Clinical analysis of transverse process fractures: A comprehensive study on patient characteristics, management, and outcomes in trauma care.

BACKGROUND: Transverse process fractures (TPFs) are commonly encountered in trauma patients and are often associated with polytrauma. While traditionally considered stable injuries, recent research suggests their significance in spinal trauma may be under-estimated. This study aims to provide insights into the management and outcomes of TPFs, evaluating their predictive potential for identifying clinically significant spinal fractures and associated injuries. METHODS: A retrospective review of trauma registry data from a Level I trauma center was conducted, encompassing patients with TPFs from September 2022 to September 2023. Inclusion criteria involved patients aged 18 or older with confirmed TPFs via com-puted tomography (CT) and magnetic resonance imaging (MRI), managed nonoperatively. Data on demographics, injury mechanisms, associated injuries, pain management, and treatment outcomes were analyzed. Pain severity and functionality were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). RESULTS: A total of 190 patients, predominantly male (129 patients, 67.9%), with a mean age of 45.7 years, were included in the study. Motor vehicle accidents (MVA) were the leading cause of admission (44.7%). Thoracic injuries were the most common associ-ated pathology. Of the study cohort, 88 patients (46.3%) presented with single-level TPFs, while 102 patients (53.7%) had multilevel fractures. Analysis revealed distinct differences between these groups, with multilevel TPF patients exhibiting a higher frequency of associated injuries and a notable proportion requiring hospitalization or surgical intervention. Multilevel TPF patients exhibited higher initial pain and disability scores compared to single-level TPF patients. Both groups showed significant reductions in VAS and ODI scores at the 3-month follow-up. CONCLUSION: TPFs, previously considered minor injuries, demonstrate significant pain and functional limitations. They often accompany systemic pathologies, particularly in multilevel fractures, necessitating a multidisciplinary approach to management. The "Protection, Rest, Ice, Compression, Elevation" (PRICE) approach, including Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and muscle relaxants, along with collar or brace support when necessary, proves effective in pain management and functional improvement. These findings emphasize the importance of recognizing TPFs as complex injuries requiring tailored management strategies. Further research and collaboration among healthcare providers are warranted to refine treatment approaches and optimize outcomes for patients with TPFs.

Neuroendoscopy-Assisted Minimal Invasive Management of Chiari 1 Malformation.

Objective The aim this study is to present the results of the minimal invasive neuroendoscopic-assisted system application as an alternative to traditional surgery in patients with Chiari malformation type 1 (CM type 1) with/without syringomyelia. Design, Setting, and Participants In the study, data of 22 symptomatic patients were prospectively collected. Before and after the operation, patient characteristics, computed tomography, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) flow dynamics MRI, and outcome scales scores were recorded. Foramen magnum decompression and C1 total laminectomy were performed. The fibrous band at the craniocervical junction was opened and a durotomy was performed. In patients with a syrinx, the pre- and postoperative axial and sagittal lengths of the syrinx were measured and compared. Results The mean age of the patients was 32 ± 5 years. There were eight male patients. Ten patients had syrinx. The mean visual analog scale (VAS) score before and after surgery was 8 ± 1.06 and 2.18 ± 1.13, respectively. When evaluated according to the Chicago Chiari Outcome Scale, there was improvement in 20 patients, while there was no change in 2 patients. Syrinx resolved completely in 3 of 10 (13.6%) patients with syringomyelia, and the syrinx volume decreased in 3 patients (13.6%). In 4 of 10 (18.1%) patients, there was no significant change in the syrinx volume. The average operation time was 105 minutes (80-150 minutes). The average blood loss was 40 mL (20-110 mL). Conclusion Although the study was limited due to the small number of patients with a short follow-up, endoscopic decompression was a safe and effective technique for surgery in CM type 1 patients.

Establishing Safe Surgical Parameters for Placement of C2 Pedicle Screws: A Retrospective Study.

