Many patients may suffer from neuropathic pain in the early post-surgical period after lumbar discectomy. Gabapentin and pregabalin are anticonvulsant agents that may decrease perioperative central sensitization and early post-surgical neuropathic pain. Gabapentin and pregabalin effectively relieved neuropathic pain and prevented the conversion of acute pain to chronic pain at the 1-year follow-up after lumbar discectomy.

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In parallel with improvements in understanding pain neurophysiology, many chemicals have recently been investigated for spinal anaesthesia and analgesia. However, studies discussing the effects of these drugs on neural tissue indicate that knowledge about some aspects of neurotoxicity is limited. Forty-nine New Zealand albino rabbits, weighing 2.2±0.2 kg, were randomly assigned to seven groups of seven animals each. Single dose groups received intrathecally through the atlantooccipital membrane 0.9% saline 1.5 ml; midazolam 100 µg/kg (low dose midazolam group) or 500 µg/kg (high dose midazolam group); neostigmine 10 µg/kg (low dose neostigmine group) or 50 µg/kg (high dose neostigmine group). Two groups had seven days of repeated dosing with either midazolam 100 µg/kg/day (repeat midazolam group) or 10 µg/kg/day neostigmine (repeat neostigmine group). The animals were sacrificed on day 8, and two spinal cord sections from the fourth cervical level and fourth lumbar level were removed and prepared for histopathological study. Transmission electron microscopic evaluations were performed on transverse spinal cord sections by a neuropathologist blinded to the group allocation. Twenty myelinated axons and neurones in the cervical and lumbar sections were investigated for the histopathological study. This study indicates that midazolam and neostigmine have different neurotoxic effects that depend on the dose and the repetition of dosing when these drugs are administered intrathecally.

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ABSTRACTcommon clinical entities encountered by any neurosurgical service.Brain herniation due to posttraumatic hematoma remains one of the most difficult situation faced by neurosurgeons, and causes significant mortality and morbidity. To our knowledge there were only few past studies focused especially into the herniated subgroup of traumatic extraaxial hematomas (31,37,43,44).The aim of this retrospective study was to assess the surgical outcome and the prognostic importance of clinical and █ INTRODUCTION A ccident is the leading cause of death among individuals younger than 45 years. Traumatic brain injury (TBI) accounts for approximately 70% of these traumatic deaths and most of the unfavorable outcomes (2). The most important complication of TBI is the development of intracranial hematomas. It is estimated that intracranial hematomas occur in 25-45% of severe TBI, 3-12% of moderate cases and approximately 1 in 500 patients with mild TBI (40). As a result, acute traumatic extraaxial hematomas (epidural hematoma (EDH) and subdural hematoma (SDH)), are among the most AIm: The aim of this study was to assess the surgical outcome and the prognostic importance of clinical and radiological data of patients operated emergently for an extraaxial hematoma causing brain herniation. mATERIAl and mEThODS:This retrospective study comprised 108 adult patients who were operated due to herniated traumatic extraaxial hematomas from January 2000 to January 2013. RESUlTS:Of 108 patients, 63 patients (58.3%) were diagnosed as subdural hematoma (SDH), and 45 patients (41.7%) as epidural hematoma (EDH). An unfavorable outcome was significantly increased for patients who were diagnosed as SDH (90.4%) compared with EDH patients (33.3%). Mortality rate for herniated SDH patients was 65.1%, and 26.6% for herniated EDH patients. High mortality and unfavorable outcome ratios were associated with Glasgow Coma Scale scores at admission, mean postoperative intracranial pressure (ICP) values, type of the brain herniation, interval from the time of trauma to the time of hematoma decompression, the duration of the brain herniation, intraoperative acute brain swelling, hematoma volume and thickness, degree of the midline shift and the obliteration of the basal cisterns. CONClUSION:Our data showed that, postoperative ICP values were one most important predictor of the mortality. We recommended postoperative ICP monitoring for all patients presenting with the brain herniation due to traumatic extraaxial hematoma.

SummaryWe assessed the effect of magnesium on the amount of bleeding, coagulation profiles and surgical conditions during lumbar discectomy under general anaesthesia. Forty patients, of ASA physical status 1-2 and aged 18-65 years, undergoing single-level microscopic lumbar discectomy, were randomly assigned to magnesium sulphate (50 mg.kg )1 in 100 ml saline over 10 min followed by a continuous infusion of 20 mg.kg.h )1 ) or saline. The mean (SD) estimated blood loss was 190 (95) and 362 (170) ml in the magnesium and saline groups, respectively (mean difference = 172 ml; 95% CI 84-260 ml). The median (IQR [range]) Fromme's scale score for surgical conditions for the magnesium and saline groups were 2 (2-3 [2-3]) and 3 (2-3 [3-4]), respectively (p < 0.05).The bleeding time, haemoglobin, platelet count, prothrombin time, international normalised ratio and fibrinogen levels were similar in the two groups. The activated partial thromboplastin time was prolonged in the magnesium group immediately postoperatively and at 6 h after surgery. After the bolus of magnesium, the heart rate was higher and the mean arterial pressure lower in the magnesium group. The use of magnesium sulphate during lumbar discectomy decreases blood loss, and provides better surgical conditions without marked haemodynamic effects.

Although further studies considering different dose regimens and time intervals are required, DA was shown to be at least as effective as methylprednisolone in spinal cord ischemia/reperfusion model.