Surgical management of interhemispheric subdural empyemas: Review of the literature and report of 12 cases.

BACKGROUND: Subdural empyemas (SDEs) are rare intracranial infections mostly secondary to sinusitis. Incidence of SDEs is 5-25%. Interhemispheric SDEs are even rarer, which makes their diagnosis and treatment difficult. Aggressive surgical interventions and wide-spectrum antibiotics are needed for treatment. In this retrospective clinical study, we intended to evaluate the results of surgical management supported by antibiotics in patients with interhemispheric SDE. METHODS: Clinical and radiological features, medical and surgical management and outcomes of 12 patients treated for interhemi-spheric SDE have been evaluated. RESULTS: 12 patients were treated for interhemispheric SDE between 2005 and 2019. Ten (84%) were male, two (16%) were female. Mean age was 19 (7-38). Most common complaint was headache (100%). Five patients were diagnosed with frontal sinusitis prior SDE. Initially, three patients (27%) underwent burr hole aspiration and ten patients (83%) underwent craniotomy. In one patient both were done in the same session. Six patients were reoperated (50%). Weekly magnetic resonance imaging and blood tests were used for follow-up. All patients received antibiotics for at least 6 weeks. There was no mortality. Mean follow-up period was 10 months. CONCLUSION: Interhemispheric SDEs are rare, challenging intracranial infections that have been related to high morbidity and mor-tality rates in the past. Both antibiotics and surgical interventions play role in treatment. Careful choice of surgical approach and repeated surgeries if necessary, accompanied by appropriate antibiotic regimen, leads to good prognosis reducing morbidity and mortality.

A series of post-traumatic midline epidural hematoma and review of the literature.

BACKGROUND: Supratentorial midline epidural hematoma is rare but challenging in diagnosis and management. Indication for surgery can arise even following hospital admission. Being familiar to the presentation and watching out for direct and indirect signs on axial computed tomography (CT) such as suture diastasis or fracture traversing midline are essential to plan multi-planar CT enabling exact diagnosis including form and mass effect of hematoma. METHODS: Nine patients with midline epidural hematoma including two pediatric patients underwent surgery between 2013 and 2018. Pre-operative and post-operative patient status, radiological features, and surgical technique were analyzed. RESULTS: Four patients had deteriorating consciousness levels and two patients had paraparesis. All had fractures traversing midline and epidural hematomas with significant mass effect. They were operated through separated craniotomies around the midline and midline bone strip was used for dural tenting and as support for natural closure of bone flaps. No post-operative complications were developed. All patients were discharged with Glasgow Outcome Score of 5. CONCLUSION: Because of the rarity of the lesion and small number of patients, definitive conclusions may be misleading but we think that, in experienced hands, midline epidural hematomas can safely be operated on and, preservation of midline bone strip pro-vides easier bleeding control.

Retrospective Analysis of Survival in Patients with Brain Metastases from an Unknown Primary Tumor.

AIM: To evaluate the patients with brain metastases from unknown primary (BMUP) cancers, and to analyze the prognostic factors and survival rates. MATERIAL AND METHODS: We conducted a retrospective study with 110 patients (mean age: 62.8 years [range 23?90], n=85- 77.3% male and n=25-22.7% female) with BMUP cancers at the time of diagnosis, who presented to our outpatient oncology clinic between January 2015 and December 2019. We employed the following variables as significant prognostic factors for a prominent index of patients? survival: age, gender, Karnofsky performance score (KPS), number of metastatic lesions, primary site, and type of treatment were analyzed for their prognostic effects on survival outcomes. Patients? survival was evaluated from plotted Kaplan? Meier curves, and the log-rank test was used for univariate analysis. RESULTS: The mean follow-up was 13 months (range 4?60 months). The means of survival after the diagnosis of brain metastasis was 18.7 months for the study group. Lung cancer was the most common primary tumor (74, 5%). The KPS and number of lesions were found to have a prognostic effect on survival. Survival analysis showed no statistical significance with age and gender, primary site, type of treatment. CONCLUSION: This study showed that KPS, and the number of lesions affect the survival outcomes but both the other variables. Therefore, BMUP cancer is indeed related to poor prognosis.

