Lumbosacral plexopathy secondary to discectomy and fixation

Lumbosacral plexopathy (LSP) is a rare entity characterized by acute onset of pain followed by sensory and motor deficits, reflex changes and muscle atrophy. The diagnosis is based on clinical and EMG findings. LSP can result from pelvic tumors, infections, trauma, abdominopelvic or spinal surgery, radiation, intravenous drug abuse, diabetic neuropathy, vasculitis or maybe idiopathic. We present a case report of LSP following spinal surgery treated by pulse steroid and immunotherapy

Effects of etofenamate and methylprednısolone on spınal cord ınjury

This study evaluates the effects of etofenamate on secondary damage following a spinal cord injury and compares the effects with those of methylprednisolone. A total of 31 male Wistar-Albino rats were used. A weight-drop model was utilized for the experimental spinal cord injury and a 50g-cm impact was applied on the spinal cord. Rats were randomly assigned to one of the three study arms (saline, etofenamate 20 mg/kg, methylprednisolone 30 mg/kg). At the sixth hour of injury electrophysiological evaluations were conducted under anesthesia, and then rats were sacrificed for histopathology. Hematoxylin and eosin staining were applied to the specimens and evaluated under light microscopy. Etofenamate revealed more beneficial results in histopathological evaluations when compared with methylprednisolone, but these favorable results have not been confirmed by electrophysiological measurements. Etofenamate may be a promising agent in the medical treatment of spinal cord injury

A comparative study for glioma classification using deep convolutional neural networks

Gliomas are a type of central nervous system (CNS) tumor that accounts for the most of malignant brain tumors. The World Health Organization (WHO) divides gliomas into four grades based on the degree of malignancy. Gliomas of grades I-II are considered low-grade gliomas (LGGs), whereas gliomas of grades III-IV are termed high-grade gliomas (HGGs). Accurate classification of HGGs and LGGs prior to malignant transformation plays a crucial role in treatment planning. Magnetic resonance imaging (MRI) is the cornerstone for glioma diagnosis. However, examination of MRI data is a time-consuming process and error prone due to human intervention. In this study we introduced a custom convolutional neural network (CNN) based deep learning model trained from scratch and compared the performance with pretrained AlexNet, GoogLeNet and SqueezeNet through transfer learning for an effective glioma grade prediction. We trained and tested the models based on pathology-proven 104 clinical cases with glioma (50 LGGs, 54 HGGs). A combination of data augmentation techniques was used to expand the training data. Five-fold cross-validation was applied to evaluate the performance of each model. We compared the models in terms of averaged values of sensitivity, specificity, F1 score, accuracy, and area under the receiver operating characteristic curve (AUC). According to the experimental results, our custom-design deep CNN model achieved comparable or even better performance than the pretrained models. Sensitivity, specificity, F1 score, accuracy and AUC values of the custom model were 0.980, 0.963, 0.970, 0.971 and 0.989, respectively. GoogLeNet showed better performance than AlexNet and SqueezeNet in terms of accuracy and AUC with a sensitivity, specificity, F1 score, accuracy, and AUC values of 1551 Mathematical Biosciences and Engineering Volume 18, Issue 2, 1550–1572. 0.980, 0.889, 0.933, 0.933, and 0.987, respectively. AlexNet yielded a sensitivity, specificity, F1 score, accuracy, and AUC values of 0.940, 0.907, 0.922, 0.923 and 0.970, respectively. As for SqueezeNet, the sensitivity, specificity, F1 score, accuracy, and AUC values were 0.920, 0.870, 0.893, 0.894, and 0.975, respectively. The results have shown the effectiveness and robustness of the proposed custom model in classifying gliomas into LGG and HGG. The findings suggest that the deep CNNs and transfer learning approaches can be very useful to solve classification problems in the medical domain

Non-invasive detection and monitoring of experimental hydrocephalus with distortion product otoacoustic emissions

