Turkish neurosurgery最新文献

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.

Oblique lateral interbody fusion (OLIF) has recently gained widespread use as a minimally invasive surgical procedure for degenerative lumbar disease. OLIF has several advantages but can also lead to several possible complications. For example, although less common, access through the retroperitoneal cavity can cause ureteral injury. Here, we report two cases of ureteral complications that occurred during consecutive OLIF procedures. One involved a 77-year-old female patient who had a double-J catheter inserted due to ureteral injury during surgery, and the other involved a 69-year-old male patient suspected of having a ureteral stricture due to retractor compression. To prevent ureteral complications in OLIF, it is necessary to accurately identify the anatomy of the ureter through preoperative imaging and to pay special attention during surgery.

Spinal intramedullary capillary hemangioma is a rare condition. Although most spinal/spinal cord hemangiomas are inborn in origin, perinatal presentation is uncommon. We present a neonate with an intramedullary hemangioma, born with communicating hydrocephalus and complete paraplegia. Spinal imagining showed an intradural mass with hemorrhagic foci, a low-lying conus medullaris, and scalloping of dorsal elements. Ventriculoperitoneal shunting was performed in an emergent setting, with cerebrospinal fluid showing a brownish appearance with high viscosity which implied a possible old hemorrhage. Tissue sample was taken from the spinal lesion in an elective setting. Histopathological examination revealed capillary lobules and extralobular large vessels resembling abnormal veins. The mentioned clues suggested that this congenital hemangioma had become symptomatic from the prenatal period. Though it is a are event, it should be kept in mind while evaluating a neonate with communicating hydrocephalus and weakness of extremities with or without cutaneous hemangiomatous stigmata.

Aim: To present the ability of standard intraoperative neuronavigation to reliably identify the stylomastoid foramen, thus providing a quick and effective recognition of the facial nerve at its exit from the skull base.

Material and methods: We describe the technical nuances of this procedure by presenting two surgical cases who underwent hypoglossal-facial nerve anastomosis for complete facial nerve palsy occurring post removal of a giant vestibular schwannoma 6 months earlier.

Results: CT-based neuronavigation allowed a quick and reliable identification of the stylomastoid foramen and of the facial nerve at its exit from the skull. The entire procedure lasted for 3 hours. Three months after the anastomosis, the first signs of facial muscle reinnervation were visible.

Conclusion: The use of neuronavigation during hypoglossal-facial nerve anastomosis is a simple and cost-effective strategy to decrease operative duration and increase surgical effectiveness.

Aim: To assess the role of topical administration of tranexamic acid (TXA) on intraoperative and postoperative blood loss of patients undergoing posterior cervical laminectomy and lateral mass screw ?xation (PCLF) compared to a control group.

Material and methods: The data of 88 patients that underwent PCLF surgery, including 41 females and 47 males, were included in this retrospective study. Data elements including intraoperative blood loss (IBL), postoperative blood loss (PBL), amount of blood transfusion, surgical time, use of hemostatic agents, length of hospital stay, and time to return to work were extracted from medical records and compared between those who received topical TXA during surgery (irrigation of the surgical field with a solution of 3 g TXA in 100 ml normal saline) and an age- and sex-matched control group.

Results: There were 48 patients in the TXA group and 40 patients in the control group. There were no significant differences in the baseline measurements and the level of operation between the two groups. The results showed that IBL and PBL were significantly lower in the TXA group compared to the control group (p=0.03 and p < 0.01, respectively). There were no significant differences in the need for blood transfusion, surgical time, and hospital stay between the two groups (p > 0.05). Moreover, the use of hemostatic materials during surgery and the time to return to work were significantly lower in the topical TXA group (p=0.04 and p < 0.01, respectively).

Conclusion: Topical TXA efficiently reduces intraoperative and postoperative bleeding in patients undergoing posterior cervical laminectomy and PCLF surgery. These results need further investigation in future studies to draw a definite conclusion.

Aim: To investigate the importance of thoracic kyphosis (TK) for treatment preference in patients with Lenke Type 5C adolescent idiopathic scoliosis by comparing radiological outcomes of the patients who underwent selective fusion (SF) or nonselective fusion (NSF).

Material and methods: Twenty-nine patients with Lenke Type 5C AIS were included and then divided into two groups as per the fusion procedure used in the surgical treatment. SF group including 16 patients (14 female patients; mean age = 15.56 yr; age range, 14?18) with normal TK and NSF group including 13 patients (nine female patients; mean age = 15.54 yr, age range, 13?18) with thoracic hyperkyphosis. Thoracolumbar/lumbar (TL/L) Cobb, thoracic (T) Cobb, TK and lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were measured on standing spine radiographs preoperatively and at the final follow-up. The correction rates (CRs) of Cobb angles and the difference in each other radiological parameters were calculated.

Results: No significant differences were observed in the mean CRs of TL/L Cobb and T Cobb angles, PI, SS, and PT (p=0.313, p=0.444, p=0.51, p=0.472, and p=0.14, respectively). However, significant differences were observed in the mean TK angle, which was ?2.13° ± 13.52° (range, 29?27°) in SF group and 28.46° ± 15.05° (range, ?4°?°47°) in NSF group (p=0.001), and LL angle was 0.88° ± 14.23° (range, ?21°?32°) in SF group and 11.54° ± 17.79° (range, ?31°?34°) in NSF group (p = 0.016).

Conclusion: In patients in whom Lenke?s sagittal modifier is N, SF can be performed efficiently. NSF can be preferred for those with (+) Lenke?s sagittal modifiers as it provides better TK control.

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.

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.