BACKGROUND The main concern regarding lung-protective ventilation strategies during neurosurgery is the reduction in venous return and increase in cerebral blood flow when using high positive end-expiratory pressure (PEEP). This study aimed to evaluate and compare the changes in regional cerebral oxygen saturations (rSO2) during the use of 5 cmH₂O and 10 cmH₂O PEEP in patients undergoing craniotomy for tumor resection. MATERIAL AND METHODS The study was designed as a prospective, single-blind randomized controlled study. Patients aged between 18 and 70 years, scheduled for an elective craniotomy for tumor resection, were divided into 2 groups: 5 cmH₂O PEEP (Group Low PEEP) and 10 cmH₂O PEEP (Group High PEEP). The PEEP was applied during general anesthesia, for controlled mechanical ventilation. The main outcome was the measurement of rSO2 before dura opening. Changes in rSO₂, hemodynamic parameters, and peripheral oxygen saturation (SpO₂) during different periods of surgery were compared between the groups. RESULTS Sixty-four patients were included. There were no significant differences between the 2 groups regarding demographic data. Mean arterial blood pressure and changes in SpO₂ were statistically similar in all periods between the groups (P=0.141 and P=0.081). When compared with the baseline value, SpO₂ increased significantly at all measurement times (P<0.05). No difference was observed in rSO₂ values compared with baseline rSO₂ values between the groups (P=0.218). CONCLUSIONS PEEP at the level of 10 cmH₂O can be safely applied during craniotomy without altering hemodynamics, and without causing a decrease in rSO₂.

Background and Objectives: Osteoporotic vertebral compression fractures (OVCFs) are a common cause of morbidity in the elderly, often resulting in pain, reduced mobility, and diminished quality of life. Treatment options include conservative management, vertebroplasty (VP), and kyphoplasty (KP). This study aimed to compare the clinical outcomes and complication rates of patients treated with kyphoplasty/vertebroplasty versus conservative methods and identify risk factors associated with the development of new fractures. Materials and Methods: This retrospective cohort study included patients diagnosed with OVCFs who were treated either surgically (KP/VP) or conservatively between January 2020 and January 2025. Inclusion criteria encompassed vertebral height loss on CT, STIR hyperintensity on MRI, and a T-score below −2.5. Patients were followed for at least one year. Clinical evaluations included pain scores (VAS), functional status (ODI), and quality of life assessments. Complications and new fracture rates were recorded. Logistic regression analysis was performed to identify risk factors influencing fracture recurrence. Results: A total of 132 patients were analyzed: 65 in the KP/VP group and 67 in the conservative treatment group. The KP/VP group achieved better postoperative pain results (3.2 ± 1.0 vs. 4.0 ± 1.2) with a significant difference of −0.8 (95% CI: −1.2 to −0.4, p = 0.032) and better mobility results (ODI: 4.5 ± 0.8 vs. 3.9 ± 0.9) with a significant difference of 0.6 (95% CI: 0.3–0.9, p = 0.047) and improved quality of life scores (6.7 ± 1.1 vs. 5.9 ± 1.3) with a significant difference of 0.8 (95% CI: 0.4–1.2, p = 0.041). The incidence of new fractures was similar between groups (15.4% vs. 17.9%, p = 0.678). Overall complication rates were 7.7% in the KP/VP group versus 11.9% in the conservative group (p = 0.435). The results from logistic regression analysis showed that age (adjusted OR: 2.48, 95% CI: 1.20–5.13), low bone mineral density (adjusted OR: 0.31, 95% CI: 0.15–0.63), and cement leakage (adjusted OR: 3.10, 95% CI: 1.21–7.99) were identified as risk factors for new fractures. The study found that outdoor activity (adjusted OR: 0.38, 95% CI: 0.20–0.73) and anti-osteoporosis treatment (adjusted OR: 0.17, 95% CI: 0.04–0.79) acted as protective factors against new fractures. The KP/VP group required half the time to recover from their injuries because they used their braces for 3.0 ± 0.5 months instead of 6.0 ± 1.0 months (p < 0.001). Conclusions: Kyphoplasty and vertebroplasty were more effective than conservative treatment in improving pain, mobility, and quality of life in patients with OVCFs. Although the incidence of new fractures did not differ significantly between groups, surgical treatment demonstrated lower complication rates and significantly faster recovery, as evidenced by reduced brace use duration. These findings support the use of KP/VP as a viable option for managing OVCFs in appropriately selected patients.

