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Emrah Celtikci, Burak Karaaslan, Alp Özgün Börcek, and Omer Hakan Emmez

OBJECTIVE

During the coronavirus disease 2019 (COVID-19) pandemic, neurosurgeons all around the globe continue to operate in emergency cases using new self-protective measures. Personal protective equipment (PPE) use is recommended in all surgeries. The authors have experienced varying degrees of field of view (FOV) loss under the surgical microscope with different PPE. Herein, they aimed to investigate the effects of different PPE on FOV while using the surgical microscope.

METHODS

Fifteen neurosurgeons and neurosurgery residents participated in this study. Three kinds of PPE (safety spectacles, blast goggles, and face shields) were tested while using a surgical microscope. FOV was measured using a 12 × 12–cm checkered sheet of paper on which every square had an area of 25 mm2 under the microscope. The surgical microscope was positioned perpendicular to the test paper, and the zoom was fixed. Each participant marked on the test sheet the peripheral borders of their FOV while using different PPE and without wearing any PPE. A one-way repeated-measures ANOVA was performed to determine if there was a significant difference in FOV values with the different PPE.

RESULTS

FOV was significantly different between each PPE (F[3, 42] = 6339.845, p < 0.0005). Post hoc analysis revealed a significant decrease in the FOV from the naked eye (9305.33 ± 406.1 mm2) to blast goggles (2501.91 ± 176.5 mm2) and face shields (92.33 ± 6.4 mm2). There were no significant FOV changes with the safety spectacles (9267.45 ± 410.5 mm2).

CONCLUSIONS

While operating under a surgical microscope safety spectacles provide favorable FOVs. Face shields increase the eye piece–pupil distance, which causes a severe reduction in FOV.

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Aydemir Kale, Alp Özgün Börcek, Hakan Emmez, Zuhal Yildirim, Emre Durdağ, Neşe Lortlar, Gökhan Kurt, Fikret Doğulu, and Nedret Kılıç

Object

Extensive research has been focused on neuroprotection after spinal cord trauma to alleviate the effects of secondary injury. This study aims to investigate the neuroprotective effects of gabapentin in an experimental spinal cord ischemia reperfusion injury.

Methods

Thirty-two adult male New Zealand white rabbits received spinal cord ischemic injury using the aortic occlusion model. Animals were divided into 4 groups (sham, control, low-dose, and high-dose treatment groups; 8 rabbits in each group). High (200 mg/kg) and low (30 mg/kg) doses of gabapentin were administered to the animals in the treatment groups after spinal cord ischemic injury. Neurological status of the animals, ultrastructural findings in injured tissue samples, and levels of tissue injury markers in these 2 groups were compared with findings in the animals that did not receive the ischemic procedure (sham-operated group) and those that received normal saline after administration of ischemia.

Results

Regarding levels of tissue injury marker levels after ischemic injury, animals in the gabapentin-treated groups demonstrated better results than animals in the other groups. The ultrastructural findings and caspase-3 activity were similar. The treatment groups demonstrated better results than the other groups.

Conclusions

Gabapentin demonstrated significant neuroprotection after early phases of ischemic injury. Further studies with different experimental settings including neurological outcome are required to achieve conclusive results.

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Oktay Algin, Murat Ucar, Evrim Ozmen, Alp Ozgun Borcek, Pinar Ozisik, Gokhan Ocakoglu, and E. Turgut Tali

OBJECT

The goal of this study was to determine the value of the 3D sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-SPACE) technique in the evaluation of endoscopic third ventriculostomy (ETV) patency.

METHODS

Twenty-six patients with ETV were examined using 3-T MRI units. Sagittal-plane 3D-SPACE with variant flip-angle mode, 3D T1-weighted (T1W), and 3D heavily T2-weighted (T2W) images were obtained with isotropic voxel sizes. Also, sagittal-axial plane phase-contrast cine (PC)-MR images were obtained. The following findings were evaluated: diameters of stoma and third ventricle, flow-void sign on 3D-SPACE and PC-MR images, integrity of the third ventricle on heavily T2W images, and quantitative PC-MRI parameters of the stoma. Obtained sequences were evaluated singly, in combination with one another, and all together.

RESULTS

The mean area, flow, and velocity values measured at the level of stoma in patients with patent stoma were significantly higher than those measured in patients with closed stoma (p < 0.05). There was significant correlation among PC-MRI, 3D-SPACE, and 3D heavily T2W techniques regarding assessment of ETV patency (p < 0.001). The 3D-SPACE technique provided the lowest rate of ambiguous results.

CONCLUSIONS

The 3D-SPACE technique seems to be the most efficient one for determination of ETV patency. The authors suggest the use of 3D-SPACE as a stand-alone first-line sequence in addition to routine brain MRI protocols in assessing patients with ETV, thereby decreasing scan time and reserving the use of a combination of additional sequences such as PC-MRI and 3D heavily T2W images in suspicious or complex cases.

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Gökhan Kurt, Alp Özgün Börcek, Berker Cemil, NeşE Lortlar Uçankuş, Fikret Doğulu, and M. Kemali Baykaner

Object

Dural defects must be repaired to protect the central nervous system from contamination. Although there are various experimental and commercial substances available for this purpose, the ultimate method of watertight dural closure has yet to be discovered. In this study, the authors investigate the effects of topically applied recombinant mouse granulocyte-macrophage colony–stimulating factor (GM-CSF) on dural healing in a rat model of dural injury and cerebrospinal fluid leakage.

Methods

In this experimental model, a dural defect at the level of the L1–2 vertebrae was created in 32 Wistar rats. Sixteen animals were treated with locally applied recombinant mouse GM-CSF postoperatively, and 16 animals received normal saline. The effects of GM-CSF on dural healing, cerebrospinal fluid leakage, and wound healing were assessed 2 and 4 weeks postoperatively. Dural healing was evaluated histologically.

Results

Dural healing was increased in rats treated with GM-CSF compared with rats in the control group. This difference was statistically significant (p < 0.05).

Conclusions

Cerebrospinal fluid leakage may impede healing of dural defects. Topically applied GM-CSF seems to aid in dural healing.

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Alp Özgün Börcek, Ertan Ergün, Hakan Emmez, Gökhan Kurt, Fikret Dogulu, and M. Kemali Baykaner

✓Myelomeningocele presenting as a retromediastinal mass originating from the midline defect through the fused T-4, T-5, and T-6 VBs is described.

An 11-year-old boy with a completely normal systemic and neurological examination suffering pulmonary problems such as effort dyspnea and severe kyphosis was evaluated and an anterior thoracic myelomeningocele was diagnosed. The boy underwent surgery for excision of the meningomyelocele sac and correction of kyphoscoliosis. His year-long follow-up period as an outpatient was uneventful.

A comprehensive PubMed search of the literature returned no results for an “anterior thoracic myelomeningocele” query. To the best of the authors' knowledge, this is the only case described in the literature.