The anatomical aspects of optic nerve decompression by transcranial and transsphenoidal approach

Optik sinirin proksimal kısmı, optik foramen girişinde tümöral ve travmatik patolojiler ile zedelenmeye oldukça yatkındır. Böyle bir durumda, optik sinir proksimal kesimini dekomprese etmek gerekir. Bu nedenle, optik kanal bölge anatomisinin öğrenilmesi önem taşımaktadır. Optik kanalın proksimal kesiminin dekompresyonu esnasında karşılaşılabilecek problemleri ve anatomik sınırları vurgulayan bu çalışmada, optikokarotid bölgenin detaylı anatomisi ve histopatolojik yapısı araştırıldı. Otuz adet sellar ve parasellar örnek yetişkin insan kadavralarından çıkarıldı. Örneklere anatomik diseksiyon ve histopatolojik inceleme yapıldı. Proksimal optik kanalın superior ve lateral duvarı, mikrocerrahi teknik kullanılarak transkraniyal yaklaşım ile; inferior ve medial duvarı ise, endoskopik ve mikroskobik teknik kullanılarak, transsfenoidal yaklaşım ile incelendi. Histopatolojik incelemede optik kanal, internal karotid arter ve optik sinir arasındaki ilişkiler kalitatif ve kantitatif olarak değerlendirildi. Transkraniyal ve transsfenoidal yaklaşım ile benzer oranlarda optik kanal çevresel dekompresyonu yapılabilmesine karşılık, transkraniyal yaklaşımın optik sinirin superiorunun ve lateralinin dekompresyonunda, transsfenoidal yaklaşımın ise optik sinirin inferiorunun ve medialinin dekompresyonunda daha üstün olduğu görüldü. Transkraniyal yaklaşımın optik sinirin daha fazla mobilize edilebilmesi açısından daha uygun olduğu saptandı. Histopatolojik olarak optik sinirin medialde ve inferiorda traksiyon veya basıdan kaynaklanabilecek zedelenmeye daha yatkın olduğu görüldü. Optik sinir dekompresyonuna karar verirken, patolojinin yerleşimine ve bölgenin anatomik-histolojik özelliklerine göre trankraniyal veya transsfenoidal yaklaşımlardan birini seçmek uygun olacaktır.Proximal portion of the optic nerve is quite prone to injury in the optic foramen entrance by tumoral and traumatic pathologies. In such a case, it is necessary to decompress the proximal part of the optic nerve. Therefore, it is important to learn the regional anatomy of the optic canal. In this study that emphasizing the problems and anatomic limitations which can be encountered during proximal optic canal decompression, detailed anatomy and histopathology of the opticocarotid region was investigated. Thirty adult sellar and parasellar samples were extracted from human cadavers. Anatomical dissection and histological examination was performed to the samples. Superior and lateral walls of the proximal optic canal were evaluated by using microsurgical transcranial approach; inferior and medial walls were evaluated by using endoscopic and microsurgical transsphenoidal approach. The relationship between the optic canal, the internal carotid artery and the optic nerve were qualitatively and quantitatively examined. Though, similar rates of peripheral optic canal decompression was achieved by transcranial and transsphenoidal approach, transcranial approach was superior in the decompression of the superior and lateral portions, transsphenoidal approach was superior in the decompression of the inferior and medial portions of the optic nerve. Transcranial approach is found to be more appropriate for optic nerve mobilization. It was found that, histopathologically the medial and inferior parts of the optic nerve, was more prone to injury caused by traction or compression. When deciding the optic nerve decompression, either the transcranial or the transsphenoidal approach should be preferred according to the localization of the pathology and anatomical-histological characteristics of the region

Neurosurgical analysis of logging accidents: An observational study

Objective: Forestry is one of the most dangerous occupations with record high rates of accidents and mortality relative to other occupations. In the past, related studies have been conducted within the scope of occupational safety, occupational health, and public health. Clinical studies on this subject are extremely rare and not within the scope of neurosurgery. We intended to facilitate the management of logging accidents for physicians by conducting a clinical study on logging accidents. This first-of-its-kind study also aimed to comprehend the injury mechanisms in order to contribute to the efforts made to prevent injuries and to facilitate the management of these cases. Methods: The hospital records of patients who presented at the Karabük University EAH Emergency Department owing to logging accidents between 1/1/2019 and 5/1/2020 in the Karabük province were retrospectively analyzed. The information about patient profile, demographic information, mechanism of the logging injury, and the patterns of spinal and cranial injuries as well as other body area injuries (if any) were retrieved from the hospital records. The spinal and cranial injury patterns were analyzed from the imaging records (MRI or CT). Results: A total of 19 subjects were included in this analysis, of which 5 had cranial injury (26.3%), 2 had spinal injury (10.5%), 1 (5.2%) had both cranial and spinal injuries (this subject died in the intensive care unit at follow-up). A total of 9 (47%) subjects died. Three subjects were followed up for observation (15.7%), while 5 (26.3%) were referred to the department of orthopedics. The cranial and spinal injuries were accompanied by additional injuries such as rib fracture, hemothorax, fibula fracture, and pneumothorax. These injuries occurred in pathological conditions such as cardiac arrhythmia, facial paralysis, and epilepsy. One subject developed spinal cord damage (5.2%) that progressed to neurological shock and crash syndrome. Overall, 19 injuries occurred mainly due to 5 different mechanisms. Conclusions: The patterns of resultant spinal and cranial injuries and the related demographic information would facilitate efficient patient management. Understanding the injury mechanisms would facilitate both the management and diagnosis of such cases and the prevention of logging accidents through combined efforts of occupational safety and public health specialists