Patients with ventriculoperitoneal (VP) shunts may have multiple complications. Migration of the peritoneal catheter into some anatomical or congenitally open cavities can cause inguinal or genitourinary manifestations such as hernia, hydrocele or acute scrotum, and these are common in male infants. We report a very rare complication of VP shunt encountered in a female infant, manifesting as hydrocele of the canal of Nuck, the female counterpart of hydrocele of the spermatic cord. It is emphasized that VP shunts may also cause clinical inguinal manifestations in female infants, and groin or external genital organ swelling in these patients may be an important sign of shunt malfunction.

Background/aim: Caudal epidural steroid injection (CESI) has been increasingly used for treating lower back pain. However, there is still significant controversy about the efficacy and safety of different imaging techniques used to guide CESI. In this context, the objective of this study is to compare the efficacies of fluoroscopy- and ultrasonography-guided CESI in patients with chronic lower back pain. Materials and methods: The population of this retrospective, observational study consisted of all consecutive patients who underwent CESI for lower back pain between 2018 and 2020. Of the 371 patients included in the study sample, 192 had undergone fluoroscopy- guided CESI (Group F) and 179 ultrasonography-guided CESI (Group U). Patients' pain and functional statuses were evaluated using the visual analog scale (VAS) and Oswestry Disability Index (ODI) immediately before (baseline) and after the procedure (postintervention day 0-D0), during the second week (D15), the first month (D30), and the third month (D90) after the procedure. Results: The mean age of Group F was significantly higher than that of Group U (p < 0.001). The number of patients with lumbar disc hernia was significantly higher in Group U, whereas the number of patients with spinal stenosis and lumbar disc hernia + spinal/lumbar stenosis was significantly higher in Group F (p = 0.001). The baseline and D0 ODI scores were significantly lower in Group U than in Group F (p = 0.006 and p = 0.017, respectively). There was no significant difference between the groups in other VAS and ODI scores (p > 0.05). Intragroup analyses revealed significant reductions in VAS and ODI scores over the follow-up period till D30 compared to the baseline scores in each group (p < 0.001). The decrease recorded in the ODI score between the D15 and baseline measurements was significantly higher in Group F than in Group U (p = 0.006). Conclusion: The CESI was as effective as fluoroscopy-guided CESI in treating chronic lower back pain.

Aim: This study aimed to evaluate the diagnostic performance of the Delta Neutrophil Index (DNI) and Neutrophil-to-Lymphocyte Ratio (NLR) in distinguishing malignant from benign primary brain tumors during the preoperative period. Methods: This retrospective cohort study was conducted at a tertiary university hospital. A total of 140 participants were included 60 patients with malignant glial tumors, 50 patients with benign brain tumors, and 30 healthy controls without inflammatory, infectious, or hematologic disease. Preoperative complete blood count results obtained within seven days before surgery were analyzed. Results: Patients with malignant tumors were significantly older than those in the benign and control groups (p < 0.001). DNI, NLR, PLR, MLR, and SII values were all significantly elevated in the malignant group (p < 0.001, for all comparisons). ROC analysis revealed high diagnostic accuracy for DNI (AUC = 0.847) and NLR (AUC = 0.850), with optimal cut-off values of 3.50 and 3.95, respectively. In multivariable logistic regression adjusted for age, DNI > 3.5 (OR = 20.67; 95% CI: 3.35–127.64; p = 0.001), NLR > 3.95 (OR = 21.17; 95% CI: 3.28–136.50; p = 0.001), and CRP (OR = 1.52; 95% CI: 1.20–1.93; p = 0.001) remained independent predictors of malignancy. The combined model including DNI and NLR achieved the highest diagnostic accuracy (AUC = 0.937; age-adjusted AUC = 0.943), with a sensitivity of 88.3% and a specificity of 86.0% after age adjustment. Conclusions: Both DNI and NLR demonstrated significant value in differentiating malignant from benign primary brain tumors prior to surgery, with DNI emerging as the most powerful independent predictor. The combined use of DNI and NLR substantially improved diagnostic accuracy, suggesting that simple hematologic indices may serve as practical, noninvasive adjunctive tools in the preoperative assessment of brain tumor malignancy. These markers may assist in surgical prioritization, patient counseling, and clinical decision-making, particularly in resource-limited settings.

