Objective: This study aimed to evaluate the utility of computed tomography (CT) guidance in difficult lumbar puncture (LP) cases, which had a history of at least one unsuccessful blind attempt at LP (no imaging guidance), and to note potential advantages and disadvantages of the use of CT guidance. Methods: In total, 32 CT-guided LP procedures performed between June 2019 and March 2021 were included. All LP indications were recorded. The procedures where the cerebrospinal fluid flow was provided by a single puncture were evaluated as “primary technical success.” “Secondary technical success” corresponded with the procedures in which additional puncture was necessary for the cerebrospinal fluid flow. Results: Intrathecal nusinersen injections due to spinal muscular atrophy constituted the largest procedure group of this study. Among 32 procedures, primary and secondary technical success rates were 78.12% and 28.57%, respectively. There were no major procedural complications. Conclusions: Computed tomography–guided LP is an effective interventional technique offering an alternative approach in the setting of difficult LP procedures.

Objectives: Methamphetamine (MA) abuse during adolescence can have a significant impact on brain development. On the other hand, regular exercise is known to promote brain health and may have neuroprotective effects. The purpose of this study is to compare brain volumes in three different adolescent groups: those with active methamphetamine use disorder (MUD), adolescent athletes who regularly exercise, and healthy control adolescents. Methods: This MRI study involved three groups of adolescents: 10 with active MUD (9 males, 1 female), nine licensed runner adolescents (three males, six females), and 10 healthy adolescents (5 males, 5 females). Brain volumes were analyzed using T1-weighted images from a 3.0 Tesla MRI scanner, and then segmented automatically with vol2Brain. Statistical analyses included ANCOVA with sex as a covariate and LSD post hoc tests performed using SPSS Statistics 23. Results: Adolescents with MUD showed a 10% increase in total white matter volume compared to the athlete group. Conversely, cortical gray matter volume was reduced by 4% compared to the healthy control group and by 7% compared to the athlete group. The frontal and insular cortices in the MUD group had significantly diminished volumes compared to the athlete group. Overall, individuals with MUD had decreased gray matter volumes and increased white matter volumes in their brains. The brain volumetric differences between the MUD group and the athlete group were statistically significant. Conclusions: The brains of those with MUD displayed a reduction in gray matter volume and an increase in white matter volume, indicating damage from MA on the developing adolescent brain. The volumetric disparities between the MUD and athlete groups were found to be significantly different, suggesting a possible neuroprotective factor of exercise. Further studies are required to explore the potential of exercise-based interventions in alleviating the harmful effects of MA abuse.

Background/Objectives: One of the surgical interventions applied in the cervical region is the pedicle screw method. The cervical pedicle screw is stronger than any other screw method; however, use of the cervical pedicle screw is limited due to the variability in the anatomy of the cervical vertebrae and the risks to the neurological and vascular structures in this region. This study aimed to determine the morphological features of subaxial cervical vertebrae of the adult Turkish population and to provide guidance for the pedicle screwing method. Methods: In our study, pedicle analyses were examined in the subaxial neck vertebrae of a total of 60 patients, 30 male and 30 female, using computed tomography images. In subaxial vertebrae (C3–C7), bilateral pedicle width, pedicle axis length, pedicle transverse angle, sagittal and transverse diameter of vertebral foramen, and the distance between two pedicles were measured. Results: Pedicle widths that did not fit the commonly used 3.5 mm pedicle screw were detected in both male and female patients. The mean bilateral pedicle width in male patients was found to be greater than in female patients. When the parameter results were compared according to the levels, it was found that the pedicle width, pedicle axis length, transverse diameter, and the distance between the two pedicles increased statistically significantly. Conclusions: We think that the data obtained from the study will help determine the appropriate screwing (screw selection) in subaxial vertebra pedicle surgery and increase the success of the surgical procedure.

AIM: To present an alternative endovascular treatment option for the vein of Galen aneurysmal malformation by ethylene-vinyl alcohol copolymer embolization via a double-lumen balloon microcatheter. MATERIAL and METHODS: A female patient was suspected with the vein of Galen aneurysmal malformation in the prenatal period and diagnosed choroidal type vein of Galen aneurysmal malformation. Once the patient was symptomatic with severe cardiac failure, an endovascular treatment decision was made. In the first step, a mixture of N-butyl cyanoacrylate-lipiodol was used for embolization. In the second session of the treatment, ethylene-vinyl alcohol copolymer was administered through a double-lumen balloon microcatheter. RESULTS: Complete cure of the aneurysmal malformation was obtained by no filling was observed in arterial feeders, collapsed appearance of the vein of Galen, and arterial-venous shunts at the end of the five-year follow-up period with magnetic resonance imaging and angiography. CONCLUSION: Ethylene-vinyl alcohol copolymer embolization via double-lumen balloon microcatheter provides an alternative and effective endovascular treatment option for the vein of Galen aneurysmal malformations using less contrast agent in less procedural time. Also, the possibility of spontaneous regression of residual aneurysmal malformations with small feeders should be considered.