BACKGROUND: The study aimed to evaluate the safety and feasibility of transpedicular instrumentation for the C2 vertebra and to establish the precise anatomical parameters and boundaries within which this procedure can be safely and effectively performed. METHODS: This retrospective study analyzed 66 patients who underwent C2 transpedicular screw fixation. Preoperative and postoperative axial, sagittal, and coronal computed tomography (CT) scans were examined. Anatomical measurements were taken to determine the horizontal and vertical distances from the C2 pedicle projection to the vertebral foramen using CT images. Based on the anatomical location of the vertebral artery within the C2 vertebral foramen, the patients were divided into four subgroups using the horizontal pedicle width (HPW) and vertical pedicle width (VPW) of the C2 spine. RESULTS: The average age of the patients included in the study was 46.48 years. The patient population comprised 32 (48.5%) males and 34 (51.5%) females. Based on the anatomical measurements, the distribution of C2 vertebra types was as follows: type 1 accounted for 68.9%, type 2 for 3.8%, type 3 for 16.7%, and type 4 for 10.6%. Significantly narrower pedicle widths were observed in types 2 and 4 compared to other vertebra types. Type 2 had the largest medial angle (MA), while type 4 had the narrowest MA. In terms of the sagittal plane, type 4 exhibited the widest MA and type 3 had the narrowest MA, but these differences were not statistically significant. Among the cases, 12 (18.1%) involved the vertebral foramen, with 1 case (8.3%) showing screw-related vertebral artery injury (0.75% of all screws). No vertebral artery injuries were observed with the other transpedicular screws. CONCLUSION: Preoperative anatomical measurements for patients undergoing transpedicular instrumentation on the C2 vertebra should include planning CT images on three planes: axial, sagittal, and coronal.

Fusiform aneurysms of anterior cerebral artery: center experience and systematic literature review.

Fusiform aneurysms of the anterior cerebral artery (ACA) are uncommon, and the natural history of this entity is poorly characterized. Along with our center experience, we conducted a systematic literature review to help shed light on the clinical course of ACA fusiform aneurysms. We queried our institutional database to identify cases with fusiform aneurysms of ACA. In addition, following the PRISMA algorithm, we identified all reported cases published in the English literature from the inception of PubMed until December 2022. We categorized clinical presentations into three categories: (i) traumatic/iatrogenic, (ii) spontaneous symptomatic ruptured/unruptured, and (iii) spontaneous asymptomatic aneurysms. We utilized descriptive statistics. We identified seven cases from our center along with 235 patients from published literature. Blunt trauma was responsible for the development of 19 aneurysms. Sixty-three percent of these aneurysms tend to rupture within 2 weeks from the initial trauma, and despite treatment, only 74% of these patients had good clinical outcomes. Spontaneous symptomatic presentation occurred in 207 patients and was often associated with previous/concomitant ACA dissection. Subarachnoid hemorrhage from ruptured aneurysms was the most common presentation. Spontaneous symptomatic fusiform aneurysm is rapidly evolving lesions, and treatment is necessary. Three of our own cases were treated with an endovascular flow diverter (pipeline) stenting with good outcomes. Spontaneous asymptomatic aneurysms were reported in nine patients. These lesions are often associated with other vascular abnormalities. Treatment included surgical clipping with good clinical outcomes. Instead, four patients from our center database were managed conservatively with equally good outcomes. Our study demonstrates good clinical outcomes when fusiform aneurysms of ACA, especially when symptomatic, are treated promptly with either reconstructive or deconstructive therapies.

The influence of stereotaxic lesions of claustrum on motor movements and behaviour in rats.

