Turkish neurosurgery最新文献

Aim: To analyze clinical and imaging characteristics of post-traumatic posterior fossa extradural hematoma (PFEDH).

Material and methods: Between 2018 and 2022, 51 patients were admitted to our tertiary care trauma center with a diagnosis of PFEDH. The management decision was tailored by an individual consultant based on clinicoradiological findings. We did a prospective analysis of patient characteristics, radiology, clinical presentation, management, and outcome at discharge and onemonth follow-up.

Results: Of the 51 patients diagnosed with a PFEDH, 45 (88.2%) were male, and six (11.8%) were female with a mean age of 31.2 years (range 2-77 years). Twenty-six patients needed surgical evacuation of the EDH, while the rest 25 patients were managed conservatively. There was one crossover patient from the conservative to the surgical arm. Road traffic accidents (RTA) were the most common cause of injury (n=35; 68.6%), followed by falls from height (n=16; 31.4%). Most patients presented with vomiting and loss of consciousness (LOC). At presentation, 30 patients (58.5%) had a GCS 15. Seven patients (13.7%) presented with a GCS of 9-14, and 14 patients (27.5%) with GCS ≤ 8. The mean EDH volume in conservatively and surgically managed patients was 14.1 and 25.1cc, respectively. Five patients (9.8%) had significant midline shift with obliteration of basal cisterns, 15 patients (29.4%) had effacement of the fourth ventricle, and 11 patients (21.5%) had the presence of hydrocephalus. All patients with features suggestive of tight posterior fossa (hydrocephalus, obliterated basal cisterns, and fourth ventricle compression) needed surgical intervention. Of the 25 conservatively managed patients, 24 (96%) had favorable GOS scores at discharge, while one (4%) had an unfavorable score. 16/26 (61.5%) surgically treated patients had a good outcome at discharge (GOS=4-5), while ten patients (38.4%) had adverse outcomes (GOS < 4). Initial EDH volume was inversely correlated with presenting GCS and GOS with a mean volume of 21.5 ± 8.5 cc in patients presenting with a GCS ?8. Patients with a GCS of 15 at presentation had a mean EDH volume of 16.1 ± 8.2 cc. Patients with smaller EDH had much higher GOS scores than patients with higher volume EDH (GOS 1 = 22.0 ± 9.83 cc vs. GOS 5 = 18.9 ± 12.2 cc). Outcomes mainly depended on factors like GCS at arrival and associated supratentorial, thoracic/ abdominal polytrauma.

Conclusion: In patients with a clot volume of < 15 cm3 and GCS of 15 at presentation with no mass effect and absence of tight posterior fossa, a conservative trial under strict clinicoradiological monitoring in a neuro-critical multidisciplinary setting can be offered with good results. In cases of altered GCS, findings of a TPF, or clinicoradiological deterioration, immediate surgery is warranted.

Aim: To describe the time between external ventricular drain (EVD) implantation and mobilization in neurosurgery intensive care unit (ICU) patients with EVDs. Due to increased intracranial pressure, neurosurgery patients with external ventricular drain (EVD) who are admitted to the ICU frequently remain at rest, resulting in prolonged ICU and hospital length of stay (LOS), mechanical ventilator (MV) duration, and other adverse effects.

Material and methods: A retrospective descriptive study was conducted on 131 neurosurgery patients admitted to the ICU with subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH) who underwent EVD. Time of mobilization, level of mobilization, ICU and hospital LOS, MV duration, and other factors were evaluated for patients who met the inclusion criteria.

Results: Of the 131 patients, 67 survived, and 61 began to mobilize in varying degrees of dangling (26.22%), standing (44.26%), and walking (29.5%). The mean number of days between EVD implantation and mobilization was 10.15. According to the findings, the mean ICU-LOS in patients was 14.56 days, the MV duration was 7.13 days, the time of ICU discharge from EVD removal was 7.08 days, and the hospital-LOS was 16.98 days. In addition, seven patients (10.44%) developed DVT, and three developed PE (4.47%).

