Efficacy of Spinous Process Splitting Decompression Compared with Conventional Laminectomy for Degenerative Lumbar Stenosis.

BACKGROUND: Spinous process splitting decompression (SPSD) is a minimally invasive surgical technique. We evaluated the clinical and radiological outcomes of SPSD compared with conventional laminectomy for the treatment of degenerative lumbar spinal stenosis. METHODS: SPSD was performed in 144 patients (group 1) and conventional laminectomy was performed in 132 patients (group 2) for degenerative lumbar spinal stenosis. Operative time, blood loss, hospital stay, and complications were compared between groups. Functional outcome was evaluated 2 years after surgery by Oswestry Disability Index, visual analog scale for back pain and leg pain, and progress in walking capacity. Spinal anteroposterior diameter and cross-sectional area were assessed by magnetic resonance imaging and computed tomography. RESULTS: Both groups showed significant improvement in mean functional outcome scores of Oswestry Disability Index and mean visual analog scale for back and leg pain after surgery (P < 0.001), although the differences in scores between the groups (P > 0.05) were not statistically significant. Walking capacity was reported as "much better" and "moderately better" in 89% of patients in group 1 and 87.8% of patients in group 2 (P > 0.05). On the basis of radiographic findings, satisfactory neurological decompression was achieved in group 1 (72.2% increase in mean spinal anteroposterior diameter, 102.5% increase in cross-sectional area) and group 2 (80.3% in mean spinal anteroposterior diameter, 108.8% increase in cross-sectional area) (P > 0.05). CONCLUSIONS: Patients who underwent SPSD for lumbar spinal decompression had comparable functional recovery rates correlated with clinical and radiological improvement to patients who underwent conventional laminectomy.

Retrospective Analysis and Comparison of 48 Intracranial Meningioma Cases As Two Groups According to Their Size.

Objective This study aims to examine the possible demographic, clinical, and surgical differences between giant and smaller meningiomas. Materials and Methods Forty-eight meningioma patients who were operated on in our clinic between 2016-2020 were included in our study. Fourteen meningiomas larger than 5 cm in diameter were defined as giant meningiomas and placed in group 1. Thirty-four remaining meningiomas, with sizes less than 5 cm, were placed in group 2. These patients were evaluated regarding age, sex, localization, symptoms and neurological findings, surgical results, histopathology, and postoperative results. Results The most common localization in group 1 was falcine-parasagittal, whereas in group 2 it was convexity. Simpson's grade I resection rate in group 1 was 35.71%, while in group 2 this rate was 67.65%. In histopathological examination, transitional type meningiomas (35.71%) were the most common in group 1, whereas fibrous type meningiomas (32.35%) were seen the most in group 2. Group 1 Karnofsky Performance Scale score average was 75.71 preoperatively and 85.71 postoperatively. In group 2, the preoperative and postoperative average was 97.35 and 96.76, respectively. The comparative statistical analysis reflects that: A) Resection rates were significantly lower in the giant meningioma group. B) Similarly, Karnofsky Performance Scale scores were also lower than group 2. C) When statistical comparisons were made according to sex, age, localization, histopathological results, postoperative complications, and recurrence rates, no significant differences were observed. Conclusion The term "Giant Meningioma" is a type of distinction that is frequently made in the literature. However, the single major difference we see in our study was the surgical results. The general condition of patients before and after surgery may be more critical than others in giant meningiomas. Although surgical resection is the main form of treatment in giant meningiomas, the risks arising from the size of the tumor should be taken into account, and necessary plans should be made for a successful surgical intervention.

The Role and Contribution of Lumbar Myelography in the Diagnosis and Treatment of Patients With Lumbar Degenerative Disorders: Clinical and Statistical Evaluation of Post-Myelography Treatment of 63 Patients.

Introduction Myelography is a radiological examination method that has been used for the diagnosis of spinal canal pathologies for a long time. More than 90 years of experience has been improved by the development of increasingly less toxic contrast agents. Nowadays, although there are many advanced diagnostic tools, lumbar myelography is a direct imaging technique and so it is a powerful diagnostic method for patients whose treatment has not been decided. The aim of our study is to evaluate the effect of lumbar myelography as a diagnostic method and its contribution to treatment. Materials and methods Between January 2016 and April 2018, 63 patients who were admitted to our neurosurgery clinic due to lumbar degenerative disorders and underwent myelography were included in our study. Patients over 30 years of age with lumbar disc disease, narrow spinal canal, and spinal instability, but for whom a surgical decision could not be made, were included in this study. Results After lumbar myelography, 55 of 63 patients underwent a surgical procedure and 8 were directed to non-surgical treatment options. The results of the patients were evaluated by Roland-Morris Low Back Pain and Disability Questionnaire (RMQ). Results showed that the contribution of selected treatment protocols to the recovery after myelography was statistically significant. Conclusion Nowadays, myelography is not the first choice for the diagnosis of lumbar degenerative disorders. However, according to the results of our study, lumbar myelography is an effective diagnostic tool for specific purposes.

