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Delayed cerebral ischemia (DCI) secondary to aneurysmal subarachnoid hemorrhage (aSAH) is a major contributor to morbidity and mortality. In addition to oral nimodipine, normovolemia, and induced hypertension, intra-arterial (IA) administration of vasodilators has been employed in DCI treatment. One such agent is milrinone, a phosphodiesterase-3 inhibitor. This study aimed to evaluate the long-term clinical outcomes of IA milrinone administration. In this retrospective controlled study, 60 patients diagnosed with DCI following aSAH and treated at our institution between January 2023 and June 2024 were analyzed. Of these, 35 received only standard DCI therapy, and 25 underwent IA milrinone administration in addition to standard treatment. No serious or permanent complications related to milrinone administration were observed. Clinical and radiological data were compared, and outcomes were assessed using the modified Rankin scale at 6 months postoperatively. The hypothesis that IA milrinone reduces mortality and functional dependency was tested. The univariate analysis showed a non-significant trend toward reduced dependency in the milrinone group (OR: 0.94, p = 0.945), and similar findings were observed in the multivariate analysis (OR: 0.56, p = 0.594). A nonsignificant increase in mortality was observed in the IA therapy group. Age was the only independent predictor of survival. In conclusion, although IA milrinone therapy appears to be safe, it does not confer a statistically significant benefit in terms of long-term survival or functional outcomes in patients with DCI. Further large-scale prospective multicenter studies are required to validate these findings.

Aim: This study evaluates the perceived educational value of four microanastomosis training models: the silicone tube model, the chicken wing brachial artery model, the UpSurgeOn Mycro simulator, and the Wistar Albino rat model, used within a structured microsurgical training program delivered during a national neurovascular symposium. Material and Methods: Sixteen participants completed a two-day, sixteen-hour microsurgical course that followed a stepwise training sequence. Pre-training and post-training surveys were administered for each modality using five-point Likert scales evaluating realism, technical difficulty, confidence, and overall suitability for microvascular skill development. Results: All modalities were perceived as educationally beneficial and contributed to microanastomosis skill development at different stages. The silicone tube model was viewed as highly effective for early-stage skill acquisition and basic instrument coordination. The chicken wing brachial artery model was appreciated for reproducing key biological characteristics while avoiding the logistical and ethical constraints. The Wistar Albino rat model was consistently rated as the most realistic and educationally valuable component of the training program, providing the closest approximation to operative conditions. The UpSurgeOn Mycro simulator did not meet participants expectations but served as a useful bridge between synthetic and biologic models. Conclusion: This multimodal stepwise approach to microanastomosis training was perceived as educationally valuable, with each model contributing at different stages of skill development. Based on these observations, incorporating structured simulation-based microanastomosis training into national neurosurgical education programs may help support preparedness for clinical practice.

Aim: Central nervous system arteriovenous fistulas (AVFs) are abnormal connections between arteries and veins that pose a significant neurological risk. This study evaluated the clinical and angiographic outcomes of patients who underwent endovascular (EVT), surgical (ST), or hybrid (surgery after endovascular treatment) treatment for cerebral AVFs. Material and Methods: A retrospective analysis was conducted on 22 patients treated at our hospital between January 2023 and January 2024. The collected data included demographics, Glasgow Coma Scale score, feeding artery, fistula classification, treatment modality, angiographic and neurological outcomes, and mortality. Treatment decisions were individualized based on fistula characteristics and patient condition. Statistical analyses were performed using SPSS v25.0. Results: Twenty-two patients (mean age 52.4, 68.2% male) underwent EVT (n=12), ST (n=5), or hybrid (n=5) treatment. Complete fistula occlusion was achieved in 11 patients (50%), with no significant difference among treatment groups (EVT 36.4%, ST 36.4%, hybrid 27.3%, p=0.29). Overall mortality was 18.2% (EVT 3 (25%), ST 1 (2%), p=0.77). Neurological outcomes showed that 31.8% developed new postoperative deficits, 31.8% had unchanged neurological deficits and 36.4% experienced complete neurological recovery. Notably, no neurological deterioration was observed in the hybrid treatment group. Patients who received hybrid treatment exhibited a significantly higher complete recovery rate (p=0.004). Hybrid treatment may be associated with less neurological deterioration and greater improvement. Conclusion: Endovascular, surgical, and hybrid approaches showed comparable effectiveness in treating AVFs in terms of occlusion rates, neurological deficits, and mortality. In addition, hybrid treatment has significant advantages, including a high complete recovery rate and low neurological deterioration rate. Larger multicenter prospective studies are warranted to further refine the treatment protocols.