BACKGROUND: This study aimed to expand our existing information on changes in the regulation of motor movement and behaviour by investigating the effects of unilateral and bilateral lesions on the claustrum (CL). MATERIAL AND METHODS: 36 Wistar Albino adult male rats were randomly divided into six groups. An electrical lesion was created with a constant current source in the unilateral and bilateral anterior clastrum using a stereotaxic frame in rats. The lesioned groups and the control group underwent an automatic behaviour recording device such as mobilisation, freezing, eating, drinking behaviour, grooming, turning, etc. behaviour was recorded and analysed. Simultaneously, ultrasonic sounds in rats were examined with ultrasonic sound recording program. Anxiety was then reassessed with the elevated plus maze test. Data were compared with the control group. Rats were eventually sacrificed and the brain tissue was post-fixed. Histochemical examination was done and lesions' existence was confirmed. RESULTS: In this study, lesions of ventral of CL can cause increase in spontaneous behaviours such as freezing and rearing. And, it has been shown to cause a statistically significant change. In addition to the behavioural changes, right CL lesions have caused a significant increase in drinking behaviour associated with increased anxiety. All operated groups showed a significant decrease in clockwise and counterclockwise rotation movements. CONCLUSION: Experimental results show that CL lesions influence spontaneous behaviour which indicate the need for new studies to understand the role of CL in anxiety-depression.

The influence of glioblastoma on patients' cognitive and demographic characteristics and psychological well-being of patients and caregivers: a single-centre retrospective study.

BACKGROUND: Glioblastoma, the most aggressive primary brain tumour in adults, poses significant challenges for patients and their caregivers. This study investigates a range of clinical parameters, such as symptoms, tumour characteristics, presence of seizures, mental status, and depression/anxiety, in glioblastoma patients. The rapid deterioration of physical and cognitive functions experienced by patients can have profound effects on both patients and their relatives throughout the course of the disease. The objective of this study was to examine and compare psychological symptoms between glioblastoma patients and their relatives. MATERIALS AND METHODS: The study included 98 adult patients with glioblastoma who underwent pre- and postoperative cognitive assessments using the Mini-Mental State Examination (MMSE). The Hospital Anxiety and Depression Scale (HADS) was also used to evaluate and compare psychological symptoms of patients and their relatives over time. Seizures were seen in 45.9% of patients, and the mean age of the patients was 60.1 ± 13.8 years. The patients were evaluated at various time intervals before and after surgery, and the data were retrospectively analyzed. RESULTS: The study found that before surgery, the anxiety levels of caregivers were significantly higher than those of patients during all evaluation periods. Additionally, the depression scores of caregivers were significantly higher than those of patients only in the first month following the operation. There were no significant differences in depression scores between patients and caregivers in the other assessment intervals. The average cognitive level of patients, as assessed by the MMSE scale was 22.4 before the operation and 20.9 after the operation. CONCLUSION: Glioblastoma has a significant impact on the mental health and emotional well-being of both patients and their relatives. This study highlights the importance of providing early support to both patients and their relatives before surgery. The study's strength is that it focuses on an early time point, prior to surgery, where both patients and their relatives are already affected and may require additional support. The results of this study can help healthcare professionals to better understand the psychological impact of glioblastoma and provide more targeted support to patients and their caregivers.

High-resolution MRI to noninvasively characterize drainage around the carotid artery into the cervical lymph nodes.

BACKGROUND AND PURPOSE: Previous studies have proposed multiple parallel channels for waste clearance from the brain, though many gaps remain in our understanding of these systems. In this study, we examined periarterial fluid drainage around intracranial and extracranial segments of the internal carotid arteries (ICAs) from the brain into the cervical lymph nodes using a noninvasive and clinical-based method. METHODS: Eighty-one subjects (45 females, aged 15-80 years old) with nonlesioned epilepsy underwent high-resolution 3-dimensional T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI. We utilized a noninvasive and clinical-based method with a manual semiautomated approach to characterize the periarterial lymphatic system's maximum thickness and signal intensities along the ICAs using high-resolution 3-dimensional FLAIR imaging. We conducted group comparisons and correlation analyses to investigate sex- and age-based trends. Results were corrected with Bonferroni's test for multiple comparisons, and we performed power analysis for sample size calculations. RESULTS: Using high-resolution FLAIR images, we show evidence that fluid drainage emerges around the ICA petrous segment and joins lymphatic flow from cranial nerves in the upper neck, with this flow ultimately draining into the cervical lymph nodes bilaterally. Lymphatic signal at the petrous segment level was significantly thinner in females compared to males bilaterally (w = 413, p = .0001 on the right, w = 356, p < .0001 on the left). Lymphatic drainage around the petrous segments of the ICAs bilaterally was thicker with age in males but not in females. CONCLUSIONS: We describe the in vivo high-resolution imaging characteristics of periarterial fluid drainage along the vessel walls of ICAs. This represents a potentially major channel for brain waste clearance. We also report interesting sex- and age-based trends in these structures within our cohort.

