Turkish neurosurgery最新文献

Aim: To determine the regulation of long non-coding RNA (lncRNA) MALAT1 on neuronal apoptosis during spinal cord injury (SCI) and to explore its possible mechanisms.

Material and methods: The motor ability of SCI rat models and apoptosis in spinal cord tissue were evaluated. Primary spinal cord neurons (SCNs) were isolated and treated with H2O2 before cell transfection. The apoptosis of SCNs and expression of PRDM5 and MALAT1 were also measured. The interactions among MALAT1, miR-199a-5p, and PRDM5 were detected.

Results: The motor ability of SCI rats decreased significantly. The proportion of apoptotic neurons increased in damaged tissue and SCN, along with an increase in the expression of apoptosis-related proteins c-caspase-3/9, autophagy-related proteins (p62 and LC3 II/I ratio), and proinflammatory factors. Moreover, overexpression of MALAT1 and PRDM5 in damaged SCN resulted in an increased apoptosis rate of neurons, elevated expression of apoptosis-related proteins, and upregulated levels of inflammatory factors. However, miR-199a-5p overexpression/PRDM5 knockdown partially counteracted the effects of MALAT1 overexpression on H2O2-induced SCNs. In addition, MALAT1 negatively regulated miR-199a-5p, which targeted PRDM5.

Conclusion: LncRNA MALAT1 promotes neuronal apoptosis during SCI by regulating the miR-199a-5p/PRDM5 axis.

Aim: To evaluate and compare postoperative ischemic complications to determine the risk factors for ischemic complications following revascularization surgery for Moyamoya disease (MMD).

Material and methods: This single-center retrospective study included 266 procedures between 2016 and 2021. Three types of revascularization approaches including direct bypass, indirect bypass, and combined bypass were performed. To identify risk factors for postoperative ischemic complications and contralateral cerebral infarction, preoperative clinical characteristics and radiographic features were examined using multivariate and ordinal logistic regression analyses.

Results: Postoperative ischemic complications occurred in 103 (6.6%) procedures. Ischemic presentation (p=0.001, odds ratios [OR] 5.59, 95% confidence interval [CI] 2.05-15.23), hypertension (p=0.030, OR 2.75, 95%CI 1.11- 6.83), advanced Suzuki stage (p=0.006, OR 3.19, 95%CI 1.40-7.26), and collateral circulation (p=0.001 OR 0.17, 95%CI 0.06-0.47) were risk factors for postoperative ischemic complications. Ordinal regression analysis revealed that unilateral involvement (p=0.043, OR 2.70, 95%CI 0.09-5.31), hemorrhagic presentation (p=0.013, OR 3.45, 95%CI 0.72-6.18), surgical approach (p=0.032, OR -1.38, 95%CI -2.65, -0.12), and collateral circulation [p=0.043, OR -1 .27, 95%CI -2.51, -0.04)] were associated with the type of ischemic complications. History of hypertension (p=0.031) and contralateral computed tomography (CT) perfusion stage (p=0.045) were associated with contralateral infarction.

Conclusion: Inability of cerebral vessels to withstand changes in blood pressure induced by revascularization-related hemodynamic instability might be associated with postoperative complications in patients with Moyamoya disease.

Aim: To examine how Naples prognostic score (NPS) relates to 6-month outcomes in patients with severe traumatic brain injury (STBI).

Material and methods: We retrospectively analyzed the clinical data of 94 patients with STBI between September 2018 and September 2021. Galizia?s method was used to calculate NPS, and patients were categorized as high (NPS > 3) or low (NPS?3) NPS according to their NPS scores based on receiver operating characteristic curve analysis. In addition, the controlling nutritional status score (CONUT) and prognostic nutrition index (PNI) were calculated. Based on the modified Rankin scale (mRS), the outcome for 6-months was evaluated. The mRS score for unfavorable outcomes was ?3.

