Turkish neurosurgery最新文献

Aim: To compare 1 and 2 level posterior lumbar interbody fusion (PLIF) to transforaminal lumbar interbody fusion (TLIF) techniques in an effort to elucidate trends in overall radiological and clinical outcome, rate of complications, operation time, length of hospital stay, reoperation rate, pseudoarthrosis or failure rate, and estimated blood loss.

Material and methods: Online databases including Scopus, Science Direct, Clinical key, Ovid, Embase, and PubMed/ Medline were queried over the period encompassing January 2000 to August 2021 for suitable studies. Search criteria consisted of ("TLIF" AND "PLIF") OR ("Transforaminal Lumbar interbody fusion" AND "Posterior lumbar interbody fusion") AND ("comparative" OR "comparison") OR ("fusion" OR "outcome" Or "reoperation" OR "Failure rate" OR "Failure" OR "Complication rate" OR "Complication").

Results: Fourteen eligible studies were selected. Neurological deficits were considerably higher in the PLIF group (24%vs.10%). The mean operation time and estimated blood loss for PLIF and TLIF were 178.5 min and 515 ml; and 160 min and 405 ml, respectively. No significant difference was found regarding the fusion rate. The reoperation rate was greater in PLIF (2%) than TLIF (0%). No clear difference was found regarding the length of stay (LOS) and surgical site infection (SSI).

Conclusion: The superiority of TLIF over PLIF may be evidenced by the lower rate of neurologic deficit, surgical technical aspects, less blood loss and shorter operation time. Cage migration, screw displacement, infection, and pseudoarthrosis may be influenced by a variety of factors, including the facility, the surgeon, and the instrumentation/ graft used, and do not appear to be different. Multicenter non-randomized prospective trials are recommended to determine the possible superiority of one method over the other.

Aim: To gain a better understanding of ischemia risk related to in-stent stenosis (ISS) or in-stent thrombosis (IST) of the middle cerebral artery (MCA) and lenticulostriate arteries after flow-diverting devices (FDD) deployment from the internal carotid artery (ICA) to proximal middle cerebral artery (M1).

Material and methods: Using data from a prospectively maintained database, we retrospectively evaluated patients who were treated with FDD between January 2015 and 2020 at a single academic center. Only patients with unruptured ICA aneurysms where the FDD was extended into M1 were included.

Results: In total, 89 patients with 94 ICA aneurysms were treated with FDD. A total of 34 patients with 36 aneurysms had FDD extending into M1. Of the 34 patients, four experienced MCA, and lenticulostriate territory ischemia. Three patients had in-stent thrombosis (IST), and one patient had severe in-stent stenosis (ISS). The overall ischemic complication rate was 17.6%, which resulted in a permanent neurological deficit in 11.7% of the patients.

Conclusion: If the distance of the distal neck of the aneurysm to the ICA terminus (ICAT) is ≤5 mm, or if the aneurysm is located directly at the ICAT, FDD should be considered only as a last option when other treatment modalities are not suitable. In addition, in the treatment of distal ICA aneurysms, extra effort should be exerted during the procedure to deploy the FDD without extending into M1. However, when traditional microsurgical clipping and other endovascular procedures are not suitable, the use of FDD is effective in terms of high aneurysm occlusion rates and preventing aneurysm rupture.

Aim: To retrospectively analyze and compare ultrasound-assisted localization in situ with the traditional, open incision method for treating cubital tunnel syndrome (CuTS).

Material and methods: We retrospectively analyzed 51 patients treated between 2018 and 2022 and categorized them according to treatment method: ultrasound-assisted precise localization in situ decompression (n=21; Cohort 1) and traditional open incision in situ decompression (n=30; Cohort 2). We additionally collected Visual Analogue Scale (VAS) scores, Vancouver Scar Scale (VSS) scores, modified Bishop scores, aesthetic appearance, preoperative Dellon's stage, and analgesics requirements. Additional dependent variables of interest included operation time, hospital stay duration, complications, and reoperation rate.