Objective: To compare the clinical and radiological e!cacy of bone cement volumes injected during unilateral percutaneous balloon kyphoplasty for thoracolumbar vertebral compression fractures. Methods: In this retrospective study, we reviewed data from 96 patients who underwent single-level unilateral kyphoplasty. The patients were categorized into 2 groups based on the cement volume injected: group 1 (cement volume "4 mL, minimum 3 mL; n=48) and group 2(cement volume >4 mL, maximum 6 mL; n=48). The clinical outcomes, as assessed using the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores, were evaluated preoperatively and then at the final follow-up 1 month postoperatively. The vertebral corpus height at the fracture level was measured at the anterior, middle, and posterior regions through sagittal computed tomography scanning. Results: The mean age of the patients was 64.2 years in group 1 and 63.8 years in group 2. In group 1, the mean anterior vertebral height increased from 19.0 ± 3.3 mm preoperatively to 19.9 ± 3.2 mm postoperatively, whereas in group 2, it increased from 17.9 ± 3.8 mm to 19.6 ± 3.7 mm, respectively. The middle vertebral heights were 15.4 ± 2.5 mm preoperatively and 16.9 ± 2.8 mm postoperatively in group 1 and 16.0 ± 3.6 mm and 17.5 ± 3.2 mm, respectively, in group 2. Both groups exhibited significant improvements in ODI and VAS scores, with no significant di#erence between the groups. A statistically significant increase was recorded within each group for the anterior, middle, and posterior vertebral heights. However, a significantly greater increase was noted in the anterior height in group 2 compared to that in group 1 (P < .05). Conclusion: Unilateral kyphoplasty is an e#ective procedure for managing painful vertebral compression fractures. The greatest loss of vertebral height occurred in the middle column, which also exhibited the greatest potential for restoration. Thus, a higher cement volume facilitated greater restoration of the anterior column height. Cite this article as: Benek HB, Ulgen T, Tabanlı A, Ak C, Akcay E, Yilmaz H. E!cacy of bone cement volume in unilateral kyphoplasty of thoracolumbar compression fractures: A clinical comparative study. Acta Orthop Traumatol Turc., 2025;59(1):63-68.

Background and Objectives: Unplanned return to the operating room (URTOR) is a sensitive indicator of surgical quality; however, data in neurosurgery are limited. This retrospective study analyzed patients who underwent URTOR following neurosurgical procedures over an eight-year period to define early and late patterns, identify underlying causes, and evaluate the distribution of cases according to surgeon experience. Materials and Methods: Records of 18,258 consecutive surgeries including both elective and emergency procedures in adult and pediatric patients, performed at a single center between 2010 and 2018 were retrospectively reviewed. Unplanned reoperations within 30 days of the index surgery were defined as URTOR; those occurring within ≤7 days were classified as “early,” and those occurring between 8 and 30 days were classified as “late.” Demographic data, surgical characteristics, causes of URTOR, and surgeons’ seniority were examined. Results: Among 18,258 neurosurgical procedures, 324 URTORs (1.8%) were identified. The median patient age was 38 years; 37% were children. Early URTOR comprised 59% and was primarily associated with hemorrhagic–vascular complications, whereas late URTOR accounted for 41% and was dominated by cerebrospinal fluid-related and infectious complications. Late events prevailed in significantly younger cases and were disproportionately followed by ventriculo–peritoneal shunt or endoscopic third ventriculostomy index operations. Junior surgeons performed 74% of later operations requiring URTOR versus 30% of early failures. Sex, weekday/weekend timing, and surgeons’ experience did not affect the overall URTOR classification categories. The median interval was six days. Conclusions: Centers worldwide have begun to examine URTOR rates, which are directly associated with hospital quality measurements. These results may inform targeted education and prevention by identifying patient groups at higher reoperation risk within a specific timeframe.

Background and Objectives: Scalp nerve block (SNB) is hypothesized to attenuate the physiological response to skull pinning more effectively than local anesthetic (LA) infiltration. This study aimed to compare the two techniques using Bispectral index (BIS) as a primary surrogate measure of cortical arousal. Materials and Methods: In this prospective observational study, patients undergoing elective craniotomy received either bilateral SNB (Group S, n = 53) or LA infiltration (Group LA, n = 35) based on anesthesiologist preference. Depth of anesthesia was monitored via BIS. The primary outcome was the change in BIS after skull pin insertion. A ΔBIS > 20% from baseline triggered rescue medication (remifentanil/propofol). Secondary outcomes included hemodynamic parameters and rescue requirements. Results: There was a significant main effect of time on BIS values (p < 0.001), indicating that BIS values changed significantly across measurement points. Post-hoc examination of parameter estimates revealed that the Group LA showed significantly greater increases in BIS values compared to the Group S at T1 (p = 0.030) and T3 (p = 0.024). No significant between-group differences in BIS changes were observed at T5, T10, or T15 time points (p > 0.05). Hemodynamic responses (mean arterial pressure and heart rate) were also transiently but significantly higher in Group LA at these time points (p < 0.001). The most clinically notable finding was that significantly more patients in Group LA required rescue medication (p < 0.001), indicating a greater frequency of clinically significant physiological trespass. Conclusions: Compared to LA infiltration, SNB was associated with statistically significant reductions in immediate BIS and hemodynamic responses to skull pinning. The key potential clinical implication is the corresponding reduction in the need for rescue anesthetic intervention. These findings support SNB as a technique for enhancing physiological stability, though the direct impact on patient-centered outcomes requires further study. BIS may serve as a useful adjunctive indicator of the cortical response to noxious stimuli.