Evaluation of Sexual Function in Patients with Lower Lumbar Disc Herniation: A Comparison of Pre- and Postoperative Status.

BACKGROUND: Neuroregulation of sexual functions requires coordination of parasympathetic, sympathetic, and somatosensory neuronal pathways. The nerves formed by the lower lumbar plexus provide the innervation of the urogenital organs. Lower lumbar disc hernias (LDHs) might impair the neuroregulation of sexual functions by compressing the neural structures. This prospective study aims to evaluate the effect of lower LDHs on libido and sexual dysfunctions. METHODS: A total of 61 sexually active patients diagnosed with single-level LDH who underwent unilateral microdiscectomy were included in the study. The patients' healthy sex partners were included in study as controls. The International Sexual Function Index-5 (IIEF-5) and Female Sexual Function Index (FSFI) were used for sexual assessment of male and female participants, respectively. Visual Analog Scale (VAS) was used for pain assessment. RESULTS: According to the FSFI scores, all 20 female patients had preoperative sexual dysfunction, which improved in 15 (75%) patients after surgery (p < 0.001). According to the IIEF-5 score for men, 38 of 41 male patients had preoperative sexual dysfunction, which improved in 26 (68.4%) patients postoperatively (p < 0.001). CONCLUSION: The preoperative sexual dysfunctions of LDH patients improved significantly after the microdiscectomy.

Posterior Endoscope-Assisted Diskectomy Is an Effective Technique for Cervical Soft Disk Herniation.

OBJECTIVE: To evaluate the clinicoradiologic conditions of patients with a herniated cervical disk who were treated with percutaneous endoscope-assisted cervical diskectomy. MATERIALS AND METHODS: The medical data of 27 patients (16 men and 11 women; mean age: 40.9 years) who were operated on with the posterior endoscope-assisted cervical diskectomy method were reviewed retrospectively. The mean follow-up was 35.1 months, and the patients were assessed with combined preoperative and postoperative visual analog scale (VAS), Prolo Functional Economic Outcome Rating scale, MacNab scale, and clinical imaging. RESULTS: The mean preoperative VAS level was 8.6 (range: 7-10), and mean Prolo score was 2.5 (range: 2-5). A postoperative assessment performed 1 week postsurgery found a mean VAS level of 2.1 (range: 0-4). At the final examination, the mean VAS level was 0.81 (range: 0-3), and the mean Prolo score was 4.5 (range: 3-5). The final MacNab scale scores were 62.9%, excellent; 25.9%, good; 7.4%, moderate; and 3.7%, poor. CONCLUSION: Percutaneous endoscope-assisted cervical diskectomy is a suitable and effective treatment method for soft cervical disk herniation.

The Experience of the Derivo® Embolisation Device in Intracranial Aneurysms.

AIM: To investigate the safety and efficacy of Derivo® embolisation device (DED), a new-generation flow diverter designed to treat cerebrovascular aneurysms, and its long-term clinical outcomes. MATERIAL AND METHODS: In total, 146 patients with 182 aneurysms were treated with DED. The mean age of the participants was 51.5 years; among them, 46 (31.5%) presented with acute subarachnoid haemorrhage. The mean aneurysm size was 8.3 mm, and 12 aneurysms were involved the vertebrobasilar system. Ophthalmic aneurysms account for most internal carotid artery (ICA) aneurysms. RESULTS: The Glasgow Coma Scale (GCS) score of 12 patients was < 15. DED was associated with a mortality rate of 2.7% and permanent morbidity rate of 3.4%, and a complete aneurysm occlusion rate was achieved in 78.7% of cases after 7.02 months. CONCLUSION: The DED device is a new-generation flow diverter with excellent opening behaviour and navigational benefits. Our results indicated a safe aneurysm occlusion with optimum morbidity and mortality values despite the fact that almost one-third of the patients presented with subarachnoid haemorrhage.

Is IL-8 level an indicator of clinical and radiological status of traumatic brain injury?

BACKGROUND: Since understanding the fact that traumatic brain injury includes an inflammatory process, the number of studies of cytokines has increased. The objective of this study was to analyze and discuss the association of interleukin (IL)-8 level with the clinical and radiological status of patients with head trauma. METHODS: Patients who were admitted to our hospital due to head trauma were included in the study. Findings of clinical and laboratory examinations were analyzed. Data regarding patient age, gender, available clinical findings, Glasgow Coma Scale (GCS) score, trauma cause, brain tomography findings, and biochemical laboratory test results were recorded. The patients were divided into 3 groups according to their GCS score: Group I: GCS ≥13, Group II: GCS = 9-12, and Group III: GCS = 3-8. RESULTS: A total of 23 (76.7%) patients were male and 7 (23.3%) were female. Overall, 17 (56.7%) patients were admitted due to a fall, 8 (26.7%) due to a traffic accident, and 5 (16.7%) due to assault. Each group comprised 10 patients. As the GCS score increased, the IL-8 level decreased. The mean IL-8 level was 1.2 pg/mL in Group I, 6.6 pg/mL in Group II, and 4.7 pg/mL in Group III; however, there was no statistically significant difference between the groups (p=0.147). Moreover, the IL-8 level was significantly greater in patients who demonstrated an abnormal tomography finding (p=0.023). CONCLUSION: IL-8 may be a beneficial indicator for monitoring the clinical and radiological status of traumatic brain injury. Nonetheless, studies of larger cohorts in which IL-8 levels are measured at all stages of brain injury and follow-up of long-term prognosis are warranted.