Objective: We aimed to find out the effects of short term and long term hydrocephalus and intracranial ventricular volume changes on cochlear functions by using distortion product otoacoustic emission (DPOAE) in experimental hydrocephalus rat models for the first time in literature. Methods: This study was performed with 48 healthy, adult (8 weeks old), Sprague–Dawley rats which weighed between 200 and 240 g. Six groups were formed in this study: short term control, short term sham, short term hydrocephalus, long term control, long term sham and long term hydrocephalus groups. Each group contained eight rats. Short term period was 4 weeks and long term period was 8 weeks after the study started. At the end of these periods, DPOAE measurements were performed and then rats were sacrificed to determine ventricular volumes. Results: DPOAE values at all frequencies were significantly decreased in the short term hydrocephalus group when compared to the short term control and short term sham groups. DPOAE values at all frequencies were significantly decreased in the long term hydrocephalus group when compared to the long term control and long term sham groups. Besides, long term sham group which had higher ventricular volumes than long term control group also had lower DPOAE measurements. Significant associations were present between DPOAE measurements and ventricular volumes in hydrocephalus models. Conclusion: The functional disturbances in cochlear functions due to hydrocephalus have been demonstrated with DPOAE measurements in this study. DPOAE measurements may be thought as an easily applicable non-invasive method in detection and follow-up of patients with hydrocephalus. Our findings should be supported with clinical studies in humans

Total resection of inferiorly located sacral chordoma with posterior only approach: case report and review of the literature

Chordoma is a primary sacral neoplasm of ectodermal origin and makes up %1-4 of all primary bone tumors. It is usually present on the midline cerebrospinal axis and the most common locations are the spheno-clival region and the sacrum. The treatment of primary sacral tumors represents a challenge because of a large tumor mass at presentation and a hemorrhage risk in surgery. Sacral tumors may present a difficult problem to the surgeon who desires to obtain a clear margin of excision. Using the retrorectal fat tissue as a cleavage line in the posterior approach guides the neurosurgeon to resect the tumor totally and reduce the hemorrhage in sacral chordomas. In this case report, we tried to discuss the advantages of using of retrorectal fat tissue as a cleavage line in sacral chordomas under the literature.Kordoma ektodermal kaynaklı primer sakral neoplazmdır ve tüm primer kemik tümörlerinin %1-4’ünü oluşturur. Genellikle serebrospinal aksın orta hattında bulunurlar ve çoğunlukla yerleşim yerleri sfenoklival bölge ve sakrumdur. Primer sakral tümörlerin tedavisi; ilk ortaya çıktıklarında büyük bir kitle oluşturmuş olmaları ve cerrahide kanama riskleri nedeniyle çözülmesi gereken bir sorun olarak durmaktadır. Sakral tümörler, net bir eksizyon sınırı sağlamak isteyen cerrahlar için zorlu bir problem oluşturur. Posterior yaklaşımda retrorektal yağ dokusunun klavaj hattı olarak kullanılması; beyin cerrahına tümörün tümüyle rezeke edilmesi için yol gösterir ve sakral kordomalarda kanamayı azaltır. Bu olgu sunumunda, sakral kordomalarda retrorektal yağ dokusunun klavaj hattı olarak kullanılmasının yararlarını literatür eşliğinde tartışmak istedik

A rare reason of foot drop caused by primary diffuse large b-cell lymphoma of the sciatic nerve: case report

Introduction Primary central nervous system lymphomas account for 2% of all malignant lymphomas. Although the involvement of peripheral nerves has been previously described as a dissemination of systemic lymphomas or a direct extension to the nerve trunk from contiguous lymphomas, primary involvement of the sciatic nerve is extremely rare. Case To the best of our knowledge, the primary localization of lymphoma within sciatic nerve has been reported only nine times. We report, a very rare example of a primary diffuse large B-cell lymphoma of the sciatic nerve. Discussion The patient presented with atypical sciatica. Such symptoms can be misdiagnosed as lumbar disc pathology and magnetic resonance imaging and electrophysiological studies avoid this misinterpretation

Vagal nerve stimulation effects on generalized-partial seizures and medication in adult drug-resistant epilepsy patients

