The relationship between sphenoidal sinus and sella turcica morphometry in the Turkish population: a retrospective study.

PURPOSE: The anatomical position of the sphenoidal sinus (SS) is very important for neurosurgeons because of the transsphenoidal approach to the pituitary gland. Therefore, the aim of this study was to determine the volume and shape of the SS and its relationship with the morphometry of the sella turcica. METHODS: This study included CT images of 282 males and 258 females with a mean age of 50.52 years (range 18-75) who underwent head CT. The morphometric values of the sella turcica and the volume of the SS were measured on the included radiologic images. Measurements were made on the sagittal slice closest to the midline in T1 sequence. Morphometric measurements were made with Micro Dicom Viewers software program and volume measurements were made with ITK SNAP software program. RESULTS: In this study, 4 types of SS shapes were obtained in the whole population: amorphous, pentagonal, triangular and quadrilateral. The mean SS volume was 7055.88 mm3 in males and 5694.48 mm3 in females and a statistically significant difference was observed (p < 0.001). In addition, a statistically significant difference was found between the sexes in the width and surface area parameters of the sella turcica (p < 0.05). CONCLUSION: In this study, the morphometric relationship between the shape of the sinus sphenoidale and sella turcica was demonstrated between men and women. In particular, the shape of the sinus sphenoidale was found to be anthropometrically different between men and women in the Turkish population. It is hypothesised that the data obtained in our study will guide surgeons performing transsphenoidal approach.

Low-Cost 3-D-Printer-Assisted Personalized Cranioplasty Treatment: A Case Series of 14 Consecutive Patients.

OBJECTIVE: The current study used polylactic acid molds [developed locally using three-dimensional printers and our software] and polymethyl methacrylate (PMMA) to perform cranioplasty of bone defects in technically demanding areas of the skull while ensuring ideal cosmetic results and functional recovery. The overall aim was to identify the ideal method for standard cranioplasty procedures METHODS: Polylactic acid duplicates of the skull defects were created for eligible patients, after which a two-part negative mold composed of plaster and silicone was used to form artificial bone with PMMA. Thereafter, cranioplasty was performed and the treatment success was assessed by evaluating the percentage of similarity objectively and the body image scale subjectively. RESULTS: No surgical complications were seen to occur in the 14 patients included in the current study. Furthermore, the subjective and objective evaluation revealed a significant improvement in outcomes (p < 0.05). No postoperative complications were observed over a follow-up period of 6 months, except in 1 patient who exhibited late infection. CONCLUSIONS: Cranioplasty operations were performed at an economical price of approximately US$50 dollars, suggesting that this method can be applied widely. Furthermore, preoperative preparation of the PMMA models can help reduce the duration of anesthesia and surgery which, in turn, will minimize the risk of surgical complications. Based on current knowledge in the field, we believe that this method represents the ideal technique.

Shunt Fractures Associated with Intermittent Hydrocephalus: Case Reviews and New Solutions.

OBJECTIVE: Although ventriculoperitoneal shunt surgery is the most common method for hydrocephalus treatment, it may lead to serious complications and require surgical interventions. Peritoneal catheter fracture is one of the common complications that may cause intermittent hydrocephalus. If patients with peritoneal catheter fracture have symptoms of hydrocephalus and ventricular dilatation, the treatment algorithm is clear. However, the diagnosis and treatment protocol remains unclear otherwise. In this article, the possible mechanisms of hydrocephalic symptoms, the diagnosis, as well as treatment algorithms are examined. METHODS: Eight patients with a ventriculoperitoneal shunt who had intermittent hydrocephalic symptoms due to peritoneal catheter fracture but without any radiologically significant ventricular dilatation at Nigde Ömer Halisdemir University from 2018 to 2021 were collected. A new diagnostic algorithm was created. Patient follow-up was performed in each patient as a procedure. RESULTS: The method that we determined was successful in all our patients. No complications were observed. We have followed the patients with a normal clinic for at least 6 months. CONCLUSIONS: The provocation test we have formulated always revealed the true cause of the clinic. Thus, on the one hand, with a positive provocation test we recommend revision surgery without waiting for the ventricular dilatation or hydrocephalic symptoms in patients with a fractured peritoneal catheter, considering the results of asymptomatic shunt revision surgery have been reported to be better than those with symptomatic shunt dysfunction; on the other hand, patients with negative provocation tests are saved from unnecessary surgical intervention as well as benefit from true etiologic fast treatment.

