Turkish neurosurgery最新文献

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 compare the Paraoxonase 1 (PON1) activity and phenotype distribution between lumbar disc herniation (LDH) patients and healthy individuals.

Material and methods: This research included 40 LDH patients and 42 healthy individuals. Spectrophotometric assays were performed to determine the serum PON1 and arylesterase activities. The PON1 ratio, which represents the salt-stimulated PON/ arylesterase level, demonstrated a trimodal distribution. This ratio was applied to identify the different phenotypes; QQ, QR, and RR of each subject.

Results: The LDH patients had lower PON1 activity than the healthy individuals (p < 0.05). LDH patients had a statistically significant QQ phenotype compared to the healthy subjects (p < 0.05).

Conclusion: LDH patients had statistically lower PON1 activity, suggesting that the low PON1 activity and PON1 QQ phenotype may be a risk factor for LDH occurrence.

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.

Aim: To obtain health-related information internet usage is rapidly increasing. However, there are concerns about the comprehensibility and reliability of internet-accessed health-related information. The aim of this research was to investigate the reliability, quality, and readability of patient education materials (PEMs) about spinal cord stimulation (SCS) on the internet.

Material and methods: A total of 114 websites suitable for the study were identified after a search on Google for the term "spinal cord stimulation." Gunning Fog (GFOG), Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), and Simple Measure of Gobbledygook (SMOG) were used to determine the readability of sites. The credibility of the websites was assessed using the Journal of the American Medical Association (JAMA) score. Quality was assessed using the global quality score (GQS), the DISCERN score, and the Health on the Net Foundation code of conduct (HONcode).

Results: Evaluating the text sections, the mean SMOG and FKGL were 10.92 ± 1.61 and 11.62 ± 2.11 years, respectively, and the mean FRES and GFOG were 45.32 ± 10.71 and 14.62 ± 2.24 (both very difficult), respectively. Of all the websites, 10.5% were found to be of high quality, 13.2% were found to be of high reliability, and only 6.1% had a HONcode. A significant difference was found between the typologies of the websites and the reliability and quality scores (p < 0.05).

Conclusion: The internet-based PEMs about SCS were found to have a readability level that exceeded the Grade 6 level recommended by the National Health Institute. However, the materials demonstrated low reliability and poor quality. It is advisable that websites addressing Spinal Cord Stimulation (SCS), a specific neuromodulation technique among various interventional strategies for chronic pain management, maintain readability standards in line with established indexes and provide content that is reliable and tailored to the general public's educational level.

Aim: To compare the efficacy and feasibility of target area cement-enhanced percutaneous vertebroplasty (PVP) and conventional PVP in osteoporotic thoracolumbar non-total vertebral fractures.

Material and methods: Retrospective analysis of one hundred and two patients treated in our hospital from March 2020 to May 2021 and divided into groups A (targeted) and B (conventional PVP). The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height ratio, intraoperative bleeding, operative time, bone cement volume, complications, and refracture of the injured vertebra were evaluated in both groups.

Results: The 2 days and 1-year post-operative VAS and ODI scores improved significantly in both groups (p < 0.05). The 2 days post-operative VAS and ODI scores were better in group A (p < 0.05), and there was no significant difference in the scores between the groups at the last follow-up (p > 0.05). The anterior vertebral height ratios were significantly higher in both groups 2 days postoperatively (p < 0.05); however, there was no significant difference in the 2 days and 1-year post-operative ratios in group A (p > 0.05). The anterior vertebral height ratio reduced in group B after 1 year compared to the 2 days post-operative value (p < 0.05). There was no statistical difference in intraoperative bleeding and the operative time between the groups (p > 0.05), and the bone cement volume was lesser in group A (p < 0.05). Six patients in group A and four patients in group B demonstrated cement leakage, the difference was not statistically significant (p > 0.05). Three patients in group A and 11 patients in group B demonstrated refracture, the difference was statistically significant (p < 0.05).

Conclusion: Target area cement-enhanced PVP can effectively relieve short-term pain and functional disability and reduce the long-term possibility of secondary collapse. Therefore, it is a technically feasible and efficacious method for the treatment of osteoporotic thoracolumbar non-total vertebral fractures.

Aim: To evaluate the efficacy of percutaneous ventriculoatrial shunting as a salvage method for pediatric patients with abdominal complications.

Material and methods: Data obtained from 9 patients with ventriculoperitoneal shunt dysfunctions owing to abdominal complications, who underwent ventriculoatrial shunting as salvage treatment at a single institution between January 2019 and September 2021 were retrospectively analyzed. All operations were conducted under the guidance of intraoperative fluoroscopy and ultrasound.

Results: The mean age of the enrolled patients was 8.1 ± 1.2 years (2-15 years). Six (67%) patients were male and 3 (33%) were female. The mean number of the patients? ventriculoperitoneal shunt revisions until atrial catheter placement was 7.5 times. The reasons for intraperitoneal catheter failure included peritoneal adhesions in 4 (44.5%) patients, pseudocyst formation in 3 (33.3%), and peritonitis in 2 (22.2%). Seven patients from the study cohort had no problem after ventriculoatrial shunt placement. Only 1 patient had shunt dysfunction related to the ventricular catheter, and ventricular catheter and shunt valve revision was performed 26 months after ventriculoatrial shunt placement. The atrial catheter of the patient was intact. One patient died from the progression of her primary disease (medulloblastoma in the 4 < sup > th < /sup > ventricle), which was unrelated to the ventriculoatrial shunt.

