Turkish neurosurgery最新文献

Aim: To assess the prognostic utility of the albumin-to-gamma-glutamyltransferase ratio (AGR) in patients with high-grade glioma [World Health Organization (WHO) grade III and IV] and to develop a predictive nomogram.

Material and methods: Data from 185 patients diagnosed with high-grade gliomas, who underwent surgical treatment between March 2013 and December 2022, were retrospectively analysed. Patients were randomly divided into training and validation cohorts. The nomogram was developed using multivariate Cox regression analysis according to selected risk factors using least absolute shrinkage and selection operator (i.e., ?LASSO?) regression. The area under the receiver operating characteristic curve, calibration curve, and C-index were used to assess the performance of the prediction model.

Results: This study included data from 185 patients; six independent risk factors were identified and used to generate a prognostic nomogram: WHO grade, body mass index (BMI), smoking, platelet (PLT) count, fibrinogen (FIB) level, and AGR. The nomogram demonstrated considerable prognostic consistency and discrimination. The prognostic utility of AGR was identified in patients with glioma [hazard ratio 0.7876 (95% confidence interval 0.6471?0.9585); p=0.0172].

Conclusion: AGR was found to be a potential risk factor for predicting overall survival in patients with glioma after surgery. The nomogram integrated WHO grade, BMI, smoking status, PLT count, and FIB level. AGR provided clinical guidance for surgeons to predict survival rates in patients with glioma.

Aim: To investigate the short- term results of dynamic/semi-rigid stabilization in patients with cervical spinal stenosis and compare them with patients for which decompression and pos-terior cervical fusion was performed.

Material and methods: 28 patients were included in this study. Group 1 was the semi-rigid group (four male, ten female), group 2 was the fusion group (nine male, five female). We compared the clinical status of the patients pre-operatively, first and twelfth month post-operatively using the Visual Analog Scale (VAS) and Neck Disability Index (NDI). Also radiologically, the pre-operative and on the postoperative first and twelfth month, cervical sagittal vertical axis (cSVA), cervical lordosis (C0-2) (C2-7) and T1 slope were measured.

Results: Our results showed that there was a significant improvement on the VAS and NDI score after semi-rigid and fusion surgery (p < 0.001). Also the cervical lordosis was obtained in both groups (p=0.033). Although, no significant differences was found between both groups regarding the change of variables over time between post-operative first and twelfth month.

Conclusion: Although, posterior dynamic stabilization has been previously used in thoracic and lumbar pathologies before, there is no crucial evidence about their effects in cervical stenosis. This study states, that semi-rigid instrumentation is as effective in clinical and radiologic out-comes as posterior fusion surgery in periods of one year. Also, the lower risk of adjacent-segment disease and pseudoarthrosis and preservation of cervical sagittal alignment are the main advantages of the new method.

Aim: To investigate the incidence of transverse carpal muscle (TCM) occurrence around carpal tunnel which may lead to carpal tunnel syndrome (CTS), and cause disorientation of surgeons during the surgery.

Material and methods: We reviewed patients in our department between January 2007 and March 2021 to identify those who underwent surgical treatment for CTS. A total of 62 carpal tunnel release surgeries were investigated, and the frequency of TCM occurrence was evaluated.

Results: There were 3 (4.8%) accessory TCM overlying transverse carpal ligament (TCL). All variations occurred in the left hand of the patients. Of the three cases, two were female and one was male.

Conclusion: There is currently insufficient evidence in the literature to suggest that TCM is causing CTS. To further investigate the origin of these muscles, cadaveric dissections should be performed. Even if this variation isn?t causing CTS, especially during minimal invasive surgeries, this variation should be kept in mind to not lose orientation.

Trigeminal schwannomas are rare lesions centered on the trigeminal ganglion at Meckel?s cave. The complexity and morbidity of surgery for these lesions have allowed stereotactic radiosurgery (SRS) to emerge as a safe and viable option for treatment. Various other lesions at this location must alert one to consider an alternative diagnosis before upfront SRS without histopathological correlation. We present three patients with trigeminal neuropathy with imaging suggesting trigeminal schwannoma. Primary clinicians recommended primary radiosurgery to these patients based on radiological diagnosis. Upon further evaluation and clinical suspicion, we established alternate diagnoses of non-Hodgkin's lymphoma, lepromatous trigeminal nerve involvement, and Aspergillosis involving the Meckel's cave in three cases. Each patient received appropriate treatment instead of SRS. SRS is one of the treatment options for trigeminal schwannomas. No neurosurgical ailment should be treated on its face value with primary SRS, but it must be carefully evaluated on a clinicoradiological profile. Upfront, primary SRS may be counterproductive or detrimental for inflammatory or infectious pathologies, attracting complications.

Aim: To examine the genetic results of patients diagnosed with pituitary neuroendocrine tumors (PitNETs) with respect to clinical, radiological, and pathological findings.

Material and methods: A total of 53 patients (30 men and 23 women) diagnosed with PitNETs were included in the study. The clinical findings, family history, imaging, and pathology results were recorded. The DNA was isolated from the peripheral blood. A customized panel test with the highest number of genes (28 genes associated with PitNET) found in the literature was used. Sequencing was conducted using the next-generation sequencing method, and the variants were analyzed according to current guidelines.

Results: A total of 22 variants were identified in 20 patients, two of which were determined to be pathogenic. Pathogenic variants were detected in AIP (c.468+1G > A) and MEN1 (c.1102_1104del) genes, which showed the most common pathogenic variant. Variants of unknown clinical significance were most frequently detected in the MSH6, RET, and CDH23 genes.