Results: Neither cohort demonstrated significant changes in Dellon's stage, modified Bishop score, or VAS scores between baseline and 6 weeks postoperative. Cohort 1 showed better aesthetics and postoperative VSS and VAS scores than Cohort 1. In addition, Cohort 1 enjoyed a significantly shorter mean operation time and hospital stay. Cohort 1 had 5 (23.80%) complications, including superficial infection (n=1), hematoma (n=1), and incomplete decompression (n=3). Cohort 2 had 9 complications (30.00%), including superficial infection (n=2), hematoma (n=2), and severe scarring (n=5). The partial, incomplete decompression cases in Cohort 1 and the severe scar case in Cohort 2 were treated with reoperation.

Conclusion: Both procedures effectively treated most cases of CuTS and were associated with good postoperative outcomes. Patients who underwent ultrasound-assisted localization in situ decompression had shorter surgeries and hospital stays, better postoperative aesthetics, better VSS and VAS scores, and required less pain medication during the postoperative period. Traditional open incision in situ produced a more thorough decompression.

Aim: To investigate the effect of the biofilm-forming ability of the bacteria on treatment in rats by using biofilm-forming and nonbiofilm- forming strains of Staphylococcus aureus (S. aureus).

Material and methods: Forty rats were divided into four equal groups as Group 1A, 1B, 2A, and 2B. All rats underwent single distance lumbar laminectomy, and titanium implants were introduced. Group 1 rats were inoculated with Slime factor (-) S. aureus, while Group 2 rats were inoculated with biofilm Slime factor (+) S. aureus. None of the rats were given antibiotics. One week later, the surgical field was reopened and microbiological samples were taken. The implants of rats in Groups 1A and 2A were left in place, while the implants of rats in Groups 1B and 2B were removed.

Results: There was no statistically significant difference between the groups inoculated with slime factor (+) S. aureus; although, Groups 1A and 2A showed statistically significant difference. Statistical analysis with respect to bacterial count also showed a statistically significant difference between Groups 1A and 2A. There was a statistically significant difference between Group 1B and 2B.

Conclusion: The results obtained in the present study reveal that in case of implant-dependent infection, the first sample taken can be checked for slime factor, and if there is infection with slime factor-negative bacterium, treatment without removing the implant may be recommended. S. aureus was used in the study because it is the most common cause of implant-related infection at surgical sites. Further studies using different bacterial species are needed to reach a definitive conclusion.

Aim: To evaluate the effects of methylprednisolone and vitamin B12 injection on the regeneration of the nerves after a mental nerve crush injury.

Material and methods: A total of 40 albino Wistar rats have been randomly divided into four groups: group 1 (n=10): crushlike nerve damage was created by pinching the left mental nerve for 60 s with an aneurysm clip and intraperitoneally administered 1 ml of saline for 14 days; group 2 (n=10): the left mental nerve was pinched for 60 s with an aneurysm clip and intraperitoneally administered 2 mg/kg of methylprednisolone for 14 days; group 3, experimental group (n=10): the left mental nerve was pinched for 60 s with an aneurysm clip and intraperitoneally administered 2 mg/kg of vitamin B12 for 14 days; and group 4, experimental group (n=10): the left mental nerve was pinched for 60 s and intraperitoneally administered 2 mg/kg of methylprednisolone and 2 mg/kg of vitamin B12 for 14 days. All rats were sacrificed on the 28th postoperative day, and histopathological evaluation was performed.

Results: Nerve damage was higher in the control group than in other groups (p < 0.05). When Neural Cell Adhesion Molecule (NCAM) expression levels were compared, no major differences were observed between the methylprednisolone and control groups (p > 0.05). The B12 and B12+methylprednisolone groups reached significantly higher NCAM expression levels compared to the control and methylprednisolone groups. When the myelin basic protein (MBP) expression levels were compared (p < 0.05), the MBP expression was significantly higher in all experimental groups than in the control group (p < 0.05).

Conclusion: Systemic vitamin B12 and methylprednisolone administration effectively supported remyelination in the crushed mental nerve by increasing Schwann cell proliferation and differentiation.