Endovascular Therapy in Posterior Fossa Brain Arteriovenous Malformations: A Clinical Study.

AIM: To assess posterior fossa brain arteriovenous malformation (PFbAVM) patients who received initial endovascular intervention to reduce the lesion size, as well as embolization for the obliteration of the lesions. MATERIAL AND METHODS: This retrospective analysis included 16 patients (7 males and 9 females) with PFbAVMs who were treated between 2010 and 2017 via surgery, endovascular techniques, or combinations of modalities. Patient demographic and clinical features, angiographic characteristics, treatment modalities, complications, and outcomes were analyzed. RESULTS: Six patients with cerebellar AVMs, 2 with brainstem AVMs, and 8 with cerebellarâ€"brainstem AVMs were included in this study. All patients were treated by endovascular embolization as initial or final treatment. Patient characteristics were assessed for all 16 patients; 7 (43.75%) presented with hemorrhage, and they were further treated by microsurgery because of residual niduses. Complete obliteration was obtained in all patients. Two patients had persistent neurological deficits. The outcome was measured with the modified Rankin scale (mRS). Serviceable outcome (mRS ≤ 2) was attained in 14 patients. CONCLUSION: Successful treatment of PFbAVMs depends on an integrated team of neurosurgeons, radiosurgeons, and endovascular neurosurgeons. In PFbAVMs, endovascular embolization as adjuvant or final treatment is useful and safe.

Investigation of Lateral Epicondylitis in Neurosurgeons.

AIM: To investigate the frequency of lateral epicondylitis (LE), depending on the tasks performed by neurosurgeons, and to determine whether it can be accepted as an occupational disease depending on its frequency. MATERIAL AND METHODS: All neurosurgery specialists enrolled in the Turkish Neurosurgical Society website were prospectively included. A questionnaire form was shared, and the subsequent responses were recorded. Those who provided incomplete responses were excluded from the study. The respondents diagnosed with LE were recorded. Exclusion criteria were investigated on complaints of pain. They were examined by an orthopedics and traumatology specialist with application of Thomsen test and necessary maneuvers. RESULTS: The study was conducted with 216 neurosurgeons. Those with more than 30 operations per month (p=0.002), those with a specialization duration of 10-20 years and > 20 years (p=0.001), and those who specialized in spinal surgery (p=0.014) had a significantly higher prevalence of epicondylitis. Considering the relationship between lumbar/thoracic pedicle screw insertion and epicondylitis, the epicondylitis diagnosis rate was significantly higher in physicians inserting 20â€"60 screws per month than those inserting < 20 screws (p=0.009). CONCLUSION: LE frequently occurs in neurosurgeons who regularly perform spinal instrumentation and appears to be an occupational disease. However, data obtained during the current study should be combined with findings from case-control studies of neurosurgeons.

Is initial optic nerve sheath diameter prognostic of specific head injury in emergency departments?

BACKGROUND: Emergency departments (EDs) are typically the first medical contact for patients with traumatic brain injury (TBI) and early diagnosis and treatment of intracranial pressure (ICP) in patients with neurotrauma primarily falls under the liability of emergency doctors. Monitoring ICP with optic nerve sheath diameter (ONSD) via tools has gained popularity among emergency service doctors. In this study, we aimed to evaluate the predictive value of ONSD for specific head injury on initial cranial tomography. METHODS: CT scans of 176 patients with a known intracranial pathology were retrospectively analyzed and compared with normal control CTs of 182 patients presented to ED at the same time interval. The attending radiologist analyzed all initial brain CT scans and randomly sampled control CTs were similarly assessed by the second senior radiologist whom were blind to the patients' medical histories and circumstances of TBI at the time of measurement. ONSD was measured at a distance of 3 mm behind the eyeball, immediately below the sclera. RESULTS: Right ONSD value was significantly higher in patients with herniation and SAH (p = 0,024 and 0,028, respectively). Left ONSD values was at the level of statistical significance and mean ONSD values was significantly higher in patients with SAH (p = 0.05 and 0.026, respectively). Right-left-mean ONSD values were statistically higher in study group with bilateral lesions on brain CT (p < 0,001). ONSD measurements and patient age were higher in patients who died (p < 0,001). CONCLUSIONS: ONSD measurement on initial brain CT is lesion dependent and indicates mortality.

