<p><strong>Objective. </strong>Our objective was to determine the safety, efficacy, and surgical outcome of an extensive posterolateral approach for giant spinal epidural tumors.</p><p><strong>Materials and Methods. </strong>Our clinical study included 12 patients with various giant primary tumors and metastases of the spine, who underwent surgery between 2008 and 2019. The surgical procedure consisted of costotransversectomy, laminectomy, corpectomy, tumor resection, spinal column stabilization, and reconstruction. Neurological status examination and pain assessment were recorded at the time of admission, upon discharge and at outpatient check-up.</p><p><strong>Results. </strong>In our clinical sample, there were no major perioperative complications. All patients were discharged from the intensive care unit back to the hospital department within a week after the surgery. Postoperative follow-up showed no deterioration of neurological status. Furthermore, there was a moderate to significant improvement of paraparesis in all patients for weeks after surgery. The most notable improvement was significant pain relief in all the patients. None of the patients had issues with failure of the implanted hardware. Two patients died less than six months after the surgery due to the progression of the primary malignant process.</p><p><strong>Conclusion. </strong>An extensive posterolateral approach to giant spinal epidural tumors is an effective one-step approach. It presents a good compromise between invasiveness and sufficient exposure for both tumor resection and spinal column reconstruction. Good short-term clinical improvement can be achieved, but the long term results depend on the advancement of the initial disease. Careful evaluation and selection of patients are necessary to achieve clinical improvement and prolonged life expectancy, and the best results are achieved with a multidisciplinary approach.</p>
Purpose: In this study, the effect of gabapentin on the regulated cell death of astrocytes in primary culture was examined. Because astrocytes are relatively resistant to decay by apoptotic pathways, the effect of different concentrations of gabapentin on apoptosis in necroptosis was tested as another form of regulatedcell death. In addition, the impact of gabapentin on the death of astrocytes that were exposed to ethanol was also examined. Methods: Primary cultures of astrocytes that were obtained from the brain cortex of newborn rats were used as the experimental model. Cells were exposed to different concentrations of gabapentin only, ethanol only or to a combination of ethanol and gabapentin. Using flow cytometry, the proportions of viable, early apoptotic, necroptotic, and secondary dead cells were determined. Results: The effect of gabapentin on early astrocytic apoptosis and necroptosis was dependent on concentration. In concentrations of up to 10 μg/mL, gabapentin did not affect astrocyte deaths; whereas at higher concentrations, the proportion of necroptotic cells increased. The concomitant exposure of the cells to gabapentin (10 μg/mL) and ethanol (100 mM) for 24 hours did not significantly affect cell death caused by ethanol. For cells that are exposed to 50 mM ethanol for 7 days, gabapentin slightly reduced the proportion of necrotic cells. Conclusion: Gabapentin did not affect the viability of astrocytes in concentrations up to 10 μg/mL. The concomitant exposure of astrocytes to ethanol and gabapentin for 24 hours did not reduce the toxicity of ethanol. In astrocytes that are chronically exposed to ethanol, gabapentin slightly reduced the effect of ethanol on necroptosis.
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