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.

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.

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.

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.

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.

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.

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.