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    Anterior transpedicular screw fixation of cervical spine: Is it safe? Morphological feasibility, technical properties, and accuracy of manual insertion
    (AMER ASSOC NEUROLOGICAL SURGEONS, 2015) Koktekir, Ender; Toktas, Zafer Orkun; Seker, Askin; Akakin, Akin; Konya, Deniz; Kilic, Turker
    OBJECT Due to lack of construct stability of the current anterior cervical approaches, supplemental posterior cervical approaches are frequently employed. The use of an anterior-only approach with anterior transpedicular screws (ATPSs) has been proposed as a means of providing 3-column fixation. This study was designed to investigate the feasibility of anterior transpedicular screw (ATPS) fixation of cervical spine, to obtain the morphological measurements for technical prerequisites, and to evaluate the accuracy of the ATPS using fluoroscopy. METHODS The study included both radiological and anatomical investigations. The radiological investigations were based on data from cervical spine CT scans performed in 65 patients. Technical prerequisites of ATPS were calculated using OsiriX for Mac OS. In the anatomical part of the study, 30 pedicles (C3-7) from 6 formalin-preserved cadavers were manually instrumented. Measurements obtained included pedicle width (PW), pedicle height (PH), pedicle transverse angle (PTA), distance of the entry point from the midline (DEPM), and distance of the entry point from the superior endplate (DEPSEP). The authors also analyzed screw position in the manually instrumented vertebrae. RESULTS The mean PW and PH values showed a tendency to increase from C-3 to C-7 in both males and females. The means were significantly larger for both PW and PH in males than in females at all levels (p = 0.001). The overall mean PTA value was significantly lower at C-7 (p < 0.0001). The mean value for the distance of entry point from the midline (DEPM) represented a point at the contralateral side of the pedicle for every level except C-7. The mean DEPSEP values showed significant differences between all levels (p < 0.0001). Seven of the 30 screws were identified as breaching the pedicle (23.3%); these screw malplacements were seen at C-3 (3 screws), C-4 (2 screws), and C-5 (2 screws). CONCLUSIONS The morphological measurements of this study demonstrated that ATPS fixation is feasible in selected cases. They indicate that ATPS insertion using a fluoroscopy-assisted pedicle axis view is safe at the C-6 and C-7 levels, but the results at the other levels did not prove the safety of this technique.
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    Laboratory Training in Bifrontal and Frontolateral Approaches Using Cadaveric Silicone-Injected Cow Craniums
    (JOURNAL NEUROLOGICAL SCIENCES, 2015) Tatarli, Necati; Turan Suslu, Hikmet; Ceylan, Davut; Seker, Askin; Karabagli, Hakan; Kotktekir, Ender; Ozdogan, Selcuk
    Background: A microneurosurgical laboratory training model was designed for trainees in neurosurgery to help them to learn how to handle surgical microscopes and microneurosurgical instruments. A silicone-injected fresh cadaveric cow cranium is a suitable alternative to using a cadaveric human brain for gaining familiarity with the frontal cranial nerves and vascular structures for bifrontal and frontolateral approaches. Methods: A silicone-injected cadaveric cow cranium was prepared by irrigating the major vessels, followed by the injection of silicone colored either red or blue. Results: A three-step approach was designed to simulate microneurosurgical dissection along the frontal lobe and for the dissection of cranial nerves and vascular structures. This laboratory training model is useful for trainees to gain experience in the use of an operating microscope and become more familiar with the anterior neural and vascular structures in bifrontal and frontolateral approaches. Conclusion: The aim of this study was to develop an innovative model to create a life-like microneurosurgical training system. This model simulates bifrontal and frontolateral approaches performed on the human brain.
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    Vascular Silicone Injection of Fresh Cadaveric Cow Cranium: Alternative Training Model For The Human Brain
    (JOURNAL NEUROLOGICAL SCIENCES, 2015) Tatarli, Necati; Suslu, Hikmet Turan; Ceylan, Davut; Seker, Askin; Karabagli, Hakan; Koktekir, Ender; Ozdogan, Selcuk
    Background: Anatomical and physiological variations of the human brain's vascular system can be observed via silicone injection of the arterial and venous systems. As a novel method, the injection of a fresh cadaveric cow cranium with silicone is an alternative to using the human brain for microanatomical studies. Objective: To report on an improved method for the colored silicone injection of a fresh cadaveric cow cranium using a silicone injection technique. Methods: Five fresh cow crania were injected as an alternative to human brains for microanatomical dissection, in which the preparation consisted of the irrigation of the major vessels and the injection of colored silicone. Cannulation of the internal carotid arteries and the internal jugular veins with catheters was performed, and the vasculature was irrigated with water (major arteries and veins). The fixation of the specimen with either formaldehyde or alcohol, and the colored injection of the arteries and veins with red and blue silicone, respectively, was then performed. Results: The silicone injections resulted in the deeper penetration of the colored solutions into the small cerebral vessels and mesenchymal structures of the fresh cadaveric cow crania. Of the five injected specimens, four exhibited successful injections, while one had suboptimal results. Conclusion: Silicone injection of the cadaveric cow brain, based on the anatomical and physiological assessment of the vasculature of the specimen for microanatomical studies, is suggested as an alternative to using human brain specimens.