Evaluation of Intraventricular/Intrathecal Antimicrobial Therapy in the Treatment of Nosocomial Meningitis Caused by Multidrug-Resistant Gram-Negative Bacteria after Central Nervous System Surgery.

INTRODUCTION: Postoperative meningitis (POM) is an infection with high mortality and morbidity following central nervous system surgery due to trauma or tumor. Intrathecal/intraventricular (IT/IVT) antibiotic administrations have been considered as the last treatment options for multidrug-resistance (MDR) Gram-negative bacteria that do not respond to intravenous (IV) regimens. IT/IVT can bypass the blood-brain barrier, obtain a more effective antibiotic concentration in CSF, and reduce systemic side effects. We aimed to determine the characteristics of postoperative patients who were diagnosed with MDR POM during follow-up in our intensive care unit (ICU). Material and Methods. In this study, POM patients who were followed up in ICU after the central nervous system intervention between January 2016 and December 2019 and whose MDR Gram-negative bacteria were isolated from CSF were evaluated. As soon as the patients were diagnosed with POM, a catheter was inserted and treatment was started. RESULTS: Microbiological eradication was achieved in 3 ± 0.8 days with 30 mg/day amikacin treatment in POM due to K. pneumoniae and 3.7 ± 1.95 days with colistin sodium 10 mg/day treatment in POM due to A. baumannii via IT/IVT catheter. IT/IVT treatment was utilized for a median of 10 days and continued until the defined cure criteria were achieved. While cure was achieved in 6 of 14 POM cases, 8 of them were exitus. Discussion and Conclusion. To avoid the severe consequences of postoperative meningitis, acting fast and adding IT/IVT methods to parenteral administration routes by considering the distribution of MDR microorganisms within the hospital while planning effective treatment will increase the clinical success.

A rare case of cervical metastatis of glioblastoma after cranial tumor resection: case report and review of literature.

Glioblastoma multiforme (GBM) is the most common and the most malignant primary intracranial tumor in adults. GBM extraneural metastases occur in only approximately 0.2-0.4% of patients. We present a case of a cervical metastasis of glioblastoma after cranial tumor resection. In concord with case presentation, we reviewed the metastatic location and metastasis time of the gliablastomas seen in the literature.

High-resolution diffusion tensor magnetic resonance imaging of the brainstem safe entry zones.

Operative management of intrinsic brainstem lesions remains challenging despite advances in electrophysiological monitoring, neuroimaging, and neuroanatomical knowledge. Surgical intervention in this region requires detailed knowledge of adjacent critical white matter tracts, brainstem nuclei, brainstem vessels, and risks associated with each surgical approach. Our aim was to systematically verify internal anatomy associated with each brainstem safety entry zone (BSEZ) via neuroimaging modalities commonly used in pre-operative planning, namely high-resolution magnetic resonance imaging (MRI) and diffusion tensor tractography (DTT). Twelve BSEZs were simulated in eight, formalin-fixed, cadaveric brains. Specimens then underwent radiological investigation including T2-weighted imaging and DTT using 4.7 T MRI to verify internal anatomic relationships between simulated BSEZs and adjacent critical white matter tracts and nuclei. The distance between simulated BSEZs and pre-defined, adjacent critical structures was systemically recorded. Entry points and anatomic limits on the surface of the brainstem are described for each BSEZ, along with description of potential neurological sequelae if such limits are violated. With high-resolution imaging, we verified a maximal depth for each BSEZ. The relationship between proposed safe entry corridors and adjacent critical structures within the brainstem is quantified. In combination with tissue dissection, high-resolution MR diffusion tensor imaging allows the surgeon to develop a better understanding of the internal architecture of the brainstem, particularly as related to BSEZs, prior to surgical intervention. Through a careful study of such imaging and use of optimal surgical corridors, a more accurate and safe surgery of brainstem lesions may be achieved.

Spontaneous regression of herniated nucleus pulposus: The clinical findings of 76 patients.

