Turkish neurosurgery最新文献

Aim: To weight the benefits and limitations of intraoperative use of micromirrors in neurosurgery.

Material and methods: Surgical cases where micromirrors were employed were retrospectively selected from the surgical database of five different surgeons in different hospitals. Complications directly attributable to the micromirrors were assessed intraoperatively and confirmed with postoperative neuroimaging studies.

Results: Fourteen patients were selected. The site of the lesion was as follows: posterior fossa (43%), frontal lobe (22%), temporal lobe (14%), parietal lobe (7%), insula (7%), and basal ganglia (7%). Five tumors (35%) were gliomas, 3 (21%) epidermoid, and 3 (21 %) supratentorial metastases. Two patients underwent microvascular decompression for neurovascular conflict, and 1 harbored a brain arteriovenous malformation. A gross total resection was achieved in all the tumors and the AVM, while an effective decompression was successfully performed in both patients with conflict. No complications directly attributable to the use of the micromirror occurred. A relatively easy learning curve was noted.

Conclusion: Micromirrors proved to be useful in enhancing the visualization of neurovascular structures and pathology residuals within deep-seated surgical fields without the need for fixed brain retraction. Their cost-effectiveness and easy learning curve constitute solid reasons for advocating a revitalization of this ?old but gold? tool in neurosurgery.

Aim: To understand the changing trends in pediatric head injury in a university hospital comparing two decades.

Material and methods: The medical records of pediatric patients hospitalized for head injuries were evaluated retrospectively between 2000 and 2020 to investigate the epidemiological differences between decades. The patient files were evaluated in terms of age, sex, mechanism of trauma, whether there was additional trauma, radiological findings, Glasgow coma score (GCS), and Rankin scores.

Results: A difference was found between the ages of the patients who were hospitalized for head trauma in 2000-2010 (first decade) and 2011-2020 (second decade) (p < 0.001). The admission rate of children in the preschool age group was higher in the second decade (p < 0.05), whereas the admission rate of school-age children and adolescents was higher in the first decade (p < 0.05). The admission rate of patients who had head trauma due to traffic accidents was higher in the first decade (p < 0.05). The rate of linear fracture was higher in the second decade (29.90% vs. 55.60%, p < 0.05). The incidence of epidural hemorrhage was higher in patients admitted in the first decade (18.50% vs. 7.90%, p < 0.05).

Conclusion: Some classical information has changed over the years. Multicenter studies with a higher number of patients will correct the changing knowledge about pediatric head trauma.

Aim: To analyze the success rates of repeat endoscopic third ventriculostomy (re-ETV) procedure according to ventriculostomy orifice closure types in patients who have undergone a second neuroendoscopic surgery for non-communicating hydrocephalus.

Material and methods: The study included 74 patients who underwent re-ETV procedure due to dysfunctional ventriculostomy orifice. Ventriculostomy closure patterns are classified into three types: Type-1 is defined as the complete closure of the orifice with non-transparent gliosis or scar tissue. Type-2 represents the closure or narrowing of the orifice by newly formed translucent membranes. Type-3 pattern is defined as the blockage of CSF flow due to newly formed reactive membranes in the basal cisterns, with an intact ventriculostomy orifice.

Results: The frequency of the ventriculostomy closure patterns was found as follows. Type-1: 17 cases (22.97%); Type-2: 30 cases (40.54%); and Type-3: 27 cases (36.48%). The success rate of the re-ETV procedure according to closure types was 23.52% in Type-1 cases, 46.66% in Type-2 cases, and 37.03% in Type-3 cases. A significantly higher rate of Type-1 closure pattern was observed in the myelomeningocele associated hydrocephalus cases (p < 0.01).

Conclusion: In cases where ETV failure occurs, an endoscopic exploration with reopening of the ventriculostomy orifice is a preferable treatment option. Therefore, identifying patients who may benefit from the re-ETV procedure is essential. Type-1 closure pattern was observed to have a higher frequency in cases where hydrocephalus was associated with myelomeningocele, and the success rate of re-ETV seems to be lower in those cases.

Aim: To investigate the effect of zinc oxide nanoparticles (ZnO-NPs) on neural tube development in early chicken embryos.

