Prognostic value of indoleamine 2, 3-dioxygenase-1 expression in glial tumors.

Background and purpose:

Gliomas are the most common primary malignant central nervous system tumors in adults, exhibiting a poor prognosis. Indoleamine 2, 3-dioxygenase-1 (IDO-1) has important functions in cancer immunotherapy due to its role in escaping cancer cells from the immune system. In this study we purposed to evaluate the correlation between IDO-1 expression and clinicopathological parameters in gliomas, and whether IDO-1 can be a prognostic marker.

n=75 patients in total, n=25 patients with low grade glial tumors (LGG, grade 1-2), n=25 patients with high grade glial tumors (HGG, grade 3-4), and n=25 persons with normal brain tissue as control group were included in this study. IDO-1 expression was categorized by using immunohistochemical staining in biopsy specimens as high (H) and low (L) groups among the patients with gliomas. We used a 95% percent confidence interval and p <0.05 to analyze the association between the degree of IDO-1 expression, clinicopathological characteristics, and survival rates in glioma patients. 

In HGG, IDO-1 levels were higher than in control brain tissue and LGG (p< 0.001). The mean overall survival (OS) was longer in the L-IDO-1 group (64.53 ± 3.34) in months (95% CI: 57.969-71.098) compared to the H-IDO-1 group (43.74 ± 4.36) in months, (95% CI: 35.218-52.330) (p< 0.05).

IDO-1 expression is an in­de­pendent prognostic biomarker to predict 
OS and progression in HGG. IDO-1 can be evaluated as an alternative instrument for precision medicine in the treatment of gliomas.

Safety and effectiveness of a posterior approach alone for surgical treatment of sacral-presacral tumors.

Aim: We aimed to examine the safety and effectiveness of a posterior approach alone in the surgical treatment of sacral-presacral tumors. In addition, we investigate factors that determine the selection of a posterior approach alone. Materials and Methods: Patients with sacral-presacral tumors who underwent surgery in our institution between 2007 and 2019 were examined in this study. Data regarding patient age, gender, tumor size (>6 cm and <6 cm), tumor localization (below or above S1), tumor pathology (benign or malignant), surgical approach (anterior alone, posterior alone, or combined), and extent of resection were recorded. The Spearman's correlation analyses were conducted between surgical approach and tumor size, localization, and pathology. Factors influencing the extent of resection were also examined. Results: Complete tumor resection was achieved in 18 of 20 patients. A posterior approach alone was used in 16. No strong or significant relation was detected between surgical approach and tumor size (r = 0.218; P = 0.355). There was no strong or significant relationship between surgical approach and tumor localization (r = 0.145; P = 0.541) or tumor pathology (r = 0.250; P = 0.288). Tumor size, localization, and pathology were not independent factors that determined surgical approach. The only significant independent determining factor for incomplete resection was tumor pathology (r = 0.688; P = 0.001). Conclusion: A posterior approach is safe and effective in the surgical treatment of sacral-presacral tumors independent of tumor localization, size, or pathology and is a feasible first-line treatment option.

The Effectiveness of Antibiotic-Coated Ventriculoperitoneal Shunts for Prevention of Shunt Infections in Patients with Myelomeningocele.

PURPOSE: Hydrocephalus is a common comorbidity among the newborns, with myelomeningocele (MMC) and ventriculoperitoneal (VP) shunts being frequently used for the treatment of such patients. In this study, we aimed to compare the effectiveness of antibiotic-free and antibiotic-coated shunts to reduce the rate of shunt infection in patients with hydrocephalus and accompanying MMC. METHODS: 116 patients with hydrocephalus and MMC who were treated with VP shunts were included in the study. Shunt infection rates among antibiotic-free and antibiotic-coated shunts were compared. RESULTS: Of the 116 patients included in the study, 39 had antibiotic-coated shunts and 77 had antibiotic-free shunts. Shunt infection developed in 4 of the 39 cases treated with antibiotic-coated shunts and in 5 of the 77 cases treated with shunts without antibiotics. No significant statistical difference was found between antibiotic-coated and antibiotic-free VP shunts in terms of shunt infection (p = 0.450, p > 0.05). CONCLUSION: In patients with MMC, using VP shunts containing antibiotics was found not to have a protective effect in preventing shunt infection. Whether the sac is intact or ruptured does not affect this result.

