001), than the controls. At the mRNA level, cytokines appeared partially induced. Double immunofluorescence labeling confirmed the costaining of these factors with inflammatory and glial markers. Conclusions The expression of hypoxia-related and inflammatory mediators was demonstrated for the first time in LSL specimens. These factors might play a role in multifactorial secondary lesion cascades underlying further damage to the neural placode in closed dysraphism.Background Cortical bone trajectories (CBTs) for pedicle screw insertion can be used to stabilize the spine. Surgeons often rely on fluoroscopy or computed tomography navigation technologies to guide screw placement. Robotic technology has potential to increase accuracy. We report our initial experience with robotic guidance for pedicle screw insertion utilizing CBTs in patients with degenerative disc disease.  https://www.selleckchem.com/MEK.html  Methods A retrospective chart review was conducted of data for consecutive patients who underwent spinal stabilization using a posterior approach for CBTs. The newest robotic platform (Mazor X, Mazor Robotics Ltd, Caesarea, Israel) was used in these cases. Accuracy was determined by applying the Ravi Scale Grade I (no breach or deviation), II (breach 4mm). The results were compared to those for a historical cohort of patients who underwent CT-navigation-guided pedicle screw insertion using CBTs. Results Twenty-two patients underwent robot-assisted pedicle screw placement using CBTs. A total of 92 screws were inserted across 24 spinal levels with Grade I accuracy and without complications in the robotic group. Eighteen patients underwent CT navigation for CBT pedicle screw insertion. A total of 74 screws were inserted across 19 levels, 69 of which were grade I accuracy and 5 were grade II accuracy. When comparing operative time (p=0.97), fluoroscopy time (p=0.8), and radiation dose (p=0.4), no significant differences were observed between cohorts. Conclusion Robotic technology and CT navigation technology for CBT pedicle screw insertion were safe and accurate.Objective To study the changes in cyst volume detected on interval computed tomography (CT) in patients undergoing radiation therapy (RT) for residual cystic craniopharyngiomas after surgery. Materials & methods A retrospective analysis of CT scans done halfway during the course of RT for residual cystic craniopharyngiomas between January 2005 and January 2018 was performed to assess the incidence of cyst expansion requiring additional intervention. Possible risk factors for cyst expansion during RT were analyzed. Results 33 patients (23 males) of median age 15 years (IQR, 8-21 years) who underwent surgical excision (n =30) or aspiration (n = 3) of cystic craniopharyngiomas followed by stereotactic (n=25) or conformal (n=8) RT were included. The extent of reduction in tumour volume following surgery was 66.5±17.9% (range, 20.6% to 88.9%). Six (18.2%) of the 33 patients had a median increase in cyst volume of 11.1cc (IQR,9.1 to 12.1cc; range - 6.3 to 40cc) that was beyond the initial planned target volume (PTV) and necessitated additional surgical intervention. Four of the six patients in whom the cyst showed increase in volume underwent cyst aspiration followed by re-planning of RT and two patients underwent re-planning of RT alone without additional surgical intervention. In 5 of these 6 patients, the increase in cyst volume was asymptomatic. Younger age (p=0.002) and larger residual cyst wall (p = 0.009) were found to be risk factors for early cyst expansion. Conclusions Cyst expansion occurs in nearly one-fifth of patients with cystic craniopharyngiomas during the course of RT. As nearly all these expansions are asymptomatic, interval CT scans midway through RT are essential to avoid geographical miss of the tumour.Objective Risk factors for developing cauda equina syndrome (CES) caused by lumbar disc herniation (LDH) remain controversial and have not been yet established. The aim of the study was to investigate whether there is a relationship between age, sex, body mass index (BMI) or the degree of spinal canal compromise and the presence of CES in patients undergoing lumbar microdiscectomy. Methods Between 2015-2019, 506 patients were prospectively identified who had an operation for LDH compressing the dural sac. The "ProlapseCanal ratio" (PCR) was calculated as a proportion of the cross-sectional area (CSA) of the disc prolapse compared to the total CSA of the spinal canal. Results In total, 35 CES (6.9%) patients were identified. Multivariate logistic regression, adjusted for age, gender, BMI and PCR shows that only PCR was associated with the presence of CES (p less then 0.001,AUC 0.7431). BMI was not associated with an increased risk of CES. Conclusions This study demonstrates a significant correlation between the size of LDH relative to size of the spinal canal and the presence of CES. A finding of LDH causing more than 60% obstruction of spinal canal should be considered a red flag and such patients need to be watched more closely.Objective The aim of this study was to define the types, prevalences and diameters of dural septations on the inner surface of the JF and to describe the distances between the JF, the glossopharyngeal (CN IX), vagus (CN X) and accessory (CN XI) nerves, the internal acoustic meatus (IAM), and nearby surgical landmarks on cadaveric heads. Methods Seventeen adult (9 male, 8 female) formalin-fixed cadaveric heads were used to analyze the types and prevalence of DS bilaterally. Diameters and distances between the DS and the adjacent cranial nerves (CN IX-XI) were measured by digital microcaliper. The multiple t test (SPSS 25) was used to analyze the comparison between both sides via diameters, numbers, distance, length, thickness of DS. Results The most frequent type of DS was type I (62.5%, right; 56.3% left), followed by type II (18.8%, right; 25% left), type III (12.5%, right; 6.3% left) and type IV (6.3%, right; 12.5% left). The mean diameter of the septum was 0.6 -1 mm, and the mean length of the dural septa was 4.01 mm, right; 3.83 mm, left. The difference in the length and thickness of the DS between the genders were statistically significant on both sides (p less then 0.05). The female DS-CN X and DS-JF distances were greater than those of males on the right side (p less then 0.05). Conclusions The significant differences between dural septum types on the two sides of the body may indicate asymmetrical location or a variant emerging site of CNs in the same individual.