Role of radiofrequency ablation and cement injection for pain control in patients with spinal metastasis.

BACKGROUND: The study aimed to investigate the effects and reliability of simultaneous vertebroplasty and radiofrequency ablation or radiofrequency ablation applied alone for pain control in patients with painful spine metastasis, and to investigate the effect of preventing tumor spread in long-term follow-up. METHODS: Patients with painful vertebrae metastasis in the Afyonkarahisar Health Sciences University, Medical Faculty, Hospital Neurosurgery Clinic between 01.01.2015 and 01.06.2020 were recruited. They were divided into groups according to the surgical procedures applied. Group 1 included 26 patients who underwent radiofrequency ablation only, and group 2 included 40 patients who underwent vertebroplasty with radiofrequency ablation. Computed tomography and magnetic resonance imaging were performed in all patients pre-operation. The patients were followed for at least 6 months. Magnetic resonance imaging was performed at the end of the 6th month in neurologically stable patients. The metastatic lesion, pain, and quality of life were evaluated with Visual Analog Scale and Oswestry Disability Survey before and after the procedure. RESULTS: The mean VAS score before the procedure was 8.3 ± 1.07 in the RFA group, and a statistically significant difference was observed in VAS scores at all post-procedural measurement time-points (p < 0.001). The pain scores decreased at a rate of 58.8 and 69.6% of patients showed significant improvements in the QoL in the RFA-only group. The mean VAS score was 7.44 ± 1.06 in group RFA + VP before the procedure; the difference in the mean VAS scores was statistically significant at all measurement time-points after the procedure (p < 0.001). The mean pre-treatment Oswestry Index (to assess the QoL) was 78.50% in the RFA + VP group, which improved to 14.2% after treatment. CONCLUSION: Ablation + vertebroplasty performed to control palliative pain and prevent tumor spread in patients with painful vertebral metastasis is more successful than vertebroplasty performed alone.

Posterior Fossa Decompression and superficial durotomy rather than complete durotomy and duraplasty in the management of Chiari 1.

Objective: We aimed to evaluate the effectiveness and reliability of posterior fossa decompression (PFD) and superficial durotomy in patients who underwent surgery for Chiari malformation type 1 (CM1).Materials and Methods: Our study included 54 patients with the diagnosis of CM1 who had surgery between January 2012 and June 2019. The patients were divided into two groups according to the surgical technique applied. Group 1 included 10 patients who underwent classic PFD and duraplasty, and Group 2 included 44 patients who underwent PFD and superficial durotomy surgery. Pre- and postoperative clinical signs and symptoms of each patient were recorded. Simultaneously, morphometric measurements were compared from computed tomography (CT) and magnetic resonance (MRI) images taken pre- and postoperatively. The data of the two groups were compared.Results: Of the 54 patients, 18 were male, and the mean age was 37.51 ± 15.14. A statistically significant difference was found between the pre- and postoperative morphometric measurements of the subarachnoid distance, craniocervical angle, syringomyelia, and hydrocephalus at the cerebellum level in Group 2 patients who underwent PFD and superficial durotomy surgery (p < 0.05). When morphometric measurements and clinical signs and symptoms of both groups were compared, no significant difference was found (p > 0.05). There was a 92% improvement in clinical signs and symptoms postoperatively. The complications seen in Group 1 decreased to a minimum in Group 2.Conclusion: We believe that a minimally invasive surgical method is superior to avoid major complications. We also found PFD and superficial durotomy shorten the duration of the patient's hospital stayAbbreviations: C1: cervical vertebra 1C2: cervical vertebra 2CM: Chiari malformationCM1: Chiari malformation type 1CSF: cerebrospinal fluidCT: computed tomographyMRI: magnetic resonance imagingPFD: posterior fossa decompressionUSG: ultrasonography.

Augmented Reality Supported Cervical Transpedicular Fixation on 3D-Printed Vertebrae Model: An Experimental Education Study.