Nonfunctioning Pituitary Adenomas Are Really Clinically Nonfunctioning? Clinical and Endocrinological Symptoms and Outcomes with Endoscopic Endonasal Treatment.

BACKGROUND: Nonfunctioning pituitary adenomas are the most common pituitary adenomas in adults and cause significant morbidity unless adequately treated. METHODS: This study retrospectively assessed the medical records of 160 patients operated via pure endonasal endoscopy. The presenting symptoms, results of neurologic and visual examinations, levels of pituitary hormones, results of radiologic examinations, size of the adenoma, rates of resection, results of postoperative visual examination, and pituitary hormone levels at follow-up were recorded to establish the appropriate approach, operative criteria, and outcomes of patients with nonfunctioning pituitary adenoma. RESULTS: Headache was the presenting symptom in 87.5% of the patients. Thirty-three percent had visual loss, and visual examinations on the whole study population revealed a visual field defect in 47.5% of the patients. Only 16.25% of the patients presented with endocrinological symptoms; 52.5% had abnormal anterior pituitary hormone levels. Regarding adenoma size, 56 patients had macroadenoma (35%), 84 (52.5%) had mesoadenoma, and 20 patients had giant adenoma. Gross total resection was achieved in 90% of the patients; subtotal resection was achieved in the remainder. The rate of total resection was lower for giant adenomas and recurrences. Visual symptoms and anterior pituitary hormone levels improved in 27 and 42 patients, respectively, after the operation. CONCLUSIONS: Nonfunctioning pituitary adenomas present frequently as mesoademonas and giant adenomas. Patients with these tumors may have subclinical visual or hormonal deficits at the time of diagnosis. Early and effective surgical treatment is essential for rapid recovery of visual and/or hormonal deficits, particularly in symptomatic cases.

In Vitro Fertilization, Levels of Pro-Inflammatory Factors and Lipid Peroxidation.

BACKGROUND: Infertility is a problem concerning 10-15% of the individuals in the fertile period. This study investigated effects of proinflammatory factors as well as lipid hydroperoxides (LPO) levels upon in vitro fertilization (IVF) success. MATERIALS AND METHODS: In this prospective, non-randomized, controlled clinical study, sera obtained from 26 fertile (group-1), 26 infertile women before (group-2) and after (group-3) IVF treatment were analyzed. Leptin, leptin receptor, resistin, tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) were analyzed using enzyme-linked immunosorbent assay (ELISA). LPO was determined spectrophotometrically. Mann- Whitney U test, paired samples t test, Wilcoxon signed-rank test as well as Pearson correlation analysis by SPSS were performed for statistical analysis. RESULTS: TNF-α, resistin and LPO levels increased (P=0.020, P=0.003, P=0.001, respectively) in group-3 compared to group-2. A significant increase in LPO was noted both in group-2 and -3 compared to controls (P=0.000). LPO were higher in non-pregnants than pregnants in group-2. For pregnants, significant correlations were observed between leptin and resistin in group-2 and TNF-α and leptin in group-3. None of these correlations were found for the women, who could not conceive. CONCLUSION: LPO, leptin-resistin correlation, associations with TNF-α may be helpful during the interpretation of IVF success rates.