Purpose: The digital age has made health information widely accessible but also fueled cyberchondria, where individuals excessively search symptoms online, increasing health anxiety. This is critical in neurosurgery, where common complaints like headaches or back pain are linked to serious conditions. This study investigates the impact of cyberchondria on neurosurgical outpatients, considering psychiatric history, gender, and socioeconomic status. Materials and methods: This prospective observational study included 90 new patients from two randomly selected neurosurgery clinics at a tertiary care hospital. Data on demographics, medical history, prior healthcare interactions, and online research behaviors were collected. The Depression Anxiety Stress Scale (DASS-21) measured cyberchondria, depression, anxiety, and stress. Statistical analysis used chi-square, Fisher’s exact, and Spearman’s correlation tests. Results: Of 90 patients, 55 (61.1%) were women and 35 (38.9%) were men. Forty percent reported researching symptoms online before their visit. Women and patients with psychiatric history scored significantly higher on all psychological measures. Pre-visit internet use correlated with elevated cyberchondria, anxiety, depression, and stress. Lower-income patients had higher cyberchondria scores. Cyberchondria strongly correlated with increased anxiety and stress levels. Conclusion: Cyberchondria significantly contributes to health anxiety in neurosurgical clinics, leading to unnecessary referrals. Gender, psychiatric history, and lower income levels are associated with higher susceptibility. Patient education, psychological support, and improved doctor-patient communication may help reduce its impact and enhance healthcare efficiency. Keywords: Cyberchondria, health anxiety, neurosurgery outpatient clinic, online health information, psychological factors.

Cervical spondylotic myelopathy (CSM) develops as a result of compression of the spinal cord in the cervical region. Early diagnosis and surgical treatment can limit the progression of symptoms. Various surgical approaches and strategies have been described in the literature. This study aims to evaluate the clinical and radiological results of open-door laminoplasty for the treatment of CSM. In this study, we retrospectively analyzed the patients who underwent expansive open-door laminoplasty secured with titanium miniplates. Thirty-four patients with CSM who were followed up postoperatively for more than 12 months were included in the study.The modified Japanese Orthopedic Association(mJOA) score was used to assess the degree of myelopathy.We evaluated cervical sagittal alignment with C2-C7 Cobb angle, the ambulatory status with the Nurick grade, and measured postoperative neck pain with the Visual Analogue Scale(VAS). The mean mJOA score was 11(range 6-15) preoperatively, and 13.5 (range 9-16) postoperatively with an average 55% recovery rate (range 0-75)(p <0.001).The mean Nurick grade was 2(range 1-3) preoperatively and 1 (range 0-3) postoperatively (p <0.001).The median cervical lordoticangle increased from 7.5° preoperatively to 12.5° postoperatively (p = 0.044).K-line (+) patients' mean mJOA scores significantly increased from 10.8 ±1.7 to 13.3±1.7postoperatively (p <0.001).The mean preoperative VAS reducedfrom 2.66±1.4 to 1.59±1.4 postoperatively (p <0.001). Open-door laminoplasty technique is an effective surgical procedure that can be used safely to treat cervical spondylotic myelopathy.Our findings suggest that it can limit the progression of symptoms and alter the poor prognosis in CSM.