group A, whereas 8 (1.16%) were in Group B. The rate of pedicle breaches was significantly different between Group A and B (p=.0052). In Group A, the lateral violation of the pedicle was seen in 10 screws (1.9%), whereas medial violation was seen in 9 screws (1.7%). In Group B, the lateral violation of the pedicle was seen in six screws (0.87%), whereas medial violation was seen in two screws (0.29%). The medial and lateral penetration of screws were significantly different between Groups A and B (p<.05). A pedicle breach occurred in 21 patients, and 15 of them underwent a revision surgery to correct the misplaced screw. Of these patients, 11 (13.6%) were in Group A, and 4 (3.4%) were in Group B (p=.0335). CONCLUSIONS: In this study, we evaluated and clarified the diagnostic value of intraoperative fluoroscopy in both the lateral and AP imaging that have not yet been evaluated in any comparative study. We concluded that the intraoperative use of fluoroscopy, especially in the AP position, significantly decreases the risk of screw misplacement and the results are comparable with other advanced techniques.

Determining the morphometry and variations of the confluens sinuum and related structures via a silicone painting technique on autopsy patients.

In this study, we aimed to investigate the morphometric and morphologic structures of the confluens sinuum (CS) and related structures with a silicone painting technique. We studied 30 cadavers. Twelve of them were washed with alcohol and filled with a silicone painting technique via the vena jugularis interna, internal carotid artery, and vertebral artery. The other 18 were autopsied postmortem. The CS and related structures were dissected under microscope. Their anatomy was investigated, and variations were noted. The diameters of the sinus sagittalis superior (SSS), CS, occipital sinus (OS), sinus rectus (SR), and bilateral transverse sinus (TS), and the angle between SSS and SR were measured. The mean diameters were 11.7 mm for SSS, 22.3 mm for CS, 5.25 mm for OS, 7.5 mm for SR, and 9.7 (right) and 9.1 mm (left) for TS. The angle between the SR and SSS was 58°. There was no difference in the bilateral venous structures that drained to the SSS and TS. There was an extra drainage to the CS from the left side in 4 cases. The right TS was located superiorly in 7 cases compared with the left TS, and this process was correlated with the type of CS. A septum in the SSS was detected in 2 cases. In addition, we encountered an OS in 80% of the cases. We conclude that the septum inside the CS affects the dominancy of the TS, the angle between the SSS and SR, and the other venous variations.

Symptomatic pneumorrhachis.

Pneumorrhachis (PR) is the presence of air within the spinal canal, whether localized in the epidural or in the subarachnoid space. Evidence of intraspinal air, especially in the subarachnoid space, had been thought to be merely a radiological artifact of serious underlying pathology until it was proven that PRs can be related to neurologic symptoms ranging from radicular pain to serious neurologic deficits. The etiologies, pathomechanisms, and natural courses show differences from case to case, with the result that no consistent treatment strategies exist in the literature. Although the conservative treatment modalities seem to be more appropriate in nonsymptomatic cases, treatment strategies in symptomatic cases remain the subject of discussion. In this study, we present two symptomatic cases of PR arising from different causes and review the literature, focusing especially on the symptomatic cases and strategies for treating them.

A variation of the cords of the brachial plexus on the right and a communication between the musculocutaneous and median nerves on the left upper limb: a unique case.

During routine anatomical dissection of the upper extremity of a 64-year-old cadaver for educational purposes, we observed variations in the brachial plexus on each side. On the right an anomaly of cord formation was present and on the left there was a communication between the musculocutaneous nerve (MCN) and median nerve (MN). On the right side the brachial plexus showed two trunks, superior (C5 and C6) and inferior (C7, C8, and T1); the middle trunk was absent. The superior trunk bifurcated into anterior and posterior divisions, the anterior division continued as the lateral cord forming the MCN. The posterior division gave off the subscapular branch. The inferior trunk trifurcated into radial, median, and ulnar nerves. The radial nerve gave off the axillary and thoracodorsal nerves. The ulnar nerve gave off the median cutaneous nerves of the arm and forearm. The median nerve received a small ascending branch from the MCN. On the right side, there was a communicating branch from the MCN to the MN in the lower third of the arm region. This communicating branch also gave rise to a muscular branch to the brachialis muscle and the lateral cutaneous nerve of forearm. No additional heads of the biceps brachii muscle were observed in either upper limb. Knowledge of the variations of the brachial plexus in humans can be valuable for operations of the shoulder joint and its repair for providing an effective block or treatment for anesthetists and also for explaining otherwise incomprehensible clinical signs for neurologists.

A unique case of intradural communicating branches between the accessory nerve and the dorsal roots of the cervical spinal nerves.

OBJECTIVE: The accessory nerve has cranial and spinal roots. The cranial roots emerge from the medulla, whereas the spinal roots arise from motor cells within the ventral horn of C1-C7 segments of the spinal cord. Communications have been described between the spinal accessory nerve rootlets and the dorsal rootlets of cervical spinal nerves. In the present case, we report a communication that has not been reported before and discuss the functional anatomy. MATERIALS AND METHODS: During the dissection of the craniovertebral junction of a 67-year-old formalin-fixed adult male cadaver, a connection between the spinal accessory nerve rootlets and the dorsal rootlets of the cervical spinal nerves was observed. RESULTS: A communication between the spinal rootlets of the accessory nerve and the dorsal roots of cervical spinal nerves was present on the right and left side. On the right, a communication between the accessory nerve spinal rootlet and the dorsal rootlet of the fourth cervical spinal nerve existed. On the left, there were two branches from the lowest accessory nerve spinal rootlet, one run ventrally and the other dorsally to the spinal rootlet and reached the dorsal root of third cervical spinal nerve. The dorsal root of C1 did not exist on either the right or the left side. Further, an unusual spinal accessory nerve formation was also observed. DISCUSSION: This case does not fit into any of the previously described classifications in the literature. Therefore, the different variations concerning the communications between the spinal rootlets of the accessory nerve and the cervical spinal nerves should be kept in mind during both surgical, especially radical neck dissections, and nonsurgical evaluations.