Lumbar disc hernia is common disease, affecting about 5% of the population. Many studies to date reported regression of disc herniation without surgical intervention.Medical records of the patients who applied to the spine clinic in an outpatient setting were retrospectively reviewed. Age, sex, radiological findings, neurological examinations, and medical treatments of the patients were evaluated.Male patients constituted 52.6% of the cases (n = 40) and 47.4% (n = 36) were female. The ages of the patients ranged from 25 to 82 years, with a mean of 48.5 ±â€Š12.1 years. Visual analog scale (VAS) measurements ranged from 0 to 8 and the mean was determined as 2.65 ±â€Š1.98. The VAS score of pain severity of 12 (15.78%) cases was 0, VAS score of 39 (51.31%) cases was 1 to 3, VAS score of 20 (26.31%) cases was 4 to 6, VAS score of 5 (6.57%) cases was 7 to 10. Eighteen (23.68%) of the cases underwent neuropathic pain treatment for more than 6 months. Fifteen (19.7%) patients also developed permanent motor deficits.Findings of our study show that there was no direct association between radiological improvement and clinical improvement. Indication for surgery still existed in a high number of patients, substantial of which developed permanent motor deficits. Current results suggest that we need to advise our patients in favor of early surgery as soon as indication for surgery is established upon neurological and radiological examination.

Morphometric Assesment of the External Anatomy of Fourth Ventricle and Dorsal Brainstem in Fresh Cadavers.

AIM: To investigate the external anatomy of the fourth ventricle and dorsal brainstem using morphometric data, which could be useful for preoperative surgical planning. MATERIAL AND METHODS: Between January 2017 and December 2017, 42 fresh adult cadavers were investigated for the measurements of the cadaver brainstems and fourth ventricle, and they were recorded by photography. Measurements were evaluated according to body mass indexes (BMIs) of the patients. We also investigate the visualization of facial colliculus and stria medullaris on brainstem. RESULTS: A total of 42 fresh cadavers with a mean age of 45.38 ± 16.41 years old were included in this research. We found no statistically significant difference between measurements and BMIs. Facial colliculus was visualized in 92.9% (n=39), but it could not visualized in 7.1% (n=3) of the subjects. When the right side of the stria medullaris was examined, one bundle was seen in 59.5% (n=25) of the subjects, two bundles were seen in 31% (n=13) of the subjects, and 3 bundles were seen in 9.5% (n=4) of the subjects. When the left side of the stria medullaris was examined, one bundle was seen in 57.1% (n=24) of the subjects, two bundles were seen in 33.3% (n=14) of the subjects, and three bundles were seen in 9.5% (n=4) of the subjects. CONCLUSION: Knowledge of the normal morphometry of the dorsal brainstem as it has been reported in this study will help one to assess distortions in any preoperative imaging studies and surgical planning.

Neuroprotective effects of hemicraniectomy in malignant middle cerebral artery infarctions: experimental study.

BACKGROUND: Despite optimal medical therapy the mortality rate approaches 50% in MCA infarctions. Although recent studies have been showed life-saving effect of hemicraniectomy; there are a few data available in regard to neuroprotection effect of decompressive craniectomy (DC). We induced a malignant cerebral ischemia model by intraluminal permanent middle cerebral artery occlusion (MCAo) in male rats for defining the neuroprotective effects of early DC on brain-blood barrier (BBB) molecular changes, infarct size and cerebral edema. METHODS: A total of 48 male Spraque-Dawley rats were allocated to 4 groups; sham (N.=9), control (N.=9), experiment 1 (N.=15), experiment 2 (N.=15). DC was performed by creating a bone flap, after MCAo at 4 and 24 hours. After 28 hours of survival, all animals were sacrificed. Infarction volumes were calculated from TTC (2,3,5-triphenyl-2H-tetrazolium chloride)-stained brain sections. In all groups, cerebral edema was quantified as a change in the percentage of brain water content. Western Blot was used to analyze the expression of tight junction protein claudin-5 and occludin. RESULTS: Brain water content was calculated 75.18±0.75% in the early DC group and 77.76±0.71% in the late DC group. No significant difference was found between experiment groups (P=0.178). In the early DC group; occludin and claudin-5 were significantly expressed at higher levels compared to late DC group (occluding, P=0.013; claudin-5, P=0.034). At early DC group (73.38±23.11 mm3) the final infarct volumes were significantly smaller than in the late DC group (377.18±39.23 mm3) (P=0.013). CONCLUSIONS: The study results supported the neuroprotective effects of early DC in malignant MCA infarcts.