Traumatic Acute Subdural Hematomas: Analysis of Outcomes and Predictive Factors at a Single Center.

AIM: In the present study, we evaluated the association of the Glasgow Coma Scale (GCS) score and amount of blood loss with mortality in patients presenting with traumatic acute subdural hematoma (ASDH). MATERIAL AND METHODS: This retrospective study was performed on 99 patients who were operated for traumatic acute subdural hematoma (ASDH) without any systemic association at a single center. Epidural hematoma was reported to be the most common additional pathology. Age, sex, mechanism of trauma, time interval between onset of trauma and admission to the emergency ward, associated problems, thickness of hematoma and Glasgow Coma Scale (GCS) score at the time of admission and on discharge were all studied. RESULTS: The GCS score was inversely proportional to the thickness of hematoma and interval between onset of trauma and surgery (p < 0.05). Although the mortality rate was reported to be high in traffic accidents, the rate was low in patients with head trauma only (p < 0.05). The mortality rate was high in patients with associated pathologies (p < 0.05). Lost patients were reported to be older patients with more extensive ASDH or those who presented earlier with a low GCS (p < 0.05). CONCLUSION: ASDH is associated with high mortality. GCS score and the thickness of the ASDH are important predictors of mortality. Age, additional trauma, and interval between trauma and hospital admission are major predictive factors for mortality.

Relationship of biological factors to survival in spinal gunshot injuries.

BACKGROUND: Gunshot injuries are the third leading cause of spinal injuries, after falls from a significant height and traffic accidents. Severity of spinal damage from gunshot injury depends upon certain mechanical and biological factors. The aim of the present study was to investigate the effect of biological factors on survival in cases of spinal gunshot injury. METHODS: A total of 110 cases of spinal gunshot injury admitted multiple times to emergency services between 2012 and 2014 were included. Age, sex, region of trauma, additional organ or systemic involvement, treatment modalities (conservative, surgical), and mortality rates were analyzed. Effects of biological factors on survival were evaluated. RESULTS: Mean age of the study population was 25.51±11.74 years (min: 4; max: 55) and 95.5% of the population was male. Regions of trauma were thoracic in 50 (45.4%) subjects, cervical in 42 (38.2%), and lumbar in 18 (16.4%). Most common American Spinal Injury Association (ASIA) score was category A, as was found in 77 (70%) cases. No significant correlation was found among age, sex, ASIA score, treatment modality (conservative or surgical), and survival (p>0.05). Additional organ or systemic injury was present in 66 (60%) patients. Additional organ or systemic injury significantly affected survival, independent of the spinal region of trauma (p<0.01). CONCLUSION: Spinal gunshot injuries are complex, with unclear treatment protocol. Irrespective of the indications of spinal surgery, additional organ injuries unfavorably affect survival in cases of spinal gunshot injury. Appropriate management of all biological factors directly affects mortality rate in cases of spinal gunshot injury.

Outcomes and demostration of cranial firearm injuries: A multicenter retrospective study.

BACKGROUND: Cranial firearm injuries (CFAI) are associated with significant morbidity and mortality.This study was aimed to determine the factors affecting mortality of CFAI cases managed in our institution by a retrospective analysis of CT scans and clinical data. METHODS: This multicenter retrospective study examined two hundred and nineteen patients presenting to neurosurgery clinics after CFAI between January 2012 and November 2014. Age, sex, Glasgow Coma Score (GCS), CT findings, and mortality and morbidity rates of the patients were analyzed to determine the factors affecting mortality. RESULTS: Mean age of the study population was 24.19±12.25 years, 85.8% of them were male. The most common CT findings were fracture (100%), intracranial hemorrhage (61.2%), and an intracranially located foreign body (44.3%). A cranial operation was performed in 64.8% of the victims. Mean GCS on admission was 8±3.9, which increased in survivors (p<0.05). CONCLUSION: CFAIs are associated with increased mortality and morbidity. We determined that many factors affected morbidity and mortality rates, and patient age, presence of intracranial hemorrhage, GCS, and treatment protocols were significantly associated with mortality.

Neuroprotective effects of tetracyclines on blunt head trauma: An experimental study on rats.