Conclusion: Percutaneous ventriculoatrial shunting under the guidance of intraoperative fluoroscopy and ultrasound is a safe, effective, and easy alternative in patients with peritoneal complications and a history of multiple operations.

Aim: To investigate the possible relationship between intracranial aneurysms and brain neoplasms.

Material and methods: A comprehensive literature review involving a search of the databases PubMed and Embase to identify relevant articles was conducted in March 2021. The initial search retrieved 451 articles. After deduplication and screening of abstracts, 56 articles were selected. After reading of the full texts, 19 articles were included in the review.

Results: There insufficient evidence to support that people with brain neoplasms have a higher incidence rate of IAs. However, the prevalence of IAs appears to be higher in patients with pituitary tumors than in the general population. The key factors affecting prognosis were tumor type in patients with unruptured aneurysms and progression of subarachnoid hemorrhage in individuals with ruptured aneurysms. Treatment should be individualized according to patient age, tumor pathology, location, and aneurysm rupture risk.

Conclusion: There is a lack of evidence to affirm that the existence of brain neoplasm plays a role in the formation and rupture of intracranial aneurysms. Additionally, there is insufficient evidence to confirm a greater prevalence of intracranial aneurysms in individuals with brain tumors. The association of these two disorders does not appear to worsen patient outcome. Prognosis depends on tumor pathology for malignant cases and on subarachnoid hemorrhage in patients with ruptured aneurysms.

Aim: To show the abnormal cerebral hemodynamics, in high-pressure hydrocephalic patients, could be restored by shunt surgery, and the tympanic membrane temperature (TMT) could be used to non-invasively monitor this recovery process.

Material and methods: One-hundred-and-four patients, with high-pressure hydrocephalus (spinal tap opening pressure > 180 mmH2O), were prospectively enrolled in our study. The computed tomography perfusion (CTP) was scheduled for 7-10 days preand post-shunt surgery. The TMT and Glasgow Coma Scale (GCS) scores were collected during the same session.

Results: The CTP after the shunt surgery revealed a significant increase in cerebral blood volume (CBV) in both hemispheres (p < 0.05). More specifically, this CBV increase was observed in the midbrain, cerebellum, basal ganglion, temporal lobe, and frontal lobe regions (all p < 0.05). Simultaneously, patients' post-surgical TMT and GCS scores also increased compared to their pre-surgical scores since the first post-shunt follow-up (p < 0.01). Notably, while the GCS scores continued to increase during the post-shunt follow-up, the TMT exhibited a fluctuation period after the shunt and required seven days to reach a steady state.

Conclusion: Our study revealed that a shunt could significantly increase cerebral perfusion in high-pressure hydrocephalic patients in a region-specific manner. During the perioperative period of hydrocephalus, TMT can be used to monitor cerebral hemodynamic changes.

Aim: To investigate the presence of Sur1-Trpm4 receptors in high-grade glial tumors, and their relationship with edema volumes in preoperative magnetic resonance imaging (MRI) sequences.

Material and methods: MRI sections were extracted from T1-weighted (T1W) and T2-weighted (T2W) sequences and fluidattenuated inversion recovery (FLAIR) images. After that, T1W 3D magnetization-prepared rapid gradient echo (MP-RAGE) sequences were taken with and without contrast medium. Tumor and peritumoral edema volumes were calculated in cubic centimeters. Sur1- Trpm4 receptors were studied by immunohistochemical examination of tissue samples. Relationships between data were analyzed using Spearman's correlation coefficient.

Results: In the immunohistochemical examinations, 58% of the samples from patients with high-grade glial tumors were positive for Sur1 and 74% were positive for Trpm4. The volume of tumors was correlated with the volume of peritumoral edema.

Conclusion: The presence of the Sur1-Trpm4 receptor complex in high-grade glial tumors was confirmed. Further preclinical or clinical studies are required to identify and validate the role of Sur1-Trpm4 in glial tumor subgroups.

Aim: To discuss adherence to guidelines for the management of traumatic brain injury (TBI) in Türkiye and physicians' attitudes toward standardized, evidence-based medical practice.

Material and methods: Survey questions were uploaded on the website www.surveymonkey.com and sent to the participants via e-mail or social media applications. The first 10 questions were about the participants' profiles, and the rest were purposed on presenting the physicians' viewpoint on and barriers against CPG adherence. SPSS version 17.0 for Windows was used for statistical analysis.

Results: A total of 404 physicians (neurosurgeons, 59.5%; anesthesiologists, 16.7%; and emergency medicine practitioners, 23.9%) who were involved in TBI management were included in this study. Of them, 61.7% stated that they frequently adhere to the CPG recommendations for TBI. In their own experience, most of the respondents agreed that CPGs frequently improve outcomes. They stated that they would occasionally or never adopt recommendations with weak evidence. Physicians reached a consensus on individualizing the decision-making along with the CPG recommendations.

Conclusion: Of the participants, 61% adopted the CPG recommendations. The main barriers to the implementation of the CPGs are the strength of evidence levels and the affordability of the recommendations.