Successful technique of manual vacuum aspiration for treatment of type 2 cesarean scar pregnancies: evaluation of 40 cases.

OBJECTIVE: To demonstrate the effectiveness and safety of the defined manual vacuum aspiration (MVA) technique for treatment of type 2 cesarean scar pregnancies (CSPs). METHODS: We treated 40 patients with CSP by MVA at the Early Pregnancy Clinic of our hospital between 1 January 2012 and 31 December 2014. The files of patients were reviewed and evaluated retrospectively. Eligibility criteria were hemodynamic stability and at least 2 mm myometrial thickness at the anterior part of the CSP. The key-point of successful MVA procedure is to keep away from entering the cesarean scar cavity directly; instead, CSP is displaced from the implantation site by applying vacuum, only while the cannula is passing near. RESULTS: During the study period, the ratio of CSP to total pregnancies was 1/1000. The ratio of CSP to cesarean delivery (CD) was 1/372. In that time period, CSPs were constituted 4.41% of all ectopic pregnancies. Total of 40 patients were treated with dilatation and MVA. Complications such as excessive hemorrhage, persistence of CSP, and any need of extra intervention were not observed. The beta-hCG values of 21 patients (52.5%) decreased below 10 mIU/mL after the first 15 days, and the rest decreased below 10 mIU/mL after 3 weeks following MVA. CONCLUSIONS: This MVA technique for treatment of CSP is easily applicable and effective method with high success and low complication rates. For appropriately selected patients, we think that this method can be considered as the first- line treatment.

Cranially migrated lumbar intervertebral disc herniations: A multicenter analysis with long-term outcome.

OBJECTIVE: Risk factors of cranial migration were investigated in patients with lumbar disc herniation (LDH) that migrated in the cranial direction and the long-term outcomes are discussed in this study. MATERIALS AND METHODS: Patients who underwent surgery for LDH at four different centers between 2012 and 2017 were studied. Extraligamentous discs were located in the lateral part of the posterior longitudinal ligament (PLL) within the spinal canal of the axial plane, and subligamentous discs were located under the PLL. The extent of cranial migration was calculated as a percentage of the height of the migrated corpus. Based on the extent of cranial migration, partial hemilaminectomy or hemilaminectomy was performed at different rates in each patient and the amount of laminectomy performed was recorded. During surgery, all free fragments were attempted to be removed. The appropriate technique was decided intraoperatively, and the surgery was performed on an individual patient basis. RESULTS: Of 1289 patients who underwent surgery for LDH, 654 (50.73%) had caudal migration, 576 (44.68%) had migration at the level of the disc, and 59 (4.57%) had cranial migration. Analysis of 59 patients with cranial migration according to the localization of the disc fragment revealed that 31 had extraligamentous and 28 had subligamentous fragments (P = 0.024). CONCLUSIONS: Extraligamentous intervertebral disc fragments migrate more cranially than subligamentous intervertebral fragments. The anatomy of the PLL that varies along the corpus is the main reason for the weakness of the resistance of the disc material to the dorsolateral region, direction of discrete force vectors, and orientation of the disc fragment due to torsional vertebral movements.

Foramen Magnum Meningioma Presenting with Cough Syncope (Case Report and Review of the Literature)

Foramen magnum meningiomas cause different symptoms based on the size and the location of the tumor. They often present with involvement of the long tracts and of the lower cranial nerves.Ataxia and occipitocervical headache are other common symptoms. In the present study, we report a case of foramen magnum meningioma presenting with cough syncope. A mass lesion located anterolateral to the foramenmagnumwas detected in a 38-year-oldmanduring amagnetic resonance imaging (MRI) exam; the lesion extended from the inferior clivus to the level of the C2 vertebra. The neural axis has pushed towards posterior and contralateral side by the mass. We think that syncope occurred due to the encasement of the vertebral arteries by the tumor in addition to the compression of the neural axis. The posterolateral approach without condylar resection provides a safe surgical plane for total excision of these tumors. In our case, the tumor was totally removed and the syncope episodes were resolved.

Simpson Grade 2 Resection and Tumor Recurrence in Ventrally Located Spinal Meningiomas.

