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 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.

Erdheim-Chester Disease is a rare systemic xanthogranulomatous infiltrating disease, characterized by lipid-laden histiocytes accumulating in various organs and almost always in bones. Etiology of the disease is still unknown. It may involve various organs and systems, such as musculoskeletal, cardiac, pulmonary, renal, gastrointestinal and central nervous system (CNS) as well as the skin. The most common systemic manifestations are bone lesions and the specific sign of these are bilateral sclerosis of the diaphysis and metaphysis of long bones. Symptoms and signs can vary related to the organ or system that is involved. In CNS involvement, cerebellar and pyramidal symptoms and signs are the most common, while headache, seizure, cranial nerve paralysis, neuropsychiatric along with cognitive complaints and mood disorders are also reported. Furthermore, there are asymptomatic cases. Histologically lipid-laden foamy histiocytes with small round nucleuses and without nuclear grooves are the characteristic histological features. These histiocytes show positive CD68 and negative S100 and CD1a immunoreaction. Surgery is a reasonable treatment in the patients who have extra- or intracranial lesions with smooth borders when the neurological signs and symptoms are mild. Medical treatment of the disease includes steroid, cytotoxic agents such as cladribin, IFN α-2a, recombinant human interleukin-1 receptor antagonist, tirosine kinase inhibitors, biphosphonate and autologue hematopoetic stem cell transplantation. In this report a 29 years old man was presented with a frontal calvarial lesion who was operated and diagnosed as Erdheim Chester disease.

Aim: To determine sac volume based on radiological examinations in patients undergoing surgery for myelomeningocele (MMC) and to investigate the relationship of sac volume with hydrocephalus and Chiari malformation type 2 (CM) with a view to determining the optimum length of follow-up and recommend a treatment plan.

Material and methods: The present study involved the retrospective review of radiologic examinations and medical files of 81 patients who underwent surgery for myelomeningocele between 2015 and 2022 in the neurosurgery clinic of Ankara Training and Research Hospital. Then, MMC sac volumes were measured and the statistical relationship of these measurements with the Evans Index, progressive enlargement of the ventricles after sac repair and CM was investigated.

Results: Of the 81 patients, 41 (50.6%) were boys and 40 (49.4%) were girls. The median MMC sac volume was 11,005.28 mm³ and the mean Evans index (EI) based on brain tomography performed on postnatal day1was 0.405 ± 0.146. Analysis of the relationship between the EI and MMC sac volume yielded r=0.622, p < 0.001 and showed a strong positive correlation between the two parameters at a statistical significance level of 5%. Evans Indexes based on brain tomography scans performed on postnatal day 1 showed that ventriculomegaly was present in 49 (60.5%) patients and absent in 32 (39.5%) patients. In patients who developed hydrocephalus after sac repair, there was no correlation between the day of intervention and sac volume. Mean sac volume was 28,297.36 mm³ in 28 patients with comorbid CM versus 7,600.32 mm³ in patients without CM. All children with CM required shunting.

Conclusion: Patients with larger myelomeningocele sac volume have higher risk of concomitant hydrocephalus or subsequent development of hydrocephalus after sac repair compared to patients with a smaller sac volume. These patients should definitely be evaluated for same-session intervention. Patients with a larger sac volume and/or comorbid CM should be followed up more frequently and for a longer period of time.

Aim: To assess the clinicopathological and prognostic significance of Tim-3, an immune checkpoint molecule, and Rel-B, an NF-?B subunit, in grade 4 diffuse glioma samples and their relationship with each other.

Material and methods: The demographic, radiologic, treatment, and prognostic data of patients diagnosed with grade 4 diffuse glioma between 2016 and 2019 were reviewed and recorded. Tim-3 and Rel-B were applied to the paraffin-embedded tissues by immunohistochemistry method. Tim-3 expression was grouped as immunoreactivity density score (IDS) (Low, High) and expression percentage ( < 12%, > 12%), while Rel-B expression was divided into positive and negative groups.

Results: Ninety-nine grade 4 diffuse glioma samples were detected, 8 of which were IDH-1 positive. Tim-3 was expressed only in immune cells around and inside the tumoral tissue, and expression was detected only in tumoral cells with Rel-B. Tim-3 IDS was found at lower levels (median 31.8) in IDH-1 positive cases and higher (median 158) in IDH-1 negative ones (p=0.020). A significant correlation was found between the Tim-3 IDS high group and Rel-B positivity (p=0.007). In the IDH-1 negative cohort, the univariate analysis revealed higher Tim-3 expression percentage and higher IDS were associated with better overall survival (OS) (p=0.041 and p=0.042 respectively) and progression-free survival (PFS) (p=0.023 and p=0.029 respectively), while in the multivariate analysis higher Tim-3 expression percentage was found to be an independent predictor for better OS (p=0.008) and PFS (p=0.022). Rel-B positive cases exhibited longer OS and PFS but the result was not statistically significant (p > 0.05).