Pure endoscopic endonasal removal of unusual anterior skull base aneursymal bone cyst extending to the frontal lobe.

Aneurysmal bone cysts (ABCs) are benign, nonneoplastic, hemorrhagic, and expansile osseous lesions that present most frequently at age younger than 20 years. Aneurysmal bone cysts typically involve long bones of extremities, thorax, pelvis, or spinal column. Skull base involvement is very rare. The authors report the case of a 23-year-old woman with ABC of the skull base and total removal of lesion with pure endoscopic endonasal approach. The patient had presented with nasal obstruction for 6 months. Physical and neurological examination findings were normal except for bilateral anosmia. Cranial magnetic resonance imaging (MRI) revealed a tumor occupying ethmoid sinuses anterior skull base that extended into bilateral frontal lobes. The patient underwent pure endoscopic endonasal surgery, and the tumor was resected gross-totally. Histologic examination revealed ABC. Consequently, ABC should be considered in differential diagnosis of skull base pathologies. Endoscopic endonasal surgical approach is a safe, minimally invasive, and effective way in the treatment of these tumors.

Endoscopic endonasal optic nerve decompression in a patient with pseudotumor cerebri.

Pseudotumor cerebri (idiopathic intracranial hypertension) is a syndrome characterized by intracranial pressure elevation and associated signs and symptoms in the absence of a space-occupying intracranial lesion. The most common symptoms are visual loss and headache. Sometimes, surgical therapy is needed in patients who have no apparent response to medical therapy and exhibit a progressive course. Optic nerve decompression is an effective and recommended treatment approach for patients with pseudotumor cerebri in whom visual loss predominates. With the growing experience with endoscopic skull base approaches, this method has begun to be used as an alternative and effective treatment modality. In this study, we aimed to present the outcome of endoscopic endonasal optic nerve decompression and to review the literature on this treatment modality in 2 patients diagnosed with pseudotumor cerebri that was unresponsive to medical therapy and associated with progressive visual loss.

Association of fetuin A, adiponectin, interleukin 10 and total antioxidant capacity with IVF outcomes.

BACKGROUND: Possible roles of anti-inflammatory factors as well as total antioxidative capacity in reproductive processes of women undergoing in vitro fertilization (IVF) are still being investigated and the contributions by some of them remain controversial. OBJECTIVE: The aim of this study is to investigate the relationship between anti-inflammatory parameters and total antioxidative capacity (TAC) of the body during IVF. In this respect, adiponectin, interleukin-10 (IL-10), interleukin-1 receptor antagonist (IL-1RA), fetuin A and TAC analyses have been performed. MATERIALS AND METHODS: In this prospective, non-randomized, controlled clinical study, sera obtained from 26 fertile (Group-1), and 26 infertile women before (Group-2) and after (Group-3) IVF treatment were analyzed. IL-1RA, IL-10, fetuin A, adiponectin and insulin were determined by ELISA. TAC was determined spectrophotometrically. Mann-Whitney U test, paired sample t-test, Wilcoxon signed-rank test as well as Pearson correlation analysis by SPSS were performed for statistical analysis. RESULTS: Clinical pregnancy and live birth rates were determined as 30.8% and 23.1%, respectively, in pregnant group. For the pregnant, significant indirect correlations were detected between fetuin A and adiponectin (r=-0.843; p=0.035) as well as IL-10 (r=-0.846; p=0.034) in Group 2. The correlation between adiponectin and IL-10 doubled in pregnant compared to non-pregnant (r=0.929; p=0.007 vs. r=0.478; p=0.033). The correlations between fetuin A and TAC in pregnant were noted both in Group 2 (r=0.892; p=0.017) and Group 3 (r=0.875; p=0.022). No correlation of fetuin A with these parameters was detected in non-pregnant group. CONCLUSION: Fetuin A, TAC, IL-10, adiponectin and their associations may be important from their predictive values for IVF success point of view. Parameters with anti-inflammatory or antioxidant property appear to improve pregnancy in women undergoing IVF.

