To evaluate the impact of nasoseptal flap (NSF) elevation on sinonasal quality of life (QOL) in patients with pituitary adenomas who underwent endoscopic endonasal trans-sphenoidal approach (EETSA), the data of 106 eligible patients were included from February 2011 to December 2014. The scores of Sinonasal Outcome Test (SNOT-22) Questionnaire were assessed in case (that received reconstruction with NSF) and control groups preoperatively as well as 1, 3, 6, and more than 12 months postoperatively. Nine most related sinonasal questions were evaluated separately (9Q). There were no significant inter-group differences in the mean SNOT-22, 9Q, and sense of taste/smell scores in preoperative and all postoperative assessments. Within each group, a significant improvement of SNOT-22 and 9Q scores were noted after 12 months of surgery compared to preoperative data. In the NSF group, comparison of the pre- and first postoperative evaluation revealed a significant deterioration in 9Q score (p = 0.007) and "sense of taste/smell" (p < 0.001) which both returned to baseline in the 3rd month. Patients who used nasal paper mask for more than 100 "hour-days" showed a better SNOT-22 scores at 1st (p = 0.04) and 3rd (p < 0.001) months after surgery. Patients with adrenocorticotropic hormone (ACTH) secretory adenomas showed significantly higher scores of SNOT-22 in all postoperative assessments compared to the others. Although nasal symptoms deteriorated at first postoperative month (compare to preoperative data) in the NSF group, no negative impacts on the sinonasal QOL was showed comparing to the control group. ACTH-secreting adenomas could be assumed as a risk factor for poorer sinonasal QOL in EETSA.

Several studies have reported clinical manifestations of the new coronavirus disease. However, few studies have systematically evaluated the neuropsychiatric complications of COVID-19. We reviewed the medical records of 201 patients with confirmed COVID-19 (52 outpatients and 149 inpatients) that were treated in a large referral center in Tehran, Iran from March 2019 to May 2020. We used clustering approach to categorize clinical symptoms. One hundred and fifty-one patients showed at least one neuropsychiatric symptom. Limb force reductions, headache followed by anosmia, hypogeusia were among the most common neuropsychiatric symptoms in COVID-19 patients. Hierarchical clustering analysis showed that neuropsychiatric symptoms group together in three distinct groups: anosmia and hypogeusia; dizziness, headache, and limb force reduction; photophobia, mental state change, hallucination, vision and speech problem, seizure, stroke, and balance disturbance. Three non-neuropsychiatric cluster of symptoms included diarrhea and nausea; cough and dyspnea; and fever and weakness. Neuropsychiatric presentations are very prevalent and heterogeneous in patients with coronavirus 2 infection and these heterogeneous presentations may be originating from different underlying mechanisms. Anosmia and hypogeusia seem to be distinct from more general constitutional-like and more specific neuropsychiatric symptoms. Skeletal muscular manifestations might be a constitutional or a neuropsychiatric symptom.

Objectives: The outcomes of Gamma Knife radiosurgery (GKRS) for cavernous sinus meningioma (CSM) are presented, and factors possibly affecting outcome are investigated. Methods: The medical records and imaging and procedural reports of 166 patients with CSM were retrospectively reviewed. Demographic data, procedural data, symptomatic improvement, radiological regression, and progression-free survival (PFS) rates were evaluated. Results: There were 124 women and 42 men; including 44 postoperative and 122 primary GKRS cases. Mean follow-up was 32.4 months. Mean marginal dose was 13 Gy. Symptomatic improvement was seen in 40.4%, while neurologic deterioration occurred in 9.6%; 50% remained symptomatically stable. Radiological regression was noted in 57.2%; the tumor remained stable in 35.5%, and 7.2% of the patients experienced tumor progression. The actuarial 5- and 10-year PFS rates were 90.1% (±3.3) and 75.8% (±8.8), respectively. History of previous surgery or radiotherapy were associated with lower symptomatic improvement. Higher tumor coverage and isodose lines were accompanied with better radiological prognosis. However, a history of conventional radiotherapy, presence of facial sensory deficits at presentation, a higher tumor volume, and tumor extension to the suprasellar compartment affected the radiologic outcome negatively. Conclusion: This study revealed a high efficacy and safety for GKRS in both postoperative and primary GKRS patients. Achievability of a good profile of tumor coverage and isodose lines at radiosurgical planning predict a better outcome.