Conclusion: Prolonged immobility in patients with EVD is associated with negative outcomes such as PE and DVT, as well as an increase in MV duration, ICU-LOS, and hospital-LOS. Therefore, designing an appropriate and standard mobilization protocol and training nursing staff to assist patients in safely mobilizing can significantly reduce the complications above, reduce postoperative care, and empower patients.

Aim: To study on the association of lnc-MEG3/miR-181b and UCH-L1 in the progression of cerebral hemorrhage. Further facilitation the development of novel strategies that use their potential as a therapeutic targets.

Material and methods: In this study, we studied the lncRNA MEG3 and miR-181b expression in 30 patients with ICH who were admitted to the General Hospital of Xinjiang Military Command from January 2021 to May 2021 by quantitative polymerase chain reaction. Serum levels of UCH-L1 were detected by enzyme-linked immune sorbent assay, and disease severity was evaluated using the Glasgow Coma Scale. We also recorded ICH-related deaths in hospital.

Results: We found that lnc-MEG3 and UCH-L1 levels increased and miR-181b levels decreased in the serum of patients with ICH. lnc-MEG3, miR-181b, and UCH-L1 levels were also associated with the severity of the condition.

Conclusion: Our data indicated that lnc-MEG3, miR-181b, and UCH-L1 are likely involved in the pathophysiology of ICH, and could form the basis of future studies on potential targets for the treatment of traumatic CNS injuries. UCH-L1 could also find application in ICH management. Further studies on the plasma lncRNA-MEG3, miR-181b, and UCH-L1 levels in patients with ICH could yield novel biological targets for the prediction and treatment of ICH.

Aim: To prove the superiority of the electromagnetic (EM) neuronavigation technique to increase the accuracy of intraventicular shunt catheter placement, and to reduce accompanying complications.

Material and methods: A total of 21 patients with hydrocephalus [age range (years): 53-84] were studied. All of them had undergone thin-slice, navigation-compatible, computed tomography (CT) preoperatively. Shunt surgery was performed under the guidance of EM neuronavigation technology. All patients underwent follow-up CT the next day to evaluate catheter tip placement and were followed up at 1, 3, 6, and 12 months.

Results: All catheter tips were placed properly in front of the foramen of Monro in the desired position, except in one case in which the tip migrated to the perimesencephalic cistern and underwent reoperation in the early postoperative period. No complications due to infection and obstruction were observed in the medium- and long-term follow-ups. The complication rate due to the incorrect catheter positioning was 4.76% of the total cases.

Conclusion: The placement of the ventricular catheter under EM-guided navigation technology reduces the proximal-end failure caused by malpositioning, obstruction, and infection.

Aim: To assess the frequency of thoracolumbar junction (TLJ) fractures (T10-L2) in survivors of the 2023 East Turkey earthquake.

Material and methods: This single-center retrospective stdy evaluated 10 earthquake survivors, who were trapped under the rubble and rescued alive by rescue teams, and were assessed for spinal trauma after the earthquake in Eastern Turkey on February 6, 2023. All patients underwent full spinal magnetic resonance imaging and computed tomography examinations to determine the level of spinal fracture and decide the treatment methods.

Results: All patients had sustained spinal fractures. Eight underwent surgery, while two were managed conservatively. Nine out of ten patients had TLJ fractures. Five patients had L1 fractures, four of them were treated surgically. Three patients had a T12 level fracture, two of whom were treated surgically. One patient with a T7-level fracture was treated surgically. Only one patient had multiple fractures (T12 and L2 levels) and was treated surgically.

Conclusion: The TLJ was the commonest vertebral fracture level as of the 2023 Turkey earthquake survivors in our study population. In the event of an earthquake, people tend to attain a fetal posture (fix and hyperflex the spine) when taking shelter in a narrow area (triangle of life). This position might place an excessive load on the TLJ, predisposing it to injuries.