Investigating a correlation between the results of transcranial Doppler and the level of nerve growth factor in cerebrospinal fluid of hydrocephalic infants: clinical study.

OBJECTIVE: In this study, the correlation between the level of nerve growth factor (NGF) in cerebrospinal fluid (CSF) and transcranial Doppler (TCD) results has been investigated during preoperative and postoperative periods of hydrocephalic infants. METHODS: In the study, 27 patients (11 males and 16 females, aged 0-6 months) with congenital hydrocephalus were studied. CSF levels were obtained from the patients preoperatively and on postoperative days 3 and 30, and TCD was applied. The level of NGF was investigated in CSF by the ELISA method. The pulsatility index (PI) and resistive index (RI) were examined in the right middle cerebral artery by TCD. RESULTS: The mean NGF level (0.27 +/- 0.48 ng/ml) on the 3rd (NGF3) postoperative day was observed to be higher than the preoperative mean NGF level (NGF0; 0.15 +/- 0.16 ng/ml; p < 0.05). The mean NGF level on postoperative day 30 (NGF30; 0.13 +/- 0.13 ng/ml) was lower than the mean NGF3 level (p < 0.05). While the mean PI value on postoperative day 30 (PI30; 1.06 +/- 0.068) was observed to decrease compared to the preoperative PI (PI0; 1.26 +/- 0.83) and the PI on postoperative day 3 (PI3; 1.09 +/- 0.063), the mean PI3 value exhibited a drop compared to the PI0 value (p < 0.05). Whereas the mean RI value on postoperative day 30 (RI30; 0.63 +/- 0.023) showed a decrease compared to both preoperative mean RI (RI0; 0.70 +/- 0.025) and RI on postoperative day 3 (RI3; 0.65 +/- 0.021), RI3 displayed a drop compared to RI0 (p < 0.05). CONCLUSION: In this study, no correlation was determined between preoperative and postoperative NGF levels and preoperative and postoperative RI and PI values obtained from TCD examination. However, a positive correlation was found between the following results: preoperative PI and preoperative RI (r = 0.848); PI on postoperative day 3 and RI on postoperative day 3 (r = 0.690), and PI on postoperative day 30 and RI on postoperative day 30 (r = 0.707).

Comparison of the effects of octreotide and melatonin in preventing nerve injury in rats with experimental spinal cord injury.

In this study, we aimed to investigate the biochemical and histopathological protective effects of octreotide and melatonin in an experimental model of spinal cord injury. Fifty- six male albino Wistar rats were divided into four groups. Rats in the G1 group (n=7; control group) did not undergo any treatment except for anesthesia prior to being killed. Rats in the G2 group (n=7) underwent laminectomy and aneurysmal clip application at the T4-5 level. G3 group rats (n=14) were either treated with a 7.5 mg/kg intraperitoneal dose of melatonin (Sigma, St. Louis, MO, USA) immediately after laminectomy, then the same dose again on the day following injury (G3a), or given three equal doses over 10 days to achieve a total dose of 7.5 mg/kg/day (G3b). G4 group rats (n=14) were either treated with a 30microg/kg intraperitoneal dose of octreotide (Sandostatin; Novartis, Istanbul, Turkey) immediately after laminectomy, then the same dose again on the day following injury (G4a), or given three equal doses over 10 days to achieve a total dose of 30miocrog/kg/day (G4b). Rats in the G3 and G4 groups were sacrificed on days 1 and 10 after spinal cord injury (n=7 at each time point) and spinal cord samples were obtained. Tissue malonyldialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) levels were assayed. G3a, G3b and G4b had significantly lower levels of MDA than G2 (p<0.01). G3b had significantly higher SOD and GSH-Px levels than G2 (p<0.01). Histopathologically, melatonin significantly reduced necrosis and degeneration in both the initial and late stages (p<0.01). Octreotide had significant effects on necrosis and degeneration during the late stages, and on edema and congestion in both the initial and the late stages of injury (p<0.01). Melatonin was found to be superior to octreotide with respect to the prevention of congestion, edema, axonal degeneration and necrosis.

