Ilker Coven

Unilateral percutaneous pedicle screw instrumentation with minimally invasive TLIF for the treatment of recurrent lumbar disk disease: 2 years follow-up.

AIM To compare the clinical and radiological outcomes of recurrent disk disease in patients who underwent unilateral and bilateral percutaneous pedicle screw instrumentation with Mis-TLIF. MATERIAL AND METHODS 10 patients treated with unilateral percutaneous instrumentation plus Mis-TLIF formed Group 1 while the other 10 patients treated with bilateral percutaneous instrumentation plus Mis-TLIF formed Group 2. Clinical outcomes were graded using the visual analog scale (VAS) and the Oswestry disability index (ODI) scores. Peroperative and 2-year follow-up scores were obtained. Postoperative imaging techniques were used for the assessment of fusion, subsidence and spinal alignment. RESULTS According to preoperative and postoperative VAS/ODI scores, statistically significant differences were noted in the unilaterally and bilaterally instrumented group. However, a statistically significant difference was not observed between the unilateral and bilateral groups. Radiological evidence of successful arthrodesis was noted in 8 of 10 patients (80%) in the unilaterally instrumented group and in 9 of 10 patients (90%) in the bilaterally instrumented group at the 2 years follow-up. No metal failure, cage migration, vertebral fracture, subsidence or adjacent level disease was experienced. CONCLUSION Mis-TLIF with unilateral percutaneous pedicle screw instrumentation is an excellent option in the treatment of selected recurrent disk disease patients.

Angiotensin I‐Converting Enzyme Gene (I/D) Polymorphism in Patients With Migraine

In addition to the wide expression in many tissues including vascular endothelial cells, production of angiotensin II and degradation of bradykinin may indicate that angiotensin‐converting enzyme could be involved in vascular tension and blood pressure. It has been reported that the deletion allele of the angiotensin‐converting enzyme gene is associated with increased serum angiotensin‐converting enzyme levels and linked to cerebrovascular diseases. In this study, the possible association of migraine with aura with the angiotensin‐converting enzyme deletion–deletion (DD) and the angiotensin–converting enzyme insertion–deletion (ID) genotype was investigated in Turkish patients. To investigate the role of the angiotensin‐converting enzyme I/D polymorphism in Turkish patients with migraine with aura, we analyzed the I/D genotype of 53 patients with that disorder. Twenty‐two control subjects, who are volunteer Turkish patients without migraine, were included in the study. The frequency of the angiotensin‐converting enzyme D/D genotype was statistically significant more frequent in patients with migraine with aura (81.1%) than in controls (59.1%) (P < .05). No differences were found regarding the I/I genotype and the I/D genotype between the 2 groups (P > .05). The results of our study revealed that the angiotensin‐converting enzyme D/D genotype was more frequent in patients with migraine with aura than in controls. This might suggest that the angiotensin‐converting enzyme D/D genotype may be a genetic risk factor for migraine with aura in Turkish patients.

Radiofrequency facet joint neurotomy in treatment of facet syndrome.

Study Design Retrospective analyses of 50 patients with lumbar facet syndrome treated with lumbar facet joint neurotomy. Objective To establish the efficacy of lumbar facet joint neurotomy under optimum conditions in selected patients. Summary of Background Data With the realization of the significance of facet joints in the etiology of chronic low back pain over the last decade, many studies were conducted about various methods of treating the facet joint syndrome. Methods Fifty patients with lumbar facet syndrome with at least 80% pain relief by controlled, diagnostic medial branch blocks underwent lumbar facet joint neurotomy. Before surgery, all were examined carefully both clinically and radiologically and evaluated by visual analog scale (VAS) and descriptive system of health-related quality of life state (EQ5D) measures of pain, disability, and treatment satisfaction. All outcome measures were repeated postoperatively and at 12 months after surgery. Results Of the 50 patients 35 were females and 15 were males with a mean age of 51.82±16.99 years. One level was treated in 26 patients, 2 levels in 14, 3 levels in 8, and 4 levels were treated in 2 patients. Symptom duration was ranging between 2 and 24 months with a mean of 7.64±5.98 months. Mean preoperative, postoperative, and at the 12th month VAS were 75.2±11.29, 23.8±10.28, and 24.6±11.817, respectively. Forty-eight percent of patients obtained a relative reduction of at least 70% in VAS, and 86% obtained a reduction of at least 60% at the 12th month. Health-related quality of life state was improved in all patients. When the VAS scores were evaluated with respect to the ages of patients, level numbers, and preoperative symptom duration, no significant differences were found, [0.106, 0.635 and 0.526 (preoperative VAS); 0.033, 0.555, and 0.235 (postoperative VAS); 0.701, 0.978, and 0.155 (follow-up VAS), respectively]. Conclusions The most important factors determining success of this procedure is strict patient selection criteria and technique of the procedure.

