Akcay, Guven; Demirdogen, Filiz; Kotan, Dilcan; Gul, Tuba; Yilmaz, Ali; Ergul, Yusuf Muslum; Celik, Cagla

AIM: To investigate the therapeutic effects of transcranial direct current stimulation (tDCS) on calcium and glutamate excitotoxicity caused by ischemia–reperfusion (IR). MATERIAL and METHODS: The IR model was generated by transient middle cerebral artery occlusion. tDCS treatment was applied at 1 mA for 30 min daily at the 2nd, 24th, and 48th h of IR. The motor and cognitive functions and the concentrations of Ca2+, glutamate, and N-methyl-D-aspartate receptor (NMDAR) in the hippocampus tissues were evaluated. RESULTS: Results showed a reduction in motor and cognitive functions in the IR group compared with that in the sham group, whereas these functions increased in the IR+tDCS group compared with those in the IR group. Ca2+, glutamate, and NMDAR concentrations were higher in the IR group than in the sham group but lower in the IR+tDCS group than in the IR group. CONCLUSION: These results suggest that tDCS treatment improves motor and cognitive dysfunctions after IR and exerts therapeutic effects on learning and memory through the regulation of Ca2+ and glutamate excitotoxicity.

Kucun, Neslihan; Ates, Irem; Laloglu, Esra; Ozmen, Sevilay; Yildirim, Serkan; Pur, Basri; Gozegir, Berrah; Celik, Mine; Kose, Duygu; Isik, Bahar

by means of histomorphological, immunohistochemical, biochemical, electrophysiological, and clinical evaluations. MATERIAL and METHODS: Thirty-two female Sprague-Dawley rats were divided into four groups of eight animals each; Group 1 (control), Group 2 (axonotmesis + normal saline), Group 3 (axonotmesis + pregabalin 30 mg/kg), and Group 4 (axonotmesis + gabapentin 30 mg/kg). Medical treatment was given for the first seven days to groups 3 and 4. Functional recovery was assessed using electromyography (EMG) and the sciatic functional index (SFI). Sciatic nerves were excised for histomorphological, immunofluorescence, and immunohistochemical examinations. Biomarkers were measured using the enzyme-linked immunosorbent assay method. RESULTS: Significant improvement in SFI scores and EMG measurements were observed on the 28th day in groups 3 and 4 (the treated groups), while Group 2 (untreated) exhibited inadequate recovery. Histomorphological and immunohistochemical analyses revealed notable decreases in Wallerian degeneration, necrosis, inflammation, and nuclear factor-kappa B (NF-κB) expression levels in the treated groups compared to Group 2. The groups receiving medical treatment exhibited increased staining areas for nerve growth factor (NGF). Biochemical assessment indicated elevated levels of NGF, ciliary neurotrophic factor, transforming growth factor beta, and myelin basic protein in the treated groups compared to Group 2. CONCLUSION: Overall, the study findings suggest that both pregabalin and gabapentin exert neuroprotective effects and can contribute to the regeneration process, with no apparent superiority of one over the other.

Akcay, Guven; Demirdogen, Filiz; Gul, Tuba; Yilmaz, Ali; Kotan, Dilcan; Karakoc, Esra; Ozturk, Huseyin Emre; Celik, Cagla; Celik, Haydar; Erdem, Yavuz