Aim: To report our experience and the technique of two-step effective Onyx embolization from occipital artery (OA) for the obliteration of dural arteriovenous fistulas (DAVFs) with OA feeders.

Material and methods: The medical records of patients with intracranial DAVFs treated with trans-arterial embolization (TAE) using Onyx from the OA were retrospectively reviewed.

Results: Seven patients were included. The methods of Onyx injection from the OA were categorized as simple Onyx injection into the shunt, and two-step embolization. Two-step embolization involved the Onyx or coil embolization of the OA distal to the branching site of the feeders in the first step, and Onyx was injected toward the target shunt in the second step. Simple Onyx injection was performed in two cases; in both cases, the residual shunt remained. By contrast, the two-step embolization technique was performed in five cases, and in all those cases, sufficient embolization of the DAVFs was achieved.

Conclusion: Prior embolization using Onyx or coil of the distal OA helped prevent Onyx from unexpected embolization through the subcutaneous branches that were not associated with the shunt, thereby leading to effective embolization. This new two-step embolization technique from the OA may improve the obliteration rate of DAVFs with OA feeders using TAE with Onyx.

The azygos anterior cerebral artery (ACA) is a rare anatomical anomaly. Clipping surgery has been conducted in approximately 30 reported cases because it is frequently associated with aneurysms. However, few cases in which coil embolization was performed have been reported. We report three cases of coil embolization for distal ACA aneurysms with distal azygos ACA at our institution in 7 years. All patients were over 65-year-old women with saccular aneurysms larger than 7 mm; two with subarachnoid hemorrhage and one with an unruptured aneurysm. No patient had surgical complications associated with coil embolization. Coil embolization is also useful for large aneurysms in the distal azygos ACA, and its indication for treatment could be broadened.

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.

The coexistence of intracranial aneurysms and a meningioma is not a clinically common phenomenon. Here we present the case of a meningioma of the left anterior clinoid process concurrent with a right clinoid aneurysm and a ruptured aneurysm of the left posterior communicating artery (PcomA). Immediately after radiographically establishing a diagnosis of multiple aneurysms and to reduce the risk of rebleeding, we performed a microscopic surgery to clip the aneurysms using a left frontotemporal approach. During the surgery, an unexpected clinoid meningioma was detected and simultaneously resected. The patient tolerated the entire procedure well and reported no postoperative neurological deficits during the follow-up visit. The use of modern microsurgical techniques along with an appropriate approach ensured that the procedure remained both successful and safe.

Aim: To evaluate and compare clinical outcomes between the posterior short-segment pedicle fixation with injured vertebra fixation (PSPFI) and fixation without injured vertebra fixation (PSPF) for thoracolumbar burst fracture (TLBF).

Material and methods: In this retrospective study, a total of 78 patients with TLBF were included and assigned to PSPFI (n=46) and PSPF (n=32) groups. The operative time, blood loss, perioperative complications, Oswestry disability index (ODI), and visual analog pain score (VAS) were examined immediately after surgery, 1 month, 3 months, and 1 year after surgery. Moreover, the postoperative vertebral height correction rate and postoperative Cobb angle correction rate were examined immediately and 1 year after surgery, as well as the corrected vertebral height loss rate and Cobb angle correction loss rate.

Results: No significant difference was identified in terms of operative time, blood loss, perioperative complications, ODI, and VAS after surgery (p > 0.05) between the PSPFI and PSPF groups. Moreover, the postoperative vertebral height correction rate and postoperative Cobb angle correction rate showed no difference between the groups as well. However, the PSPFI group had a significantly lower loss rate in terms of corrected vertebral height loss rate and Cobb angle correction loss rate than the PSPF group 1 year after surgery (p < 0.05).

Conclusion: PSPFI and PSPF achieve similar clinical outcomes. However, posterior short-segment pedicle fixation with injured vertebra significantly maintains vertebral height correction rate and Cobb angle correction rate, which serve as a better choice for the treatment of TLBF.