Investigation of the Efficacy of Bilateral Osteoligamentous Decompression via Hemilaminectomy in Cervical Spondylotic Myelopathy: A Clinical Study.

OBJECTIVE: Cervical stability may deteriorate and kyphotic spinal deformities may develop in cervical spondylotic myelopathy (CSM) after laminectomy or laminoplasty. This study aimed to investigate the therapeutic efficacy of the "bilateral osteoligamentous decompression via unilateral hemilaminectomy approach (UHBOLD)" technique in CSM patients. METHODS: The study included 34 adult patients who underwent UHBOLD surgery for CSM between 2016 and 2022. A record was made for all patients of age, gender, number of operated levels, preoperative and postoperative long-term follow-up VAS scores, Nurick grade values and mJOA scores, kyphosis angles measured on X-ray, and spinal canal areas measured on T2-weighted MR axial images. RESULTS: Preoperative VAS scores of the patients were 6 (4-9), Nurick grade values were 3 (2-5), mJOA scores were 10.50 ± 3.42, kyphosis angles were -13.34 ± 13.69° and spinal canal areas were 87.11 ± 28.30 mm2. In postoperative long-term follow-up of these patients, VAS scores were 2 (1-5), Nurick grade values were 1 (0-5), mJOA scores were 13.94 ± 3.09, kyphosis angles were -15.07 ± 12.78° and spinal canal areas were 149.65 ± 42.57 mm2. A statistically significant difference was determined between the preoperative and the postoperative long-term follow-up VAS scores, Nurick grade values, mJOA scores, and spinal canal areas (P < 0.001). Kyphosis angles were not different (P = 0.198), and no instability was observed in any patient in long-term follow-up. CONCLUSIONS: The UHBOLD technique performed in multilevel CSM patients did not cause any change in cervical lordosis angle in long-term follow-up, did not cause cervical kyphotic deformity or cervical instability, and significantly improved Nurick grade values, and VAS and mJOA scores.

Investigation of therapeutic effects of calcium dobesilate in cerebral hypoxia/ reperfusion injury in rats.

OBJECTIVES: Cerebral stroke is a serious clinical condition in which oxidative stress, inflammation, necrosis, apoptosis, and autophagy play important roles in its pathogenesis. This study investigated the neuroprotective and healing effects of calcium dobesilate (CD) on cerebral hypoxia/reperfusion injury in rats. METHODS: Forty Wistar albino male rats, each weighing 300-350 g, were separated into the Control group (no surgery and no pharmacological agent was administered); Sham-A group (only surgery was performed); DBL-A group (surgery was performed and CD 100 mg/kg/day was administered intraperitoneally for 3 days); Sham-C group (only surgery was performed); and DBL-C group (surgery was performed and 100 mg/kg/day CD was administered intraperitoneally for 10 days). Under sedation anesthesia, the bilateral common carotid arteries of all rats except the Control group were clipped for 30 min. After 4 h, the CD was given to the relevant groups, and then, all subjects were euthanized at scheduled times. The brain of each animal was removed for histopathological (hematoxylin and eosin staining), immunohistochemical (beclin-1, anti-MHC class II and anti-CD-68 staining), and biochemical (TNF, IL-1ß, IL-6, caspase-3, GSH/GSSG, malondialdehyde, protein carbonyl, LC3II/LC3I, and beclin-1 levels) evaluations. RESULTS: It was observed that CD could reduce necrosis and mitigate polarization of microglia to the M1 phenotype, autophagy, free oxygen radicals, protein carbonylation, lipid peroxidation, IL-1ß, IL6, TNF, caspase-3, beclin-1, and LC3II/LC3I levels in acute and chronic periods of hypoxia/reperfusion injury. CONCLUSION: From these results, it was observed that CD treatment could reduce neuronal necrosis and create anti-inflammatory, anti-edema, anti-oxidant, anti-apoptotic, and anti-autophagic effects in hypoxia/reperfusion injury in rats.

Can Routine Blood Biochemistry Parameters be Predictive Prognostic Marker(s) in Operated Patients with Meningioma WHO Grade 1?

