Evaluation of Percutaneous Unilateral Kyphoplasty Results in Osteoporotic Vertebral Compression Fractures Using Individual 3D Printed Guide Template Support.

AIM: To compare the clinical and radiological outcomes of unilateral percutaneous kyphoplasty (PKP) surgeries performed using 3D printing technology in patients with osteoporotic compression fractures to conventional unilateral PKP surgeries. MATERIAL AND METHODS: Patients with acute painful single-level osteoporotic vertebral compression fracture (OVCF) who need surgical treatment were divided into two groups: group A (patients who had 3D template-guided PKP) and group B (patients who conventional PKP). To compare the two surgical procedures, Total Absorbed Radiation Dose (TARD), pre- and postoperative visual analog scale (VAS) scores, and Total Surgery Time (TST) were calculated and compared between groups in both surgical groups. RESULTS: A total of 44 patients with single-level OVCF who were experiencing acute pain were successfully operated on, with 22 patients in each group. TARD (2.6 ± 0.4 mGy vs. 6.1 ± 1.9 mGy, p < 0.05) and TST (12.4 ± 2.6 min vs. 20.2 ± 3.2 min, p < 0.05) differed significantly different between groups A and B. There was no statistically significant difference between the patient groups in preoperative and postoperative VAS values (p > 0.05). Cement leakage was lower in group A (3/22, 13.6%) than in group B (6/22, 27.3%) (p > 0.05). There were no neurological complications or infections in either group. CONCLUSION: When compared to the conventional procedure, the unilateral percutaneous kyphoplasty method was supported by a 3D printing guide template. By reducing operative time and radiation exposure, tt has resulted in a more effective surgical procedure for patients and a safer surgical procedure for surgeons and anaesthesiologists.

Effects of Pterional and Osteoplastic Craniotomy on Temporalis Muscle and Calvarial Bone Graft Atrophy.

This study aims to compare the effects of osteoplastic craniotomy on temporalis muscle and bone graft atrophy in patients operated on with a pterional approach to the standard technique. Patients operated on for an intracranial aneurysm with a pterional approach between 2014 and 2018 were studied. Following the exclusion criteria, 36 patients were included in this retrospective study. Temporalis muscle volume and bone graft volume were calculated. The volumes were compared from preoperative and postoperative computed tomography images for temporalis muscle and from early and late postoperative computed tomography images for the bone graft. The osteoplastic craniotomy group (group I) had 17 patients, and the standard craniotomy group had 19 patients (group II). Temporalis muscle volume and bone graft volume decreased statistically significantly in group II after surgery. However, no significant volume difference was found in group I measurements. When compared with the standard technique, osteoplastic craniotomy reduces the likelihood of postoperative temporalis muscle and bone graft atrophy in patients undergoing pterional craniotomy. As a result, the patients' cosmetic and functional well-being is improved.

What is the Effect of Pedicle Screw Reinsertion Through the Same Trajectory on Pullout Strength?

AIM: To investigate the pullout strength of a pedicle screw reinserted through the same trajectory MATERIAL and METHODS: Fifty freshly frozen lamb L4 vertebrae were divided into the following five groups: Group 1, inserted with a 5-mm pedicle screw; Group 2, inserted with a 5-mm pedicle screw followed by the removal and reinsertion of the same screw after control; Group 3, inserted with a 5-mm pedicle screw followed by the removal and reinsertion of a 5.5-mm screw after control; Group 4, inserted with a 5.5-mm pedicle screw; and Group 5, inserted with a 5.5-mm pedicle screw followed by the removal and reinsertion of the same screw after control. Pedicle screws were inserted into the right pedicles, and axial pullout testing was performed at 5 mm/min. All data were recorded. A load-displacement curve was used to obtain the peak value of the pullout strength for all specimens. RESULTS: The mean pullout strengths were 1086.22 N, 1043.32 N, 1039.18, 1199.10, and 1131.68 N for Groups 1?5, respectively. No significant difference was observed among all groups (p > 0.05). CONCLUSION: Perioperative reinsertion of the same screw or (0.5 mm) larger in diameter through the same trajectory after the control of the screw trajectory did not affect the pullout strength of the screw.

Microscopic Unilateral Approach for Bilateral Decompression of Lumbar Spinal Stenosis.

BACKGROUND: This is a study based on single-surgeon data on spinal stenosis surgery via microscopic approach. The aim is to evaluate the effectiveness of the unilateral approach to bilateral decompression and the usage of Taylor retractors and brain spatula in patients with spinal stenosis. METHODS: This is a retrospective study on bilateral decompression for lumbar spinal stenosis using a microscopic unilateral approach by a single surgeon, between April 2015 and March 2018. In total, 50 patients were operated due to single level lumbar spinal stenosis. All patients were evaluated by preoperative and postoperative plain radiographs and magnetic resonance (MR) images. Walking distance (WD), visual analog scale (VAS) for pain and Odom's criteria were evaluated for follow-up. RESULTS: One level of the lumbar spine was surgically decompressed in all patients. The median age of patients was 64.6 (51- 82). Of the patients, 72% (36) were women, and 28% (14) were men. Most patients had refractory low back pain (96%) after conservative treatment. The stenotic levels of the cases were as follows: L3-4, 23(46%); L4-5, 24(48%); and L5-S1, 3 (6%). VAS scores decreased in all patients after surgery. According to Odom's criteria, an excellent or good score was found in 43 patients at the 12th follow-up examination. WDs increased up to 1000 meters for 41 patients. CONCLUSION: The microscopic unilateral approach to bilateral decompression is an effective method for decompression in spinal stenosis. Via this approach, surgical trauma is reduced and surgically induced instability is avoided as much as possible.