AIm: The aim of this study was to find out if vagal nerve stimulation (VNS) affect the generalized-partial seizure count and medical treatment in adult drug resistant epilepsy patients. Mater Ial and Methods: Twenty adult patients who were diagnosed with drug-resistant epilepsy were investigated retrospectively for vagal nerve stimulator implantation between 2001 and 2010 at the Neurosurgery Departments of Ufuk University and Gulhane Military Medical Academy. The effects of vagal nerve stimulation on generalized-partial seizures and medical treatment was scored and if a significant difference was found, a comparison was made by Wilcoxon Signed Ranks test and Pairwise. For all the group analyses, the statistical significant rank was accepted as a p value <0.05. Bonferroni correction was made when it was needed during pairwise comparisons. Results : VNS significantly decreased the scores of generalized-partial seizures. There was no decrease in the doses of antiepileptic drugs and the medical treatment was resumed as before the implantation. The results were correlated with the relevant literature. ConclusIon: VNS is an alternative treatment option for drug resistant epilepsy for patients who are not ideal candidates for surgery or are not healed after epilepsy surgery

Split cord malformation: Diastometamyelia

Split kord malformasyonu, diğer adıyla Diastometamyeli; gelişimsel embriyolojik bir orta hat anomalisidir ve 2 tane omurilik oluşumu ile karakterizedir. Sınıflandırmada Tip 1 ve 2 olmak üzere ikiye ayrılır. Skolyoz oluşumu etyolojisinde önemli bir etkendir. Tanıda; magnetik rezonans görüntüleme ile bilgisayarlı tomografi tetkiki önemlidir. Son yıllarda, magnetik rezonans görüntülemenin sık kullanılması nedeniyle; bilgisayarlı tomografi daha az tercih edilmektedir. Ancak yine de kemik septum ve vertebra anomalilerinin görüntülenmesindeki etkinliği için çekimi ihmal edilmemelidir. Olgularının cerrahi tedavisinin planlanma sürecinde en önemli etken; eğer varsa skolyoza neden olan esas etkenin ortaya çıkarılmasıdır. Sonuç olarak, split kord malformasyonlu hastayı değerlendirme sürecinde; nöroşirurjiyen ve ortopedist işbirliği çok önemlidir. Paraplejiye yol açmamak için skolyoza yönelik cerrahi girişimin; split kord malformasyonuna neden olan etyolojik faktör ortadan kaldırıldıktan sonra yapılması gerekmektedir.Split cord malformation (Diastometamyelia) is a developmental embriologic fusion defect and characterized by two spinal cord formation. In classification, two type is present: Type 1 and 2. It has an important etiologic factor in consistence of scoliosis. In diagnosis, magnetic resonance imaging and computed tomography are very important radiologic examinations. In last years, due to frequently usage of magnetic resonance imaging; computed tomography is less preferred. But then depending on highly effective diagnosis accuracy of bone septum and vertebrate anomalies; computed tomography should not be neglected. The most important factor in planning of surgical treatment is to reveal the primary reason for scoliosis In conclusion, collaboration of neuro and orthopedic surgeon is so important in assessment of patient. For not to lead to paraplegia; surgical treatment of scoliosis should be performed after removal of etiologic factor for split cord malformation

The effect of preemptive lornoxicam or tramadol on postoperative tramadol consumption in lumbar spinal surgery