The Carotid Endarterectomy Cadaveric Investigation for Cranial Nerve Injuries: Anatomical Study.

Cerebral stroke continues to be one of the leading causes of mortality and long-term morbidity; therefore, carotid endarterectomy (CEA) remains to be a popular treatment for both symptomatic and asymptomatic patients with carotid stenosis. Cranial nerve injuries remain one of the major contributor to the postoperative morbidities. Anatomical dissections were carried out on 44 sides of 22 cadaveric heads following the classical CEA procedure to investigate the variations of the local anatomy as a contributing factor to cranial nerve injuries. Concurrence of two variations was found to be important in hypoglossal nerve injury: the presence of a direct smaller vein in proximity of the carotid bifurcation, and the intersection of the hypoglossal nerve (HN) with this vein. Based on the sample investigated, this variation was observed significantly higher on the right side. Awareness of possible anatomical variations and early ligation of any small veins can significantly decrease iatrogenic injury risk.

Effects of Quetiapine on Neural Tube Development in the Early Stage of Chicken Embryos.

AIM: To investigate the effects of quetiapine exposure on neural tube development in early stage chicken embryos. MATERIAL AND METHODS: Eighty-four fertilised specific pathogen-free chicken eggs were divided into four equal groups (groups 1?4). Three experimental groups (groups 2, 3 and 4) and a single control group (group 1) were used. Each egg in group 2 (n=21) was injected with 20 ?L of saline after 30 hours of incubation. Eggs in groups 3 and 4 were injected with 0.02 ml of a solution containing 400 and 800 ?g of quetiapine dose, respectively. Incubation was continued until the end of 72 hours. All embryos were then removed from the eggs and histopathologically examined. RESULTS: Normal development and the closed neural tubes were shown in 18, 16, 13 and 9 embryos in groups 1 2, 3 and 9, respectively, of the 84 embryos incubated. Open neural tubes were found in one, three and five embryos in groups 2, 3 and 5, respectively. Also, developmental anomalies were found in three, four, five and seven embryos in groups 1, 2, 3 and 4, respectively. Moreover, no significant relationship between NTD and quetiapine exposure had been found. CONCLUSION: Quetiapine has no significant effect on the occurrence of neural tube defects in the chicken embryo model.

Effects of Tartrazine on Neural Tube Development in the Early Stage of Chicken Embryos.

AIM: To investigate the effects of tartrazine exposure on neural tube development, in early stage chicken embryos. MATERIAL AND METHODS: A total of 120 fertilized specific pathogen-free chicken eggs were divided into 4 equal groups (groups 1?4). After 30 hours of incubation, the eggs, except for the Group 1 (control group), were opened under 4X optical magnification. Group 2 was administered physiological saline. Group 3 was administered a middle dose of tartrazin (4.5 mg/kg) at a volume of 20 µL by the in ovo method, and group 4 was administered a high dose of tartrazine (7.5 mg/kg) using the same process. Incubation was continued until the end of the 72nd hour; all embryos were then removed from the eggs and histopathologically examined. RESULTS: Of the 120 embryos incubated, normal development and the closed neural tubes were shown in all embryos in group 1; 23 in group 2; 19 in group 3 and; only 9 in group 4. Open neural tubes were found in; 4 embryos in group 2; 5 embryos in group 3 and; 13 embryos in group 4. The neural tube closure defect was found to be significantly higher in group 4 compared to the other groups (p < 0.01). CONCLUSION: Based on our data, tartrazine, as one of the widely used food coloring agent, was seen to cause a neural tube defect in the chicken embryo model.

Effects of Erythrosine on Neural Tube Development in Early Chicken Embryos.

OBJECTIVE: Erythrosine (E127), a synthetic food dye containing iodine and sodium, has often been used inside packaged foods and beverages in Turkey and many other countries. We evaluated the effects of erythrosine on neural tube development in early-stage chicken embryos. METHODS: The study included 4 groups, with a total of 80 embryos: a control group, a normal saline group, a half-dose group, and a high-dose group. After 30 hours of incubation, saline and erythrosine solution was injected under the embryonic discs. At the end of 72 hours, the embryos were excised and evaluated macroscopically and histopathologically. RESULTS: Neural tube defects were detected in the erythrosine-administered groups with statistically significant differences. In contrast, the embryos in the control and saline groups displayed normal development. CONCLUSIONS: Erythrosine increased the risk of neural tube defects in early-stage chicken embryos, even at half of the approved dose.

Morphologic Variations of the Collateral Sulcus on the Mediobasal Region of the Temporal Lobe: An Anatomical Study.