AIM: To evaluate postoperative clinical outcome and recurrence rates in cases with ventrally located spinal meningiomas who underwent Simpson grade 2 resection. MATERIAL AND METHODS: We evaluated eight cases (six females and two males; age, 28?86 years; mean age, 60 years) with ventrally located spinal meningioma that underwent surgical treatment in our clinic. The tumors were located in the thoracic region in seven cases and in the cervical region in one case. All cases underwent surgery, which was performed using a traditional posterior midline approach. Laminectomy was unilaterally extended. The case with cervically located tumor differed from the other cases in that a skull clamp was used and laminoplasty was performed. RESULTS: The tumor was completely resected in all cases. Furthermore, in all cases, the tumor nidus that caused the thickening of the dura was cauterized using bipolar cautery and peeled off (Simpson grade 2). The pathological examination of the tumor specimens revealed typical grade 1 meningioma in all cases (fibropsammomatous type, n=1; meningothelial type, n=3; and psammomatous type, n=4). Recurrence was not observed in any of the cases during the follow-up. None of the cases demonstrated postoperative neurological deterioration. At 1 month postoperatively, pain and motor deficit completely improved in all cases, with remarkable improvements of motor deficits in the early postoperative period. CONCLUSION: Simpson grade 2 resection in ventrally located spinal meningiomas results in low complication rates and is satisfactory in terms of recurrence.

Intraoperative Results and Postoperative Clinical Outcomes of Lumbar Microdiscectomy in Patients who Previously Received a Transforaminal Anterior Epidural Steroid Injection for Lumbar Radiculopathy.

AIM: To describe the intra- and postoperative results of patients who received a transforaminal anterior epidural steroid injection (TAESI) prior to lumbar microdiscectomy. MATERIAL AND METHODS: Sixty-four patients who did not improve after minimally invasive techniques (MIT) for lumbar radiculopathy were evaluated. Thirty-two of them treated with techniques other than TAESI and those receiving thrombolytic or anticoagulant drugs before microdiscectomy were excluded. We recorded the type of MIT, numbers of levels and injections, time interval between the last MIT and microdiscectomy, duration of surgery, amount of intraoperative blood loss, rate of incidental durotomy, postoperative infection, and visual analogue scale (VAS) scores for leg pain before and after microdiscectomy at 24 hours, and the 1st and 3rd months (Group 1). A total of 35 patients with no history of MIT or lumbar surgery who had undergone unilateral, single-level lumbar microdiscectomy at our clinic were randomly selected to be included in the control group (Group 2) and same parameters were recorded for the comparison of both groups. RESULTS: The mean duration of lumbar discectomy was 140 minutes, and the amount of average intraoperative blood loss was 227 cc in the study group (Group 1), and 65 minutes and 73 cc, respectively in the control group (Group 2)(p > 0.05). The comparison of VAS scores revealed that lumbar discectomy was still effective after TAESI (p=0.00). CONCLUSION: Although epidural steroid injection is an effective modality for the management of chronic pain, these patients should be informed preoperatively about the relatively long duration of surgery and the possible requirement for blood transfusion.

A comparison of the type IX collagen levels of the intervertebral disc materials in diabetic and non-diabetic patients who treated with lumbar microdiscectomy.

PURPOSE: The purpose of this study was to compare type IX collagen levels in the intervertebral disc (IVD) materials of diabetic and non-diabetic patients with lumbar disc herniation and to determine whether there is a relationship between diabetes mellitus (DM) and type IX collagen levels in degenerated discs. METHODS: Overall, 30 non-diabetic patients and 30 type II diabetic patients who underwent lumbar microdiscectomy were included in this study. All patients underwent lumbar microdiscectomy, and IVD samples were obtained during the surgery. Deparaffinization, macroscopic digestion, and staining procedures were performed immunohistochemically. Fractional area stained, staining intensity, and total staining score were graded semi-quantitatively. The results were evaluated within a 95% confidence interval, and significance was evaluated as bidirectional at 0.05 and 0.01 significance levels. RESULTS: The type IX collagen staining intensities and fractional area stained were lower in the diabetic group than those in the non-diabetic group (p = 0.001). The total immunoreactivity staining scores of type IX collagen in the diabetic group were statistically lower at higher significance levels than the total immunoreactivity staining scores of type IX collagen in the non-diabetic group (p = 0.001). The duration of DM of the patients with DM was increased, the total immunoreactivity staining score of type IX collagen was decreased (p = 0.001). CONCLUSIONS: Diabetes reduces the type IX collagen level in the intervertebral disc and the duration of diabetes is the most important factor for this reduction. Diabetes may play a role in the development of disc herniation by reducing type IX collagen levels in the intervertebral disc. However, the causes of increased herniation in diabetic patients still have to be determined.