Material and methods: Fifty pathogen-free fertilized eggs were initially incubated for thirty hours. The eggs were divided into 5 groups. In the control group (C) the egg?s apex was opened and closed without any administration. In the distilled water group (DW), 10 microliters of distilled water were injected into the sub-blastodermic area. ZnO-NP suspensions were prepared in distilled water and injected sub-blastodermically into the low, medium and high dose ZnO-NP groups (10 mg/kg, 30 mg/kg, and 50 mg/kg, respectively). Incubation was completed in 72 hours, and embryological and neural tube development was evaluated histologically with a light microscope.

Results: Embryos in all groups were evaluated according to the Hamburger-Hamilton (HH) staging. It was observed that the staging progressed by the developmental process between 68-72 hours, which is equivalent to the 19-20th stage of HH. Differentiated otic vesicle, optic cup, lens vesicle, pharynx, and Rathke?s pouch were all observed in embryo sections. Both forebrain and hindbrain vesicles were easily distinguished in the sections by cranial flexion. Neural tube closure defect was not detected in any of the groups.

Conclusion: In our observations, ZnO-NPs did not affect neural tube development at the applied dose ranges. We believe that additional studies with higher doses using a higher number of subjects will help clarify the conflicting data in the literature.

Aim: To evaluate the efficiency of two models for prognostication of patients with isolated traumatic brain injury.

Material and methods: The models developed with the data of the patients who applied within ten years were subjected to internal validation with the data of the patients who applied within the following five years. The records of 204 patients with traumatic brain injury admitted into Neurosurgery Department and Intensive Care Units were reviewed. Models were applied to procure estimates of prognosis. The estimates were statistically compared with the actual clinical outcome of patients using discriminant analysis.

Results: For Model 1, the correct classification rate was calculated as 87.9%, the specificity as 66.7%, the sensitivity as 94.2%, the positive predictive value as 68.8%, and the negative predictive value as 93.6%. For Model 2 the correct classification rate was evaluated as 90.2%, the specificity as 57.6%, the sensitivity as 96.5%, the positive predictive value as 76%, and the negative predictive value as 92.2%.

Conclusion: Both of the models had decent correct classification rates and may be efficient estimation tools for the prognostication of unfavourable outcome in patients with isolated traumatic brain injury. These models are good candidates to be used widely following the evaluation of their validity with national and international multicentric studies.

Aim: To compare, and to analyze the effects of fronto-orbital band anterior displacement in the operation of premature closure of coronal suture in infants.

Material and methods: A total of 31 infants with premature closure of coronal suture were randomly divided into two groups; experimental group (n=16) and control group (n=15). In the experimental group, the skull model was reconstructed by an imaging examination and three-dimensional (3D) printing technique before the operation, and the fronto-orbital band was anteriorly displaced during the operation to guide the surgical treatment of craniosynostosis. In the control group, the skull model was reconstructed by an imaging examination and 3D printing technique before the operation, and the fronto-orbital band was not anteriorly displaced during the operation by the same operator. The surgical effects of the two groups were compared.

Results: During the 12-month follow up after the operation, the cephalic index of short head deformity in the experimental group was 80.7 ± 1.1, while that in the control group was 89.3 ± 4.5. There was a significant difference between the two groups.

Conclusion: Fronto-orbital band anterior displacement may guide the operation of craniosynostosis and significantly improve the effectiveness of surgical treatment of children with premature closure of coronal suture, which is worth popularizing in the clinical management of cases.

Aim: To investigate the prevalence and type of ponticulus posticus (PP) and ponticulus lateralis (PL) in the Chinese population by analyzing computed tomography (CT) scans, and to uncover the pathogenesis of PP and PL.

Material and methods: A total of 4,047 cases were included in this study. We evaluated cervical spine CT scans with three dimensional reconstructions and collected age, gender, and presence of PP and PL in each case. If either or both were present, location and type were recorded.

Results: The overall prevalence of PP was 8.01%. The age of patients with PP was significantly higher than those without. Men had a higher prevalence of PP than women. The presence of PP was more common on the left side than the right. According to our previous classification, the most common type of a PP was AC (32.41%), followed by CC (20.06%) and CA (16.98%). The overall prevalence of PL was 4.67%, with no differences between age groups, genders or by location. The most common type of PL was AC (43.92%), followed by CA (35.98%) and CC (20.11%). The prevalence of PP and PL occurring in the same patient was 1.26%.

Conclusion: Based on cervical spine CT scans of 4,047 Chinese patients, we found that the prevalence of PP and PL were 8.01% and 4.67%, respectively. PP was more common in older patients, which strongly suggests that PP may be a congenital osseous anomaly of the atlas that mineralizes during aging.