Objective: This study aimed to compare the clinical outcomes of navigation-assisted and conventional (freehand) ventriculoperitoneal (VP) shunt placement in pediatric hydrocephalus patients. Methods: A retrospective review was conducted of 164 patients under the age of 18 who underwent VP shunt placement for hydrocephalus between 2015 and 2023 and had a minimum postoperative follow-up of 12 months. The conventional technique was used in 116 patients. The navigation-assisted technique (intraoperative ultrasonography or frameless neuronavigation) was used in 48 patients. Demographic data, hydrocephalus etiology, catheter tip position (Yim classification), revision rates, infection, complications, and length of hospital stay were recorded. Catheter tip position was assessed on postoperative imaging by two independent investigators. Results: No significant differences were found between the groups in terms of age, sex, and hydrocephalus etiology. The optimal catheter placement rate was significantly higher in the navigation-assisted group compared to the conventional technique (81.25% vs. 60.34%, p = 0.017). The revision rate was significantly lower in the navigation-assisted group (16.67% vs. 38.79%, p = 0.010). The mean hospital stay was shorter in the navigation-assisted group (7.85 ± 3.97 days vs. 10.20 ± 3.70 days, p < 0.001). The groups were similar in terms of infection (2.08% vs. 9.48%, p = 0.183) and overall complication rates (14.58% vs. 16.38%, p = 0.959). Conclusions: Navigation-assisted VP shunt placement in pediatric hydrocephalus patients is associated with a high rate of optimal catheter position, a low revision rate, and a short hospital stay. These findings support the use of navigation technology in pediatric hydrocephalus surgery, but also reveal that infection and complications are unassociated with the surgical technique.

Background Context: For cervical disc replacements to be comparable to the gold standard of cervical discectomy and fusion (ACDF), disc replacements they must be able to provide normal range of motion as well as predictable and reliable correction of cervical alignment. The Synergy Disc was designed to provide correction of alignment in the sagittal plane while restoring physiologic range of motion. Purpose: This study evaluated whether the Synergy Disc provided preservation and/or restoration of sagittal alignment while normalizing kinematics and providing acceptable clinical outcomes. The alignment provided by the Synergy Disc was compared with a retrospective cohort of 30 single- level ACDF patients. Study Design/Setting: The pilot trial was a multi-center, prospective, consecutive patient enrollment study using the Synergy Disc for the treatment of single and two-level degenerative disc disease of the cervical spine. Patient Sample: The procedure was performed on 43 patients (45 implants) with follow-up on 40 patients (42 implants). For the historical cohort ACDF arm, 30 patients with similar follow-up with single level anterior discectomy, fusion and plating were used for segmental lordosis measurements. Outcome Measures: For the Synergy Disc group, the kinematic outcome parameters included: range of motion (ROM), shell angle (SA), disc height (DH), sagittal plane translation and center of rotation (COR) in the X and Y direction. Standard assessments of clinical outcomes were also measured (Neck Disability Index, Visual Analog Scale). For the fusion arm, only functional spinal unit (FSU) angle was recorded using a single preoperative and postoperative standing lateral cervical radiograph. Methods: In the Synergy Disc group, static and dynamic radiological assessments were performed in 43 consecutive patients prior to the placement of the Synergy Disc. Forty patients were studied for the course of the study protocol (3 patients lost to follow-up). For the Synergy Disc group, lateral cervical radiographs were evaluated for range of motion, translation, center of rotation, disc height and shell angle before and at the longest postoperativr follow-up. Neck Disability Index and Visual Analog Scale for arm and neck pain were collected and analyzed. For the fusion group, standing lateral radiographs were reviewed. Results: In all the patients (40 patients, 42 implants), followed up for at least 24 months at an average of 28 months the average SA of the Synergy Disc was maintained at 6±2.7° of lordosis. Preoperative ROM, translation and center of rotation on X axis did not change significantly following surgery. There was a significant upward shift in the center of rotation on Y axis. There was significant improvement in all clinical outcome measures. In the fusion group, with a similar follow-up period, there was a 4° increase in lordosis at the FSU. Conclusions: The Synergy Disc provided lordosis at the surgical level, while maintaining preoperative range of motion, translation and COR X. The lordosis of 6±2.7° provided by the Synergy Disc at 2 years following surgery was comparable to the lordotic correction provided by an anterior cervical discectomy with interbody fusion and plating.