Turkish neurosurgery最新文献

Turcot syndrome (TS) is an extremely rare genetic disorder characterized by the concurrent occurrence of primary brain tumors and colorectal cancer. The prognosis for patients with TS is typically poor. A 57-year-old man with TS who developed recurrent glioblastoma and had a family history of colon cancer is reported. In 2022, the patient underwent robot-assisted stereotactic surgery for the resection of a central nervous system (CNS) tumor. Molecular genetic analysis identified microsatellite instability in the DNA mismatch repair (MMR) gene, confirming the diagnosis of TS. Additional mutations in the ATM and TP53 genes were also detected, which are rarely associated with TS. Despite treatment with the Stupp regimen, the patient experienced acute neurological deterioration, ultimately resulting in death 15 months after the onset of symptoms. Molecular diagnostics play a crucial role in guiding appropriate care and management for patients with TS. Early diagnosis, genetic testing, and preventive measures are essential for the effective management of this condition.

We aimed to introduce Ernst von Bergman, who contributed greatly to the establishment of modern neurosurgery and introduced antisepsis practices to routine use in surgery, and his important work, which is the first book on neurotrauma. The world?s first book dedicated to neurotrauma, Lehre von Kopfverletzungen, written in 1880, is examined and presented together with the author?s academic career. Bergmann was the first surgeon to use surgical instrument sterilization and played a pioneering role in the establishment of the antiseptic method. In addition to his valuable studies and important results on intracranial pressure changes in head trauma, the innovations and principles he brought to wound care are very important. Surgical sterilization, head trauma and the resulting increase in intracranial pressure, and his standardization of wound care make Ernst von Bergmann an important figure in the establishment of modern neurosurgery. Bergmann is the author of the first book on neurotrauma, which places him in a distinguished place in the history of neurosurgery.

Aim: To evaluate the patients who underwent surgery with a diagnosis of Moyamoya disease (MMD), and to contribute to the literature from a single-center in Türkiye.

Material and methods: Patients were evaluated retrospectively based on age, symptoms, history of cerebrovascular events (CVE), genetic disorders, pre-operative (pre-op) radiological stage, surgical technique, post-operative (post-op) improvement, and post-op radiological staging. The absence of new CVEs and reduced seizure frequency were considered indicators of clinical improvement.

Results: A total of 7 patients, 4 of whom had bilateral MMD, underwent surgery. The average age was 11.8 ± 5 years. 4 patients (57%) presented with cerebrovascular events as symptoms, and the remaining 3 patients (43%) presented with headaches. Cranial digital subtraction angiography (DSA) revealed that the patients were in advanced stages (Suzuki Stage 4.9 ± 1.1). Encephalo Duro Arterio Myo Synangiosis (EDAMS) surgical technique was performed on 10 hemispheres, and a combined bypass (EDAMS + direct) was performed on 1 hemisphere. Clinical improvement was observed approximately 6 months postoperatively. During followup, disease progression in the contralateral hemisphere with associated symptoms was noted in 4 patients, and these patients subsequently underwent surgery on the contralateral hemisphere. The average time between the first and second surgeries was 15 ± 7.7 months. Post-operative follow-up was conducted with DSA, and radiological success was defined as Lucia Stage 2 ± 0.85. No clinical difference was observed between craniotomy and craniectomy as surgical techniques. No differences were found between vessel selection and clinical outcomes.

Conclusion: The EDAMS protocol has proven to be an effective treatment method for pediatric patients with MMD. Postoperative clinical improvements are rapidly observed, followed by radiological improvements. Patients may experience progression from unilateral to bilateral disease, which can progress quickly.

Aim: To evaluate the incidence, risk factors, and spinopelvic alignment parameters associated with distal junctional failure (DJF) following posterior thoracolumbar stabilization surgery.

Material and methods: This retrospective cohort study included 40 patients who underwent thoracolumbar stabilization between 2018 and 2024. Patients were divided into two groups: those who developed DJF (n=20) and those who did not (n=20, control group). Radiographic evaluations, including pre- and postoperative lateral radiographs, were used to assess spinopelvic parameters such as lumbar lordosis (LL), pelvic incidence (PI), and PI?LL mismatch. Statistical analyses were conducted to examine the correlation between these parameters and DJF occurrence.

Results: The DJF group exhibited a significant postoperative reduction in LL and an increase in PI?LL mismatch compared to the control group, which maintained better sagittal alignment postoperatively (p < 0.05). Patients with higher preoperative PI?LL mismatch were more likely to develop DJF, highlighting the importance of preoperative planning and correction to prevent this complication.

Conclusion: Optimizing spinopelvic alignment, particularly LL and PI?LL mismatch, is crucial for reducing the risk of DJF after thoracolumbar stabilization surgery. Future studies should aim to refine surgical techniques and strategies to enhance postoperative outcomes and minimize complications.

Amyloidosis is a progressive disorder marked by the aggregation of insoluble fibrillar proteins in various tissues, leading to tissue damage. Localised amyloidosis, known as amyloidoma, is particularly rare in the central nervous system and may be mistaken for a neoplastic lesion due to similar radiological features. Consequently, the general treatment approach often involves total excision. However, it is important to consider that a biopsy of the amyloidoma, rather than total excision, may suffice for complete recovery when paired with appropriate systemic treatment. This report presents two rare cases of amyloidoma: one located in the falx cerebri and the other in the lumbar spine. Both cases were successfully operated on, with the patients recovering without complications following treatment. (1).