OBJECTIVE: The fusiform gyrus and the collateral sulcus are the anatomical structures located in the temporobasal region. In this study, the topographic anatomy of the fusiform gyrus and the collateral sulcus is detailed to make a contribution for a successful course of temporal lobe surgery. METHODS: We studied the basal surface of the temporal lobes of 38 formalin-fixed adult human brain specimens. In the morphometric analysis, the distance between anterior and posterior transverse collateral sulcus and the distance between the occipitotemporal sulcus and fusiform apex were used as parameters. The topographic anatomy of collateral sulcus was identified in detail, and 4 sulcal patterns were used to classify the sulcal arrangement of basal surface of temporal lobe in each hemisphere: type 1, single-branch and unbroken collateral sulcus with no connection; type 2, continuous with the rhinal sulcus; type 3, continuous with the occipitotemporal sulcus and; type 4, continuous with both rhinal and occipitotemporal sulcus. RESULTS: The current study showed that type 1 was the pattern seen most frequently (42.1%, 16/38), whereas type 4 was the least (7.9%, 3/38). Overall, 63.2% (12/19) of subjects had the same sulcal pattern in both temporal lobes. The morphometric analysis showed that the mean distance between anterior and posterior transverse collateral sulcus was 50 ± 16.2 mm and the mean distance between occipitotemporal sulcus and fusiform apex was 26 ± 8.4 mm. CONCLUSIONS: The topographic anatomy of the collateral sulcus with its surrounding structures is detailed in this study. This study clarifies and supplements the knowledge presently available to help develop a more feasible surgical concept.

Transcortical selective amygdalohippocampectomy technique through the middle temporal gyrus revisited: An anatomical study laboratory investigation.

The anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SelAH) have been used for surgical treatment of mesial temporal lobe epilepsy. We examined the comprehensive white matter tract anatomy of the temporal lobe to gain an insight into the trans-middle temporal gyrus, a lateral approach which has been commonly used. The transmiddle temporal gyrus approach was performed in a stepwise manner on cadaveric human heads to examine the traversing white matter pathways through it and the structures located in the temporal horn. We reviewed the literature to compare the trans-middle temporal gyrus approach with other SelAH techniques based on surgical outcomes. There does not appear to be a significant difference in seizure outcome between SelAH and ATL. However, the SelAH provides a better neuropsychological outcomes than the ATL in selected patients. Each SelAH approach has individual advantages and disadvantages. Based on our anatomical study, in the transcortical amygdalohippocampectomy technique through the middle temporal gyrus the white matter pathways to be encountered. In the temporal horn, the collateral eminence, hippocampus, lateral ventricular sulcus, choroidal fissure, inferior choroidal point, choroid plexus, fimbria of the fornix, and amygdala are exposed. The subpial dissection is performed along the lateral ventricular sulcus from the collateral eminence on lateral side and from the choroidal fissure on medial side by microdissector for en bloc resection of the hippocampus proper. The trans-middle temporal gyrus approach is commonly used in treatment of mesial temporal lobe epilepsy patients. A better anatomical and functional understanding of the structures of the temporal lobe is crucial for safer and more accurate surgery.

Microsurgical and Tractographic Anatomy of the Supplementary Motor Area Complex in Humans.

OBJECTIVE: To evaluate the microsurgical anatomy of the fiber tract connections of the supplementary motor area (SMA) and pre-SMA, and examine its potential functional role with reference to clinical trials in the literature. METHODS: Ten postmortem formalin-fixed human brains (20 sides) and 1 cadaveric head were prepared following Klingler's method. The fiber dissection was performed in a stepwise fashion, from lateral to medial and also from medial to lateral, under an operating microscope, with 3D images captured at each stage. Our findings were supported by in vivo magnetic resonance imaging tractography in 2 healthy subjects. RESULTS: The connections of the SMA complex, composed of the pre-SMA and the SMA proper, are composed of short "U" association fibers and the superior longitudinal fasciculus I, cingulum, claustrocortical fibers, callosal fibers, corticospinal tract, frontal aslant tract, and frontostriatal tract. The claustrocortical fibers may play an important role in the integration of motor, language, and limbic functions of the SMA complex. The frontostriatal tract connects the pre-SMA to the putamen and caudate nucleus, and also forms parts of both the internal capsule and the dorsal external capsule. CONCLUSIONS: The SMA complex has numerous connections throughout the cerebrum. An understanding of these connections is important for presurgical planning for lesions in the frontal lobe and helps explain symptoms related to SMA injury.

Avulsion fracture of the anterior iliac crest after bone graft harvest: case report and review of techniques, risk factors and treatment.

The anterior iliac crest is the harvest site preferred by many surgeons because of the quantity and quality of bone obtainable and the simplicity of harvesting techniques. Avulsion fracture of the iliac crest following bone grafting is an extremely rare occurrence. We present a case report of avulsion fracture of the anterior iliac crest following bone graft harvesting for anterior cervical fusion in a 63-year-old man. Non-operative treatment was the method of our treatment in the patient. By means of the presented case, iliac crest bone grafting techniques, risk factors of avulsion fracture, and treatment options were reviewed.