Turkish neurosurgery最新文献

Aim: To demonstrate the curative effect of digoxin on peripheral nerve damage with its anti-inflammatory role on interleukin (IL)-17.

Material and methods: The study was conducted with 30 male Sprague Dawley albino mature rats, of which 10 formed the control group, 10 were surgically treated and administered saline (group S), and another 10 were surgically treated and administered digoxin (group D). Motor functions and immunohistochemical and biochemical variables of the rats were assessed after therapy.

Results: The amplitude of the inclined plane test scores and the compound muscle action potential levels were greater in group D than in group S. Likewise, there were higher nerve growth factor percentages, higher axon counts, and lower fibrosis score percentages in group D than is group S. Lastly, lower tissue malondialdehyde and plasma IL-17 levels were determined in group D, while the IL-10 level was higher.

Conclusion: Digoxin contributes to nerve healing and neuroprotective effect by demonstrating its anti-inflammatory effect on IL-17. It can be considered an adjunctive therapy for peripheral nerve injury.

Aim: To evaluate the safety and efficacy of posterior transdural discectomy for thoracic disc herniation.

Material and methods: The medical records of seven patients who underwent posterior transdural discectomy for thoracic disc herniation were retrospectively evaluated.

Results: Between 2012 and 2020, seven patients (five men and two women) who were aged between 17 and 74 years underwent posterior transdural discectomy. Numbness is the most common presenting symptom, and two patients complained of urinary incontinence. T10-11 was the most affected level. All patients underwent at least 6 months of follow-up. There were no postoperative cerebrospinal fluid leaks and neurological complications postoperatively. All patients maintained their baseline neurological status or improved after surgery. No patient had secondary neurological deterioration or need for further surgical treatment.

Conclusion: The posterior transdural approach is a safe procedure that should be considered in lateral and paracentral thoracic disc herniations providing a more direct surgical intervention.

Aim: To present the properities of intraoperative sodium fluorescein video angiography (NaF-V) use in intracranial aneurysm surgery and to discuss the limitations of repeated NaF-V administration.

Material and methods: The clinical findings and imaging results during and after surgery for patients with aneurysm who underwent surgery between September 2020 and June 2022 were examined. NaF-V and micro-doppler imaging were used to control the flow of the parent and perforating arteries and obliteration of the aneurysm dome. The dose of sodium fluorescein administered via the central venous route was 5 mg/kg.

Results: Overall, 102 aneurysms were treated during 95 operations in 92 patients. NaF-V was applied at least once in all operations, twice in 17, and thrice in 3 operations. The period between repeated doses of NaF-V ranged from 4 to 50 min. The method allowed for the desired imaging of the parent and perforating arteries in all cases but failed to provide satisfactory results regarding the complete obliteration of the aneurysm dome in three cases. No NaF-V-related complications were encountered in any case.

Conclusion: Sodium fluorescein is safe, with a high minimum toxic dosage, and provides benefits, even in repeated use, in the evaluation of perforating and parent arteries. NaF-V is effective when used alternatively or in combination with various methods.

Aim: To describe the role of metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) in glioblastoma (GB) progression in patients concurrently diagnosed with diabetes mellitus (DM).

Material and methods: Formalin-fixed paraffin-embedded (FFPE) tumor samples of 47 patients diagnosed with GB only and 13 patients diagnosed with GB and DM (GB-DM) were enrolled in this study. Data for p53 and Ki67 immunohistochemical staining of the tumors and blood HbA1c levels of patients with DM were retrospectively collected. MALAT1 expression was assessed using quantitative real-time polymerase chain reaction.

Results: The coexistence of GB and DM induced the nuclear expression of p53 and Ki67 compared with GB only. MALAT1 expression was higher in GB-DM tumors than in GB only tumors. The expression of MALAT1 and HbA1c levels were positively correlated. Additionally, MALAT1 was positively correlated with tumoral p53 and Ki67. The disease-free survival of patients with GB-DM with high MALAT1 expression was shorter than that of those diagnosed with GB only and with a lower MALAT1 expression.

Conclusion: Our findings suggest that one of the mechanisms of the facilitating effect of DM on GB tumor aggressiveness is via MALAT1 expression.

Aim: To evaluate the association between global cerebral edema (GCE) after subarachnoid hemorrhage (SAH) and its impact on functional outcome evaluated by the modified Rankin scale (mRS).

Material and methods: This is a prospective cohort study with patients who were admitted to the hospital due to SAH. During the period from January 2018 to November 2019, 107 patients with intracranial aneurysms were enrolled. Using univariate and multivariate analysis, we sought to identify predictors and evaluated the impact of GCE on outcome after 6 months using the mRS.

Results: GCE was present in 54 (50.5%) patients, of which 27 (25.2%) were mild, 20 (18.7%) moderate and 7 (6.5%) were severe. Univariate analysis identified high Hunt-Hess and Glasgow coma scale on clinical admission as predictors factors of GCE (p < 0.05), and higher modified Fisher scale as a radiological predictor of Glasgow coma scale (p < 0.05). Thirty-three (30.8%) patients were deceased at 6 months. Death or severe disability were predicted by higher age, poor clinical scale on admission and severe GCE (p < 0.05).

Conclusion: GCE on admission is independently associated with poor clinical outcomes at discharge, and six months after SAH. Given its strong association with poor clinical grade on admission, GCE should be considered a straightforward and radiological important marker of early brain injury, with ominous implications.

Aim: To construct a reliable prediction model for pediatric atypical teratoid/rhabdoid tumor (ATRT) patients.

Material and methods: Population-based data of patients diagnosed with intracranial ATRT were extracted from the National Cancer Institute?s Surveillance, Epidemiology, and End Results database. These patients were randomly assigned into training and validation cohorts at a ratio of 2:1. Univariable and multivariable Cox analyses were conducted to determine independent factors of overall survival (OS). A nomogram was then developed using the covariates with the best prognostic value, and the predictive performance of the nomogram was assessed by calibration curves, concordance index, time-dependent receiver operating characteristic curve analysis, and decision curve analysis.

Results: A total of 267 cases were included. The OS rates at 6 months, 1 year, and 3 years were 61.6%, 50.1%, and 35.4%, respectively. The results of multivariable Cox analysis showed that tumor extension, surgery type, radiotherapy, and chemotherapy were independent prognostic indicators. A nomogram integrating these factors was established to predict the 6-month, 1-year, and 3-year OS rates. This prediction model was validated in the validation cohort. The nomogram had favorable predictive performance and discrimination ability.

Conclusion: We developed and validated a novel nomogram with favorable discrimination ability to predict prognosis for newly diagnosed pediatric ATRT patients. Although additional validation is required, this may be a useful tool in clinical decision making.

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.