Spinal paragangliomas: Surgical treatment and follow-up outcomes in eight cases.

Paragangliomas are neuro-endocrine tumors originating from the adrenal gland. They are usually benign and nonfunctioning, rarely seen in central nervous system. More than 90% of central nervous system paragangliomas are manifested as carotid and glomus jugulare tumors. Spinal paragangliomas are quite rare.The study was conducted through retrospective analysis of the files of the patients who had undergone surgery with pre-diagnosis of spinal intradural tumor between 2011 and 2017 and diagnosed with paraganglioma.A total of 8 patients (4 females and 4 males) were included in the study. Mean age of the patients was 51.1 years (28-64). Time to admission was mean 6.5 months (3 weeks-24 months). Recurrence was not observed in 7 patients, 1 patient is being followed up due to residual tumor.Treatment may be achieved through recognizing malignant transformation in patients who were not diagnosed histopathologically. We consider that quality of life of the patients may be improved through this way.

Additional Surgical Method Aimed to Increase Distractive Force during Occipitocervical Stabilization : Technical Note.

OBJECTIVE: Craniovertebral junctional anomalies constitute a technical challenge. Surgical opening of atlantoaxial joint region is a complex procedure especially in patients with nuchal deformity like basilar invagination. This region has actually very complicated anatomical and functional characteristics, including multiple joints providing extension, flexion, and wide rotation. In fact, it is also a bottleneck region where bones, neural structures, and blood vessels are located. Stabilization surgery regarding this region should consider the fact that the area exposes excessive and life-long stress due to complex movements and human posture. Therefore, all options should be considered for surgical stabilization, and they could be interchanged during the surgery, if required. METHODS: A 53-year-old male patient applied to outpatients' clinic with complaints of head and neck pain persisting for a long time. Physical examination was normal except increased deep tendon reflexes. The patient was on long-term corticosteroid due to an allergic disease. Magnetic resonance imaging and computed tomography findings indicated basilar invagination and atlantoaxial dislocation. The patient underwent C0-C3-C4 (lateral mass) and additional C0-C2 (translaminar) stabilization surgery. RESULTS: In routine practice, the sites where rods are bound to occipital plates were placed as paramedian. Instead, we inserted lateral mass screw to the sites where occipital screws were inserted on the occipital plate, thereby creating a site where extra rod could be bound. When C2 translaminar screw is inserted, screw caps remain on the median plane, which makes them difficult to bind to contralateral system. These bind directly to occipital plate without any connection from this region to the contralateral system. Advantages of this technique include easy insertion of C2 translaminar screws, presence of increased screw sizes, and exclusion of pullout forces onto the screw from neck movements. Another advantage of the technique is the median placement of the rod; i.e., thick part of the occipital bone is in alignment with axial loading. CONCLUSION: We believe that this technique, which could be easily performed as adjuvant to classical stabilization surgery with no need for special screw and rod, may improve distraction force in patients with low bone density.

Intraventricular Gadoteric Acid Intoxication: First Report.

BACKGROUND: Gadolinium-based contrast agents are relatively safe for use in magnetic resonance imaging (MRI) of nervous system pathology. Few reports have been reported regarding the severe adverse effects. These are mostly mild anaphylactoid reactions, especially in the vulnerable group. CASE DESCRIPTION: We report a case of an adverse effect of gadoteric acid concerning the misuse as intraventricular administration. To our knowledge, this is the first report related to intraventricular spillage and its results. A 38-year-old male patient with a complaint of headache and drowsiness was admitted to the hospital, after which cranial MRI revealed that he had a posterior fossa mass. An operation was performed with the catheterization of the lateral ventricule as a safety device at the beginning, and later mass was evacuated gross totally. Frozen pathology result showed the tumor was medulloblastoma. On the first postoperative day a control contrasted cranial and total spinal MRI was planned. He was observed to have a tonic-clonic generalized seizure soon after returning to the ward. After giving the acute management with antiepileptics, the patient was stabilized and it was recognized that the patient was administered contrast media by the intraventricular route. Symptomatic treatment and cerebrospinal fluid irrigation by external ventricular drainage helped the patient's improvement. After a week his symptoms were relieved and he had no complications during outpatient controls. CONCLUSIONS: In addition to formal basic supportive treatment, cerebrospinal fluid irrigation of the toxic contrast material is the best management method in case of such an unexpected misadministration of gadoteric acid.