Posttraumatic intratumoural haemorrhage: an unusual presentation of spinal ependymoma

Ependymomas presenting with intratumoural and/or subarachnoid haemorrhages are seen rarely. These haemorrhages are mostly due to anticoagulation, epidural analgesia or pregnancy. A 62-year-old male farmer with cauda equina syndrome after a work-related trauma is presented. He was admitted to our hospital with paraparesis, faecal incontinance and sensory loss below the level of the lumbar-2 dermatome. Magnetic resonance imaging of the spine displayed an intradural mass lesion at the level of the first lumbar vertebrae. The lesion was excised totally via dorsal midline approach. Histopathologic examination revealed grade-3 ependymoma with intratumoural haemorrhage. The patient’s symptoms were relieved completely on postoperative day 7. The patient was given information about periodical examination for recurrence and discharged on the third postoperative week. Asymptomatic spinal lesions should be considered for operation whenever detected because of unpredicted complications.

SUNCT syndrome findings accompanied by cavernous segment aneurysm

Headache has been a discomfort for all mankind since ancient imes. In 1988, the International Headache Society (IHS) develped a headache classification system to serve as a standard in the iagnosis of headache and for clinical usage [1]. According to this lassification, there are four main groups for primary headaches nd 13 sub-groups for secondary headaches. Short-lasting Unilatral volatile Neuralgiform headache with Conjunctival injection nd Tearing (SUNCT) is a rare group of volatile headache syndromes 2]. Clinical findings are unilateral medium density stabbing pain –200 times daily in the orbital, periorbital and/or temporal areas. atients are mostly male, with a male/female ratio of 4.25, and the ean age is 50.7 years [2]. In the medical literature, secondary UNCT syndrome cases are divided into two groups as posterior ossa and pituitary abnormalities. The case reports representing the UNCT syndrome group secondary to a posterior fossa abnormality ave included homolateral cerebellopontine angle arteriovenous alformations; a brainstem cavernous hemangioma; a posteior fossa lesion in a human immunodeficiency virus/acquired mmunodeficiency syndrome (HIV/AIDS) patient; severe basilar mpression causing pontomedullary compression in a patient with steogenesis imperfecta; craniosynostosis resulting in a foreshortned posterior fossa; and ischemic brainstem infarction. Cases of UNCT syndrome secondary to pituitary adenomas, intracranial

Endovascular treatment of wide necked ruptured saccular aneurysms with flow- diverter stent.