Results: In the univariate analyses, patients in the unfavorable group had higher NPS scores (p < 0.001). The multivariate analysis demonstrated that NPS was an independent predictor of poor outcomes after adjusting for potential confounding factors (adjusted odds ratio = 7.463, 95% confidence interval [CI]: 1.131?49.253, p < 0.05). The area under the NPS curve for predicting poor outcomes was 0.755 (95% CI: 0.655?0.837, p < 0.001), which was significantly higher than Glasgow coma score (GCS), CONUT, and PNI (NPS vs. GCS, p=0.013; NPS vs. CONUT, p=0.029; NPS vs. PNI, p=0.015).

Conclusion: NPS can be considered to be a novel and better independent predictor of poor outcomes in patients with STBI.

Aim: To compare the results of fluoroscopically guided transforaminal epidural steroid injection (TESI) for pain reduction in ipsilateral early recurrent lumbar disc herniation (RLDH) with ipsilateral late RLDH.

Material and methods: A total of 738 patients complaining of radicular pain due to ipsilateral early and late RLDH were assessed. Of these, TESI was administered to 390 subjects for ipsilateral early RLDH and 346 for ipsilateral late RLDH. TESIs were performed based on radicular leg pain; all subjects were followed up and reexamined after 12 weeks of the therapy. Pre- and postprocedural visual analog scale (VAS) scores and all complications were recorded for the study.

Results: For radicular pain, the mean pre-, and postprocedural VAS scores for ipsilateral early RLDH were 85.44 ± 6.85 and 20.16 ± 3.77 respectively. For late RLDH, the mean pre-, and postprocedural VAS scores were 72.82 ± 5.12 and 30.87 ± 4.17, respectively. A significant statistical difference for pre- and postprocedural VAS scores were observed between ipsilateral early and late recurrent disc herniation TESI groups (p < 0.05).

Conclusion: TESI was more effective for early RLDH than for late RLDH during the 12-week follow-up period.

Aim: To identify the cage retropulsion (CR)-associated risk factors following lumbar interbody fusion (LIF).

Material and methods: Clinical data of patients who underwent LIF between January 2014 and December 2018 at three medical centers were retrospectively analyzed. Patients were divided into CR group and non-CR (NCR) group according to whether they experienced CR or not. This study analyzed radiological and surgical parameters to identify the risk factors associated with CR.

Results: The enrolled 823 patients who underwent LIF had a total of 1205 disk levels. There were 387 men and 436 women, with a mean age of 58.8 (range, 33-86) years old. The average follow-up time was 16.6 (range, 12-27) months. CR was found in 21 patients (9 men and 12 women, 21 levels). Besides, 14 patients complained of radicular pain postoperatively, of whom 10 patients were recovered after conservative treatment, while the remaining 4 patients further required revision surgery. The mean age was 62.3 ± 8.1 (range, 44-74) years old in the CR group and 59.7 ± 9.7 (range, 33-86) years old in the NCR group. The incidence of CR was higher in patients with osteoporosis than those with a normal bone mineral density (BMD). Moreover, 12 of 21 patients had osteoporosis (57.1%), however, only 29.2% of patients without CR had osteoporosis. The cages of retropulsion were all placed at the posterior disk space by immediately postoperative X-ray or computed tomography (CT) scan. On the contrary, only 35.6% of cages were placed at the posterior disk space in the NCR group. Pear-shaped disk was found in 10 of 21 patients in the CR group (47.6%), whereas it was noted in only 13.4% of cases in the NCR group. Furthermore, 13 out of 21 patients in the CR group experienced intraoperative endplate injury (61.9%), while only 13.4% of patients experienced that in the NCR group. Risk factors for CR were osteoporosis [odds ratio (OR)=8.7, 95% confidence interval (CI) (3.42-34.6), P=0.01], posterior cage position [OR=5.8, 95%CI (2.12-24.6), p=0.03], pear-shaped disk [OR=9.9, 95%CI (6.21-46.42), p < 0.001], and intraoperative endplate injury [OR=9.9, 95%CI (6.21-46.42), p < 0.001].

Conclusion: Intraoperative endplate injury, pear-shaped disk, osteoporosis, and posterior cage position were noted as CRassociated risk factors after LIF.