We report the safety and efficacy of bilateral foraminoplasty of Monro in a patient with partial occlusion of right Monro and complete occlusion of the left one. A 38-year-old man who underwent a ventriculoperitoneal shunt three years ago, and shunt revision surgery twice, presented with hydrocephalus, and was referred to us because of continuing complaints of headaches, nausea and vomiting. The primary surgical treatment of the patient was bilateral endoscopic Monro foraminoplasty. Then, the patient did not need a ventriculoperitoneal shunt, and hydrocephalus was resolved. Bilateral monroplasty in a single-session surgery can be the treatment of choice, instead of microsurgically open reconstruction of the foramen of Monro. The procedure can be less invasive, and it avoids ventriculoperitoneal shunting. KeywOrds: Foramen of monro, Foraminoplasty, Hydrocephalus, Neuroendoscopy ÖZBu yazıda, sağ foramen monroda parsiyel ve sol foramen monroda tam oklüzyonu olan hastada yapılan bilateral foraminoplastinin etkinliği ve güvenilirliği sunulmaktadır. Üç yıl önce ventriküloperitoneal şant takılan ve iki kez revizyon ameliyatı yapılan 38 yaşındaki erkek hasta, sürekli olan başağrısı, bulantı, kusma yakınması ile kabul edildi. Hastaya bilateral endoskopik foraminoplasti yapıldı. Bundan sonra hastanın şant bağımlılığı ortadan kalktı ve hidrosefalisi düzeldi. Tek seansta iki taraflı monroplasti açık yolla yapılan foramen monro rekonstrüksiyonuna alternatif bir yöntem olarak düşünülebilir. Monroplasti daha az invaziv ve şant bağımlılığını ortadan kaldıran bir yöntemdir.

Rathke cleft cyst (RCC) is an uncommon albeit benign sellar lesion with an incidence rate of between 2 to 33%. RCCs are usually asymptomatic except in the large cases whit suprasellar extension. We herein describe a unique case of RCC, which presented with severe visual loss owing to massive herniation of the optic chiasm and third ventricle down into the sphenoid sinus through a small 8×8 mm foramen after transnasal endoscopic surgical fenestration and marsupialization of the cyst. We describe a reconstruction method via endonasal transsphenoidal approach in this case and suggest prophylactic reconstruction of the sellar floor in sellar lesions with equal or more voluminous suprasellar extensions that are susceptible to such massive herniation and secondary empty sella syndrome.KeywOrds: Rathke cleft cysts, Sella turcica, Secondary empty sella syndrome ÖZRathke yarığı kisti nadir ve benign bir sellar lezyon olup insidansı %2 ila 33 arasındadır. Rathke yarığı kistleri genellikle suprasellar uzantılı büyük olgular dışında asemptomatiktir. Burada optik kiazm ve üçüncü ventrikülün transnazal endoskopik cerrahi ile fenestrasyon ve kist marsüpializasyonundan sonra küçük 8x8 mm bir foramen içinden sfenoid sinüse masif herniasyonu nedeniyle şiddetli görme kaybıyla gelen benzersiz bir Rathke yarığı kisti olgusu sunuyoruz. Bu olguda endonazal transsfenoidal yaklaşımla bir rekonstrüksiyon yöntemi öneriyor ve bu tür masif herniasyon ve sekonder boş sella sendromuna yatkın olan eşit derecede veya daha hacimli suprasellar uzantılara sahip sellar lezyonlarda, sella tabanının profilaktik olarak rekonstrüksiyonunu öneriyoruz.AnAhtAr sÖZCÜKler: Rathke yarığı kistleri, Sella tursika, Sekonder boş sella sendromu

We report a case of bilateral three-level lumbar spondylolysis that was directly repaired by use of hook-screw technique. The patient complained of low back pain for 2 years that progressively worsened and was exacerbated with standing and walking. He also mentioned bilateral sciatalgia. The neurological examination was normal. Interestingly, we found bilateral lumbar spondylolysis in L3, L4, and L5 levels in imaging studies. After proving that spondylolysis was the source of the low back pain by local anesthetic agent injection, we used a direct technique for correction of spondylolysis by use of a hook-screw device plus decortications of lysis area and iliac crest autograft. We assessed the patient after surgery to evaluate pain recovery and fusion rate. The results were favorable and proved the efficacy of the hook-screw technique for treatment of symptomatic multilevel lumbar spondylolysis.

Spinal penetrating trauma has a complex neurosurgical management. This study presents a 55-year-old male admitted in our center with a 1 × 1 centimeter laceration on the sacral area skin due to a wooden penetrating object. The computed tomography (CT) of the spine revealed a hypodense penetrating object that was introduced from the posterior aspect of the sacrum into dural space and then stopped in the S1 vertebral body. We performed a laminectomy of intact superior portion of the S1 lamina and released the wood from the surrounding bone, and finally, we pulled it out.

No abstract