BACKGROUND: Prevention of primary damage caused by head trauma may be avoided with protective measures and techniques which is a public health concern. Experimental and clinical studies about treatment of head trauma were all centered to prevent secondary damage caused by physiopathological changes following primary injury. Neuroprotective features of tetracyclines were the focus of several experimental studies in the last decade. In the present study we aimed to investigate the neuroprotective effects of tetracycline in an experimental model of blunt brain injury in rats. MATERIALS AND METHODS: 32 male Sprague-Dawley rats were divided into four experimental groups (n = 8). Head trauma was not performed in control group (group 1, craniectomy only). In the second group, head trauma and craniectomy were performed. Intraperitoneal saline was used in addition to trauma and craniectomy for treatment in group 3 whereas intraperitoneal tetracycline and saline were used for treatment in group 4. RESULTS: When histological examinations performed by transmission electron microscopy were evaluated, injury at ultrastructural level was demonstrated to be less pronounced in tetracycline group with decreased lipid peroxidation levels. CONCLUSION: In accordance with these findings, we conclude that systemic tetracycline administration is effective in reduction of secondary brain damage and brain edema and thus it may be considered as a therapeutic option.

Surgical management of traumatic cerebrospinal fluid fistulas with associated lesions.

BACKGROUND: Head trauma is associated with a significant risk of cerebrospinal fluid (CSF) fistula. METHODS: In this study, it was aimed to report twenty-two cases subjected to operative intervention for otorrhea, rhinorrhea and oculorrhea with associated traumatic lesions. Majority of the cases had moderate to severe head trauma with a Glascow Coma Scale (GCS) score under 14. The study group included eleven cases with depression fractures, 6 with epidural hematomas and 4 with tension pneumocephalus. RESULTS: Rhinorrhea was the most common presenting symptom encountered in fifteen cases; whereas, otorrhea was prominent in 7 and oculorrhea in 2 cases. Two patients having rhinorrhea also had oculorrhea and otorrhea. The patients were operated with unilateral approaches in twelve and bifrontal approaches in ten of the cases. CONCLUSION: Early surgical intervention should be performed in cases presenting with CSF fistula and associated traumatic lesions without considering conservative management to provide an effective control of associated complications due to CSF fistulas.

Analysis and injury paterns of walnut tree falls in central anatolia of turkey.

INTRODUCTION: Falls are the second most common cause of injury-associated mortality worldwide. This study aimed to analysis the injuries caused by falls from walnut tree and assess their mortality and morbidity risk. METHODS: This is a retrospective hospital-based study of patients presenting to emergency department (ED) of Ahi Evran Univercity between September and October 2012. For each casualty, we computed the ISS (defined as the sum of the squares of the highest Abbreviated Injury Scale (AIS) score in each of the three most severely injured body regions). Severe injury was defined as ISS ≥ 16. The duration of hospital stay and final outcome were recorded. Statistical comparisons were carried out with Chi-Square test for categorical data and non-parametric spearman correlation tests were used to test the association between variables. A p value less than 0.05 was considered to be statistically significant. RESULTS: Fifty-four patients admitted to our emergency department with fall from walnut tree. Fifty (92.6%) patients were male. The mean age was 48 ± 14 years. Spinal region (44.4%) and particularly lumbar area (25.9%) sustained the most of the injuries among all body parts. Wedge compression fractures ranked first among all spinal injuries. Extremities injuries were the second most common injury. None of the patients died. Morbidity rate was 9.25%. CONCLUSION: [corrected] Falls from walnut trees are a significant health problem. Preventive measures including education of farmers and agricultural workers and using mechanized methods for harvesting walnut will lead to a dramatic decrease in mortality and morbidity caused by falls from walnut trees.

Systemic administration of atorvastatin improves locomotor functions and hyperacute-acute response after experimental spinal cord injury: an ultrastructural and biochemical analysis.

AIM: Spinal cord injury (SCI) is characterized by posttraumatic inflammatory cascades including excitotoxicity, oxidative stress, and apoptosis. Agents against neuroinflammation are the current scope of studies on experimental SCI with promising results. MATERIAL AND METHODS: Thirty-two male Sprague-Dawley rats weighing 250-320 gram were used. They were randomized and divided into four groups with eight animals in each as sham, control, SCI+PEG (polyethylene glycol) and SCI+atorvastatin group. Rats were anesthetized with intraperitoneal ketamine (80 mg/kg) and xylazine (10 mg/kg) and SCI was induced by the weight-drop model. A single level laminectomy was performed at T10 and the spinal column was immobilized with a stereotactic device. Rats in the treatment group received ip atorvastatin at 0.2 mg/kg. Neurological impairments were examined through Modified Tarlov's and inclined angle scores. The SCI section was resected for electron-microscopic analysis, IL-1ß and IL-6 level. All data were analyzed using one-way ANOVA and Dunnet T3 test. RESULTS: Atorvastatin improved locomotor recovery after rat SCI. The results were further confirmed with a statistically significant decrease of IL-1ß, IL-6 and lipid peroxide levels. This finding revealed the anti-inflammatory and beneficial effect of atorvastatin on rat SCI. CONCLUSION: The present study focused on both B and T cell mediated immunity and confirmed the beneficial effect of atorvastatin with decreased expressions of IL-1ß and IL-6.