Isolated tubal torsion: Successful preoperative diagnosis of five cases using ultrasound and management with laparoscopy.

Our aim was to evaluate the presentation and diagnostic evaluation of patients with isolated tubal torsion and to evaluate the surgical approach to these patients. We also aimed to define the ultrasonographic diagnostic criteria. Five patients with isolated tubal torsion who were admitted to our gynecology department between January 2014 and January 2017 were evaluated and included in this study. All cases were diagnosed through ultrasonographic imaging alone. The preoperative findings of the patients were similar to those described in the literature. No further imaging modality was used for diagnosis and all patients were managed with laparoscopy. The clinical findings and ultrasonographic findings were consistent with literature. It may be difficult to preoperatively diagnose isolated tubal torsion, which is a rare clinical entity. Evaluation of these patients by an experienced sonographer and knowledge of the ultrasonographic findings of isolated tubal torsion may have vital preventive measures.

The effectiveness and clinical outcomes of the Minerva cervical thoracic jacket in patients with type II odontoid fractures

Background/aim: The objective of this study was to carry out a detailed analysis and assess the outcomes for the Minerva cervical thoracic jacket (CTJ) in patients with type II odontoid fractures who could not be surgically treated. Materials and methods: Twenty-six patients for whom the Minerva CTJ was used rather than surgery for different reasons were included in the study. All patients were fitted with the Minerva CTJ within the first 24 h following diagnosis. The patients were followed 4 weeks after hospital discharge and then at 2-week intervals. Results were considered significant at P < 0.05 and a 95% confidence interval was calculated. Results: Of the 26 patients, 17 were male and 9 were female. The mean age was 49.03 years old (range: 16?86 years old). Fusion occurred in 25 of the 26 patients (P = 0.004), and the mean time to fusion was 6.8 weeks (P = 0.002). The mean length of hospital stay was 4 days and the mean follow-up period was 7.3 weeks. None of the patients had any complications due to the Minerva CTJ and the mortality rate was 0%. Conclusions: The Minerva CTJ application was a safe and cheap technique in the management of type II odontoid fractures. It had a high fusion rate and no complications.

Effect of radiation on brain tissue endothelin-1 level and tumor development.

BACKGROUND: Radiotherapy causes injury in the endothelial cells of blood vessels and the production of vasoactive amines such as endothelin-1 (ET-1). ET-1 is an important peptide in cancer development. In this study, the effects of radiation on brain tissue ET-1 level were evaluated. Is it possible to suggest a mechanism using ET-1 level in the production of this adverse effect? In this paper, the relationship between the development of brain tumors and the ET-1 level has been discussed. MATERIALS AND METHODS: Twenty-eight adult Sprague Dawley rats were used in the experiments. The rats were divided into four groups (n = 7) as follows: control group: radiation was not applied during the experiment; Group 1: Decapitated on the 1st day following radiation; Group 2: Decapitated on the 7th day following radiation; and Group 3: Decapitated on the 30th day following radiation. ET-1 levels were measured with enzyme-linked immunosorbent assay (ELISA) method. The t-test, variance analysis, and Tukey honestly significant difference (HSD) tests were used in the statistical analysis. A value of P < 0.05 was accepted as significant. RESULTS: No statistical differences were observed in the tissue ET-1 levels between the control group and other groups. According to the variance analysis and Tukey test, the differences between the groups were not significant. CONCLUSION: We observed in this study that the effects of radiation on brain tumor development or malignant transformation are not mediated by ET-1 levels. In addition, these results support the hypothesis of the fact that medical treatment with ET-1 antagonists in clinical cases receiving radiotheraphy is unnecessary.

Morphological Changes of Anterior Cerebral Artery (ACA) in Hydrocephalic Pediatric Patients.

