Turkish neurosurgery最新文献

Aim: To describe the role of metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) in glioblastoma (GB) progression in patients concurrently diagnosed with diabetes mellitus (DM).

Material and methods: Formalin-fixed paraffin-embedded (FFPE) tumor samples of 47 patients diagnosed with GB only and 13 patients diagnosed with GB and DM (GB-DM) were enrolled in this study. Data for p53 and Ki67 immunohistochemical staining of the tumors and blood HbA1c levels of patients with DM were retrospectively collected. MALAT1 expression was assessed using quantitative real-time polymerase chain reaction.

Results: The coexistence of GB and DM induced the nuclear expression of p53 and Ki67 compared with GB only. MALAT1 expression was higher in GB-DM tumors than in GB only tumors. The expression of MALAT1 and HbA1c levels were positively correlated. Additionally, MALAT1 was positively correlated with tumoral p53 and Ki67. The disease-free survival of patients with GB-DM with high MALAT1 expression was shorter than that of those diagnosed with GB only and with a lower MALAT1 expression.

Conclusion: Our findings suggest that one of the mechanisms of the facilitating effect of DM on GB tumor aggressiveness is via MALAT1 expression.

Aim: To construct a reliable prediction model for pediatric atypical teratoid/rhabdoid tumor (ATRT) patients.

Material and methods: Population-based data of patients diagnosed with intracranial ATRT were extracted from the National Cancer Institute?s Surveillance, Epidemiology, and End Results database. These patients were randomly assigned into training and validation cohorts at a ratio of 2:1. Univariable and multivariable Cox analyses were conducted to determine independent factors of overall survival (OS). A nomogram was then developed using the covariates with the best prognostic value, and the predictive performance of the nomogram was assessed by calibration curves, concordance index, time-dependent receiver operating characteristic curve analysis, and decision curve analysis.

Results: A total of 267 cases were included. The OS rates at 6 months, 1 year, and 3 years were 61.6%, 50.1%, and 35.4%, respectively. The results of multivariable Cox analysis showed that tumor extension, surgery type, radiotherapy, and chemotherapy were independent prognostic indicators. A nomogram integrating these factors was established to predict the 6-month, 1-year, and 3-year OS rates. This prediction model was validated in the validation cohort. The nomogram had favorable predictive performance and discrimination ability.

Conclusion: We developed and validated a novel nomogram with favorable discrimination ability to predict prognosis for newly diagnosed pediatric ATRT patients. Although additional validation is required, this may be a useful tool in clinical decision making.

Aim: To evaluate, and to compare the clinical outcomes of minimally invasive surgery (MIS), and open surgery for single-level lumbar fusion over a minimum of 10-year follow-up.

Material and methods: We included 87 patients who underwent spinal fusion at the L4 - L5 level between January 2004 and December 2010. Based on the surgical method, the patients were divided into the open surgery (n=44) and MIS groups (n=43). We evaluated baseline characteristics, perioperative comparisons, postoperative complications, radiologic findings, and patientreported outcomes.

Results: The mean follow-up period was > 10 years in both groups (open surgery, 10.50 years; MIS, 10.16 years). The operative time was longer in the MIS group (4.37 h) than that in the open surgery group (3.34 h) (p=0.001). Estimated blood loss was lower in the MIS group (281.40 mL) than in the open surgery group (440.23 mL) (p < 0.001). Postoperative complications, including surgical site infection, adjacent segment disease, and pseudoarthrosis, did not differ between the groups. Plain radiographic findings of the lumbar spine did not differ between the two groups. Visual scores for back/leg pain and the Oswestry disability index did not differ between the two groups, preoperatively and at 6 months, 1, 5, and 10 years after surgery.

Conclusion: After a minimum of the 10-year follow-up, postoperative complications and clinical outcomes did not differ significantly between patients who underwent open fusion and MIS fusion at the L4 - L5 level.

Aim: To evaluate the effectiveness of improved motor-evoked potentials (MEPs) in treatment of degenerative disc diseases using the transforaminal lumbar interbody fusion (TLIF) technique.

Material and methods: Data of one hundred and eleven patients who underwent TLIF were retrospectively reviewed. The inclusion criteria were preoperative radiculopathy and presence of neurological deterioration without previous surgery. Improved MEP amplitudes reaching the baseline MEP amplitudes of the contralateral side at the same level were used as the thresholds for determining the final disc height and cage size during surgery. Cage size, disc heights of the three areas, foraminal area, and global spinal and local balance were measured.