Assessment of the neuroprotective effects of the acetylcholinesterase inhibitor huperzine A in an experimental spinal cord trauma model.

BACKGROUND: Spinal cord injury is nowadays still a challenging disease, and a treatment option aimed at the primary site of injury does not currently exist. Therefore, the management of acute spinal cord injury has recently focused on the reasons behind the aggravation of the initial insult through secondary mechanisms, and the search for pharmacological treatment protocols is generally aimed at reducing and minimizing the neural injury and neurological sequela. The secondary spinal cord injury usually develops following a primary lesion induced by spinal cord contusion and the emergence of apoptotic cells has been found to play an important role in the development of secondary injury. We propose that huperzine A may induce a significant reduction in the number of apoptotic cells because it possesses the ability to protect cells against glutamate, ischemia and staurosporine-induced cytotocity and apoptosis. METHODS: Huperzine A was administered intraperitoneally to male Wistar Albino rats (220-340 g of body weight) after moderate static clip compression (70 g for 60 s) of the spinal cord at T7 level. Neurological functions were assessed using the Basso-Beattle-Breshanan (BBB) motor rating scale until 3th and 7th days before perfusion, following which the spinal cord was harvested for histopathological examinations and apoptotic cell counts. RESULTS: Histopathological evaluations of the spinal cord of the control, trauma and huperzine A treated groups were evaluated. Control group showed normal neuronal and vascular structures of the spinal cord. However, in both trauma groups 3rd- and 7th-day perfusion showed extensive cavitation and hemorrhage, areas of necrosis and edema in gray matter, and degeneration in motor neurons along with patchy areas of necrotic and apoptotic cells. In the group treated with huperzine A, an increased number of normal cells was observed, along with a lower number of necrotic cells, with a significant reduction in the apoptotic cells (P<0.01). The administration of huperzine A improved post-trauma motor performance. Furthermore, BBB scores of all groups showed that there was an improvement of locomotor abilities in the treatment group as compared with the control. CONCLUSIONS: When compared with controls, huperzine A treatment demonstrates a significant reduction in the number of apoptotic cells. In addition, the group treated with huperzine A showed significant and appreciable neurological improvement in rats.

What do we know about ALARA? Is our knowledge sufficient about radiation safety?

BACKGROUND: The aim of this study was to determine the knowledge of neurosurgeons and emergency physicians about ALARA (as low as reasonably achievable) and to gain awareness to them about this topic. METHODS: A multiple-choice survey comprising 17 questions was performed to 30 neurosurgeons and 70 emergency room doctors. RESULTS: Emergency medicine doctors, neurosurgeons, emergency medicine residents, neurosurgery residents and general practitioners participated in the survey. Sixty-six percent of participants stated that they examined more than 50 patient with headache, dizziness and head trauma in emergency service per diem and more than half of the participants stated that brain CT was performed in the event of patient's request, even if there was not an indication. 75% of the participants stated that they requested CT scan without neurological examination when the number of patients increased in the emergency room. Eighty-three percent of the participants did not think there was a safe dose limit in CT, 92% did not know the radiation dose received during brain CT, 96% did not know the meaning of the ALARA. Fifty-seven percent of the participants stated that if they informed about the criteria of ALARA, they will take into acount these criteria while requesting CT scan. CONCLUSIONS: In our country, doctors working in emergency services request brain CT needlessly because of taking into account the patient's wish and fear of malpractice. The knowledge of the neurosurgeons and emergency service doctors about ALARA is insufficient. It is necessary to educate our physicians about ALARA protocol, for taking these criteria into their consideration when requesting CT examination. For protecting the patients from the effects of ionizing radiation and reducing the economic loss of hospitals, it is necessary to increase awareness of the ALARA protocol and to increase the number of hospitals which protocol is applied.