Aim: To assess the risk factors and simultaneously compared the benefits of procedures (clipping vs. coiling) in the recovery of function from oculomotor nerve palsy (OMNP) between cases with unruptured and ruptured posterior communicating artery (PCOM) aneurysms.

Material and methods: Among the 225 cases of aneurysm treated in our department between July 2018 and February 2020, 25 patients with PCOM aneurysm with OMNP (unruptured: n=13; ruptured: n=12) were retrospectively analysed.

Results: The average duration from onset of symptoms to treatment in unruptured PCOM aneurysm cases was 13.33 ± 3.76 days compared with 7.41 ± 2.42 days in ruptured aneurysm cases. Moreover, an 80% improvement was observed when OMNP was treated within 17 days with the earliest improvement noticed in 33.05 ± 18.75 days in unruptured aneurysm cases compared with 39.66 ± 31.75 days in ruptured PCOM aneurysm cases. Stepwise logistic regression analysis revealed that the type of aneurysm (better recovery in unruptured aneurysm cases) was a significant risk factor (p=0.0126), but not the procedure (clipping vs. coiling) performed, for function recovery from OMNP.

Conclusion: Patients with unruptured PCOM aneurysms with OMNP have a better recovery rate than those with ruptured PCOM aneurysms. No procedural (clipping vs. coiling) advantages were observed on the recovery of function from OMNP. Transmitted pulsation reduction significantly affects the recovery of function from OMNP.

Aim: To compare endovascular coiling and surgical clipping for the evaluation of clinical outcomes in patients with unruptured intracranial aneurysms.

Material and methods: We searched MEDLINE, EMBASE, the Cochrane Library and three Chinese domestic electronic databases, namely, Wanfang, CNKI and VIP for studies published between January 1990 and January 2018. We included controlled clinical studies comparing clinical outcomes between surgical clipping and endovascular coiling treatments. Two researchers extracted the data and assessed the quality of the studies, and a meta-analysis was performed using RevMan 5 software.

Results: We analysed a total of 23 controlled clinical studies including 117,796 cases. Meta-analysis demonstrated similar ischaemia rates between clipping and coiling with an odds ratio [OR] of 1.36 (95% CI: 0.77?2.40). The occlusion rate and bleeding risk were higher with clipping than coiling; the pooled ORs were 5.31 (95% CI: 3.07?9.19) and 2.39 (95% CI: 1.82?3.13), respectively. In addition, clipping resulted in a longer hospital stay (OR = 2.90, 95% CI: 2.14?3.65) than coiling did. Patients who underwent clipping had a higher short-term mortality (OR = 1.99, 95% CI: 1.70?2.33) and neurological deficit rate (OR = 2.05, 95% CI: 1.73? 2.44) compared with those who underwent coiling. However, 1 year mortality and deficit rate were similar for both clipping and coiling, with pooled ORs of 0.75 (95% CI: 0.41?1.38) and 0.94 (95% CI: 0.53?1.67), respectively. Funnel plots did not demonstrate a publication bias, with the exception of ischaemic outcome, and sensitivity analysis showed consistent results.

Conclusion: Our study demonstrates that coiling is associated with a lower rate of occlusion, shorter hospital stay, lower bleeding risk and lower short-term mortality and morbidity compared with clipping. In terms of ischaemic risk, 1 year mortality and morbidity, coiling and clipping bear a similar risk. In addition, we speculate that surgical clipping may have a better outcome than endovascular coiling in the long term especially in young patients. Further research is needed to confirm our conclusion.

Aim: To investigate the feasibility and safety of lumbar spinous process split laminotomy by quantitative anatomic analysis.

Material and methods: Nine fresh adult human cadaveric specimens (including 45 lumbar segments) were divided into 3 groups randomly. The simulated operations and anatomic measurements were performed to evaluate the visibility angle and surgical corridor at different retraction widths (8 mm, 10 mm, and 12 mm). By measuring the width causing bony fracture in 45 lumbar segments, the safety margin of retraction width was determined. The findings of lumbar spinous process split laminotomy in one typical case were presented.