AIM: To investigate the therapeutic and neuroprotective effects of transcranial direct current stimulation (tDCS) application on the traumatic brain injury (TBI)-induced glutamate and calcium excitotoxicity and loss of motor and cognitive functions. MATERIAL and METHODS: Forty rats were equally divided in the sham, TBI, tDCS + TBI + tDCS, and TBI + tDCS groups. Mild TBI was induced by dropping a 450-g iron weight from a height of 1 m onto the skull of the rats. The tDCS + TBI + tDCS group was prophylactically administered 1 mA stimulation for 30 min for 7 days starting 5 days before inducing TBI. In the TBI + tDCS group, tDCS (1 mA for 30 min) was administered 2 h after TBI, on days 1 and 2. Cognitive and locomotor functions were assessed using the novel object recognition and open field tests. The calcium, glutamate, and N-methyl-D-aspartate receptor 1 (NMDAR1) levels in the hippocampus were measured using enzyme -linked immunosorbent assay. RESULTS: Although the motor and cognitive functions were substantially reduced in the TBI group when compared with the sham, they improved in the treatment groups (p<0.05). The calcium, glutamate, and NMDAR1 levels were considerably higher in the TBI group than in the sham (p < 0.001). However, they were considerably lower in the tDCS + TBI + tDCS and TBI + tDCS groups than in the TBI groups (p < 0.05). In particular, the change in the tDCS + TBI + tDCS group was higher than that in the TBI + tDCS group. CONCLUSION: Application of tDCS before the development of TBI improved motor and cognitive dysfunction. It demonstrated a neuroprotective and therapeutic effect by reducing the excitotoxicity via the regulation of calcium and glutamate levels.

Cakir, Tayfun; Yucetas, Seyho Cem; Yazici, Gulce Naz; Sunar, Mukadder; Arslan, Yusuf Kemal; Suleyman, Halis

AIM: To evaluate the neuroprotective effects of benidipine hydrochloride on the cerebral cortex tissues in rats exposed to cerebral ischemia-reperfusion (I/R) injury. MATERIAL and METHODS: Twenty-four male Wistar albino rats were randomly divided into three groups, and administered benidipine hydrochloride (10 µg/kg/day) orally through a catheter for 2 h to form the study group (BIR group, n=8). The I/R procedure was performed in the rats of the IR group (n=8), and a sham group was formed to determine the normal structure of the cerebral cortex (n=8). Transient ischemia was performed by clamping the left common carotid artery for 2 h. Subsequently, reperfusion was applied for 12 h. Cerebral infarct volumes were measured and cerebral cortex tissue samples were analyzed histopathologically and biochemically by measuring malondialdehyde (MDA), total glutathione, cyclooxygenase 1 (COX-1), COX-2 and superoxide dismutase (SOD) RESULTS: The infarct area was markedly reduced in the BIR group vs. the IR group. Histopathologically, neuroprotective effects of benidipine hydrochloride were observed in the cerebral cortex tissues. The mean malondialdehyde and COX-2 levels were statistically higher in the IR group; however, in the BIR group, these levels were within the normal limits. Furthermore, the mean total glutathione, COX-1 and SOD levels were markedly lower in the IR group, and within the normal limits in the BIR group. CONCLUSION: Benidipine hydrochloride may play a certain protective role in cerebral I/R injury. This effect may be related to improvement in the antioxidant capacity of brain tissue, and the inhibition of overproduction of inflammatory cytokines.

Cakir, Tayfun; Yolas, Coskun

Aim: To compare the clinical and radiological results of using synthetic bone graft versus autograft obtained from the spinous process in posterior lumbar interbody fusion. Material and Methods: This retrospective study included 102 patients with degenerative lumbar spondylolisthesis who underwent one-segment posterior lumbar interbody fusion (PLIF) followed by one-segment posterior transpedicular instrumentation. PLIF surgery was performed using a local solid bone graft obtained from the spinous process in group A and using a synthetic solid calcium hydroxyapatite block in group B. The Oswestry Disability Index (ODI), visual analogue scale (VAS) scores, degree of bone formation, intervertebral disc heights at the operation segment, wound infection, and instrumentation complications were compared between the 6-month and 5-year follow-ups. Results: In both groups, ODI and VAS scores significantly improved at the 6-month and 5-year follow-up. Bone formation at both 6 months and 5 years were higher in group A than that in group B, but without a significant difference when compared. Moreover, the difference in maintaining the intervertebral disc heights was not significant between the two groups. Surgical wound infection more commonly occurred in group B, but without significant difference between the two groups, and rod fractures were observed in two patients in group B; however, no metal breakage was observed in group A. Conclusion: Successful fusion of the intervertebral space and intervertebral height restoration can be achieved and maintained with an autograft from the patient’s spinous processes.