Effect of the "Time to Surgery" on Civil Cranial Gunshot Injuries: Syria War.

ABSTRACT: Studies on cranial gunshot injuries in the Syrian war are present in the literature. However, the effect of surgical timing on the clinical outcomes of patients undergoing surgical treatment has not been discussed extensively. In this study, the time from injury to surgery is called "time to surgery." Kilis, a city close to Aleppo, Afrin, and Azez, where the conflicts in Syria are intense, is one of the cities where the first emergency treatments were administered. This study aimed to evaluate patients who underwent surgery in Kilis State Hospital due to cranial gunshot injury in the Syrian war and to investigate the effect of surgical timing on mortality and Glasgow Outcome Score.Surgical treatment was applied to 42 (32.8%) patients in the first 4 hours, 64 (50%) patients within 4 to 24 hours, and 22 (17.2%) patients between 24 hours and 3 days. As the time to surgery decreased, the good Glasgow Outcome Score (GOS) (4-5) outcome rates increased. The differences in surgical timing and GOS results of patients with Glasgow Coma Score (GCS) <8 and >8 were found to be significant for good GOS results. As the time to surgery decreased for patients with a GCS <8 and >8, mortality rates decreased equally. This result was statistically significant.Our study showed that surgical timing is as important as early intubation, aggressive resuscitation, and admission GCS for both survey and GOS.

Are 3D Printing Templates an Advantage in Upper Thoracic Pedicle Screw Fixation?

Background This study aims to compare the clinical results of patients with upper thoracic vertebral fractures treated with pedicle screw and posterior spinal fusion with preoperative surgical planning and 3-dimensional (3D) modeling and patients treated with freehand screws. Methods Fifty patients who underwent pedicle screw placement with a diagnosis of upper thoracic fracture between June 2018 and October 2020 were included in our study. Pedicle screws were used in 25 patients (group 1) after the planning was completed with the help of 3D preoperative printing and modeling. Pedicle screws were applied in 25 patients in the control group (group 2) using the freehand technique. Intraoperative bleeding amount, operation time, and correct screw placement data in both groups were recorded. Results The operation time was 134 ± 22 minutes for group 1 and 152 ± 38 minutes for group 2. The difference in operation times was found to be statistically significant (p < 0.05). Based on axial and sagittal reconstruction images, the accuracy rate of pedicle screw placement (grades 0 and 1) in group I was 96.6% compared to 83.6% in group II. The minor perforation rate (grade 1, <2 mm) was 5.8% in group I compared to 11.8% in group II. The moderate perforation rate (grade 2, 2-4 mm) was 3.4% in group I compared to 14% in group II. The severe perforation rate (grade 3, >4 mm) was 2.3% in group II; however, misplaced screws were not associated with neurological deficits. The difference in overall accuracy rates between the two groups was significant (p < 0.05). Conclusions For 3D models of upper thoracic pedicle screw insertion, guide plates can be produced inexpensively and individually. It provides a new method for the accurate placement of upper thoracic pedicle screws with high accuracy and secure use in screw insertion.

Comparison of dural closure alternatives: an experimental study.

Introduction: Dural closure preference has been a topic of debate in contemporary neurosurgery. This study aims to compare different closure techniques using an in vitro model.Methods: Human cadaveric dura mater was attached to a cylindrical metal glass filled with blue dyed saline. A 1 cm dural incision was made. Dural closure was performed using three different techniques. Each group had six samples: Group I - interrupted simple 4-0 polyglactin suture (S) only, Group II - S plus on lay collagen graft, Group III - S plus fibrin sealant. In Group NS, a 1 cm × 1 cm dural window was made. An onlay collagen graft was used with no suturing for this group to serve as an overtly weak reconstruction reference. Primary and secondary leak pressures were recorded (PLP and SLP, respectively).Results: All groups (I-III) had significantly higher PLP and SLP than Group NS. PLP was significantly higher in Group III as compared to groups I and II. Groups I and II had similar PLP values. SLP was similar in all three groups.Conclusion: In this study, the use of fibrin sealant has proven to be the best option in preventing dural leak. However, no technique was superior in the case of SLP.

Success Rate and Complications of Cerebrospinal Fluid Rhinorrhea Treated With a Transcranial Approach.

The aim of this study was to evaluate the clinical outcomes of cerebrospinal fluid (CSF) rhinorrhea in patients treated with transcranial surgery. Here, we retrospectively reviewed 23 patients with CSF rhinorrhea between 2008 and 2015 at our university hospital. Nine (39.1%) patients were treated conservatively, whereas 12 (52.2%) patients were treated with a transcranial approach. Our results showed that 7 (30.4%), 11 (47.8%), and 5 (21.7%) patients had spontaneous, traumatic, and iatrogenic CSF leakage, respectively. In our study, the cribriform plate was the most common site of leakage, and it was found to be involved in 5 (21.7%) patients. The mean diameter defect of the fistula was 130.40 ±â€Š190.47 mm and there was no significant difference between this defect and the different etiology types. In our study, meningitis, third nerve palsy, and vasospasm were the main complications that arose during the treatment of CSF rhinorrhea. Moreover, 6 (26.1%) of 7 (30.4%) patients had spontaneous CSF leaks that were treated with surgery. Notably, spontaneous CSF leaks did not stop when treated with conservative measures. In addition, there were no significant differences between etiology types and CSF leaks. The primary surgical repair rate was 78.3% and the secondary surgery repair rate was 91.6%. Importantly, as we preferred using this type of transcranial surgery in our clinic, there has been a higher success rate with endoscopic treatments and fewer major complications from CSF rhinorrhea in the literature.