OBJECTIVE: The morphology of anterior cerebral artery (ACA) in patients with hydrocephalus (HCP) was analyzed, and its importance was discussed in maintaining cerebral perfusion. MATERIALS & METHODS: A total of 84 cases in 2 groups between 0 and 3 months, followed-up at Firat Universitesi Hastanesi, Beyin Cerrahisi Klinigi, Elazig, Turkiye due to in 2010-2013, were enrolled. Two groups were created for the study. Group 1; patients with HCP and Group 2; as control group without HCP. In both groups, the length of the A2 segment of ACA was measured from its origin to the junction of the genu and body portions of the corpus callosum on T2 mid-sagittal magnetic resonance (MR) scans. For all cases, axial MR imaging scans were used to calculate Evans' index (EI), and the cases were divided into three groups: Group A, EI ≥50%; Group B, EI of 40-50% and Group C, EI <40%. The two groups (Groups 1 and 2) were compared with respect to ACA length, and the correlation with the EI was quantified. P values below 0.05 were considered statistically significant. RESULTS: Mean length of ACA was 57.3 mm in Group 1 and 37.5 mm in Group 2. EI increased as the length of ACA increased. A statistical comparison of the two groups revealed that the ACA length was significantly greater in Group 1. The relationship between EI and ACA length was statistically significant. CONCLUSION: Reducing ventricular size appears to be an important factor in addition to reducing intracranial pressure in an attempt to maintain normal cerebral perfusion(CP).

Smartphones and Programmable Shunts: Are These Indispensable Phones Safe and Smart?

OBJECTIVE: This study aimed to determine whether smartphones affect programmable shunts. METHODS: iPhone 5S (Apple Inc., Cupertino, CA, USA) and Samsung Galaxy S5 (Samsung Electronics, Gumi, South Korea) smartphones were chosen for this study. For both phones, magnetic field mapping was performed with 3-dimensional magnetic scanning systems constructed with high-precision motorized stages, and a Hall effect sensor was used to measure the flux density on the smartphone surface. The distance (h) between the distal outlet of the reservoir and the rugby ball of the Strata valve (Medtronic Inc., Minneapolis, MN, USA) was measured using highly sensitive microanalysis optical method. During optical microanalysis, while keeping a 3-cm distance between the valve and the magnetic generator, the h value (µm) was recorded for different magnetic flux densities (MFDs). Then, direct x-ray radiography was performed for radiologic assessment after each process under different magnetic fields. For analysis of the Codman Certas valve (Codman Neuro, Raynham, MA, USA), the magnet orientation and the angle between the magnet with the tantalum ball were measured with the same optical analysis. RESULTS: Maximum MFDs found 62 G for iPhone 5S and 61 G for Samsung Galaxy S5. When the magnetic generator formed a current at 0, 30, 60, and 90 G, the h values of the Strata valve adjusted to 100 mm H2O opening pressure were 320, 280, 190, and 175 µm, respectively. When the magnetic generator was removed from the environment, the h value returned to 320 µm. In direct graphs taken after each optical analysis at different Gauss values, substitution was not observed at the indicator. The angle in the Codman Certas valve was 123.9°, 112.5°, and 103.6° at the magnetic flux densities of 0, 60, and 90 G, respectively. When the magnetic field was removed (0 G), the angle was still 103.6°, suggesting an irreversible effect in the shunt construct. CONCLUSIONS: Smartphones exert reversible effects on Strata programmable valves without producing remarkable radiologic findings and irreversible effects on Codman Certas valves.

Ventriculoperitoneal shunt malfunction caused by fractures and disconnections over 10 years of follow-up.

PURPOSE: We have discussed the diagnosis and treatment approaches in patients with discontinued (disconnected or fractured) ventriculoperitoneal (VP) shunts that caused mechanical dysfunction. METHODS: Between 2006 and 2016, VP shunt surgery was performed on 1357 pediatric patients in our clinic. In follow-up examinations, we retrospectively reviewed patients who underwent revision surgery. Except for diagnosis of discontinued VP shunt, by excluding revision-surgery patients, only those patients who underwent surgical treatment owing to discontinued (fracture or disconnection) catheter were included in the study. Age at first surgery, sex, reason for shunt discontinuity, anatomical region of pathology, time to discontinuity diagnosis after first surgery, and presence or absence of symptoms were evaluated. RESULTS: One thousand three hundred fifty-seven VP shunt surgeries were performed in total, with 305 (22.4%) patients requiring revision surgery. Of these 305 patients, after accounting for other complications like obstruction, infection, overdrainage, and so on, 25 (8.1%) patients (14 male, 11 female) required re-surgery due to discontinuity. The mean age of these patients was 5.4 ± 2.1 months during the first VP shunt surgery, and the mean age during revision surgery was 71.7 months. The mean duration until discontinuity was diagnosed was 66.3 ± 24.1 months (76.1 months for catheter fractures and 45.6 months for disconnections (p 0.021)). CONCLUSION: Disconnection and fracture are two significant mechanical VP shunt dysfunctions and must be adequately researched and understood even during routine follow-ups. A disconnected or fractured shunt may be working and it is not safe to state that the shunt is no longer needed.