Intracranial intraventricular tumors: long-term surgical outcome of 25 patients.

BACKGROUND/AIM: The aim of this paper is to provide the long-term surgical outcome of patients with intracranial intraventricular tumors. MATERIALS AND METHODS: Twenty-five patients operated on for intraventricular tumors between June 1999 and June 2014 are reviewed. Data from before, during, and after surgery were obtained from the patients' files and patients were followed regularly after surgery. RESULTS: The group of patients comprised 15 females and 10 males with a mean age of 31.6 ± 16 years. The majority were adults and only 3 children were included. Three, 4, and 18 patients had tumors in the 4th, 3rd, and frontal horn of the lateral ventricles, respectively. All patients showed a varying degree of hydrocephalus and headache was the most common presenting symptom. Overall, central neurocytoma was the most common pathological diagnosis. Complications were found in only 4 patients and, in long-term follow-up, 3 patients had died due to the malignant nature or upgrading to a malignant tumor and the rest were alive. CONCLUSION: Total removal of the intraventricular tumor increases survival because the majority of these tumors are benign and slow-growing. The type of surgical intervention should be chosen according to the location of the tumor in the ventricular system.

Expression of miRNA-21, miRNA-107, miRNA-137 and miRNA-29b in meningioma.

OBJECTIVE: Meningiomas are among the most common intracranial tumors, accounting for 30% of all tumors of the central nervous system. Recent studies analyzing microRNA (miRNA) profiles and functions in cancer have provided valuable information about the molecular pathogenesis of several tumor types, including glioblastoma multiforme (GBM), hepatocellular carcinoma, and breast, lung, colon, and prostate cancer. miRNAs are a family of small, endogenous, noncoding RNAs of 18-25 nucleotides. In this study, we carried out a genome-wide array screen comparing miRNA-21, miRNA-107, miRNA-137 and miRNA-29b expression in meningiomas. PATIENTS AND METHODS: A total of 50 meningioma patients (16 men and 34 women) aged between 32 and 80 years were included. The study was conducted at Istanbul Research and Training Hospital Neurosurgery Clinic. RESULTS: Our results have shown a significant increase in miRNA-21 expression with increasing histopathologic grade, while there was a significant reduction in miRNA-107 expression with the increasing histopathological grade. miRNA-137 and miRNA-29b expression did not differ significantly according to histopathologic grade. CONCLUSION: The subject of our study, i.e. the association between miRNA expression and meningioma, is continuously gaining more importance in the wider context of the recent developments in genetic treatments.

Neuroprotective Effects of Chronic Fenofibrate Treatment via Modulating the Immunoreactivity of Cleaved Caspase-3 in Stroke Induced by Transient Middle Cerebral Artery Occlusion Rat Model.

AIM: Current stroke therapies include lipid-lowering drugs, which reduce inflammation and serve to stabilize the atherosclerotic plaque to demonstrate better outcome and neuroprotection. Peroxisome proliferator activated receptors (PPAR) ? regulates lipid homeostasis and is a target of fibrates, which have a neuroprotective function by various mechanisms. In this study, we aimed to evaluate the role of the PPAR? agonist, fenofibrate, in the modulation of cleaved caspase-3 immunoreactivity and at the final infarct volume in an experimental ischemia/reperfusion rat model by induced transient proximal middle cerebral artery occlusion. MATERIAL AND METHODS: A total of 65 male Sprague Dawley rats were allocated into 4 groups; sham (n =5), experiment 1 (n=20), experiment 2 (n=20), experiment 3 (n=20). All experiment groups were divided to 3 subgroups in order to evaluate the final infarct volume at 24th hour (n=5) and the immunoreactivity of cleaved caspase -3 at different time periods [at first hour (n=5), at 6th hour (n=5), at 24th hour (n=5)] after transient middle cerebral artery occlusion (MCAo). At the study, the experiment groups (Experiment 1 and Experiment 2) were received the fenofibrate-diet during 14 days before ischemia procedure. All animals were sacrificed at 24th hours after MCAo. Infarction volumes were calculated from 2,3,5,triphenyltetrozolium chloride (TTC)- stained brain sections. RESULTS: We found that fenofibrate-therapy reduced significantly more body weight than the other experiment groups (p < 0.05). At the time intervals, a decrease of immunoreactivity of cleaved caspase-3 was significantly observed with fenofibrate therapy after MCAo (p < 0.05). Chronic fenofibrate treatment before cerebral ischemia significantly reduced the infarction size after MCAo compared with the other groups (respectively; p = 0.011 and p < 0.000). CONCLUSION: Fenofibrate treatment has neuroprotective effects on middle cerebral artery infarcts.