Kayaci, Selim; Bas, Orhan; Celiker, Fatma Beyazal; Ucuncu, Yilmaz; Arslan, Yusuf Kemal; Ozveren, Mehmet Faik; Aykol, Sukru

AIM: To measure and to compare the volume of thalamus using magnetic resonance imaging (MRI) and the anatomical sections. MATERIAL and METHODS: In this study, 13 brain specimens were used. First, the images were taken in 3 mm sections on MRI, the thickness of the thalamus was measured. Subsequently, 4 mm coronal sections were prepared using a microtome. The thalamic volumes calculated from cadaveric specimens were compared with the measurements obtained using MRI. RESULTS: On MRI, the mean thalamic volumes on the right and left hemispheres were found to be 5843.4 ± 361.6 mm3 and 5377.0 ± 666.2 mm3 respectively. The mean volumes of the cadaveric sections were 5610.8 ± 401.3 mm3 on the right side and 5618.5 ± 604.1 mm3 on the left hemisphere. No statistically significant difference was found between the volume calculated from MRI and that obtained from the cadaveric section (p<0.05). CONCLUSION: This study shows a correlation between measurement of thalamus volume based on MRI and those calculated from anatomical sections. Our findings support the reliability of DBS procedures using MRI and stereotactic method.

Sevencan, Ahmet; Misir, Abdulhamit; Ucpunar, Hanifi; Balioglu, Mehmet Bulent; Gur, Volkan; Akinci, Suayip

AIM: To report the incidence and interrelationship of concomitant anomalies in congenital scoliosis (CS) patients. MATERIAL and METHODS: Whole-spine computed tomography and magnetic resonance imaging (MRI) examination, echocardiography, and renal ultrasonography (USG) evaluations of 231 patients with CS were reviewed. Additionally, intraspinal pathologies and structural cardiac and renal anomalies were recorded. RESULTS: The incidence of intraspinal pathology was 53.7%. Echocardiography was performed in 140 of 231 patients, and congenital heart disease was detected in 38 patients. Renal USG was performed in 133 of 231 patients, and a renal disease was detected in 37 patients. In 133 patients, spinal MRI, echocardiography, and renal USG were performed. In 22 of 67 (32.8%) patients with an intraspinal anomaly, an additional cardiac anomaly was detected. In 27 of 67 (40.3%) patients with an intraspinal anomaly, an additional renal anomaly was detected. In 47.3% of patients with a cardiac anomaly, an additional renal anomaly was detected. In 15 of 133 patients (11.2%) intraspinal, cardiac, and renal anomalies were identified. CONCLUSION: Surgeons should evaluate additional anomalies in CS if patients report having a congenital anomaly. Because cardiac and renal anomalies increase intra- and postoperative complication risks, a careful and comprehensive preoperative evaluation is needed.

Yucetas, Cem Seyho; Ucler, Necati; Cakir, Tayfun

AIM: To evaluate the effects of agomelatine on the biochemical and pathological features of cisplatin-induced peripheral neuropathy. MATERIAL and METHODS: This study included a total of 30 male Wistar albino rats that weighed 285-300 grams and were divided into three groups: healthy controls (HC, n=10); cisplatin group (CIS, n=10) and agomelatine plus cisplatin group (AC, n=10). The CIS group received only cisplatin (EbeweLiba, Turkey) at a dose of 2.5 mg/kg, whereas the AC group received both agomelatine (25 mg/kg, Les Laboratoires Servier, France) and cisplatin (2.5 mg/kg). The animals were sacrificed by thiopental anaesthesia (50 mg/ kg, IE Ulagay, Turkey) and sciatic nerves were dissected. The sciatic nerve tissue was analysed for the levels of malondialdehyde (MDA), myeloperoxidase (MPO), total glutathione (tGSH) and superoxide dismutase (SOD) and was examined histopathologically. RESULTS: The mean levels of MDA, MPO, tGSH and SOD were 34.90 ± 13.83, 41.30 ± 18.03, 15.40 ± 6.06 and 48.60 ± 18.19, respectively. MDA and MPO were significantly lower in the AC group than in the CIS group (p < 0.001 for both). However, the antioxidative parameters tGSH and SOD were significantly higher in the AC group than in the CIS group (p < 0.001 for both). Pathological examinations revealed swollen myelinated nerve fibres and evident myelin sheath degeneration in the CIS group; in the AC group, the myelin sheath degeneration was less and the blood vessels were normal. CONCLUSION: Agomelatine decreased the oxidative status in an experimental rat model of cisplatin-induced peripheral neuropathy. Myelin sheath degeneration was less in the AC group than in the CIS group. To our knowledge, this was the first study that showed the positive effects of agomelatine on cisplatin-induced neuropathy in rats.