Assessment of CSF flow dynamics using PC-MRI in spontaneous intracranial hypotension.

AIM: Spontaneous intracranial hypotension (SIH) is caused by spontaneous cerebrospinal fluid (CSF) leaks and is known to cause orthostatic headaches. Phase-contrast magnetic resonance imaging (PC-MRI) is a non-invasive technique that can be used to quantify variation in CSF flow. The aim of this study was to assess CSF flow dynamics using PC-MRI in SIH. MATERIALS AND METHODS: Twenty-five patients with a definitive diagnosis of SIH and 25 healthy subjects were evaluated with PC-MRI. Magnetic resonance (MR) images were acquired using a 1.5-T unit with an 8-channel head coil. Differences between SIH patients and control subjects were assessed statistically using Wilcoxon's rank sum test, Spearman's rho test, or Pearson's chi-square test, as appropriate. RESULTS: CSF flow volumes toward the third ventricle, CSF flow volumes toward the fourth ventricle, the absolute stroke volume, the peak systolic velocity, and the peak diastolic velocity in SIH patients were significantly smaller than those in control subjects (P < .0001). On the other hand, the net CSF flow volume (P = .9227) and the net CSF flow direction (P = .2472) for SIH patients and control subjects were not significantly different. CONCLUSIONS: The results obtained by CSF flow analysis were directly related to values of CSF opening pressure, determined by lumbar puncture, and clinical findings, such as headache scores. Thus, CSF flow analysis with PC-MRI, which has a short performance time and is non-invasive, may contribute to assessment of SIH patients.

Spontaneous intracranial hypotension due to intradural thoracic osteophyte with superimposed disc herniation: report of two cases.

Spontaneous intracranial hypotension (SIH) is a clinical syndrome in which absolute or relative hypovolemia of the cerebrospinal fluid (CSF) results in various neurological symptoms. The etiology of spontaneous CSF leaks often remains unknown. However, it is believed that the most common cause is the fragility of spinal meninges at the level of radicular nerve root sleeve. These tears can be spontaneous (primary) or secondary. Spinal pathologies can cause this tear with resultant CSF leak and SIH, which include spinal trauma, degenerative diseases and spinal surgery. Uncommonly, SIH is developed by osteophyte with disc herniation without any other pathology. In this article, we reported two cases of SIH secondary to spinal dural tear due to intradural thoracic osteophyte with superimposed disc herniation, with the absence of other pathologies, which were treated successfully with epidural blood patch (EBP).

Diffusion-weighted imaging findings in brain death.

INTRODUCTION: The purpose of the present study was to determine the role of diffusion-weighted imaging (DWI) and to investigate the use of DWI in the diagnosis of brain death (BD). METHODS: We prospectively evaluated 22 patients diagnosed with clinical BD (9 women, 13 men; mean age, 39.63 ± 15.1 years; age range, 9-66 years). All clinical criteria for BD were present in all 22 patients before magnetic resonance imaging, including a positive apnea test. For all cases, DW images, T2-weighted images, and fluid-attenuated inversion recovery were obtained. Thirteen distinct neuroanatomical structures were selected for analysis in all the cases. For each region of interest, the mean, standard deviation, and range of the average apparent diffusion coefficient (ADCav) values were obtained. RESULTS: For BD patients, ADC values in all neuroanatomical structures were significantly lower than those for control subjects. We determined how ADC values in all structures were related to the diagnostic condition as well as the appropriate threshold ADC values to classify a subject as BD or control. The sensitivity, specificity, positive and negative predictive values, and correct classification rate of ADC cutoff values to distinguish BD from control groups were 100%. CONCLUSIONS: DWI might be used as a noninvasive confirmatory test for the diagnosis of BD in the future.