Effects of 4% Icodextrin on Experimental Spinal Epidural Fibrosis.

AIM: The aim of this experimental study was to investigate whether spinal epidural 4% glucose polymer solution is effective in the prevention of postoperative fibrosis. MATERIAL AND METHODS: Twenty eight adult Wistar albino rats were randomly divided into two equal groups, including treatment and control. Both groups underwent L1 vertebral total laminectomy to expose the dura. Topical treatment group received 4% icodextrin. Four weeks later, epidural fibrosis was examined in both groups histologically, biochemically and macroscopically. RESULTS: Topical use of 4% icodextrin prevented significantly epidural fibrosis following the laminectomy operation. CONCLUSION: Topical 4% icodextrin application inhibits postoperative epidural fibrosis with various mechanisms and prevents adhesions by playing barrier role between tissue surfaces through flotation. Our study is first to present evidence of experimental epidural fibrosis prevention with 4% icodextrin.

The Relationship of Hematoma Growth to Red Blood Cell Distribution Width in Patients with Hypertensive Intracerebral Hemorrhage.

AIM: Hypertension is a primary risk factor for intracerebral hemorrhage (ICH) and is thought to be responsible for about 55% of all ICH cases. Thus, the primary goal of the study was to examine whether the status of vascular rheological factors upon admission to the hospital was associated with hypertensive ICH growth and early outcomes. MATERIAL AND METHODS: Over a 2-year period, the present study evaluated 60 ICH patients who were admitted within the first 12 hours of symptom onset. Brain computed tomography scans were performed at admission and then 24 hours later as a control. Hematoma growth was classified as an volume increase more than 6.5 ml or > 33%, and good outcome was defined using the modified Rankin Scale (mRS) score (? 2 at 3 months). RESULTS: The mean age of the study population was 65.07 ± 11.659 years, with 34 men and 26 women. The leading vascular risk factor was hypertension (86.7%). There were significant associations between the initial red blood cell distribution width (RDW) and hematoma growth (p=0.038). Therefore, hematoma growth in the first 24 hours after symptom onset was significantly related to a poor clinical outcome at 3 months (p = 0.050). CONCLUSION: The study identified significant relationships between the initial RDW and poor outcome as well as the initial RDW and hypertensive hematoma growth. Additionally, this study demonstrated that these parameters are easily obtainable and could be used to effectively evaluate outcomes in ICH patients.

Morphometric Analysis of Lumbar Disc Space in the Turkish Population and Safe Discectomy Distance in Lumbar Disc Surgery.