Amaç: Postoperatif ağrı kontrolünde, opioid ve nonsteroid antiinşamatuar ilaçlar (NSA‹) preemptif olarak sıklıkla kullanılmaktadırlar. Bu çalışma, spinal cerrahide preemptif tramadol veya lornoksikam kullanımının, postoperatif tramadol tüketimine etkisini ve yan etki insidansını karşılaştırmak için planlanmıştır. Yöntem: Tek seviye lomber diskektomi planlanan, ASA I-III risk grubunda, yaşları 18-60 arasında değişen 60 hasta çalışmaya alındı. Hastalar, rastlantısal olarak iki gruba ayrıldı (n=30). ‹ndüksiyondan 30 dakika önce Grup L’ ye 8mg lornoksikam, Grup T’ ye 100mg tramadol intravenöz olarak verildi. ‹ndüksiyonda tiyopental sodyum, vekuronyum bromid, idamede sevoşuran, NO2 ve O2 kullanıldı. Postoperatif 1., 2., 4., 6., 12. ve 24. saatlerde vizuel analog skala (VAS) skoru, kalp hızı (KH), ortalama arter basıncı (OAB), bulantı, kusma, ortostatik hipotansiyon gibi yan etkiler kaydedildi. Postoperatif analjezi için her iki grupta da tramadol ile hasta kontrollü analjezi (HKA) uygulandı ve tüketilen tramadol miktarı kaydedildi. Bulgular: Her iki grupta demografik veriler, cerrahi ve anestezi süreleri benzerdi. Postoperatif dönemde KH, OAB ve VAS değerleri benzerdi. Gruplar karşılaştırıldığında yan etki insidansında, tramadol tüketimi ve hasta memnuniyetinde fark bulunamamıştır. Sonuç: Lomber disk cerrahisinde premptif lornoksikam, tramadol kadar iyi ve etkili postoperatif analjezi sağlamıştır.Objective: Opioids and nonsteroid antiinflammatory agents are being widely used preemptively in postoperative pain management. This study has been planned in order to measure the effect of preemptive tramadol or lornoxicam on tramadol consumption and adverse effect incidence postoperatively in spinal surgery. Methods: 60 ASA I-III patients who were 18-60 years of age and scheduled for lumbar discectomy were included in the study. The patients were randomly allocated into two groups (n=30). Group L was given 8 mg lornoxicam, Group T was given 100 mg tramadol intravenously 30 minutes prior to surgery. Thiopental sodium and vecuronium bromide was used for induction, NO2 and O2 and sevoflurane was used for maintenance. Visuel analog skala (VAS) scores, heart rate (HR), mean arterial pressure (MAP) and adverse effects such as nausea, vomiting, orthostatic hypotension were recorded in the 1st, 2nd, 4th, 6th, 12th and 24th hours postoperatively. Both groups received patient controlled analgesia (PCA) with tramadol for postoperative analgesia and tramadol consumption was recorded. Results: There was no difference between demographic data and duration of anesthesia or surgery. Postoperative HR, MAP and VAS values were similar in both groups. There was no difference between adverse effect incidence, tramadol consumption and patient satisfaction. Conclusion: Preemptive lornoxicam provides postoperative analgesia comparable to tramadol in lumbar spinal surgery

Etofenamate Ve Methylprednisolone' Un Omurilik Hasarina Etkisi

Bu çalışma omurilik hasarını izleyen ikincil olaylar üzerine etofenamate' ın etkisini değerlendirmek ve bu etkiyi metilprednizolon etkisi ile karşılaştırmak amacıyla yapılmıştır. Toplam 31 erkek Wistar-Albino sıçan kullanılmıştır. 50g-cm etkili ağırlık düşürme modeli deneysel omurilik hasarı oluşturmak için kullanılmıştır. Sıçanlar üç çalışma koluna randomize olarak ayrılmışlardır (saline, etofenamate 20 mg/kg, metilprednizolon 30 mg/kg). Hasarın 6.saatinde anestezi altında elektrofizyolojik değerlendirme yapılmış ve sonra histopatolojik inceleme için sıçanlar feda edilmiştir. Hematoksilin-eozin boyaması ile ışık mikroskopu altında değerlendirilmiştir. Etofenamate, metilprednizolon ile karşılaştırıldığında histopatolojik olarak daha faydalı bulunmuştur, fakat bu durum elektrofizyolojik olarak doğrulanamamıştır. Etofenamate omurilik hasarının tedavisinde ümit verici olabilirThis study evaluates the effects of etofenamate on secondary damage following a spinal cord injury and compares the effects with those of methylprednisolone. A total of 31 male Wistar-Albino rats were used. A weight-drop model was utilized for the experimental spinal cord injury and a 50g-cm impact was applied on the spinal cord. Rats were randomly assigned to one of the three study arms (saline, etofenamate 20 mg/kg, methylprednisolone 30 mg/kg). At the sixth hour of injury electrophysiological evaluations were conducted under anesthesia, and then rats were sacrificed for histopathology. Hematoxylin and eosin staining were applied to the specimens and evaluated under light microscopy. Etofenamate revealed more beneficial results in histopathological evaluations when compared with methylprednisolone, but these favorable results have not been confirmed by electrophysiological measurements. Etofenamate may be a promising agent in the medical treatment of spinal cord injur