Aim: To propose a patient-specific interbody cage with graded stiffness distributions analogous to the Young?s modulus of the cervical spinal bone interface in order to improve mechanical compatibility, promote physiological load sharing, and enhance osseointegration.

Material and methods: A synthetic database of spinal bone Young modulus values was used, incorporating anatomical regions (cervical, thoracic, lumbar) and patient-specific factors (age, bone density, health status). A parametric generative design approach allowed dynamic modification of lattice unit cell geometry to achieve target stiffness values (200?3000 MPa) while preserving structural integrity.

Results: Finite element endplate analysis demonstrated a 30%?50% reduction in stress shielding compared with conventional solid or homogeneous mesh lattices. Additively manufactured prototypes showed tunable stiffness?porosity trade-offs, achieving yield strength ?150 MPa while supporting osseointegration.

Conclusion: This study demonstrates improved load distribution and reduced risk of cage collapse compared with cadaveric spine data. Integrating computational design, biomechanical compatibility, and additive manufacturing may facilitate the development of patient-specific spinal implants with superior mechanical and biological performance.

Aim: To provide insight into the molecular mechanism of contusional expansion (CE) by creating experimentally induced contusion cerebri (CC) in rats and investigating whether melatonin administration prevents CE or not.

Material and methods: Rats were randomized into four groups: Group 1 (control, n=5), group 2 (trauma, n=25), group 3 (trauma plus placebo, n=25), and, group 4 (trauma plus melatonin, n=25). Rats in the control group were sacrificed without undergoing any invasive procedure. Groups 2, 3, and 4 were further divided into 5 subgroups (A?E), with animals in each sacrificed at 12, 24, 72, 120, and 168 h after CC induction. Samples from these subgroups were analyzed for levels of caspase 3, caspase 8, and matrix metalloproteinase-9, as well as for evidence of ischemia, blood-brain barrier (BBB) breakdown, vasogenic edema (VE), and hemorrhage. Temporal progression of CE and correlations between these variables were also investigated.

Results: Our results indicated that the ischemia, BBB breakdown, and VE are early events that initiate CE, with VE and hemorrhagic transformation due to BBB breakdown identified as key factors. Melatonin treatment prevented CE injury.

Conclusion: Melatonin, a safe and well-tolerated substance with minimal toxicity, may serve as a potential therapeutic agent for preventing CE injury.

Aim: To compare the efficacy of intra-articular PRF (IA-PRF) and medial branch PRF (MB-PRF) in the treatment of facet joint-related low back pain.

Material and methods: In this prospective observational study, 116 patients with ?50% pain relief after diagnostic intraarticular anesthetic injection were included. Patients underwent IA-PRF (n=60) or MB-PRF (n=56). Pain and disability were assessed using the Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI) at baseline and 1 and 6 months post-treatment.

Results: Both groups showed significant improvements in NRS and ODI scores at 1 and 6 months (p < 0.001). In the IA-PRF group, NRS scores improved from 6.55 ± 0.65 to 3.23 ± 0.43 (1 month) and 3.70 ± 0.46 (6 months); ODI scores improved from 49.70 ± 3.75 to 25.13 ± 1.66 and 26.90 ± 2.13, respectively. In the MB-PRF group, NRS scores decreased from 6.43 ± 0.66 to 3.13 ± 0.33 (1 month) and 3.57 ± 0.49 (6 months); ODI scores decreased from 49.18 ± 3.49 to 24.71 ± 1.34 (1 month) and 26.68 ± 2.20 (6 months). No significant intergroup differences were observed at follow-ups (p > 0.05). No complications occurred.

Conclusion: IA-PRF and MB-PRF are effective and safe in treating LFJ-induced pain after 6 months of follow-up. Significant pain control and functional improvement were achieved with both methods, with no significant difference between them regarding clinical efficacy. Our findings suggest that treatment selection should be individualized according to patient characteristics. Randomized studies with large samples and long-term follow-up are needed to improve the level of evidence in this field.

Aim: To evaluate the potential genetic differences between systemic lupus erythematosus (SLE) and cerebrovascular disorders (CVDs) patients.

Material and methods: This genetic association study conducted Mendelian randomization (MR) analyses on the derived exposures and outcomes from summary statistics of genome-wide association studies (GWAS). This study employed univariate MR (UVMR) analysis, multivariable MR (MVMR) analysis, and meta-analysis, using data from large genomic databases such as the UK Biobank, FinnGen, and OpenGWAS. These methods aim to overcome confounding factors by using genetic variants as instrumental variables to infer causal relationships.

Results: UVMR analysis revealed a genetic causal relationship between SLE and ischemic stroke, with a positive correlation (odds ratio [OR] 1.000367; 95% confidence interval [CI] 1.000074--1.00066; p=0.014). No evidence of a genetic causal relationship was found between SLE and other types of CVDs, including cerebral aneurysm, intracerebral hemorrhage, subarachnoid hemorrhage, stroke, and transient ischemic attack. MVMR analysis, after adjusting for confounders such as smoking and type 2 diabetes, confirmed the robustness of the association between SLE and ischemic stroke. Furthermore, a meta-analysis of multiple MR outcomes was conducted to verify the stability of the results (OR, 1.00037; 95% CI, 1.00008-1.00067).

Conclusion: Our study enhances the understanding of the genetic basis between SLE and various CVDs, particularly suggesting a positive causal association between SLE and ischemic stroke, and we emphasize the need for further research.