AIM Flow diverter (FD) stents have been used in the treatment of unruptured intracranial aneurysms. There are a few studies that report the use of these devices in ruptured blister-like aneurysms. We present 5 consecutive patients, who had ruptured intracranial wide necked or side branch close to the neck of saccular aneurysms, with no other treatment options, treated with FD stents and coil embolization. MATERIAL AND METHODS Between September 2012 and April 2015, 139 ruptured aneurysms of 133 consequent patients were treated. Of these, 48 were surgically treated aneurysms. Five of the remaining 85 aneurysms treated with FD stents. Three aneurysms were in the posterior communicating artery, and 2 were in the supraclinoid internal carotid artery (ICA). Partial coil embolization was performed in addition to FD stents in three patients. All patients were treated in the first 3 days after bleeding. RESULTS Technical success was 100%. Inappropriate deployment of silk stent and partial thrombus formation occurred in one patient due to the jailed micro-catheter. Inappropriate apposition of stent was corrected with a balloon, and the thrombus resolved with tirofiban, tissue plasminogen activator (t-PA) injections. No other complication or death occurred related to the procedure. One patient who had a giant ICA aneurysm and Fisher grade 4 bleeding died due to vasospasm, cerebral edema and sepsis on the postoperative 13 < sup > th < /sup > day. The other patients were followed-up uneventfully with computed tomography angiography (CTA) at 6th month and digital subtraction angiography (DSA) at 12 < sup > th < /sup > month. CONCLUSION FD stents can be used in the treatment of ruptured large wide necked or side branch close to the neck of saccular aneurysms when other treatment options can not be used.

The effect of repetitious concussions on cognitive functions in rats.

AIM In this study, we aimed to investigate the effect of repetitious concussions on the spatial learning and memory function in rats. MATERIAL AND METHODS 46 adult, male Sprague-Dawley rats were assigned to three homogenous groups by stratified random sampling according to their basal performance during the first four days of the Morris water maze (MWM), as Control (n=10), Sham (n=10) and Concussion (n=26) groups. On the 12th day, the MWM experiment was repeated to evaluate the memory function. Rats in the concussion group were then subjected to the first head trauma. Some of the trauma-applied rats were sacrificed for histopathological examination 4 hours (n=4) and 24 hours (n=3) after the trauma. The spatial memory function of the rest of the rats was re-evaluated by MWM on the 20th day. Some of the rats were then subjected to the second head trauma (n=13), four of which were then sacrificed at the 4th hour, and three of which were sacrificed at the 24th hour. On the 27th day, six rats that had received single concussion and the remaining six that had received two concussions were re-evaluated for retention development by the third MWM experiment. RESULTS Escape latency curves showed a decrease in Sham and Control groups on the 20th and 27th days, and an increase in concussion group on the 20th day but no statistical significance was found between the groups. CONCLUSION Repetitious concussions did not significantly affect spatial learning-memory functions in rats, and may lead to a counter-adaptive mechanism against concussive injury.

Radiofrequency Thermocoagulation of the Ganglion Impar for Coccydynia Management: Long-Term Effects

To investigate the short‐ and long‐term effects of ganglion impar radiofrequency thermocoagulation (RFT) treatment in patients with chronic coccydynia.

Unusual Traumatic Midthoracic Spondyloptosis and Its Surgical Management: Case Report

Posttraumatic spondyloptosis develops as a result of complete subluxation of the vertebral bodies and causes complete transection of the spinal cord. Severe trauma-related spondyloptosis of the upper-mid thoracic region is a rare form of spinal trauma. Traumatic midthoracic spondyloptosis is quite rare, and radiology plays an important role in the diagnosis and treatment of this condition. Surgical reconstruction and stabilization are required for early mobilization and rehabilitation of patients with this injury. Here, we report the clinical features, radiographic findings, and management of an unusual case of traumatic midthoracic spondyloptosis that showed complete spinal cord transection and was operated.

Arachnoiditis ossificans in a patient with ankylosing spondylitis, syringomyelia, and a history of spinal surgery.

BACKGROUND AND OBJECTIVE In this article, we describe a patient unusual presenting with both arachnoiditis ossificans and syringomyelia. We have reviewed the patients evaluation, surgery, and treatment. CASE DESCRIPTION This patient developed paraparesis following thoracolumbar spinal surgery to treat kyphosis secondary to ankylosing spondylitis. RESULTS We performed a T9-T11 total laminectomy, drained the cyst, dissected and removed the calcified plaques posterior to the cord, and decompressed the neural structures. CONCLUSION Symptomatic arachnoiditis ossificans (AO) a rare clinical manifestation is characterized by the calcification or ossification of the spinal arachnoid. The occurrence of AO with syringomyelia is rare. To date, a few cases with both AO and ankylosing spondylitis have been reported.