Comparison of the biochemical and radiological criteria for lumbar disc degeneration

Background The relationship between radiological degeneration criteria on lumbar magnetic resonance imaging (MRI) and both the keratan sulfate (KS) and chondroitin sulfate (ChS) levels was examined in disc material taken from patients undergoing lumbar disc herniation (LDH) surgery. To examine whether the biochemical and radiological degeneration criteria testing the reliability of radiological degeneration findings agreed and to evaluate the contribution of the KS/ChS ratio to disc form (protruding or extruding). Methods This was a prospective experimental cohort study. Using enzyme-linked immunosorbent assay, KS and ChS levels were measured in the degenerate nucleus pulposus taken from 71 patients with a diagnosis of LDH who underwent surgery. The degeneration levels and disc form (protruding or extruding) were determined according to the Pfirrmann five-stage grading system on preoperative T2-weighted lumbar MRIs. According to the Pfirrmann system, 28 patients were grade III and 43 were grade IV. The relationship between radiological criteria and the KS/ChS ratio was statistically evaluated. Results The KS levels (p=0.046) and the KS/ChS ratio (p=0.001) were significantly higher in grade IV patients than in grade III patients. However, there was no difference between the KS and ChS levels and the KS/ChS ratio when patients were classified as protruding or extruding according to their disc structure. Disc structure and biochemical degeneration indicators were not correlated. Conclusions The KS level and the KS/ChS ratio were high in patients with marked radiological degeneration on lumbar MRI, demonstrating the sensitivity and reliability of the Pfirrmann five-stage grading system for showing radiological degeneration

Servikal disk hernisi nedeniyle opere edilen hastaların operasyon öncesi servikojenik baş ağrısının sıklığı ve operasyon sonrası değişiminin değerlendirilmesi

Amaç: Servikojenik baş ağrısı (SBA) popülasyonun %2,5-4,1 kadar kısmını etkilemektedir. Tanı ve yönetimi zor olup etyopatogenezi henüz tam anlaşılmamıştır. Bu çalışmamızda servikal disk hernisi (SDH) nedeniyle opere ettiğimiz hastalarda SBA sıklığı ve ameliyat sonrası düzelme oranlarının araştırılması amaçlanmıştır. Metod: 2012-2019 yılları arasında SDH nedeniyle kliniğimizde ameliyat edilen 51 hasta retrospektif olarak tarandı. Hastalarda SBA Uluslararası Baş Ağrısı Derneği (ICHD-3) tanı kriterleri kullanılarak değerlendirildi. Operasyon öncesi ve sonrası nörolojik muayeneleri, ağrı skorları (vizüel analog skala [VAS] ile) değerlendirildi. Operasyon tekniği kaydedildi. Bulgular: 38 (%74,5) kadın ve 13 erkek (%25,5) olmak üzere toplam 51 hasta çalışmamıza dahil edildi. Ortalama yaş 45,76 ± 11,56 ve ortalama takip süresi 30,40 ± 32,31 aydı. Hastaların 41’inde (%80,4) tek seviye, 10’unda (%19,6) multipl seviyede SDH mevcuttu. Hastalarda %25,5 oranında SBA saptandı. Bu hastaların operasyon öncesi ve sonrası VAS puanlarındaki düşüş ortalama 5,54 ± 4,46’ydı (p<0.01). Sonuç: SBA etyopatogenezi henüz tam anlaşılmamış olup, ilk muayenede tanı ve tedavisi zordur. Çalışmamız SDH olan hastaların dörtte birinden fazlasında şiddetli SBA olduğu ve operasyon sonrası ağrı skorlarının belirgin olarak azaldığını göstermiştir.Objective:Cervicogenic headache (CH) affects between 2.5% to 4.1% of the whole population. As its diagnosis and management are difficult, its etiopathogenesis is not completely understood. In the current study, we aimed to investigate the prevalence and the postoperative improvement rate in our operated patients with cervical disc herniation (CDH). Methods: Medical records were retrospectively reviewed for 51 patients who underwent surgical treatment for CDH at our institute from 2012 to 2019. The patients were evaluated according to the diagnostic criteria of the international Headache Society (ICHD-3). Pre- and postoperative neurological examination and pain scores were recorded. Pre- and postoperative pain severity was assessed via (pain visual analog scale[VAS]).The surgical techniques were recorded. Results: A total of 51 patients, 38 (74.5%) females and 13 (25.5%) males, were included in our study. The mean age was 45.76 ± 11.56. The patients were followed-up with an average of 30.40 ± 32.31 months. 41 (80.4%) patients were operated for one CDH level, and the remaining 10 patients (10.6%) were operated for multiple CDH levels. CH was observed in 25.5% of our patients. The mean improvement regarding the differences between pre- and postoperative VAS scores 5.54 ± 4.46 (p <0.01). Conclusions: The diagnosis and examination of the CH at the first time is difficult. The etiopathogenesis of CH can be interpreted by discogenic, convergence and sensitization-desensitization theories. We observed that more than a quarter of our patients with CDH were involved with severe CH. Postoperative pain scores were significantly reduced

Three level spinal dysraphism: multiple composite Type 1 and Type 2 split cord malformation