Results: Twenty-two patients (3 male and 19 female) with a mean age of 61.9 ± 8.9 years were included into the study. The mean height of cages was 10.3 ± 1.4 mm (range, 8-14 mm). The mean improvement in MEP amplitude was 27 ± 11% (range, 15-50%). The anterior, middle, and posterior disc heights improved to 2 ± 1.6, 2.7 ± 1.7, and 1.7 ± 1.3 mm, respectively. The improvement in the middle disc height was significantly greater (p < 0.05). Segmental lordosis improved from 16.2° ± 10.7° to 19.4° ± 9.2°. Additionally, lumbar lordosis improved from 46.7° ± 14.6° to 51.2° ± 11.2° (p < 0.05). Cage height or improvements in disc height was not correlated with MEP changes. However, there was a positive correlation between ipsilateral foraminal area restoration and MEP changes (r=0.501; p < 0.01).

Conclusion: Improved MEP amplitudes reaching the baseline MEP amplitudes of the contralateral side of the same spinal level might be a useful threshold for determining the final minimum disc height during TLIF surgery with satisfactory postoperative radiological results, including sagittal and segmental radiological parameters.

Aim: To measure the baseline spinopelvic parameters and characterize the sagittal, and coronal plane deformities in patients with idiopathic normal pressure hydrocephalus (iNPH).

Material and methods: We analyzed a series of patients at one academic institution who underwent ventriculoperitoneal shunting for iNPH with pre-shunt standing full length x-rays. The series of patients was enrolled consecutively to minimize selection bias. We quantified comorbid sagittal plane spinal deformity based on the Scoliosis Research Society-Schwab classification system by assessing pelvic incidence and lumbar lordosis mismatch (PI-LL), pelvic tilt (PT), and sagittal vertical axis (SVA).

Results: Seventeen patients (59% male) were included in this study. Mean (± standard deviation) age was 74 ± 5.3 years with a body mass index (BMI) of 30 ± 4.5 kg/m < sup > 2< sup > . Six patients (35%) had marked sagittal plane spinal deformity by at least one parameter: five (29%) had greater than 20˚ PI-LL mismatch, three (18%) had > 9.5 cm SVA, and one (6%) had PT greater than 30˚. Additionally, the thoracic kyphosis exceeded the lumbar lordosis in nine patients (53%).

Conclusion: Positive sagittal balance, with thoracic kyphosis exceeding lumbar lordosis, is common in iNPH patients. This may lead to postural instability, especially in patients whose gait does not improve following shunting. These patients may warrant further investigation and workup, including full length standing x-rays. Future studies should assess for improvement in the sagittal plane parameters following shunt placement.

Aim: To compare the clinical outcomes of Target 360 nano (TG) and Microplex hypersoft 3D (MH) used as a finishing coil (FC).

Material and methods: From January 2018 to December 2020, we retrospectively reviewed 243 coil embolization procedures performed using TG (n=152) and MH (n=91) coils of 1mm x 2 cm the same size as FC. Further, the clinical and radiographic results were compared by matching the propensity score between the two groups.

Results: There were no statistically significant differences in the clinical and angiographic results of the two coils after the propensity score matching. Successful occlusion was 89% and 86.8% and FC insertion failure was 20.9% and 28.6%. There were no differences in procedure-related complications and recurrence between the groups during the eight months follow-up period (3.3% versus 4.4% and 4.4% versus 3.3%, respectively). We also compared two subgroups of failed FC insertion (19 of TG and 26 of MH). The number of angled catheters was significantly higher in the failed TG group than in the failed MH group.

Conclusion: There was no statistically significant difference between the clinical and radiological outcomes of TG and MH used as FC. However, in the FC insertion failure subgroups, the number of angled catheters was significantly higher in the TG failed group than in the MH failed. It was experimentally confirmed that the angle change of microcatheter tip with a large angle was large; however, further studies are required.

Aim: To investigate the surgical value of MER recordings and improve surgical technique by demonstrating the consistency between preoperative radiological STN volume and intraoperative neurophysiological STN length.

Material and methods: Sixty-one patients with PD were enrolled. The volumes of the STN were measured using magnetic resonance images 3-dimensional volume reconstructions of stereotactic magnetic resonance images. MER were performed in all patient and the maximal electrophysiologic length of the STN was recorded each patient. In the postoperative period, the permanent electrode was modeled and reconstructed in 3D, and the longest distance traveled in the STN was calculated.

Results: A total of 61 patients who underwent surgery between 2012-2022 were included in the study. Thirty-six (59%) of the patients were male, and 25 (41%) were female. A total of 122 STNs were performed with 166 electrodes. The most common end alignment used was center with 86. STN length averaged 4.9 mm (0-10.5 mm). The mean STN volume was 0.11 cm3. The STN Volume of men were significantly higher than women. The STN Length, Volume, and the target MER length showed a positive correlation significantly.

Conclusion: With radiological advances, it is possible to better visualize the target points and define the boundaries better, and direct methods can be used more in making targeting plans. MER records obtained during surgery and STN dimensions in presurgical planning show compatibility, and it is seen that there may be differences between the right and left sides because of brain shifting. Although radiology is increasingly providing better support, electrophysiological recordings provides real-time information on the electrodes? locations and give the opportunity to surgical team choosing alternative target.