AIM: Lumbar discectomy is a common surgical intervention in neurosurgical practice. Iatrogenic vascular injury during this surgery is a rare, but serious complication. In this study, our aim was to review the average safe depth of discectomy for both sexes. MATERIAL AND METHODS: This study involved a total of 56 patients between 21 and 79 years old (28 male and 28 female) who had no surgical pathology as documented by lumbar magnetic resonance imaging study. Measurements at L3-4, L4-5, and L5-S1 were performed for both sexes as follows: 1 < sup > st < /sup > measurement, from the furthest lateral part of the dura to the end of the disc (right-left); 2 < sup > nd < /sup > measurement, the anteroposterior length of the cross-section passing through the midline of the disc; 3rd measurement; from the furthest lateral part of the dura to the furthest lateral part of the disc (right-left); 4th measurement, the length from right to left of the cross-section passing through the midline of the disc. RESULTS: Measurement 1 at L3-4, L4-5, and L5-S1, this value was estimated to be 35.9 and 36.7 mm, 35.9 and 36.9, and 34 and 34.9 mm in the right and left sides respectively, for female subjects. The corresponding values for males were 41.4 and 42.1, 40.6 and 40.9, and 37.4 and 37.7 mm at L3-4, L4-5, and L5-S1, respectively. Measurement 3 in L3-4, L4-5, and L5-S1 disc spaces on the right and left sides in female subjects were 14.8 and 16.3 mm, 15.7 and 17.2 mm, and 14.9 and 17.1 mm, respectively, with corresponding figures of 18.6 and 19.5, 19.7 and 20.6, and 18.2 and 18.6 mm among male participants. Measurement 2 and 4 in females for L3-4, L4-5, and L5-S1 were 38.4 and 52.3 mm, 38.9 and 53.4 mm, and 37 and 51.8 mm, respectively. The corresponding figures for males were 43.2 and 57.6 mm, 43.2 and 58.9 mm, and 40.1 and 56.7 mm, respectively. CONCLUSION: Determination of the safe discectomy depth in both males and females, as well as the use of marking disc punches to indicate the safe margins may help clinicians to avoid this unwanted complication.

Polymorphisms in the Matrix Metalloproteinase-9 Promoters and Susceptibility to Glial Tumors in Turkey.

AIM: Evidence suggests an association between MMP-9 functional gene polymorphisms and several tumors. The aim of this study was to investigate the possible role of single-nucleotide polymorphisms (SNP) at MMP-9 R279Q A/G, P574R G/C and R668Q G/A and R668Q (rs17577) genotypes with glial tumors in Turkey. MATERIAL AND METHODS: The present series consisted of tissue samples obtained from 100 cancer-free controls and 100 patients who had undergone glial tumor resection from 2007 to 2011 at the Cerrahpasa Medical Faculty of Istanbul University. Blood samples were collected to extract the genomic deoxyribonucleic acid (DNA) of each subject by polymerase chain reaction (PCR) and DNA sequencing. The genotypes of MMP-9 P574R, R279Q and R668Q SNPs were determined by using the PCR-RFLP assay. Genotypic distributions between patient and control groups were compared for correlations with glial tumor occurrence. RESULTS: SNPs in MMP-9 were not found to be significantly associated with glial tumor risk among participants except R279Q (G-G) which showed high risk only in multivariate analysis (OR adjusted, 3.15 95% CI, 1.10-9.01). The comparisons between the grade of tumor and the genotypic polymorphisms also showed no significant associations in the case group (all p values > 0.05). CONCLUSION: The current study showed a significant association between the R279Q G/G polymorphism and formation of glial tumor in advanced age. Changed protein features may cause triggering of some subcellular mechanisms that may have a role in activating oncogenic processes over the years. These data add to the growing epidemiological and experimental evidence that MMP-9 may play a role in glial tumors.

Pentoxifylline Inhibits Epidural Fibrosis in Post-Laminectomy Rats.

BACKGROUND: The aim of this experimental study was to investigate the effectiveness of intramuscular pentoxifylline in the prevention of postoperative fibrosis. MATERIAL/METHODS: We divided 16 adult Wistar albino rats into 2 equal groups: treatment and control. Both groups underwent L1 vertebral total laminectomy to expose the dura. The intramuscular treatment group received pentoxifylline. Four weeks later, epidural fibrosis was studied in both groups using electron microscopy, light microscopy, histology, biochemistry, and macroscopy. RESULTS: The evaluation of epidural fibrosis in the 2 groups according to macroscopic (p<0.01) assessment and light microscopy revealed that epidural scar tissue formation was lower in the treatment group compared to the control group (p<0.001) and the number of fibroblasts was also decreased significantly in the pentoxifylline-treated group (p<0.05). More immature fibers were demonstrated in the treatment group by electron microscopy in comparison with the control group. In biochemical analysis, a statistically significant decrease was detected in hydroxyproline, which indicates fibrosis and myeloperoxidase activity, and shows an inflammatory response (P<0.001). CONCLUSIONS: Systemic pentoxifylline application prevents postoperative epidural fibrosis and adhesions with various mechanisms. Our study is the first to present evidence of experimental epidural fibrosis prevention with pentoxifylline.