İstanbul Bilim Üniversitesi, Tıp Fakültesi.It has reported an uncommon case a 3 year-old girl a composite split cord malformation (SCM) with two different levels of SCM type1 and one level SCM type2, tight filum and sacral dermal sinus. The patient was admitted with a hypertrichosis and hyperpigmented patch. MRI of whole spine and brain was done. SCM type1 at T 7 and L2 levels and SCM typ2 at T11 level were removed then tight filum was cut and dermal sinus was excised at different sites during the same surgery

Evaluation of balance after surgery for cerebellopontine angle tumor

WOS: 000460934600013PubMed ID: 30248037BACKGROUND: The origin of about 10% of tumors located in the intracranial region is the cerebellopontine angle. Therefore Cerebellopontine Angle (CPA) tumors affect patients' balance. OBJECTIVE: The aim of this study was to compare the balance in individuals who underwent surgery for CPA tumors with healthy individuals. METHODS: Thirty patients who were being followed-up by the Department of Neurosurgery and had been operated on CPA tumor and 31 healthy individuals were included in the study as group 1 and group 2, respectively. The participants were evaluated using Romberg Test, Sharpened Romberg Test, One-leg Stance (OLS), Tandem Walking, Walk Across, Berg Balance Scale (BBS), Dizziness Handicap Inventory (DHI) and Short Form 36 (SF-36). RESULTS: In comparison of the groups, OLS tests (p <0.001), BBS (p <0.05) and DHI (p <0.05) were significantly different in favor of healthy group. SF-36 results revealed a significant difference between the groups, except for Bodily Pain and Vitality (p <0.05). CONCLUSIONS: The results of this study demonstrated a decrease in balance parameters and quality of life in individuals who underwent CPA tumor surgery in comparison to healthy individuals. Evaluation of balance in the preoperative and postoperative period should not be ignored in these patients and they are suggested to start rehabilitation in the early postoperative period

Investigation of Brain Impairment Using Diffusion-Weighted and Diffusion Tensor Magnetic Resonance Imaging in Experienced Healthy Divers

Background: The aim of this study was to understand the changes of decompression illness in healthy divers by comparing diffusion-weighted (DWI) and diffusion tensor MRI findings among healthy professional divers and healthy non-divers with no history of diving. Material/Methods: A total of 26 people were recruited in this prospective study: 11 experienced divers with no history of neuro- logical decompression disease (cohort) and 15 healthy non-divers (control). In all study subjects, we evaluated apparent diffusion coefficient (ADC) and type of diffusion tensor metric fractional anisotropy (FA) values of different brain locations (e.g., frontal and parieto-occipital white matter, hippocampus, globus pallidus, putamen, internal capsule, thalamus, cerebral peduncle, pons, cerebellum, and corpus callosum). Results: ADC values of hippocampus were high in divers but low in the control group; FA values of globus pallidus and putamen were lower in divers compared to the control group. DWI depicted possible changes due to hypoxia in different regions of the brain. Statistically significant differences in ADC values were found in hypoxia, particularly in the hippocampus (p=0.0002), while FA values in the globus pallidus and putamen were statistically significant (p=0.015 and p=0.031, respectively). We detected forgetfulness in 6 divers and deterioration in fine-motor skills in 2 divers (p=0.002 and p=0.17, respectively). All of them were examined using neuro-psychometric tests. Conclusions: Repeated hyperbaric exposure increases the risk of white matter damage in experienced healthy divers without neurological decompression illness. The hippocampus, globus pallidus, and putamen are the brain areas responsible for memory, learning, navigation, and fine-motor skills and are sensitive to repeated hyperbaric exposure

Clinical evaluation of decompressive craniectomy in malignant middle cerebral artery infarction using 3d area and volume calculations

Objective: We aimed to measure the craniectomy area using three-dimensional (3D) anatomic area and volume calculations to demonstrate that it can be an effective criterion for evaluating survival and functional outcomes of patients with malignant middle cerebral artery (MCA) infarction. Material and Methods: The patients diagnosed with malignant ischemic stroke between 2013 and 2018, for which they underwent surgery due to deterioration in their neurological function, were retrospectively reviewed. Radiological images of all patients were evaluated; total brain tissue volume, ischemic brain tissue volume, total calvarial bone area, and decompression bone area were measured using 3D anatomical area and volume calculations. Results: In total, 45 patients (27 males and 18 females) had been treated with decompressive craniectomy (DC). The removed bone area was found to be significantly related to the outcome in patients with MCA infarction. The average decompression bone area and mean bone removal rate for patients who died after DC were 112 ± 27 cm2and 20%, whereas these values for surviving patients were 149 ± 29 cm2and 26% (P = 0.001), respectively. At the 6-month follow-up, the average decompression bone area and mean bone removal rate for patients with severe disability were 126 ± 30 cm2and 22.2%, whereas these values for patients without severe disability were 159 cm2± 26 and 28.4% (P = 0.001), respectively. Conclusion: In patients with malignant MCA infarction, the decompression area is associated with favorable functional outcomes, first, survival and second, 6-month modified Rankin scale score distribution after craniectomy