Background Today, there is a need for new and independent additional advanced markers that can predict the prognosis of meningioma patients, postoperatively. The present study aimed to find out postoperative short-term prognostic markers in patients with meningioma using their demographic data and routine blood biochemistry findings evaluated preoperatively. Methods The Glasgow Coma Scale (GCS), and Glasgow Outcome Scale (GOS) scores of the patients were recorded. Additionally, preoperatively obtained serum glucose, Creactive protein (CRP), sodium, potassium, creatinine, blood urea nitrogen, aspartate aminotransferase (AST), alanine aminotransferase, and hemoglobin level values, platelet, leukocyte, neutrophil, lymphocyte, eosinophil, basophil, andmonocyte count results, erythrocyte sedimentation rate (ESR), neutrophil-lymphocyte ratio, plateletlymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) values were evaluated. Results In the present study, 23 operated patients with meningioma World Health Organization (WHO) grade 1 (17 females, 6 males) were included. Correlation test results revealed that the GCS score, platelet count, and serum potassium level values could directly predict the short-term prognosis of these patients. Additionally, these test results suggested that the lymphocyte, monocyte, and eosinophil count values, PLR, LMR, ESR, serum glucose, CRP, and AST level values could be indirect markers in predicting the short-term prognosis. However, likelihood ratio test results revealed that only monocyte count value, LMR value, and serum CRP level value could be the markers for prediction of the short-term prognosis. Conclusion At the end of the present study, it was concluded that the monocyte count value, LMR value, and serum CRP level value could be the best markers in predicting the short-term prognosis of the operated meningioma patients.

Using of the Synthetic Dural Graft as Described in Bogota Bag Technique to Decrease the Adhesions in Decompressive Craniectomy.

AIM: To create an alternative synthetic dural graft using a parenteral solution bag made of polyvinyl chloride/polypropylene (PVC/ PP). MATERIAL AND METHODS: Twenty-two albino rats were divided into the Sham, DC and BAG groups. Except for the Sham group animals, the right parietal bone of the rats was totally drilled in a diameter of 1.0 x 0.5 mm. Then, the PVC/PP BAG was layered over the craniectomized bone of the BAG group animals. Thirty days later, all animals were sacrificed, and inflammatory processes consisting of polymorphonuclear cell infiltration, inflammation, edema, hyperemia, lymphocytosis, histiocytosis, vascular proliferation, and fibrosis were graded at the craniectomy site. RESULTS: The grade values of inflammation, edema, histiocytosis, and fibrosis were found different among the groups (p < 0.017). It was observed that placing a synthetic graft to the surgical site undergoing craniectomy could prevent fibrotic adhesions that might occur between the brain tissue and scalp in the chronic period. Furthermore, it was considered that this synthetic material did not increase inflammatory processes secondary to surgery at the surgical site and did not produce a foreign body reaction, toxicity, or infection. CONCLUSION: As a result of this study, it was argued that the synthetic material used in this study could be compatible with dermal and neural tissues and reduce adhesions at the craniectomy field. Therefore, it was considered that this material could be used as an alternative synthetic dural graft in decompressive craniectomy in human subjects after detailed toxicity studies.

Predictive diagnostic and/or prognostic biomarkers obtained from routine blood biochemistry in patients with solitary intracranial tumor.

BACKGROUND: Radiological and/or laboratory tests may be sometimes inadequate distinguishing glioblastoma from metastatic brain tumors. The aim of this study was to find possible predictive biomarkers produced from routine blood biochemistry analysis results evaluated preoperatively in each patient with solitary brain tumor in distinguishing glioblastoma from metastatic brain tumors as well as revealing short-term prognosis. METHODS: Patients admitted to neurosurgery clinic between January 2015 and September 2018 were included in this study and they were divided into GLIOMA (n=12) and METASTASIS (n=17) groups. Patients' data consisted of age, gender, Glasgow Coma Scale scores, duration of stay in hospital, Glasgow Outcome Scale (GOS) scores and histopathological examination reports, hemoglobin level, leukocyte, neutrophil, lymphocyte, monocyte, eosinophil, basophil and platelet count results, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio values, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels were evaluated preoperatively. RESULTS: The CRP levels of METASTASIS group (143.10 mg/L) were higher than those of GLIOMA group (23.90 mg/L); and it was 82% sensitive and 75% specific in distinguishing metastatic brain tumor from glioblastoma if CRP value was >55.00 mg/L. A positive correlation was determined between GOS score and hemoglobin level and between ESR and CRP values. However, GOS scores were negatively correlated with the ESR level and duration of stay in hospital. CONCLUSIONS: Study results demonstrated that CRP values could be predictive biomarker in distinguishing metastatic brain tumor from glioblastoma. In addition, ESR, CRP, hemoglobin levels and duration of stay in hospital could be prognostic biomarkers in predicting short-term prognosis of patients with solitary brain tumor.