Evaluation of Doppler USG and CSF flow wave patterns in the diagnosis of ventriculoperitoneal shunt obstructions.

OBJECTIVE: In the present study, our aim was to designate standards for Doppler USG images correlating with dysfunctions in each segment of the ventriculoperitoneal (VP) shunt. MATERIALS AND METHODS: For this mechanical study, a platform was formed with pools filled with SF on both sides. Low-, intermediate- and high-pressure shunt mechanisms were placed on this platform. For each shunt system, flow wave pattern was evaluated. Doppler USG was performed when the shunt functioned normally, the peritoneal, ventricular ends and the exit of the valve were obstructed. The results were recorded. RESULTS: When the distal end of the peritoneal catheter was obstructed, no flow wave pattern was observed in Doppler USG. When the exit of the valve was obstructed, no flow pattern was taken from the peritoneal end, either. When the valve was pressed on the ventricular catheter, a second wave pattern with lower amplitude and a wider base was observed, in addition to the wave pattern that was observed when the pressure on the valve was removed. CONCLUSION: Doppler USG is an effective method for the diagnosis of shunt obstruction. The evaluation of flow wave patterns using this method instead of measuring flow rates creates a different standard for each situation.

The association of Chiari type III malformation and Klippel-Feil syndrome with mirror movement: a case report.

Basically Chiari type III malformation is a combination of encephalocele with of brain stem and cerebellar abnormality. Although Klippel-Feil syndrome may be associated with other congenital anomalies, this syndrome is mainly associated with varying degrees of cervical vertebral fusion anomalies. In this study, we reported the association of Chiari type III malformation and Klippel-Feil syndrome with the mirror movement by imaging studies. The main involvement in Chiari type III malformation and Klippel-Feil syndrome is in the craniocervical junction. In such a small area, the emergence of these complex pathologies in our case was remarkable. Our patient had reconstruction surgery of the posterior fossa and his encephalocele was excised successfully. Hydrocephaly and/or deterioration in the functions of other posterior fossa structures have not been seen in the patient's follow-up.

Lateral lower thoracic lipomyelomeningocele: a case report.

INTRODUCTION: Lipomyelomeningocele is a form of the spina bifida occulta, which show differentiation from spina bifida aperta by pathogenesis. Laterally located thoracal lipomyelomeningocele is very rare congenital spinal pathology. The clinical presentation may be soft tissue mass, sensorial-motor loss and/or bladder dysfunction. CASE PRESENTATION: Here we presented a 10-month-old girl patient harboring lipomyelomeningocele in left lateral side of the lower thoracal region. CONCLUSIONS: We have not found the entity of lateral lower thoracal lipomyelomeningocele and especially as large as this size mass at ages of our patient in the literature. We operated our patient for the possible emerging complications and purposed prevention of these complications with this intervention.

Delayed trigeminocardiac reflex induced by an intraorbital foreign body. Case report.

OBJECTIVE: To emphasize the importance of the mechanism and surgical approach to trigeminocardiac reflex (TCR) developing 48 h after orbital trauma due to a foreign body. CASE REPORT: After gunshot injury of a 17-year-old male patient, computerized tomography evaluation revealed a right globe perforation and an intraorbital metallic foreign body in the right orbita adjacent to the lateral wall. The ocular perforation was repaired, but the foreign body was not removed. Constant bradycardia (45/min) developed 48 h after the operation. Since there were no cardiological findings, a temporary cardiac pacemaker was inserted and on the 6th postoperative day, the foreign body was removed through orbitolateral approach. After the removal of the foreign body, bradycardia completely recovered. CONCLUSION: In the presence of an intraorbital foreign body accompanied by globe perforation, TCR may develop 48 h after the trauma and insertion of a temporary pacemaker may be required to control the cardiac rhythm. In this paper, the delayed TCR complication presented an indication for the removal of the intraorbital foreign body.