Does Ventriculoperitoneal Shunting Improve Thyroid Hormone Levels in Hydrocephalic Newborns?

OBJECTIVE/AIM: The aim of this report was to investigate the effect of ventriculoperitoneal shunt insertion for the treatment of hydrocephalus on thyroid hormones in the first 3 months of life. METHODS: Thyroid-stimulating hormone (TSH), free T3 (fT3), and free T4 (fT4) levels were compared at 7 days (preoperatively) and at 30 and 90 days (postoperatively) after birth between 25 ventriculoperitoneal shunt-inserted hydrocephalic newborns and 20 healthy newborns. RESULTS: The TSH level at 7 days was higher in the hydrocephalic patient group (6.33 µIU) compared to the control group (3.76 µIU). This value was significantly decreased at 90 days in the ventriculoperitoneal shunt-inserted newborns (2.35 µIU) compared to the control group (3.33 µIU; p < 0.05). There were no significant differences between time points for fT4 and fT3 values in the patient group or for TSH, fT4, and fT3 values in the control group. CONCLUSION: We propose that a ventriculoperitoneal shunt inserted in the early period of life may have beneficial effects on thyroid hormones.

Is the existence of cervical rib an advantage for C7 posterior stabilization?

BACKGROUND AND AIM: Defining a new screwing method for C7 posterior stabilization in case of a cervical rib existence aimed in this report. MATERIALS AND METHODS: Ten adult patients, five of which without cervical rib (Group 1) and the other five of which (Group 2) with cervical rib that has been chosen from the radiology archive. Axial, sagittal, coronal sections of cervical computed tomography and three-dimensional images were obtained. Lateral mass sizes of all cases were measured and compared between two groups. The relationship between cervical rib and lateral mass was identified in Group 2. RESULTS: The mean length, width, and height of lateral masses were measured respectively, as 5.4, 17.6, and 12.7 mm in Group 1. The measurement of Group 2 (with cervical rib) revealed the mean length of 20.7, the width of 20.4, and the height of 15.9 mm. When both groups were compared, there were no significant differences between the width and height of the lateral masses. However, axial measurements of Group 2 revealed a remarkable and significant length for screwing. CONCLUSION: In patients with cervical rib, directing lateral mass screw toward cervical rib conjoint can present a simple and reliable alternative method in C7 posterior stabilization process.

The Efficacy of Gabapentin in the Treatment of Pain Due to Far Lateral Lumbar Disc Herniations.

OBJECTIVES: Far lateral lumbar disc herniations (FLLDHs) can cause difficulty and differences in diagnosis and treatment compared with intraspinal herniation. We have aimed to analyze the efficacy of gabapentin as a noninvasive treatment of pain in patients with isolated FLLDH. METHODS: Thirteen patients with isolated FLLDH were evaluated for the study prospectively. All of the cases were diagnosed by lumbar magnetic resonance imaging. The previously prescribed medical therapy of the patients was not changed and gabapentin (3 × 600 mg/d) was added. For each patient, visual analog scale and Odom criteria were administered and recorded at 4 time points as follows: pretreatment and days 1, 7, and 30 posttreatment. Paired t test was used to examine scores of the cases before and after gabapentin treatment. Results were considered significant at P < 0.05, and 95% confidence interval was calculated. RESULTS: Mean visual analog scale score was 9.3 in the pretreatment period, and reduced to 5, 2.6, and 1.3 on posttreatment days 1, 7, and 30, respectively (P < 0.05). Mean Odom criteria score was 4 before gabapentin treatment. It decreased to 2.3 at posttreatment day 1 and 1.5 at day 7. At the end of 1 month, symptoms had resolved completely in all cases (P < 0.05). CONCLUSIONS: Gabapentin provided fast and effective relief of pain caused by FLLDH. We advise that the gabapentin should be kept in mind in the first-step medication of pain for such patients. Direct compression of the dorsal root ganglion or its distal part may be related to the intense pain-relief effect provided by gabapentin.