Conclusion: Although the number of studies that conducted multigene testing in patients with PitNETs is limited, all studies, including ours, have shown that the patient?s age at diagnosis and family history are the most important determinants of germline variant detection.

Aim: To evaluate the efficacy and safety of the guideless catheter placement technique in revision surgeries for external ventricular drainage (EVD) and ventricular shunt systems to improve treatment outcomes for hydrocephalus.

Material and methods: We retrospectively analyzed 111 patients who underwent revision surgeries for EVD or ventricular shunt systems at the Istanbul Umraniye Training and Research Hospital from January 2020 to January 2023. Patients' demographic (age, sex), and clinical (cause of hydrocephalus, type of surgery, and postoperative complication rates, specifically for bleeding and catheter malposition) data were extracted from the patient files.

Results: The use of the guideless catheter placement technique significantly reduced postoperative complications, with notably lower rates of bleeding (n=2, 1.8%) and catheter malposition (n=5, 4.5%).

Conclusion: The guideless catheter placement technique is a viable, cost-effective, and efficient approach for revision surgeries in EVD and shunt systems, which can potentially improve the safety and accuracy of catheter placement, reduce complication rates, and ensure favorable patient outcomes associated with revision surgeries for hydrocephalus.

Aim: To determine the prognostic value of routine hematological indices in patients undergoing carotid endarterectomy (CEA).

Material and methods: As a retrospective single center study, we measured the systemic immune inflammation index (SII) and other systemic inflammatory parameters to estimate the morbidity and mortality of patients undergoing CEA. These parameters include inflammatory markers which are included in routine preoperative haematologic tests like complete blood count (CBC).

Results: After the analysis of the collected datas from 72 patients, the results showed that inflammatory indices were significantly different in patients with different clinical courses.

Conclusion: Inflammatory parameters calculated from routine preoperative hematologic parameters proved to be important predictive parameters that can be used in morbidity/mortality estimation of patients scheduled for CEA.

Intraventricular hydatid cysts are extremely rare. Till date, these cysts have been believed to originate from the ventricle itself. Of the various intraventricular cysts, primary solitary cysts are the most common ones. These cysts are purely intraventricular or partly parenchymal with an intraventricular spread. These cysts have so far never been reported to spread contiguously from the extradural location, breach the dura, and thereafter, migrate intraventricularly. Here, we present a unique case of intraventricular spread of an extracerebral hydatid cyst after a dural breach. The ability of hydatid cysts to breach the dura has not been described previously. The pathogenesis of the hydatid cyst has been discussed here along with its surgical and medical management.

Aim: To examine intraoperative cone-beam computed tomography (iCBCT) accuracy, and the need for postoperative imaging to confirm electrode position, and to assess the complications of deep brain stimulation (DBS) surgery.

Material and methods: Thirty-two movement disorder patients and 69 targets were retrospectively reviewed. All patients had preoperative non-stereotactic 3.0 Tesla magnetic resonance imaging (MRI), preoperative stereotactic multidetector computed tomography (MDCT), post-implantation iCBCT, and postoperative conventional MDCT scans. Stereotactic coordinates of electrode tips were compared between postoperative MDCT and iCBCT. We calculated the absolute and Euclidian differences (ED) between iCBCT and postoperative MDCT coordinates for each electrode. To assess whether intraoperative brain shifting influenced electrode tip localisation, subdural pneumocephalus volume was measured in iCBCT images.

Results: The mean absolute (scalar) differences in x, y, and z coordinates were not significantly different from the absolute precision value of 0 (p > 0.05). The mean ED between the iCBCT electrode tip and the postoperative MDCT electrode tip coordinates was < 1mm (0.55±0.03 mm) and differed significantly from zero (p < 0.0001). There was no correlation between pneumocephalus volume and electrode coordinate deviation.

Conclusion: iCBCT can eliminate the need for routine postoperative studies since it is a safe, effective, and rapid procedure that can be performed at any step of the surgery. It provides reliable and definitive confirmation of correct DBS electrode placement.

Aim: To develop a nomogram model that provides a clinical prediction method for preventing septated chronic subdural hematoma (sCSDH) recurrence after surgery and serves as a reference for selecting surgical approaches.

Material and methods: This study involved 237 patients diagnosed with sCSDH. Based on the recurrence status of the affected side during follow-up, patients were divided into a recurrence group (43 cases) and a non-recurrence group (194 cases). The imaging-related factors influencing the recurrence of sCSDH after surgery were initially screened using univariate analysis, followed by multivariate logistic regression analysis to identify independent risk factors. A nomogram model was developed using R software, and internal validation was conducted using the bootstrap method.

Results: The univariate analysis revealed that cerebral atrophy, bilateral hematomas, preoperative midline shift distance, sCSDH typing, and neovascularization were the significant factors in the postoperative recurrence of sCSDH. However, the multivariate logistic regression analysis identified encephalatrophy, bilateral hematomas, and neovascularization as independent risk factors for sCSDH recurrence. Furthermore, the nomogram model analysis demonstrated good discrimination with an AUC of 0.764 (95% CI: 0.6958-0.8322), while the P-value of the Hosmer-Lemeshow test was 0.4382, indicating good consistency.

Conclusion: Encephalatrophy, bilateral hematomas, and neovascularization are independent imaging risk factors associated with sCSDH recurrence. The developed nomogram model will enable clinicians to assess and identify patients at a higher risk of sCSDH recurrence, enabling them to formulate appropriate diagnostic and treatment strategies.