AIM: To investigate the use of Augmented Reality (AR) technology as it contributes to spinal surgery education with the free-hand technique, and might reduce the error ratio. MATERIAL AND METHODS: Ten candidates, with anatomy education but no surgical experience, applied 36 pedicle screws with C2-C3 posterior transpedicular fixation technique to nine vertebrae models produced via a three-dimensional (3D) printer. RESULTS: Using AR to apply pedicle screws to the experimental vertebrae model increased the safety screw ratio significantly. In comparison of Grade 0 screws to other grades: 6/18 screws (33.3%) in the free-hand technique Group (n=18), and 14/18 screws (77.8%) in the AR Group (n=18), were measured for screw insertion safety ratios. The difference was statistically significant (p=0.018). The resemblance between our results and the results of previous studies researching supportive systems indicates our 3D printed vertebra model might be a helpful educational material. CONCLUSION: AR increases the safety ratio of cervical pedicle screw fixation significantly. The parameters investigated and used for the production of vertebrae models in this study can be used for experimental material production for future studies to investigate pedicle screw positioning.

How necessary is the computerized brain tomography in minor head trauma?

BACKGROUND: Head trauma is a health problem that may be observed in all age groups, and it may cause significant losses in terms of health and economy. The purpose of our study is to evaluate the abnormal computerized brain tomography (CBT) prevalence and the rate of admission to brain surgery clinics in patients who applied to the Emergency Service Department for CBT due to minor head trauma. METHODS: In the present study, the patients who were admitted to Afyonkarahisar Health Sciences University, Faculty of Medicine Hospital, Emergency Service Department between January 1st, 2017, and December 31st, 2017, due to head trauma and in who CBT was performed were examined retrospectively. The electronic files, CBTs, and consultation notes of these patients were accessed in the information system of the hospital. RESULTS: A total of 43,389 patients who applied to the Emergency Service Department in 1 years' time (2017) were examined retrospectively. As a result of the examination, it was determined that a total of 2,515 (5.7%) patients received CBT. The reason for a total of 1,152 (45%) of these patients was traumatic injury. It was determined that 618 (53.6%) of the patients in who CBT was performed due to trauma were aged <18 years; 280 (24.3%) patients were aged <2 years; 179 (15.5%) patients had to consult with the Brain Surgery Clinic; and 94 (8.1%) were hospitalized. It was also determined that there were abnormal computed tomography (CT) findings in only 68 (5.9%) of the patients in who CBT was performed. CONCLUSION: The use of CBT indication criteria, which have been previously established and which reliability has been proven, in emergency trauma cases applying to the Emergency Service Department with minor head traumas may reduce the complication risk that may appear as a result of an unnecessary CBT and avoid complications that may occur in the long run due to CBT.

Effects of 2-Aminoethyl Diphenylborinate, a Modulator of Transient Receptor Potential and Orai Channels in Subarachnoid Hemorrhage: An Experimental Study.

BACKGROUND: Cerebral vasospasm remains a serious problem affecting morbidity and mortality in patients with subarachnoid hemorrhage (SAH) during neurosurgery. We aimed to demonstrate the role of the transient receptor potential channel and other channels for Ca2+ in the etiology of cerebral vasospasm using 2-aminoethyl diphenylborinate (2-APB) and the effective dose range of an unstudied pharmacological agent, which can limit vasospasm. METHODS: We performed an experimental study using 32 Sprague-Dawley rats divided into 4 groups: sham group (n = 8), SAH group (n = 8), 2-APB group (SAH rats intraperitoneally administered with 0.5 mg/kg 2-APB; n = 8), and 2-APB-2 group (SAH rats intraperitoneally administered with 2 mg/kg 2-APB; n = 8). The rats were sacrificed after 24 hours, and superoxide dismutase, glutathione peroxidase, malondialdehyde, tumor necrosis factor-α, and interleukin-1ß in the brain tissue and serum were measured. The histopathological investigation of brain tissue included measurement of the luminal diameter and wall thickness of the basilar artery (BA), and apoptotic cells in the hippocampus were counted after caspase staining. RESULTS: Autologous arterial blood injection into the cisterna magna caused vasospasm in rats. 2-APB treatment increased the BA wall thickness and reduced the BA lumen diameter, inducing significant vascular changes. 2-APB also alleviated cell apoptosis at 24 hours after SAH. CONCLUSION: In experimental SAH in rats, 2-APB treatment increased the BA wall thickness and reduced the BA lumen diameter, inducing significant vascular changes. 2-APB also alleviated cell apoptosis at 24 hours after SAH.