Aim: To evaluate the quality of life of patients with postural kyphosis (PK) compared with those adolescent idiopathic scoliosis (AIS) and Scheuermann Kyphosis (SK).

Material and methods: Health-related quality of life (HRQoL) of adolescents with PK who were admitted to our clinic between January 2020 and June 2022 was compared with that of patients with AIS and SK who were admitted during the same period by using the Scoliosis Research Society-22 (SRS-22) questionnaire. All patients were asked to complete the SRS-22 questionnaire before the radiological evaluation. In the radiological evaluation, the sagittal and coronal deformities of the patients were measured.

Results: In total, 126 patients with PK were compared with age and sex-matched AIS patients and 42 SK patients. The mean SRS-22 function score of the PK group was 4.72 ± 0.3 while it was 4.38 ± 0.6 (p=0.015) in SK patients and it was 4.34 ± 0.6 (p < 0.001) in AIS patients. The mean SRS-22 pain scores of PK patients was 4.18 ± 0.7. The mean pain score was 3.68 ± 0.8 (p=0.033) in the SK group and 3.6 ± 0.8 (p=0.010) in the AIS group. Adolescents with PK perceived less pain than those with AIS or SK. The scores for the other domains of SRS-22 revealed no differences.

Conclusion: HRQoL of patients with PK is reduced, similar to that of patients with common structural spine deformities. Recognizing the effects of PK on the HRQoL in adolescents can help physicians to treat these patients.

Aim: To compare the procedural features of transforaminal epidural steroid injection (TFESI) performed using two different needles (Stimuplex® and Quincke) in terms of procedure time, exposed radiation dose and adverse effects and complications, thus providing preliminary data to aid needle selection for TFESI.

Material and methods: Patients who received fluoroscopy-guided single-level lumbosacral TFESI between September 2020 and September 2021 were retrospectively included in this study. The patients were divided into two groups with respect to the needle type used for the procedure ? those treated with a Quincke needle were classified as Group Q and those treated with a Stimuplex® needle comprised Group S. Subsequently, the two groups were compared in terms of their demographic data, procedure time, radiation dose, amount of contrast use, first-hour numeric rating scale (NRS), intravascular flow and complication rates.

Results: The number of patients recruited for Groups Q and S was 65 and 61, respectively. No significant difference was observed between the groups regarding their demographic data, preprocedural NRS scores, procedure time, exposed radiation dose and the amount of contrast dye used. Notably, the first-hour NRS scores were found to be significantly lower in Group S (p=0.040) after the procedure. Moreover, the intravascular contrast spread was significantly different between the two groups (p < 0.05) ? it was encountered during four procedures in Group Q, but was altogether absent in Group S.

Conclusion: The Stimuplex® needle may decrease the possibility of inadvertent intravascular leakages during TFESI and may also improve immediate pain scores after the procedure.

Intradiploic meningiomas are rare neoplasms, often mistaken for metastases or malignant bone tumors. Surgical management can be challenging, considering their diffusive bony invasion. Two main critical decisions need to be taken: the timing for cranial vault reconstruction and the choice of the adequate material for cranioplasty. We believe that this case underscores the complexity of such lesions, the importance of a prompt devascularization, and the pivotal role of an immediate reconstruction to avoid the additional morbidity of a re-do surgery. Here, we report a case of 68-year-old men who presented with slow growing right parietal bone swelling he noted many years before, but for which he didn't seek medical attentions, associated with mild contralateral hemiparesis. Neuroradiological examinations revealed a giant extradural intradiploic tumor affecting the right temporo-parietal bone and conditioning significant compression of the underlying brain. We planned a surgical strategy to deafferent the tumor and to reduce the intraoperative bleeding. At first, a circumferential craniectomy centered upon the lesion was performed, then it was devascularized by means of surgical ligation of the ipsilateral superficial temporal artery (STA) and middle meningeal artery (MMA); these steps allowed a subsequent en block tumor excision, despite its large size, without significant blood loss and respecting the oncological principles. At the end, a contextual calvarial reconstruction was performed using a precurved titanium mesh. The patient was discharged seven days after surgery with complete recovery of the left-sided motor deficit. Thereafter, he underwent scheduled outpatient evaluations and radiological examinations. At 1-year follow-up, the Modified Rankin Scale (MRS) was 1, with no evidence of recurrent disease. To conclude, surgical complications can be reduced adopting an optimal preoperative work-up and a tailored surgical strategy focused on early tumor deafferentation. Moreover, an immediate cranial vault reconstruction avoids the risks related to a second procedure.

