AIM:To determine the relationship between the serum urate (SU) level, neutrophil / lymphocyte ratio (NLR), and pain severity using preoperative and postoperative visual analogue scale (VAS) scores in patients with lumbar disc herniation (LDH). MATERIAL and METHODS:This single-center, cross-sectional study included 20 consecutive patients who were operated for LDH by the same surgeon. The patients'pre-and postoperative UA levels, NLRs, and intensity severity VAS scores were investigated. Preoperative magnetic resonance imaging (MRI) findings, serum UA levels, and neutrophil and lymphocyte counts were recorded. Pain severity was recorded preoperatively and at 6 months postoperatively. Effects of the preoperative SU levels and NLRs on the pre-and postoperative VAS scores were statistically assessed. RESULTS:Statistically significant positive correlation coefficients were determined between NLR and the preoperative and postoperative VAS scores. Negative correlation coefficients were found between the SU levels and preoperative VAS scores; in contrast, positive correlation coefficients were found between the SU levels and the postoperative VAS scores. CONCLUSION:Our results demonstrate the importance of not ignoring the serum UA level and NLR in pre-and postoperative pain in patients with LDH. Nevertheless, further extensive studies are warranted.

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Background and aim Late-onset seizure due to intracerebral needle is a rare entity. Most of them were clinically asymptomatic and rarely presented with seizure. Sewing needles are used in homicidal attempt in infancy or early childhood before the closure of the fontanels. Because of sociologic, politic, and scientific deficiencies subject remained untouched. We tried shedding some light on this ambiguous phenomenon. Material and methods We report a 54-year-old man who was admitted to our neurosurgery outpatient department with epilepsy due to a sewing needle located in the left frontal lobe of the brain and made extensive literature review. Result Patient's physical and neurological examinations were completely normal. All biochemical and hematological tests were normal. Cranial tomography demonstrated a linear density at the left frontal lobe compatible with a sewing needle. Patient was followed-up with antiepileptic treatment with no seizure. Sixty cases from up-to-date literature and past cases were reviewed. Patients' ages differ from 4 days to 70 years. Our review showed four cases treated with antibiotics, 19 patients went to surgery, and others just followed-up with antiepileptic and other drugs. Conclusion Literature needs an autopsy series for a more intimate estimation. Due to psychosocial and legitimacy problems, matter should be handled cautiously and law enforcement agencies must be informed. Follow-up with medication is the first line of treatment with asymptomatic patients. Treatment is dictated by clinic onset, physical examination, and patient consent.

BACKGROUND: Adalimumab (ADA), which is a new-generation recombinant human monoclonal antibody for tumor necrosis factor α (TNFα), has strong anti-inflammatory effects. The role of enhanced inflammation is well established for the development and progression of cerebral vasospasm. Investigated in the present study is the probable ameliorating and neuroprotective effects of ADA in rabbits using a cerebral vasospasm model with biochemical and histopathological methods. METHODS: Thirty male New-Zealand white rabbits were randomly divided into control, subarachnoid hemorrhage (SAH) only and SAH plus ADA treatment groups. SAH was established as a single cisterna magna autologous arterial blood injection. ADA treatment was started just after intracisternal blood injection and continued for 72 hours once a day. The animals were sacrificed 72 hours after the induction of SAH, serum and brainstem tissue obtained for investigations. RESULTS: Brainstem tissue and plasma levels of tumor necrosis factor-alpha and Interleukin-1β, brainstem tissue Matrix metalloproteinase-9 levels increased after SAH and partly decreased after treatment. Plasma levels of brain-derived neurotrophic factor decreased after SAH and partly restored after treatment. ADA treatment significantly increased the mean cross-sectional area of the vasospastic basilar arteries, reduced the basilar artery wall thickness and also ameliorates enhanced endothelial apoptosis. CONCLUSION: Findings obtained in this study suggest that ADA is an effective neuroprotective agent for ameliorating cerebral vasospasm in experimental rabbit vasospasm.

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Study design: Single-center retrospective study Objectives: This study is performed to determine the anatomic feasibility of the C1 posterior arc screw and help select an optimal screw trajectory in treating patients with craniovertebral junction pathologies. Material and Methods: We reported a single-centre retrospective study. Forty patients (20 male and 20 female) who underwent cervical computed tomography (CT) were chosen from the hospital records. Based on CT images, we measured left laminar length (LLL), right laminar length (RLL), left laminar angle (LLA), right laminar angle (RLA), left laminar axial thickness (LLAT), right laminar axial thickness (RLAT), left laminar coronal thickness (LLCT), right laminar coronal thickness (RLCT), and craniocaudal angle (CCA) of the C1 posterior arc. Results: The mean values and standard deviations (SD) for nine parameters at the C1 posterior arc were determined. LLL, RLL, LLCT, and RLCT were statistically longer in men than women. RLAT was bigger in men but there was no statistical difference. RLA was statistically wider in women than men. LLA and CCA were wider in women but there was no statistical difference, LLAT was bigger in women but there was no statistical difference. There was no statistical difference in measurements by age. Conclusion:  The results of this study are important to avoid neurovascular injury and pedicle breakage because of choosing large screw while performing C1 laminar screw fixation.

Objective: We aim to demonstrate the fusion efficiency of anterior screw fixation technique in all types of type 2 odontoid fracture by presenting a study of 11 cases and updating the literature. Methods: Retrospectively we analyzed 11 (8 males and 3 females) patients with type 2 odontoid fracture treated through anterior odontoid screw fixation in the Neurosurgery Department of XXX University Hospital between 2015 and 2018. All patient records were evaluated with current clinical, neurophysiological examination, radiological studies, and results. In operation we used retropharyngeal approach of Robinson and Smith and created a gutter in the superior edge of C3 corpus for proper trajection of screw. The patients were followed over a minimum period of eighteen months with a range (18-24 months). Assessments of the union, nonunion, screw displacement and overall, with complications were all recorded. Results: 10 patients had no postoperative complication. Separation of odontoid fracture was observed in 1 patient after discharge from hospital, but during follow up period computerized tomography revealed fusion of the odontoid of the patient. Our patients had no complication such as screw related problems, pseudoarthrosis and dysphagia. Conclusion:We recommend surgical treatment in all cases of type 2 odontoid fractures, including the anterior oblique fracture. The method used in our study is more reliable for trajection of screw and suitable for type 2 odontoid fracture, also fusion rate is higher than the other techniques

Epidermoid tumors, which constitute 0.2 to 1.8% of primary intracranial neoplasms, occur in the third and fifth weeks of fetal development. Epidermoid tumors, which are known to occur most frequently in the cerebellopontine angle, are rarely located intraventricularly. A third ventricular location can be seen in 0.7% of cases. Epidermoid tumors are more common between the ages of 19 and 69, and are very rare in the pediatric period. In this report, we present a third ventricular epidermoid tumor in an 11 years old pediatric patient.