Conclusion: Tim-3 can be a good prognostic predictor and treatment candidate, especially in patients with IDH-1 negative grade 4 diffuse gliomas however, further studies with more cases are needed for Rel-B. The significant relationship between Tim-3 and Rel-B expressions supported the interaction between NF-?B and immune checkpoint pathways.

Aim: To investigate the effect of obesity on the severity of cerebral vasospasm after subarachnoid hemorrhage.

Material and methods: In this study, six experimental groups, each consisting of 10 rats, were defined (60 rats in total). Groups 1 and 2 comprised rats with normal body weight, Groups 3 and 4 comprised obese rats, and Groups 5 and 6 comprised rats that returned to normal body weight after being obese. Rats in Groups 2, 4, and 6, represented the study groups, and experimental SAH was induced in them. Group 1, 3 and 5 was determined as the control group. Basilar artery lumen areas and wall thicknesses were measured and compared in all groups.

Results: The luminal area of the basilar artery was significantly reduced in Groups 2, 4, and 6, than in Groups 1, 3, and 5, respectively. This indicated the development of vasospasm. No significant differences were found in the basilar artery luminal areas and wall thicknesses between Groups 1, 3, and 5. However, there were significant differences between Groups 2, 4, and 6. The basilar artery luminal area was significantly smaller in Group 4 than in Groups 2 and 6. There was no significant difference in basilar artery luminal areas between Groups 2 and 6.

Conclusion: This experimental study elucidated that the severity of vasospasm subsequent to subarachnoid hemorrhage escalated in the presence of obesity, and conversely, a return to normal body weight mitigated the severity of cerebral vasospasm. Prospective clinical investigations ought to scrutinize the correlation between obesity and vasospasm, emphasizing the necessity for vigilant monitoring of vasospasm post-SAH in obese patients.

Aim: To evaluate the radiological characteristics, clinical features,and surgical outcomes of bicoronal incision and bifrontal craniotomy for olfactory groove meningiomas (OGMs).

Material and methods: This was a retrospective review of 16 patients (nine male and seven female) with large and giant OGMs operated through unilateral extended pterional craniotomy between 2010 and 2022. The radiological characteristics, clinical features,and surgical outcomes were examined.

Results: All patients underwent surgical resection via a unilateral extended pterional approach.The mean age of patients was 62.1 years. The most common presenting symptoms were altered consciousness, seizures, headache,and anosmia. Ten (62.5%) and 6 (37.5%) patients had large (4-6 cm) and giant ( > 6 cm) OGMs, respectively. The mean tumor diameter was 6.3 cm (range:4-9). Simpson Grade2 resection was achieved in all 16 patients.

Conclusion: Unilateral extended pterional craniotomy offers a safe and effective alternative to the bilateral coronal approach for large and giant OGMs, minimizing risks of frontal lobe retraction, brain edema, and venous infarction. This approach allows for total resection with very low morbidity and mortality rates, making it a viable surgical approach for these complex tumors.

Aim: To evaluate the postoperative magnetic resonance imaging (MRI) findings and clinical outcomes of patients who underwent monoportal endoscopic lumbar discectomy.

Material and methods: Preoperative and postoperative 3rd and 6th month MRI features, visual analog scale (VAS), and Oswestry Disability Index (ODI) scores, as well as other clinical features of patients who underwent monoportal endoscopic lumbar discectomy between August 2009 and January 2012 were retrospectively analyzed.

Results: A total of 65 patients (37 female, 28 male) were included in the study. VAS and ODI scores showed significant improvement postoperatively (p < 0.001). Intervertebral disc height loss was observed only in two patients. In 31 (48%) of the 64 levels treated, no significant anterior soft tissue mass developed. However, 33 patients (52%) showed anterior epidural edema and tissue formation postoperatively. Contrast enhancement of the nerve root was found in 20 levels (29.4%), nerve root edema in 3 levels (4.41%), and nerve root displacement in 3 levels (4.41%). None of the patients had all 3 aforementioned findings concomitantly. Of the 57 levels evaluated, 36 levels (63%) showed no or minimal changes in the posterior elements, and at the 3rd month, 9 levels (15.8%) demonstrated grade 1+ changes, 9 levels showed grade 2+ changes, and grade 3+ changes were seen in only 3 levels; however, at 6-month follow-up, all vertebral levels showed improvements.

Conclusion: Endoscopic discectomy is a safe and effective minimally-invasive method. However, owing to the lack of definitive radiological criteria indicating success or failure, the radiological findings should always be interpreted in conjunction with clinical outcomes.