Results: At 8 mm retraction width, there was not enough surgical corridor for the operation procedures. At 10 mm and 12 mm retraction width, all operation procedures could be conducted smoothly. The 12 mm group presented a larger surgical corridor and shorter operative time compared with the 10 mm group. The imaging examination confirmed no bony fracture and articular capsule impairment. The visibility angle and exposure extent increased in proportion to the retraction width. The retraction width that resulted in the bony fracture ranged from 12.34 mm to 16.82 mm, with an average of (14.56 ± 1.73) mm. The positions of fracture were in the pedicle of the vertebral arch (68.9%), the lamina (26.7%), and the vertebral body (4.4%).

Conclusion: The retraction width of 10 mm-12 mm is safe and effective. The micromanipulations such as tumor resection, nervous exploration, dural suture, etc. can be conducted smoothly via the surgical corridor. In addition, the retraction width of 12.34~16.82 mm could serve as a safety margin for surgical planning. Our findings may provide a quantitative reference for clinical application of lumbar spinous process split laminotomy.

Aim: To evaluate systemic immune inflammation index (SII), systemic inflammatory response index (SIRI), multi-inflammatory index (MII), and prognostic nutrition index (PNI), and to compare them with the previously reported inflammation-related hematologic index in lumbar discectomy (LD).

Material and methods: This was a retrospective, cross-sectional, single-center study with 105 consecutive patients who underwent surgery for LD. The study comprised three groups: Group I included data from healthy participants, Group II included data before LD, and Group III included data after LD. We analyzed mean platelet volume (MPV), platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), SIRI, SII, MII, and PNI, in comparison with the Roland-Morris Disability Questionnaire (RMDQ), Oswestry Disability Index (ODI), and Visual analog scale for leg (VASLeg).

Results: CRP and MPV were similar for the preoperative and postoperative periods (p=0.489). In the postoperative measurements, NLR, PLR, SII, and SIRI increased (p < 0.0001). On the contrary, PNI decreased with LD (p < 0.0001). NLR (p < 0.001), SII (p < 0.001), and SIRI (p < 0.001) were the valuable indices for LD. PLR (p < 0.001), MII-1 (p=0.004), and MII-2 (p < 0.001) also predicted LD. ODI, RMDQ, and VASLeg correlated with MII-1, MII-2, and SIRI.

Conclusion: LD's most substantial and valuable indices were NLR, SII, and SIRI. Regarding superiority to SII and NLR, SIRI showed significant agreement with the scales and drew a more appropriate marker profile for LD than MII-1, MII-2, and PNI.

Aim: To assess, and to compare the efficacy of anterior endoscopic cervical discectomy (AECD) and anterior cervical discectomy with fusion (ACDF).

Material and methods: Major databases, registries, and other relevant material were screened for prospective trials directly comparing AECD and ACDF. No restrictions were imposed. Meta-analysis was not conducted due to high heterogeneity.

Results: After screening a total of 1339 articles, 2 studies enrolling 225 patients were included. One of these is a randomizedcontrolled- trial, including 120 patients, with a 14% lost to follow-up, showing no statistically significant differences in clinical outcomes according to the visual analogue scale (VAS) of the neck/arm and the North American Spine Society criteria regarding pain/neurological status. Radiological follow-up showed no adjacent-segment disease, with both groups presenting a statistically non-significant progression of a pre-existing adjacent-disc degeneration, and no difference in kyphosis. Recurrence was registered in 7.4% and 6.1% of patients who underwent AECD and ACDF, respectively. No statistically apparent differences in complications were observed. The second is a cohort study, including 135 patients with a 14.8% lost to follow-up. No statistically significant difference was found in clinical outcomes assessed using the VAS of the neck/arm and the neck disability index. No radiological data were provided. Recurrence was reported in 4% and 2% of patients in the AECD and ACDF group, respectively. No remarkable differences in complications were reported. Both studies reported that the surgical time was statistically shorter in AECD.

Conclusion: A definitive conclusion cannot be drawn. Single-level AECD seems to have results equivalent to ACDF, presenting even some benefits. Technical limitations combined with required surgical skills and experience should be considered. We recommend cautious employment in anticipation of future updates.