Morphometric Analysis of Lumbar Arteries and Relationship with Intervertebral Discs: A study of Surgical Anatomy on Human Fresh Cadavers.

AIM: To examine the morphological structure of anterior lumbar spinal region. MATERIAL AND METHODS: Fifteen fresh human cadavers were studied in our forensic medicine institution. Within the first 24 hours after death, cadavers were subject to a routine autopsy, by which the intestines were removed and the structures adjacent to the lumbar arteries (LAs) were examined. The following characteristics of the LA were examined and recorded: diameter, number of LA, intervertebral disc, and vertebral corpus relationship, and LA anatomical variations. RESULTS: In 14 of the 15 cadavers (93.3%), the first four LAs originated from the abdominal aorta. In one (6.7%) cadaver, the fourth LA originated from the right aortic trunk together with the median sacral artery (MSA), and this was observed only in the right side. In one cadaver, the first LAs emerged as a common trunk. Twelve cadavers did not have a fifth LA. In one cadaver (6.7%), the fifth LAs emerged as in a pair, distally from the origin of the MSA. Two cadavers (13.3%) had fifth LAs that emerged from the common trunk with the MSA and this occurred only on the right side. LAs which emerged from the right side of the abdominal aorta passed under the inferior vena cava. Of the first four LA, the third LA had the largest vessel diameter, and the first LA had the narrowest vessel diameter. Fifth LAs had one of the narrowest vessel diameters of all LAs. CONCLUSION: We consider that anatomical study of LAs using fresh cadavers can be useful to ensure safer anterior lumbar spinal surgeries.

"Honey" can prevent epidural fibrosis development after laminectomy: an experimental study.

AIM: One of the most important causes of failed back surgery is the development of epidural fibrosis. Many methods and substances have been used to prevent the development of epidural fibrosis after laminectomy. In this study, effects of "manuka honey" on epidural fibrosis development after laminectomy was evaluated in rats. MATERIAL AND METHODS: Subjects were divided into two groups:In Group-1 (n=8);only laminectomy was carried out in the L1 level; in group-2 (n=8), laminectomy was carried out in the L1 level and manuka honey was applied to the area. The related vertebral columns were removed en bloc 6 weeks later. Leveled sections with thicknesses of 6 mm were obtained from paraffin blocks. RESULTS: In the grading made based on the fibroblast count and scar tissue degree, it was found that epidural fibrosis developed significantly less in the group-2 as compared to the group-1, and the difference was statistically significant. CONCLUSION: It was shown in our study that manuka honey reduces the degree of epidural fibrosis in rats following laminectomy. We believe that manuka honey, which can be used safely in the clinic for surgical wounds, can be used routinely to prevent development of epidural fibrosis following laminectomy.

The relationship between disability, quality of life and fear-avoidance beliefs in patients with chronic low back pain.

AIM: The aim of this study is to investigate the relationship between fear and avoidance beliefs with the disability of patients with chronic low back pain and the prediction of quality of life. MATERIAL AND METHODS: 105 outpatients with chronic low back pain were included in the study. Patients were evaluated with a sociodemographic questionnaire Visual Analog Scale Roland Morris Disability Questionnaire Beck anxiety inventory Beck depression inventory, Somatosensory Amplification Scale Fear and avoidance beliefs questionaire and Short form-36 health survey questionnaire. RESULTS: As pain intensity increased, FABQ increased. Higher levels of anxiety, depression, FABQ (work) leads to higher level of disability. The disability predictors were found to be pain intensity and level of anxiety. When levels of pain intensity, level of anxiety and depression, FABQ increased, physical function decreased. Pain intensity and FABQ (physical) were found to be the predictors of quality of life. CONCLUSION: Findings of our study were compatible with the previous studies that evaluated the relationship between pain intensity and FAB with the disability of patients with chronic low back pain. We think that it'd have a role for the perception of disability and connected to this to prevent the impairment of life quality by implications for FAB in these patients.