Aim: To investigate the risk factors and optimize the management of entrapped temporal horn (ETH) following lateral ventricular tumor surgery.

Material and methods: We reviewed 41 cases of lateral ventricular tumors treated at the department of neurosurgery of our institution between January 2012 and September 2020. We summarized and analyzed the preoperative symptoms, intraoperative conditions, postoperative complications of the entrapped temporal horn, treatment measures, and recovery.

Results: Of the 41 patients, 14 (34.1%) had ETH complications. A univariate analysis revealed that the tumor location, tumor diameter, the intraoperative use of hemostatic materials, no extraventricular drainage (EVD) was placed at the end of the operation, tumor stroke, the exposure mode of the tumor boundary, and postoperative meningitis were potential risk factors for the development of ETH. A multivariate binary logistic stepwise regression analysis revealed that tumor diameter ≥3.2 cm (OR=14.808, p=0.037), tumor stroke (OR=50.793, p=0.015), non-EVD (OR=0.023, p=0.033), and the mechanical separation of the tumor boundary (OR=30.617, p=0.045) were risk factors for ETH.

Conclusion: ETH often occurs following the surgery of lateral ventricle tumors. Large tumor diameter, tumor stroke, non-EVD at the end of operation, and the mechanical separation of the tumor boundary are the risk factors of ETH. The natural exposure of the tumor boundary during surgery, avoiding the use of hemostatic materials, placing an EVD tube at the end of operation, and postoperative infection control can effectively reduce the occurrence of ETH. It is essential to select the appropriate treatment method for patients with postoperative ETH.

Aim: To elucidate the function of ASK-1 and the role of its modulators in the induction of Temozolamide (TMZ) resistance in glioma and the underlying mechanism.

Material and methods: ASK-1 phosphorylation, the IC50 of TMZ, cell viability, and apoptosis were assessed in the U87 and U251 glioma cell lines and the derived TMZ-resistant cell lines U87-TR and U251-TR. We then blocked ASK-1 function, either with an inhibitor or by overexpression of multiple ASK-1 upstream modulators, to further explore the role of ASK-1 in TMZ-resistant glioma.

Results: TMZ-resistant glioma cells showed high IC50 values of TMZ, high survival, and low levels of apoptosis following the TMZ challenge. ASK-1 phosphorylation, but not protein expression, was higher in U87 and U251 cells than in TMZ-resistant glioma cells exposed to TMZ. The addition of the ASK-1 inhibitor selonsertib (SEL) resulted in the dephosphorylation of ASK-1 in U87 and U251 cells after the TMZ challenge. SEL treatment increased the TMZ resistance of U87 and U251 cells, as evidenced by the increased IC50 and cell survival rate and low apoptosis rate. Overexpression of some ASK-1 upstream suppressors [Thioredoxin (Trx), protein phosphatase 5 (PP5), 14-3-3, and cell division cycle 25C (Cdc25C)] led to various degrees of ASK-1 dephosphorylation and a TMZresistant phenotype in U87 and U251 cells.

Conclusion: Dephosphorylation of ASK-1 induced TMZ resistance in human glioma cells, and several ASK-1 upstream suppressors, including Trx, PP5, 14-3-3, and Cdc25C, are involved in this phenotypic change induced by dephosphorylation of ASK-1.