Musluman, Ahmet Murat; Ozoner, Baris; Kircelli, Atilla; Can, Songul Meltem; Yilmaz, Adem; Kaldirimoglu, Ayca; Sahin, Balkan

AIM: To report neurological and radiological features, surgical management, and mid-term outcomes of patients with chronic subdural hematoma (CSDH) associated with ipsilateral arachnoid cyst (AC) of the middle fossa. MATERIAL and METHODS: A total of 453 patients with CSDH were treated at our clinic between August 2004 and August 2012. Of these patients, 15 had ipsilateral AC in the middle fossa. A single burr hole craniostomy was performed to drain the hematoma. The AC was left intact in 14 patients, and one patient had no surgical intervention. The follow-up period ranged from 13 to 88 months (mean 43.07 ± 23.23 months). RESULTS: The patients with AC associated CSDH were found to be younger than the patients with CSDH alone, and the mean age of 58 patients was 13.15 ± 13.17 years, while it was 11 ± 14.22 years in the other patients. Eleven patients had experienced head trauma at 21-50 days before admission. Hematoma evacuation through a single burr hole with closed-system subdural drainage performed at 2-4 days after surgery improved the symptoms in all patients. Two patients developed subdural fluid collection, which was treated by subduroperitoneal shunt placement. CONCLUSION: Greater prevalence of ACs in patients with CSDHs has been reported in the literature. We recommend the drainage of the hematoma via a single craniostomy and to leave the AC intact as the first choice of treatment if the associated AC is a Galassi type I or II. Additional subduroperitoneal shunting may be performed in patients with Galassi type III cyst.

Can, Songul Meltem; Turkmenoglu, Osman Nuri; Tanik, Canan; Uysal, Ender; Ozoner, Baris; Kaldirimoglu, Saime Ayca; Musluman, Ahmet Murat; Yilmaz, Adem; Cavusoglu, Halit; Bayindir, Cicek

Aim: Computed tomography (CT)-guided stereotactic brain biopsy has been performed in our clinic since March 1998. In this prospective study, we examined the patient data undergoing stereotactic biopsy and the results of biopsies in 500 consecutive patients. Material and Methods: Between the dates of March 1998 and January 2015, CT-guided stereotactic biopsies were performed by using the Leksell stereotactic frame system (Elekta Instruments EU, Sweden) in 500 patients. A total of 512 procedures were performed in patients consisting of 184 females (36.8%) and 316 males (63.2%), ages ranging from 3 to 81 years (mean 50.40±16.67). Results: Conclusive histopathological diagnosis was not achieved in 17(3.3%) of 512 procedures. Of the others, 173 (33.8%) were high-grade gliomas, 103 (20.1%) were low-grade gliomas, 36 (7%) were malignant lymphomas, 34 (6.6%) were other types of brain tumors, 82 (16%) were metastasis and 67 (13.1%) were non-tumoral lesions. Complications were occurred in ten cases: 3 tumoral bleedings, 2 hypertensive cerebral hematomas, 2 peroperative convulsions, 1 epidural hematoma, 1 myocardial infarction and 1 brain edema. The patients who developed myocardial infarction and hypertensive thalamic hematoma died. The mortality was 0.4% and morbidity was 1.6% in 512 procedures. ConclusIon: CT-guided stereotactic biopsy is a reliable and a safe procedure in cases with intracranial lesions when histopathological diagnosis is required for the appropriate treatment.